Physicians and Ethics in Health Care Reform Debate

By Fleischman, Alan R. | The Hastings Center Report, May-June 1994 | Go to article overview

Physicians and Ethics in Health Care Reform Debate


Fleischman, Alan R., The Hastings Center Report


The desire for health care reform in the United States has been motivated by the need to provide universal health insurance coverage to all citizens while at the same time controlling the spiralling costs of the health care industry. The debate has focused primarily on the politics and economics of various proposals while discussion of the values inherent in the choices has been lacking. Americans have finally realized and accepted that health is a primary good and the need for health care services is unevenly distributed throughout the population. It is obvious to everyone that the various options for providing and paying for these needed services are value laden and controversial.

As major players in the provision of health care and as respected professionals in the community, physicians ought to be consulted and should participate in setting the priorities and determining the solutions. Physicians, however, do not speak with a single voice. Their views about the appropriate values to be fostered and the correct course for health care reform vary greatly based on sex, ethnicity, race, age, medical specialty, locale, type of practice, and income level. In addition, unfortunately, physicians have focused primarily on the self-serving issues of the impact of reform on their own autonomy and income rather than advocating for the interests of their patients. Physicians ought to be aware that the provision of universal insurance and access to care is not sufficient to ensure that patients will in fact receive care. Thus, any system of health care reform must take into account the development of culturally appropriate, community-based programs to meet the needs of the population as defined by the patients themselves.

Health care professionals and politicians alike have placed a great deal of emphasis in recent years on the technological advances in medicine. These modern miracles of medical science involve expensive, hospital-based interventions to rescue those who are critically ill and provide life-prolonging care. Such treatments are highly visible, with obvious benefit to those in need. However, preventive and educational initiatives that are community-based, less visible, and less easily proven to be effective have not received their deserved prominence. Rescue has always been more exciting and sellable than prevention, but focusing on rescue ignores the social and environmental factors that have a major impact on the health of a population. Here again we will need to prioritize the values chosen for reform of the health care system to ensure that preventive interventions are given sufficient emphasis.

Assuring access to preventive services need not detract from the provision of appropriate high-technology services to those in need. Preventive interventions have the potential to save significant dollars by decreasing the number of patients requiring high-tech care. …

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