University of Pennsylvania professor of bioethics Art Caplan spoke on health care reform at a talk sponsored by the Kegley Institute of Ethics at California State University, Bakersfield, on Monday, Oct. 5.

America can’t move forward with health care reform without a consensus on whether health care is a right, bioethicist Art Caplan argued Monday night at California State University, Bakersfield.

And that right has to be rooted in an American concept, just as other countries have come up with their own rationales — as a reward for getting through World War II in the United Kingdom, for efficiency’s sake in Germany or for solidarity in Canada.

That American concept, Caplan said, is equality of opportunity. Implicit in American philosophy is the notion that someone who works can pursue anything. But that breaks down without health care, he said.

“If you can’t chew, or walk, or eat, or see, then you can’t get far,” he said.

Until America accepts that health care is a right, it’s easy for opponents of any proposal to pick it apart without offering their own solution, he said.

Caplan spoke to a crowd of about 300 people, about half of whom were students from CSUB and other schools, as part of a series presented by the Kegley Institute of Ethics at CSUB. Caplan is a professor of bioethics and the director of the Center for Bioethics at the University of Pennsylvania.

Pro- and anti-Obamacare

Caplan had both praise and criticism for proposals for health care, most of which he ascribed to President Obama. He praised the attempt to change the system, which is crippling the economy and could send more industries down the path of the auto industry. And he highlighted four major areas — mandated insurance, an emphasis on prevention, research on what works and electronic records — as centerpieces of the plan that will make great strides.

But he also said tort and malpractice reform are needed, to end what he called the lottery you enter when something bad happens to you. And he said the real debate should be about what is covered in “basic health care” — and that question hasn’t even been addressed yet.

“That’s where the fight should be,” he said.

Critics of health care reform haven’t seized upon that gaping hole, either, he noted.

He said concern over a public option versus co-ops is misplaced. Germany and Switzerland, with regulated and subsidized private markets to provide universal coverage, use basically the co-op system. He said it would be better to have co-ops and get something in place, and if co-ops prove not to be workable, then we can come back and try again. However, he said the private insurance plans need to be able to sell across state lines — while some proposals out of the Senate have called for state or regional co-ops with less flexibility.

Death panels and bureaucrats

Caplan pointed to “comparative effectiveness” studies as a good proposal that’s been maligned by opponents as bureaucrats getting in the way of doctors.

“No, it’s not,” he said. “It’s science!”

The studies would just make sure that, for example, a patient used a generic drug that is shown to be just as effective before getting a more expensive name-brand drug.

There has been no opposition, he said, to that proposal by medical groups.

Caplan said the health-care system also needs to move to electronic records, if only to eliminate duplicate tests caused by lost charts and injuries caused by bad penmanship. The current system, he said, is a 21st century health care system managed with 19th century information systems.

And to deal with a shortage in primary care doctors — a shortage that will only get worse if the uninsured can suddenly go to the doctor — more power must be given to nurses and pharmacists to provide basic health services.