The Moral Failings of Presidential Health Care Politics

By Ruth Faden

It is ethically unacceptable that millions who live in the U.S. do not have guaranteed access to adequate health care.

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Jonathan Ernst / Reuters

Pick your rally, pick your placard. No campaign stop is complete without the obligatory Kill Obamacare! or Save Obamacare signs.

Make no mistake, I am squarely in the Save Obamacare camp. It is ethically unacceptable that millions of people who live in the United States do not have guaranteed access to adequate health care and that so many cannot get the care they need without devastating financial hardship. Obamacare is our only hope in the near term to do something meaningful about these egregious moral wrongs.

But Obamacare goes only a limited way towards addressing health care's other moral failings, and Governor Romney's plan even less.

We all know that healthcare costs are out of control, and that these costs are jeopardizing the system's very future. Behind these costs are immediate human casualties. Medicine's most famous moral maxim, "above all, do no harm," is being violated daily all over this country. Mounting evidence indicates that many patients are harmed, rather than helped, by the health care they receive. Approximately 300,000 Americans die annually from health care-acquired infectionshealth-care acquired venous thromboembolism, and diagnostic errors. It is likely that thousands of others die or become more ill because the care they get is unnecessary but still risky, or because they failed to receive the evidence-based services that would have made them better.

When patients and their families are treated disrespectfully, when the care they receive is undignified, these too are harms. There are no data on how often patients and their families suffer in this way but odds are you or someone you know has a story to tell. Leaving the hospital without understanding what you should do when you get home; clinicians who don't introduce themselves or let you finish what you have to say; waiting at an ER for hours without any real-time information about what is happening to your critically-ill loved one -- these may seem like little mistakes compared to getting the wrong medication but, particularly when we are ill and frightened, they can make us feel even more out of control and less like moral equals than we already do.

Doctors and nurses also suffer in this system. Every health professional I know wants to do what is best for her patient, and wants to deliver respectful, dignified care each and every time. But many healthcare systems are not designed to support clinicians in their desire to do what is right, and as a consequence clinicians experience what we call moral distress, leading in some cases to total burn out.

And none of this helps to keep us well.

The documentary Escape Fire: The Fight to Rescue American Healthcare, released in select cities on October 6, does a good job of bringing much of what's wrong with our healthcare system to life. The film introduces victims of our failed system: a young woman with heart disease gets many more cardiac catherizations than she could possibly need, and an older man who has suffered a heart attack continues to eat exactly what is likely to put him back in the hospital because he can't afford heart-healthy foods. The film's most compelling character is a young army sergeant recovering from battle injuries and unspeakable loss, who suffers horribly until he encounters remarkable innovations in military medicine that utilize what acupuncture and meditation have to offer.

This is where the movie turns hopeful, and we can as well. What Escape Fire does best is highlight ways to fix some of what is broken in American healthcare. These strategies are not theoretical; they are already being implemented in the real world to reduce harmful and unnecessary care and to empower us to stay well, and when ill, help us heal ourselves. In September we previewed the film at Johns Hopkins to an audience of medical and nursing students who responded incredibly positively out of a deep desire to be part of the solution. That is hopeful too.

Which takes me back to Obamacare. Some of these good-for-us strategies are slated for funding as pilot projects under the Affordable Care Act. More fundamental change than what is in the law is sorely needed, but it's still a step in the right direction. And that's yet another reason why you know which placard I'm carrying.



A version of this article also appears on Johns Hopkins' Berman Institute of Bioethics Bulletin.

This article available online at:

http://www.theatlantic.com/health/archive/2012/10/the-moral-failings-of-presidential-health-care-politics/263630/