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05/05/2017

Rethinking The Obligation To Provide Universal Healthcare Coverage: The need for moral imagination

Healthcare is indeed complicated, in case anyone with a
speck of knowledge about it ever thought otherwise. There are many ways to
organize a healthcare system, as is evident from all the various ways advanced
industrial societies around the globe provide healthcare to their citizens.
Questions about the extent to which the private insurance system versus the
government is involved brings us back to protracted debates about the legitimate
role of government and whether or not citizens have a basic right to healthcare,
or should healthcare be assumed to be one more market service which individuals
may elect to use or not? Sadly, in the United States these questions often are
framed in abstract terms appealing to general ideological values and goals that
shape and limit the range of viable policy options. What I want to emphasize in
my blog today is the need for moral imagination—what’s it like to be in the
shoes of those who are suffering, and often without health insurance, and
without a job?  This is a first step we
all must take before we can weigh our moral obligations to provide healthcare
to everyone.

Before the passage of the Affordable Care Act (ACA) there
were over 45 million uninsured Americans who did not have access to a primary
care physician. That number has been reduced by about 18 million, but now we at
risk of seeing this number rise again with the possibility of a repeal of the
ACA and passage of a GOP led alternative. The Congressional Budget Office
(CBO), a politically independent agency, estimated that if the American
Health Care Act had past would eventually lead to 24 million people loosing
their health care insurance by 2026. That means the total number of uninsured
citizens will be back close to the 50 million mark. This number is not just a
statistic in the abstract—it’s a compelling measure of human suffering. Imagine
you, the reader of this blog, become one of those unfortunate souls included in
that number, which you and I could? What will that feel like?

Most of us, who have the good fortune of spending our days working in academic
medical centers and many other professional settings, have access to not just
good healthcare, but to excellent, state of the art, healthcare. Just think
about it—have you or members of your family ever been sick or injured and is
urgent need of seeing a competent physician? How long did it take you to get
your appointment and receive the medical attention you needed? Most of us who
have been in situations of need are amazingly fortunate to get what we need
reasonably soon, so it is easy for people like us to take healthcare for
granted.  Imagine having a troubling
medical condition—news from a test, or a worrisome new symptom, or what may be
worse, your family, being is serious need and not having health insurance. How
would you feel? What would you do? What if you applied for insurance coverage
and your premiums were exorbitant, beyond what you could afford, because of a
preexisting condition?

Jimmy Kimmel did a remarkably good deed on his show
recently by describing the scare he had with his newborn son who required
urgent surgery to repair a heart condition. He was among the lucky—to have
health insurance but also to be rich. His family’s needs are not at risk of not
being met. But he showed moral imagination—empathy for others—when he prompted
us to imagine what it would be like to have a baby who needed life saving
medical interventions and not have access to medical care. When we ponder
healthcare at this level, aren’t we all in agreement, as he said:

“We were brought up to believe that we live in the greatest
country in the world, but until a few years ago, millions and millions of us
had no access to health insurance at all,” Kimmel said. “If your baby is going
to die, and it doesn’t have to, it shouldn’t matter how much money you make. I
think that’s something now, whether you’re a Republican or Democrat, or
something else, we all agree on that, right?”

 

 There are many Americans today who have gone without
healthcare coverage for years after losing a job that never came back, which
mean getting sick or injured puts them a great risk of personal bankruptcy, the
number one reason individuals
file for bankruptcy. Can you imagine what’s like to be out of job, no money,
and have serious healthcare needs for yourself or your family? Sadly too many
Americans know first hand exactly what that experience is like. And it is all
the sadder because the United States of America is the richest nation on earth
and the only advanced nation without universal healthcare. How can a nation be
so rich and not provide basic healthcare to all of its citizens?

One barrier seems to be the necessary means by which
universal healthcare would be made possible: government involvement. Our lack
of moral imagination also limits our options. For decades the so-called conservative
mantra has been the demonization of government programs, which perpetuates the
myth that government is totally inept to effectuate any important social goal.
But there is no other way to provide for the healthcare needs of our population
than through government involvement. Individual action, local communities,
religious institutions and organizations, NGO’s, etc., etc., alone will never
solve this problem. Only the collective action of “we the people”, as an
expression of our social and moral goals and values, can accomplish such a
mammoth task. So how can we the people start thinking differently about this
problem?

We need to be thinking with fresh interest and robust moral
imagination about how we are going to fulfill our obligation provide healthcare
to all Americans. This starts with first imagining and allowing yourself to
feel what it’s like to be sick and without healthcare, and experience your or
your family member’s illness getting worse and worse, with the only option at
some points to go to a hospital emergency department. If we would not want this
for ourselves or for those we care about, we shouldn’t want it for anyone else.


The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our 
website.  

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