- How do you define health?
- What does your ideal health care system look like? (Briefly sketch it out—what kinds of services should it provide? Who is covered? How is it paid for?). You might consider what you saw in the Emperor of All Maladies -- the cost of treatment for cancer, and other high costs associated with medical care (we've seen some stories about it in our Current Events blog).
- Kai Nielsen writes: “If there is the need for some particular regime of care and the society has the resources to meet that need, without undermining structures protecting other at least equally urgent needs, then, ceteris parabus, the society if it is a decent society, must do so” (p. 652). Do you agree with Nielsen? Does his argument apply to the U.S.? Explain. Can a just society refuse to provide health care to all of its citizens? Is health care a right, and if so, what kind? For whom is it a right (citizens, military, the elderly, children, all, none?).
Monday, March 7, 2016
Thinking Out Loud Final Exam (18 March)
An excerpt from your final exam to collectively consider here. Respond to at least two of the points below:
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ReplyDeleteThis is a very interesting take on how you define health. I really believe health means so many different things to different people what you may define is health is different from the next person.
DeleteYou are so correct, Alex. So much about healthcare, and health, and one's well-being is different from person to person. I think that's a huge observation and statement.
DeleteHealth means a lot of different things to different people. It can be personally defined in many ways, but Webster’s defines it as “the condition of being well or free from disease” ("Webster’s" n.d.). Many times in my experience as a nurse, when interviewing a patient and posing questions about their medical history, I have patients state that they are healthy and don’t have any medical history; however, upon review of their chart, you find that they have a multitude of health conditions, for example, Chronic obstructive pulmonary disease, Cardio vascular disease, diabetes, kidney disease, high blood pressure, smoked for thirty years, and have had two total knee replacements. Most typical Americans wouldn’t describe that as “health”, but for some people, if they can just get out of their rocking chair and go to the bathroom or walk up the stairs without being in pain or getting out of breath they would consider that a good day for them. My definition of health is being at your highest level possible of functioning for your age. Some disease processes can be completely unavoidable as you age like arthritis, depression, Alzheimer’s disease, osteoporosis, and degeneration of your joints leading to total knee and hip replacements. However, there are some that you can avoid like diabetes and in some cases heart disease (I know genetics are involved, but I’m speaking about what type of food you eat). My definition of health relies on the fact that the majority of it is how you take care of your body, which includes what you eat, getting regular exercise, getting plenty of sleep, and generally having a balanced life of work and play.
ReplyDeleteI think there is a huge difference in what is an ideal healthcare system, and a healthcare system that is functional and realistic for the majority of Americans. Having said that, I believe that providing health care to all citizens is a great idea in theory, and would be ideal for a society. However, in reality, I do not believe it would work, and therefore, I do not agree with Nielsen. I do not believe that health care is a right. I believe that the only way to provide health care to all citizens, including those that are not paying for it themselves, would cause the quality of healthcare to drop drastically. For this reason, by providing healthcare to all citizens you are not “protecting other at least equally urgent needs” (Nielsen). Health care is available to all citizens and all citizens have an equal ability to obtain it. By providing health care to all citizens, those who have taken the necessary steps to obtain it through employment, for example, are being punished by diminishing the quality of health care available. John Rawls presents the theory of Justice and Fairness, and one of his principles is the principle of greatest equal liberty: “Each person is to have an equal right to the most extensive system of equal basic liberties compatible with a similar system of liberty for all (Rawls, 1971 pg. 201). I understand his argument that everyone should have the same access to health care, most everyone today in America does have some access to health care. When they come into a hospital for care they aren’t denied because of a lack of insurance. Hospitals all over the country have people come into Emergency rooms, Operating rooms and Urgent cares and don’t end up paying, and those establishments end up writing it off as charitable work. Patients without insurance just don’t have access to the most advanced practices, such as advanced cancer care, total joint replacement, among other treatments and care.
Webster’s. (n.d.). In health. Retrieved from http://www.merriam-webster.com/dictionary/health
Degrazia, D., Mappes, T. A., & Brand-Ballard, J. (2011). Social justice and access to health care. In Biomedical Ethics (7th ed., pp. -). New York, NY: Mcgraw Hill.
Rawls, J. A Theory of Justice, Cambridge, Mass.: Harvard University Press (1971)
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DeleteAlex, excellent post and excellent points. I love this definition of health - highest level possible of functioning for your age.
