Compassionate Capitalism – by Sanjiv Mehta at the #India2022Exchange
The Ethics of Health Care Reform: Issues in Emergency
This paper describes the basic provisions of the PPACA of 2010 and addresses important ethical issues of health care reform, including the moral foundations of reform, the American College of Emergency Physicians Code of Ethics as a guiding document, and health care reform’s likely effects on cost containment, public health, access to care, ED crowding, and end of life issues. The Patient Protection and Affordable Care Act is a federal statute signed into law along with its amendment, the Health Care and Education Reconciliation Act, by President Obama in March 2010.[i] It is designed to take effect in stages over the next 8 years and includes reforms such as prohibiting insurers from denying coverage for pre-existing conditions, expanding Medicaid eligibility, subsidizing insurance premiums, and providing incentives for businesses to provide health care benefits. To understand the moral dimensions of the health care reform debate, it is useful to begin by examining the fundamental goals of our health care system. Evaluation of health care reform practices according to this Code of Ethics will provide guidance to ensure the ethical delivery of emergency medical care. An accountable care organization is defined in the PPACA as an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare patients for whom they provide the bulk of primary care services.
Xvi] ACOs have been suggested as a strategy to deliver integrated health care by promoting evidence-based medicine, reporting data about quality and cost of care, and coordinating health care. Finding the balance between provision of value in health care and cost containment remains a fundamental ethical challenge for health care reform. ACEP’s policy on Medical Screening of Emergency Department Patients states that ACEP strongly opposes deferral of care for patients presenting to the ED. Furthermore, ACEP believes that deferring care for patients presenting to the ED reflects a void in the health care system. Further bolstering an expanded scope of care argument is the fact that racial and ethnic disparities may be increased by expanded health insurance coverage by the PPACA.
Those who have difficulties in obtaining PCP care are often from disadvantaged backgrounds, and in Massachusetts health reform did exacerbate this health care disparity. This reform will invest in community health centers and pay for primary care, to give patients options to receive non-urgent care and follow-up care in settings more appropriate than the ED. Unfortunately, PPACA does not address the underlying issues that influence ED crowding. Lxx] Health care reform provisions, including the possible future adoption by law or regulation of funding for advance care planning consultations, demonstrating the value of expert symptom management in parallel with standard therapies and improving pain management, would enhance ethical care by promoting patient autonomy and well-being, avoiding harm, and matching resources with patients’ goals for medical therapy. Ethical issues of health care reform include moral foundations, cost containment, public health, access to care, ED crowding, and end-of-life issues.
The American Conservative
A few years ago I began a book about cruelty to animals and about factory farming in particular, problems that had been in the back of my mind for a long while. Industrial livestock farming is among a whole range of animal-welfare concerns that extends from canned trophy-hunting to whaling to product testing on animals to all sorts of more obscure enterprises like the exotic-animal trade and the factory farming of bears in China for bile believed to hold medicinal and aphrodisiac powers. Surveying the various uses to which animals are put, some might be defensible, others abusive and unwarranted, and it’s the job of any conservative who attends to the subject to figure out which are which. A certain moral relativism runs through the arguments of those hostile or indifferent to animal welfare-as if animals can be of value only for our sake, as utility or preference decrees. If one animal’s pain-say, that of one’s pet-is real and deserving of sympathy, then the pain of essentially identical animals is also meaningful, no matter what conventional distinctions we have made to narrow the scope of our sympathy.
Often applying felony-level penalties to protect certain domestic animals, these state and federal statutes declare that even though your animal may elsewhere in the law be defined as your property, there are certain things you may not do to that creature, and if you are found harming or neglecting the animal, you will answer for your conduct in a court of justice. Our pets are accorded certain protections from cruelty, while the nameless creatures in our factory farms are hardly treated like animals at all. If conservatives do nothing else about any other animal issue, we should attend at least to the factory farms, where the suffering is immense and we are all asked to be complicit. If we are going to have our meats and other animal products, there are natural costs to obtaining them, defined by the duties of animal husbandry and of veterinary ethics. Factory farming came about when resourceful men figured out ways of getting around those natural costs, applying new technologies to raise animals in conditions that would otherwise kill them by deprivation and disease.
Actually, all of factory farming proceeds by a massive denial of reality-the reality that pigs and other animals are not just production units to be endlessly exploited but living creatures with natures and needs. Factory farming is a predatory enterprise, absorbing profit and externalizing costs, unnaturally propped up by political influence and government subsidies much as factory-farmed animals are unnaturally sustained by hormones and antibiotics.