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The Affordable Care Act: Ethical Considerations in Health Care Reform

Ethical Challenges in Global Healthcare
by

Chelsea Foster

on 30 April 2013

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Transcript of The Affordable Care Act: Ethical Considerations in Health Care Reform

Ethical Considerations in Health Care Reform The Affordable Care Act The U.S. spends more, both per-person and as a percentage of gross domestic product (GDP) on healthcare, as compared to other nations of equivalent development. Did You Know? In the year 2006, each American’s healthcare cost $6,714, as compared to the median cost among other industrialized nations participating in the Organization for Economic Cooperation and Development (OECD): $2,880. Some people believe that our higher income in the U.S. results in the greater healthcare spending, however America seems to be an outlier from the overall curve between GDP and healthcare spending.
Most countries do follow this thought, but the U.S. disproportionately spends more- by about $3,000 per person. Others, believe that we have an older and sicker population than other nations of this scale. For example, “mortality rates in U.S. hospitals after admission for a heart attack, for example, are just average—at 4.3% as compared to just 2.3% in Denmark.” “Among prescription drug costs, we pay far more than any other country, at least 20% more than Canada and over 60% more than New Zealand.

For the same MRI’s and CT scans, we also pay more: $1,080 is the commercial average cost for an MRI in the U.S. as compared to $599 in Germany; at CT of the head costs $510 on average in the U.S. versus $272 in Germany." Annually in the U.S. the average number of visits to a physician per person is 4.

The OECD median of 6.4,

Japan’s is 13 visits per person. The U.S. also spent almost 16% of its GDP on healthcare as compared to the 7% to 11% spent among other industrialized nations. Where is all this money going? -> -> In all actuality however, the percent of population over 65 in:

America 13%
OECD median of 16%
Japan’s 23%

and among key healthcare risk factors, such as smoking- Americans actually do better in most cases. The OECD median of smokers is 22%, the Netherlands hold a rate of 28%, and only 16% of Americans smoke. “Similar trends exist for alcohol use and related healthcare risk factors. The one exception to this rule is our obesity rate, which is at a whopping 34% among adults, though this does not seem to sufficiently explain the overall heavier health expenditures.” “Similarly, we have fewer hospital discharges at 131 per 1,000 people versus the OECD median of 160 and France’s 263 per 1,000.

The average hospital stay per person is also lower in the U.S., at 5.4 days versus the OECD median of 5.9 days and Canada’s average of over one week.” "For a hip replacement, we again pay the most: $1,634 among public payers and $3,996 among private payers, versus $1,046 and $1,943 respectively in Australia.

And physicians’ incomes are the highest: $187,000 on average among primary care doctors in the U.S. versus $93,000 in Australia; and $442,000 among orthopedic surgeons in the U.S. versus $154,000 in France.” This would naturally lead one to believe that we receive more care for more money. However, the numbers do not show evidence to support this idea. There is nothing impeccably spectacular about our healthcare system. “Overall we have the highest rate of death that would be amenable to healthcare intervention (deaths among people less than 75 years old that are from heart attacks, strokes, diabetes and bacterial infections); the U.S. has 96 such deaths per 100,000 people as compared to France’s 55 deaths.” Ethical Considerations-> Despite the fact that America spends the most of it's GDP on healthcare, as of 2009, 46.3 million Americans had either none or inadequate amounts of health coverage- therefore leaving them without access to healthcare. However, with our current healthcare system in place, we have the capacity as a nation to provide care for the entire population.

In fact, we already do that.

In our society, no one is absolutely denied healthcare, but care is provided in the wrong manner. For example, individuals without healthcare can go to the emergency health departments for treatment of expensive acute care, instead of being seen in a physician's office or outpatient clinic. America currently operates under a fee-for-service payment system- therefore, healthcare specialists, pharmaceutical companies, and hospitals that provide services within the health care system feel no incentive to control costs.

Alternately, because they charge fees for individual services, there is incentive to increase costs. There is a culture of American physicians to treat each patient without worry in regards to costs, and hospitals throughout the country preach the practice of “ defensive medicine” in order to avoid medical liability lawsuits. Costs within our healthcare system could be saved immensely by reducing overall physician compensation. As a country, we pay our physicians the most out of any other country in the world.

