2. Increasing Costs and Ethical Choices: Health Care in the Industrial World

(1) Although industrial countries have made great advances in health care, today their health-care systems are experiencing some serious problems. By far the most urgent of these problems is financial: medical costs are rising faster than prices in most other areas of the economy. In the United States, for example, nearly $2 billion is spent every day for health care, and this amount is in­creasing at an annual rate of 12 percent. As a result of these increasing costs, access to good health care is being reduced rather than expanded. In Britain, a country with public health insurance, economics has forced the government to reduce the num­ber of hospital beds, to cut back purchases of new equipment, and to employ fewer doctors and nurses. Today certain expensive treat­ments are not available to every patient who might need them. Other patients must wait for up to two years for some types of nonemergency surgery. In the United States, a country with a sys­tem of private health insurance, employers are finding it difficult to provide the same level of health insurance for their workers as they used to. Many are reducing or even eliminating health benefits for their employees. In 1992, for example, it was estimated that 37 million Americans were without health insurance.

(2) The problem of increasing costs is partly due to the ex­pensive new technology that has been introduced into health care. This technology allows doctors to treat a variety of conditions that were incurable and often deadly some years ago. However, the use of the new technology also increases medical costs enor­mously. The costs of purchasing, maintaining, and operating mod­ern medical technology are extremely high. These are costs the health-care providers need to recover; as a result, the costs are passed on to the consumers – the patients – in higher charges for all treatment. For example, a CAT scanner, a machine that en­ables doctors to discover abnormal growths inside a patient's body without operating, costs $1 million to buy and $100,000 a year to operate. A renal dialysis machine, which performs the same func­tions as a patient's kidneys, costs over $35,000 a year to operate for each patient.

(3) For some critics of our health-care systems, a more basic fac­tor in rising health-care costs is this: Our health-care systems place too much emphasis on the treatment of diseases after they occur. Doctors are trained and hospital facilities are built mainly for this purpose. In Britain, for example, 70 percent of the funds for the National Health Service goes to hospitals. According to the critics, the traditional attitude of our health authorities means that we tend to ignore the fact that it is often more expensive and less effective to try to solve medical problems after they occur than to prevent them from occurring. The great infectious diseases of history, these critics point out, were not eliminated by better medi­cal treatment. They ultimately disappeared because there were great improvements in housing and sanitation and because of im­munization.

(4) Today the great killers of the industrial world, for exam­ple, heart disease and cancer, are diseases that are clearly associated with our environment and with the way we live. Tobacco, alcohol, poor nutritional habits, lack of exercise, stress, and environmental pollution can all be factors that contribute to the development of these diseases. Our health-care systems, how­ever, use a large part of their resources for the treatment of the diseases, treatment that is extremely costly and often not very ef­fective. The critics of our health-care systems argue that there needs to be a better balance between prevention and treatment. Some of the money that is now spent for treatment would be better spent for the prevention of these diseases. Prevention is always better than cure, they argue; and usually it is cheaper!

(5) There are, however, some indications that attitudes toward health care are changing. Health-care providers are beginning to emphasize healthy living. The general public, as a result of public­ity about the causes of heart disease and cancer, for example, is becoming aware of the link between disease and the way they live. As a result, many people are changing their habits. They are tak­ing regular physical exercise, cutting out cigarettes, and being much more careful about their diet. These developments are welcome, but more needs to be done before we can achieve a good balance between preventative medicine and curative medicine.

(6) Economic problems are not the only problems that are created by the use of new drugs, new surgical techniques, and new medical technology. Modern medicine has raised a number of serious ethi­cal questions that have not yet been answered in a satisfactory way. One central question is this: Should we prolong life if we can, regardless of the quality of that life? With new drugs and new technology, we are often capable of keeping a patient alive but in­capable of improving that patient's condition. In some cases, the patient remains unconscious, incapable of thought or feeling; in other cases, the patient is conscious and suffers terribly while mod­ern medicine keeps him or her alive. What should be done in such circumstances?

