The Patient Protection and Affordable Care Act (PPACA) is commonly referred to as Obamacare. President Obama signed this federal statue into effect in March 2010. There are many provisions in this statue including the mandate requiring all US citizens to have health care coverage. On June 28, 2012 the Supreme Court Uphold the Individual Mandate. Chief Justice Roberts voted to up held the mandate the provision which requires citizens to buy health care insurance or pay a penalty. Robert’s decision created the majority ruling approving the mandate as a tax.

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Although the Supreme Court upholds the Individual Mandate for Health Care it does not answer the question if it’s ethical. The general consensus holds that societies today have a responsibility to ensure all members of the society have access to the medical care they need. ObamaCare provides a way for existing private resources and the individual participate in government transactions. This will increase the federal government regulation of private health care coverage. E. Haislmaier, March 2013.

The consensus among the stakeholders is there are four ethical obligations regarding access to health care. The Hasting Center Report in 2007 defined these four obligations as the following:

1. Every Member of Society Have Adequate Health Care Benefits

2. The Contents and Limits Must be Established Through Ethical Process

3. The Healthcare System Must Be Sustainable

4. Stakeholders in the Health Care system known their responsibilities and be accountable Michael Hartwig, 2011, “states that health care is an investment in the shared well -being and productivity of our communities which in turn, foster more opportunity and well-being for individuals.” He further points out the work of Wilkinson and Pickett show societies with poorer health care outcomes for the poor but for all in the society. Vicki Lachman, PhD ,2012 writes the United States is the only developed nation in the world without that does not guarantee health coverage. She goes on to suggest that health care coverage for all members of society allows members to be fully functioning making the society better for all.

Although the

Page 2 Ethics in Healthcare Essay

Libertarians advocate for the Free-Market since the individual has free will and personal responsibility for their actions. Thus health care is an option and should not be funded. The Libertarians argue why treatments they do not believe in be reimbursed. Maggie Maher, 2008 in her essay writes low-income people are more likely to be obese, smoke, drink and abuse drugs. She explains the reason for this is due to living healthy is expensive, the stress of being poor and having little control of their life leads many to self-medicate. This explains why the poor are sicker and die prematurely of treatable conditions. Libertarians who view this as low-income individuals should learn how to take care of themselves.

For this statue to be considered ethical in providing for all members to have access to adequate care efforts need to be made to ensure those currently underserved see measurably improved health care. Those with disadvantaged access now are self- employed individuals, low-wage earners, the homeless, those with pre-existing conditions, the disabled, mentally ill and individuals with poor English skills. Currently, those with the greatest needs have the most difficulty obtaining coverage. Mark Levine, 2007 The new health care opportunities will need to establish what services are to be covered and under what circumstances. Opponents will refer to this as rationing.

Whatever name it is called it is necessary due to limited resources but it can be done ethically,, 2006. The process of setting limits in an ethical manner will require acceptance of five expectations. The full transparency for establishing and administering health care benefits to those it will impact. All stakeholder and this includes patients should have an active and meaningful part of creating and overseeing the process for determine services and how they will be administered Once the services are agreed upon it will be important they are provided in an equal and consistent manner. These services should be agreed upon by evidenced outcomes and best practice models. These services will need to be defined as to when and under what circumstances and the resources needed to achieve the desired outcome.

Lastly, in order for these limits to be acceptable and ethical the services will need to be flexible, respond to the patient’s needs and attend to the most vulnerable and those with the most critical needs. In Hartwig’s Social Justice and Health Care 2011, he discusses two potential fears of the people of the United States. The first is if the government provides the universal coverage costs would explode. The other fear is health care will decline. He continues that there is no evidence in the health care systems in Canada, Germany UK or France that it is more expensive or the quality less.

In fact health care outcomes in these countries are better than in the USA. Under Obama Care the cost of health care needs to be addressed. Setting limits will assist in addressing this concern. It would be considered unethical to set the limits on individual spending. However setting limits on shared society resources is ethically necessary for sustainability. It is not sustainable or ethical to place the burden of costs on the future generation. Several factors will need to be addressed on how to share the resources available for health care. The rate for reimbursement, improvement in efficiency and care delivery and most importantly preventive care should all be considered in the sustainability of the health care system.

