If Public Healthcare Is Too Expensive to Cover All Eventualities, It Must Be Rationed - Essay Example

If public healthcare is too expensive to cover all eventualities, it must be rationed. Discuss. Public healthcare has become increasingly expensiveto support and maintain. The health needs of the growing population coupled with the increasing cost of medical research and healthcare have become too much for the government to handle. Many practitioners and government officials have proposed health care rationing in order to help minimize the cost of healthcare services. However, other government officials and practitioners have taken issue with healthcare rationing, arguing that it is an unethical and unfair solution to our healthcare problems. This paper shall explore and present both sides of the issue. It shall discuss the benefits and demerits of each side of the argument and after considering the points of discussion, this student shall make an informed decision about the issue. Health care rationing has various benefits and advantages for the health care system in general. First and foremost, health care rationing will help patients who cannot afford medical care and who do not have medical insurance. It will help improve their medical options and give them access to better health care. “For patients without health insurance who must pay the entire cost of the medicine, their doctors…opt for the cheaper of two types of medication…leaving them more money for other expenses” (Dingeman, 2004). In worst case scenarios, patients sometimes opt not to take any medication or undertake any medical procedures at all. Advocates of rationing argue that rationing will give patients a chance to avail of the best possible medical care that their financial circumstances would not normally allow. Rationing is the preferred solution to the increased cost in healthcare spending because it encourages implementers of the system to remedy the situation. “Even if the money is there, the UK has a long-standing ideological hang-up about tapping it from all available sources, private as well as public” (Redwood, 2000, p. 24). Because of this, many practitioners and government officials believe that rationing is inevitable because it is the solution that will work when times will really get rough. Two years ago, a report revealed that many doctors have come to agree that the time for health care rationing has come “because the NHS cannot cope with spiralling demand from patients” (Campbell, 2007). The British Medical Association (BMA) claimed that treatments like plastic surgery, fertility sessions, and other minor ailments will be among the first procedures that will be cut from the list of medical procedures in the healthcare rationing system. The BMA emphasized that the increasing cost of health care is now urging the NHS to choose and to be more realistic about what it can do and pay for. In this sense, rationing will help bring a sharper focus to medical procedures that the patients actually need. Rationing implies the prioritization of health care. It will help the National Health Services (NHS) focus on what the people really need, not on what they want. The National Health Service (NHS) is not an unlimited source of funds. It also cannot afford to pay for every medical procedure and service that citizens will need and demand. Many chemotherapy drugs are too expensive for the NHS to cover; hence the latter usually limits coverage on these drugs for patients in the more advanced stages of cancer. Medical practitioners contend that health care rationing will help divert needed treatment for those procedures that will serve patients better. It will help draw out funding from breast enhancements or reductions to more vital medical procedures like chemotherapy and other more expensive (but very important) treatments that the NHS often has trouble paying for. Advocates of healthcare rationing emphasize that before this system can be set into place, certain standards must be put into place in order to ensure that the process is fair and not discriminatory to anyone. They further stress that there should be control mechanisms in order for this system to work. “With control of rationing, we will have a second chance as health care professionals to modify the system for the patient’s benefit” (Friedenburg, 2000, p.628). Rationing should be based on various standards like age, stage in the disease process, quality of life, and productivity. These standards can help serve as rational bases for entitlement to health care. These are factors that many managed care systems already use in their decision-making process. They help add a modicum of fairness for individuals who cannot have access to health care services because of their financial difficulties. They further contend that the individuals with unlimited financial resources can always pay for to get what they need. And health care rationing “provides an