Collectively consider the questions at the end of the case here. Contributing to this prompt will help you think about health care reform, which will get you ready for one of your final exam questions.
Amanda, the young lady with no health insurance, is hopefully not being judged based on her insurance status. It is not morally right to let someone potentially die do to their inability to pay for services. Due to the fact that her symptoms resolved and her risk factors (age); being sent to her PCP is appropriate treatment.
Transferring Amanda to a not-for-profit hospital to continue her care should an admission be required is morally acceptable. She is still getting the care that she needs and hopefully saving her some medical expenses that she cannot afford.
Health care reform is much needed. This is not a question. The ongoing debate about how to go about this reform continues to spark strong opinions around the globe. A recent health care reform initiative in Massachusetts by the Governor Romney has made considerable news due to its impact on the state. Both favorable and unfavorable aspects of this legislation make for a hot argument. Some say the push for universal coverage is a substantial improvement, because the uninsured are under-served. This is an obvious need, and the reform has already reduced the number of uninsured. Of course, it brings a down side which is the rising costs of health care that drives big business into deficit. Business must pay more for employee health coverage and hospitals struggle to stay afloat as the rising health care costs escalate. A Massachusetts-style reform vs a more fundamental reform is a question to consider. I think a slow push to universal health care would be a huge positive reform taking considerations of not only individual requirements to purchase insurance by providing adequate subsidies for the poor, but also providing legislation that supports the business and state funded hospitals to stay viable.
Biomedical Ethics, 7th ed. Thomas Mappes, David DeGrazia, Jeffrey Brand-Ballard, eds.
I do believe that there is a tremendous need for healthcare reform. I believe that Massachusetts had the right idea, it just needed to be expanded upon and tweaked. The idea of healthcare for everyone is the going consensus when the topic is addressed. Countries all over the world have managed to provide universal coverage. How to go about it in the US has been the debate. I believe that Affordable Healthcare Act started out with the best intentions. The problem being that some of the plans are still unaffordable for people. The premiums, co-pays, medications, and numerous other fees still make it hard for some people to afford, therefore they are still going without. A complete restructure of the health insurance market may help us meet our goals. If there was a way to make it universal, all insurance companies covered the same things, charged the same amounts and made it easy to understand we would be in much better shape. The pharmaceutical companies also need to be addressed. The markup on medications is outrageous. People are sometimes unable to afford the medications they need to live, and yet they are somehow expected to find a way. I believe the Massachusetts style reform is what we should model our healthcare reform on. By building on and restructuring the system we have in place, we are more likely to reach our goal of universal coverage. In a perfect role, politics would have nothing to do with how we receive healthcare. Both parties should share the same drive to create a stable, thriving healthcare plan that serves the people. They should focus on creating and passing bills that benefit the people they govern rather than focus on lining their pockets. Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
I think there is no question that a healthcare reform is needed. Massachusetts’ approach was on the right track as far as the idea for universal coverage but needs to be improved upon when it comes to cost control and individual healthcare goals. The fact that the residents of Massachusetts are showing support for this approach speaks a great deal.
Honestly I don’t know the answer to this question. I suppose a complete restructure might be more likely to achieve major health care goals, but how will we know for sure unless it is put into place? A more responsible approach I feel like would be to gradually improve on the current system rather than making “drastic” and “massively expanded” changes.
I am leaning towards the Massachusetts style reform verses fundamental. I wouldn’t feel comfortable making a confident vote verses the two issues due to lack of knowledge of both approaches. However, as I mentioned in the previous question, the fact that the residents of Massachusetts are happy with this system and approach as shown by their supporting votes shows a lot in my opinion.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
I wonder what the health status for the residents of Massachusetts is like. If they are a relatively healthy group, then they may not need to use the health services very often and may be very happy with the reform that had happened. If they are a sickly bunch, and use it often and are still happy, then that speaks volumes to the effectiveness of the reform.
Healthcare reform is much needed in the United States. I think the model in Massachusetts is going in the right direction, however, I think we need to start with reform of the drug companies and the insurance companies. Until these two entities are reigned in and the astronomical costs of medication, treatments and insurance are addressed, I don't believe any national system will work the way it is intended. More often than not, the monthly cost of Obamacare to individuals and families is not affordable and they are finding the fine is cheaper than the cost of the insurance. When they drop the insurance, this causes a rise in ER visits for illnesses that could have been addressed in the GP office.
Healthcare reform, in my opinion, needs to include changes to the high prices of coverage, drugs and treatments.
Yes the cost of drugs and insurance could both be worked on. I feel ours may be better than a lot, but I still feel our insurance is rediculous considering we work in the health care industry.
