Dividing Up Health Care Resources

Dividing Up Health Care Resources Vaughn, Ch. 11

Is U.S. Health Care Bad? According to the Organization for Economic Cooperation and Development (OECD), the U.S. spends the most on health care per capita: • U.S. $6,102 • Luxembourg $5,352 • Canada $3,326 • U.K. $2,724 • Japan $2,358 Vaughn, p614

Is U.S. Health Care Bad? Nonetheless, the U.S. has a lower life expectancy than the average of 30 other democracies: • 77.8 years, compared to 78.6 years The infant mortality rate (deaths per 1000 live births) in the U.S. is: • 6.8 deaths, compared to 5.6 in those other democracies http://www.psychologytoday.com/files/u26/old%20couple-743330.jpg http://static.guim.co.uk/Guardian/society/gallery/2007/jul/11/childrensservices/GD3984330@Water-Babies---pics-s-1824.jpg

Is U.S. Health Care Bad? Because of lack of insurance, it is estimated that 18,000 people died prematurely in 2000 (due to not getting tested for diseases like ovarian and prostate cancers). Vaughn, p614 What, besides health care alone, might explain some of these numbers?

Defining Health and Disease Garrett’s definition of disease: Any deficit in the physical form or the physiological or psychological functioning of the individual in terms of • what society wants or expects from that individual, or • in terms of what the individual wants or expects for himself

Defining Health and Disease Health, then, is defined as a lack of any such deficit. Note that there is great opportunity for disagreement between what an individual considers “being diseased” and what society considers that state to be. With society’s interest in decreasing the cost of healthcare, we can expect tension to arise between individuals and society on this question, especially: • in nursing homes • for the homeless • parental concern for children

Goals of Healthcare In defining the goals of healthcare … is the main idea … • trying to live forever? • ¼ of all Medicare funds are spent in the last year of life, and more than ½ of that spent in the last month • trying to alleviate suffering? • trying to eliminate the pain, or • trying to eliminate the cause of the pain

Goals of Healthcare If healthcare is the effort to protect and preserve the dignity of patients, then some efforts in prolonging life and alleviating suffering may not always be good • trying to optimize happiness? • what does it cost to relieve all anxiety of patients? • how much money should be spent, how many resources consumed, in trying to ensure full mental health and happiness to only some individuals?

Goals of Healthcare Ultimately, the individual’s desire for a certain level of functioning cannot control the definition of adequate care. With the expense and scarcity of care, society will have to have a say what is reasonable accommodation of patient desire. This leads us to consideration of the components that form the basis of that accommodation… http://www.ornithology.com/images/BabyBirds_Miller_061705.jpg

Three Theories of Distributive Justice Libertarian – social goods are distributed by the workings of the free market, not government Utilitarian – social goods are distributed based on maximization of the good of society (the greatest good for the greatest number) Egalitarian – social goods are distributed based on maximization of equality (the good of each) Vaughn, p616-617

Libertarian Distribution Joe the Plumber! Taking from individuals and redistributing to needy is theft People pooling their money in a company for easing the costs of health care is permissible Government taking money from the rich to dispense to the poor is not Classic Problem: • many will go without health care

Utilitarian Distribution Our current system A mix of insurance and public funding for easing the costs of health care Covering the most while maintaining high quality of care Taking from rich to give to poor is okay Classic Problem: • many will go without health care • freeloaders

Egalitarian Distribution Ideal of socialism, communism, progressivism Public funding (government) eases the cost of health care by managing distribution based on taxes Covers everyone equally Classic Problem: • freeloaders

Dividing Up Health Care Resources