even playing field for all” (Friedenburg, 2000, p.628). Age-based rationing has been advocated by those favouring rationing because it will help divert thousands of dollars spent for the elderly population to the younger population. In the United States alone, it is “estimated that the government now spends more than $9000 per elderly person and less than $900 per child each year” (Andre & Velasquez, 2008). Advocates believe this to be an unfair distribution of funds, especially considering the fact that these elderly patients are no longer contributing anything to the economy. These elderly patients are sometimes also past their age expectancy and therefore should give the younger population a chance to enjoy long and healthy lives as they have. A survey of about 2000 British adults revealed that the prioritization of patients entitled to health care is needed. The study revealed that most respondents agree that first in rank in health care access should be children with life threatening illnesses; second are people who need special care and who are dying; of the lowest priority are patients who need fertility treatments and the lowest ranking patients are those who are 75 years old and over with life threatening illnesses (Bowling, 1996, p. 670). This survey revealed in not so many words that among patients with various health care needs, there are those who are deemed to greater entitlement than others. This is the principle behind rationing – that other people need and deserve it more than others. In the United States, rationing is slowly becoming a common occurrence in many of their hospitals. Many hospital administrators contend that the health needs of people are infinite, but the hospital resources are not infinite. Many of these hospitals offer emergency care to uninsured patients, however, their follow-up and succeeding medical care is no longer free unless they pay for their previous medical bills. Patients take issue with this practice, and find it to be very degrading and humiliating. In the past, the policy of most hospitals has been not to turn anyone away; however “in recent years, officials have decided that policy is simply no longer possible and instead have turned to a system of medical rationing” (Bazell, 2004). Hospital officials have now set-up policies on the regulation of services for uninsured patients. They believe that rationing is very much necessary in the present world where the hospital resources can no longer cover every patient. Healthcare rationing is not favoured by many practitioners because of its various adverse consequences to the patients. One argument against healthcare rationing is that it will open doors for discrimination and inequalities in the access to health care services. “Rationing…involves an unavoidable tension between what is owed to each person in a society and what is owed to the common good of all the members of society” (Bondeson, 2002, p. 1). Some practitioners advocate an age-based rationing system, where the elderly are the most likely persons to not be rationed with medical care. Because of prioritization, they will most likely be least prioritized in accessing medical care. Various medical practitioners argue that “[r]egulating access to medical care based on age runs against the egalitarian nature of society and the principle that all human life is sacred and equally deserving of protection” (Kilner, 1990, as quoted by Smith, 2002). They further argue that the value of life of the elderly citizens must not be downgraded because of their age. Elderly individuals have made substantial contributions to the world during their lifetime, and these contributions are nowhere near what the younger population has contributed so far to the world. “It must not be forgotten that the sacrifices of the elderly created many of the resources, opportunities and services that younger generations now enjoy” (Smith, 2002). Rationing of health care is also not favoured by other practitioners because it will unfairly discriminate against the elderly and against the critically ill. They argue that rationing will be unfairly decided by economists and bureaucrats who will naturally not find it cost-effective to treat the elderly and the terminally ill. They further contend that medical care will now become an industry “where concern about profits rather than quality of health care [will] become the bottom line” (Williamson, 2007). They worry that discriminating against the elderly and the terminally ill patients is just a first step towards discrimination against other patients and other treatments. They put forth that the power to decide who gets to be treated and who does not will open doors to all sorts of reasons for deciding against coverage. Some doctors or health officials may decide that based on a person’s worth to society, he or she may or may not be ‘worth’ treating. A person’s questionable moral, social, and lifestyle may be deemed