A-CAPS 4360 Moral Issues in Society

A-CAPS 4360 Moral Issues in Society

Keep in mind that given the scope of the paper, the individual nature of the projects, and the interests of the writer, the emphasis on different components will vary. However, this paper “gets the job done.”

Hays County Healthcare District and Access to Healthcare for the Underprivileged

Introduction

Even as the United States creates new laws intended to broaden access to healthcare, the services offered are being stretched beyond their capacity to provide coverage.While government and non-profit funded institutions make large strides to provide healthcare services for this large portion of the population, they are notoriously under-funded and in some cases not available in the areas with the highest level of need. Of the thirty industrialized nations, the United States is the only remaining country that “does not guarantee access to healthcare as a right of citizenship (Case).” The resulting consequences are astonishing. At least twenty nations have better statistics than the U.S. in regards to infant mortality, life expectancy, and immunizations (Case). Health is a fundamental prerequisite to any other good hoped to be achieved in this life. The United States has failed to provide this basic need for all of our citizens. We must address this critical issue by implementing an economically sustainable solution to provide access to quality healthcare for all citizens.

Many citizens without access to primary care, education, and funding delay addressing health issues until their symptoms escalate to a crisis state. Delays can have catastrophic consequences. Treatable symptoms from the flu have a tendency to escalate to potentially deadly pneumonia. The only option at that point is emergency care, which is incredibly expensive compared to preventative care. When these patients are unable to pay, the hospital is left covering the cost at a financial loss. There is also a negative impact on the Emergency Room physicians’ ability to care for patients who are truly in an emergency situation such as being a victim of a car crash.

The Situation in Hays County

Hays County, Texas is a rural community that has been historically underserved from a healthcare perspective. The introduction of the recently opened Seton Medical Center Hays (SMCH) and upcoming Communicare Clinics are striving to close these critical gaps in the community. The creation of a healthcare district in Hays and surrounding counties would provide much needed funding towards these critical services.

Key Term:Healthcare District - A local tax base created to direct a portion of tax revenue towards healthcare

A key partnership that has developed in Hays County is that between Seton Family of Hospitals and San Antonio based Communicare. Communicare is classified as a Federally Qualified Health Clinic (FQHC). “FQHCs have survived to become active participants, if not owners, in the newer market (Adams 380).” As Adams points out in his article, FQHCs play a critical role in distributing healthcare to those with the highest level of need. By distributing primary and routine care to the FQHCs the critical and expensive Emergency Room space is freed to focus on treating trauma and other emergent clinical cases. Like many FQHCs, Communicare provides services for mental, vision, and dental health as well as family planning and access to general practice physicians.

Key Term:FQHC – Federally Qualified Health Clinic. A clinic that is authorized to provide Medicare / Medicaid services. Services are partially funded by the federal government.

Federally Qualified Health Clinics

FQHCs serve the neediest members of our society. 10% of the 71 million patients seen by these facilities each year are uninsured. One in three are Medicaid patients, and the majority are living at or belowthe federal poverty level. A large percentage do not speak English proficiently and many are homeless(Rust, mla317). Rural counties without an FQHC have a noticeable impact on Emergency Rooms.“We recently found a 30% absoluteexcess of uninsured emergencydepartment visits in ruralcounties without an FQHC comparedwith counties that did havea health center(Rust, 317).”Because of the efficiencies in the FQHC model these clinics are able to right-size care to their core set of patients, removing large costs from the effort in the process. FQHCs significantly reduce the burden on hospitals and Emergency Rooms by providing preventative and long term treatment to patients outside the hospital environment. Communicare even goes as far as to assist patients with the Medicaid qualification process to ensure they are not denied access to critical healthcare services.

National & Global Perspective

The issue has a far broader reach than Hays County, Texas. According to the American Journal of Public Health, 46 million Americans are without insurance. Add another 10 million Americans who may have insurance but are categorized as “medically disenfranchised (Rust 317).” Texas has the most uninsured of any state at 24%. This figure includes the uninsured as well as those who live in medically underserved areas (Rust 317).

Poverty is listed by the World Health Organization as the root cause to 45 percent of the “disease burden in the poorest countries (Campaign).” Many of these diseases such as diarrhea, measles, and tetanus have known treatments that if properly distributed globally could save 3 million children annually (Campaign). “Poor nutrition, indoor air pollution, and lack of access to proper sanitation and health education” are all listed as symptoms of poverty that lead to high rates of disease (Campaign). Education and adoption of known treatment programs would raise the quality of life and life expectancy itself across the world.

