healthcare financing article.pdf

In any system as costs mount ethical issues become

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In any system, as costs mount, ethical issues become apparent in caring for the ill and disabled. For example, the abortion rate for disabled fetuses is very high in the current system. 53 Would it be even higher in CDHP plans because of parental concerns about medical bills? Would it be lower if parents were assured of lifetime medical support for their child through a national health plan? Or, when state and federal budgets are strained due to costs, will there be a push for mandated prenatal testing to “prevent” disabilities and pressure parents even more to abort a “defective” unborn child? Is it ethical to allow the disabled to receive disparate services because of more or less assets under a CDHP plan, or should government mandate the same benefits for all? If the program cannot fund the same level of services for all, should resources be rationed based on “quality-of-life”, and if so, who decides? David Thomasma says, […] quality of life judgments must be used in a rationing scheme…Normally we try to avoid such judgments, especially at the
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© 2008 Leah M. Willson, MD, MA - 15 - bedside. But they are actually an intimate part of the virtue of justice seen as distribution of a good. Quality of life … means that persons still function as moral persons, able to make determinations about their lives. 54 This seems to say that rationing or denying services is inherently just if the person is non- communicative, demented, or mentally retarded. An “equality of opportunity” ethic may also be problematic for the disabled, especially if they have no chance of recovery or cure. Citizens must be discerning in their evaluation of a health plan’s proposals for the chronically ill and disabled. Is the plan financially realistic (a question of truth- telling)? Will it protect and assist the most vulnerable (nonmaleficence and beneficence), yet promote choice and responsibility for the competent ill and disabled (respect for autonomy)? How susceptible is the plan to manipulation by special interests (a question of justice)? X. Caring for Children and Adolescents Approximately 89% of children are already covered by private or government insurance. Of the 11% who are uninsured, an estimated 70% are eligible for SCHIP or Medicaid, but have not enrolled. 55 In addition, charity care for children abounds, including the newest technology available, in children’s hospitals and research centers throughout the country. 56 As a general U.S. population group, children are among the most medically healthy, with very low morbidity and mortality due to acute illness, thanks to advances in immunization, nutrition, safety, and sanitation. However, there is a great deal of focus in healthcare reform on the need for “health care for all children”.
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