A few assumptions that I want us to operate under as we engage in discussion about healthcare.
1. Anyone who presents to an emergency room with a truly emergent need should receive at least the minimum treatment necessary to ameliorate the emergency regardless of insurance status, citizenship, etc.
2. This is about patients, not politics. We are not discussing who is right and wrong and which group should submit to the other's desires.
First, I want you to think globally about the question. Don't read anything or Google the topic or ask anyone else's opinion. Decide for yourself whether or not you think access to healthcare should be guaranteed to everyone. After doing this, take a look at these articles (1), (2) and evaluate how they are in contrast or support of your position. You may also want to search for other opinions to see what others think. We will spend the next 2 weeks discussing this topic.
** Sorry for the delay in getting this posted. We had some technical issues that had to be worked out **
9 comments:
What are potential risks/benefits of making health care a right?
Joey Bero
j.d.bero@wingate.edu
To the mentors, what should be considered basic health care, and what should be reserved for those who can afford it?
Nina Joiner
n.d.joiner@wingate.edu
Do you think Health Care is a right or a privilege?
Justin Roten
Should basic healthcare be a right to all individuals? If so, at what point is it no longer basic healthcare?
If it is assumed that everyone is entitled to basic medical care even if they cannot pay for it, then who will pay for it? Currently, the hospitals absorb the cost and pass it on to patients. What other viable options are available?
Lauren Hawkins
l.m.hawkins@wingate.edu
In my opinion, basic healthcare is a right that all Americans are entitiled to. Basic healthcare could be defined as life-saving or life-maintaining care. This term is problematic because there is no concrete way to define basic healthcare. In my mind, this would be determined on a case by case basis. I would be willing to support a system in which some level of insurance was provided to all individuals on an equal basis, and then those who "earned" the "right" to supplemental insurance could pay additional premiums to have it. I realize that would leave taxpayers with more taxes. I also realize we would be paying for those who do not "earn" their "right"; however, we do that now. The only difference is I believe we would end up paying out less for "emergent" healthcare for these individuals. When I think about healthcare as a right, I automatically turn to the pediatric population and consider them. They have no means of earning insurance, but does that mean we deny healthcare to them because of their parents/guardians? Some would say this is looking at extremes, but I think it is a valid way to consider the question of right vs. privilege. I believe we would pay less if we provided basic insurance to everyone.
Now, I think accountability should enter into this picture. One major problem we have is that no one is accountable for their state of health. Look at the obesity epidemic and all of the healthcare expense it will lead to. If basic healthcare is provided, there should be some way of making accountability part of it. For example, there should be rewards for losing weight and being compliant. I am not sure how to build this type of reward system, but I am certain it could be done. Maybe procedures, medications, etc should be covered at a lower rate or even refused if a patient is not trying to improve or maintain a healthy lifestyle.
One point made in the article "Entitlement or Privilege" makes me reconsider my view. People are not guaranteed food or shelter, so why should they be granted access to healthcare? Wow, that is an argument with so many gray areas. As a Christian, I believe you must work to provide for yourself. In today's society, are their people who try and provide for themselves but fall short because of past mistakes, society's unwillingness to grant a second chance, etc? Absolutely, so I do believe it is our responsibility to assist them. Now, maybe basic healthcare coverage should only include "emergent" medicine. There should be a fund to pay these expenses from so hospitals do not have to absorb the costs. I also think that if the patient survives, a one month supply of necessary medications should be included to give them opportunity to make arrangements to better their situation in whatever way that may be. How do you draw the line with patients coming in all the time for DKA, recurrent A Fib, recurrent MI, etc? You still have to try and save their life. This is where giving everyone basic healthcare coverage, which you could base on income as well, would benefit society the most. I will say, however that children up until age 18 should all have healthcare available to them regardless of the situation.
Basic healthcare could be defined as how their disease's guidelines suggests to treat patients. Elective and cosmetic procedures should be excluded. These are already defined by most insurance companies now. I think there would be a need to establish unbiased ethical commitees to hear cases in which there is debate.