I thought that working for a hospital we would have pretty decent insurance. That is not totally true. Just trying to get birth control now you need prior authorization from your physician and even then it can be pricey. They don't want to pay for it, even though the affordable care act states that they must provide birth control. Its frustrating that different insurances will cover this med or that med, but others will not. Perhaps a universal system where everything costs the same would be best.
Tracy, Good point about the drug companies and the insurance companies. They seem to call all the shots regarding patients hospitals stay and what medications that are covered. Drugs can be so astronomically high priced, that insurance won't pay for it all, and even the left over amount is too much for any average person, so the patient cannot take his prescribed med, but a 'therapeutic equivalent'. Is this true healthcare?
Yes, yes, yes! My thoughts exactly. They think pinching pennies from the little people will make up for the stacks of cash that goes to making healthcare such a big business for the pharmaceutical and insurance companies, and some politicians. Someone completely not involved with any of the three, and unable to be bought, with many others in the group the same, need to drive the reform, not those who are involved nd can stand to profit.
Our original system started to break when the majority of people who don't have coverage are needing health care often enough to where it is burning hospitals and drug companies and now that cost is getting passed on to everyone else.
I do think that we are in great need of healthcare reform. I do agree with what others are saying- I think Massachusetts had the right intentions and approach. There will always be a need for working out the kinks when something is implemented on this scale. I do believe we are moving in the right direction in achieving universal coverage and some cost control. Other cost controls need to be adjusted on a hospital and pharmaceutical level. Even the insurance itself could be more cost effective across the board. Some restructure in the health insurance may still be needed in order to reach our health care goals. I think ripping out the current and a total restructure at this point would just set us further back in the wrong direction. I do think the Massachusetts style approach is more preferred than a more fundamental reform.
I agree the style of reform they did in Massachusetts is more realistic and is a better idea for our country. Until costs can be controlled I don't know if it will ever change and it is those companies that are paying our government officials.
The debate isn't is healthcare reform is or is not needed, it is without doubt; the debate is how it should happen, and who should foot the bill. The Massachusetts approach, featuring "individual Mandate", is not the answer. Universal healthcare is needed, and expansion of Medicaid may be warranted, and everyone should be required to be covered, the true reform must start higher up.
If healthcare is reformed totally, and all parties are held accountable, it can happen without such a substantial cost to the little people and the small businesses. They should be responsible for their part, but it should not be up to them to carry the burden. . If the insurance companies and their CEOs and the pharmaceutical companies are also held to new guidelines, money will become available to the system from all their over-charging. Those drug companies marking cancer drugs up from dollars per treatment to tens of thousands per treatment must not be allowed to do so. Their profits, and free enterprise, must be limited. In addition, there is absolutely no reason the CEO of Humana should make $10.1 million annually and the CEO of Aetna more than $15 million. If the insurance companies were limited on their profits, and the CEOs made salaries of $500,000- $1 million each (still what I consider unnecessary and obscene), that would free up approximately $50 million just from CEO salaries of the top 5 insurance companies. Sadly, the issue is the relationship between politicians and the pharmaceutical and insurance companies. So often it's not about the public needs, but more about making money and sharing the profits between those who can make things happen on Capitol Hill.
In addition to holding the politicians and the healthcare profits companies to stricter guidelines, and taking away the business aspect, patients need to be held responsible as well. I'm very much about liberties and rights, freedom to do as you choose.... However, how is it okay for Bob The Patient to have a massive MI, require an extensive hospital stay, have a CABG, tally a $70K hospital bill covered by a universal (or even private insurance) plan, then have him blatantly undo everything you just fixed, that was at no cost to him. Is it okay for Bob to go home be non-compliant with his meds, continue to smoke and eat very poorly consistently, and come back in with complications or an extension of his heart disease in a couple months? Is it okay for patients to come in for respiratory failure, be on the vent for a month, go to rehab, then go home an smoke only to come back for the same? This drives up the cost of healthcare. If people can't follow the guidelines for what will help to heal them, should they be allowed to keep running up their tab for the same thing, only to not try to live healthier and respect their needs?
Fundamental reform is necessary, but must take place on all these levels.
This country is in need of healthcare reform but the real problem is the cost of healthcare and when a person who is uninsured receive health care drug and device companies along with hospitals essentially pass that bill along to us. So if the cost could be controlled in my opinion that would be the first step in fixing the issue. To give universal coverage is a great idea but what that ends up doing is punishing the people who really take the responsibility to get a good job with benefits. All the while others get free or subsidized health care for doing little or nothing. I can't even tell you if there is a system that would work for all citizens.
