You will need to review the information provided for every source for each member of your group.  Questions to ask (and items on which to provide feedback): Are th

[Name]

Dr. Butkus

PHIL-251-[Section]

[Date]

Topic: Single-Payer Systems

References Comment by Matthew Butkus: Strengths: 8+ Sources meeting the criteria (8+ pages and published after 2000 in a peer-reviewed journal). Consistent APA style. Alphabetized for clarity. Uniform text style. 12 pt Times New Roman

1. Bindman, A. B., Mulkey, M. R., & Kronick, R. (2018). Beyond The ACA: Paths To Universal Coverage In California. Health Affairs, 37(9), 1367–1374. https://doi.org/10.1377/hlthaff.2018.0504 Comment by Matthew Butkus: This seems to be more current affairs than a dedicated ethics article. Be careful how you plan to incorporate this into your argument.

Abstract: California has long sought to achieve universal health insurance coverage for its residents. The state's uninsured population was dramatically reduced as a result of the Affordable Care Act (ACA). However, faced with federal threats to the ACA, California is exploring how it might take greater control over the financing of health care. In 2017 the state Senate passed the Healthy California Act, SB-562, calling for California to adopt a single-payer health care system. The state Assembly did not vote on the bill but held hearings on a range of options to expand coverage. These hearings highlighted the many benefits of unified public financing, whether a single- or multipayer system (which would retain health plans as intermediaries). The hearings also identified significant challenges to pooling financial resources, including the need for federal cooperation and for new state taxes to replace employer and employee payments. For now, California's single-payer legislation is stalled, but the state will establish a task force to pursue unified public financing to achieve universal health insurance. California's 2018 gubernatorial and legislative elections will provide a forum for further health policy debate and, depending on election outcomes, may establish momentum for more sweeping change. [ABSTRACT FROM AUTHOR]

2. Blewett, L. A. (2009). Persistent Disparities in Access to Care across Health Care Systems. Journal of Health Politics, Policy & Law, 34(4), 635–647. https://doi.org/10.1215/03616878-2009-020 Comment by Matthew Butkus [2]: This looks to be useful, but you will likely need to translate it into ethical terms and principles.

Abstract: The article presents the author's comments on disparities in access to medical care across health care systems. In response to an article on the issue by Michael K. Gusmano, Daniel Weisz, and Victor G. Rodwin, the author says that universal coverage through a government-run health care system need not include one government payer. Equity in access to medical care mean that all citizens have the same access to the needed health care services. The author also comments on single payer system.

3. Feldman, R. (2009). Quality of Care in Single-Payer and Multipayer Health Systems. Journal of Health Politics, Policy & Law, 34(4), 649–670. https://doi.org/10.1215/03616878-2009-019 Comment by Matthew Butkus [2]: As above, you will need to translate this into ethical terms and principles – for instance, when a country is working with limited resources, is there an obligation to maximize quality of care provided or maximize the number of people covered?

Abstract: In this article, I argue that unregulated markets will not find the right level of health care quality but that at the same time it is not clear that single-payer systems will do any better. My perspective combines the economic theory of public goods and the institutional payment arrangements found in many single-payer systems. If, as I believe, health care quality is a public good, it will be under-provided in a multipayer system. Single-payer systems often allocate a fixed budget to health care professionals or administrators and give them considerable discretion in determining quality as well as quantity of service. With care being free or almost free at the point of use, patients will demand more services than administrators want to provide. The result is rationing by waiting — which should be present in all such systems and is present in most of them. I develop several implications of the theory and an agenda for future research on quality of care in single-payer and multipayer health systems. [ABSTRACT FROM AUTHOR]

4. Flood, C. M. (2009). Is the Canadian System Right for the United States? Journal of Health Politics, Policy & Law, 34(4), 585–592. https://doi.org/10.1215/03616878-2009-016 Comment by Matthew Butkus: You will need to read White’s article to put this one into context.

Abstract: The article presents the author's comments on Joseph White's article on Canadian health care system. In response to White's comments on the viability of single-payer system, the author calls for includes a significant role for private health insurers. The author says that a large role for supplementary private health insurance can be implemented through extensive government protectionism and subsidization.

5. Fox, A. M., & Blanchet, N. J. (2015). The Little State That Couldn’t Could? The Politics of “Single-Payer” Health Coverage in Vermont. Journal of Health Politics, Policy & Law, 40(3), 447–485. https://doi.org/10.1215/03616878-2888381 Comment by Matthew Butkus: See above about current affairs versus ethical argumentation.

