On Healthcare: What Right Have We?

I had an interesting conversation with someone I do not know on Twitter when I replied to a tweet that was retweeted by someone I follow.  It was about healthcare and rights.  That is really what it boiled down to, and that is what I feel is the fundamental question at the heart of the healthcare debate — Is healthcare a right?  And should it be?

To elaborate:  As Americans we believe in certain rights, we have codified many of them in a document we call the Bill of Rights.  We believe in a right to freedom of religion, press, assembly, speech and petition.  We believe in a right to keep and bear arms.  And we believe in a whole long list of rights regarding the legal system and protecting individuals from the government.  The right to have protection from quartering of troops without consent (apparently this must have been a big deal in the late 1700s), the right to protection from unreasonable search and seizure, the right to due process of law and a speedy and public trial by a jury.

Are those the only rights that we claim as citizens of the United States?  Of course not.  In fact the 9th Amendment specifically states, “The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.”  So, we believe in rights that exist even though the Constitution does not specifically outline them for us.  Which then begs the question — what are those other rights?  How are they determined?  Who decides what rights we have and what rights we don’t have?  Who makes the determination as to what is and is not a ‘Right’?  (I think this debate will become increasingly more important, especially since a right to privacy is not enumerated and that is becoming a huge deal in national and global politics.)

As I think about healthcare and especially the healthcare system in a America I keep remembering a PBS documentary I watched in an Anthropology class at BYU, Sick Around the World, where Washington Post foreign correspondent T.R. Reid visits five different countries (U.K, Switzerland, Germany, Japan, and Taiwan) and spoke with doctors and healthcare professionals, with legislators, and with average people and discussed their views on healthcare and how it worked in their countries, all the while comparing their systems with that of the United States.  He pointed out things that worked well in each country’s system, as well as a few areas where they fell short.  I would highly recommend this documentary to anyone wanting to join the conversation on healthcare.

 

The thing that stuck out to me about that documentary was an interview he had with the president of Switzerland, Pascal Couchepin. The president states,

Couchepin: We want also high quality for everybody in the health system. … School, healthcare, railway system, aging, to have a good place for nursing homes for old people, retired people, we think that we must have equality of that — not quite complete equality, it is impossible, but to have a great sense of solidarity among the people.”

And the interviewer follows with:

Interviewer: Now, see, that’s striking for an American, because we would certainly say everyone is entitled to an education, everyone is entitled to legal protection if you get in trouble with the law, but we don’t say that everyone is entitled to healthcare.

 

Couchepin: Why? Because it is a profound need for people to be sure that, if they are struck by a stroke of destiny, they can have a good health system.

 

Interviewer:  So if you ask the people of Switzerland, is everyone entitled to decent healthcare, the Swiss would say?

 

Couchepin: Everybody has a right to healthcare.

 

That conversation has stayed with me, years after I first watched this documentary, because the reporter has a valid point.  In America we believe in certain rights, but we do not believe that healthcare is one of those rights, as the people of Switzerland, and many other countries, do.  And that is the difference.  Because they believe that healthcare is a right, they are willing to pay the taxes, to set up the organization, to overhaul their system, as they did in 1994, to ensure that healthcare was accessible to all.

And, then this brings us to one of the other fundamental issues when discussing healthcare, and especially when we want to get the government involved — What does/should the government control?  How much should the Government do to help those who find them in a position where they are not able to take care of themselves?

To be honest, I am a fan of what we call the free market system. I think that competition is a healthy and good thing for society and will generally work itself out.  Customers will not pay a business that does not provide the service or good in the way they want and then that business will either fold or change and improve itself.  In the same way, prices tend to regulate themselves as more competition springs up and consumers are able to choose a different company offering the same product for a lower price.  But, as we look at the way the world actually works, we see that there are certain industries and fields where this does not happen, or where we do not want this to happen, areas of public interest or safety.   Can you imagine if the police or fire were private companies and charged for the service they provided?  Or, if there were private road companies that built and maintained roads, and you had to pay to use certain routes to where you wanted to go? There are certain services that we want to always work, despite the market, and so we are willing to pay taxes to have these regulated by the Government.