The risks of making basic healthcare a right are people abusing it. Even if you continue with the current standard of not denying emergent care, how can you say someone who is SOB from a cold that progressed to PNA is not emergent? People abuse the ER for this all the time. I suppose we could turn these people away until they come in emergently. Is that right?
As I read the articles for this week’s topic discussion, I was admittedly perplexed when I sat down to consider the question as to whether health care is a right or a privilege. I do not know the answer. Do I think that we should, as people, take care of our fellow man and provide care to those who are unable to afford it? Yes. Do I feel that you are violating someone’s Constitutional Rights if you do not fall in line lock-step to pay for it? Absolutely not. This whole issue, as Winston Churchill once quipped, “is a riddle wrapped in a mystery inside an enigma”. To the question about what defines basic healthcare I have no answer. “Basic” is a relative term and what meets the “basic” needs for one person may not meet the “basic” needs of another. Someone is going to have to decide what “basic” means; and unfortunately for all of us, that person, or group of people, will most likely be politicians. Annual visits to primary care providers would most likely need to be covered under any “basic” plan; but what happens if you are diagnosed with a chronic disease at one of these annual visits and your “baseline” suddenly involves new medications that you cannot afford? Do these medications now fall under your “basic” needs? What if you somehow contributed to your own condition by, say for instance, smoking? Have you then lost your “right” to these medications? Do we then insert the “deserving” factor into the equation? Are certain tests such as mammograms, colonoscopies, and MRIs superfluous entities that should only be reserved for certain individuals? Should organ transplants and the medications that go along with them, be reserved only for the very young or very rich? Some would say yes. Others would say no. Then you have to consider the question about, when do “we” (as collective members in our healthcare cooperative) decide that enough treatment has been provided? Who makes that call? For example, there is a patient in our ICU that arrived at our institution the same week that I started my residency. He has had multiple abdominal surgeries, and currently has 7 drains in his abdomen (that have been replaced multiple times). He has never gotten off of the ventilator, has received every antibiotic known to man for his multiple infections, and is TPN-dependent because he cannot tolerate tube feeds and no one will dare try and place a PEG. With all of these issues, he is still a full-code, and his wife and family are in absolute denial about his poor prognosis. They think he is going to be fine, but that it is “just going to take some time for him to get better”. Who decides under a government-run system when this type of situation ends? How much healthcare does one consume before they become a burden to the system? As for the question about the funding for this type of system; it should be obvious. Taxpayers will have to pay for it. Taxes. Taxes. And more taxes. Newly graduated pharmacists who sign up to work at CVS/Walgreens/Rite-Aid and make $130,000 a year will have to pay for it. All while getting absolutely no break on those loan payments you owe to Citibank for going to school so that you could become Dr. (insert your last name here). The last thing I remember reading about this current plan is that it involves spending somewhere in the ballpark of $2 trillion over the next 10 years on healthcare coverage for “everyone” while generating the revenue to do so by only taxing a small percentage of Americans. But our national deficit is only $11.4 trillion. So I guess my question is…if we can generate that kind of tax revenue by taxing such a small percentage of the population, then why do we have a deficit to begin with? The answer is simple. Everyone will eventually have to pay. The taxable income brackets will continue to grow, but once this thing gets rolling, it will be impossible to stop. People will just have to accept the taxes.