Abstract: In May 2011, a year after the passage of the Affordable Care Act (ACA), Vermont became the first state to lay the groundwork for a single-payer health care system, known as Green Mountain Care. What can other states learn from the Vermont experience? This article summarizes the findings from interviews with nearly 120 stakeholders as part of a study to inform the design of the health reform legislation. Comparing Vermont's failed effort to adopt single-payer legislation in 1994 to present efforts, we find that Vermont faced similar challenges but greater opportunities in 2010 that enabled reform. A closely contested gubernatorial election and a progressive social movement opened a window of opportunity to advance legislation to design three comprehensive health reform options for legislative consideration. With a unified Democratic government under the leadership of a single-payer proponent, a high-profile policy proposal, and relatively weak opposition, a framework for a single-payer system was adopted by the legislature–though with many details and political battles to be fought in the future. Other states looking to reform their health systems more comprehensively than national reform can learn from Vermont's design and political strategy. [ABSTRACT FROM AUTHOR]

6. Glied, S. (2009). Single Payer as a Financing Mechanism. Journal of Health Politics, Policy & Law, 34(4), 593–615. https://doi.org/10.1215/03616878-2009-017 Comment by Matthew Butkus [2]: Policy-oriented articles tend to focus on law rather than philosophy, so you will likely need to explain the philosophical weight of the arguments made. What principles are at stake? Why do they matter?

Abstract: This article uses Organisation for Economic Co-operation and Development (OECD) data to assess whether a single-payer health system delivers more care at less cost than do other universal coverage models. Single-payer plans are defined as those that rely on a limited number of revenue sources and systems in which financing is concentrated and private insurance for hospital and medical services is limited. Single-payer advocates argue that this organizational model is best able to reduce administrative costs, control provider payments, and limit the supply of services. This analysis shows that single-payer-like systems do not do a consistently better job of controlling physician incomes but do achieve some administrative cost savings compared to more fragmented systems. Overall, single-payer systems are modestly less costly than their peers and spend a slightly smaller share of the gross domestic product (GDP) on health. There are, however, substantial variations both over time and across countries in the performance of the single-payer-like nations, as well as among the nations in the other universal coverage model categories. Overall, the differences in system performance among the universal coverage OECD countries are very small, while the difference between the performance of any one of these countries and the United States is enormous and persistent. [ABSTRACT FROM AUTHOR]

7. Gorey, K. M., Luginaah, I. N., Bartfay, E., Zou, G., Haji-Jama, S., Holowaty, E. J., … Richter, N. L. (2013). Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women. Health & Social Work, 38(4), 240–248. https://doi.org/10.1093/hsw/hlt022 Comment by Matthew Butkus: Descriptive research must be put into ethical terms. Whenever you are exploring surveys of opinion or experience, you need to clarify what principles are at stake, why they matter, etc. What is the philosophical impact of this?

Abstract: Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged. They were more likely to have received indicated surgery and chemotherapy, and their wait times for care were significantly shorter. Consequently, the Canadian women were much more likely to experience longer survival times. Regression analyses indicated that health insurance nearly completely explained the Canadian advantages. Implications for contemporary and future reforms of U.S. health care are discussed. [ABSTRACT FROM PUBLISHER]

8. Gorey, K. M., Richter, N. L., Luginaah, I. N., Hamm, C., Holowaty, E. J., Guangyong Zou, & Balagurusamy, M. K. (2015). Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States. Social Work Research, 39(2), 107–118. https://doi.org/swr/svv006 Comment by Matthew Butkus: Same concern as above – you will need to put this into ethical/philosophical terms.

Abstract: This historical study estimated the protective effects of a universally accessible, single-payer health care system versus a multipayer system that leaves many uninsured or underinsured by comparing breast cancer care of women living in high-poverty neighborhoods in Ontario and California between 1996 and 2011. Women in Canada experienced better care, particularly as compared with women who were inadequately insured in the United States. Women in Canada were diagnosed earlier (rate ratio [RR] = 1.12) and enjoyed better access to breast conserving surgery (RR = 1.48), radiation (RR = 1.60), and hormone therapies (RR = 1.78). Women living in high-poverty Canadian neighborhoods even experienced shorter waits for surgery (RR = 0.58) and radiation therapy (RR = 0.44) than did such women in the United States. Consequently, women in Canada were much more likely to survive longer. Regression analyses indicated that health insurance could explain most of the better care and better outcomes in Canada. Over this study' s 15-year time frame 31,500 late diagnoses, 94,500 suboptimum treatment plans, and 103,500 early deaths were estimated in high-poverty U.S. neighborhoods due to relatively inadequate health insurance coverage. Implications for social work practice, including advocacy for future reforms of U.S. health care, are discussed.

