The list of ethical relationships continues to include procurement and communicability, behond the space for the present report. There is probably no way to include all stakeholders in this decision since that group includes future applicants as yet unidentified, other providers and the consumers at large. If a policy of insured to uninsured is enacted at Health Springs, consumers will decide for themselves how long to remain on wait lists if at all, or to engage in priority points behaviors if such policy is implemented. Likewise employees and partners will decide for themselves if other opportunities deliver more utility than remaining with our partnership after such policy takes effect or not. Partners have clear interest toward maximizing their own revenue and rational consumers generally want to pay only for their own expenses with the consideration that many of them also probably value altruism to some degree and realize the benefits of reducing disease in the aggregate society. Individuals all have biases toward themselves if they are suffering and want immediate access to care, or at least priority as demonstrated by high continuity of care for existing clientele. Employees are biased toward avoiding job loss and apparently, some other providers apparently have biases against taking on new uninsured. We have an interest in maximum performance for all these complementary inputs and a bigger firm may be an asset rather than an obstacle.

The decision is whether to implement a formal policy determining share of patient mix between insured and uninsured, and/or whether to increase the number of partners and thus payroll or not. The course of action is a cost-benefit analysis comparing different shares of insured to uninsured, per existing or potential partners. The Board will at least have possible outcomes to compare rather than making uninformed decisions, without overlooking utilities potentially worth public investment (indigent care, communicable diseases, etc.). If the only factor all parties can agree on is the ethical and moral guidelines, then maximizing compliance to the guideliness may be the only way to balance conflicting claims on scarce resources all parties want the most access to. This is a blend af a deontic application of "principlism, with its foundation in formal philosophy, [which] tends to prize logic, reasoning, and argumentation while expressing skepticism about intuition," and the group discussion of our Governing Board and full-time stakeholders trying to solve a shared problem in the way "communitarianism recognizes that moral intuition and narrative may provide legitimate starting points for developing consensus about our shared values" (Cheyette, 2011, 681).

The decision to seek more information increased the moral defensibility of the ultimate decision to take policy or not. What this decision does not address is the moral justification of our having to screen access to care based on ability to pay backfilling caseload for providers who restrict by insurance status, many of them with the highest insured to Medicaid ratios already for years now (Cunningham and May, 2006, n.p.). Other firms are closing their rolls to uninsured, which forces the poor onto other providers, and our taking policy is a reaction to these other providers' restriction of care, by restricting access ourselves which undoubtedly lowers overall access, but which we cannot solve ourselves without eventually going out of business and thus reducing total potential care absolutely. The best decision may be to expand the firm but that incurs risk and ignoring that would be irresponsible given multiple stakeholders.
Works Cited

American Nurses Association (2008). Guide to the code of ethics for nurses. Marsha Fowler

(ed.). Maryland: American Nurses Association.

Bandman, E. And Bandman B. (2002). Nursing ethics through the life span. (4th ed.). New

Jersey: Prentice Hall.

Cheyette, C.M. (2011). Communitarianism and the ethics of communicable disease: some preliminary thoughts. Journal of Law, Medicine & Ethics, 39(4), 678-689. doi:10.1111/j.1748-720X.2011.00635.x

Cogan, J. (2011). The Affordable Care Act's preventive services mandate: breaking down the barriers to nationwide access to preventive services. Journal of Law, Medicine & Ethics, 39(3), 355-365. doi:10.1111/j.1748-720X.2011.00605.x

Cunningham, P. And May, J. (2006). Medicaid patients increasingly concentrated among physicians. Center for Studying Health Care Change. "Table 3, Physicians accepting no new Medicaid patients." Retrieved from http://www.hschange.com/CONTENT/866/

Eisert, S.L., Durfee, J., Welsh, a., Moore, S.L., Mehler, P.S., and Gabow, P.A.

(2009). Changes in insurance status and access to care in an integrated safety net healthcare system. Journal of Community Health, 34(2), 122-128. doi:10.1007/s10900-008-9136-2