| Do all segments of society share in the benefits of | | | | are paying the rent, paying utility bills, and putting |
| medical research? Not exactly. For the tens of millions | | | | enough food on the table so family members will have |
| of Americans who have chronic diseases such as | | | | the energy to survive another day. Filling prescriptions |
| diabetes, heart disease, and cancer - and who also | | | | addresses problems that are usually not immediate. |
| have no health insurance - medical care is | | | | Choosing between being able to buy a half-gallon of |
| unaffordable. Additional tens of millions of Americans | | | | milk and a loaf of bread every day versus spending |
| have health insurance but the annual premiums are | | | | $150 (without insurance) for a month's supply of |
| exorbitant, the benefits are minimal, and out-of-pocket | | | | antihypertensive medication is simple. Milk and bread |
| expenses are high. | | | | win every time. |
| Imagine that one of these Americans wakes up one | | | | When a family chooses, by necessity, to buy food |
| day with a pounding headache, experiencing unusually | | | | rather than prescription drugs, their illnesses worsen |
| intense pain. The person is not prone to headaches, | | | | over time and add substantial costs to the heath care |
| hasn't had one in a long time, and the pain is severe. | | | | system. When a father suffers a heart attack |
| Will she go to the emergency room and get a "brain | | | | because he has avoided taking his medication, the ER |
| scan" - a magnetic resonance imaging (MRI) study? | | | | and hospital charges may exceed $50,000. He is |
| Most likely she will not, choosing to wait out the pain | | | | uninsured and the hospital attempts to recover the |
| rather than spend $3000 at the hospital ($1500 for ER | | | | losses by eliminating important services and by raising |
| services and $1500 for the MRI). Not many | | | | its rates. These higher rates are paid by everyone. |
| middle-income or low-income persons are able to | | | | The losses of services, such as cutbacks to burn units |
| blithely tack on $3000 to their household debt. | | | | and community outreach programs, affect everyone. |
| Unfortunately in this case the person is experiencing a | | | | Members of Congress are asleep at the switch - they |
| real emergency, but she doesn't know it. She thinks | | | | consistently fail to recognize the implications of their |
| she has a bad headache and it will go away within a | | | | failure to address these deep inequities. Every |
| few hours. She is unaware that a berry aneurysm is | | | | American suffers from these ongoing violations of the |
| about to burst in a small artery in her brain. Later that | | | | bioethical principle of distributive justice. But we don't |
| day the aneurysm explodes and the woman falls into | | | | recognize that the medical problems of the |
| a coma, dying before her husband and children return | | | | underinsured affect our pocketbooks. |
| home from a day at the beach. | | | | When distributive justice is violated, everyone is |
| Similar scenarios may be outlined for many acute | | | | affected. We all pay substantial hidden costs to |
| emergencies and chronic ailments. For many families, | | | | support our failing health care system. |
| medications are luxury items. Their primary concerns | | | | |