E.K. Adams is the author of one of the scholarly articles referenced for this discussion. He was at one time affiliated with Emory University’s Rollins School of Public Health. This illustrates the connection of the topic to the scholarly discipline of Public Health. According to the school’s website, their mission is to educate students in public healthcare issues that have the highest impact on the global society (Rollins.) The Public Health discipline is a much broader category than local healthcare districts. Other sample topics include a more global perspective of healthcare trends including illnesses, epidemics, and success of various treatment options. The school provides access to research on disease transmission, funding healthcare, healthcare education, and research into the cause and potential cures of terminal illnesses.

Rollins is located in Atlanta, which is billed as the “Public Health Capital of the World” because of the multiple Public Health entities based there including the Center for Disease Control, American Cancer Society, Arthritis Foundation, and many others. Because of the location, students and professors at the university have direct access to some of the best research in the world. There is a global community approach applied in the field, where contributors come from across the nation and the globe to collaborate on pressing healthcare issues. When research is performed by one entity it is routinely leveraged by the next to take solutions to the next step. “The mission of the Rollins School of Public Health of Emory University is to acquire, disseminate, and apply knowledge, and train leaders to promote health and prevent disease in human populations around the world (Rollins).”

Local Financial Challenges

As with any complex issue, funding plays a critical role in addressing the healthcare gap. Seton and other non-profit organizations do much to contribute to the community by providing an extraordinary amount of free services. Even a non-profit must watch the bottom line though. Seton and similar organizations are forced to manage charity care in a similar manner to corporations managing their daily business. In order for Seton to continue to sustain service to the community over the upcoming decades and centuries expenses must be balanced with income. This is where government enters the picture. Medicaid is a joint state and federal program that provides medical coverage for those who qualify based on financial status (Medicaid). Not all physicians, clinics, hospitals, and pharmacies accept Medicaid as a form of payment.

Even with all of the best intentions and efforts of FQHCs such as Communicare and not-for-profit hospital networks such as Seton, resources are expensive and require funding. If these organizations were to simply donate all of their services they would run out of funding sooner rather than later.

Proposed Solution for Hays County

The creation of a healthcare district would allow these operations to sustain themselves for years to come. Reallocation of existing tax revenue is needed to fund this model long-term. According to Herb Dyer, Chief Operating Officer at SMCH, Hays County currently provides approximately 2% of tax revenue to healthcare services. This compares to 10% in nearby Travis County, which does have a healthcare district (Dyer). The impact of the district in Travis County has been tremendous. This funding offsets the losses realized by Seton in Travis County and could do the same for SMCH and Communicare in Hays County, ensuring the longevity of these services to those in most dire need.

Achieving the goal of creating a Hays County Healthcare District will not be easy. The decision must come to a county vote for approval. Dyer has created a coalition in the Hays community to raise awareness of the issue. The Seton Executive is showing his political savvy by choosing to time the introduction of a vote wisely. Up for vote in coming months is annexation of Hays County into the Austin Community College (ACC) zoning. This is a very popular proposal in the community that will bring education opportunities as well as more business (and in turn tax revenue) to the area. Seton also partners with ACC in a Nursing Education program. So by waiting for the ACC initiative to clear the polls, Dyer and his coalition can continue to gain political and build momentum towards a potential ballot initiative for the healthcare district within the next 2-3 years. By this time, SMCH and Communicare will have contributed significantly towards providing free healthcare to the community and will be well-deserving of the tax basis a healthcare district could provide.

Values and Obligations

What motivates organizations such as Seton and Communicare? What justification exists for re-routing tax dollars and raising philanthropy to support healthcare for those who cannot afford to pay their own way? Why should we, as a society, support the creation of a healthcare district for Hays County? How will this justification be reconciled with those who oppose the concept? These are all important questions that must be answered in order to understand the moral imperatives as well as the pragmatic consequences of such a program.

Seton began its work providing healthcare in Austin in 1902, founding the hospital on Catholic principles as described in the mission statement on the organization’s current web site. Seton later became a local ministry of the national Ascension Health network. At Seton’s 100th anniversary, leaders at Ascension issued a call to action for their associates to make the following commitments.

Healthcare That Works

Healthcare That Is Safe

Healthcare That Leaves No One Behind

Seton is committed to these values and holds associates accountable to upholding them in all course of business. “Healthcare That is Safe” is honored by the organizations fastidious evaluation and prevention programs for patient falls and negative drug interactions. “Healthcare That Leaves No One Behind” speaks to the obligation of the hospital to provide healthcare for all that are in need. “Healthcare That Works” acknowledges that the Seton model must be economically sustainable for the long term in order to meet the goals of the other two tenants. A charitable organization cannon thrive and continue to grow for over a century without understanding the important impact of financial sustainability.