Alex, I respect how exasperating this is, but does all the responsibility lie on those who are underinsured or uninsured? I've found myself upset about this in the past. I now think it's much deeper than that. What about the companies overcharging for drugs and insurance and making billions? Also, what about those who are insured but continue to mistreat their bodies leading to countless readmissions (the COPD patient who keeps smoking and repeatedly in admitted to the ICU on the vent)?
I agree Shelley. This is something that I really feel strongly about and feel that there should be incentive of how we take care of ourselves. Working in the ICU we educate these patients like the one you gave an example that they need to really start taking care of themselves and they just don't listen and for that matter don't care. We tell them how costly this is and they still do not care. I just hate how people abuse the system. In anything, and it really irks me and rubs me the wrong way. I do believe that a reform is in need and there needs to be someone who understands and sees all points of view and takes everyone in to account.
Something definitely needs to change. The rising cost of health care is not just the under-insured or the un-insured. It is also the companies, the insurance companies and the political fat cats that are profiting from the $25 Tylenol that is administered at the hospital. I believe they are all scratching each others backs and until there is some kind of reform, the costs are still going to rise.
I have always said that it would be interesting if we didn't have actual insurance for when things happened. However, a glorified health savings account, each person would be given x amount of dollars to use per year. What would be included in this would be for doctor visits, medications, test, etc. When that money ran out then you would have to pay for it out of pocket. I know that it is not ideal because there are things that happen and in my imaginative world there would be an account and ways to have that taken care of. I think though that this would really have people take better care of themselves if they knew they were only allowed so much and wouldn't have a chance to necessarily abuse the system because then the system would look at how well you have tried to manage diseases and they would be able to grant you more money or they would be able to decline. It is obviously not the most realistic way but it would be interesting if it worked this way.
Amanda, the young lady with no health insurance, is hopefully not being judged based on her insurance status. It is not morally right to let someone potentially die do to their inability to pay for services. Due to the fact that her symptoms resolved and her risk factors (age); being sent to her PCP is appropriate treatment.
ReplyDeleteTransferring Amanda to a not-for-profit hospital to continue her care should an admission be required is morally acceptable. She is still getting the care that she needs and hopefully saving her some medical expenses that she cannot afford.
Sorry to be the bearer of bad news, but I think you may have done the wrong case study. :(
Delete(She did, but that's okay -- 41 is a good case, too! Jessica -- can you contribute to some part of the discussion below?)
Deletefabulous!
DeleteHealth care reform is much needed. This is not a question. The ongoing debate about how to go about this reform continues to spark strong opinions around the globe. A recent health care reform initiative in Massachusetts by the Governor Romney has made considerable news due to its impact on the state. Both favorable and unfavorable aspects of this legislation make for a hot argument. Some say the push for universal coverage is a substantial improvement, because the uninsured are under-served. This is an obvious need, and the reform has already reduced the number of uninsured. Of course, it brings a down side which is the rising costs of health care that drives big business into deficit. Business must pay more for employee health coverage and hospitals struggle to stay afloat as the rising health care costs escalate.
ReplyDeleteA Massachusetts-style reform vs a more fundamental reform is a question to consider. I think a slow push to universal health care would be a huge positive reform taking considerations of not only individual requirements to purchase insurance by providing adequate subsidies for the poor, but also providing legislation that supports the business and state funded hospitals to stay viable.
Biomedical Ethics, 7th ed. Thomas Mappes, David DeGrazia, Jeffrey Brand-Ballard, eds.
I do believe that there is a tremendous need for healthcare reform. I believe that Massachusetts had the right idea, it just needed to be expanded upon and tweaked. The idea of healthcare for everyone is the going consensus when the topic is addressed. Countries all over the world have managed to provide universal coverage. How to go about it in the US has been the debate. I believe that Affordable Healthcare Act started out with the best intentions. The problem being that some of the plans are still unaffordable for people. The premiums, co-pays, medications, and numerous other fees still make it hard for some people to afford, therefore they are still going without.
ReplyDeleteA complete restructure of the health insurance market may help us meet our goals. If there was a way to make it universal, all insurance companies covered the same things, charged the same amounts and made it easy to understand we would be in much better shape. The pharmaceutical companies also need to be addressed. The markup on medications is outrageous. People are sometimes unable to afford the medications they need to live, and yet they are somehow expected to find a way.
I believe the Massachusetts style reform is what we should model our healthcare reform on. By building on and restructuring the system we have in place, we are more likely to reach our goal of universal coverage. In a perfect role, politics would have nothing to do with how we receive healthcare. Both parties should share the same drive to create a stable, thriving healthcare plan that serves the people. They should focus on creating and passing bills that benefit the people they govern rather than focus on lining their pockets.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
I agree with you Jocelyn. I love my job, just strongly dislike the political side to healthcare and insurance companies policies, etc.
