Some preliminary thoughts on healthcare

Hello! I moved to DC this past weekend and now am done with my first week at the Primary Care Coalition (PCC) of Montgomery County. PCC is a non-profit that aims to provide high-quality, cost-effective, and culturally sensitive care to low-income, uninsured people. It's been crazy because the last fellow, Aditi, is trying to show me the ropes before she leaves next week. Thus far, I've been mostly meeting with the directors and coordinators of the programs under the auspices of PCC.

As soon as I stepped back from the hectic schedule of the first few days, the philosophy major in me began to reflect on some basic questions at the intersection of ethics and health care. Obviously can't speak to the complexity of such questions in a quick, rambling, blog post, but thought I'd mention a few I'm excited to think about and gain real-world perspectives on. I'd be interested in hearing my other fellows or others' opinions on them.

First of all, the ramifications of distinguishing between quality health care and health care interests me. If some sort of obligation to help people who can't afford it get health care in fact exists, is this an obligation to provide the best, or very good, health care? Or is it just to provide health care, unqualified? (Analogously, we may feel as though we should provide phones or laptops to people who cannot afford them. However, we may not feel as though we should provide iPhones to those who already have LG Chocolates. Which, from personal experience, are just terrible.)

Second, if there are clear rational incentives to thinking that strangers shouldn't get health care on our dime, what would justify a responsibility to subsidize their health care? After all, we're taking a financial hit by subsidizing their care via Medicaid/Medicare, or just paying a ton for ER services. We're maybe taking a quality of care hit too due to the increased burden/strain on the health system. There's a fairness issue here: why should we take a hit to help others when they're not doing anything for us? (Conversely, are we being unfair to them by not giving them access to care, or good care?)

And, are the harms we experience marginal enough to be outweighed by a stranger's recovery? What of a 90-year old stranger living another year? What of a stranger living another day in the ICU, which can be exorbitantly pricey? There is an intuitive difference in the value to me of one more day in the life of my mother, versus one more in the life of someone I never have nor never will meet. Is that an intuition I should reject? These questions are hugely controversial - health care rationing is unavoidable and already happening because health care is not an infinite resource, but this term seems to me to have been co-opted by political figures to mean something terrifying and evil.

Maybe the most central issue to me is whether health care is or is not a fundamental human right. This is because I vividly remember writing my application for Princeton Project 55 and terming it as such. Given further thought, I don't know what I meant by this. Or whether I meant quality, equitable health care or health care unqualified. A lot of the arguments for fundamental human rights seem to me to be tautological - I'll have to think hard about this since the "self-evidence" justification makes me uneasy. Maybe there are other reasons to for providing health care to all - for the functioning of a democratic society (unhealthy people have a harder time participating), for a more productive population that is less of a burden on poverty assistance programs, and many more. I'll have to think long and hard about this question in particular this year.