Is health care a right or a privilege? The debate has been raging since health
care moved from the bartering system into a monetarily driven machine. In
the bartering system of old, individuals could mostly afford the health care
provisions. As mentioned in previous modules, when the Flexner Report
was released, the impact on health care costs was astronomical. As such,
the working class turned to their employers for answers. Fueled by desire to
retain workers and inhibited by the federal government and their wage
controls, the American business sector created and perfected the medical
insurance benefit.
The end of World War II saw the American enterprise soar to new heights.
Millions of employees received medical coverage through their employers.
As long as the economy was in full force, employers were providing
coverage to their employees. Unfortunately, there have been many
downturns. When money is scarce, employers look at controlling costs. The
largest expenditure is that of payroll and the associated employee benefits.
Cutting positions is one option and reducing benefits is another. At one
point, employers were providing coverage to nearly 75% of all Americans.
Today, that number is a little over half. As mentioned before, an estimated
48 million Americans currently lack insurance. Over half of them once had
insurance through their employers.
A recent study of emergency departments revealed that one in three
patients who sought care were uninsured. In previous modules, we learned
of the impact of EMTALA, which guarantees access to medical care for
those with emergent needs. As a result of this law passing, 15% of
emergency rooms have closed. Unfortunately, this has had a negative effect
on wait times, which has proven detrimental to the patients they have been
created to serve.
Current research suggests that those in the lower income groups use more
medical services than those in higher economic brackets. These individuals
are also in lower employment groups that have historically limited access to
insurance benefits. However, the central question remains: Does everyone
deserve access to health care services? Is it a right or privilege? Does
income truly limit one’s capacity for access to health services? Does it stand
to reason that if those in the lower income groups cannot pay for
emergency services, those in the higher income groups ultimately pay the
price through EMTALA and other legislation? Does everyone pay the price?
The last area for discussion within this module’s lecture is the idea of social
responsibility. Snyder, Dharamsi, and Crooks (2011) define social
responsibility as “the claim that an individual or group of individuals has a
moral responsibility to promote the welfare of the communities to which
they belong or with which they interact.” In the last 10 years, we have seen
a sharp rise in social responsibility in the corporate sphere. Businesses have
stepped up their efforts to assist in charities, sponsorships, etc. The field of
health care has been heavily involved in social responsibility for decades,
just not at the same level of media coverage. Doctors Without Borders is a
volunteer group that was formed in 1971 to help physicians meet the first
code of ethics issued by the American Medical Association in 1847. In
summary, the code reads that the physician should be “ever vigilant for the
welfare of the community.”
It is without question that medical training within the United States is
among the best in the world. The rising number of medical tourists solidifies
this claim. As a side note, medical tourists are those individuals wealthy
enough to travel to foreign countries seeking medical care and recovery
time. While there are definitely individuals in the United States who travel
abroad, there are large numbers of individuals who come to America to
receive medical services. In most universal health systems across the globe,
while there are services available, very long waitlists are the impetus to seek
care elsewhere.
In closing, we must be clear that President Obama’s health reform is not
universal coverage. There will still be millions of individuals without medical
coverage. What do we do with them? Will our cycle repeat itself? Only time
will tell.
References
Kingston, L., Cohen, E., & Morley, C. (2010). Debate: Limitations on
universality: The “right to health” and the necessity of legal nationality. BMC
International Health and Human Rights, 10 (11).
Rashford, M. (2007). A universal healthcare system: Is it right for the United
States? Nursing Forum, Vol. 42, (1), 3-11.
Snyder, J., Dharamsi, S., & Crooks, V. (2011). Fly-by medical care:
Conceptualizing the global and local social responsibilities of medical
tourists and physician voluntourists. BMC International Health and Human
Rights, 7 (6).
