healthcare financing article.pdf

If there is a national plan there will be strong

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If there is a national plan, there will be strong legal precedent to require “equality under the law”. For example, physicians at private infertility centers are currently allowed in most States to refuse some patients based on conscience—such as singles and unmarried couples, including homosexuals. They would not have this option under a government- funded plan. XIII. Rights of Conscience Rights of conscience are already under scrutiny in many health and medical-related arenas. Many persons and groups believe that they have a right to receive any possible
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© 2008 Leah M. Willson, MD, MA - 19 - medical care from any physician, and that religious beliefs [of physicians and others] are “interfering with personal rights” in the U.S. healthcare system. 72 Proponents of CDHP plans explicitly note that patients should be allowed to choose health plans that exclude services that the enrollee feels are morally unacceptable to subsidize. 73 Also, since health professionals would be more independent, they in turn would be more likely to maintain freedom of conscience to refuse treatment requests that they find ethically objectionable. However, individual cases might still need to be fought through the legal system. In a national healthcare plan, with all monies for medical care coming from a single source, that source would have the power to set rules for health professionals, with the ultimate control being to deny them the ability to participate in the national plan if they refuse to abide by its regulations (e.g. such as provision of “comprehensive counseling for emergency contraception”, referrals for abortion, IVF services for single women, non-discriminatory hiring of office staff, etc.). XIV. Conclusion The healthcare financing system will determine who makes the ethical decisions in medicine and will heavily influence what decisions are made. If reform tips to a market-driven approach, issues will center on a consumer-oriented system: how and if to regulate ethically problematic services or research in the free market; how to maintain ethical doctor/patient relationships instead of a seller/buyer mentality; how to make just accommodations for those with fewer financial resources; and how to adequately protect the many who cannot make their own decisions due to age or infirmity. If reform tips towards increased governmental intervention, ethical issues will center on political control: who will make rationing decisions and what ethical basis will they utilize; who will be able to challenge those decisions; and who will protect patients who have little social or political resources. There could also be significant concerns for providers’ rights of conscience. Incentives will be different in each system, and therefore opportunities and temptations for unethical behavior will be different. There must always be heightened concern for the potential of devastating evil in a system with powerful, centralized control.
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