I believe that the Government should manage only that which the free market will not regulate of itself in the best way to benefit all citizens.  Yeah, I know that is a very vague statement, and even I am not sure exactly what I mean by it, only that I know I want the Government managing the infrastructure, such as roads and highways, and Police and Fire, so that I will always have access to these services.  In the same attitude, I believe that the government should be involved in the healthcare system, at least partially, to help ensure that exactly what is happening with healthcare in this country does not.  I do not believe it is right that a person goes bankrupt due to medical costs (CNN reported in 2009 that 60 percent of bankruptcies in US are caused by medical bills).  I am not asking for free healthcare for all (though that would be nice and works in other countries), I realize that cannot happen in America overnight, it is too big a change.  I just believe that the Government should step in and help regulate and protect its citizens from bankruptcy simply because they happened to get sick.  And I realize there is no such thing as free anything.  If the Government is going to be involved with lowering healthcare costs, someone is going to have to pick up the tab, and that will be the taxpayers.  Personally, I am okay with paying more tax in order to have this service, just as I am okay paying taxes to enjoy the other services that Government provides.  And honestly, is it really that much different than paying insurance?  You’re paying for the healthcare one way or another.  But, we need to be mindful of those less fortunate than ourselves.  I am willing to pay to help my neighbor.  And a government-run healthcare system, in my mind, as I understand it, is like a communal insurance program.  We all pay the taxes to the government, and then we use the services that we need. If one uses the service more than others, oh well, that’s the way it works.  (But, in that documentary issues like that are addressed in some of these countries, where people may abuse the free access to healthcare, going too often to the doctor for needless issues, causing a drain and clogging the system for those who actually need it.)

And, let me be the first to say that I admit that the Government is not the best solution, but the free market health insurance system has not been the best solution for millions of Americans, either.  Something needs to be changed, and I’m hoping we can discuss this as a nation, debate this, listen to each other, find new ideas and talk about them rationally, pointing out the benefits and detriments of each proposal, and then come to a compromise, make a decision that helps make healthcare — and I mean affordable healthcare, an accessible right for all Americans.

As I stated, it all comes down to the two fundamental questions for me — Is healthcare a right that all Americans should have access to?  And to what extent should the Government be involved?

 

I know that I have a lot of friends who live in other countries, England, Germany, Canada, etc.  I would love to hear your thoughts to this debate.  Are you satisfied with the healthcare system in your country?  What do you like about it?  What would you change?  Would you exchange it for an American healthcare system?

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7 thoughts on “On Healthcare: What Right Have We?

  1. Very well put. I just did a similar piece on my blog Medicalrevolt.com. I am a physician and think of this issue often. Many people (I am sorry to say they are often conservatives) state that healthcare is not a right. However I don’t know anyone who really backs this up with true belief. What they are really saying is that even if you are dying, in a car accident, having a stroke, a hospital is not required to treat you. They can leave you for dead outside the emergency room doors if they don’t think you can pay. I have yet to meet anyone who believes that. And in fact we have a law in this country that if you go to an emergency room for ANY reason they HAVE to treat you. That is a law right there making healthcare a right. And that is true of every state in the USA. So basically we do have a right to healthcare in the US. There is just to right to have it paid for.

  2. Pingback: Our Private Capitalist Healthcare System- Not Even Close | Medical Revolt

  3. Joe

    Hm. Police and fire are regulated at the state level, not the federal government. The reason businesses often employ “security” or pay for services is because this is insufficient for many businesses and individuals. Education is “free” in america, but many areas require charter schools to drive competition and improve local education. Free education only applies to the basic education. Not “higher learning” is college free? Is grad school free? Is that killing America? should we all be able, if we choose, to graduate from Harvard? I guess so. And it should be free. Medicine is the same, there currently exists free healthcare to ALL that are in need. Basic health care, emergency and nonemergent. People seem to miss that entirely. Please refer to EMTALA legislation. Free is as affordable as it gets.

    Also local police and fire often supplement their income with fines and tickets. Having worked in EMS and a father that was life time of police work, they do charge, and it is location dependent. Some charge more for the same service, even double. Also you say the Free market in medicine has failed. I would challenge that it has not been tried in many years. Health insurance companies have been dictating price and availability in the USA since I was born. Do not confuse a doctors office telling a patient “leave and don’t come back until you can pay” with an insurance company telling a person they must travel back to their home to receive medical care. And then telling them that it will cost them “x”$. None of that is the doctors decision or the hospital for that matter. Doctors and hospitals submit claims for services rendered and bills for 200$ and the insurance company delays payment for 90-400days and then cuts a check for $23.55 (as happened recently) and considers the issue resolved. Then turns and charges the patient through copay and 30% of the bill which was more than the company paid. Should health insurance companies be making money that could be redirected to patient care? If you take what insurance co make and then compare it to the doctor and staff income after the actual cost of providing the service, think there is a large margin for cost cutting in healthcare there too.

