Currently, there are approximately five to six special interest group lobbyists working on behalf of the private health insurance industry for every single publicly elected representative in Washington, D.C. (Reid, 2009). The breakdown of political support for legislation and policies that benefit the industry reveals a remarkably close association between political contributions from that industry and the voting and statement records of political representatives (Kennedy, 2006; Tong, 2007). It is no surprise that the major source of opposition to some of the most potentially beneficial elements of healthcare reform at issue today comes from the representatives who have received the largest campaign contributions from the private health insurance industry and representatives from states where the largest corporate parents of private sector health insurance companies (Reid, 2009).
Preventative Medicine and Reimbursement Based on Beneficial Results
Sufficient information already exists from other nations that very strongly suggests that any efficient, affordable, and socially beneficial model of national healthcare must rely of a results-based fee structure instead of the fee-for-services model still relied upon in the U.S. (Kennedy, 2006; Reid, 2009; Tong, 2007). That is simply a realistic function of the fact that human beings tend to be motivated by whatever is most in their self-interest. Physicians are often dedicated to their professions but the format whereby their compensation is substantially determined by how many services they render and how many tests they perform provides an unavoidable ethical conflict that undermines the quality of healthcare services while inflating their costs tremendously.
In European nations (and in other countries), physicians earn bonuses for the actual measurable benefits their services provide to patients rather than for merely rendering services without any connection to their efficacy (Kennedy, 2006; Reid, 2009; Tong, 2007). Meanwhile, in the U.S., the cost of healthcare is increased by unnecessary testing because it is profitable and because there is virtually no general or holistic approach to patient welfare. For example, orthopedists in the U.S. may not address the fact that their patients smoke because those concerns are not within their specialty (Kennedy, 2006; Reid, 2009). In nations that have adopted the preventative medicine focus, all physicians address the overall health of their patients and there is no profit in providing medical services and tests that do not provide beneficial results (Beauchamp & Childress, 2009).
The Ethical Distribution of Healthcare Costs Based on Relative Affluence and Need
Perhaps the most significant ethical and moral issue in connection with equal rights to healthcare raised by the contemporary debate about American healthcare reform is in the area of the most appropriate source of funding for it. Unfortunately, the traditional format of reliance upon taxing the earnings of the young to finance the medical treatments needed by the elderly (and the poorest in the community) is no longer feasible because of demographic changes in the American population (Kennedy, 2006; Reid, 2009; Tong, 2007).
Furthermore, even under the existing federal medical coverage programs, there is a large gap in eligibility between those who qualify for government subsidization of their healthcare needs by virtue of age and low income and the many heard-working members of the population who are too young for Medicare but earn too much to qualify for Medicaid (Kennedy, 2006; Reid, 2009; Tong, 2007). A truly ethical and moral society must find a better way to provide uniform medical coverage to all of its citizens (Beauchamp & Childress, 2009).
The most equitable format for doing so is increasing income-based taxes on the wealthiest segment of society to help provide for the essential medical (and other social service) needs of all Americans. In principle, this is no different from the traditional manner in which tax rates are determined by income for the purpose of funding all of the other social benefits that should be available to improve the quality of modern life for everybody in modern society. In that regard, taxes for the purpose of making healthcare more available to those who cannot afford it through no fault of their own is a fundamental shared obligation of society that is rightfully shouldered by those best able to afford additional taxes for that worthwhile purpose.
Beauchamp, T., and Childress, J. (2009). Principles of Biomedical Ethics. Oxford Kennedy, E. (2006). America: Back on Track. Viking: New York.
Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and…