Case study: subject and methods

Philosophy Case Study

The Ethical Provision of Health Insurance

The current state of healthcare is in crisis. The costs of healthcare are soaring, which has caused many employers to either reduce health insurance benefits for employees or to cease offering insurance coverage to their employees. Middle and lower income workers feel the pressure the most, with many of them opting out of insurance benefits, even when they are offered by employers. Currently, 80% of all uninsured people are working or are the dependents of workers. Many of the working uninsured now rely on publicly funded insurance programs, such as Medicaid, which is rapidly depleting state resources. Despite these facts, the United States has continued to resists efforts to socialize its medical system. The just solution to this dilemma is to offer state-sponsored systems of healthcare, which are not funded or subsidized with public money.

One of the major problems with the current health insurance crisis is that those workers who opt-in to their employer's insurance programs are carrying a double-burden. Not only are they paying for their own insurance benefits, but their tax money is also paying for health insurance workers for those who opt-out of employee sponsored insurance programs, but take advantage of government-subsidized insurance programs. It is not just or equitable to require those persons paying for insurance coverage to subsidize medical care for those who may be earning more money, but who choose not to allocate resources for health care.

Furthermore, given that the actual cost of health insurance premiums is soaring, due to factors outside of the control of most employers, it is not fair to expect employers to continue to pay for the majority of health insurance coverage. With insurance premiums of over $9,000 per family, many employers are faced with the dilemma of reducing wages, reducing insurance coverage, or reducing the number of employees.

State-sponsored insurance coverage, offered in the form of an HMO, would solve both of these problems. The proposed state-sponsored coverage would be managed by each individual state, but would have to comply with Federal guidelines. In order for a doctor to be licensed to practice within the state, they would have to accept the state-sponsored insurance program in their office. Doctors could also benefit from the implementation of this system, because potential insureds could be required to contract away their rights to large pain and suffering settlements in the event of accidental malpractice, which would reduce the costs of medical malpractice insurance.

The first test of fairness is consistency. Would a state-sponsored health insurance program treat all citizens fairly? The answer to that question requires an examination of costs to the individual, costs to the companies, cost to the doctors, and an examination of any expected rise or decline in healthcare quality.

A state-sponsored health insurance program would be fair to all citizens. All citizens making a salary above a certain amount would be entitled to purchase insurance at a set rate for them, and at a set rate for dependents. This is inherently fairer than the current insurance system, which typically gives an unfair advantage to workers with more dependents. For example, a single worker may pay $400 per month for health insurance benefits, $600 per month for individual and spouse benefits, and $800 per month for family benefits. Even though a spouse, in theory, will not requires less medical care than the worker, the worker gets a break for insuring an additional person. Furthermore, insurance benefits for families typically cost the same, whether a worker has one child or ten, causing workers with fewer children to subsidize the healthcare costs of workers with more children. In contrast, a system that required a monthly charge of $100 per adult and $50 per child would make healthcare more attainable for middle income workers. A two child family would see a $500 per month reduction in their healthcare costs. Health insurance costs for large families would rise, but parents are aware that adding additional children to a family increases the financial burden on a family. Those who choose not to do so should not be forced to subsidize those who choose to do so.

Furthermore, a state-sponsored insurance program could target actual illness and make sure that insurance companies were not picking up the tab for medically unnecessary procedures. State-sponsored insurance would not cover any of the cost of purely cosmetic procedures or devices. One example would be for vision insurance: the state-sponsored insurance would cover the cost of lenses and lowest-cost frames, any additional expenses, such as contacts or more expensive frames would have to be paid for by the individual. Furthermore, a state-sponsored insurance program could require patients to undergo regular screening exams as a condition of remaining insured. It has been repeatedly demonstrated that early screening for certain disease, such as heart disease, cancer, and diabetes, not only saves lives, but could save millions in healthcare costs. Non-compliant patients could be denied further coverage in the state system, and lose eligibility for indigent insurance programs like Medicaid. Again, this solution is equitable because it would no longer force those who take care of their personal health needs to pay for those who do not.

Companies that offer their workers insurance coverage could continue to do so, and could even give their workers the option of continuing with existing private insurance coverage. However, if an employee opted for state-sponsored health coverage, the company would be required to pay the same amount towards the employee's state-sponsored insurance program. In this way, the burden on companies would remain the same as it is today, with the added benefit to smaller companies that health insurance would no longer be out of reach for their employees.