AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. November 2012, Volume 14, Number 11.

Ethics Poll

Paying for Our Medical Care

The Ethics Poll is a snapshot of the opinions of interested readers.

Physicians for a National Health Program think that the U.S. should adopt single-payer national health insurance, a system in which a single public agency pays for health care, but delivery of care remains largely private [www.pnhp.org/facts/single-payer-faq]. Do you think single-payer insurance is the best way to pay for health care in the U.S.?
Many believe that the cost of medical school and the debt most graduates incur drives the majority of them to pursue training in lucrative subspecialties, thus contributing to the shortage of primary care physicians in the U.S. As a solution, Drs. Peter B. Bach and Robert Kochner propose making medical school free. Instead of paying for school, those who pursued highly specialized training would receive no stipend during their residency, while those who pursued training in primary care fields would receive the stipend that residents now get, about $50,000 a year. The forgone stipends of the many in specialty training would finance medical school for all. Which of the following best expresses what you think of this plan?
In allocating limited medical resources, the cost-effectiveness of a treatment is often assessed in terms of “quality-adjusted life-years” or QALYs. QALYs are the number of years of improved quality of life a person can expect to gain from a particular intervention. Who should participate in assessing the improvement in quality of life an intervention confers on people with a specific chronic condition?