Injustice of Healthcare in the US - Essay Example

Running head: Injustice in Healthcare INJUSTICE IN HEALTHCARE INTRODUCTION This essay identifies the distributive injustices in the healthcare industry in the United States. Criticism of health care in the United States usually focuses on the Americans who lack health insurance of any kind. But the uninsured are not the only Americans whose welfare should concern policymakers. The welfare of lower and middle income premium payers, who are being burdened because of the U.S. healthcare system acting for the benefit of the providers and high income consumers, must also be considered. It is an issue of injustice that too much money flows or appears to flow from the less-than-affluent to the benefit of elite interests. The health care system's systematic exploitation of the many for the benefit of the privileged few has been over-looked, underestimated, or conveniently ignored by analysts and policymakers. Contrary to the assumptions of many observers, ordinary Americans are not well served by health policies and practices founded on the premise that health care should be beyond price. There are numerous identifiable ways in which political and legal systems in the United States directly or indirectly foreclose opportunities for lower- and middle-income consumers to enhance their own, as well as aggregate, welfare by purchasing low-cost, arguably lower-quality health care and health coverage. In this essay, the over regulation of the providers has been outlined and the various theological and philosophical perspectives on the injustice have been produced in the subsequent sections. OVERREGULATING PROVIDERS The most wide spread kind of regulation of the health care sector is entry control through occupational licensure. The barring from the market of individuals who do not meet minimum standards of competence in the regulated field of endeavor, can enhance consumers' welfare by minimizing both their exposure to risks of bad service and their uncertainty in purchasing complex services. However, entry controls raise costs by excluding providers who might serve some clients adequately and cheaply, thus forcing those clients (mostly lower-income individuals) to pay higher prices for arguably more reliable services. The resulting higher prices cause some consumers to forgo needed services, with adverse health consequences. The lower-income segment of the population, even if protected against costly mistakes, bears many more of the costs of exclusionary licensure than more affluent interests. In any field in which government regulates entry, entry standards will be inefficiently high, causing more hardship than is optimal. Although quality-enhancing standards limit opportunities for cost-reducing innovations, the consumers tend to value disproportionately the added security they are supplied. Occupational regulation has other costs besides those flowing from state-imposed restrictions on entry. State legislatures typically also delegate responsibility for regulating practice of a licensed occupation to its licensing board. Such boards make rules not only curtailing the supply of competitors but also suppressing advertising, corporate or commercial practice, and other practices that might intensify competition and foster consumer choice. Moreover, at the same time that they largely control the regulatory apparatus, the licensees in each field generally organize themselves privately not only to advance their political objectives, but also to set private standards for professional practice, educational programs, and institutional providers of services. Although such private entities may not directly enforce the standards they set, these standards and their accompanying certifications of compliance usually carry decisive weight in the marketplace and with state regulators. With the public generally unaware of the cost and competitive implications of such publicly sanctioned self-regulatory regimes, the interests of the regulated are commonly advanced at consumers' expense, with cost increases a natural result. Because the actions taken are always rationalized by reference to quality concerns, elite observers tend to be generally supportive and, in any event, less concerned about higher costs than lower- and middle-income consumers should be. Institutions in the health care field, particularly hospitals, also frequently enjoy substantial benefits from the regulatory regimes to which they are subject and from the activities of private standard-setting and accrediting organizations. In addition, institutional providers may enjoy the protection of certificate-of-need regulation, which operates to curb new market entry threatening to their market power. Originally put in place under the rationale that competition could never work in medical care, these laws remain on the books today largely to prevent competition from undermining the ability of hospital monopolies to cross-subsidize unspecified good works that hospitals presumably do. ANALYSIS OF THE ISSUE - THE BIBLICAL STANDPOINT The Old Testament allows clearly, some state interference with the private lives of its citizens (Ex. 21:33; Deut. 22:8). For example, Deut. 22:8 declares "When you build a new house, make a parapet around your roof so that you may not bring the guilt of bloodshed on your house if someone falls from the roof." At least two principles are evident within this passage. First, it is the product that is regulated, i.e., the construction of a parapet. Characteristics of the person building the parapet are not stipulated in any way. Having an incompetent person build the parapet may subject the owner to charges of negligence in the event of injury but the decision of who will build is left to the owner, not the church or state. The state activity would be more prosecutorial than regulative. Second, the possible consequence of not abiding by the regulation is immediately severe, i.e., bloodshed. Someone may be severely injured or killed if he or she fell from the roof. Thus, this suggests that the potential damage in licensed activities should be: (a) observable to noninvolved parties and (b) obviously damaging