Speaking Notes

February 17, 2010

PADM 5791

Dr. Neubauer

Selected aspects of Chapter 5 -- Health Care and the Disadvantaged

Equity and equality

Equality is fairness -- people in like circumstances treated the same; people in different circumstances treated differently

Equity -- (an extension of equality) -- extra help to those disadvantaged

Life is not fair and no amount of human effort can make life always and everywhere fair.

One of the three "pillars" of PA is social equity (along with efficiency and effectiveness).

This is one of the major distinctions between business administration and public administration, which is not intended to be a statement reflecting badly on BA.

It is one thing to have noble values but can be quite another to actually deliver on those values.

• Resources are limited
• Medical care resources and costly.
• Everyone will die (sooner or later) and no one is likely to get through this life without at least some medical problems.
• The potential "demand" for medical services is infinite.
• Given that we now have a two-tier system that is serving about 85% of Americans reasonably well, would it be right to reduce the quality of care available to the 85% in the hope of possibly improving the quality of care to the 15%?
• Without "blaming the victim," let us realize that the life choices that people make can affect their health. We do not want to create a situation in which people can neglect to do what they can to take care of themselves, assured that society will do everything possible to remedy the consequences.
• Medicine is both science and art. Healing is both a natural process and a matter of the quality of personal relationships. This tends to be overlooked as we push to measure everything and to "mandate" best practices. Individual people differ in how they respond to treatments and medications.
• Not everyone wants the same things and what is "normal" or sane may be subject to interpretation.

IS ACCESS TO QUALITY MEDICAL CARE A HUMAN RIGHT?

CAN (SHOULD) ACCESS TO QUALITY MEDICAL CARE BE DECOUPLED FROM EMPLOYMENT?

If yes, it might really give the economy a shot in the arm, no pun intended.

Can a system be designed that rewards people doing their part while not "penalizing" people with preexisting conditions, genetic issues, and limited to having access only to kinds of employment that are dangerous?

CAN IMPEDIMENTS TO ACCESS TO CARE SUCH AS CULTURAL DIFFERENCES, LANGUAGE DIFFERENCES, AND LOCATION BE EFFECTIVELY ADDRESSED?

CAN PATIENT'S MEDICAL INFORMATION BE MANAGED BETTER COLLECTIVELY TO REDUCE THE NEED FOR REDUNDANT TESTS WHILE STILL PROTECTING THE PRIVACY AND INTERESTS OF PATIENTS?

CAN (SHOULD) THE MEDICAL CARE SYSTEM BE HELD RESPONSIBLE FOR THE NUMBER OF SHOOTINGS INVOLVING YOUNG PEOPLE?

NOW THAT CHILDBIRTH IS SAFER THAN IT WAS A CENTURY AGO, WOMEN, ON AVERAGE, LIVE LONGER THAN MALES. IS THE MEDICAL COMMUNITY SOMEHOW RESPONSIBLE NOW TO FOCUS ON EXTENDING THE LIVES OF MALES?