Hello Dazzle! Thanks for coming and hanging out with me today, I’m glad that you are here.
People often say that Americans enjoy the finest healthcare system in the world. And, in some ways, that’s true. Our hospitals deliver top-notch emergency and acute care, and we’re known globally for breakthroughs in drugs, surgical techniques, and diagnostic tools.
But, if you’ve been following the conversation about the future of healthcare in the U.S., you know it’s not all smooth sailing. Insurers—both public and private—are feeling the strain of high prices and rapidly rising costs. They’re crying out for change. Healthcare providers, on the other hand, are overwhelmed by an endless stream of regulations, paperwork, and bureaucratic hurdles. Some estimates suggest that 30 cents of every dollar spent on healthcare in the U.S. goes toward administrative costs. That’s a lot of money that isn’t being spent on actual patient care.
And here’s the kicker: despite the high costs, many Americans still don’t have access to the services they need. At least 30 million people in the U.S. don’t have health insurance, and millions more live in fear of a prolonged hospital stay or a long-term nursing home admission. Many elderly Americans have to spend down their savings just to qualify for care. So, while the U.S. might excel at treating life-threatening conditions, it’s spending more on healthcare than any other comparable country and still failing to provide adequate access for all its citizens.
Now, here’s another layer to this: America is getting older. Thanks to medical and public health advances, more Americans are living longer. Some are surviving severe injuries or illnesses due to amazing healthcare technology. But all this success comes with a hefty price tag. When the topic of who pays for this comes up, the elderly are often seen not as beneficiaries, but as “the problem.” Policymakers worry that treating age-related illnesses or paying to extend life for the elderly is a major factor driving up healthcare costs, and some believe that older people are using more than their fair share of social resources.
Because of these costs, some commentators argue that we should ration healthcare for older adults. They suggest that the only way to manage the costs of success is to limit access to life-extending medical services based on age. Their argument is essentially that Americans aren’t willing to foot the bill for universal care. They point out that, over the past few decades, U.S. healthcare has evolved in ways that seem to support this position—like drawing a line somewhere in the second half of life to limit healthcare access.
Even though our current public and private insurance programs are clearly lacking, when it comes to actually spending money—especially in the form of taxes—many Americans hesitate. For example, back in 1989, Congress decided to scale back the Catastrophic Health Care Program, which aimed to provide extra hospital days and drug coverage under Medicare. It was initially popular, but strong backlash from high-income Medicare beneficiaries over a surtax led to its undoing. This fiasco showed that Americans care deeply about fairness when it comes to who pays for what. People might say they’re willing to pay more for healthcare, but in reality, that willingness can fade quickly when the costs become personal.
And here’s the problem: the costs are only going to increase. New diagnostic and therapeutic technologies are being developed at a rapid pace, many of them funded by public money through institutions like the National Institutes of Health. But all these advancements have brought their own financial burdens. U.S. health policymakers now face an ironic challenge: how do we ensure fair, affordable access to the many benefits of these advances when people don’t want to pay for them?
One way to deal with this problem is to simply pay the price. But the U.S. doesn’t have the best track record with that approach. Take the End Stage Renal Disease (ESRD) Program, for example. Added to Medicare in 1972, this program aimed to eliminate the tough decisions doctors had to make about who to dialyze. The goal was to help 20,000 Americans with kidney failure, with expected costs of around $220 million. Fast forward to today, and the program costs over $2.2 billion to cover approximately 100,000 people.
This example of trying to provide universal access to a necessary service shows how quickly costs can spiral out of control. It’s made many policymakers skeptical about the idea of public financing for healthcare. The costly experience with the ESRD program has cast a long shadow over efforts to extend federally subsidized access to other therapies.
Now, Americans believe deeply in the power of technology to solve problems. However, without some form of public financing or a system to shift costs from the wealthy to the poor, these high-tech solutions often end up distorting who gets access to care. For example, access to organ transplants often depends on the ability to pay, even though the public heavily supports the infrastructure needed for transplants—everything from organ procurement agencies to hospitals, pharmaceutical companies, and medical education.
So, what’s the answer? Should we start denying access to expensive medical care to those who are in the latter half of their lives? It might seem like the only solution. But is it the right one? Not necessarily—especially if we take a closer look at the philosophical assumptions behind this idea.
Philosophy challenges us to rethink how we see healthcare. Should it only be about fixing the most immediate, life-threatening problems? Or should it also be about ensuring fairness, justice, and dignity for everyone, regardless of age? Philosophers argue that we need to think critically about these questions, not just focus on cutting costs.
Philosophy can also provide a framework for thinking through these ethical concerns. For instance, from a deontological perspective, rationing healthcare based on age violates the principle of treating all individuals with equal respect and dignity. The principle of justice, which is a cornerstone of ethical theory, demands that resources be distributed fairly, without discrimination. Rationing care to the elderly could be seen as a form of ageism, denying them their right to fair treatment. Meanwhile, a virtue ethics approach, which focuses on character and the common good, might emphasize compassion and empathy in healthcare—suggesting that we should strive to care for all members of society, regardless of their age or the cost involved.
Philosophy, particularly existentialism and phenomenology, invites us to take a deeper look at what we mean by “health.” These perspectives encourage us to see health as more than just the absence of disease—it’s a dynamic, holistic concept that includes physical, mental, and social well-being. With this broader view, healthcare could shift from being disease-focused to being truly person-centered. The goal wouldn’t just be to prolong life at any cost, but to enhance overall quality of life. This kind of thinking could lead to a more balanced approach in how we allocate healthcare resources, valuing preventive care, mental health services, and social support just as much as high-tech medical interventions.
A critical perspective inspired by the philosophy of technology might question the assumption that more technology always equates to better care. Heidegger’s critique of technology, for instance, warns against viewing technology as an end in itself, rather than a means to enhance human flourishing. By reconsidering the role of technology through a philosophical lens, healthcare policymakers can make more informed decisions about which technologies to prioritize and how to integrate them into a system that balances cost, access, and quality.
So, could philosophy offer us a way to rethink and improve our healthcare system? While it might not have all the answers, it certainly encourages us to ask better questions. By challenging our values and assumptions, philosophy might just help us find a path that balances cost with compassion and ensures fair access to care for everyone.
Well, that’s about it for my rambling today. Thanks for coming and spending some time with me. If you like my rambling then click on that like button. It really does help! Until we talk again, you take care of yourselves!
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