Received: 21-Jan-2019 Published: 12-Feb-2019, DOI: 10.35248/2375-4273.19.07.240
Is healthcare a right? Many controversies over healthcare have been present in the media lately. Passage of the affordable care act (ACA) also known as Obama care in March 2010 focused on cost and access, intended to be the solution to years, decades, of healthcare discrepancies. It offered healthcare to all at affordable prices and penalized citizens who did not carry health insurance. The problem is that ACA is only affordable if you can afford it and no one should have to decide between debt and health. Bioethical principles govern healthcare, as an advanced practice nurse, a delicate relationship between the principles must be maintained, therefore, consideration must be given as of how each bioethical principle is affected by the right to healthcare. Healthcare is a right and a necessity of every American citizen, but not only the right to healthcare is important, also the right healthcare needs to be provided; with the ultimate goal of decreasing health disparities and improving the population health.
Healthcare; Affordable care act; Advanced practice nurse
1. Is there a right to healthcare?
2. Should the United States adopt a system that provides entitlements to necessary services to all citizens?
3. Who decides what services the citizens of the United States are entitled to receive?
4. Should all citizens be entitled to the same services?
5. The right to healthcare or the right healthcare?
Should healthcare in the United States be a birthright? Or should healthcare be a privilege that must be earned and provided only to those able to afford it? Or those who merit it? Many controversies over healthcare have been present in the media lately. Passage of the affordable care act (ACA) also known as Obama care in March 2010 focused on cost and access, intended to be the solution to years, decades, of healthcare discrepancies . It offered healthcare to all at affordable prices and it penalized citizens who did not carry health insurance. Over 20 million people have received healthcare through the ACA since 2010, but over 29 million still lack coverage or are underinsured due to cost of premiums, deductibles and copays . The problem is that ACA is only affordable if you can afford it and no one should have to decide between debt and health .
The right to healthcare or the right healthcare? What is the real ethical question that we should be discussing? Healthcare is a matter of global concern but for the purpose of this writing I will concentrate in the American system and leave the global issues for discussion another time.
The question again is asked, should the United States adopt a system that provides entitlements to necessary services to all its citizens? What happens then, when services needed are not considered necessary? Implementing a system that provides necessary services limits every citizen’s autonomy and undermines the power of work and responsibility. Healthcare is a right but also a privilege requiring the efforts and accountability of all those involved .
Autonomy provides every human with the ability to self-determine a course of action, to respect and support independent decision making . Is there a right to healthcare? A more important question to ask is if there is a right to the right healthcare? As an advanced practice nurse I view healthcare as a right, given the right healthcare is provided and made accessible to all, after all, all lives have equal worth. Everybody has a right to access healthcare . The social issue with providing healthcare as a birthright is the possible abuse to the system. When services are given as entitlements, both providers and patients think little about the cost . The value system applied to its foundation is nullified. The structure is removed and replace by a horizontal plane of healthcare equality. But not all citizens are created equal, and therefore healthcare should be individualized and catered to individual’s needs.
There is a right to healthcare and also a right to the right healthcare. Of course all “necessary services” should be provided to all citizens, but who pays for such system when all citizens are equal and services are provided as an entitlement? What encourages one to progress and achieve higher, to be able to afford more or to be entitled to more considering the individual’s input and value to society. What does the incentive for progress if a bigger income means have to carry the burden of paying for another citizen right to healthcare? Should the United States instead implement a value point healthcare? Would that promote progress and increase contribution towards the cost and affordability of healthcare? Could that be the final answer to an affordable healthcare system? Or would that create more health disparities? Should there be stringent qualifying criteria for free healthcare, such as disabilities, mental illness or temporary hardship? Healthcare is a right that should never be denied but everyone should contribute to its sustainment . It is unjust that working people making minimal wage cannot afford healthcare, but those who do not work obtain it at no cost . That discussion, however, is beyond this paper, but one that requires careful thinking and evaluation.
The question here is simply to discuss if healthcare should be a birthright to the United States citizens. Viewed in its simplest form, without any other considerations, healthcare should be a right available to every citizen in the United States. The Constitution of the United States give all citizens the right to vote and the right to bear arms, it should also give the right to healthcare. Ethical questions arise with the right to healthcare as with every right given by the constitution. The results of fights for basic human rights and necessities are expected to contribute positively to society and its constituents. The main goal must remain the health of the individual, which in turn translates to the health of society.
Bioethical principles govern healthcare, as an advanced practice nurse, a delicate relationship between the principles must be maintained, therefore, consideration must be given as of how each bioethical principle is affected by the right to healthcare. What follows is a discussion on how different bioethical principles need to be analyzed while considering the right to healthcare.
Autonomy is the agreement to respect another’s right to self-determine a course of action. It is the agreement to support independent decision-making. Healthcare is a necessity of human existence and as such an essential right. However, healthcare as a right threatens the empowerment of people to become in charge of their own health, to become more autonomous and self-reliant. On the other hand, healthcare as a right gives every citizen the right to seek medical treatment or to refuse it, allowing for self-determination, and therefore, autonomy.
Beneficence is the core principle of our patient advocacy. The desire to do good and show compassion by taking positive action to help others. Beneficence is exemplified by providing equal access to healthcare to all citizens.
Non-maleficence as the core of medical oath and nursing ethics demands providers to do no harm. Healthcare as a right of all citizens would provide ammunition all providers can use to bring forth necessary care, decrease health disparities and continue to “do no harm” to all its citizens. Gone will be the days of limiting care due to insurance coverage. All citizens would be offered necessary care aiming at all times to do no harm.
