Allocating Health Care Fairly

The Challenge

While we rightly debate the implications and ethics of new biotech treatments, we have yet to resolve basic questions about access to health care in general. We also have not determined if we have any responsibility to make the benefits of our health system available to all, or-as individuals-whether to accept responsibility for keeping ourselves healthy.

What's at Stake

Somewhere in between the war on terrorism and the collapse of the tech boom, the difficulties average people face in securing adequate health care fell off the front pages of the newspaper. But the desperate need that fueled demand for greater Medicare prescription coverage, for health care for the uninsured, for inexpensive AIDS drugs in the developing world-these fairness issues must resurface in the coming year. In the Bay Area, for example, thousands of senior citizens covered by Medicare HMO Secure Horizons saw their co-payments for chemotherapy jump from $25 to as much as $550 per treatment because, the insurer argued, federal reimbursements have not kept pace with rising health costs. At the same time, many people suffer from illnesses to which they themselves have contributed through behaviors such as smoking. As we understand more about the relationship between personal behavior and health, we must examine how far individuals must go in accepting responsibility for the consequences of their own actions.

Critical Questions

• Is it up to society to provide universal access to health care? If so, what would minimum care look like?

• Do limited resources mean there must be a trade-off between the pursuit of high-tech therapies and the provision of basic medical services? If so, how should we decide the proper proportions to provide of each?

• Are there some therapies so vital to world public health that they should be taken out of the realm of profit making and provided freely? If we did this, how could we encourage research on new drugs?

• If we smoke, overeat, consume too much alcohol, or drive too fast, is it fair to expect society to bear the costs of our health problems?

May 21, 2002

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