Expert backs global health care
A visiting scholar believes Medicare should be expanded
Access to health care is the most important ethical question in medicine in most countries, says George J. Annas, internationally renowned health law scholar and activist.
The solution in the United States, he suggests, is to make Medicare, the government's health care program for seniors, available to all.
"Hawaii is a little better than most, but for 90 million Americans, access to health care is problematic," said Annas, a Boston University professor and chairman of Department of Health Law, Bioethics and Human Rights.
Uninsured and underinsured people with no regular doctor or health care end up in emergency rooms in worse shape than if they had early treatment, he said in a telephone interview. It's not only more expensive, but it's "no way to live, with pain and suffering," he added.
The only solution in the United States ultimately is "to take the one health care program everyone thinks is working, and make it available to everybody," Annas said.
"Medicare has an incredible track record of keeping administrative costs very low," he said, suggesting transferring it to private health care. The present system "is the most expensive in the world and still doesn't cover everybody," he said. "It is very wasteful."
Annas will be a key speaker at a conference today and tomorrow at the Hale Koa Hotel titled "New Frontiers in Maternal and Infant Health Care: Ethics, Outcomes and Practices in the 21st Century."
He touched on a range of issues in the interview, from reproductive technology, stem cell research and abortions to interrogations and force-feeding by physicians at Guantanamo Bay.
Annas is a national authority in law and medicine, co-founder of Global Lawyers and Physicians and author or editor of 16 books on health law, bioethics and human rights.
Regarding abortion, he said it has been a "giant issue in bioethics and law for 33 years" and there is a lot of talk about it in the Supreme Court. Congress theoretically could make it illegal based on a few opinions this year about the Constitution's commerce clause, he said.
But after last year's controversial court and congressional intervention in the Terri Schiavo case, he said: "I really think it is alarmist to even think that is a possibility. ... Bottom line, the worst it could get is to return the issue totally to the states."
Reproductive technology and embryonic stem cell research are other controversial issues, Annas said.
More twins and triplets are being born with assisted reproduction, and there are more premature births, raising a question of birth defects, he said. But no one is keeping data on kids born with in vitro fertilization, he said.
Informed consent is one of the problems of any of the reproductive technologies, he said: "It still is not routine to let children know who their genetic fathers are. There is a trend in that direction but in the U.S., it is probably 50-50."
Many states are funding embryonic stem cell research, since the federal government is not, but it has generated controversies because it requires donor eggs, Annas said: "The question is, what should be the procedures for protecting or reimbursing women? Everyone's decided you more or less can't pay for eggs."
But there are medical risks and ethical issues to donating eggs, Annas said. "It's one thing for a woman to donate an egg to a sister or to have a baby. It's quite another to donate eggs for research that may not have a payoff."
Annas said there are a lot of concerns about war and terror and what military doctors are doing at Guantanamo Bay. "Using physicians both in interrogations and force-feeding is just wrong. It's wrong for the doctors and wrong for the military to put them in that position."
A few doctors say force-feeding is necessary to save lives of suicidal prisoners, Annas said: "On the other hand, the military says these guys are doing it to make a point.
"If doctors believe they are suicidal and there is no other way to save life, they should do it in a medically humane way," he said, instead of using "cruel and arguably tortuous" methods.
Conference explores care for moms, kids
New research findings and policies affecting maternal and infant health care will be explored at a conference from 7 a.m. to 3:15 p.m. today and tomorrow at the Hale Koa Hotel.
The Healthy Mothers, Healthy Babies Coalition of Hawaii is sponsoring the meetings with the Department of Obstetrics, Gynecology and Women's Health in the University of Hawaii's John A. Burns School of Medicine.
Professor George J. Annas of the Boston University School of Public Health opens the meetings with a major address this morning on "Making Babies Without Sex: Social Policy Issues from AIDS to Cloning."
Mainland and local experts will lead sessions on a range of topics, including genetic screening for newborns, caring for pregnant women with drug and alcohol problems, mercury in cord blood and improving perinatal outcomes for native Hawaiian women and their infants.
Other topics will be long-term outcomes of premature infants, limited access to care, perinatal drug exposure, early intervention and advocacy, limited access to care, exercise during and after pregnancy and controversies in neonatal resuscitation. Sessions also will cover treatment options for mood disorders in pregnancy an postpartum, immunizing pregnant women and domestic violence and pregnancy.
For more information, see www.hmhb-hawaii.org or call 951-5805.