Dividing Up Health Dividing Up Health Care ResourcesCare ResourcesVaughn, Ch. 11Vaughn, Ch. 11

Is U.S. Health Care Bad?Is U.S. Health Care Bad?

According to the Organization According to the Organization for Economic Cooperation for Economic Cooperation and Development (OECD), and Development (OECD), the U.S. spends the most on the U.S. spends the most on health care per capita:health care per capita:

U.S. $6,102U.S. $6,102 Luxembourg $5,352Luxembourg $5,352 Canada $3,326Canada $3,326 U.K. $2,724U.K. $2,724 Japan $2,358Japan $2,358

Vaughn, p614Vaughn, p614

Is U.S. Health Care Bad?Is U.S. Health Care Bad?

Nonetheless, the U.S. has a lower Nonetheless, the U.S. has a lower life expectancy than the average life expectancy than the average of 30 other democracies:of 30 other democracies:

77.8 years, compared to 78.6 77.8 years, compared to 78.6 yearsyears

The infant mortality rate (deaths The infant mortality rate (deaths per 1000 live births) in the U.S. per 1000 live births) in the U.S. is:is:

6.8 deaths, compared to 5.6 in 6.8 deaths, compared to 5.6 in those other democraciesthose other democracies

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http://static.guim.co.uk/Guardian/society/gallery/2007/jul/11/childrensservices/GD3984330@Water-Babies---pics-s-1824.jpg

Is U.S. Health Care Bad?Is U.S. Health Care Bad?

Because of lack of insurance, it is estimated that Because of lack of insurance, it is estimated that 18,000 people died prematurely in 2000 (due 18,000 people died prematurely in 2000 (due to not getting tested for diseases like ovarian to not getting tested for diseases like ovarian and prostate cancers). and prostate cancers).

Vaughn, Vaughn, p614p614

What, besides health care alone, might explain What, besides health care alone, might explain some of these numbers?some of these numbers?

Defining Health and Defining Health and DiseaseDisease

Garrett’s definition of disease:Garrett’s definition of disease:

Any deficit in the physical form or the Any deficit in the physical form or the physiological or psychological functioning of physiological or psychological functioning of the individual in terms ofthe individual in terms of

what society wants or expects from that what society wants or expects from that individual, orindividual, or

in terms of what the individual wants or expects in terms of what the individual wants or expects for himselffor himself

Defining Health and Defining Health and DiseaseDisease

Health, then, is defined as a lack of any such Health, then, is defined as a lack of any such deficit.deficit.

Note that there is great opportunity for Note that there is great opportunity for disagreement between what an individual disagreement between what an individual considers “being diseased” and what society considers “being diseased” and what society considers that state to be.considers that state to be.

With society’s interest in decreasing the cost of With society’s interest in decreasing the cost of healthcare, we can expect tension to arise healthcare, we can expect tension to arise between individuals and society on this between individuals and society on this question, especially: question, especially:

in nursing homesin nursing homes for the homelessfor the homeless parental concern for childrenparental concern for children

Goals of HealthcareGoals of Healthcare

In defining the goals of healthcare … is the In defining the goals of healthcare … is the main idea …main idea …

1.1. trying to live forever?trying to live forever? ¼ of all Medicare funds are spent in the last year ¼ of all Medicare funds are spent in the last year

of life, and more than ½ of that spent in the last of life, and more than ½ of that spent in the last monthmonth

2.2. trying to alleviate suffering?trying to alleviate suffering? trying to eliminate the pain, or trying to eliminate the pain, or trying to eliminate the cause of the paintrying to eliminate the cause of the pain

Goals of HealthcareGoals of Healthcare

If healthcare is the effort to protect and If healthcare is the effort to protect and preserve the dignity of patients, then some preserve the dignity of patients, then some efforts in prolonging life and alleviating efforts in prolonging life and alleviating suffering may not always be goodsuffering may not always be good

3.3.trying to optimize happiness?trying to optimize happiness? what does it cost to relieve all anxiety of what does it cost to relieve all anxiety of

patients?patients? how much money should be spent, how many how much money should be spent, how many

resources consumed, in trying to ensure full resources consumed, in trying to ensure full mental health and happiness to only some mental health and happiness to only some individuals?individuals?

Goals of HealthcareGoals of Healthcare

Ultimately, the individual’s Ultimately, the individual’s desire for a certain level of desire for a certain level of functioning cannot control functioning cannot control the definition of adequate the definition of adequate care.care.

With the expense and scarcity With the expense and scarcity of care, society will have to of care, society will have to have a say in what is have a say in what is reasonable accommodation reasonable accommodation of patient desire.of patient desire.

This leads us to consideration This leads us to consideration of the components that form of the components that form the basis of that the basis of that accommodation…accommodation… http://www.ornithology.com/

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Three Theories of Three Theories of Distributive JusticeDistributive Justice

Libertarian – social goods are distributed by the Libertarian – social goods are distributed by the workings of the free market, not governmentworkings of the free market, not government

Utilitarian – social goods are distributed based Utilitarian – social goods are distributed based on maximization of the good of society (the on maximization of the good of society (the greatest good for the greatest number)greatest good for the greatest number)

Egalitarian – social goods are distributed based Egalitarian – social goods are distributed based on maximization of equality (the good of on maximization of equality (the good of each)each)

Vaughn, p616-617Vaughn, p616-617

Libertarian DistributionLibertarian Distribution

Joe the Plumber!Joe the Plumber!

Taking from individuals and Taking from individuals and redistributing to needy is theftredistributing to needy is theft

People pooling their money in a People pooling their money in a company for easing the costs of company for easing the costs of health care is permissiblehealth care is permissible

Government taking money from Government taking money from the rich to dispense to the poor the rich to dispense to the poor is notis not

Classic Problem: Classic Problem: many will go without health caremany will go without health care

Utilitarian DistributionUtilitarian Distribution

Our current systemOur current system

A mix of insurance and public A mix of insurance and public funding for easing the costs of funding for easing the costs of health carehealth care

Covering the most while Covering the most while maintaining high quality of caremaintaining high quality of care

Taking from rich to give to poor is Taking from rich to give to poor is okayokay

Classic Problem: Classic Problem: many will go without health many will go without health

carecare freeloadersfreeloaders

Egalitarian DistributionEgalitarian Distribution

Ideal of socialism, Ideal of socialism, communism, communism, progressivismprogressivism

Public funding Public funding (government) eases the (government) eases the cost of health care by cost of health care by managing distribution managing distribution based on taxesbased on taxes

Covers everyone equallyCovers everyone equally

Classic Problem: Classic Problem: freeloadersfreeloaders