Saturday, September 12, 2009

The Real Reasons We Need Health Reform

Over the last few months, many people (including me) have been making the point that health care reform / health insurance reform is necessary and urgent. I've tried to make the point by giving examples of patients who have suffered under the system, the additional fees and costs incurred by uninsured patients, the challenge to finding useful and affordable health insurance, etc. These are all valid reasons, but I don't know if they are the REAL reasons why we need healthcare reform.

In medical school, we took a class in medical ethics. As part of the class, we were taught the 4 key principles of medical ethics:


In more detail:

Beneficence: the requirement to do good for your patients; the obligation to provide benefits to those in need.

Non-maleficence: the obligation not to cause harm (primum non nocere); the obligation to prevent injury to our patients.

Autonomy: patients must have the personal rule of the self while remaining free of controlling interests by others and by personal limitations. This is patient autonomy, not autonomy in the restricted "conservative" sense of "hands off my property." I am referring to autonomy in the sense that without good health we cannot be in control of our lives and that harmful actions by any outside influences (including multinational corporations and the insurance companies) need to be avoided.

Justice: giving to each his due; equals must be treated equally, but unequals need to be treated unequally--if you have greater needs, you might require more resources.

If we value all human life (and "conservatives" claim to value human life more than anyone else), then we should hope that all people have the chance to flourish and to maximize their capabilities. In our economy and government, we do not guarantee equality of results. We do, however, claim equality of OPPORTUNITY. The classic American story is the individual who comes from poor beginnings and reaches great heights. This potential, this opportunity, is greatly restricted or lost altogether if one is in poor health.

Our current health care system violates all 4 principles of medical ethics. It does not allow for beneficence--insurance companies restrict access to care and the costs keep millions from accessing the system at all. It does not allow physicians to prevent harm: patients may not get follow-up tests or visits because of cost or access issues. It does not allow for patient autonomy in any meaningful form--the final decision is oftentimes not really the patients' decision. Finally, the system is evidently and fundamentally unjust. This system also negates any premise or claim we might make of truly valuing other people.

To me, these are the real reasons we need healthcare reform. Physicians and other healthcare professionals must stand behind reform that will make our system effective and ethical.

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