Thursday, October 8, 2009

Is Health Care a Right?

The U.S. Supreme Court has opined that we cannot falsely scream Fire! in a crowded theater, despite our sacrosanct right of free speech. Even sacred rights have limits. When individual rights collide with societal rights, then each side’s arguments must be weighed to determine whose rights will prevail. This is not a clean or satisfying process as each claimant brings passion and legitimate arguments to the table.

I have been involved in a cyber colloquy with Maggie Mahar at Health Beat discussing if health care is a right. Maggie is well known in health care circles and examines health care policy from a liberal perspective. She’s on the left and I’m not. I hesitate to define health care is an absolute right before considering some of the broader ethical ramifications.

  • Is health care a human right?

  • Is health care a constitutional right?

  • Is health care a privilege?

  • Is health care a commodity to be purchased at the discretion of the consumer?

  • Is health care a responsibility?

A laudable position is that every American has a right to health care. While this slogan sounds noble, what does it really mean? Does it mean that every citizen has a right to every available medical benefit? Or, would every American have a right to a basic package of medical benefits? Who would define these scaled down benefit packages? If someone with the guaranteed ‘no frills’ plan needed chemotherapy or a bone marrow transplant, which are not covered benefits, would we be prepared to act as the infamous ‘death panels’, recently vocalized by several conservative commentators?

My hesitancy in declaring a health care a right it that it ignores the necessary elements of personal responsibility and societal rights. While there is a potent moral argument that we provide every citizen with decent health care, this must be balanced against society’s interest in a system that allocates health care resources fairly. Here are some hypothetical issues to consider.

  • If health care is a natural right, then, are illegal aliens entitled to it as a basic human right? If not, then what is our response when they develop chronic illnesses, which cannot be effectively treated in emergency departments?
  • Do irresponsible or reckless individuals have an absolute right to health care? Is it fair to the rest of us to pay for health care for those who pursue a riskier lifestyle? Does a man with multiple DUI citations, for example, have the same right to health care as a practicing nun?
  • Should individuals who won’t take cardiac medications that they can afford, or see their physicians when advised to do so, have a right for emergency treatment for a heart attack at our expense?
  • If health care is truly a right, then should it be illegal for any citizen in America to not have medical coverage? If this were the case now, then who would be legally liable for the 46 million uninsured?
  • Can folks waive their right to health care, as the Amish community now does? Who pays when this individual needs emergency surgery?

These are very delicate issues that torment folks on all sides of the political spectrum. The Nation, an organization on the far left and the more moderate newspaper USA Today, both agree that health care is a right. The Foundry, Crystal Clear Conservative and KevinMD have reached a different conclusion. It is an enormous challenge to establish a stable equilibrium balancing society’s rights, human compassion, personal rights, medical ethics and fiscal realities. I can’t solve it, but I know that the proclamation health care is a right is a quixotic mantra that fails to appreciate the enormous complexity of the issue. If rights were so easy to establish, then we wouldn't need a judiciary.

It is possible that the Supreme Court may hear this case. While this gang of nine are the last word on determining rights, this doesn't mean they will get it right.


11 comments:

Teresa said...

I don't think that health care is a right. With living in society, every individual has certain responsibilities that they must adhere to, or follow. Now, I am not saying turn away the poor if they can't afford a necessary procedure. But, sometimes the emergency rooms are used more like a walk-in doctor's office,and thats not its true intended purpose. Maybe, opening more clinics for the poor, having physicians donate their time, and be able to have that as a tax deduction. Honestly, I think medicare, medicaid and welfare needs to be revamped and rid the waste in those programs first, then focus on tweaking the health care system, but not completely changing the whole setup of health care as we know it today.

MarlboroJones said...

I look dimly on the grotesquely obese. If they chose to remain fat and suffer associated health problems, do I have to pay for their health care? I ask this as a person who's lost over 100 lbs and has kept it off for several years.

Maggie Knowles said...

How about insurance companies that refuse to cover newborn babies because they're too fat. They're considered to have a "pre-existing condition".
http://rawstory.com/2009/10/insurer-refuses-to-cover-baby-says-hes-too-fat/


I agree with Franklin D. Roosevelt and his Second Bill of Rights:

1. The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

2. The right to earn enough to provide adequate food and clothing and recreation;

3. The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;

4. the right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

5. The right of every family to a decent home;

6. The right to adequate medical care and the opportunity to achieve and enjoy good health;

7. The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

8. the right to a good education.

Evinx said...

Rights are something the govt CANNOT take away from you. It cannot prevent you from exercising your religion, or free speech. Of course, there are some very limited constraints on these rights.

There is no such thing as a right toward another person's labor or knowledge. I do not have a right to your GI knowledge or services.

Our present healthcare debate is one that should focus on how to allocate a scarce resource - and imo, we have not found any system better at doing it (providing the greatest amount of good for the greatest number of people) than the free market/capitalistic system.

Once the govt got involved as a supplier (and not simply a regulator), it succumbed to the influence (and corruption) of special interest groups which is inevitable in the political allocation of healthcare. That is why there are so many distortions to the system - mandating chiropractic exams but not more than 20, or psychiatric evaluations, or pregnancy etc.