DeleteI find it interesting we are one of the only countries on the Healthcare Elsewhere spreadsheet (and as we discussed in our nursing class)that does not have universal healthcare. Interestingly enough, the patients without commercial insurance, the patient with medicare and Medicaid, do get the advanced practices with much less hassle than the people paying for commercial insurance. I worked Utilization Management then Care Coordination for five years prior to/ concurrent with Quality Management, and the denial for procedures were not with the government health policies, or the self pays (we don't deny them the surgeries, they get the surgeries, get billed, and it often gets written off). The denials, and the jumping through hoops occurred with the commercial insurance companies. This wasn't for frivolous care, it was for necessary procedures, like hip replacements, cholecystectomies, ablations, etc. I can understand them trying to scrutinize and save costs for unnecessary care, but that isn't the case. I've had to fight with my provider several times because they questioned if Zach's insulin was truly needed, and if he needed his insulin pump, and test strips. It's especially crazy people have to fight with the commercial insurance companies when they are making billions of dollars in profits. We could reform healthcare if it was not such a business for some.
Great points Alex. I find it interesting the different ways people view "health". Like you mentioned about the individual able to make it to the bathroom or up a flight of stairs is having a "good day" I agree, they are functioning at their optimal level of health versus what another may view as their optimal level of health.
DeleteYes in a perfect world we could offer care and coverage to all but you are right, it is just not realistic. I believe it's important to offer basic health care needs but you are essentially helping those who don't want to help themselves a lot of times.
DeleteYes, in a perfect world there wouldn't be a need for health care. But in reality, we could start with reforming some of the things that are wrong with our health care system today. We need to tackle the outrageous costs of medicine and treatments.
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ReplyDeleteShelley SimpsonMarch 15, 2016 at 6:16 PM
Health is defined as the state of being free from illness or injury or a person’s mental or physical condition (merriem-webster.com). However to me, health is a more holistic thing, a persona, the state in which a person, or a society exists. This persona, or state, can be good, it can be bad, and it can be a clashing of both states, with one or the other prevailing at different times. Health encompasses habits, choices, a person’s mental state, a person’s physical state, the caregivers, the treatments, and the way of living constantly to help win the battle raging within and all around our bodies, and our society.
My ideal health system is balanced. It is not a battle of payer or versus payee, government versus citizen, or caregiver versus care recipient. It’s a coalition of everyone to assure every citizen, and our society, is having their needs met. It requires responsibility from everyone, not just the physicians and caregivers like it is now. The ideal system has the government holding the insurance and pharmaceutical companies to standards to not make saving someone’s life a “get rich” scheme. It requires responsibility on the patients’ parts to assure they are making every effort to change habits and get rid of vices to try to achieve the ultimate health and overcome their chronic illnesses. It’s a constant practicing of virtue ethics by evert party involved. It’s Kant’s deontology in motion daily. In my ideal health system, there is universal care available to everyone, and the cost is not just to them to carry. The cost is divided between government programs, what was once profit from the big business side of healthcare (the pharmaceutical companies, the insurance companies, device companies). Waste is kept to a minimum, it is not taken for granted, and everyone can benefit.
As Nielsen writes: “If there is the need for some particular regime of care and the society has the resources to meet that need, without undermining structures protecting other at least equally urgent needs, then, ceteris parabus, the society if it is a decent society, must do so” (brand-Ballard et al, p. 652). Anyone who has studied ethics, studied virtues, questioned “what kind of person do I want to be?” must agree with this. How can a decent society, and its leaders, allow people to become numbers, and allow them to be a means for them to use to accomplish their ends of the almighty dollar, or political power? I think we have to be in need at some point, have to be that person who is looking to others for help, to truly have empathy and an understanding. Health care should be a right, not just a privilege for those who can afford it, or those deemed indigent and provided for to keep the peace in a war between political parties. It definitely needs to cover the vulnerable populations of children, elderly, women, but should extend to all society. However, if it is made a right, the citizens must be responsible enough to not take it for granted. They should do their part to try to earn, and try to contribute to society in turn. It isn’t about handouts, it’s about making something available, and those it benefits doing what they can to contribute to the entire system and process.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. New York, NY. MCGraw Hill.
I really like your definition of health, it makes perfect sense. Being holistic, and especially including the habits and choices as you mentioned being part of one's health.
