limitedgovernment – DOSS ECONOMICS https://alexisdoss.agnesscott.org A Contemplative Platform Dedicated To Understanding Health Economics, Health Policy, Health Services and Health Care Mon, 09 Dec 2019 01:48:56 +0000 en hourly 1 https://wordpress.org/?v=5.3.2 https://alexisdoss.agnesscott.org/wp-content/uploads/2016/11/cropped-bw-me-32x32.jpg limitedgovernment – DOSS ECONOMICS https://alexisdoss.agnesscott.org 32 32 The Social Contract within American Medicine https://alexisdoss.agnesscott.org/health-politics-political-thought/the-social-contract-within-american-medicine/ https://alexisdoss.agnesscott.org/health-politics-political-thought/the-social-contract-within-american-medicine/#respond Fri, 31 May 2019 07:46:34 +0000 http://alexisdoss.agnesscott.org/?p=218

Photo: “Social Contract and American Healthcare” by Alexis Doss
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Purpose: As an intern for a respected lobbying firm in Washington D.C., I had the tremendous honor of attending many congressional meetings on Capitol Hill. I attended one in particular that explored whether the government or the physcician/provider should have input in health-related decisions that affect the patient. I believe in little to no government participation, given that physicians are the preeminent stakeholders that best understand the elements that contribute to disease and health than any other healthcare actor. This brief will prepare for further economic analysis of how political philosophy can certainly impact health policy and healthcare regulation. I hope to utilize this perspective as a foundation for further interpretations and economic evaluations of sustainable health policy. This post demonstrates my ability to associate political philosophy with healthcare policy.

The understanding of a social contract is arguably the most pivotal aspect of the health care system in the United
States. Unlike other nations in the Western hemisphere, the United States has implemented a more dispersed model of health care procedure; that is, pluralism in the medical profession is revered, specialization and up-to-date technology are highly valued, and emphasis on tertiary care services is greatly preferred. Patients would not accept these specificities if they weren’t openly engaged in and approved of a social contract with the health care system and, more specifically, the physician in practice. 

Social contract theory is a moral and politically philosophical idea rooted within the “state of nature” paradigm of political theory. It is, essentially, the notion that demonstrates the reasoning in which (perceived) rational individuals decide to voluntarily consent to renounce their natural freedom to obtain the benefits of order and accordance. The individual gives up her rights to the state for a myriad of reasons, such as for security, safety, and protection.

This relationship between the state and the individual is analogous to the relationship between the physician and the patient. The physician/patient social contract is an agreement between two parties: one party, the patient, relinquishes her right(s) to acquire medical training and expertise and entrust her physical, social, and mental wellbeing to her physician; the other party, the physician, must provide adequate care to enhance the health conditions of the patient and ultimately prevent death. Principally, “professional sovereignty” of physicians is granted for the betterment of patient health outcomes.

Our interactions, transactions, correspondence, and procedural endeavors rely on the agreement set forth by the patient and the physician. If the relationship is not established, the success of the health care system would inevitably be non-existent. The providing of medical and health care to those in need embodies a certain level of
professionalism. Within the context of American medicine, the physician/patient relationship is the “medical” version of social contract theory, for “in return for the privilege of autonomy, physicians bear the responsibility for acting as the patient’s agent, and the profession must regulate itself to preserve the public trust” (Bodenheimer and Grumbach, p. 57).

Bibliography

Bodenheimer, T., & Grumbach, K. (2016). How Health Care Is Organized – 1: Primary, Secondary, and Tertiary Care. In Understanding Health Policy: A Clinical Approach (pp. 45-59). Place of publication not identified: McGraw Hill Education.

