healthcare financing article.pdf

The more liberalprogressive view of human beings is

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The more liberal/progressive view of human beings is that humans are generally good, but individuals can be corrupted by political systems. The best economic result will come from societies that promote equality and caring, and in turn discourage or punish choices based on selfishness (i.e., greed, exploitation, profit). A benevolent government can most efficiently distribute resources to do the most good for the most people. The best outcomes in health for a population will come when experts and leaders work together so as to prescribe countrywide “best practices” and prioritize needs of society as a whole. “From an ethical perspective, resources should be allocated appropriately so everyone can enjoy the best health possible.” 34 VI. The Unspoken Agendas Unfortunately, most public debate about healthcare reform is reduced to “sound bites”, simplistic rhetoric, or utopian political
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© 2008 Leah M. Willson, MD, MA - 10 - proposals. It is confusing to hear people from all social classes and walks of life disagree so profoundly on health care policy. One last element is needed to best understand the debate. It is that most powerful bias in ethical decision-making: self-interest. Even though many decry selfishness, it cannot be assumed that they have absolutely no bias about their own health or in the $2 trillion a year currently spent on medical care in the U.S. Advocates of healthcare financing reform are many, and most have multi-faceted perspectives. All are or will be patients someday, and all want available, quality medical care for themselves and their families. Those who are well-insured now do not want to lose benefits or pay more; those who are uninsured want healthcare coverage; those with specific diagnoses want benefits that will cover their conditions. Physicians prefer to treat patients without concern about cost. They also want independence in decision-making, minimal paperwork, and good incomes. Most politicians want to support whatever they believe their constituents want. It seems impossible to predict what changes will occur in the U.S. system in the next few years, but it is highly unlikely that anyone will get everything they want. And most citizens will not even have an idea of what they will get until they have it. Two authors (advising policymakers who want universal coverage) write: “Proposed reforms that make headway … are more likely to be successfully enacted if they are inherently ambiguous and stress benefits and subsidies rather than cost-constricting regulations or funding cuts. […] Complexity and ambiguity are necessary…” 35 It is in this milieu that physicians, ethicists, and other professionals should begin to evaluate how various shifts in our health financing structure may impact clinical ethics.
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