Introduction
The ethical issue in the financing of healthcare is the cost of medications and their effectiveness or ineffectiveness. Due to these high costs, providers are unable to cover all needs of the aging nation. More controversial issues will arise, transforming healthcare in the United States.
How Policy Decisions Are Made
Current policy decisions are based on a variety of factors, including the overall financial support that programs of government insurers (such as Medicare or Medicaid) or private insurers can provide, eligibility criteria (or a lack thereof) in different states, and the price and effectiveness of new drugs. New drugs and health technologies play a specially important role as both public and private insurers can rely on the information provided in scientific reports and by the manufacturers of drugs and technologies to evaluate their effectiveness and determine whether the coverage of these medications would be cost-effective.
As the U.S. Supreme Court stated that the expansion of the Medicaid program to all individuals younger than 36 and at or below the 138% poverty level is unconstitutional, the states can independently decide whether they support the expansion or not (Milstead, 2016). An obligatory expansion could improve the process but, at the same time, it could also limit the opportunities for other individuals under Medicare or Medicaid or private programs.
An example of the difficulties that both public and private insurers experience is the drug against cancer, Provenge, discussed by Stein (2010). The Centers for Medicare and Medicaid Services conducted a national coverage analysis of the medication, which triggered anxieties and alarms among cancer experts and patients, lawmakers, and advocacy groups. The drug’s effectiveness, its high cost, and specifics of the therapy were considered as factors that downsized the cost-effectiveness of the medication in the eye of the Services’ administration.
The high cost of the treatment ($270,00 per year) is believed to be unaffordable for society (Stein, 2010). As private and public insurers were unable to support it due to its expensiveness and low efficiency, many patients had to face the fact that their life-prolonging treatment was impossible to obtain.
Cost and Care
The ethical issue that arises here is the problem of the price that both patients and insurers have to consider. Patients who have terminal illnesses are ready to invest as much money as they can to prolong their life, but not all patients have this opportunity. While insurers could provide help, they have to consider other factors (such as the needs of other patients with less specific, costly, and unique treatment plans) to ensure that all members of the program are covered. It should also be noted that some gaps in the system, such as physician’s need to order various analyses to avoid fees for readmissions also lead to a decreased cost-effectiveness of healthcare (Tilburt et al., 2013).
Another problem is that the aging population will grow, multiplying the number of members of Medicare and Medicaid. As Fleck (2013) points out, “this aging out of the population implies dramatic increases in the incidence of cancer and equally dramatic increases in the cost of treating those patients”, especially in the case of targeted therapies (p. 128). The rising burden of expensive care will negatively affect patients with rare conditions and/or costly treatments, leading to more ethical problems and tensions.
All patients need to have the right to receive adequate care, but insurers will be unable to cover the costs of some of these types of care, thus deciding whose life deserves to be prolonged and whose does not. The rising demands of the aging population will only aggravate the issue. New types of coverage that will include patients with costly and rare therapies will be needed more than ever and can potentially cause a transformation in healthcare.
References
Fleck, L. M. (2013). “Just caring”: Can we afford the ethical and economic costs of circumventing cancer drug resistance? Journal of Personalized Medicine, 3(3), 124-143.
Milstead, J. A. (2016). Health policy and politics: A nurse’s guide (5th ed.). Burlington, MA: Jones and Bartlett Publishers.
Stein, R. (2010). Review of prostate cancer drug Provenge renews medical cost-benefit debate. The Washington Post. Web.
Tilburt, J. C., Wynia, M. K., Sheeler, R. D., Thorsteinsdottir, B., James, K. M., Egginton, J. S.,… Goold, S. D. (2013). Views of US physicians about controlling health care costs. JAMA, 310(4), 380-389.