Ultimately, one ends up with an entangled web of corrosive and distortionary mandates bcs we have assigned healthcare to a political process.

Providing a basic level of service for the poor is one thing, but having the govt run the system is quite another. When you agree or succumb to the latter, you forgo the ability to do an effective job for the former.

Agreeing to a right to healthcare is tantamount to agreeing to a right (of society, however nebulous that term is) to a right to price controls on other people. It will create just any many distortionary effects as price and wage controls did roughly 45 years ago.

The pricing mechanism is a feeback loop. It provides information to millions on how to allocate supply and demand. It guides individual decisions on which fields to enter or stay away from. It provides information on what is worth (to the individual) purchasing or not. Govt run programs remove the price mechanism and thereby remove the feedback loop. That is why the so-called solution to govt program is always to throw more money at it. It reinforces failure.

A truly free market system is Darwinian and encourages evolutionary reform for the greatest amount of suppliers AND consumers.

Anonymous said...

Healthcare is too broad a term. Public health is a police power of the state. Examples: you have to be vaccinated before going to school, you can't build a home without a sewer hookup or septic tank.

Medical care is an individual good. Indeed, a luxury good in many societies. Declaring it a right is one more step on the road to serfdom.

Anonymous said...

the FDR comment- that's all fine and a good thing to strive for, but two of them stick out to me:

2. The right to earn enough to provide adequate food and clothing and recreation

the key word here is "earn." you do not have the right to do nothing and be handed resources for food and clothing and recreation.

6. The right to adequate medical care and the opportunity to achieve and enjoy good health

the key word here is "adequate." who decides what is adequate and what isn't? i think that's what this whole discussion is about.

Anonymous said...

When someone has a serious medical need they are probably better off with insurance. How many people are actually better off if they have no insurance? They probably don't get all of the unnecessary treatment. How many live longer as a result of not having insurance compared to how many would have been better with insurance compared to how many without insurance have a serious medical need? Ohhhhh another load of baggage to sort no doubt.

How much food do we send around the world but some dislike the idea of free school lunch for poor in our country?

Somewhere in all of this there is a need to look out for the needs of Americans first.

So, some poor soul is lying on the sidewalk with a serious cut but they can't afford the $20.00 bandaids at the hospital. Just walk around them or try to help them or?

With so much money devoted to war and various would some of it be better spent taking care of our own?

A few years ago I read statistic of longevity and healthcare ratings compared with other countries. To my surprise, at the time, we were not ranking so high. Is that because some don't have insurance, or could it be that people with insurance are overtreated, or at least a need for our healthcare to be examined? I will find the statistics and come back asap.

Evinx said...

Anon
The longevity statistic is based on politics and not facts. The US life expectancy is #1 when you exclude homicides and accidents - both clearly not the fault of our medical system.

18% of the uninsured today are those in the 18-34 group even though they are only 10% of the population. 16% of those who said they have no health insurance are actually covered by Medicaid - and just failed to report it on the Census forms (the basis for all the statistics). And 9% of the 46 million are illegals - people who should not be in the US in the first place.

After all the math is done, 5% of our 300 million population are not covered bcs they are willing yet unable to get insurance.

Does it make sense to revamp 1/6 of our economy for an unproven system to cover at most 5%? The politics of the argument is what is the real driver here - there is a percentage of people (oftentimes politicos) who simply want the govt to be the provider of most goods + services. Let's be honest - that is the real issue and the rest is just smokescreen to camoflage (sp?) this ideology.

Anonymous said...

I don't think one needs to address the morality of extending health care to all. We pay for uninsureds and under-insureds right now under the current system. We spend significantly more per capita than any other industiralized democracy. We'd save money overall if all were covered and hospitals didn't have to charge wildly different rates to make up for all the times they are stiffed. This really isn't rocket surgery! We have dozens of fairly successful and humane examples to base a health care DELIVERY system on. While your piece sounds reasonable, your objections are mostly distractions. We really don't need to delve into these finer points to change the system. How broken is the system now? Could you do an analysis of all the fine points of our current unfair, for-profit, corporate-controlled, inhumane health care delivery system in the U.S.? I find it difficult to believe that we could make it worse or more expensive. Our system is barbaric for all but the wealthiest. Huge, incredibly wealthy insurance corporations are doing everything they can and spending millions (per day!) to derail this reform attempt by ANY means. Take a look at that. That's the elephant in the room.

Michael Enders said...

A person has a right to all the health care he or she can and will pay for. That much is in both the Declaration of Independence and the Constitution (as amended), which prevents anyone from being deprived of life, liberty, or property without due process of law. It is when someone else is expected to pay for it that it becomes a problem.

Michael Kirsch, M.D. said...

Appreciate all comments. While I struggle over the question if health care is a right, I maintain that there should be an element of personal responsbility. If an individual is reckless and irresponsible, are they entitled to the same right to health care as a cautious and prudent person, particularly if the rest of us are paying for it?

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