Market Justice vs. Social Justice in Health Care – Our National Identity Crisis

An outstanding commentary in this week’s Journal of the American Medical Association succinctly traces the history of U.S. health care in the context of “market justice.” Peter Budetti, MD, PhD, who teaches health policy at the University of Oklahoma, observes, “Fragmented and struggling to come to terms with externally imposed pressures, medicine is losing both its political force and moral compass.”
Those so-called externally imposed pressures come from stakeholders behaving according to their own self-interest in the health market: employers, physicians, hospitals, suppliers, insurers, public officials, and of course, consumers.

Dr. Budetti concludes that, “Market justice may have outlived its role in US health care.”
A striking example of the lack of market justice in real time in our health system was published in the same issue in JAMA. The study examined the use of opioids, narcotic drugs, which are used to treat patients with moderate to severe pain. Black and Hispanic patients are less likely than white patients to receive opioid drugs in emergency rooms to relieve pain. There are national quality guidelines on pain control issued in 2001 which increased monitoring of pain and managing pain control. These grew out of the emerging evidence-base on effectively managing pain in patients.

A good summary of the JAMA article on pain appears in Science Daily here.
The resesearchers examined over 150,000 hospital visits and found that 31% of whites received opioid drugs versus 23% of blacks and 24% of Hispanics. Non-opioid pain relievers (e.g., acetaminophen and ibuprofen) were prescribed more often to non-whites than to whites.
Here is but another example of health disparities that continue to mar U.S. health delivery. The greatest gap in prescribing strong pain meds were for people with the worst pain.
“We think our data indicate that opioids are being underprescribed to minority emergency department patients, especially black and Hispanic patients,” according to Dr. Mark Pletcher, co-author of the study.
Health Populi’s Hot Points: Who are we? Do Americans believe that every citizen should have access to an equitable standard of care? Tylenol and Motrin may be excellent meds for the occasional ache or pain, but they don’t do the job for the level of pain that motivates a visit to the hospital ER. Dr. Budetti shows us that we are at a fork in the road between market justice and social justice in health care. Let’s make the right turn toward a system that guarantees access to evidence-based health for all Americans.
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