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Guest column
Andrew Gioia

Andrew Gioia is currently a senior at Cornell University majoring in government and political science.

Though there’s been great debate lately over various issues in health care, few have spoken at any length on a moral or ethical basis for reform. Health care decisions are inherently personal, yet within the current health care system individuals and families have little genuine choice when it comes to the terms and benefits of their health plan.

Furthermore, advances in biomedical research promise great improvements in care, yet at the same time many Americans would likely object to funding procedures or treatments through their health insurance premiums that they find morally offensive. Such decisions, however, are almost always made by employers, insurance executives, or government officials, leaving no room for Americans to control their own health care dollars and participate in plans that respect their values.

Recently, the Heritage Foundation published a paper outlining the merits of what they call a values-driven health plan. In it, the authors answer a number of important questions and call attention to several freedoms current health plans prohibit, all of which respect individual moral beliefs and give greater control over personal health plans. The paper identifies the legislative and policy changes that would be necessary for consumer- and values-driven health plans to exist and flourish.

For instance, Americans deserve the right to choose both their own doctor and a health plan that respects their personal beliefs. It seems only natural for all families to choose who they want taking care of them and to participate in organizations or health plans that they want to support. It seems equally natural for health care in America to function as a genuine consumer- and values-driven market, just like nearly everything else Americans buy.

Ultimately, as Heritage puts it, these freedoms would allow individuals and families to “vote with their feet, freely choosing which health benefit plans, packages, and medical procedures they wish to support.” Health care, in effect, would be open to consumer and market demands.

Such an open system is important in setting Americans free from an impersonal, bureaucratic health care system. Employers shouldn’t control an individual’s or family’s health care dollars; not only does this greatly limit health plan options, it takes personal beliefs out of the equation and results in difficulties when people change or lose jobs. Instead, refundable, individual health care tax credits would level the playing field, freeing individuals to make their own health care decisions by purchasing a plan on the individual market, through an organization or association of their choice, or simply keeping a plan their employer offers. The point is that individuals need the freedom to make real choices.

So how does America go about enacting such fundamental changes to its health care system? For one, as Heritage outlines, policymakers can start by enacting changes to the tax code that would enable Americans to choose plans from a variety of providers, as noted above. By allowing Americans to pay for care sponsored by professional associations, unions, or religious groups in addition to their employer, such individuals and families can guarantee that their health plans are compatible with their ethics and beliefs.

Perhaps the biggest and most fundamental change, however, would be in opening up the health insurance markets. Instead of operating under highly regulated state health insurance markets, health care should be sold in a single market, or “insurance exchange.” In this way, plans would be competing directly with each other and even across state lines. If car insurance, homeowners insurance, and virtually every other good or service sold in America operates this way, certainly something as important as health insurance should be.

As abortion, physician-assisted suicide, stem cell research, and many other medical procedures and treatments become personal, the freedom to choose the types of health care seem essential. Unfortunately, right now most Americans “get what they are given and pay what they are told to pay,” and personal choice is limited. With something as important as health care, the buyer needs to be in charge and making the decisions that will affect their treatment and coverage.

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Join the dialogue here

Aug 16, 2006 12:56:49 PM
sweet lou says

As the current healthcare system slowly limps into total meltdown and providers are struggling to make their services ever more efficient to save money and preserve capacity, you suggest opening up countless separate delivery channels – each with duplicative services – just to assuage the morals of patients. That’s not healthcare reform; that is lunacy.

If I understand the logic correctly, every possible variation of every religion would need its own providers just to ensure that someone doesn’t accidentally receive healthcare from a provider whose beliefs differ from their own. What a phenomenal idea, and so cost efficient! Separate hospitals and providers for each branch of Christianity, and let’s not forget Judaism and Islam. Why stop there. I would love to enroll in a vegetarian healthcare system, because I don’t like the idea of some meat eating doctor providing services to me. And he should be a dog lover. But not a cat lover. And preferably pro-choice, pro same sex marriage. And must love country music.

