Is healthcare a moral obligation to be provided to everyone freely or a commodity, reserved for those with the financial means to pay for it? The intellectual depth of this question is startling and has been due cause for incredible reflection as a human and as a nurse. When faced with questions of what is moral I have to refer to the source of my internal moral compass; the Bible. I truly have been grappling over this question and it is very apparent one’s answer to it is the source of all arguments in regards to healthcare. Moreover, I do not believe individuals, healthcare providers, insurance companies or our government at large realize how fundamental it is to answer this question on a deep personal level.
When first beginning this class I had very limited understanding of health policy and politics and I have been on a personal journey of discovery as my mind has been opened to all the implications policy has on every facet of our lives. I lived very unaware of how government regulations affected me on a daily basis but now I am empowered and deeply moved to become an advocate for nurses and the health and prosperity of our nation. Mark 12:31 (2011) instructs for us to love our neighbors as we love ourselves and this is repeated dozens of times throughout the New Testament. What does this mean in regards to healthcare? We are instructed throughout the gospels to care for the poor, sick and widowed (2011), so the answer may then seem obvious – health care should be provided for all.
This answer appears too simplistic, and it is. The Bible also gives ample instruction about caring for one’s body as if it is God’s temple (1 Corinthians 3:16) and warns not to be a glutton with wine or food, as well as instructing its readers to stay away from laziness and to work hard and be disciplined in the book of Proverbs (2011). Regardless of one’s belief system, The Bible refers to healthy behaviors that will produce good health outcomes (prevention of disease). Do I want to pay for people who have been irresponsible with their bodies, have been gluttons with drinking, eating and haven’t contributed to society by means of working hard? No, I definitely do not. Is it a moral obligation to care for these people when they are sick? In the emergency department we cannot turn anyone away, so yes we are morally and legally obligated to provide healthcare services to anyone who comes through our doors. Where then, does the responsibility lie in preventing chronic disease processes that take so much of our healthcare dollars? Damron, Champan and Outlaw refer to the importance of prevention if there is any hope in reducing healthcare costs for the future (p. 160, 2016).
Chronic diseases are not going to go away overnight, and therefore providing health insurance and accessibility to those in need is necessary and right. According to the Journal of the American Medical Association’s review of health care reform, the affordable care act has made insurability and accessibility possible by reducing the number of uninsured by 43% and by disallowing insurance companies to deny coverage due to preexisting conditions (p. 527, 2016). If healthcare is viewed as a commodity, greed will inevitably ensue. This view of healthcare is what brought us to the position we are in today. Clearly viewing healthcare as a commodity is not working to benefit our fellow humans or our nation as a whole. What motivation will a doctor have to care for the underprivileged if they are only paid by those who can afford it? What incentive would an individual have to seek out health screening with the knowledge that they will not be able to afford any needed intervention? Hence, the health disparities that exists today.
There is hope for America to turn our health around. An investigation published by the Journal of the American Medical Association in 2015 showed the annual death rate percentage per 100,000 deaths for several preventable diseases decreased by 42.9% from 1969 to 2013 (Ma, Ward, Seigel, Jemal, 2015). Contrary to mass media reports, which may be skewed by other nations lack of data tracking, health in the United States is in many ways increasing. Also encouraging to see, the broadly publicized numbers regarding our nation’s health care expenditures is reflected upon by Timothy J. Bray, an orthopedic surgeon and his colleague Peter L. Althausen, MD, MBA in their introductory article in the Journal of Orthopedic Trauma, which encourages renewed vigor for stewardship of our healthcare dollar (2016). Both Althausen and Bray encourage clinicians to gain an understanding of healthcare economics, ensure decisions for patients are based on sound scientific-medical principles and strongly encourage the development of evidence based care pathways for their patient population in order to reduce cost and improve outcomes (2016). The healthcare industry is realizing their own obligation to giving good care.
I believe there is moral individual responsibility on my part to get involved in policy making where preventative care is supported and to place personal responsibility in the hands of the patient by educating on healthy behaviors as well as giving grace to those who may have caused their own conditions. If we focus our healthcare dollars on prevention instead of tertiary care, our spending will eventually be reduced, even if we are providing health coverage for all people I truly believe it will be less than what we spend today. Directed by a finely tuned moral compass and driven by evidence based outcomes America will prosper.
Althausen, P., Bray, T. Current state of healthcare economics, expenditures, and our moral obligation to cost containment. (2016). Journal of Orthopedic Trauma, 30(12). doi:10.1097/BOT.0000000000000714
Damron, B., Chapman, D., Outlaw, F. (2016). Health care delivery and financing. In Mason, D.J., Gardner, D.B., Outlaw, F.H, & O’Grady, E.T. (Eds.), Policy & Politics in Nursing and Health Care (7th ed.). (pp. 151-163). St Louis, Missouri: Elsevier.
Ma, J., Ward, E., Siegel, R., Jemal, A. Temporal trends in mortality in the united states, 1969-2013. (2015). Journal of the American Medical Association, 314(16), 1731-1739. doi:10.1001/jama.2015.12319
Obama, B. (2016). United states health care reform progress and next steps. Journal of the American Medical Association, 316(5), 525-532. doi:10.1001/jama.2016.9797
The Holy Bible, New International Version. (2011). Grand Rapids, MI: Zondervan.