Is Health Care A Right?

Your question depends on what you mean by "right" and what level of care you're referring to. By "right" do you mean an unfettered "right of access" to any level of care, or do mean a right to government provided (tax payer funded) care on a restricted level? Obviously you can't have both.

I'm going to go with Scott here. We have access, it's just VERY costly in certain situations. In fact, it's costly because the US has the best of the best when it comes to catastrophic care.

The cost conundrum gets hairy when insurance denials, malpractice and setting fees for services are talked about. Our right to health care is shadowed by how much we pay for it. With 17% of GDP and rising, the cost of doing nothing is getting scarier.

Access is there, but dwindling due to the way health care is rationed by ability to pay. I believe that is the moral/ethical problem being discussed here. Remember that even in universal systems in France, the UK and Canada, the rationing occurs through taxation and access is limited on the specialty side as opposed to the primary side.

There's a give and take we have to agree on, but nobody denies we should have it. It truly hits you when you've been in an accident or diagnosed with a chronic condition.

Agreed, for a country of our stature we should have universal health care benefits. The US is one of the only countries not to have universal benefits, and somehow we spend more on health care than other countries and have a lower life expectancies?! Ummm, that isn't how it should be!

The only thing I am nervous about is the increased number of people seeking medical attention. Think about it, increased wait times, slower service due to individuals taking care of medical problems that they previously couldn't because of the lack of insurance, more competition for required services, and a lack of practicing physicians to help patients. Initially, it will be chaos and we will need to figure out the perfect way to introduce universal benefits...how should services be allocated? Who should receive treatments first?

There is a lot that has to be considered for universal benefits to be a solid idea! Very thought provoking post! Thanks Andrew!

Andrew, I want to hug you. 100% love your post.

Scott, I used to be a volunteer EMT. You get charged for using an ambulance. Sometimes they'll wave the fee if you can prove you're low income, but not always. Also, just to point out to you, if you are in an accident and taken to a hospital by ambulance, you will likely be treated whether you have health care or not, but you will also get charged for it. ER fees sometimes run up in the tens of thousands. That's why America is running itself into the ground with health care debt.

@Norcross - Are you assuming all doctors go into for the "nice feeling" they get from helping people?

I don't think the profit motive should be ignored.

@Norcross - The fact of the matter is, I was not saying that doctors only go in for the money. And frankly, you didn't' say the opposite. I merely made the point to point out the assumption you made in my statement. I digress...

I am merely asking what if there was a shortage. The shortage can come from anywhere. Maybe there is a study in the future that Medical care providers have a high incidence of cancer, or maybe the media rips them a new one and it no longer is looked upon as a reputable profession (not debating whether this will happen). In this instance, how will this "right" be provided? Does the government merely increase the incentive (i.e. pay) of it's doctors?

Not to bring economics into this, but medical care is a limited resource and medical need demand is fairly constant. A shift in the supply of medical providers could cause some real issues. No other right we have is like this (life, liberty, et. al.).

If national defense is a right, then health care is a right, and by health care I mean services that keep you or get you healthy, not cosmetic stuff. (Up to a point--if you're horribly burned then of course I support funding cosmetic surgery to help you recover.)

Disease and injury kill more of us than war does. If we're not going to fund single-payer, ever, then it's time we dismantled the military too.

Seriously.

And, finally, because I have not commented enough I guess--if you want rationed care, try not having insurance. I've been like that for most of the last ten years and I'm paying for it now in other ways besides money.

It is not enough to have access to the emergency healthcare system. And I was on Medicaid for about a year and a half and that didn't do me much good either. I got a C-section where they cut into me before my epidural had completely kicked in, and then I got brusque treatment and brushed off postpartum when I went in to a gen. practitioner with a thirty-pound weight gain in six weeks. Oh, it's not your thyroid, your TSH is normal. Now I have abnormal blood sugar responses and am a hundred pounds overweight with very similar habits to when I was at a normal weight. Fifty of those pounds came on after that last pregnancy. I have also had a lot of hair loss. Who knows where this will lead but regardless of who pays for it it will be more expensive than if I had had access to good primary care to begin with.

Imagine a world in which we pay for a normal doctor visit for the indigent rather than making them wait for an ER visit that costs ten times as much. And dying prematurely comes at an even higher cost not only to the patient but also to his or her loved ones.

I define a right as those rights guaranteed to us by the constitution of the United States. Rights guaranteed to us include the right to bear arms, the right to a speedy trial, etc. These rights are set forth in the constitution and its amendments. If health care is to be classified as a right, it should be passed as an amendment to the constitution. The first step is to introduce a bill that passes (by a two-thirds majority in each) both houses of the legislature. It then goes on to the states where it must be ratified by three-fourths of the states. The President or his administration does not have a role in the formal amendment process. So I would have to say, at this time, health care is not a right.