Joseph Stiglitz published an article in Vanity Fair, May 2011 that he explains that 1% of the USA population controls 40% of the wealth in the USA. He continues to suggest that there is a growing gap between the middle and poor class and it is no longer sustainable- environmentally, health wise, economically or politically. One area where costs need to be explored is in end –of- life options. Currently, 30 percent of all Medicare dollars are spent in the last year of life and half of that is spent during the last sixty days. This amounts to $70 billion a year on futile care that prolongs suffering (Brody, 2009). This topic was dropped from the ACA but was restated in the 2011 Medicare reimbursement for health care providers (, 2012b). The poor’s limited health care access is felt by all stakeholders in this country.

The high cost for health care premiums affect productivity and our global economic competitiveness. The stakeholders including patients, purchasers, business, regulators and health care providers and institutions need to familiarize themselves with their responsibilities and being held accountable for their actions. The new health care system will need to incorporate American values of justice and individual and social responsibility. The patient and health care provider need to use the resources most effienctly. The patient needs to take responsibility for their own health. This includes being encouraged to live a healthy lifestyle. Participate in preventive health examinations, attend appointments and participate in treatment as prescribed. If the patient doesn’t comply with responsibilities they can be held accountable for their actions.

For this to be ethical the patient can only be held accountable for what they have control over. It is also unethical to hold patients accountable for issues where they have little or no control over. It most protect the most vulnerable. Patients need to be educated that their failure to be proactive in their own health care not only compromises their health care but also could result in higher out of pocket expenses. General overall improved health may not be enough of an incentive for the patient to change their behavior it may take an associated fiscal benefit to motivate the patient M Rogers, 2010.

From a Professional Health Care provider it is expected they will provide realistic and meaningful measures which reflect the equity, efficiency and most important patient centered and clinical quality services. Individual professional providers should be accountable for only the clinical factors they can control. Ongoing assessment of quality outcomes should be part of a system-wide performance monitored program. Efforts should be made to reduce waste, fraud inequitable use and other misuse of health care resources. Working together the patient and the health care professional who provide care to the high risk and most vulnerable need to develop programs that are sensitive to the needs of the this particular group as to not reduce the patient’s health care coverage.

Shared responsibilities should be shared among the responsible parties. Thus the hospital and the doctor would be responsible for inpatient care. An ethical system would reward teamwork among the stakeholders and promote high quality care. Encouraging the patient and the health care providers to work together as partners in health it should develop a relationship of respect, health lifestyles, and participation in treatment plans, self-management and effective communication. Today the United States has a private health care and insurance system. The exemption is Medicare and Medicaid which is available to citizens who met the criteria. This system has its strengths and some flaws as well.

There are many citizens who do not health care insurance and the current system is not sustainable. The Libertarians are advocating for a Free Market Health Care system. This means it is free of the government licensing regulation and taxpayer funding. Proponents of this reform claim the free market health care will produce better quality care and the cost of care and insurance will decrease from competition. Currently, most Americans get their health care from their employers. They suggest instead of employer paid insurance individuals purchase insurance privately with pretax dollars. Liberal Egalitarians believe healthcare is a fundamental good and access to it allows us to become full members of society. Health care is a right and a single payer system is the solution.

America’s Medicare is a single payer system. In a single payer system has one payer. The government, individuals and companies would pay premiums in a form of a tax to an organization that then would pay the health care providers. Many countries have single payer systems already. In England, the doctors work directly for the government. Their system is known as National Health Service which manages the health care for all its citizens. Advocates for this system report the amount of paperwork is greatly reduced and the resources can be directly given to the patient. Some people are against this system since although treatment is available there are waiting lists and fewer choices in the doctors or specialists available. The Utilitarian view would be for the United States institute a socialized healthcare system.

Society then could provide the greatest happiness to the greatest number of people. John Stuart Mill believed that health allows a person to be a functional member of society. This would allow more people to be healthy and able to work thus supporting one another. Utilitarianisms believe the wellness of the person is most important. No one is happy when they are sick or injured. Socialized health care system is similar to what Obama Care will be as a single-payer system. It is not a question is Health Care for everyone ethical. It is unethical not to provide for every member access to care. All three views of Justice, Libertarian, Utilitarians and Egalitarians all accept the need for health care for all society’s members. Each view has its own perspective of what is the best way to provide the Health Care but all consent it must be sustainable, available and be built on a framework of ethical values.

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