Health reform a hot topic in bioethics circles

SAN FRANCISCO (MarketWatch) -- Bioethicists are often associated with exotic, scary-sounding scenarios such as human cloning, but it turns out they spend a lot of time weighing something far more familiar: Health-care reform.

Bioethicists make up a hodgepodge of doctors, nurses, legal scholars, philosophers, theologians and academics. Most hold advanced degrees and publish regularly.


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They can be secular or religious and don't speak with one voice. But when it comes to the proposed health-care overhaul, many agree that extending coverage to the uninsured is essential.

"It's a fundamental ethical issue of the highest order," said Eric Meslin, director of the Indiana University Center for Bioethics in Indianapolis. "This is why many of us went into bioethics in the first place -- because we were concerned about fairness and access and the role of medicine in caring for patients."

Art Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, agreed.

"We can't afford to wait. The access problems are ridiculous," he said. "That you have 50 million uninsured people is the worst kind of rationing."

Health care is a right, Caplan said, but not an open-ended one. Americans should agree that everyone won't get everything they want from an overhaul, he said. Lower-income people shouldn't expect to get extras such as private hospital rooms and breast implants covered by insurance, for example, but reform should provide a floor beneath which they can't sink.

"Morally, the issue should be what's a decent minimum?" he said.

Putting the onus on Americans to rein in unhealthful habits such as overeating and smoking instead of passing a package of new insurance regulations and coverage extensions would miss the mark, Caplan said, calling some critics' focus on personal responsibility "a complete red herring."

"The same Republicans who killed helmet laws, who fight for their right not to wear seatbelts, who want to disconnect the airbag are talking about personal responsibility?" he said. "It's complete ideological hooey."

Upside to higher costs?
Still, the overhaul may not have enough cost-containment provisions to work as planned, said Haavi Morreim, a bioethics professor at the University of Tennessee Health Science Center in Memphis.

"I've long thought we are not likely to get health reform that sticks until and unless we get a handle on costs," she said. "Our system is fundamentally inherently highly inflationary because it involves fee for service with third-party payment."

"If we simply open the doors under the current system to another several tens of millions, it is difficult to envision that anywhere in the near term we will have anything but a substantial escalation in how much we're spending," she said.

But that unintended outcome, should it happen, may have an upside, Morreim said. See related story on estimated cost savings under current health-care overhaul bills.

"If we do see costs rising very quickly, which we saw in creating Medicare and Medicaid, maybe that will finally be the trigger to get some of the kinds of changes in how we deliver and finance care that we've needed for along time."

Extending coverage and eliminating preexisting condition exclusions is critical for improving access to care and cutting down on the amount of uncompensated care that hospitals face, said Marie Hilliard, director of bioethics and public policy for the National Catholic Bioethics Center in Philadelphia.

"People are using Catholic ERs for their general practitioner," she said.

Chasm opens among Catholics
While she acknowledges "an obligation for a society to assure that all persons have access to affordable health care," Hilliard objects to various provisions such as the Senate bill's less-restrictive language on abortion funding and a requirement that everyone have coverage, known as the individual mandate.