Bioethics Discussion Blog: Ethical Injustice of Medical Care: Possible Cure in California

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Saturday, April 28, 2007

Ethical Injustice of Medical Care: Possible Cure in California

Ability to obtain medical care is ethically unjust in the United States because of the fact that 44 million people are uninsured and have no access to medical care other than going to and waiting in hospital emergency rooms for all illnesses. It is also bad in my state of California. Uninsured in California estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey as published at Kaiser statehealthfacts.org reveal 6,598,940 Californians or 18% of the state population have no medical insurance and are not covered by any state or federal or private plans.
California Governor Arnold Schwarzenegger spoke to the California Medical Association sponsored Legislative Leadership Conference meeting earlier this week and guaranteed health care reform for California this year. Over 500 physicians, medical students, residents, and medical executives from throughout the state gathered in Sacramento for the conference. The governor was confident in his prediction of health care reform this year,in fact he stated "I guarantee it."

In view of the way our governor has been moving California to lead the nation in a number of important societal issues through working with both political parties, I find it reasonable to suspect that his promise will likely come to fruition soon. You may want to watch the approximately 17 minute speech courtesy of the California Medical Association. I think that the states should get into the act rather than wait for the federal government to finally do something about this injustice. ..Maurice.

12 Comments:

At Saturday, April 28, 2007 8:42:00 PM, Blogger Lisa said...

Dr. Bernstein,
A couple of points:
1. Suppose for a moment you live in a very isolated community where no one can enter or leave for the purposes of providing or getting health care. You're the only doctor to serve the people who live there. What if you want to retire? Can others claim that being deprived of access to your skills and labor is unjust to them?

2. For more fun, suppose the world consists of just you, me, and some doctors (who for the sake of argument have no money, but need to be paid). You and I both will die without medical care. The care we need costs the same amount, and we have the same income. The cost of the care we need exceeds this income. Both our incomes, if combined, could pay for the care of only one of us. Who should pay for whose care, and who is violating whose rights if we do not? Do you give all your money to me? Do I give all mine to you? If health care is a right that must be supplied to individuals by other individuals in order to achieve justice, you have a situation of conflicting rights.
3. Forcing you to pay for my medical care treats you as a means to my ends rather than an autonomous individual with your own rights and ends. How is that just?

 
At Saturday, April 28, 2007 9:03:00 PM, Blogger Maurice Bernstein, M.D. said...

Lisa, you make interesting points. What I would like to know is how would you organize healthcare so that everyone could get the medical attention and care that they need? If we say all physicians will be treated as public servants such as the police,fire,sanitation workers, etc. and paid for their services out of the pool of tax dollars would that be a fair solution? By this approach, however, as with all these other public servants we are paying for services which might not personally benefit each taxpayer equally. ..Maurice.

 
At Sunday, April 29, 2007 7:03:00 AM, Anonymous bob koepp said...

I think it's entirely appropriate for individual states to "get into the act" of ensuring access to quality health care for everyone in their jurisdictions -- even if the federal government is also one of the players.

I just hope that for whomever is "center stage," success will be measured in terms of improvements to health status rather than the accumulation of political points.

 
At Sunday, April 29, 2007 9:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Bob, I fully agree with your hope. ..Maurice.

 
At Monday, April 30, 2007 2:11:00 PM, Blogger Lisa said...

Dr. Bernstein,
It's a fair question. It's also a complex one. Do you do guest posts? :)

 
At Monday, April 30, 2007 4:49:00 PM, Blogger Maurice Bernstein, M.D. said...

Lisa, if you mean by "guest posts" if a visitor would write me e-mail on a new topic that the visitor wanted discussed and, if I felt was an appropriate topic for my blog, I would publish that as a new thread, the answer is yes. If you or others would want me to post their topic then write the posting to me:
DoktorMo@aol.com.

 
At Thursday, May 03, 2007 10:51:00 PM, Anonymous Anonymous said...

Unfortunately, Americans are not willing to accept universal health insurance. In other countries, universal health care does mean less availability of unusual, often expensive, tests and procedures. The American public has yet to embrace the fact that despite the enormous amounts of money we spend on healthcare, we lag behind many industrialized nations in key public health measures such as infant mortality and life expectancy. In addition to this ignorance, universal health care goes against the American ideal of individualism. Although many will not admit it, there is often an underlying thought, "if you do not have health insurance, that is your fault". The uninsured person does not have a job, or is in the country illegally or did somethings else wrong to "deserve" his status. It is this type of thinking that leads to comments such as Lisa's. In the health conscious environment we live in, there is also a sense that if you are sick, it is because you did something to bring it on and deserve your fate: smoking or drinking, not eating right, not exercising.

It is important for policy makers to recognize these factors when constructing policy. Some countries with universal health care, like Germany, still have more comprehensive services available for those willing to pay. Not ideal from an ethical standpoint, but at least the whole population would get the basics.

 
At Friday, May 04, 2007 8:43:00 AM, Blogger Maurice Bernstein, M.D. said...

Continuing on with Anonymous from yesterday, could it also be that the American culture also is more directed toward individual autonomy and more directed to individual control of their medical life and the medical experience? If not, then why is it that Americans seem to demand tests, procedures and treatments which are more expensive and are not necessarily appropriate based on professional medical experience, evidence based medicine and established standards of medical practice? Are Americans just spoiled to a culture where everything is available.. but at a price? This culture was either initiated or is being nourished by direct to consumer advertising, publicity of stereotype healthy and attractive bodies to be copied through cosmetic surgery and other procedures and medications. Further there are television dramas or news stories that pick out and stress the successes to bad diseases rather than the realistic results. And, physicians themselves contribute to the culture by not willing or seemingly unable to refuse requests even if the physician knows that it is medically unnecessary. Its the American culture... but only of benefit for some Americans. ..Maurice.

 
At Friday, May 04, 2007 12:17:00 PM, Blogger Lisa said...

Actually, Anonymous, you have no idea what I think or where it comes from. None of what you said has anything to do with why I oppose universal health care. Just because it makes you feel like you're morally superior doesn't make it a good system, so don't take cheap shots at those who disagree.

 
At Friday, May 04, 2007 10:01:00 PM, Blogger Maurice Bernstein, M.D. said...

If you haven't already done so, you might want to read the thread I posted today on "boutique" medical practice where for a monitary retainer, the patient will receive benefits which are not available to the patients who pay or their insurance pays only with the medical service. Go to the thread to write comments specifically on this topic.
..Maurice.

 
At Friday, May 04, 2007 10:28:00 PM, Anonymous Anonymous said...

Lisa- I did not mean that as a cheap shot, so I apologize if it came off as such. Specificly, I was referring to the relationship of individualism and your second point about individual rights. It would have been more polite, though to refer to the point specificly, and not just your name. I guess like you and everyone else, I believe in my morals thought not in being superiour. In my view societal interests have to come before some individual rights, though obviously there are other views which I am always interested to hear. These things are rarely black and white. I certainly do not know you, but you gave some idea of what you think about this issue.

 
At Saturday, May 05, 2007 10:05:00 AM, Blogger Lisa said...

Anonymous,
Fair enough. For starters, there's no such thing as "societal" interests. Societies cannot act or have interests; only individuals can. This is where my thinking starts. I don't think that insurance or lack thereof has to do with "fault" (although it is certainly the result of choices people make). The health care system we have is massively screwed up, but universal health care is not the answer. The answer is kind of a long one, which I'm getting around to posting eventually.

 

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