9. Gusmano, M. K., Weisz, D., & Rodwin, V. G. (2009). Achieving Horizontal Equity: Must We Have a Single-Payer Health System? Journal of Health Politics, Policy & Law, 34(4), 617–633. https://doi.org/10.1215/03616878-2009-018 Comment by Matthew Butkus [2]: This looks to be useful – make sure that you explain why horizontal equity matters (since that seems to be the focus of the article in question).

Abstract: The question posed in this article is whether single-payer health care systems are more likely to provide equal treatment for equal need (horizontal equity) than are multipayer systems. To address this question, we compare access to primary and specialty health care services across selected neighborhoods, grouped by average household income, in a single-payer system (the English NHS), a multiple-payer system with universal coverage (French National Health Insurance), and the U.S. multiple-payer system characterized by large gaps in health insurance coverage. We find that Paris residents, including those with low incomes, have better access to health care than their counterparts in Inner London and Manhattan. This finding casts doubt on the notion that the number of payers influences the capacity of a health care system to provide equitable access to its residents. The lesson is to worry less about the number of payers and more about the system's ability to assure access to primary and specialty care services. [ABSTRACT FROM AUTHOR]

10. Herzlinger, R. E. (2010). Healthcare reform and its implications for the U.S. economy. Business Horizons, 53(2), 105–117. https://doi.org/10.1016/j.bushor.2009.10.002 Comment by Matthew Butkus [2]: What makes this ethically meaningful? You will likely need to translate this into ethical terms and principles in the course of making your argument.

Abstract: U.S. healthcare is currently a poor value proposition in relation to its cost. This must change. Driven by the fundamental forces of financing, consumer preferences, and technology, the U.S. is heading for a profound revolution in healthcare, one that will affect not only the system itself but also the larger U.S. business community. This new healthcare system will create vast opportunities and commensurately large risks for healthcare innovators. The outcomes of the present healthcare reform debate will either liberate or further shackle these innovators. Reforms that depend on governmental controls are more likely to dampen innovation than those achieved through control by consumers, and given the profound ramifications of healthcare reform outcomes, policy makers would be well-advised to harness the forces of consumerism in fashioning reform. [Copyright Elsevier]

11. Hsiao, W. C., Knight, A. G., Kappel, S., & Done, N. (2011). What Other States Can Learn From Vermont’s Bold Experiment: Embracing A Single-Payer Health Care Financing System. Health Affairs, 30(7), 1232–1241. https://doi.org/10.1377/hlthaff.2011.0515 Comment by Matthew Butkus: See above about current affairs and ethical principles.

Abstract: Single-payer health care systems consist of publicly financed insurance that provides basic benefits for all citizens. The design is intended to achieve universal coverage and allow greater cost control. Many states have attempted to reform their systems around single-payer principles, but none succeeded until Vermont enacted a law in May 2011. In this article we describe how our team developed a viable single-payer proposal that served as the foundation of Vermont's law. According to our estimates, after the first full year of operation in 2015, our proposed single-payer system is expected to produce an annual savings of 25.3 percent when compared to current state health spending levels; cut employer and household health care spending by $200 million; create 3,800 jobs; and boost the state's overall economic output by $100 million. We describe how this plan was designed, and we discuss lessons for other states considering health system reform. [ABSTRACT FROM AUTHOR]

12. Ke Xu, Evans, D. B., Carrin, G., Aguilar-Rivera, A. M., Musgrove, P., & Evans, T. (2007). Protecting Households From Catastrophic Health Spending. Health Affairs, 26(4), 972–983. https://doi.org/10.1377/hlthaff.26.4.972 Comment by Matthew Butkus: As above, make sure you integrate this into an ethical argument – what principles are at stake? What ethical lessons can be learned?

Abstract: Many countries rely heavily on patients' out-of-pocket payments to providers to finance their health care systems. This prevents some people from seeking care and results in financial catastrophe and impoverishment for others who do obtain care. Surveys in eighty-nine countries covering 89 percent of the world's population suggest that 150 million people globally suffer financial catastrophe annually because they pay for health services. Prepayment mechanisms protect people from financial catastrophe, but there is no strong evidence that social health insurance systems offer better or worse protection than tax-based systems do. [ABSTRACT FROM AUTHOR]

13. Noseworthy, T. (2011). Health Resource Allocation. Journal of Legal Medicine, 32(1), 11–26. https://doi.org/10.1080/01947648.2011.550823 Comment by Matthew Butkus: I assume you are including this as a means of exploring Canada as a model for HC in the U.S.

