Healthcare
All citizens in our world are entitled to comprehensive health care.
Before conception, all women of childbearing age are kept in good health, with mandatory health maintenance visits. When conception is desired, before discontinuing contraceptives, women are counseled about nutrition, prevention of birth defects, and recreational drug and alcohol use. Similarly, they are counseled regarding the commitment involved with child rearing. Throughout pregnancy they are monitored with prenatal visits. If a patient fails to show up for these visits, they are contacted and brought in by a health care worker. If they cannot be located at their registered address, they can usually be found using data from their Swipe Card use.
All citizens, throughout their lives, are subjected to periodic health maintenance visits, at which time compulsory immunizations are given, and screening tests are performed. Any conditions detected which require further investigation are discussed with the patient, and specialist appointments are arranged.
While citizens have the right to choose whether or not to seek medical attention for their health problems, there are some public health decisions that our society mandates. One of these is immunization. We feel that it is unfair for a citizen to put others at risk of dangerous infectious diseases by not obtaining available immunizations. Likewise, it is a burden to our resources to care for a patient with a preventable illness. Another example would be a patient with AIDS that insists on pursuing unprotected and uninformed sexual relations. We reserve the right to restrict such a person to a living center with other AIDS patients with the same intent. That is not to say that we send all of our AIDS patients to a "leper colony". Almost all of these afflicted individuals live freely in society with no stigma.
In the past, healthcare was a very expensive burden to individuals, employers, and to the government. There were two reasons for this; profit and insurance companies.
Consider the development of a new antibiotic medicine. A pharmaceutical company would pay a staff of researchers to work for years, modifying an existing drug into a new, slightly different molecule. They would immediately fill out a patent application to protect the company's rights to the new drug. They would then work out all the fine points of the chemical synthesis and demonstrate its activity in vitro, suppressing bacterial growth in a petri dish. Then they would get permission to begin animal testing for safety and efficacy in treating infections. Finally a series of clinical trials aimed first at showing it was safe enough for a large scale trial, and then a number of trials to show that it was superior to the leading brands of antibiotics. The company would then apply for FDA approval to market the drug for clinical use. An advertising agency would be hired to think of a catchy name, slogan, tablet shape and color, and this would be tested on a focus group to see what their reaction would be. Then a sales force would be educated in the use of the drug, samples would be packaged and they would proceed to visit the office of physicians and give them pretty pens and note pads, calenders, wall clocks, and buy them lunch to tell them why they should prescribe the new drug over the current leading brands.
Profit was built in to every step of the process. The researcher and his staff had to earn a living. The people who made the laboratory glassware, analytical instruments, benches, purified reactants, notepads, and protective eye goggles all had to make a profit. The patent attorney and her staff all made a profit. The research animal breeder made a profit. The patients in the clinical trials may have been compensated. The advertising corporation and the test audience made a profit, and so did the pen company, the notepad company, and the salesman all made a profit. It was this compounded profit that sometimes brought the cost of an antibiotic to five dollars a pill.
Consider what was involved in getting an MRI scan performed on a patient's brain. A great deal of research was done by the instrument company to initially develop their MRI technology, and finally get government approval to use the technology on humans. Then the market version of the scanner had to be designed, tested, approved, and manufactured. Each resistor, capacitor, spool of wire, and every integrated circuit in the scanner's computer that was purchased from an outside company had built-in profit. The plastic knob on the control panel was injection molded by a knob company, on a complicated, expensive machine. That machine was, in turn, purchased at a profit from its manufacturer who similarly bought components from a variety of vendors who profited from the transaction. Finally, the small plastic knob on the mold machine was purchased, ironically, from the very same knob company using the mold machine! There were endless layers and cycles of profit in every manufactured product, including the MRI scanner. Even the little red light that blinked when the machine was in use, had built-in profit.
However, in our world we do not have layer after layer of built in profit. To us, manufacturing an integrated circuit chip only costs as much as the labor dedicated to the work, and the raw materials. An MRI scanner only costs as much as the labor dedicated to assembling its parts, and the labor dedicated to assembling the parts of the parts, and so on down to the raw materials. Our real cost of an MRI scanner, in terms of labor and materials, is really only a small fraction of its cost in the Old World. An antibiotic pill only costs as much as its raw materials, the equipment to manufacture it, and the labor to perform the previously mentioned research activities.
For this reason, it is financially feasible to provide all citizens with good health care throughout their lives. A liver transplant once cost hundreds of thousands of dollars, plus thousands of dollars each year for medications. This was because every day of hospitalization, hundreds of items were used that were supplied to the hospital at a profit; dozens of syringes, IV catheters, dressings, disposable ventilator tubing, intravenous solutions, antibiotics, anti-rejection medications, electrodes, and specimen bottles. Dozens of health professionals charged for their services; surgeons, intensivists, gastroenterologists, nurses, physical therapists, occupational therapists, social workers, dialysis technicians, laboratory assistants, radiologists, x-ray technicians and many more. Now, a liver transplant only costs as much as the required labor, and the manufactured supplies and medicines. There is no fifteen thousand dollar ventilator or ten thousand dollar bed; these pieces of equipment are similarly deflated in cost to our society. Once compounded profit is removed from health care, it is really very inexpensive.
The elimination of insurance companies has further freed our society to efficiently deliver health care to all. Insurance companies did little more than collect money from patients, distribute some of it to hospitals and physicians, and keep the remainder as profit. There was an insane tournament between the patient and the insurance company; the former betting he will get sick and need millions of dollars of services before paying his first premium, while the insurance company was betting that the patient would pay premiums for years without a claim, and then suddenly and inexpensively drop dead. They employed unimaginable numbers of people to manage benefits, shuffle funds, and generally impede delivery of needed services. Once our concepts of money and profit disappeared, so did the insurance industry. Another layer of profit has been stripped away from healthcare, and millions of people have been transferred to more productive jobs.
In our world, patients can elect doctor assisted suicide when they have developed a chronic and incurable illness that has so altered their quality of life that they are suffering, or unable to have a meaningful life due to their condition. In previous eras there was concern that patients might elect to terminate their lives to save their family from the financial burden of caring for them. Since that is no longer an issue in our world, it is unlikely that family members would pressure a patient to make such a decision against their will. All requests for assisted suicide are reviewed by the Thanatological Ethics Board. This board evaluates the patient's diagnostic certainty, prognosis, mental status, and social situation before permission is granted.