STS News, Winter 2012 -- Robert M. Sade, MD, Chair of the STS Standards and Ethics Committee and Ethics Editor of The Annals of Thoracic Surgery, delivered the prestigious John J. Conley Lecture on Ethics and Philosophy at the American College of Surgeons 97th Annual Clinical Congress in San Francisco on Oct. 26, 2011. His presentation, titled “Ethical Foundations of Health Care Reform: Implications for Policy and Law,” was especially timely as it explored two ends of the ethical spectrum regarding responsibility for providing health care, while Congress debates the provisions of the Affordable Care Act and the Supreme Court deliberates on its constitutionality.
In detailing the central-planning and free-market approaches to health care, Dr. Sade highlighted the ethical and moral foundations of health care planning over the past several decades. The premise for the freemarket system is that people must be free to make their own choices, including the choice to opt out of health care programs, if they so desire. According to the central-planning point of view, however, health care should be provided to all as a minimum of what society owes its members.
Dr. Sade provided background on the current U.S. health care system and explained how it has evolved into its current state. He noted that today’s disarray can be attributed to a lack of system coherency and a design that was created out of political and economic developments in the 1930s and 1940s. Pieces of both central planning and free markets are woven into the current health care system – and not necessarily in a harmonious way.
“Awareness of this history and underlying ethical issues is necessary for a clear understanding of the debates that are going on in Washington and the ideological basis of the various sides of the debates,” said Dr. Sade. “Most politicians don’t even know the ethical underpinning for their positions – but those underpinnings are critical to successful functioning of health care systems.”
In his conclusion, Dr. Sade came down clearly on the side of free-market solutions to rectify the imbalances, inefficiencies, and inequalities that have resulted from 70 years of regulatory interventions. Those interventions, he said, have led us into a downward spiral toward professional subordination and economic chaos. “A more effective and morally appropriate system will result when people are allowed to make their own choices in a health care market freed from central planning, and when physicians are liberated from the rising mountain of timeconsuming, expensive, and ineffective regulations—only then can we keep our professional activities fully focused on their proper objective, care of and caring for our patients.”