Kantian Motivation

These values are clearly in line with Kantianism. Seton provides access to healthcare to the poor because it is “the right thing to do” regardless of the consequences. The services provided by Seton support Kant’s Universal Law Formulation,“Act only according to that maxim by which you can at the same time will that it should become a universal law (Kant 39).” The point here is that it is a moral obligation to provide access to healthcare for all, regardless of their ability to pay. This is a basic fundamental right for each human being, not a privilege that should be accessible only to those who can afford it.

Kant believed in a universal truth that is free from contingency and empirical observation (Pojman 143). Kant’s first categorical imperative removes the “if” from decision making. There is no reason consistent with Kantianism that would declare healthcare as a privilege for those who can afford it. Rather, access to healthcare is a basic human right that should be available universally. To deny access to healthcare to an individual based on inability to pay would be to act immorally according to Kant. Kant outlines the following test for refraining from helping others.

A man is flourishing, but he sees others who have to struggle with great hardships…and he thinks, “What does it matter to me? Let everyone be as happy as Heaven wills or as he can make himself; I won’t deprive him of anything… only I have no wish to contribute anything to his well-being or to his support in distress.”

According to Kant’s second categorical imperative, we must “treat humanity, whether in your own person or in that of any other, in every case as an end and never as merely a means (qtd. In Pojman 154).” Kant believed in the sanctity of human life. We are obligated to treat all human beings with dignity. We must act towards others in a universal manner. There is not an option to provide access to basic human needs to one group of people over another. The current healthcare system in America does not provide equal access to all citizens. Kant would not allow us to will our system to be universalized. Therefore it must be changed.

Providing access to healthcare for anyone who needs it removes the circumstances of chance that are uncontrollable by individuals.The socioeconomic standing a child is born into is pure chance to that individual. If we accept the premise that all children are innocent and deserve to be protected, we must rationally conclude that we must provide healthcare to all children, regardless of the ability of their parents to pay. If we also accept the premise that all human life is precious and that we must protect it whenever possible, we cannot reject the concept that society is responsible to ensure the best healthcare available is provided to all who are in need.

Utilitarian Reason

The creation of a healthcare district can further be justified by taking a more pragmatic viewpoint.It is less expensive to society to provide access to preventative and long term healthcare and health education than to treat the conditions that arise when being forced to treat patients that have ended up in an emergency room because they have neglected a serious medical condition for the simple fact that they could not afford to visit a doctor. In order for Seton and Communicare to sustain their charitable healthcare contributions, they must receive additional funding from the government.

There are many who oppose this as another socialist governmental expansion requiring hard-working citizens to contribute more tax dollars to the less fortunate. By leveraging a Utilitarian perspective and value-set, proponents of the healthcare district are able to justify the proposal as providing “The Greatest Happiness for the Greatest Number (qtd. In Pojman 107).” Putting the issue into terms of monetary cost to society places perspective of how the proverbial ounce of prevention is worth more than a pound of cure.

By creating a healthcare district that will re-route tax dollars currently being spent cleaning up the mess left by treating illness in the emergency room to clinics and healthcare education, less overall cost will be required to increase the overall health of the citizens of the community. These citizens are then able to further contribute to society, expand business, and increase the economy, and so on to create a domino effect of further wealth and overall improvement to the community. This is the essence of the Utilitarian Theory of providing the most happiness to the most people. Kant’s values are also met by providing healthcare to all simply because it is the right thing to do.

Conclusion

So whether you subscribe to Kantianism or Utilitarianism, creating a healthcare district is the right thing to do for Hays County. Providing access to tax dollars for the purpose of funding healthcare programs for the community is both morally justifiable and financially pragmatic. This ideal state of the future would provide the most happiness for the most people while at the same time satisfy the moral imperative to provide the basic human right of healthcare to all.

My Journey

I have worked as an Information Technology (IT) consultant to Seton Healthcare Network since 2004. In that time I have managed the IT scope of major construction projects for Seton. This included the design, build, and occupancy transition of Dell Children’s Medical Center of Central Texas and Seton Medical Center Hays (SMCH) as well as the design of Seton Medical Center Williamson and Seton’s Executive Administration Offices. Having worked with Seton Executives and clinical staff for the past six years, I have gained an appreciation for the complexity of the healthcare industry. From the vantage point of a technologist and a business student I have beenexposed to the intricate network required to support healthcare. In the planning phases of each construction project there are no fewer than 45 departments involved, each with its own detailed requirements and perspectives that must be considered in order for a hospital to run efficiently and effectively in serving patients.