Chapter Eleven: A New Era Of Healthcare And Medical Ethics

Chapter Elevena New Era Of Health Care The Ethics Of Health Care Refo

Chapter Eleven a New Era of Health Care: The Ethics of Health Care Reform Health Care Reform in the U.S. HR 3590 and HR 4872 signed into law in 2010 (PPACA) by President Obama. PPACA represents a century of efforts to provide access to high quality, affordable health care. Access, cost, and quality are the triumvirate mantra of health care reform.

There are three ways to provide universal coverage for populations: The Bismarck Model, The Beveridge or National Health Service Model, and The National Health Insurance Model.

Otto von Bismarck introduced universal healthcare insurance in Germany in 1883. Other European countries provided universal health care for a variety of reasons and variations. European plans evolved from wage protection motives to providing medical and hospital coverage.

In the United States, efforts to establish universal health care have a long history. Theodore Roosevelt was the first to support universal health care insurance, but his ideas faced opposition from labor, medical societies, insurance companies, and business interests. Universal coverage was initially excluded from the Social Security Act of 1935. Several attempts were made over the years, including President Truman's campaign in 1948 for national health insurance, which garnered 71% public support but failed to pass Congress.

In the 1960s, efforts shifted toward addressing the health care needs of specific populations, leading to the creation of Medicare and Medicaid in 1965. Later, proposals for mandatory employment-based insurance surfaced but did not succeed. The Clinton administration’s attempt at comprehensive health reform also failed in Congress. The persistent issues of rising costs, variable quality, and inadequate access spurred the development of the Affordable Care Act (PPACA).

Key Provisions of PPACA

Among its main features, PPACA mandated that all Americans and legal immigrants obtain health insurance or face penalties, with exemptions available. The law required employers to provide insurance, extended Medicaid eligibility, and improved Medicare benefits. Insurance reforms prohibited lifetime limits and mandated preventive care without copays. States received support to establish insurance exchanges, and measures to improve quality, research, and coordination of care were implemented.

The law also focused on increasing the healthcare workforce, particularly in underserved areas, through incentives. Funding for PPACA came from new taxes, savings, and penalties. Its phased implementation began in 2010, with full enforcement anticipated by 2020.

Impact and Challenges of PPACA

PPACA expanded healthcare access for approximately 50% of the uninsured, reducing barriers to coverage and incentivizing quality improvements. However, around 20 million Americans remained uninsured, including undocumented immigrants, those exempt from penalties, and those opting out. The law improved Medicare quality but faced challenges as some insurance companies exited marketplaces due to rising costs and losses, limiting consumer choice.

While initial data indicated a decrease in healthcare spending between 2010 and 2013, costs increased again in subsequent years, underscoring ongoing challenges in cost containment.

Ethical Foundations of Healthcare Reform

Support for healthcare as a fundamental right is widespread, backed by international organizations such as the WHO, United Nations, and regional entities, along with religious traditions endorsing health equity. The concept of health care as a social good underpins the social contract, emphasizing societal benefit through universal access.

From a philosophical perspective, John Rawls' theory of justice advocates for social programs aimed at aiding the worse-off, aligning with ethical duties to improve health equity. Conversely, libertarian views emphasize individual choice and market-based solutions, allowing states to refuse Medicaid expansion or individuals to opt-out by paying penalties, reflecting a focus on personal liberty and market justice.

Ongoing Ethical and Political Debates

The ongoing conflicts between principles supporting social justice and those favoring market autonomy highlight the complexity of health policy reform. These ethical tensions influence legislative decisions and implementation strategies, causing health reform to evolve through continual adjustments.

Future of Healthcare Reform

Although PPACA has made significant strides, ongoing issues with access, affordability, and quality suggest that health care reform remains a work in progress. Repeal, replacement, or repair of PPACA could all be options, but regardless, ethical considerations will continue to shape health policy.

Conclusion

Reforming the healthcare system to effectively address core issues of access, cost, and quality remains an ongoing challenge. The ethical foundations of health care highlight the importance of equitable resource distribution and societal responsibility. As health care continues to evolve, ethical principles will persist as guiding ideals for policy decisions, ensuring that reforms serve both individual rights and the collective good.

References

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