Do all segments of society share in the benefits of medical research? Not exactly. For the tens of millions of Americans who have chronic diseases such as diabetes, heart disease, and cancer – and who also have no health insurance – medical care is unaffordable. Additional tens of millions of Americans have health insurance but the annual premiums are exorbitant, the benefits are minimal, and out-of-pocket expenses are high.
Imagine that one of these Americans wakes up one day with a pounding headache, experiencing unusually intense pain. The person is not prone to headaches, hasn’t had one in a long time, and the pain is severe. Will she go to the emergency room and get a “brain scan” – a magnetic resonance imaging (MRI) study? Most likely she will not, choosing to wait out the pain rather than spend $3000 at the hospital gereedschap sticker ($1500 for ER services and $1500 for the MRI). Not many middle-income or low-income persons are able to blithely tack on $3000 to their household debt.
Unfortunately in this case the person is experiencing a real emergency, but she doesn’t know it. She thinks she has a bad headache and it will go away within a few hours. She is unaware that a berry aneurysm is about to burst in a small artery in her brain. Later that day the aneurysm explodes and the woman falls into a coma, dying before her husband and children return home from a day at the beach.
Similar scenarios may be outlined for many acute emergencies and chronic ailments. For many families, medications are luxury items. Their primary concerns are paying the rent, paying utility bills, and putting enough food on the table so family members will have the energy to survive another day. Filling prescriptions addresses problems that are usually not immediate. Choosing between being able to buy a half-gallon of milk and a loaf of bread every day versus spending $150 (without insurance) for a month’s supply of antihypertensive medication is simple. Milk and bread win every time.
When a family chooses, by necessity, to buy food rather than prescription drugs, their illnesses worsen over time and add substantial costs to the heath care system. When a father suffers a heart attack because he has avoided taking his medication, the ER and hospital charges may exceed $50,000. He is uninsured and the hospital attempts to recover the losses by eliminating important services and by raising its rates. These higher rates are paid by everyone. The losses of services, such as cutbacks to burn units and community outreach programs, affect everyone.
Members of Congress are asleep at the switch – they consistently fail to recognize the implications of their failure to address these deep inequities. Every American suffers from these ongoing violations of the bioethical principle of distributive justice. But we don’t recognize that the medical problems of the underinsured affect our pocketbooks.