Andrew- I think it was pretty clear that the initial question was that of a US right..."If we are consider ourselves the leaders of the ‘modern’ world...", the very next line, leads me to that assumption.

I believe my statement "If you honestly think the number of doctors that do it just to "practice medicine" outweighs those that get involved for the paycheck, you are mistaken" covers the fact that I ALSO believe there are doctors out there that do practice because they love it, I just feel they aren't as many as those that do it for the payout. I also think that your statement "if the doctor is solely motivated by money, and has no real interest in my health or well-being, then I damn well better get a new doctor." is only half truthful. Let's be honest, if a doctor is really passionate about making money, he/she has to make sure that they are the BEST in their area and in order to do that, they must take extremely good care of you. Matter of fact, I would rather see a doctor that strives because of that factor than one that is just happy to be a doctor. Where I agree with you is if they have no real interest in your health or well-being that you "damn well" better find a new doctor...AGREED! Hence the freedom of choice when it comes to doctors, amen...that will diminish with a public option where you are told where to go, ask someone in the military, at least for now a lot of our soldiers can get secondary care off base to supplement because the government treatment is so bad!

You misread me by the way, and I apologize for making it seem like you demonized the rich, I was merely saying the "overall feeling in this country" is that of demonizing them currently.

You are also right on the burdening...with the health care we give away for those that can't pay, it really boosts costs and I understand that. The other thing that is not being mentioned about costs though currently is that the "preventative care" that they are boasting about will also increase the costs of the program. Just because you find diseases early and treat them before they become a "costly" problem does not take away from the fact that the initial tests that would be even more widely used under said plan...still have to be paid for! The more open it is, the more people will flock to those services.

I also believe it takes more than just tort reform to fix the problem and Akshay needs to equip more of the other options (and then some) that I had mentioned above.

@Chris - It could be semantics, but my first question was just overall, then a secondary point was in regards to the US.

One of the issues I see in the debate is about losing 'choice' of doctors. With most insurance plans (I've had 5 different ones in my life), I had a list of pre-approved doctors that would be covered. Could I go to someone else? Sure could, but I'd be paying 100% out of pocket. And my insurance plan also dictates what brands of medicine they will cover, in what order I have to try them, what labs will do any testing, radiology, etc.

I've got quite a bit of personal experience with this. When I was 20, I had a bad accident where I shattered the ball joint of my femur in my hip socket. Fortunately I had insurance at the time. However, I still got pegged with a bill because I didn't go to my 'approved' hospital. The problem? I was 3 hours away from my home on a vacation. It took 4 months of fighting for them to cover it. The total bill from that whole ordeal (surgery, hospital stay, medication, physical therapy) was over $100,000. Had I not had insurance, I would not have gotten most of that care.

Now, the doctors who treated me were well-paid, I'm sure. But they all had the honest desire to be a good doctor, in the same way I want to be an awesome programmer and you want to be an awesome marketing person. And if we make some money doing it above and beyond meeting our basic needs? Even better. But given how the ADA rations the amount of doctors available, they don't have to really care to stay in business. And there are only so many hours in the day, so their practice can only thrive so much.

@Milena - You're correct, most people are incapable of having a rational debate on anything, whether it's something as important as health care or who got kicked off some reality show.

What I am conflicted about is if you feel that there is a moral obligation to provide care, how other than the government would that take place? And who pays for it? I'm not arguing your points, I just really want to know. You're one of the few folks I know who can probably answer that without some pre-fabed talking points.

@Norcross - I think that is the most common question. People cannot seem to conceive of how health care can be provided without the government. My first answer is: it already is. My second answer is, it is flawed, inflexible, and expensive because of too much third party involvement. It needs to follow a model of something like car insurance, which is sought by the individual using it, the end-user. This is not how health insurance is run, and is one of the major factors in its uncompetitive nature and high cost structure.

The United States actually has a history of mutual benefit organizations which were comprised of people banding together to help each other. They were called "friendly societies" which eventually became so popular, they grew into what we know today as insurance companies or credit unions. What happened to cause their demise in the area of health care is beyond the scope of this comment, but google it.

The problem is most people believe no one would help anyone if it weren't by force. But oddly, it seems a majority of people believe this, so wouldn't such a majority (who does believe in helping others) have the mass to organize themselves?

In short, we'd pull money out of our own pockets to help other people, and hope they'll do the same for us if we need it. In my opinion, even under universal health care, I'm certain there would still be a major shortfall in quality and coverage, so we better get used to helping each other now. Things will not be getting better.

Again, I'm going back to the idea of 'where do you draw the line?'.

There is always going to be some rationing of health care. We are a capitalist society, so we currently ration health care based upon the ability to pay.

