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Ethics, Business, and American Medical Care

The American medical care program is one of the major spenders of the federal tax revenue. The healthcare sector has experienced a significant increase in allocation. However, millions of people are still being forced to pay substantial amounts of money to get quality healthcare. The health insurance companies have taken the cue and made healthcare provision a lucrative business which is unethical. This essay investigates the ethical issues apparent in the American medical care and how private health insurers have managed to con the public while making profits for themselves. The essay will also compare the healthcare systems of the US and the UK showing the percentage of money allocation and how effective they are in enabling provision of quality health care. Analysis indicates that the US and the UK spend almost equal percentage of their total spending on healthcare. The US is not capable of providing universal healthcare even if the allocated percentage is increased because there is mismanagement of funds that makes the system ineffective.

Part 1: Sicko

Sicko is a documentary by Michael Moore that was made in 2007. The producer analyzes the healthcare systems of different countries including the US, the UK, Canada and France. Through telling the stories of the people who have interacted with these healthcare systems, Moore was able to demonstrate what works and what does not. Moore performs an investigation concerning the rot in the health insurance provision. Moore established that there are more than 50 million American citizens who do not have medical insurance cover. In most of the cases it was because of the inability of the seeker to make the regular deposits. However, in some instances the insurance companies simply denied the prospective policy holders on questionable grounds such as body mass index. And the 250 million who had a medical policy at the time did not get their expenses covered at their time of need. It was essentially a scam by insurance policy providers to defraud the public of their hard-earned money.

One of the most striking stories is that of Rick. Rick had an accident when operating his table saw. The scene caused him two of his fingers. After the accident, the first thing that came to Rick’s mind was that he had no medical insurance cover. He knew he was doomed and he had no capability of accessing proper healthcare services. After visiting a hospital he was told he would have to pay as much as US$ 60000 to have his middle finger reattached. The cheaper option involved his ring finger being attached for US$ 12000. They were both expensive options. He finally settled for the latter and lost his middle finger. This incident is unethical since the physicians placed money before Rick’s wellbeing. The physicians also did only what Rick could afford. An ethical healthcare system would have placed Rick’s wellbeing first and profitability later. The incident indicates that the health sector is fundamentally flawed.

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Another case involved Dr. Linda Peeno who worked as a medical reviewer. Her story is insightful since she managed to reject the program that made profits on the basis of denial of healthcare. Dr. Peeno worked for Humana. She was expressly instructed to make sure that her denial rate stands at 10%. Increasing the denial rate for medical cover, in fact, got one a bonus or a salary raise. The more denials of claims a medical reviewer could make, the more money the reviewer would earn. The same applied for the insurance company because they would have fewer patients to pay for. To show how crooked the thinking in the insurance industry is, Dr. Peeno points out that the payments made by the insurance company to cater for a patient were referred to as losses. This highlights the motives of the companies; to receive payments but not to make any when needed to. This is unethical. It is tantamount to conning the public. What is more appalling is the efficiency with which the insurance companies move to find a reason not to cover medical expenses. Not making payments becomes a priority instead of the patient’s life yet the patient has duly been making payments via yearly deductibles. An ethical system would have indemnified the policy holders if and when they have a genuine case of need. It would not set a certain percentage of claims denial. What is more, an ethical system would not be obsessed with profitability such that the first instinct after a claim is made is to look for a reason so that the medical cover is not provided. An ethical system would put the patients’ interests above profitability.

Another insightful story involved Tracy Pierce. Tracy suffered from kidney cancer. His wife, Julie, was a healthcare worker at a nearby hospital meaning that Tracy and the children were covered by her insurance. When Tracy fell ill they approached Joseph’s Medical Center, the institution where Julie worked in the ICU department. They were denied assistance despite having a medical cover. Tests were conducted and established Tracy’s youngest brother as a suitable donor of a bone marrow that would have helped Tracy to live. The hospital’s board of trustees still refused them the opportunity. They could not afford it without medical cover. Tracy eventually died of kidney cancer. It was unethical for the board of trustee of the hospital to refuse Tracy Pierce treatment so that they will not have to foot the bill. An ethical system would have covered Tracy’s expenses especially given the fact that he had found a suitable donor to help cure the cancer.

The last case involves the little Mychelle. Her mother, Dawnelle Keyes, had taken an insurance cover with Kaiser Permanente. One day the 18-month old baby got sick. She had severe fever. The mother took her to Martin Luther King hospital for treatment. The management contacted Kaiser for medical cover. Kaiser refused to let the child be treated at that hospital and insisted that Dawnelle had to take Mychelle to their hospital, by car. Mychelle’s developed seizure due to the delayed care. Still Kaiser did not consent to her being treated at the local hospital. When she arrived at the Kaiser-owned hospital, little Mychelle had a cardiac arrest and died. An ethical insurance system would have covered Mychelle’s medical expenses regardless of the hospital that was offering to treat her. Kaiser should have put little Mychelle’s interests first.

Part 2: England

All the aforementioned cases took place in the US. However, Moore paints a different picture of the UK healthcare system.  For instance, there was the case of Eric Turnbow from Washington who benefited from the UK healthcare system paying as little as US$ 10. Eric toured the UK and wanted to visit Abbey Road crosswalk. He decided he would walk across the road on his hands to make it a moment to remember. Unfortunately he broke his arm. The government hospital he visited did not charge him anything for his stay apart from the US$ 10 he paid for his drugs. Any person below 16 years or above 60 years is exempted from making medical expenses. Those within that bracket are only charged a standard charge of £6.65, an equivalent of US$ 10, for drugs if treated in a facility under the National Health Service.

