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Zoloth: Shrinking resources require redefinition
Healthy populations need "healthy health care systems"
While some focus on the specific policies and standards of achieving a safe, quality health care system in the United States within the existing system, Laurie Zoloth, PhD, professor of bioethics at Northwestern University in Chicago, suggests a broader approach is necessary to achieve "healthy health care systems."
To accomplish that end, Zoloth says, "Obviously, there are two things that I think are equally important, and they come from utterly different directions.
"The first direction is a powerful reconsideration of what health care means, [that is,] to have health care, and the commitment from the Obama administration to have a robust and inclusive system of health care, as opposed to just a market-based, catch-as-catch-can series of collaborations and alliances."
Zoloth suggests that such efforts, beginning with the health care summit orchestrated by the present administration in early March, "will draw a far wider coalition to solve a problem . . . obviously we can't continue to have a healthy economy without healthy health care systems."
She illustrates this with the specter of individuals falling into bankruptcy due to, in many cases, the cost of their health care. "Really, no insurance," covers the cost of care adequately, she says.
"Saying 'yes' means saying 'no'"
In an economy that makes it "difficult to retain one's equanimity of spirit," Zoloth suggests that "health care is a fixed given."
"We have to care for people. To care for people, we have to run hospitals. They're the least able to take any cuts," she says. "But I do believe that saying yes to universal health care means saying no to something. Saying yes means saying no in health care reform."
By that, she says she means that some health care practices that are now considered acceptable will need to be renegotiated.
"Let me be blunt: One of those practices is how much money doctors make in America, vs. any other place in the world," Zoloth says. "There's a direct line between the fact that there's not a universal health care access system in the United States and the fact that doctors, by and large, especially specialists in the United States, make far more money relative to other professions . . . That's just a fact."
Regardless of whether it's the cost of health care insurance or the cost of medical training and medical education — all of which are cited as factors in the cost of care — something additional must be considered.
"There's a sense of right to livelihood that has to be part of the discussion," she says. "It can't just be that patients get less care, or that patients have to pay more, or that certain procedures are considered too expensive."
Everyone in the health care professions and associated businesses, including drug company executives "all have to put remuneration on the table," she says.
The politics of choice
While hospitals across the country address factors such as the increase in uninsured patients due to job losses associated with the economic downturn, Zoloth points out that the public health care system in Cook County in Chicago "shut down critical aspects of the health care system" beginning in 2008 due to budget constraints.
Zoloth maintains that such decisions are not inevitable.
"It's completely a political decision," Zoloth suggests. "If there's a political will to maintain excellent health care, and to say there should be a preferential option for the poor, then there will be a way to do it."
"When we talk about the big salaries and the bloated bonuses for CEOs" such as occurs in public and Congressional discussions of the banking industry today, she says, "that means health care CEOs, too. The market model that failed in the banks also needs to be carefully examined in the health care professions," Zoloth explains.