The questions are simple, even if the solutions are not:

1. If individuals are not primarily responsible for paying for their health care, then who is? (I know that employers pay for a chunk of it, but that is rolled into your compensation, so it is still on the back of the individual).
2. If someone else pays for, or helps pay for, someone’s health care, how do you apply the payments fairly for everyone? (This is the rationing, i.e. 'where you draw the line')
3. How much will this cost once we decide on where that line is?

All the arguments come down to these 3 questions. Some of them are philosophical (how much should I be responsible for my own life?). Some of them involve economics (how does a public plan affect the existing free market? Do we need to raise taxes to pay for a public plan?). Some of it is moral (how much responsibility do we take for our neighbors well-being?).

These are hard questions. But I see both sides unwilling to present facts and admit any kind of uncertainty. Both sides seem to say "my way is perfect and your way is a disaster". A public plan presents real funding challenges and issues about "rationing". A total free market solution leaves moral issue about our responsibility to the poor who can't afford basic health care. Neither side seems to admit this.

Personally, I think the President has presented a good compromise as a starting point, but I don't see many people having reasoned, factual, discussions about it. And the term “factual” implies quoting policy and scientific studies that support your position, not just stating your opinion.

I don’t have all the answers, but I’m willing to listen to someone who has a good argument and the facts to back it up.

I think it should be a right with codicil.

I also don't think the industry of health insurance should be part of the free market system, any industry where the profit for stockholders depends on some people living or dying is unethical (The free market was never meant to be a protection coercive industry), as is a medical profession where doctors have vested interest in the very surgery centers, radiology clinics and labs where they send their patients. Of all industries the health insurance industry should be regulated and beholden to anti-trust laws too.

There are certain things the government could do well, and other things they should stay our of, and health insurance and education are two things where I think a government should intervene.

Scott, the problem is the fiction that there is true competition between private insurers and government agencies. It's actually the antithesis of free market.

Anyway, what is the right again? A right to government dispensed healthcare? Where did this supposed "right" originate?

Andrew - Good post. I think this is an important question, because it always comes up. Of course, the answer depends on the definition of the word "right." My answer is no, healthcare is not a right.

If you require healthcare and are not provided that care for free, who has infringed on your right to free healthcare? Is it the doctor who wouldn't treat you at no cost? If so, then you must conclude that every doctor is obligated to treat every patient seeking his or her services, regardless of cost. The absurdity of that conclusion leads me to believe that the premise is false.

If it is society as a whole who owes this right to each individual member of society, then each of us has at least a partial obligation to pay for the healthcare of each other citizen. I don't think this should be the case. To be clear, I do support some social policies that adhere to this principle, such as welfare, medicaid, etc. But I don't regard any of those things as a right, and I don't think that everyone who opposes those policies is necessarily immoral.

When I think of a universal right, I think of things like the right to free speech, freedom of religion, and property rights. All of these things restrict the power of the government, i.e. the government can't tell you what to say, can't tell you who to worship, and can't take your stuff. To define healthcare as a right is to say that the government *must* do something for you, rather than restricting what they *can* do to you. And I know there are many different definitions of "right," and there are positive and negative rights, but this still doesn't seem logical to me.

I can't think of a valid principle according to which all the healthcare a person wants must be provided to that person at no cost, and so I don't think universal healthcare is a right.

As Milena, I see this as more of a question about who pays for health care or is health coverage a right. However, I don't see is at as only a moral issue as the government provides health insurance to do some people because it's a good or cost-effective idea. It became a good idea to give seniors health insurance because before Medicare the hospitals were full of poor, dying seniors. It's also become a good idea to give pregnant women health insurance because pre-natal care saves $4 for every $1 spent.

On that line, health insurance is already a "right" or provided by law for:
1. People over 65
2. People with End Stage Renal Disease (Medicare)
3. Veterans
4. People who are blind (Medicaid)
5. Most low income children (Medicaid and SCHIP)
6. Most pregnant women

So since we already have basically provided insurance as a right to half the US population, why not cover the rest? Why this continued incremental coverage of adding diabetics to Medicare or albinos to Medicaid, or Gingers to another insurance plan. For the purposes of this argument, we have already picked a good percentage of the population who has the right to health insurance.

@Scott. As far as drawing the line goes for coverage, the Oregon Health Plan did that for its Medicaid program. They ranked services by their value and when the money ran out so did the coverage. For example, dental cleanings are covered but lower back surgery is not. So that's a model that we have for addressing your questions.

@Olivia, I know that you don't like the insurance industry and there's some good reasons. However, when you talk about health care and GDP, insurance administration and profit and CEO salaries is only 15% of the health care dollar and it increases at the rate of inflation. Let's also talk about the other 85% that increases at 6%-8%/year.

If you believe that either health care or health insurance is a right, you cannot possibly be familiar with the Constitution. Neither is a right. The government has no authority to prevent access to either, but also has NO AUTHORITY to participate in either.