It is good for people to understand their insurance coverage and the reasoning that has shaped it, to be able to contribute their two cents if they want to, and to know that their plan has at least attempted to make decisons that are consistent, fair and compassionate. It is also good for them to be told that attention to cost is ethically required. Nevertheless, while following the recommendations of Wynia et al (2004) might make benefits design and administration appear (...) more fair, it will not do as much as they suggest for them to be more fair. (shrink)

*The views represented are the author's alone and should not be construed as representing policies of the American Medical Association.

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by (...) those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups. (shrink)

Individuals each have their own unique conceptions of what is good. Nevertheless, because human beings have common needs, there is a significant overlap in their appreciation of what counts as good...

The American Journal of Bioethics, Volume 11, Issue 7, Page 16-18, July 2011.

As the only nation in the western world without a national health insurance program, the United States faces ongoing issues of access and fairness in health care coverage. The Clinton administration tried and failed to address the problem of universal coverage. Since then we have focused on the narrower, but nonetheless real, issues of fairness and equity in the benefits package provided in insurance plans. The LORAN Commission spent two years trying to devise agreed-upon principles to govern such issues. The (...) lesson learned was the same as that of the Ethics Force study: there was no possibility of getting agreement, let alone consensus, among the participants on how to decide what should be a covered benefit. There were, however, two generally agreed upon principles that emerged regarding health care: “Every individual should be treated alike,” and “When it comes to health, cost cannot be a consideration.” That formula translated into providing everyone with everything. The only certain outcome from such a policy would be fiscal insolvency and ultimately bankruptcy. (shrink)

The organizational self-assessment tool presented in this issue (Wynia et al. 2004) is a valuable contribution not merely to the ethics literature, but also, one hopes, to health insurer practice....

As health care coverage gets more and more unfair by international standards, “Improving Fairness in Coverage Decisions” (Wynia et al. 2004) shows that the best of America's employers, unions, heal...

The American Journal of Bioethics, Volume 11, Issue 7, Page 18-20, July 2011.