Providence News  September 2009

|   Healthcare Reform Ethical Pillars: Touchstones for Dialogue

TINLEY PARK, ILLINOIS (December 2009)  | In order to contribute positively to the healthcare reform debate currently in play across our nation, the Ethics Committee of Providence Life Services has reviewed our own institutional ethos regarding this public policy discussion and generated ten ethical "pillars" or standards designed to support a productive discussion of any specific policy proposal.

Our pillars for an ethical foundation are intentionally rooted in our understanding of an historic biblical faith tradition, a world-and-life view that, without apology, has implications for every aspect of God's creation. While our tradition is distinct, we believe these principles are logical, well-informed, cohesive in thought, and held in common by a majority of our fellow citizens.

We understand that it is unlikely that a specific legislative proposal will meet every social health care objective in its fullest sense. Compromise is the hallmark of the legislative process in a diverse democracy. However, if our ethical foundation is not rooted or anchored somewhere we would never know if we were being pulled off course.

The point of this exercise is not to use the pillars as a drafting bench for legislation. Rather, these are designed as an ethical environment within which the intent and the "the reason we came to the dance." In our case, the reason specifically is to enhance the healthcare of our clients and the senior citizens of our nation.

We believe that any healthcare reform proposal:

• Should increase access to healthcare services for those lacking such access today. If it fails to accomplish this, it would, in large measure, fail in a principle element of its purpose.


• Should not decrease the availability or the quality of health care services for those who are insured. This would be nothing more than a zero sum game, with winners and losers. Enhanced access for some must not decrease access or quality for others.
• Should not reflect any "ageism" or bias against the elderly. Societies have not always protected the young, infirm, or elderly as they should. Our special mission is to assist in that protection.


• Should increase choice within the healthcare system. Individuals should be free to choose their provider — including a private purchase provider — or enter into "systems of care" where the provider panel is established and known in advance, regardless of what other insurance or government options exist.


• Should be adequately funded so that providers are reimbursed for the costs of any mandates. Wealth sharing or cost shifting is a more appropriate role for government or philanthropists, not those tasked with care decisions.


• Should include Quality Assurance programs and "best practices" that have broad professional, consumer and government participation. Any program mandated by one or two of these groups, without the significant concurrence of all three parties, will be biased and misleading.
• Should include malpractice reform. The costs of "defensive medicine" and frivolous lawsuits are documented in various places. Healthcare reform that does not address malpractice reform will not be comprehensive.


• Should be a system paid for by those that use it. Reaping healthcare benefits and laying the costs on future generations is irresponsible.


• Should include a "conscience clause" that protects those individuals and institutions required to participate from providing service inconsistent with their beliefs. Providers must communicate their positions to persons choosing their services; they must also be allowed to remain true to their basic beliefs.


• Should have the strength of ownership. Designers of a new healthcare system should embrace it to the point of participation.

NOTE: Much has been said about fraud and abuse in Medicare and Medicaid. We concur that there has been (and probably will be) significant abuses of the system. However, we disagree with the suggestion that new healthcare reform will be able to be paid with savings from fraud control. We are skeptical of the magnitude of resources that could be garnished from fraud eradication measures.

Also, we want to acknowledge that inherent in a single payer system, should one ever be proposed, is the prospect of a single determiner making decisions between many of the social ideologies that exist across the American landscape.  If the debate moves toward a single payer system, methodologies for resolution of conflicting and deeply held religious beliefs — such as abortion, end-of-life decisions — would need to be included.