Fidelity is dedication to our patients by demonstrating loyalty, fairness, and truthfulness. It involves an agreement to keep our promises. Fidelity refers to the concept of keeping a commitment, keeping our promises. Keeping a commitment to care for all citizens equally by providing healthcare as a right for every citizen. It is difficult for the disadvantaged and the impoverished to have their needs met. The ethical principle of fidelity and healthcare as a right allows for an end to that difficulty, allowing all to have their medical needs met by healthcare providers dedicated to a system that is fair, true and loyal to them.
Justice requires for all citizens to have an equal right to healthcare, regardless of contribution or value to society. This principle refers to an equal and fair distribution of healthcare. As citizens we have rights to services from the postal service, firefighters and police. All services provided equally to all. Justice ensures all citizens have the opportunity to benefit from societal provision. It would be just to provide healthcare as a right to all citizens to protect and promote the health of all people.
Paternalism is a principle that is synonymous with having power over the patient but not necessarily incompatible with respect. Advanced practice nurses (APNs) make decisions about patient care based on their beliefs of what is in the best interest of the patient influenced by insurance coverage and patient’s affordability of the care. Healthcare as a right eliminates obstacles in choosing the right treatment or course of action. However we must be cautious in deciding what is considered basic necessity in an equal healthcare system for all. Who decides for the citizens what services to provide? Or what is considered necessary? Making choices over services offered is the meaning of paternalism. Having the power to determine what services are considered necessary. What services, according to the provider, is considered to be in the best interest of the citizen. Paternalism at its best!
Veracity refers to the ethics of telling the truth. In order to create and sustain a healthcare system that is affordable to all, all providers and citizen alike must be held up to this principle. For example, only necessary services should be provided and services provided should always be documented and submitted for payment. Holding all citizens and providers accountable could eliminate fraud and abuse and help contain cost. Extensive, transparent, and accurate documentation enhances credibility as it relates to the principle of veracity.
Citizens: Every individual deserves to have healthcare, after all without individuals society would not exist. Healthcare as a right will be providing a good for individuals while at the same time minimizing harm. Individuals are not disposable, every life is viewed equally, therefore, every life must receive equal healthcare, equal “right” healthcare. Healthcare that is free of bias, self-interest and prejudice. Every citizen deserves equal healthcare as a right. Healthcare is a necessity of human existence.
Providers: Every provider must maintain ethical principles and standard of care. Providers must be mindful of their impact on individuals, society and even the world. Healthcare as a right brings a larger group of citizens, who might never had contact with healthcare providers, to seek care. Providers and particularly APNs must always remember that all human beings are equally worth of moral consideration.
Payors: Healthcare cost, misuse and abuse needs to be closely monitored. With healthcare as a right, a single payor system that provides equal value received for care obtained must be implemented. After all, as citizens we all pay the same for a first class stamp when we go to the post office. As such, a payor system, equal across the board, is needed. Creating a system of equality and fairness for all. Somehow we all manage to send and receive mail. Healthcare as a birthright of every US citizen will also achieve its goal and provide necessary medical care to all with a fair and affordable payor system. In the present healthcare system in the US routine care is accessible and affordable only to those insured . A new, reinvented system must take its place.
Violation of ethical principles will result in a loss of credibility and respect with other professionals and patients alike. APNs hold a position of trust in the community; they are held to high standards, which promote accountability and overall professionalism. Ethical principles are an integral part of the relationship advance practice nurses have with the community. The delicate relationship between these principles means that the needs of the patient must be prioritized when determining which principle should be honored first. APNs need to communicate clearly to the best of their abilities and prevent misunderstandings whenever possible. The APN must honestly represent the client's perspective and wishes. It is essential that all APNs prepare for the future of healthcare, providing the foundation of a sustainable health care system .
It is obvious by my writings that I favor healthcare as a right, however, healthcare as a right does not mean free healthcare, it means accessible and affordable healthcare for all. A right to healthcare also means no right to opting out, every citizen contributes and every citizen gets access . Through the research for this paper I have learned that the American healthcare as it is now is a system of money over care, a death sentence for many from a healthcare system that profits off human suffering and pain . The American health care system access to care, quality of care and equity of care consistently ranks last in the world . Much work needs to be done, not only research but also a plan must be put into action soon, before the nation deteriorates to a point of no return, before health is lost over the mere need to survive. Much conflict has to be resolved in regards to coverage, financing, budgeting and providing care with a healthcare system that is provided as a right and available to all. As a short-term recommendations priority should be placed in building a system, an infrastructure, which would support an influx of uninsured citizens seeking care. With over 29 million citizens presently uninsured enough healthcare facilities and providers have to be made available. Also a plan needs to be drawn to determine funding and allocation of resources to support all the citizens. Healthcare should be a right provided to all and not just to those that can afford it. It is a human right, a moral and ethical right. America stands divided by an unhealthy healthcare system. Change takes time, therefore the most important long-term recommendation is to provide the citizens with ample time to understand the change and accept it. We need to sacrifice the comfort of private care and private insurance for the health of all the citizens. We must be proactive in recognizing the ethical obligation of every citizen. As with any change, providing healthcare as a right will have tradeoffs and controversies; possible higher taxes, longer waits for appointments, mandatory preventive care and most likely mandatory immunizations, among some. However, it would change the priority on questions when contacting a provider for an appointment and no one would ever have to be asked what type of insurance they carry as a determinant for care. Healthcare is a right and a necessity of every American citizen, but not only the right to healthcare is important, also the right healthcare needs to be provided; with the ultimate goal of decreasing health disparities and improving the population health.
Citation: Bouquet O (2019) Is There A Right To Healthcare? Health Care Current Reviews 7: 240. doi: 10.35248/2375-4273.19.07.240.
Copyright: Â© 2019 Bouquet O. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.