DeleteI agree, very good prospective.
DeleteI agree, I also hate all the politics in everything for that matter. It really is heartbreaking but that is just how things are.
DeleteIf we could reduce the involvement of the government in the health care sector, I think we would be moving in the right direction.
DeleteI think there is no question that a healthcare reform is needed. Massachusetts’ approach was on the right track as far as the idea for universal coverage but needs to be improved upon when it comes to cost control and individual healthcare goals. The fact that the residents of Massachusetts are showing support for this approach speaks a great deal.
ReplyDeleteHonestly I don’t know the answer to this question. I suppose a complete restructure might be more likely to achieve major health care goals, but how will we know for sure unless it is put into place? A more responsible approach I feel like would be to gradually improve on the current system rather than making “drastic” and “massively expanded” changes.
I am leaning towards the Massachusetts style reform verses fundamental. I wouldn’t feel comfortable making a confident vote verses the two issues due to lack of knowledge of both approaches. However, as I mentioned in the previous question, the fact that the residents of Massachusetts are happy with this system and approach as shown by their supporting votes shows a lot in my opinion.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
I wonder what the health status for the residents of Massachusetts is like. If they are a relatively healthy group, then they may not need to use the health services very often and may be very happy with the reform that had happened. If they are a sickly bunch, and use it often and are still happy, then that speaks volumes to the effectiveness of the reform.
DeleteThis comment has been removed by the author.
ReplyDeleteHealthcare reform is much needed in the United States. I think the model in Massachusetts is going in the right direction, however, I think we need to start with reform of the drug companies and the insurance companies. Until these two entities are reigned in and the astronomical costs of medication, treatments and insurance are addressed, I don't believe any national system will work the way it is intended. More often than not, the monthly cost of Obamacare to individuals and families is not affordable and they are finding the fine is cheaper than the cost of the insurance. When they drop the insurance, this causes a rise in ER visits for illnesses that could have been addressed in the GP office.
ReplyDeleteHealthcare reform, in my opinion, needs to include changes to the high prices of coverage, drugs and treatments.
Yes the cost of drugs and insurance could both be worked on. I feel ours may be better than a lot, but I still feel our insurance is rediculous considering we work in the health care industry.
DeleteI thought that working for a hospital we would have pretty decent insurance. That is not totally true. Just trying to get birth control now you need prior authorization from your physician and even then it can be pricey. They don't want to pay for it, even though the affordable care act states that they must provide birth control. Its frustrating that different insurances will cover this med or that med, but others will not. Perhaps a universal system where everything costs the same would be best.
DeleteTracy, Good point about the drug companies and the insurance companies. They seem to call all the shots regarding patients hospitals stay and what medications that are covered. Drugs can be so astronomically high priced, that insurance won't pay for it all, and even the left over amount is too much for any average person, so the patient cannot take his prescribed med, but a 'therapeutic equivalent'. Is this true healthcare?
DeleteYes, yes, yes! My thoughts exactly. They think pinching pennies from the little people will make up for the stacks of cash that goes to making healthcare such a big business for the pharmaceutical and insurance companies, and some politicians. Someone completely not involved with any of the three, and unable to be bought, with many others in the group the same, need to drive the reform, not those who are involved nd can stand to profit.
DeleteOur original system started to break when the majority of people who don't have coverage are needing health care often enough to where it is burning hospitals and drug companies and now that cost is getting passed on to everyone else.
DeleteI do think that we are in great need of healthcare reform. I do agree with what others are saying- I think Massachusetts had the right intentions and approach. There will always be a need for working out the kinks when something is implemented on this scale. I do believe we are moving in the right direction in achieving universal coverage and some cost control. Other cost controls need to be adjusted on a hospital and pharmaceutical level. Even the insurance itself could be more cost effective across the board. Some restructure in the health insurance may still be needed in order to reach our health care goals. I think ripping out the current and a total restructure at this point would just set us further back in the wrong direction. I do think the Massachusetts style approach is more preferred than a more fundamental reform.
ReplyDeleteI agree the style of reform they did in Massachusetts is more realistic and is a better idea for our country. Until costs can be controlled I don't know if it will ever change and it is those companies that are paying our government officials.
DeleteThe debate isn't is healthcare reform is or is not needed, it is without doubt; the debate is how it should happen, and who should foot the bill. The Massachusetts approach, featuring "individual Mandate", is not the answer. Universal healthcare is needed, and expansion of Medicaid may be warranted, and everyone should be required to be covered, the true reform must start higher up.