DeleteThat was is a good definition of health I didn't include the spiritual aspect in mine but emotional and spiritual health can be just as important as physical health.
DeleteI like the idea of moving toward holding the patient responsible for his own health, especially when it comes to some of the chronic conditions that could be avoided by lifestyle changes. This is not emphasized enough. Patient's are showing up 'complaining' about their doctor not giving them the right medication or treatment, and then continue to smoke and eat unhealthy foods regularly.
DeleteI read at least 10 different definitions on health. Amazing that they cannot agree on one definition. I ended up choosing WHO definition since they are trans cultural and treat all over the world. I like it is mind, body, and soul.
DeleteI came up with my own definition of health. I think we should be responsible for our own health. We have google, that should be enough to give us all a medical education and degree. Right??? LOL
DeleteThe definition of health varies according to many different sources. My favorite definition I found and represents my personal definition of health is from the World Health Organization. They define health as “the state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity." (WHO, 2016)
ReplyDeleteMy ideal health care system would include utilizing and expanding on the technology we currently have in place. We live in a digital world now, while I feel that we are continuing to depend more and more on technology as time goes by, it is what it is and will continue to be so. As the younger generations age and become part of the working class, they have the baseline knowledge of current technology and can only move forward from there. Technology is key; it empowers people with the important data needed to make an informed and educated decision. In healthcare, accessible, quick, and efficient access to important data and resources provides patients, physicians, insurance companies, and the government agencies with the power to run a more efficient, quality driven, evidence based system of health.
The services my ideal health care would provide are not much different than the services currently provided. I would like to see a larger focus on addiction treatment and prevention measures however. In my ideal health care system, I would hope to see that everyone is eligible for coverage. If we could somehow drastically cut healthcare costs then insurance costs would in turn decrease making it more feasible for people to afford healthcare. For those truly disabled or not capable of affording healthcare (Medicaid) I would like to see a plan in place that would enable these individuals to utilize Medicaid for a certain set period of time while they make attempts to financially support themselves.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. New York, NY. MCGraw Hill.
World Health Organization (WHO). 2016. Definition of Health. Retrieved from: http://www.who.int/en/
I agree technology is not going away and it has the promise to make us a healthier society. I think the health care field will look a lot different in 10 years.
DeleteI agree Erin that a focus on addiction treatment has become absolutely essential. I think we are moving in the right direction, with the tighter laws regarding the physicians handing out RX for pain pills all the time. A prevention of addiction somehow is needed for those at risk of pain medication addiction.
DeleteTechnology is certainly going to change the face of healthcare. We might not be far from the sick bay in Star Trek. Able to diagnostics with handheld computers. We all seem to understand the importance of universal and affordable health care. Somehow we have to add the equation on how people live. Are they healthy or not and should you pay more for behaviors that are not consistent with good health.
DeleteExcellent post, Erin. I agree with you completely. I like your attention to addiction services, as it is such an epidemic and has such an impact on our society's future. I love that definition of health!
ReplyDeleteA definition of health is not equal to all as an opinion, or what one believes. Although it can be defined by Webster, health means different things to different people. For example, if you ask a patient about there overall health, you may get an answer like "I'm fine, I've been healthy all my life until this". They may be presenting at this point in their life with some symptoms they no longer could ignore, and have a new diagnosis of lung cancer. Now this individual likely is not considered healthy by another's standards, yet his own mind he perceives himself healthy because he has continued to function and do what he wants to do on a regular basis. He is a long time smoker, and has not gone to a doctor ever in his life. This isn't because he's been 'healthy', but because he doesn't go to doctors and get diagnosed and receive medication. Health is subjective.
ReplyDeleteAn ideal health system would be affordable and available to everyone, not just some. It would be simple, not so complex that you need a trained professional to explain the plan to you. It would cover prescriptions and endorse preventative care.
I really like that you incorporating having a professional explain a plan to you. I really struggle because honestly my parents have always had my coverage and you know they don't teach about this is school or anything. I think educating kids at a younger age would also be beneficial
DeleteI believe the definition of health differs from culture to culture and person to person. Health, in my opinion, means to be free from disease or injury and be sound of mind. Others believe that one is able to maintain with the presence of disease or permanent injury. I looked up the WHO definition to see hoe they apply it across all cultures they come across. There definition is, “the state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." (WHO, 2016). The more I read there definition the more I like it and agree with it. They look at health through all angles of how we live our lives. We can be physically healthy but mentally unstable. Then in there definition you are not healthy. I agree with there point.