Another case in Moore’s film in Britain is that of a woman who had her entire maternity leave paid for. She was seven weeks to delivery and had six months of her stay fully paid off by the healthcare system. She was not required to pay even a single cent because the national insurance catered for that. The third case is that of a man with a broken ankle that Moore met with. Moore reckoned that the operation is an expensive procedure; surely, the man will be required to pay something. Again, he was wrong. The emergency department operated on the ankle without charging the man anything. In fact, Moore learnt, there was a cashier who reimbursed patients who had used money to visit the hospital yet had reduced means. The UK healthcare system is geared towards offering quality care to the masses. The criteria, unlike that of the US where payment is the major consideration, in Britain it is the patient’s wellbeing.

Part 3: Comparing US and UK Spending

Both the UK and the US governments spend substantial amounts of taxpayer’s money on providing healthcare services. Data from the World Bank indicates that the UK used 9.3% and 9.1% of the country’s GDP in 2012 and 2013 respectively to providing healthcare services. During the same period the US used 17.0% and 17.1% of the GDP in 2012 and 2013 respectively in healthcare services. However, basing the healthcare on the GDP may not paint the bigger picture. The comparison of the expenses needs to be based on the total amount spent.

In 2014, the UK government set aside £129.5 billion for healthcare services. This amounted to 18% of the total government expenditure in that year. The figure increased to £133.0 in 2015 still totaling 18% as illustrated in Figure 1 and 2 below.

 Figure 1: UK Spending in 2014

Figure 1: UK Spending in 2014

 Figure 2: UK Spending in 2015

Figure 2: UK Spending in 2015

The other major expenses included provision of education services which averaged at 12% of the government expenditure and welfare at 15%. Pension expenses also contributed a substantial amount of expenditure since it averaged at 20% which was £143.2 billion in 2014 and £149.7 billion in 2015.

In contrast, the US spends 14% of the GDP on the healthcare system, a substantial amount. In terms of the percentage of spending, the US spent 24% of the budget which totaled US$ 836 billion (CBPP). The amount allocated dwarfs the much allocated to Britain’s National Health Service (NHS). But then, the US population at 321.2 million dwarfs England’s population at 64 million. The US is right to allocate more money. However, the percentage allocated does not correspond to the population increase. There is a more than 250 million population yet the difference in money allocated does not reflect this gap in population. Essentially, the ratio of amount of the taxpayer’s money allocated to the population is greater in the UK than in the US. Figure 3 shows the allocation of taxpayer’s money in government spending in 2014.

 Figure 3: US Public Spending in 2014 (Source: CBPP)

Figure 3: US Public Spending in 2014

However, an increase in the amount of healthcare budget will not necessarily heal the ailing American medical care. The problems run deep. There is the issue of management of the funds. Of the US$ 836 billion that was allocated in 2014, nearly 75% of it, US$ 511 was channeled to Medicare. Medicare money takes care of the elderly above 65 years and the disabled. The total number of people that the amount serves is 54 million. The remaining 25% is appropriated as Medicare and Children Health Insurance Policy (CHIP) and other complementary programs such as the ones introduced by the Affordable Care Act. The population that has to benefit from the remaining 25% is more than 100 million. The implication is that the larger population is allocated less money. The government can only match the amount of money spent by an individual which makes healthcare services expensive. If this system of allocation is maintained, even an increase in allocation or an increase in taxation will not help much. The little amount allocated to the majority is what perpetuates the unethical behavior exhibited by the private health insurers. They understand that the masses need to have a medical cover since the Medicare and other programs are not adequate.

However, while I maintain that an increase in allocation would not bring sanity in healthcare insurance, it will reduce the malaise. It is worth noting that the UK spends only 6% of their expenditure on defense and other military activities. The US spends 18% of the taxpayer’s money amounting to US$ 615 billion to facilitate military expeditions in the Middle East. The US also spends US$ 851 billion on social security, an equivalent of 24% of the total expenditure. The amount is more than what the UK spends on welfare, 15% an equivalent of £109.8 billion. The US should reduce some of these expenses and channel it toward healthcare provision. If the deficit reduces, unethical practices will reduce too.

Conclusion

In conclusion, it is evident that the US healthcare system is ailing. As Moore demonstrated in the film, many private healthcare insurance companies have prioritized profitability over the patients’ wellbeing. Some have gone as far as denying prospective policy holders a chance to be insured on grounds that can only be described as flimsy. Ethical systems have the patients’ interests at heart for example UK’s. The US allocates more money than the UK to the healthcare sector but the UK National Health Service is more effective in providing healthcare services. This can be attributed to mismanagement of the funds. For the allocated funds to make the desired impact, the US administration should change the allocation patterns to match the percentage of the population meant to benefit from the incentives. Otherwise, a mere increase in allocation to the healthcare sector may not improve service provision. The US should, nevertheless, reduce the colossal amounts channeled towards military and defense. Since the war in the Middle East is over healthcare services should now be given the priority over military and defense.

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