Health care is rationed, one way or another

Health care policy is an endless debate in the USA, and in New Mexico the debate has its own special complications.

Thoughts about how theories and ethics bump up against pragmatic realities come to mind in the wake of two recent public discussions I attended.

Is there such a thing as “deserving” health care, and do some people deserve more than others?   Should some people be more entitled to access to health care, or better quality health care, than others? (“Entitled” is a loaded word. I used it deliberately to provoke your thoughts. ) Should those who can afford to pay for it have a greater right than those who don’t? Should smokers, or fat people, or drug addicts have less access or be forced to pay more than others? Should young people be at the front of the line and old people forced to the back? These questions arise starkly when we consider extremely limited resources such as organs for transplant, but they permeate the entire health care system.

To develop the system we really want, we have to know what our values are. This message emerged from a presentation titled “Balancing Universal Healthcare with Medical Rationing,” by Dr. David Teutsch, Ph.D., a rabbi and ethicist, speaking recently to a New Mexico audience.

Countries with single payer systems have decided that wealthier people are not more entitled. They have opted to provide access to everyone and to pay for it through taxation, though in some countries the wealthy can still jump ahead by paying privately.

The health care system in America is based largely on an irrational factor, Teutsch said: employer-provided health insurance. This is the result of a historical accident. During World War II the government instituted a wage freeze. Employers seeking ways to attract the best employees developed fringe benefits that were not considered part of wages. Employer-paid health insurance was one of those benefits. In today’s world it’s not logical but we have inherited it, it’s entrenched, and we’re stuck with it, at least for now. It has resulted in major inequality of access based on who your employer is.

Obamacare, said Teutsch, is a big step in the direction of equalizing access.    Acknowledging that Obamacare is a flawed system, he pointed especially to community clinics as a highly positive factor. Those clinics, he said, will make services available for lower-income consumers in a coordinated way that significantly reduces costs and improves service compared to older delivery systems. Here’s where pragmatic reality rears its head.

This point called to mind another presentation I attended recently – a meeting with FCC Chairman Tom Wheeler (covered in a previous column). The discussion was about the lack of broadband access in rural New Mexico.

Dr. Dale Alverson was on that panel. Alverson, medical director at UNM’s Center for Telehealth, talked about the importance of broadband access to rural health care delivery. New Mexico has a growing number of community clinics. Distance medicine enables local health care workers to talk with expert physicians at central locations such as UNM. The use of new diagnostic hardware enables the specialists to provide diagnosis in real time and to guide treatment.

But that can only happen if the networks exist. In parts of New Mexico, they don’t. That’s one way care is rationed – by location.

We’ve always known that if you choose to live in a small town, you are probably making the choice to accept less access to health care as one of many inconveniences. Now technology has created new options and perhaps created new expectations.

Like the debate about health care itself, the ethical implications are endless.

Triple Spaced Again, © New Mexico News Services 2014

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