As part of my masters program in health care ethics at Creighton University, my class was asked to present brief remarks to a hypothetical congressional committee regarding one aspect of health care in view of vulnerable populations. Here’s my stab at it:
Madam Chair, members of the Committee, my name is Robert C. Baker. I am a graduate student at Creighton University in Omaha, Nebraska, pursuing a master of science degree in health care ethics. The focus of my studies the past month and a half has been on ways to address the needs of vulnerable populations vis-a-vis health care and the broader concept of health.
I sincerely appreciate your invitation to speak to you today. In the time allotted to me, I thought it best to limit my remarks to one key element of health policy under your oversight that transects my area of study. This morning I would like to suggest to you that, cognizant of our weaknesses as a nation, we work towards our strengths in providing the best quality care to those who are most vulnerable among us.
Introduction
Madam Chair and members, I won’t spend time rehashing the comparisons of American health care outcomes to like outcomes in Europe when some such comparisons, such as in the reporting of live births in the US and the life spans of relatively homogeneous European populations, skew one-to-one comparisons. Likewise, I find no need to reverberate the financial crisis we are in over Medicare and Medicaid, since these troubles have been brewing for years and Congress has, until now, not yet found the fortitude sufficiently to address them. Further, unlike some of my esteemed colleagues and friends, I will not argue for the establishment of a right to health care. Rather, I will make an ontological argument that we should strive to be the best we can be.A Weakness: Vulnerability
American health care is the best in the world–for those who can afford it. Yet American health, at least as a broader category envisioned by many theorists such as Madison Powers and Ruth Faden, among others, is far worse off. In a more holistic view of justice, “justice for all” certainly being an American virtue, broad determinants to health such as opportunities for education and suitable employment, which go beyond mere access to health care, are deficient, even more so for those who are especially vulnerable. I agree with theorists such as Marion Danis and Donald L. Patrick, who argue for the concept of universal vulnerability. While certain members of our society are especially vulnerable now, we all will be in a state of vulnerability sometime in the future.A Strength: Solidarity
That concept of vulnerability lends itself to a discussion of how we as Americans have traditionally viewed and responded to vulnerability. Here one can easily recall the Mayflower Compact, the Articles of Confederation, and the US Constitution and Bill of Rights. We as a people are particularly constituted, if you will, to delimit duties and to enact protections and aids in order to preserve our individual, state, and national rights, but doing so in recognition of our own vulnerability to the vagaries and extreme cruelties of human existence, sometimes also from the hands of other human beings. Viewed from this angle, meaningful dialog and constructive work can be accomplished by focusing on how we, as community, have organized ourselves not only for our own betterment, but also the betterment of others. This view stands in sharp contrast to strict libertarian and free market views that clearly have, in my opinion, run amuck.A Way to Move Forward
Earlier this year, Professor Uwe Reinhardt appeared before the House Ways and Means Committee and broached the subject of social solidarity, in particular the concept of viewing health care as a social good as opposed to strictly a private good. I would argue that we have reached a point in our national life that such an approach as suggested by Professor Reinhardt is now necessary. Countries such as the Federal Republic of Germany, while by no means having a perfect health care system, nevertheless operate from such a basis while maintaining a competitive insurance market. Such an arrangement also is appealing inasmuch as it allows for a great degree of patient autonomy and choice, all while providing universal health care–including care for vulnerable populations.Conclusion
Madam Chair and members, long-regarded and practiced American civic virtues also include caring for our neighbor. The Pilgrims and the Founding Fathers and Mothers of our nation recognized the need to work together in order to sustain each other so that not only individuals, but also society, would flourish. Viewing the interlocking and diverse needs of our society’s most vulnerable today, while committed to a vision of social solidarity, is in my view the right approach because any one of us may be vulnerable–tomorrow.Madam Chair and members, I thank you for the opportunity to speak to you today.
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Sources:Danis, Marion, and Patrick, Donald L., “Health policy, vulnerability, and vulnerable populations,” Ethical Dimensions of Health Policy, Danis, et. al., eds. (New York: Oxford University Press, 2002), 310-334.
Powers, Madison, and Faden, Ruth, Social Justice: The Moral Foundations of Public Health and Health Policy, (New York: Oxford University Press, 2006).
Reinhardt, Uwe E., “Testimony before the House Committee on Ways and Means,” April 22, 2009, http://waysandmeans.house.gov/hearings.asp?formmode=view&id=7672 (accessed October 10, 2009).
