Limited resources, unlimited needs: Americans should ration health care, says MSU ethicist

March 10, 2009

EAST LANSING, Mich. -- As health care costs soar past $2.5 trillion and more than 47 million people remain uninsured, Americans must be willing to give up certain medical options to ensure health care reform is successful, argues a Michigan State University medical ethicist.

Thousands of uninsured Americans die each year because of their lack of insurance, yet millions of dollars are spent annually on medical procedures that save very few lives or yield only a few extra weeks or months to live. According to MSU's Leonard Fleck, whose book "Just Caring" was recently published by Oxford University Press, a discussion on rationing health care is needed to tackle the paradox that represents health care in America.

"When it comes to health care in America, we have limited resources for unlimited health care needs," said Fleck, a philosophy professor and faculty member in MSU's Center for Ethics and Humanities in the Life Sciences. "We want everything contemporary medical technology can offer that will improve the length or quality of our lives as we age. But as presently healthy taxpayers, we want costs controlled."

Since America's real shortage when it comes to delivering health care is a fiscal one, a collective discussion needs to be launched to come up with socially acceptable guidelines, states Fleck's book. Otherwise, the gap between those who can and can't afford care will grow.

"This is the 'just caring' problem: Why should anyone else pay attention to my demands for justice in meeting my health needs when I refuse to pay attention to their demands for justice in meeting their health needs?

"No one has a moral right to impose rationing decisions on others if they are unwilling to impose those same rationing decisions on themselves in the same medical circumstances."

Fleck cites several examples of the health care paradox in America:

Cancer treatment: Many lower-cost cancer treatments can successfully knock back the disease for years, though many patients cannot afford them. At the same time, Fleck said, there are advanced cancer therapies costing as much as $100,000 that only prolong life for a few extra weeks. Would Americans be willing to give up access to the more advanced treatments to ensure all cancer patients have access to the lower-cost treatments? "Patients could still pursue the higher-cost options, just at their own cost," Fleck added.

Cardiac arrhythmia: More than $8 billion is spent each year on supplying 200,000 Americans - at a cost of $40,000 each - with an implanted cardiac defibrillator that regulates electricity in the heart. More than 80 percent of the patients never need the device during a five-year period, and about 10 percent die within a year from other causes. There is a $60 test that if given to all 200,000 Americans could predict within 98.5 percent exactly which patients really need the device. If only those at greatest risk received the device, about $3 billion would be saved. However, the 1.5 percent of patients who were not correctly predicted represent about 800 deaths.

Decisions on how to best ration health care require Americans to recognize they all are part of the same health care system, in which the savings achieved by imposing rationing on our future selves will be captured and used for what we judge are higher priority, more cost worthy and more beneficial services, Fleck said.

As health care costs exponentially rise - 5.2 percent of the U.S. gross domestic product was spent on health care in 1960, compared with 16.5 percent presently - Fleck adds this is an issue that needs immediate attention.

"What we have to identify are marginally beneficial, non-cost-worthy health care options that we would be willing to deny to our future selves to guarantee we have sufficient resources to provide health care to everyone," he said. "If we are unable to control health care costs, we have no chance at health care reform."
-end-
Michigan State University has been advancing knowledge and transforming lives through innovative teaching, research and outreach for more than 150 years. MSU is known internationally as a major public university with global reach and extraordinary impact. Its 17 degree-granting colleges attract scholars worldwide who are interested in combining education with practical problem solving.

Michigan State University

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.