ReplyDeleteMy ideal health care system would look much different then it does today. There would be universal health care for everyone. No matter what your income is you have to pay something into the system. I don't care if it is only 10 dollars a month. Preventive medicine would be practiced regularly. Required physical every two years with counseling for healthy living. Rate hikes for those with a high BMI that is not due to a medical problem. Risky behaviors such as smoking and drug use would also raise the rates on that individual. Lower rates for those who have adopted healthier lifestyles. Everyone would be covered. Research would still exist but at a slower pace. Most of the money would be used for education, preventive medicine, and lowering the cost of healthy foods.
My opinion after Nielsen writes: “If there is the need for some particular regime of care and the society has the resources to meet that need, without undermining structures protecting other at least equally urgent needs, then, ceteris parabus, the society if it is a decent society, must do so” (brand-Ballard et al, p. 652). I agree that we must help those in our society that cannot help themselves. We must not create a culture that enables certain people to live off the system. We must draw a line and teach our society they are ultimately responsible for their lives and lifestyles. Should we continue to take care of patients that are non compliant. The CHF patient who is discharged and goes home to their high sodium diet and returns every week. I think at some point our obligation ends and they are responsible for the choices that they take.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. New York, NY. MCGraw Hill.
World Health Organization (WHO). 2016. Definition of Health. Retrieved from: http://www.who.int/en/
I agree, preventable medicine can be more utilized. We need to hold people to take a proactive stance on health because it it easier and cheaper to prevent than play catch up.
DeleteI agree preventable medicine is a great thing.
Deleteinstead of paying a monthly amount into the system which you know people would find a way around we could do what other countries do and raise the sales tax and have that money go towards universal healthcare. Everyone buys stuff, so theres no way around that payment. For people that come here as tourists from other countries and buy things, they will essentially help us by contributing to our economy and our healthcare.
DeleteI agree with you Jocelyn. As in England, sales tax and tax money goes toward universal healthcare. I think that is something our government should look at.
DeleteMy definition of health is having the optimal level of functioning in mind, body, and spirit. This is one having a balance in their physical, mental, spiritual, and mental health. I believe that all four are key and essential to maintaining each persons optimal level of functioning. As each person is different from another, so is their optimal health. Freedom from injury and acute diseases are essential elements. Having chronic diseases does not merely impede one from having optimal level of health. I believe they can still achieve health as long as on is functioning at their highest capacity.
ReplyDeleteI do believe health care is a right to all even though today it is more of a privilege. We should be able to provide basic levels of health to our community. However, I do believe we need to hold individuals more accountable for many things including their health. Today we can see a elderly person struggling with their health and needing basic needs and not being able to afford them due to many reasons. Then on the other hand we can have a young individual who does not care about their health who continues to get free government handouts at the cost of all. I highly do not believe this is fair. One needs to be held responsible to care about their optimal health! So with that being said, I do agree with Nielsen's basic concept. But I do think there needs to be more accountability and not expect you deserve it.
My basic view of a health system would not vary too much from as it stands. I do believe basic health should be available to all, but not as a mean if a free handout. I believe we should offer coverage at expense of the individual. I believe we could strive to find a way to make that more accessible by cutting costs at a capital level. Costs need to be the focus because that is the barrier for most. Controlling the costs of medical treatment, prescription coverage, and insurance coverage are key components to making this work. Right now it feels as the costs have soared either because they can or to make up the deficit of those abusing government systems. Medicaid needs to be revamped. It is great for those needing coverage at times of need but we basically live in a society where it is not utilized as a assistance but as a chronic crutch. There are times where I see people utilizing it and they absolutely do not need it. This is causing a struggle for those that need it and those of us who are hard working and have our tax dollars abused to pay for their unnecessary life style choices.
It is hard to post about this when we are writing it in a paper for you. But I will give a little opinion about what I think health is. I believe that health is truly not just physical health but we tend to forget about the mind and the spirit I feel that we are all so quick to judge someones "health" by their physical physique. I know that I have a long way to go on my self to become healthy physically, but mental and spiritually I definitely would consider myself healthy.