The Affordable Care Act promotes a concept of an Accountable Care Organization (ACO). The ACO will help rework the problem of physician overcompensation by initiating a prepaid global system or payment caps to healthcare providers rather than the troublesome fee-for service system that is now in place. Conditions within the act have been drawn to expand medical insurance coverage, control costs of care, and target prevention (Gable, 2011).
The primary target of this aid is adults aged 19-64. Their access to health care, and use of health services experienced a major fallout from 2000- 2010, particularly among those who were uninsured (Kenney, McMorrow, Zuckerman, & Goin, 2012).

The Act also includes reforms that prohibit insurers from denying coverage for pre-existing conditions, that expand Medicaid eligibility, reforms that subsidize insurance premiums, and provide incentives for businesses to provide health care benefits.
The act also ensures that insurance companies will not be able to drop clients if they become ill. A recent study suggests that in doing this, the act may end up saving thousands of lives.

Researchers found a 6% drop in the adult death rate in three different states that expanded coverage for residents with a lower socio-economic standing, along the guidelines of the Affordable Care Act; preventing one death each year for every 176 adults covered under the expansion of Medicaid (Sommers, Baicker, & Epstein, 2012). The ACA is often characterized as a “government takeover” of health care, and with that- a move towards socialism.

The act requires that most citizens and legal residents have health insurance, but this could be insurance from anywhere- "private companies, employers, Medicaid, Medicare, or from state-based insurance exchanges" (Werhane, & Tieman, 2011).

Through the insurance exchanges, individuals that would pay more than 8% of their annual income for insurance would be able to obtain subsidized premiums. What control will the government have? "Efforts to reform the U.S. health care system have largely avoided the language of human rights" (Gable, 2011).


When access to quality health care is understood as a moral right, health care reformation takes on greater ethical standing.


The Affordable Care Act changes the social contract, creating a new effort fighting for universal health insurance, with a underlying notion that everyone deserves access to basic health care (Gable, 2011). Thoughts? References: * David M., Pariser. "Ethical Considerations In Health Care Reform: Pros And Cons Of The Affordable Care Act." Clinics In Dermatology 30.Ethics in Dermatology: Part I (n.d.): 151-155. ScienceDirect. Web. 29 Apr. 2013.

* Duncan, Mortimer, and Peacock Stuart. "Review: Social Welfare And The Affordable Care Act: Is It Ever Optimal To Set Aside Comparative Cost?." Social Science & Medicine 75.(n.d.): 1156-1162. ScienceDirect. Web. 29 Apr. 2013.

* Knadig, Dr. Thomas M. Sorrell, "Ethics: The Patient Protection and Affordable Care Act: Ethical Perspectives in 21st Century Health Care" OJIN: The Online Journal of Issues in Nursing Vol. 18 No. 1." Lecture. University of Pennsylvania Health System. 2012. Web.

* Lawrence O. Gostin, et al. "Improving The Population's Health: The Affordable Care Act And The Importance Of Integration." Journal Of Law, Medicine & Ethics 39.3 (2011): 317-327. Academic Search Premier. Web. 29 Apr. 2013.

* Leonard, Elizabeth Weeks. "Employers United: An Empirical Analysis Of Corporate Political Speech In The Wake Of The Affordable Care Act." The Journal Of Corporation Law 38.(2013): 217. LexisNexis Academic: Law Reviews. Web. 29 Apr. 2013.

* Menzel, Paul T. "Justice And Fairness: A Critical Element In U.S. Health System Reform." Journal Of Law, Medicine & Ethics 40.3 (2012): 582-597. Criminal Justice Abstracts with Full Text. Web. 29 Apr. 2013.

* Shay, Patrick D., and Stephen S. Mick. "Post-Acute Care And Vertical Integration After The Patient Protection And Affordable Care Act." Journal Of Healthcare Management 58.1 (2013): 15-27. Business Source Premier. Web. 29 Apr. 2013.

* Sorrell, J., (November 9, 2012) "Ethics: The Patient Protection and Affordable Care Act: Ethical Perspectives in 21st Century Health Care" OJIN: The Online Journal of Issues in Nursing Vol. 18 No. 1.

* "U.S. Versus European Healthcare Costs: The Data." EpiAnalysis. N.p., 18 July 2012. Web. Apr. 2013.

* Vecchione, Anthony. "Debating the Ethical Implications of the Affordable Care Act." NJ Spotlight: Where Issues Matter. Community Foundation of New Jersey, 26 Sept. 2012. Web. Apr. 2013.
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