As we continue to struggle with the rising cost of healthcare and the financial impact it has on people, it is imperative that one addresses the justness involved in pricing. Since I am framing this conversation within a social context, I am making an assumption that healthcare at certain levels is a right and not just a privilege. If you are not in agreement with this statement, I would suggest discontinuing reading further. However, I would remind everyone that in these United States we deem healthcare to be a right as we are legally responsible for providing care in our emergency rooms regardless of ability to pay. Though this is not efficient, it is the basis of our civic duty as members of society. From a religious and spiritual perspective, the right to basic healthcare falls under the premise of a human right since humans are created in the image of God.
In a recent Health Affairs article by Ezekiel Emanuel, When Is the Price of a Drug Unjust? The Average Lifetime Earnings Standard, he lays out an argument for a drug price being unfair if it exceeds 11 percent of the average American’s disposable income. This argument further suggests the prices for the many drugs above this level are therefore, unjust.
As part of this conversation, Emanuel points out guiding principles to establish a fair price. Historically, we have used Quality Adjusted Life Years as a measurement, but this does not allow for one’s complete life; therefore, the first principle is the unit of analysis which should be the impact over a lifetime, not just one year. Emanuel also argues that the price of a drug should reserve enough resources for people to pursue valued life activities; thus, healthcare and their costs are not central, but layer within a more contextual framework. Value is also crucial where the actual benefits align with the cost. Lastly, how does the treatment benefit comprehensiveness, support life activities other than the health matter at hand? And, how does treatment impact employment and other valued life activities?
Whether we agree with the math, the principles present an extremely different way of thinking about the pricing of services within the framework of social services. This conversation falls within the context of ethical principles, and I am only interested in bringing up the conversation within the context of these principles; our country demands delivery of care, and we as members of our society both expect it and are responsible for the costs. Therefore, elevating these discussions are essential since all of us are involved and, if we want to manage the polarity, we first must understand the nature of the question and the problem that requires a solution.
We will not create sustainable solutions that meet the needs of all involved unless we have the difficult conversations around fairness, ethical practices and access to care.