ReplyDeleteI also think that health care is a right I think that we should be entitled to good healthcare and that people should not abuse it and once that happened then you had no other resources it would be up to you to prove that you were serious about the care that was given to you as your rights.
Health system is so hard to discuss with out writing pages on it. I mean my basic view does not change. I think that it will always be about money and politics so until that changes and we truly have people that are making guidelines care about the actual health of someone and care about the people taking care of them, I do not think that much will change. And I do not think that things are going to be better here in the next few years to come.
I agree that the politics needs to be taken out of healthcare and leave it up to the people that actually care and took an oath to do no harm. If my understanding was correct there was not a single M.D. on the board that made p the Affordable Care Act, which just seems ridiculous.
DeleteHeath to me is a happy medium between being well physically, mentally, and socially. When all of these things are in harmony we are at our optimum level of health.
ReplyDeleteKai Nelson wrote “If there is the need for some particular regime of care and the society has the resources to meet that need, without undermining structures protecting other at least equally urgent needs, then, ceteris parabus, the society if it is a decent society, must do so” (Brand-Ballard, pg. 652). Our country is founded on the principles of life, liberty and the pursuit of happiness. Given this truth, how can we ethically refuse to provide a healthy life to our citizens. We pride ourselves on being one of the top nations in the world. I believe that we have a moral obligation and societal commitment to ensure that everyone has access to at least some form of basic healthcare. No decent and compassionate society according to this line of thinking, could fail to provide healthcare to its members when it has the financial resources to do so, thus appealing to our virtuous nature (Brand-Ballard, pg. 62).
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. New York, NY. McGraw Hill.
I agree that as the USA we should have it figured out to provide healthcare to all of our citizens, however I don't think we have figured it out yet. there must be a way for everyone to get healthcare, but nobody should get it for nothing.
DeleteI define health as maintaining a healthy body, mind and spirit. This can be attained by eating right, exercising and trying to maintain a positive attitude. Seeking preventative care is important. Preventative care can stop illnesses before they happen and possibly recognize disease or illnesses in the early stages when they are most treatable.
ReplyDeleteMy ideal healthcare system would be to take government out of the equation. With government involvement we have lost our right to choose, there is no longer healthy competition between healthcare companies and costs for healthcare has been driven up. It is still not affordable for those who may need it the most, the people living in poverty, people with families and the elderly. Insurance companies and pharmaceutical companies are price gouging the consumer. Why should a Tylenol cost $25 when you are in the hospital? Doctors should be able to choose what patients they want to have as patients. Hospitals should be able to deny treatment to the addicts that are frequent fliers looking for a quick morphine fix. Hospitals are mandated to treat everyone regardless of the ability to pay. This is just driving up the costs in taxes to every American worker. The whole insurance system needs to be re-vamped. I think if we reduced the government's role and maybe looked at a National Healthcare System such as in the UK where it is funded by sales tax and other taxes, where EVERY person pays, including tourist, this might be a good solution to our needs as a nation.
I agree, government needs to be taken out of the equation. also, healthcare need to not be seen as a business.
DeleteWhen I think of the word “health” the first thing that comes to mind is balance. Overall health to me is a balance of activity and rest, work and play, healthy food and splurges in moderation and love with independence. Health is so much more than the physical body, as studies have shown when the spiritual and emotional self is out of balance it shows on the body. Working in an emergency room I see first hand how relationships, finances, stress and the environment itself can bring people to the hospital facing serious illness.
ReplyDeleteAs stated in our text, “over 46 million Americans, about 16% of the population, lack health insurance; millions more are underinsured.’ (Biomedical Ethics, 623) My ideal healthcare plan would not allow this to happen. However, I am sure that no American wants their neighbor to be uninsured. The question is, how do we all get help with our medical bills without having one group cover the cost of others; while some pay nothing for their services and medication. Also, my ultimate image of the healthcare system would not allow senior citizens that have put in their time in the work force to have to pay a large amount of money for necessary medicine. Or worse, have to go without due to the inability to pay. I feel that if everyone had to pay something or work for it in some fashion than people may not go to the hospital or clinic for needless things. Living in a quick fix society doesn’t help either! It is a shame that we have elderly with untreated hypertention due to lack of money for medications while we have young able bodied Americans not working and going to the emergency room for every tooth ache and sore throat. There has got to be a better way.