Recently, I have been getting in conversations with people who are politically active. The main discussion point I find myself struggling to be able to answer is the ethics of single-payer health care systems. He claimed that everyone would be able to get health care from anywhere. My response was the government can limit the services someone is allowed to have. His response was that not everyone is deserving of a service they ask for. For some background on single-payer health care systems:
The single payer [model] tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.
A similar problem regarding cost control and refusing to pay for services can be found in traditional models of private insurance. However, the outcome is still the same; someone is denied a healthcare service.
Traditional insurance, to the extent that it insulates the patient from almost all costs, will eventually adopt access restrictions and even price controls just like government- run plans. And that development undermines our principle of patient choice.
The problem I ran into it in formulating a response exists in practical ethics. The principle of beneficence/non-maleficence would say that the patient absolutely is deserving of the procdure/treatment if it is beneficial to them and prevents them from being injured. Justice would say that whoever is most deserving of a procedure/treatment should receive it. The principle of autonomy would state that only the patient has the right to deny or accept a treatment/procdure.
With all of these disagreements amongst some of the basic prinicples of health care ethics, I found a base question that must be answered for a response can be properly formulated. Therefore, whether it be for any reason, can we be in the ethical and still deny someone a health procedure to treatment, even if that procedure or treatment is necessary?