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University of California at Irvine

The UCI Interdisciplinary Center for the Scientific Study of Ethics and Morality

October 27, 2009

A round table discussion of health care reform

"Making Sense of the Health Care Debate"

Comments of Don McCanne, M.D. (from memory, edited and abridged):

I'll be brief because I want to make only one very simple point: An ethical health care system is designed to take care of patients. What could be more obvious? If the health care system is doing its job in taking care of patients then the health care system itself is being taken care of. Special interests legitimately involved in health care delivery will do just fine.

Although this principle seems very obvious, it hasn't been guiding the process in Washington, DC. Our politicians are designing a health care system that is taking care of the private insurance industry. Patient care is secondary, as it must conform to the private insurance model.

As Senator Joe Dunn just said, legislation is 10 percent principles and 90 percent politics. Congress is providing us with a political solution rather than a solution based on sound health policy science.

We were told that we would have health care reform that would cover everyone, and that costs would be controlled, making health care affordable for each of us. Yet when they insisted that reform be based on private insurance plans and that the budget be limited to $900 billion over the next ten years, they realized that at least 20 million people could not be insured under this proposal. Likely it will be many more, especially after four more years of health care inflation before the basics of this plan are even in place. And since there are no effective measures for controlling costs, health care will be even less affordable.

The limitations imposed have resulted in such bizarre policy proposals as granting waivers to individuals to exempt them from the fines that would be imposed for committing the criminal act of being uninsured.

A fundamental flaw of their proposal was to try to craft reform based on a package of benefits in a private insurance plan that has a premium assigned to it. That premium plus the out-of-pocket expenses must cover the average family health care costs of $16,771 (Milliman Medical Index). With a typical family income of perhaps $60,000, those costs now create a financial hardship for families, especially those at income levels where the subsidies phase out.

By designing reform that primarily benefits insurers, the most productive sector of our society - middle income Americans - is going to be the hardest hit by the adverse consequences of this legislation.

Since this is a forum on ethics, I have to conclude that our legislators, by failing to place the patient first, compromised ethics when they crafted this reform.

http://www.ethicscenter.uci.edu/