Earning Patient Trust Crucial to Health Care Reform. (2017, April 27).
Retrieved February 05, 2019, from
https://deloitte.wsj.com/cio/2015/04/27/earning-patient-trust-crucial-to-healthcare-reform/

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The Role of Government in the U.S. Healthcare System https://alexisdoss.agnesscott.org/health-politics-political-thought/the-role-of-government-in-the-u-s-healthcare-system/ https://alexisdoss.agnesscott.org/health-politics-political-thought/the-role-of-government-in-the-u-s-healthcare-system/#respond Fri, 05 Apr 2019 06:40:21 +0000 http://alexisdoss.agnesscott.org/?p=198

 

Photo: “Role of Government and American Healthcare” by Alexis Doss
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Purpose: This is a work that I completed while interning for the Healthcare Leadership Council in Washington D.C. After attending a multitude of Congressional hearings, I have settled on the belief that limited government regulation of healthcare is necessary. That is not to say that no regulation is the solution. On the contrary. Regulation is necessary, but only to a certain degree, especially in domestic and global healthcare markets. This brief essay explores this idea. This will be used to supplement my understanding of how decisions to regulate are reliant on economic modelling and evaluations. This post highlights my strength in stating a claim and supporting it with contextual evidence. 

Drug development and medical procedures are becoming relevant matters within the healthcare industry, and these topics of interest have influenced debate over whether the government should determine the effectiveness and/or cost benefit of every procedure or drug offered to patients. Countless authorities have expressed that since there is not sufficient evidence to support the assumed functionality and cost-effectiveness of drugs and procedures, the government should intercede and determine what options should be accessible to healthcare consumers and patients. I argue for a collaborative solution, an approach that understands that government intrusion can stifle innovation and experimentation for treatments, procedures, and drugs, while still acknowledging that some level of government oversight is necessary to combat developments that could potentially harm patients. The government should not regulate which treatments are offered to patients; however, it can make recommendations as to the clinical testing of such pharmaceuticals.

              When policymakers are faced with a dearth of evidence regarding drug developments and treatments, clinical testing is an ideal solution. The Food and Drug Administration (FDA) and other publicly-funded entities such as the National Institute of Health (NIH) serve this exact purpose, for both were designed to ensure the safety and security of patients that utilize pharmaceuticals, medical devices, and biological products. As healthcare companies invest millions upon millions of dollars in research development, the government can also fund research projects intended to protect the public health. Furthermore, policymakers should consult with medical practitioners before such determinations are made. Physicians are the primary agents that fully recognize the complexity of medical care because some approved (and unapproved) therapies may be the key to providing relief for patients undergoing severe medical ailments. Fundamentally, a physician’s perspective is superior to that of the policymaker, for the policymaker has no jurisdiction on how certain treatments may or may not be appropriate for patients.

              With right-to-try laws gaining popularity in the United States, for example, more patients are gaining access to experimental therapies (drugs, biologics, devices) that could potentially cure (or simply relieve) their ailments. As these treatments typically proceed past Phase I of testing, they are not approved by the FDA. These pieces of legislation allow for medical decisions to return to the patient and grants the doctor the privilege to evaluate the effectiveness of these drugs on a case-by-case basis, as all patients have different susceptibilities and reactions to a myriad of drugs, biologics, and devices. Although this is a pivotal move that provides more agency to the provider, the government could also impose a requirement in which clinical trials are still implemented to ensure the solvency of the treatment. In many cases, once unapproved drugs become accessible, research testing for their effectiveness stalls and no further experimentations are done to approve the treatments. Accountability measures imposed by the government may be necessary to guarantee that these unapproved biologics, drugs, and devices pose no harm to the public.

              This matter emphasizes the increasingly apparent struggle between the role of government in ensuring the public health and the role of the physician in providing services, treatments, and drugs to patients. Healthcare is multifaceted with various actors upholding different responsibilities. Healthcare cannot be completely dependent on government control or only reliant on the decisions of the doctor. Administrative costs, healthcare expenditures, affordability and other factors must be considered to create an effective healthcare system. Essentially, the policymaker and the provider must work together to deliver a system that promotes quality care for the patient and the consumer.

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