17th Annual Fall Ethics Symposium: The Ethics of Providing Healthcare
Date and Time
Friday, December 2, 2022
9:00 am to 4:30 pm
This is an in-person event.
A co-production of Cosumnes River College and Sacramento State Center for Practical and Professional Ethics.
We want a health care system that is efficient and just, where these criteria are compatible with the idea that anyone who needs some important care will receive it. But it’s important to pay attention to the supply-side — where the specific services will come from and how they will be delivered. Most people think the US does poorly along these lines and that there are ways we could do better. Our speakers will offer their perspectives on how we could.
This event is free and open to the general public.
- Dr. Edward Bush, President, Cosumnes River College
- Dr. Robert S. Nelsen, President, Sacramento State University
- Dr. Rick Schubert, Executive Director, CRC-CPPE Fall Ethics Symposium Series
Facing Goliath: How State Policymakers Can Address the Harms from Healthcare Consolidation
Katherine L. Gudiksen is a Senior Health Policy Researcher for The Source on Healthcare Price and Competition. She is a recent graduate of the UCSF/UC Hastings Master of Science in Health Policy and Law program, where she studied policy solutions to promote competition in the pharmaceutical industry. Prior to joining The Source, she co-founded a cancer diagnostics company and worked as Director of Technology where she worked to develop technologies to detect biomarker signatures for aggressive prostate cancer. She also holds an A.M. and Ph.D. in Chemistry from Harvard University and a B.S. and B.A. from Hope College.
Abstract: Every American deserves access to high-quality affordable healthcare. The U.S. healthcare “system” relies on markets to deliver care, but many of those markets have failed to provide equitable and affordable care. The preponderance of the academic research shows that the unrelenting consolidation results in higher prices, can erode quality, and worsen patient experiences. Providers and insurers rarely deliver on promised claims of cost savings and increased care coordination used to justify a merger. Instead, waves of hospital mergers have led to regional and national health systems that provide most of the care. These systems may discontinue unprofitable services at independent or community hospitals or move them to other facilities, requiring patients to travel longer distances for necessary care. Additionally, in many places, a shortage of providers, cultural barriers, and racial discrimination mean patients struggle to access adequate health care. Policy interventions, including those to better review proposed mergers, limit health care costs, and improve access and equity, are needed to address these market failures. The time has come for lawmakers to change a system that costs too much and fails too many residents.
Ban, Subsidize, Mandate: Health Policy in the U.S.
James Bailey is an Associate Professor of Economics at Providence College. His research interests include health economics, labor economics, and entrepreneurship. He received his PhD in Economics from Temple University.
Abstract: In many key respects, US health policy is about restricting the choices available to patients and health care providers. These restrictions on autonomy are typically justified by the idea that they lead to superior health or economic outcomes. In some cases this tradeoff between freedom and efficient utilitarian outcomes is real, but I highlight some policies such as Certificate of Need laws that appear to harm both freedom and efficiency. I argue that the overarching US approach to health policy is to subsidize demand while restricting supply, which together lead to exceptionally high prices but mediocre health outcomes. Finally, I discuss some ethical dilemmas facing patients and providers in this flawed system.
Distributive Injustice: Race, Age, and Government Healthcare Spending
Melissa Alexander is Professor at the University of Wyoming College of Law. She teaches Intellectual Property, Health Law, Bioethics, and Civil Procedure. She received her Bachelor of Arts in Philosophy, with distinction, from Yale University and her law degree from the University of Virginia School of Law. Her scholarship focuses on the intersection of bioethics, health law, and public policy.
Abstract: One in three Americans cannot afford needed healthcare. The government subsidizes the cost of care for certain individuals, prioritizing Americans of advanced age. While well-intended, the government’s blanket preference for older adults lacks normative basis, squanders resources, and perpetuates significant racial disparity in access to care, structurally reinforcing centuries of disadvantage. This presentation advocates a more ethical and efficient framework for government healthcare spending, an evidence-based approach that distributes care to individuals in need, regardless of age, with priority based on likely benefit, after some adjustment for equity. Applying the proposed framework, the presentation analyzes the recently passed Inflation Reduction Act of 2022. It applauds certain new healthcare spending therein that targets racial health inequity. However, it also decries the manner in which the Act continues and expands an unjust age-based government spending approach that largely ignores younger low-income adults, disproportionately from communities of color, who have equal or greater need and potential benefit. Racial justice, fairness, and good stewardship demand that America adopt a more just distribution of government healthcare spending.
Defining Affordable Health
Govind Persad is Assistant Professor at the University of Denver Sturm College of Law. His research interests center on the legal and ethical dimensions of health insurance, health care financing, and markets in health care services, as well as professional ethics and the regulation of medical research. He holds a B.A. in Philosophy, a B.S. in Biological Sciences, and a Ph.D. in Philosophy from Stanford University, as well as a J.D. from Stanford Law School.
Abstract: When it comes to health care and insurance, Americans prize affordability. The largest recent advance in American health care policy was titled the “Affordable Care Act.” During the 1980s and 90s, earlier health reform proposals—from both Democrats and Republicans--likewise centered affordability. While affordability is often invoked, it is rarely defined—and offered definitions are even more rarely defended. Yet assessing proposed or enacted reforms that promise greater affordability requires understanding what affordability is. To know whether changing the structure of a health program, or including access to a new drug or procedure, would serve or hinder affordability, we need to understand what affordability means. This talk examines how health law has invoked affordability and how it has defined, or failed to define, the concept. It then argues for a hybrid definition on which affordable insurance (or health care) must be both obtainable for the poorest and compatible with reasonable life plans for the middle class.