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    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

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    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.



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Ethics in Modern Healthcare

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The Access to Medical Care Dilemma

By David E. Marcinko MBA

By Render S. Davis; MHA, CHE

[Certified Healthcare Executive]

Crawford Long Hospital at Emory University

Atlanta, Georgia, USA


In his book, “Back to Reform”, author Charles Dougherty writes that “cost containment is the goal for the healthy.  Access is the goal for the sick.” 

A Meaningless Distinction

So, for an increasing number of Americans, the concerns experienced in-vitro, in-vivo, or described on this Medical Executive-Post blog, are almost meaningless because they are, for the most part, outside the structure of the current health care system. Why?

  • Employers are downsizing staff or cutting out health insurance benefits in an effort to be financially successful in a global economy.
  • Demands for greater government accountability in the expenditure of tax dollars have brought about increasingly more stringent eligibility requirements for safety-net programs like Medicaid. 
  • As insurance becomes more expensive or government programs undergo budget cuts, people are being excised from the system.
  • New competitive demands have fostered unprecedented consolidations, mergers, and closures of healthcare facilities.

This shake-out may have served to greatly reduce the overcapacity that plagued the system, but it has been done with greater emphasis on cutting costs than on fostering efficiency and effectiveness in creating a true system of care delivery. 

The Healthcare Commodity Issue

Those who view health care as little different from any other commodity available through the free market see the present access concerns as simply a byproduct of the inevitable restructuring of the system. While they argue that we must adhere to market solutions to solve our health care access problems, others demand a different approach calling for governmental national health insurance or some form of subsidized care providing at least a basic level of treatment for all citizens. 

Moreover, while Americans continue to proudly tout that we do not explicitly ration care as do some other countries (notably Great Britain and Canada); we tacitly accept a health care system that implicitly excludes citizens who are unable to overcome financial barriers to access.

Care Access Issues

Access to care represents the most visible issue at the very foundation of the ethical principle of justice. 

In their text, “Principles of Biomedical Ethics”, authors Thomas Beauchamp, Ph.D. and James F. Childress, Ph.D. point out that “justice” is subject to interpretation and may even be evoked to support the positions of parties in direct opposition.

A Philosophical Mixed Bag

For example, those who support the predominant principle of distributive justice – the fair allocation of resources based on laws or cultural rules – still must decide on what basis these resources will be used. 

On the other hand, this mix-ed bad of philosophical thoughts include among others:

  • Utilitarians, who argue for resource distribution based on achieving the “greatest good for the greatest number.”
  • Libertarians, who believe that recipients of resources should be those who have made the greatest contributions to the production of those resources – a free market approach to distribution.
  • Egalitarians, that support the distribution of resources based on the greatest need, irrespective of contribution or other considerations. 

Consequently, developing a system of access based on “justice” will be fraught with enormous difficulty.

The Current System

In the current health care environment, access to medical care is approaching crisis levels as increasing malpractice insurance premiums are driving physicians from high-risk specialties such as obstetrics, emergency medicine, and surgery in record numbers. 

The impact is most dramatic in rural and under-served areas of the country where sole-practitioners and small group practices are discontinuing services, leaving local citizens with no choice but to forego care or travel greater distances to regional medical centers to find necessary treatment. 

At the same time, significant budget cuts at both the federal and state levels have seriously eroded funding for Medicaid, leaving this especially-vulnerable segment of the population with even fewer options than before.

Issues Moving to the Forefront

Two areas of the medical care access dilemma are moving to the forefront.

1. The first is in emergency medicine.

An initial study by the Federal Centers for Disease Control and Prevention, cited statistics showing that in the decade ending in 2001, emergency room visits increased 20 percent, while the number of emergency departments shrank 15 percent. Increasingly, hospitals have closed emergency departments due to increasing costs, staffing shortages, and declining payments for services. This crisis comes at a time when post 9/11 fears of terrorism and global disease outbreaks like Severe Acute Respiratory Syndrome (SARS) have placed an even greater burden on the delivery of emergency services.  It continues and is exacerbated, even today.

For example, Arthur Kellerman, MD, former director of emergency services at Atlanta’s Grady Memorial Hospital, the city’s only level one trauma center, writes that “the situation is alarming and has been for some time… It’s unconscionable that we are not coming to terms with the Achilles’ heel of our health care system.”

2. The second area that will grow in significance is in the area of genetic testing.

As technological capabilities improve, medicine’s ability to examine an individual’s genetic makeup will open up remarkable opportunities to predict a person’s susceptibility to certain diseases or handicapping conditions. From a scientific standpoint, we are on the threshold of an extraordinary new era in medicine, where identifications of and treatments for potential illnesses may begin before the person is even born.