ReplyDeleteIf healthcare is reformed totally, and all parties are held accountable, it can happen without such a substantial cost to the little people and the small businesses. They should be responsible for their part, but it should not be up to them to carry the burden. . If the insurance companies and their CEOs and the pharmaceutical companies are also held to new guidelines, money will become available to the system from all their over-charging. Those drug companies marking cancer drugs up from dollars per treatment to tens of thousands per treatment must not be allowed to do so. Their profits, and free enterprise, must be limited. In addition, there is absolutely no reason the CEO of Humana should make $10.1 million annually and the CEO of Aetna more than $15 million. If the insurance companies were limited on their profits, and the CEOs made salaries of $500,000- $1 million each (still what I consider unnecessary and obscene), that would free up approximately $50 million just from CEO salaries of the top 5 insurance companies. Sadly, the issue is the relationship between politicians and the pharmaceutical and insurance companies. So often it's not about the public needs, but more about making money and sharing the profits between those who can make things happen on Capitol Hill.
In addition to holding the politicians and the healthcare profits companies to stricter guidelines, and taking away the business aspect, patients need to be held responsible as well. I'm very much about liberties and rights, freedom to do as you choose.... However, how is it okay for Bob The Patient to have a massive MI, require an extensive hospital stay, have a CABG, tally a $70K hospital bill covered by a universal (or even private insurance) plan, then have him blatantly undo everything you just fixed, that was at no cost to him. Is it okay for Bob to go home be non-compliant with his meds, continue to smoke and eat very poorly consistently, and come back in with complications or an extension of his heart disease in a couple months? Is it okay for patients to come in for respiratory failure, be on the vent for a month, go to rehab, then go home an smoke only to come back for the same? This drives up the cost of healthcare. If people can't follow the guidelines for what will help to heal them, should they be allowed to keep running up their tab for the same thing, only to not try to live healthier and respect their needs?
Fundamental reform is necessary, but must take place on all these levels.
References
DeleteBrand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. pg. 402-404. New York, NY. MCGraw Hill.
http://www.fiercehealthpayer.com/story/top-health-insurance-ceo-pay-exceeds-10-million-2014/2015-04-10
This country is in need of healthcare reform but the real problem is the cost of healthcare and when a person who is uninsured receive health care drug and device companies along with hospitals essentially pass that bill along to us. So if the cost could be controlled in my opinion that would be the first step in fixing the issue. To give universal coverage is a great idea but what that ends up doing is punishing the people who really take the responsibility to get a good job with benefits. All the while others get free or subsidized health care for doing little or nothing. I can't even tell you if there is a system that would work for all citizens.
ReplyDeleteAlex, I respect how exasperating this is, but does all the responsibility lie on those who are underinsured or uninsured? I've found myself upset about this in the past. I now think it's much deeper than that. What about the companies overcharging for drugs and insurance and making billions? Also, what about those who are insured but continue to mistreat their bodies leading to countless readmissions (the COPD patient who keeps smoking and repeatedly in admitted to the ICU on the vent)?
DeleteI agree Shelley. This is something that I really feel strongly about and feel that there should be incentive of how we take care of ourselves. Working in the ICU we educate these patients like the one you gave an example that they need to really start taking care of themselves and they just don't listen and for that matter don't care. We tell them how costly this is and they still do not care. I just hate how people abuse the system. In anything, and it really irks me and rubs me the wrong way. I do believe that a reform is in need and there needs to be someone who understands and sees all points of view and takes everyone in to account.
DeleteSomething definitely needs to change. The rising cost of health care is not just the under-insured or the un-insured. It is also the companies, the insurance companies and the political fat cats that are profiting from the $25 Tylenol that is administered at the hospital. I believe they are all scratching each others backs and until there is some kind of reform, the costs are still going to rise.
DeleteThis comment has been removed by the author.
ReplyDeleteI have always said that it would be interesting if we didn't have actual insurance for when things happened. However, a glorified health savings account, each person would be given x amount of dollars to use per year. What would be included in this would be for doctor visits, medications, test, etc. When that money ran out then you would have to pay for it out of pocket. I know that it is not ideal because there are things that happen and in my imaginative world there would be an account and ways to have that taken care of. I think though that this would really have people take better care of themselves if they knew they were only allowed so much and wouldn't have a chance to necessarily abuse the system because then the system would look at how well you have tried to manage diseases and they would be able to grant you more money or they would be able to decline. It is obviously not the most realistic way but it would be interesting if it worked this way.
ReplyDelete