Healthcare is not online dating. We don’t need multiple systems that allow us to match up the qualities of the ideal nurse or doctor. Here's a crazy idea, instead of creating a labyrinth of providers to meet niche demands, how about patients assume some personal responsibility and educate themselves on how to make appropriate decisions. If you don't want to benefit from stem cell research, then opt out of therapies and procedures that utilize it. If you don't want an abortion, don't get one. The healthcare realm is no place to let ideology drive services. In the end, what you are really proposing is a world in which everyone shares your ideals. And that is never going to happen. If you find some aspect of care morally unpalatable, don’t pursue it. You don’t need a separate delivery channel just to validate your own world view.

Truthfully, I find this sort of “philosophical” discussion about beliefs distasteful and highly suspect as it too often seems that only one world view is ever truly considered as an alternative “core belief” – that of fundamental Christianity. But please, prove me wrong. Tell me how separate healthcare channels for ALL belief systems is a good idea in a healthcare system poised on the brink of disaster.

Aug 17, 2006 8:47:31 AM
Jim says

I don't think the idea is to have separate hospitals and doctors for every different belief system. I don't know what you were reading or how you arrived at that conclusion, but as I understand it the idea is to allow consumers to purchase their healthcare from an organization they choose, be it their employer or some other one, who spends those health care dollars in line with its beliefs.

Maybe I can avoid the "benefits" of stem cell research by opting out of those procedures, but I can't really control what my money is funding under the current system.

I have no idea how a "philosophical discussion" of the healthcare system assumes one world view. No where does this endorse Christian groups or any religion for that matter; it's about morals and beliefs.

How about less personal attacks and more rational arguments, sweet lou.

Aug 17, 2006 11:33:32 AM
Jim Holman says

I'm all in favor of having a system that gives people more choice and portability of health insurance. The benefits of that are obvious.

But among those benefits I had not considered "values." The article does not state that this is about religious values per se. But in the real world, talk about "values" is almost always religious in nature or motivation. Everyone has values, but religious folk talk about theirs all the time.

It seems to me that under the proposal what would happen would be a proliferation of health plans that somehow supported religious values. So I assume the point would be to have health plans that didn't cover abortion, birth control, gender reassignment surgery, infertility services using frozen embryos, drug and alcohol treatment, pre-birth genetic screening, and so on. I can only speculate what features such a plan would have because the article only lists a few examples, and the full set of "values" and their health plan implications are not provided.

The proposal is said to provide greater "choice" for individuals. But I believe in many areas it would reduce choice. In areas of the country dominated by fundamentalist or conservative Christians, these "values-driven" health plans might be the only options offered. Such health plans might only contract with "values-driven" physician practices and hospitals. And so on. You could end up with a situation in which health insurance in some areas covered only those things approved of by Revs. Falwell, Robertson, or Dobson.

In my old age I try not to be suspicious of everything, but in the case of the "values" group I think we always have to be suspicious. This proposal sounds innocent enough, but though decorated with the language of "choice," and "freedom," it is just another way that the religious right seeks to achieve dominion over the rest of us -- over our health care options, in this case.

Aug 17, 2006 11:59:17 AM
sweet lou says

Thanks for making the point much more effectively than I did!

In response to "Jim," no personal attack intended. Allow me to clarify. While there was no direct mention of religion in the article, the three examples chosen as bellwethers - abortion, physician-assisted suicide, and stem cell research - certainly appear to reflect a particular belief system. Further, if you read the linked synposis of the referenced Heritage Foundation report, it appears to suggest that, among other organizations, faith-based organizations become a part of the "payer" system in medicine in order to discourage medical procedures that go against their values. This is the values part of the report, I believe.

That's all well and good. I'm all for following one's values and core beliefs. But since our society is made up of perhaps a hundred million different core beliefs, how can a healthcare system ever hope to reflect that in a comprehensive fashion? If the argument is about morals and beliefs, then clearly EVERY moral and belief should be able to be accommodated, not just the morals and beliefs of the largest groups. The system would become hopelessly fragmented and politicized (even more so than it is). I’m a vegetarian. How do I “vote” on a system that matches that belief? How can I opt out of medical research conducted by meat eaters or on animals? I can't. I accept that. My comments were not intended to “attack” any group, but were about expanding this argument to a logical (and inescapable) conclusion. Either it’s about accommodating all beliefs – and if so, how can you possibly create such a system without spending a hundred times more than necessary? – or its about promoting one belief – in which case its insular and agenda-driven to ensure that a certain set of beliefs dominate healthcare.

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