Bioethics Blogs

The Unique Challenge of Healthcare Reform in the US, and Why it Might All Fall Apart

Those of us who aspire to eventually having an affordable,
quality, accessible healthcare system for all citizens, or even for most
citizens, must first face an obvious but under-discussed challenge that
uniquely American: The major players in the US healthcare system—including
private insurance companies, pharmaceutical companies, medical device and
equipment makers, medical specialties and sub-specialties, healthcare
organizations and their executives and shareholders, and all of their lobbyists—are
motivated by their own economic self-interests first and foremost. Which means
our aspirations must be viewed as a long-term struggle.

Healthcare in American is simply unfettered capitalism at
work. Let me hasten to add, this is not to say that all of these entities don’t
do some remarkable work—I owe my life to the U.S. healthcare system as do
millions more. But the fact remains that much of the extravagantly high costs
of medical care in the U.S. healthcare system has nothing to do with improving
or adding quality care for patients and producing good outcomes. Rather it’s a
reflection of how these key players pursue their own entrenched financial
interests, while creating narratives to the public that the services they provide
is essential for quality healthcare. Interestingly, over time, this bloated,
inefficient system has been generally accepted by the public and therefore
gained a façade of legitimacy that makes it virtually intractable to reform.

In this light, it is quite remarkable that the Affordable
Care Act (ACA) is actually less expensive than was originally forecast and
during its implementation so far overall healthcare costs are declining. These
encouraging cost considerations notwithstanding, the primary virtue of the ACA
is its very modest goal of expanding healthcare coverage for more citizens
within the confines, more or less, of the status quo US healthcare system.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.