Abstract: The article discusses health resource allocation Canada and Canadian Medicare. Topics include an overview of the evolution, structure and organization of the Canadian health care system, examples of access to services, pharmaceuticals, and health technologies to illustrate resource allocation and management in Canada, and the potential implications for the United States.

14. Starr, P. (2018). Rebounding with Medicare: Reform and Counterreform in American Health Policy. Journal of Health Politics, Policy & Law, 43(4), 707–730. https://doi.org/10.1215/03616878-6527996 Comment by Matthew Butkus: This is a step towards a single-payer system? I’m curious to see how you plan to integrate this. Medicare for all?

Abstract: America's major health care programs were all enacted on the rebound from defeat of more expansive progressive ideas. Chastened reformers have typically adopted rebound strategies that accommodate some sources of opposition, incorporate elements of counterreforms, and reflect intervening institutional change. This dynamic has unfolded three times: from the Progressive Era to the enactment of Medicare and Medicaid in 1965, from the late 1960s to the expansion of Medicaid in the 1980s, and from defeat of the 1993 Clinton plan to the enactment of the Children's Health Insurance Plan in 1997 and the Affordable Care Act in 2010. Setbacks in the Trump era will require advocates of universal coverage to coalesce around a rebound strategy that similarly takes account of recent developments and recognizes the Affordable Care Act's limitations and political vulnerabilities. This article argues that Medicare provides a platform for such a strategy and that the next fiscally and politically feasible step is the creation of a new "Midlife Medicare" program that would extend protection to people fifty to sixty-four years of age. [ABSTRACT FROM AUTHOR]

15. Stone, D. (2009). Single Payer–Good Metaphor, Bad Politics. Journal of Health Politics, Policy & Law, 34(4), 531–542. https://doi.org/10.1215/03616878-2009-014 Comment by Matthew Butkus [2]: As above, this will need to be translated into ethical terms and principles. There appears to be a good element of that present, but you may still need to explain the impact.

Abstract: Health insurance reform requires political solutions, not technocratic fixes. Single payer frames the problem as a grossly inefficient bursar's office. Great political leadership means reframing the problem as a faulty social compact, rewriting the compact, and making everybody play by the new rules. Most of all, great leadership means explaining in powerful language why participating in the new social compact would fulfill both enlightened self-interest and social responsibility. [ABSTRACT FROM AUTHOR]

16. Tuohy, C. H. (2009). Single Payers, Multiple Systems: The Scope and Limits of Subnational Variation under a Federal Health Policy Framework. Journal of Health Politics, Policy & Law, 34(4), 453–496. https://doi.org/10.1215/03616878-2009-011 Comment by Matthew Butkus [2]: This looks to be more descriptive than prescriptive – i.e. it is looking to explain the concept of single-payer without making an argument for or against. This can help to clarify the question and issue but does not seem to be providing an answer to it.

Abstract: In political discourse, the term "single-payer system" originated in an attempt to stake out a middle ground between the public and private sectors in providing universal access to health care. In this view, a single-payer system is one in which health care is financed by government and delivered by privately owned and operated health care providers. The term appears to have been coined in U.S. policy debates to provide a rhetorical reference point for universal health insurance other than the "socialized medicine" of state-owned and -operated health care providers. This article, like others in this special issue, is meant to provide a more nuanced view of single-payer systems. In particular, it reviews experience in the prototypical single-payer system for physician and hospital services: the Canadian case. Given Canada's federal governance structure, this example also aptly illuminates the scope and limits of subnational variation within this single model of health care finance. And what it demonstrates in essence is that the very feature that defines the single-payer prototype — the maintenance of independent providers remunerated by a single public payer in each province — also leads to a set of profession-state bargains that define the limits of variation. [ABSTRACT FROM AUTHOR]

17. Woolhandler, S., & Himmelstein, D. (2011). Healthcare Reform 2.0. Social Research, 78(3), 719–730. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=sih&AN=67182020&site=ehost-live Comment by Matthew Butkus [2]: This also appears descriptive, not prescriptive, so you will need to explain the ethical impact of the points it makes.

