In the US, the responsibility of covering healthcare has largely been left to the private sector. The private sector is able to achieve this through employer-sponsored health insurance (ESI). However, the ESI is marred by a number of problems, which have hampered its effective implementation. As such, the US has introduced certain reforms as well as observing the principle of justice to ensure that the health sector carries out its roles smoothly.
Problems caused by employer-sponsored health insurance
The first ethical concern is that employer-sponsored health insurance hampers transparency and accountability. Despite the fact that there are significant increases in insurance premiums, employers make only small changes in employees’ health benefits (Buttaro, 2013). In fact, employers have managed to shift some of the costs to the beneficiaries of the health services. Some of the employers who contribute a fixed percentage towards health insurance premiums have come up with built-in mechanisms that will enable them to pass some of the increases in insurance premiums to their employees. The other problem is that of the eligibility rate. Usually, not all employees working with the private sector get a health insurance cover from their employers. In the US, employees without full-time status are not eligible to get employer-sponsored health insurance. Moreover, the full time employees who are newly employed often have to wait for a certain period before they can become entitled to enjoy these benefits.
Additionally, the problem with employment-based health insurance is that it is temporary (Buttaro, 2013). An employee can only enjoy the health benefits when they are in a particular job. This is a major problem for the American health insurance scheme because it is unfair for an employee to lose both their job and insurance cover. Actually, this does not happen anywhere in other industrialized countries and this goes to show that this practice is unethical. Finally, insurance companies tend to base their premiums on the employees’ health history (Cowen & Moorhead, 2011). As such, premiums are group rated meaning that even if just one employee suffers from a serious ailment then the entire group will have to pay very high premiums.
Reform Actions of the US Government
The first reform arose from the establishment of the Affordable Care Act in 2010. This act aimed at reducing the high costs involved in providing employees with health insurance (Payne-James et al, 2009). In this regard, employers could drop the coverage and instead give employees higher salaries to cater for their own medical expenses in the event of illness. Alternatively, employers could come up with better offerings that would be more attractive to employees. The alternative of dropping the ESI is would also help to end the problem where an employee’s benefit is tied to their job. Many employees would find higher compensation a better alternative because they will not lose anything when their employment is terminated or they move from their current job.
The other aspect of this act is that it will promote cost sharing between individuals, the government, and employers and thus do away with the problem of group premiums where the insurance companies charge premiums depending on employees’ health history (Dreeben-Irimia, 2011). Furthermore, the act focuses on strategic investments in which case expansions have been made in community investments and clinical preventive care. This move helps to assist even those employees who do not work on a full time basis.
Ethical principle of justice
According to Ashcroft (2007) the ethical principle of justice refers to a situation where equality, fairness and impartiality should be observed amongst all people. This principle plays an important role in healthcare, as it requires that the scarce resources should be shared equally amongst different people regardless of their gender and financial status. As such, the government should subsidize treatment in situations where reproductive technologies are used because they cause treatment to become expensive thus causing inequality in healthcare. Additionally, the legislations established in healthcare like the ACA should be applied in an impartial manner amongst everyone.
ESI encounters a number of problems like employers having to pay prohibitive premiums that are indirectly transferred to employees. Even so, the ACA has been able to solve most of the problems encountered using the ESI system. The principle of justice is important in ensuring that problems in the healthcare sector are eradicated by observing fair treatment to all.
Ashcroft, R. E. (2007). Principles of health care ethics. Chichester, West Sussex, England: John Wiley & Sons.
Buttaro, T. M. (2013). Primary care: A collaborative practice. St. Louis, Mo: Elsevier/Mosby.
Cowen, P. S., & Moorhead, S. (2011). Current issues in nursing. St. Louis, Mo: Mosby Elsevier.
Dreeben-Irimia, O. (2011). Introduction to physical therapy for physical therapist assistants. Sudbury, MA: Jones & Bartlett Learning.
Payne-James, J., Wall, I., & Dean, P. (2009). Medicolegal essentials in healthcare. Cambridge: Cambridge University Press.