(7) If a conscious patient says that he or she wishes to be allowed to die, some doctors will agree to stop treating the patient. How­ever, it is a very difficult decision. The problem is even more diffi­cult when the patient is unconscious or is a baby. In these cir­cumstances, who takes the decision about life or death for the patient? The doctor? The parents? The relatives? The government? And what should that decision be? If we decide to keep an incura­bly ill person alive, will that use up medical resources that could be used to treat patients with curable diseases? If we allow people to decide about the life or death of others, how can we be sure that the decisions are best for the patient and not merely for the benefit or convenience of the person who is making the decision?

(8) Other ethical problems are raised by progress in genetic research. Doctors are now able to identify genes that carry serious and fatal genetic diseases. Amniocentesis and chorionic villus sam­pling, tests that are performed on women during early pregnancy, are enabling doctors to discover a number of these genetic diseases in babies before they are born. Already women are asking for and receiving abortions after the tests have identified serious genetic defects in their babies. However, is this practice ethically right? Should medicine attempt to solve the problem of genetic disease through abortions? And if abortions become more and more accept­able as a way to avoid giving birth to a severely handicapped child, how long will people have the freedom to choose or not to choose an abortion? There are already influential people who argue that we should not permit people with defective genes to have children. Will there come a time when people are forced to have abortions in order to eliminate new carriers of a genetic disease? These then are some of the problems and questions that modern medicine is forc­ing us to consider.

Main Idea Check

1. Check for the meaning offer this purpose:

a. to treat diseases

b. to train doctors

c. to develop new technology

2. Check back for the meaning of these de­velopments.

3. Check for the meaning of in such circum­stances.

4. Check for the meaning of in these circum­stances.

5. Check back for the meaning of this prac­tice.

6. Here are the main ideas for this section of the passage. Write the correct para­graph number beside its main idea.

___ Modern medicine is forcing us to consider a number of difficult ethical ques­tions.

___ Our health-care systems can be criticized because they place too much em­phasis on the treatment of disease.

___ People disagree about giving abortions to women who have unborn babies with serious genetic defects.

___ The large number of cases of heart disease and cancer show the need to spend more money on prevention.

___ Modern technology has contributed to the considerable increase in the cost of health care.

___ "Should we allow an incurably ill person to die?" There is no agreement about the answer to this question.

___ Health-care systems in industrial countries are experiencing problems because of rapidly rising health-care costs.

___ Although people are becoming aware of the importance of disease prevention, medicine still does not have a good balance between prevention and cure.

A Closer Look

1. Why does the writer use the example of Britain in paragraph 3?

a. to show that increasing health-care costs are causing problems for the health-care systems of industrial countries

b. to show that great advances have been made in health care in the indus­trial countries

c. to show that the British health service is not as good as the health-care system in the United States

2. Why does the writer use the examples of the CAT scanner and the artificial kidney machine in paragraph 4?

a. to show that modern medical equipment can save the lives of patients who are dangerously ill

b. to show that some medical equipment is more expensive and more so­phisticated than other medical equipment

c. to show that modern technology is one of the causes of rising medical costs

3. What may be a more basic reason for the economic problems of our health-care systems?

a. They tend to stress the prevention of certain diseases.

b. They pay no attention to the treatment of certain diseases, like heart dis­ease and cancer.

c. They do not pay enough attention to the prevention of disease.

4. What is not mentioned as being a factor in the elimination of infectious dis­eases in the industrial countries?

a. better sanitation

b. better housing

c. better drugs

d. vaccines

5. The public has received no information about the connection be­tween heart disease and the way people live. T / F

6. Find two possible reasons in the text that a person could use to argue that we should allow an incurably ill patient to die.

7. What is the writer's answer to the question "Should doctors attempt to pro­long life regardless of the circumstances?"

a. Yes. Doctors must do everything in their power to keep a patient alive.

b. No. There may be circumstances where a person should be allowed to die.

c. The writer does not give a clear answer to this question.

8. Some people believe that we should force people who carry se­rious genetic diseases not to have children. T / F

9. What is the writer's answer to the question "Is it right to abort babies who have serious genetic defects?"

a. The writer does not give a clear answer to this question.

b. The writer believes that abortions are wrong regardless of the circum­stances.

c. The writer believes that abortion should be permitted in these circum­stances.

What Do You Think?

What type of health insurance do you have in your country? Is it public, private, or mixed? How could the health-care systems of your country and the United States be improved? Use your reading and your own experience for ideas.