Abstract: The article discusses health care reform in the U.S., examining the obligations of the state with regards to the health of the human body, the quality of medical care, and U.S. residents who are uninsured and underinsured. The authors examine regional disparities in medical costs and medical care quality in the U.S., the growth of profit-driven health maintenance organizations (HMOs), and the costs of the federal insurance program Medicare. Other topics include Canada's national health program, the computerization of health care, and health care reform in Massachusetts.

,

Bailey Istre

Dr. Butkus

PHIL 251-– 24S 26162

1/23/24

Topic: Is fetal tissue research justifiable?

References

1. Alghirani, Amel, and Margaret Brazier. (2011). “What Is It? Whose It? Re-Positioning the Fetus in the Context of Research?” Cambridge Law Journal, vol. 70, no. 1, pp. 51–82. EBSCOhost, https://doi.org/10.1017/S0008197311000171.

Abstract: The article discusses the legal and ethical laws concerning the legitimacy of research involving living fetuses and just born infants or neonates in Great Britain. It examines how should the research on octogenesis or artificial womb technology could be regulated in the country. It focuses on discussing the question on what the fetus is and whose is it, as well as in several kinds of research like research into fetal development and disability. [ABSTRACT FROM AUTHOR]

2. Bass, S. B. (2001). Why Can’t a Fetus Be More Like a Sperm? The Woman’s Role in Fetal Tissue Research and How Women are Left Out of the Discussion. Gender Issues, 19(1). https://doi.org/10.1007/s12147-001-0002-0

Abstract: The use of fetal tissue for scientific research is a good example of the ways that cultural definitions have enveloped and galvanized the link between culture, science, and politics. Since the Roe vs. Wade decision in 1973, use of fetal tissue has been connected to arguably one of the hottest political firestorms of the century…abortion. While the abortion issue, as well as the use of fetal tissue for research, has been debated and discussed in almost every major field of thought, the debate consistently fails to address some of the key cultural interpretations we give to issues such as gender, science, and the role of women, who have largely been forgotten, and how these interpretations influence the national debate. To gain understanding of how these issues affect the fetal tissue dialogue, one must explore the role these cultural interpretations have in the discussion on the use of fetal tissue for research by looking at the cultural meanings we give to the terms "mother" and "fetus" and how these scientific metaphors affect the way we think about women who donate fetal tissue. These concepts must then be applied to fetal tissue use by exploring both political and ethical arguments surrounding the issue. [ABSTRACT FROM AUTHOR]

3. Burchell, M. S. (2004). America’s Struggle to Develop a Consistent Legal Approach to Controversial Human Embryonic Stem Cell Research and Therapeutic Cloning: Are the Politics Getting in the Way of Hope? Syracuse Journal of International Law & Commerce, 32(1), 133–161. https://search.ebscohost.com/login.aspx?direct=true&db=lgs&AN=502556872&site=eds-live

Abstract: Discusses the struggle of the U.S. in developing a consistent legal approach to human embryonic stem cell research and therapeutic cloning. Factors that led people across the U.S. to discuss the scientific and ethical aspects of human embryonic stem cell research and therapeutic cloning; Difference between the stance of the British government and the U.S. government on human embryonic stem cell research; Advantage of human embryonic stem cells over adult stem cells.

4. Childress, J. F. (2009). Ethics, Public Policy, and Human Fetal Tissue Transplantation Research.  Kennedy Institute of Ethics Journal,  1(2), 93–121. https://doi.org/10.1353/ken.0.0073

Abstract: This article focuses on the deliberations of the National Institutes of Health Human Fetal Tissue Transplantation Research Panel in 1988. It explores various arguments for and against the use of fetal tissue for transplantation research, following elective abortion, and for and against the use of federal funds for such research. After examining the relevance of various positions on the moral status of the fetus and the morality of abortion, the article critically examines charges that such research, especially with federal funds, would involve complicity in the moral evil of abortion, would legitimate abortion practices, and would provide incentives for abortions. Finally, it considers whether the donation model is appropriate for the transfer of human fetal tissue and whether the woman who chooses to have an abortion is the appropriate donor of the tissue.

5. Ethical Research Involving Fetal Human Subjects: American Association of Pro-Life Obstetricians and Gynecologists. (2023).  Issues in Law & Medicine,  38(2), 182–194.. https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=174192317&site=eds-live.

Abstract: Fetal tissue research refers to research using several types of tissue, including but not limited to samples obtained from aborted fetuses, cell lines derived from aborted fetuses, and in rarer cases, living previable neonates who have survived an abortion attempt. The ethical questions surrounding each type of tissue procure