Biomedical Ethics: Assignment Week 6

Chapter 22

A New Era of Health Care: The Ethics of Health Care Reform

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Health Care Reform in the U.S.

• HR 3590 and HR 4872 signed into law in 2010 by President Obama.

• These acts represent 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.

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Health Care Reform in the U.S.

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

Model. – The National Health Insurance Model.

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A Bit of History

• Otto von Bismarck introduced universal healthcare insurance in Germany in 1883.

• Other European countries provided universal health care for a variety of reasons.

• European plans evolved from wage protection motives to providing medical and hospital coverage.

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A Bit of History for the U.S.

• Theodore Roosevelt was the first to support universal health care insurance.

• His ideas were not supported by labor, medical societies, the insurance business, and business interests.

• Universal coverage was excluded from the Social Security Act of 1935.

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A Bit of History for the U.S.

• In 1939-1943, attempts were made to create national health insurance, but they were not successful.

• In 1948, President Truman campaigned strongly for national health insurance.

• 71% of Americans were in favor of universal coverage, but it never passed in Congress.

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A Bit of History for the U.S.

• In 1960, there was a new effort to address the healthcare coverage of a new group: the elderly.

• President Johnson’s political skills contributed to the passage of Medicare in 1965.

• Medicaid, designed to provide care for needy children, was also passed in 1965.

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A Bit of History for the U.S.

• In 1971, President Nixon proposed a plan for compulsory employment-based health insurance that died a quick death.

• The Clinton administration attempted health care reform with the Clinton National Health Security Plan.

• This plan had endorsements, but died in committee.

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What Contributed to PPACA?

• The percentage of the population without insurance reached 16%

• Shortages of professionals lead to compromised access to care.

• Costs for health care continued to rise and quality lapses continued.

• Health care reform sought to: increase access, improve quality and control costs.

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Ethics and Health Care Reform

• Numerous groups conclude that there is fundamental right to health care. Including:

• WHO, The United Nations, The Organization of American States, and The U.S. Declaration of Independence.

• Religious traditions also support it.

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Key Areas of PPACA

• All Americans and legal immigrants must have health insurance.

• Businesses must provide health insurance. • Medicaid eligibility is extended. • Medicare benefits are improved.

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Key Areas of PPACA

• Insurance reform is extensive. • No lifetime limits are allowed. • Preventive care must be provided with no

copays. • Minimum loss ratios are required. • States can receive assistance to set up

insurance exchanges.

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Key Areas of PPACA

• The Act supports quality efforts. • New research is supported. • Coordination and integration of services is

required. • Incentives are based on quality efforts.

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Key Areas of PPACA

• The Act is concerned with adequate workforce an coverage for underserved areas.

• Incentives are provided to increase the balance of health care professionals.

• The Act is funded by new taxes, savings, and penalties.

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PPACA Is Phased In

• The provisions of the Act will be phased in through stages beginning in 2010.

• Note the changes by year given in the Chapter. • The Act will not be fully implemented until

2020.

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Justice and PPACA

• A just system would provide access to high quality care for those who need it.

• How does PPACA increase access, improve quality, and control costs?

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Justice and PPACA

• Access is increased because more people will be insured.

• Supply and distribution of personnel to meet the needs of the newly insured is addressed.

• Insurance reform and subsidies addresses cost.

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Justice and PPACA

• However, PPACA does fall short in some areas. • There will still be 18-20 million uninsured

Americans. • The effectiveness of workforce incentives and

quality programs remains to be seen.

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Justice and PPACA

• However, PPACA does fall short in some areas. • PPACA is predicted to slow the costs of health

care. • However, costs are predicted to continue to

rise faster than the GDP and inflation.

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Is Health Care Reformed?

• Given the need for addressing the three areas of access, costs, and quality, PPACA will continue to be a work in progress.

• The healthcare system will continue to be refined and reformed in the years to come.

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In Summary…

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