The Morality of Managed Care
"The preservation of health is a duty" according to Herbert Spencer, an English philosopher (Andrews, 1993). Managed care conglomerates provide health coverage for increasing numbers of Americans. Many critics question whether these businesses provide care dutifully. At the very least, the present managed care system requires health care providers and recipients to reexamine established principles underling physician-patient interaction. Although health maintenance organizations are commonly misunderstood, Americans hope these institutions will dampen runaway health care expenditures. Since HMO's are increasing in number, health care recipients need to examine how established, ethical principles in America are changing. These subtle alterations create conflicts between physicians, HMO's, and patients. Ultimately, patients are regarded as consumers, and understandably, quality care may be more difficult to obtain.
Definition Of Managed Care
Although numerous health care plans presently exist, managed care plans have dominated the marketplace since the early 1980's. Preferred provider organizations (PPO's) and health maintenance organizations (HMO's) are the most common, and they continue to grow in number. Since managed care has become commonplace, the differences between PPO's, HMO's and fee-for-service reimbursement arrangements must be critically evaluated. Without understanding their general organizational and payment structures, moral judgments pertaining to varying plans cannot be ascertained easily. PPO's contract with a limited number of physicians and hospitals who agree to care for patients on a discounted fee for service basis. On the other hand, HMO's amass insurers and providers...
... middle of paper ...
...ew York Times, July 15, 1996, pp. A13.
Kassirer, Jerome P. "Managed Care and the Morality of the Marketplace" The New England Journal of Medicine, July 6, 1995, pp. 50-52.
King, Cheryl S. "Managed Care: Is It Moral." Advanced Practical Nursing, 1995,
pp. 7-11.
Larson, Erik. "The Soul of an HMO." Time, January 22, 1996, pp. 44-52.
Light, Donald W. "The Practice and Ethics of Risk-rated Health Insurance." The Journal of the American Medical Association, 1992, pp. 2503-2508.
Peliegrino, Edmund D. "Ethics." The Journal of the American Medical Association, June 1, 1994, pp. 1668-1670.
Relman, Arnold S. "What Market Values Are Doing to Medicine." The Atlantic Monthly,
March 1992, pp. 99-106.
Shenkin, Budd N. "The Independent Practice Association in Theory and Practice." The Journal of the American Medical Association, June 28, 1995, pp. 1937-1942.
An example of this would be that the federal government has control over the military, foreign policy, our postal system and the monetary policies. The state government has the responsibility for the police/law enforcement, road building and the schools.
The case of Marguerite M presents an ethical dilemma. Medical ethics play a special role in medicine and is directly concerned with its practice. Its role has continued to evolve as changes develop in
Veatch, Robert M.,"The Normative Principles of Medical Ethics." In Medical ethics. 1997. Reprint, Boston, MA: Jones and Bartlett, 1989 29-56.
Theoretically, in a Federal system the sovereignty is shared between the national government and the local government but the ultimate sovereignty lies on the people. The federal government does not have the power to be involved in the states laws as they are only able to deal with national security, taxation and foreign affairs. The States however, deal with public welfare, education and justice. For instance, in different States there are different laws in executing criminals implemented as such in California death sentence is applied. However, it differs in practice whereby in the recent events the federal government is heavily involved in the public welfare especially when it dealt with major crises.
...n our federal system has changed dramatically over the years. State governments have served as training grounds for national politicians and as laboratories in which new ideas can be tested. The Supreme Court, in its role as interpreter of the Constitution, has been a major player in the redefinition of our federal system. Increasingly, Congress has been guilty of undertaking areas traditionally reserved to the states and restricting authority to regulate these areas. Both federal and state politicians compete to address problems. Over the years, power in the federal system has flowed to the national government because tax money has flowed to there. With its financial resources, the federal government has been able to offer assistance to state and local governments and thereby, involve itself in just about every governmental function performed by these governments.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
First, let's consider the situations in which genetic testing would be beneficial to patients. Genetic testing for diseases that are preventable or treatable could allow individuals to alter their lifestyles so as to treat the disease or reduce their risk of developing the disease. For instance, the E2 version of the APOE gene, which is found on chromosome 19, has been linked to heart disease (Ridley, 1999). Individuals who have two copies of the E2 gene are particularly sensitive to high-fat and high-cholesterol diets. Therefore, a genetic test to determine whether a person has the high-risk version of the APOE gene could inform a person of future health risks, thereby allowing the person to change his diet to help prev...
Gedge, E., & Waluchow, W. (2012). Readings in health care ethics (2nd ed.). Toronto, Ontario: Broadview Press.
Steinbock, Bonnie, Alex J. London, and John D. Arras. "The Principles Approach." Ethical Issues in Modern Medicine. Contemporary Readings in Bioethics. 8th ed. New York: McGraw-Hill, 2013. 36-37. Print.
9) Wall, L.L. (2006). The medical ethics of Dr J Marion Sims: a fresh look at the historical record. Journal of Medical Ethics, 32(6), 346-350. doi: 10.1136/jme.2005.012559
Then there is the state government which are responsible for governing affairs within their borders, and carrying out federal laws and programs at the state level. They are governed by their own constitutions and retain any rights that the U.S. Constitution does not exclusively grant to the federal government. The state government is limited as they cannot form alliances with other states and must honor and respect the laws and institutions of the other states. And finally there is the federal government which is the central and highest level of government in the U.S. It is divided into three branches and each branch has its own rights and power to check and balance the powers of each branch. The federal government has the power to regulate taxes, establish federal welfare programs and make laws in the interest of the nation as a whole. There are also limitations set to the federal government’s authority, as they cannot ask local law enforcements agencies to do minor administrative jobs. Although all levels of government have their own responsibilities there are limits to interfering with other governments
The U.S. Constitution creates a unique system of federalism. It is a system of government that divides power between a central governmental unit and local administrations. In this way, both central and local governments enjoy sovereignty. However, because the two governments share authority over the same territory, it may be problematic to establish the division of their powers. The central power needs to exercise its authority without infringing the authority of a local government while local governments should not encroach on national interests. The American federalism is defined by the Constitution which establishes the separation of power between federal and state governments, but throughout history, federalism has experienced a number
Freedman B. Equipoise and the ethics of clinical research. N Engl J Med. 1987; 317(3): 141-145
McGee, Glenn and Arthur L. Caplan. "Medical Ethics." Microsoft® Encarta® 98 Encyclopedia. © 1993-1997: Microsoft Corporation. CD-ROM.
Garrett, T. M., Baillie, H. W., & Garrett, R. M. (2010). Health care ethics: Principles and problems (5thed.). Upper Saddle River, NJ: Prentice Hall.