For those of you who may think that I am being a bit Limbaugh-esque, I do not mean to come across as such. I liked the ideas from the article in The Wall Street Journal about the health savings accounts with the balances that roll over from year to year, and the higher deductibles for private plans. I like the suggestions about opening up insurance across state lines and allowing consumers to search for their own coverage based on what plans best fit their needs. I mean, if you can purchase car insurance online from some company with a cartoon for a spokesperson, why couldn’t you do the same for health insurance? Allow competition in the free market system to help decrease the costs associated with health insurance, and put incentives in place for insurance companies to work with small businesses to provide health coverage for their employees. Then, after all of this….offer a government option; but make it income-based. Those who are unable to pay for their own care, receive care free of charge. Taxes suck, but there is no way around it. Some people are always going to be unable to pay. Individuals who would like to enroll in the government plan, but exceed some preset income threshold, could choose to buy in at an income-based rate. This would continue the theme of the free market system, and allow individuals to find the plan that best fits their need. But you cannot force people into a government-run option by destroying the insurance companies with policies designed to undercut them to the point that everyone jumps ship and runs to the plan that will eventually become a VA-type system for the whole country (yes, there is a government-run healthcare program with a multitude of problems that everyone seems to have forgotten about). As far as medications are concerned, I have no idea how to fix this, but I do not believe that giving someone a month’s supply of medications when they are discharged from the hospital is going to fix anything. I also refuse to vilify the pharmaceutical industry and blame them for all of this. They make a product and they expect to get paid. Plain and simple. We get all bent out of shape if someone wants to put a vending machine in a doctor’s office that spits out vials full of medicine, but regularly trash pharmaceutical representatives for simply doing their own jobs. If I had to come up with something, I would assume that the best way to deal with this issue is much the same way that you deal with health insurance itself; with deductibles (realistic ones) and health savings accounts. Again, allow the free market system to work and let people find the prescription drug plan that best fits their needs. Offer the same government options as before with similar income-based rates. Are any of these ideas feasible? Who knows? Is any system going to be perfect? Absolutely not. Someone will always be left out and people will always want more. But the more options we have, the better off I believe we will be.
I just got off the phone with a dear friend who was complaining of a major toothache and her wondering what to do about the fact that she needs work done but her dental insurance is so bad that she might as well be paying out of pocket for the services she needs. Her intentions today were to go to an urgent care facility to get a medicine to treat her pain since she cannot afford the dental work she needs to have done. Certainly, in time, the costs of ignoring this problem will outweigh the costs of the work being done, but they will be incremental costs instead of one huge lump sum which she does not have. It is so easy for me to get to the dentist and get treatment because my husband has fairly good dental insurance for us through his job as a pharmacist.
I felt the desire to somehow share with her my benefits (if it were possible.) It seems so wrong that she cannot get her teeth taken care of because she is not a pharmacist, but a pre-K teacher for the Goddard School, an upscale, national chain of preschool/daycare facilities.
Why should those who work full time at one job not get the same dental care or health care as someone at another job? Is their job any less important to our nation? What if preschool teachers ceased to exist? What if daycares ceased to exist? Where would we be? While these jobs may not save lives, they are essential to our daily lives and our own ability to earn the degrees we pursue and follow the career paths we choose. These people are a vital part of our own livelihood! And what about the vast majority of us in pharmacy school now who get the university's insurance which limits us to the level of care you can receive? Is it right that if the meds you need on this plan are barely covered that you should go broke while in school? Or that your health should decline? You may not be a pharmacist yet, but you will be... what about so many other people in the U.S. who will one day have a different position than they currently hold and will eventually make a significant impact on their communities?
Another thought I had was this: in every given situation, perception has a major impact on how we do things. We can look at increased taxes no matter how small or how large they are as:
1) someone is taking money from me! it's mine, mine, mine! i don't want to share with others and i certainly don't want to share with people i don't even know... you know those people- they're ALL like this- they're just out to take, take, take... i don't want them to have MY money!
OR you could also see it this way:
2) I wonder who my money is helping today? Is it a teacher who is working with children because she loves them and not for the pay... it feels good to know she's healthier because of me... or maybe it is that person five seats down from me in lecture who isn't on their parents' insurance but needs meds for their diabetes, asthma, or congenital heart condition...
Sometimes, I look around at my children's new school and think- I am so happy we are in a position to make this possible. I am so blessed to have a husband who makes enough money that we can make a substantial donation to society as we know it- all while being very financially comfortable ourselves. It is great. And anyone who has been to my house knows we are not the hippies living at a bare minimum (though it is admirable- it's not for us) and we are not living like Bill Gates or Oprah... BUT- we are damned sure living comfortably! All this is before I graduate and brign my own income to the table...
Not everyone will be as blessed as we are now (we aren't guaranteed to remain this blessed, either,)but it seems only right that all humans be able to live healthy lives, at the very least. Especially here in the United States.
Virginia Bailey
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