The bottom line up front (BLUF): “Following the passage of the Affordable Care Act (ACA), much of the national discussion was focused on expansion of coverage and value in health care, but new concerns about rationing of care are emerging.” And who do you think this is going to affect? That’s right, the have not’s. In a recent blog, I wrote about a two tier healthcare system developing with one for the haves(who have resources etc) and the have not’s (who lack such resources). So now another ethical problem emerging with the rationing of care. It’s likely not the private healthcare plans, nor the Cadillac plans that will ration, but those on the government plans of Medicare and Medicaid. I would hate to think that it would affect both Veteran’s and Military Retiree plans, but those are government run, so nothing is off the table. Bauchner (2019) writes: “The cost of health care continues to increase, now approaching 18%of the US gross domestic product. Health care expenditures consume approximately 30% of many state budgets.”Then projected rates of increase exceed the rates of inflation. Where’s the money going to come from? You can only tax people so much. Cuts. That’s right, cut’s will be needed. But what and who’s plans will be cut leading to a cut in care? You guessed it, again not the private and Cadillac plans. The have not’s lose again.
For the United States to prosper in the 21st century, controlling health care costs is critical—indeed, it is the single most important challenge facing health care. Greater rationing of care is inevitable if health care costs continue to increase. Controlling health care costs is the only way to ensure appropriate investment in other areas, such as education, the environment, and infrastructure, and to provide a more equitable, just, and fair distribution of the remarkable health care advances that have been achieved with even more on the horizon.
I surmise too that conditions such as obesity, hypertension, diabetes, addiction etc, which are modifiable with changes in lifestyle, will be conditions that care to will be cut also. What’s to stop the insurance plans from discriminating against these conditions on the belief that individual’s own choices lead to the condition, so they should pay for it themselves. After all, the cuts need to come from somewhere right? While some risk factors in these conditions are not modifiable and anyone one can be subject to developing them, often it’s the most vulnerable in our society with more risk factors more often facing the greatest healthcare need (the have not’s). Isn’t the Hippocratic Oath still relevant today? Having recently just graduated medical school and taking the Oath, maybe I’m jaded into believing that it is relevant in the equity of care provided regardless of societal class or socioeconomic status. However in 2019, it seems pretty easy to discriminate against the poor, the obese, the addicted, the afflicted etc. The article closes with:
It has been said many times that in the richest country in the world, inwhich many of the greatest scientific and medical advances are developed, it is a blight on the US soul that each of its residents does not fully benefit from available health care.