New polls suggest that Americans’ support for health care reform is wavering. Attacks by opponents of reform appear to be succeeding in increasing fears that health care reform is bad for those of us who already have insurance—that is to say, bad for most of us. The critics claim that government will get between ourselves and our doctors, we will get less care and have fewer choices.
That none of this is true seems almost beside the point. Americans are getting nervous and that is not good news for health care reform. Supporters of reform are now working overtime to reassure us that health care reform will not make us worse off, that it will instead improve the quality of the care we get, and that if we like what we have, we can keep it. Health care reform will not change, in any way that matters to us, the self-interested world we each inhabit.
At the risk of sounding like a Pollyanna, we want to try a different tack. Each of us should support health care reform because it is the right thing to do.
Medicare’s controversial decision in 2009 not to cover virtual colonoscopy underscores the tremendous challenges involved in interpreting medical research findings. Although they examined the same evidence, different review groups emphasized different risks and other scientific information. Such choices are judgments, not facts, and this is true of all such clinical policy decisions, no matter how “evidence-based.”
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Myth #1: Health care reform will mean giving up control of my own health care decisions.
Fact: The field of bioethics has long championed the rights of individual patients to make their own health care decisions in consultation with their physicians. If we thought the major proposals being considered posed a serious threat to these rights, we would be the first to speak out. But that is NOT the case. The right of individuals to make decisions about their health care is engrained in the ethics of American medical practice and that won’t change under any of the approaches to health care reform currently under discussion.
Myth #2: Health care reform will control health care costs by depriving patients of important, but costly, medical treatments.
Fact: This is also untrue. If anything, the provisions in current health care proposals will increase the likelihood that patients will get quality medical care and decrease the likelihood of medical errors that kill thousands of patients every year. There are unethical ways to control costs, including refusing to treat the uninsured or those who have insurance but cannot afford the exorbitant out of pocket costs of expensive treatments—that is the status quo. Health care reform offers a more coherent approach to delivery of health care that aims to control costs while maintaining the quality Americans have come to expect and deserve.
Myth #3: Health care reform will deny older Americans medical treatments at the end of life.
Fact: This may be the most pernicious myth of all. In proposed approaches to reform, there is a provision that supports the rights of individuals and their families to make decisions at the end of life by institutionalizing a process for patients and families to express their desires to their physicians and other health care professionals. This right is part of the culture of American medicine, defended since the beginnings of the field of bioethics, and supported by case law going back over 50 years. Some opponents of health care reform have twisted both the intent and effect of this provision, making unsupported claims about how it will push older Americans into hospice against their will, and even euthanasia. Nothing could be further from the truth.
Straightforward conversations about end of life are critical to quality health care, with decisions continuing to be made by individuals and their families in ways that are consistent with their values and in consultation with their physicians.
Here is the real bottom line: The current state of health care is unethical. It is neither just nor fair. There is no morally defensible reason why some Americans get excellent medical care at costs they can afford and other Americans lose their homes or go into bankruptcy attempting to secure treatment for a seriously ill loved one. The current proposals being debated in Congress all go a long way towards making health care in America more just. At the same time, there is nothing in the current proposals that threatens a patient’s right to choose, a critical feature of an ethically acceptable health care system.
We commend efforts to reform the health care delivery system with commitments to cover all Americans while protecting choice and maintaining the high quality care that our fellow citizens deserve. We stand ready to aid however we can in this vital effort.
This statement is issued by the ABPD Board of Directors on behalf of its members.
By Jay Hancock, Baltimore Sun, August 14, 2009
Democrats are against health care rationing if it's done by insurance companies. Republicans are against it if it's done by government.
What neither side will admit is that medical rationing is part of the future. We can't afford a system where everybody gets whatever care they want regardless of cost and effectiveness. The only question is whether we'll ration intelligently and fairly. Or not.
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