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The increasing demand for health insurance to meet the high costs of healthcare

system has raised several issues related to justice and equity in the conceptual structure of the

bioethics. The health care costs are rapidly increasing due to a number of reasons including

the emergence of challenging healthcare issues, the need of innovative technologies,

increasing population, aging baby boomers, and lack of resources to address their needs1. The

lack of resources has made it difficult for the US government to compensate low income

families, which on the other hand has strengthened the rule of private health insurance over

the market. However, private health insurance also does not provide sufficient coverage

making it difficult for the people to access health care benefits2. The US government should

eliminate the burden of healthcare costs from the shoulders of employer and employees by

offering socialized and universal health care insurance plans through fair distribution of

resources because huge health care barriers are putting burden on the US economy.

The urge for government interference to ensure equity in health care system is that the

costs of health care services and medicines are rapidly increasing making it hard for the

uninsured as well as insured people to access quality and appropriate health care services.

The current government health care subsidies or health care assistance programs for low

income families or individuals are not appropriate making it hard for the low income

individuals and families to access health care services3. The criterion is quiet complicated as

well as the coverage is very low which is forcing low income families to pay out of their

pockets and as a result the majority of people do not take health care services.

On the other hand, the inappropriateness of government health insurance is creating

inequality in health care system4. Health care inequality is an undeniable part of Americans

1
("US Health Care System Earns Poor Marks" 2008)
2
(Swartz 2002)
3
(Jacob 2014)
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(Thorsen 1974)
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because of the inability of the government in addressing several social and economical issues

like education, income inequalities, and racism etc. In US, the secret to a longer life is all

hidden in money which means that every person who has enough money to pay the expanses

of health care services would have high chances to get longer life. Although, the US health

care system does not prevent or prohibit uninsured, low income and poor people from

accessing health care services, however, the expensiveness of the health care infrastructure is

making their access difficult5.

Not to mention that the inability of the US government in the proper access and

distribution of the available resources to cope with rising costs of health care services are

increasing pressure on the private insurance, i.e. both on employer and employees. The

increase in health care costs immediately increases the premiums for health insurance that is

automatically putting pressure on employer as well as on employees6. In such situation,

again, employees are suffering because they cannot pay high premiums and as a result they

get a minimum coverage which is making their access difficult to health care services even

though they are insured.

Apart from the private and personal health insurance costs, the increasing costs of

health care are also affecting the overall health care system. In the past four to five decades,

the population of US is growing rapidly and currently it is growing at a rate of 0.77% and it is

expected that it will continue growing at the similar rate by 2020. On the other hand, the

persons 65 years and above are making 14.5% of the whole US population as per the

estimations of 2014. It is also estimated that by 2060 the population of older people in US

will double its numbers7. This is showing that the pressure on health care system is expected

to grow in the coming years, especially in the chronic health conditions. However, the focus

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(Thorsen 1974)
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(Swartz 2002)
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("Dealing With Rising Healthcare Costs" 2006)
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of the government health care spending is mostly on acute care making it less likely suitable

for aging population8.

To meet the rising health care costs increased due to technological advancements,

prescription drugs, and greater demand for service result in the underfunded public health

care programs which shifted the burden on the private insurance and has increased inequality

in healthcare system9. This is the evidence of the inappropriate resource distribution of the

US government that needs to be addressed on immediate basis. The only solution to this issue

is a universal healthcare system10.

Critics on the other hand argue that the US government is still doing well for the

effectiveness of healthcare system through the introduction of new government programs. It

has introduced several programs in the past as well as most recently. The Affordable Care

Act also known as Obamacare Act is the true example of the appropriate decisions of the US

government. The program is specially designed to improve the quality of healthcare services

while reducing its costs11.