to the injured party. Further, the priority is on the finished product, not the person who accomplished it. The law is task-oriented rather than credential-oriented. The negative consequences fail to be balanced by any substantial empirical body of data supporting the use of licensure. For example, licensing does tend to increase the credential status of practitioners but there is no relationship to the quality of service actually delivered. Thus, from the biblical perspective, occupational licensure can be regarded as something that actually robs the freedom of creative ideas of cost effective practices that can enter into the market, calling it a sub-standard. ANALYSIS FROM A PHILOSOPHICAL PERSPECTIVE The philosophical perspective of this issue of injustice in healthcare can be visualized as being guided by the principles of utilitarianism, libertarianism, social contract and the theological principles of Catholic movement and liberation theology. The way in which the guidance occurs has been explained below. Utilitarianism is the idea that the moral worth of an action is solely determined by its outcome. Thus, the occupational regulation is not morally prudent, from the utilitarian perspective of a potential competitor. Also, from the point of view of the low income group, it is a theft of their money, or to simply put it, it is a bad or undesirable outcome. But it maximizes utility of the service provider who has the license and thereby allowing rise of costs. From the point of view of the Difference principle of the theory of justice by John Rawls, "each person is to have an equal right to the most extensive scheme of equal basic liberties compatible with a similar scheme of liberties for others." Licensing requirements with no clear relationship to occupational competency continue to favor the rich and violate the economic equality of opportunity principle. For example, the American Psychological Association (APA) has recommended that licenses only be granted to psychologists graduating from APA-approved doctoral programs. This curbs or at least affects adversely, the freedom of people without sufficient economic strength. Libertarianism principle of Robert Nozick's Entitlement theory, particularly the principle of justice in transfer, concerns itself with the just nature of the contracts. It sets the governing laws for specifying fair contracts in licensing while ruling out fraudulence. Therefore, the occupational regulations, if the regulations be advocated, must be fair. Next, from a liberation theology perspective, again, inasmuch the same way as the catholic principles, it brings to the forefront, the consideration of the poor. The impact on the lower income and middle income group, which are directly affected by such regulatory measures like licensing, is the prime focus from this theological standpoint. The term injustice can be applied to this issue mainly based on this view. THE VIEW OF THE SOCIETY AND INDIVIDUALS ON OVER-REGULATING PROVIDERS As has been already mentioned, the society or the customers are caught into believing that a licensure always means a better standard. While the reality maybe that, there could have been fraudulence during the issue of license, the provider could have bribed or maybe during the award of license the practitioner could have performed well but that in reality, he may not be talented enough. The idea of a standard, a license or accreditation by a private entity actually convinces both the public and also the government. This is the reason why even legislations are enacted which allows the domination of those providers who pass the accreditation standards. As for the public, the fear of insecurity and other quality concerns drive them into buying the costlier so-called standards. Common people being one of the affected members of the society, particularly the low income level category are generally not even aware of the injustice imposed on them. From an individual healthcare provider's viewpoint, they might have to actually come up with procedures to comply with standards, which could merely be obligatory. Hence, potential business opportunities with low cost innovation may go unexplored, even if they are as efficient as their standard counterparts. In a nutshell, these types of unwanted regulations only rob the freedom of a competitor to compete in the market and it is nothing more than a social injustice. Conclusion This essay has attempted to briefly explain the issue of occupational regulations and licensing as an act of injustice in healthcare industry. The biblical and philosophical views on the issue have been presented to give the reader an understanding of how justice or injustice is arrived at on the issue. Also, finally the way the society and individuals look upon the issue has been produced. The cumulative inequity that results from the much discrete unfairness should be the dominant concern of health policymakers, to be addressed either before or in conjunction with the problems of the uninsured and disadvantaged. It is concluded that a justice that is fair to all must prevail. REFERENCES Richman B.D. & Havighurst C.C.(2006) Distributive Injustice(s) In American Health Care. Law and Contemporary Problems 69 (7) Retrieved May 2, 2008 from http://www.law.duke.edu/shell/cite.pl69+Law+&+Contemp.+Probs.+7+(autumn+2006) Johnson Carl. (2007) Liberation Theology Retrieved May 2, 2008 from http://mb-soft.com/believe/txn/liberati.htm Christi. F & Lamont. J (2007) Distributive Justice. Stanford Encyclopedia of Philosophy Retrieved May 3, 2008 from http://plato.stanford.edu/entries/justice-distributive/#Strict Neumann J.K. (2003) Licensing of Healthcare Professionals from a Biblical perspective. Journal of Biblical Ethics in Medicine 2 (2) Retrieved May 2, 2008 from http://www.bmei.org/jbem/volume2/num2/neumann_licensing_of_health_care_professionals_from_a_biblical_perspective.php Mill J. S. Utilitarianism Retrieved May 2, 2008 from http://www.utilitarianism.com/mill1.htm A Theory of Justice. (2008, April 29). In Wikipedia, The Free Encyclopedia. Retrieved May 2, 2008, from http://en.wikipedia.org/w/index.phptitle=A_Theory_of_Justice&oldid=209036468 Read More