by doctors and health professionals as reasons for not treating the patient. “While there may be good arguments for treatment refusal in specific cases does this justify granting the power to doctors and health authorities to assess the worth of patients?” (Williamson, 2007). There are moral and ethical questions that affect the issue of rationing, and these moral questions make many practitioners very uncomfortable about the concept of withholding treatment from patients because of financial reasons. They feel that they did not sign up for it, and they feel that they are going against their principles and their oath as medical professionals when they refuse treatment to ‘undeserving’ patients. Based on the discussion above, I believe that it is high time that health care should be rationed. Our resources are not infinite. We cannot continue to support and provide every one with every medical procedure they need. The arguments against rationing are mostly about the danger of unfair prioritization or unfair distribution of health rations. These dangers are credited to poor planning of the rationing system; and these dangers may easily be prevented by health administrators and practitioners. If the system of rationing is prescribed with clear rules and clear priorities, the dangers of unequal distribution and unfair prioritization will be eliminated. It is time to prioritize those who really need medical care, and de-prioritize those who do not really need it. These are difficult decisions to make for medical practitioners and health officials; however, it is time to be practical and realistic in our healthcare services. The time will come when we would not anymore have a choice but to ration health care. It is better to do it now, when we can properly set up the policies and standards for prioritization and rationing. It is not prudent for us to wait until the decision is taken out of our hands. To do so would be more dangerous because the system will then be inadequately set-up and unplanned; the system will also be haphazard and safeguards against discrimination will not have time to be set in place. This is when the dangers that we are trying to avoid will seep in. The more political, profit-minded, and influential voices will be the ones to dominate the chaos and unwittingly put into place policies that will not serve the ultimate interests of healthcare rationing. Rationing in healthcare is inevitable. It is a necessary evil we have to face in order to give a chance for the younger population and those who can ill afford health care to have access to health care services. Works Cited Andre, C. & Velasquez, M. 2008, Aged-Based Health Care Rationing, Santa Clara University, viewed 17 January 2009 from http://www.scu.edu/ethics/publications/iie/v3n3/age.html Bazell, R. 24 February 2004, Rationing health care among the uninsured, MSNBC, viewed 17 January 2009 from http://www.msnbc.msn.com/id/4363789/ Blais, F. 2004, An Egalitarian Argument in Favour of Free Access to Healthcare Rationing, Ethics and Economics, viewed 17 January 2009 from http://ethiqueeconomique.neuf.fr/BLAIS.pdf. Bondeson, W. 2002, The Ethics of Managed Care, Netherlands: Kluwer Academic Publishers. Bowling, A, 16 March 1996, Healthcare Rationing: The Public’s Debate, British Medical Journal 312: 670-674 Campbell, D, 6 May 2007, Doctors Admit: NHS Treatments Must Be Rationed, The Guardian, viewed 17 January 2009 from http://www.guardian.co.uk/uk/2007/may/06/health.politics Dingeman, R, 13 February 2004, Doctors See Benefits in Healthcare Rationing, Honolulu Advertiser, viewed 17 January 2009 from http://the.honoluluadvertiser.com/article/2004/Feb/13/ln/ln26a.html Dranove, D. 2003, Whats Your Life Worth?: Health Care Rationing-- who Lives? who Dies? who Decides? New Jersey: FT Press. Friedenburg, R. 2000, Health Care Rationing: Every Physician’s Dilemma, Radiology Journals, viewed 17 January 2009 from http://radiology.rsnajnls.org/cgi/content/full/217/3/626 Purves, L. 11 August 2008, NHS Rationing is a Reality We Should Deal With, The Times, viewed 17 January 2009 from http://www.timesonline.co.uk/tol/comment/columnists/libby_purves/article4498748.ece Rationing care from limited funds. (n.d) BBC News, viewed 17 January 2009 from http://news.bbc.co.uk/1/hi/health/251988.stm Redwood, H. November 2000, Why Ration Health Care, CIVITAS, viewed 17 January 2009 from http://www.civitas.org.uk/pdf/cs08.pdf. Smith, G. 2002, Allocating Health Care Resources to the Elderly, Australasian Legal Information Institute, viewed 17 January 2009 from http://www.austlii.edu.au/au/journals/ElderLRev/2002/9.html Stanhope, M. 2004, Community & Public Health Nursing, Missouri: Mosby Williamson, G. 21 July 2007, Rationing of Medical Resources or Medical Discrimination Against the Sick: Medical attitudes to the chronically ill, Holistic Health Topics, viewed 17 January 2009 from http://www.holistichealthtopics.com/HMG/rationing.html Read More