Furthermore, they argue that this is an initiative that the Obama government has taken

for the improvement of US health care system and it should be expected to have some more

programs that will gradually bring equity in health care system. The government have a clear

understanding to the needs and demands of the public and their policies are much in track

because of which health care spending are also growing rapidly in response to the growth of

health care costs. This will allow more Americans to get health insurance by making it

affordable and less costly12. Moreover, it will allow people with pre-existing diseases such as

Cancer, to get the coverage for their health issue which was previously not possible. People

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("Dealing With Rising Healthcare Costs" 2006)
9
("Dealing With Rising Healthcare Costs" 2006)
10
(Rashford 2007)
11
(Hall and Lord 2014)
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(Hall and Lord 2014)
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have to pay less out of pocket money for prescription drugs that will help them in increasing

their savings.

Although, the arguments made by the opponents about the efforts of the US

government for bringing equity in healthcare system are true and reasonable, however, such

programs have less potential in addressing the issues that the US healthcare system is

currently experiencing13.

The programs like Obamacare/Affordable Care Act have an ability to provide benefits

to insured people but it is actually about the accessibility problems of both personal/private

insured persons as well as of uninsured. The Affordable Care Act does not address the high

premiums of the insurance policies rather it has further increased them because this Act has

expanded the coverage area of insurance policies for which insurance companies will raise

their prices. Under this Act, people will be fined if they don’t have insurance which will

mostly affect the low income class14.

Instead of addressing the existing pressure on the economy and people, the Affordable

Care Act program is making things worse as to fulfil the costs of this program, the

government will raise several taxes. The supporters of the Affordable Care Act argue that the

program is designed in a way that will force the rich and wealthy to pay for the health care of

the poor15. This is not a new or unusual thing as in past government have offered several

health care assistance programs for poor and low income class, however, they failed due to its

complicated process and eligibility criteria and the new Affordable Care Act is not an

13
(Rashford 2007)
14
(Saper 2015)
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(Saper 2015)
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exception as it is following the same complicated process and eligibility criteria that prevents

people from applying for the program16.

From the above arguments, it is concluded that the only thing that can address the

bioethical issue of inequality in health care system/ health insurance is the introduction of a

universal/socialized healthcare system. Such systems has been in practice in most of the

western countries including but not limited to Canada, France, England, and Ireland17. A

universal healthcare system guarantees fair and affordable healthcare services to every citizen

regardless of their class and income level.

16
(Rashford 2007)
17
(Rashford 2007)
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Work Cited

"Dealing With Rising Healthcare Costs". 2006. Community Oncology 3 (4): 225-226.

doi:10.1016/s1548-5315(11)70686-6.

Hall, M. A. and R. Lord. 2014. "Obamacare: What The Affordable Care Act Means For

Patients And Physicians". BMJ 349 (oct22 7): g5376-g5376. doi:10.1136/bmj.g5376.

Jacob, K.S. 2014. "DSM-5 And Culture: The Need To Move Towards A Shared Model Of

Care Within A More Equal Patient–Physician Partnership". Asian Journal Of

Psychiatry 7: 89-91. doi:10.1016/j.ajp.2013.11.012.

Rashford, Marleise. 2007. "A Universal Healthcare System: Is It Right For The United

States?".Nursing Forum 42 (1): 3-11. doi:10.1111/j.1744-6198.2007.00060.x.

Saper, Clifford B. 2015. "The Affordable Care Act…Or Is It?". Annals Of Neurology 78 (2):

155-157. doi:10.1002/ana.24467.

Swartz, Katherine. 2002. "Effects Of Rising Costs On Health Insurance Coverage: Private

And Public Choices Are Not Independent Of One Another". Inquiry 39 (2): 93-95.

doi:10.5034/inquiryjrnl_39.2.93.

Thorsen, Laurence C. 1974. "How Can The U.S. Government Control Physicians' Fees Under

National Health Insurance? A Lesson From The French System". International Journal

Of Health Services 4 (1): 49-58. doi:10.2190/u599-rtgv-u5xm-99nn.

"US Health Care System Earns Poor Marks". 2008. JAMA 300 (24): 2843.

doi:10.1001/jama.2008.851.