“Medicine’s Iceberg”

However, there is a more troubling access side to the potential of genetic testing as noted by Johns Hopkins University president, Dr. William R. Brody. He described genetic testing as “medicine’s iceberg,” where serious dangers for access to care are lurking beneath the surface. 

According to Brody, heated debate has already begun regarding the value of genetic information to insurance companies who could use the information to determine premium levels, even the overall insurability, for individuals and/or families with a member identified through testing as predisposed to a catastrophic and/or potentially expensive medical condition.

In this scenario, infants manifesting a genetic predisposition to certain illnesses or potential behavior disorders may find themselves faced with lifelong un-insurability based on the results of prenatal genetic testing.


Furthermore, Brody persuasively argues that the potential of this technology, regardless of the incredible scientific potential it offers, could lead to dramatically diminished access to health insurance for tens of thousands of individuals and families and bring about an “end to private health insurance as we know it.”  He suggests that some form of community-rated, universal health insurance may be the only reasonable alternative to assure that Americans at all levels, from indigent and working poor, to the most affluent, may receive needed, basic medical care. 


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11 Responses

  1. About the Journal of Medical Ethics
    [Aims and Scope]

    The Journal of Medical Ethics [JME] is a leading international journal that reflects the whole field of medical ethics. The journal seeks to promote ethical reflection and conduct in scientific research and medical practice. It features original articles on ethical aspects of health care, as well as case conferences, book reviews, editorials, correspondence, news and notes. To ensure international relevance JME has Editorial Board members from all around the world including the US, Europe, Australasia and Far East.

    Subscribers to the Journal of Medical Ethics also receive Medical Humanities journal at no extra cost. JME is the official journal of the Institute of Medical Ethics.




  2. Patient’s Bill of Rights

    The White House just released this “Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights,” the Obama administration’s summary of new regulations issued by the Department of Health and Human Services.

    The formatting is from the original version of the Patient’s Bill of Rights, as released by the administration.


    Hope Hetico RN, MHA


  3. Study Says Doc Ownership Affects Likelihood of Surgery

    Patients treated by doctors who had ownership interests in a specialty hospital or ambulatory surgery center were more likely to receive arthroscopic knee surgery or carpal tunnel and rotator cuff surgical repair than patients treated by physicians who had no such interests, according to a new study in the Archives of Surgery based on an analysis of five years of claims data from a large private insurer in Idaho.

    The report, written by Jean Mitchell of the Georgetown Public Policy Institute at Georgetown University in Washington, examined outpatient surgical data from ambulatory surgery centers, specialty hospitals, and community hospitals in Idaho for 2003 through 2007.

    The report concluded: “The increased utilization that characterizes physician self-referral arrangements will continue to lead to higher health insurance premiums, which in turn is likely to result in more uninsured and underinsured persons.”

    Source: Andis Robeznieks, Modern Physician [7/16/10]


  4. Is this Ethical?

    Federal health officials just released their final selection of nine graphic warning labels to cover the top half of cigarette packages beginning next year, over the opposition of tobacco manufacturers.

    In the first major change to warning labels in more than a quarter-century, the graphic images will include photos of horribly damaged teeth and lungs and a man exhaling smoke through a tracheotomy opening in his neck.



  5. What is ‘Moral Monday’?


    It is a Southern thing.



  6. 4 ethical dilemmas facing physicians

    Time and financial pressures force physicians to confront difficult decisions every day.


    A personal and topical mission of mine.

    Dr. David Edward Marcinko MBA


  7. More on Ethics


    OR – Why the WHO ethics advisory group is a start but hardly sufficient.



  8. Internal Survey Shows the Red Cross’ Own Employees Doubt the Charity’s Ethics

    According to Justin Elliott, survey results obtained by ProPublica also show a crisis of trust in the charity’s senior leadership.




  9. Steven Pinker is right about biotech and wrong about bioethics

    Steven Pinker published an editorial in the Boston Globe that scorned the profession of bioethics, telling them to “Get out of the way” of biomedical research. Ironically, he made this point with a poor bioethical argument.


    Despite that, he made a valid point about how we should evaluate novel biotechnologies. In short: this is a mess, but it’s worth straightening it out.

    Bill Gardner via Ann Miller RN MHA


  10. Ethics,

    An often neglected topic by Obama and Trump; well done.



  11. Internet Medical Ethics review


    Dr. David E. Marcinko MBA


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