    Next point of interest. “we see that there are certain industries and fields where this does not happen, or where we do not want this to happen, areas of public interest or safety. Can you imagine if the police or fire were private companies and charged for the service they provided? Or, if there were private road companies that built and maintained roads, and you had to pay to use certain routes to where you wanted to go?”
    The state and federal gov collect bids from private construction businesses, low bid or best friend, if you are a cynic like me, gets the job. That same body, state or fed depending on the road, then places what is known as a toll. Then You pay each time you choose to use this convenient road. There are no exceptions because there are alternatives.nif you don’t want to pay use the long way around town. So it is in medicine, if you don’t like the overburdened free healthcare….pay for it and see a local non free doctor or service. Most if not all practices and hospitals have a price break (pennies on the dollar) for uninsured or cash patients. Some do sliding scale based on income.
    If you want to discuss the public interest. Shouldn’t we start with current issues that plague the USA. Smoking and drug abuse account for billions of dollars of self inflicted harm each year. Are we allowing people to intentionally do things that will cost millions to care for and not holding them a little accountable. If there is not repercussion from a decision, what will keep people from doing it? Not every thing is predictable, but if I take a knife to my foot, intentionally, do I deserve to have some dad or mom stay at work all night away from their “pursuits of happiness” to take care of my bleeding foot? Do I also deserve a plastic surgeon to come in on my demand and work magic for 6-9 hours repairing what I did intentionally? I would say not. I think there is an already provided level of care in America that is a reasonable starting point.

    Maybe once we fix insurance companies, we can work on those aspects that waste so much of the money in healthcare.
    Also if the government is going to get involved in bankruptcy avoidance, in 2010 42% of bankruptcies were from medical expenses but 78% of them HAD medical insurance. Again, fix the insurance company. Next on the list was job loss at 22%, uncontrolled spending habits collectively for approx 20% and student loans closes out the top 10. If the gov would pay for higher education entirely then doctors wouldn’t have the burden of 3000.00 monthly student loan bills and would be more successful in a practice that charges less.

    Can or should the government be involved in things like uncontrolled spending? This will help the individual financial hardships and allow for more people to afford their healthcare.
    A recent patient of mine came in and this patient has been entirely supported by the people of the USA for 20+ years. He made a few poor decisions and got unlucky a few years ago and contracted HIV to go along with the unfortunate results of years of smoking that have left this person with lung disease. He receives monthly medications that help manage all of his medical issues totalling approx $2,0000 a month. He continues to smoke making his problem worse and is unwilling to consider slowing down or stopping. All available resources have been offered at no cost. He informed me that he gets his 2000$ worth of mess from the pharmacy and sells most of them and then flushes the rest down the toilet. He doesn’t want to take them but must fill them monthly because a clause in the whole free expensive medication rules says that he must pick them up each month on time and take them or his disease will get worse and if he fails to comply the insurance will stop covering him entirely. The insurance understands it is cheaper to pay for him to get better than care for him as he slowly dies I the hospital. Medicine is trying to do the right thing. The patient is abusing the system. This is an average day. This patient is NOT the exception. This patient costs $2k + in Rx so that he feels better knowing he can go to the hospital and not pay for it. We are spending 2k to save him $45-60.00.
    Patients consistently come to the ER in luxury or borderline luxury cars and without identification or a wallet (left in the car) give an address of 1600 Pennsylvania ave or some thing similar and demand immediate evaluation of their cold. They get the same great service that any other would and then they leave with approprite prescriptions if needed once it is obvious they have a non emergent situation. The hospital eats the bill. That is free. That happens every day of the year. Their ER evaluation cost the hospital $600-1500 and would have billed $2000-3000 but cannot. S the next person in line pays it as the cost rises to $2100-3200. In a way you are already paying for your neighbor to get healthcare! That IS what you and many others are “complaining” is wrong with healthcare. The cost. The cost is high because you are the only one actually paying. Those backruptcies all go back to the hospital as unpaid losses. Business cannot survive long on net losses. Therefor the price goes up. You have what you want, an opportunity to pay for,your neighbors healthcare and access to free healthcare! It’s already done!

    While I admit there are some obvious changes that are needed in America’s healthcare, I do to think government run healthcare is good for the doctor or the patient. If it is bad enough for the doctor, I believe many will choose another field of work, like business, where they are less of a public servant and more of a respected employer/employee able to make a business model and work hard in a competitive market and reap his reward or failure. In the current “shortage of primary healthcare doctors” the government has done little to open new post graduate training facilities. If the government really wants more doctors that can afford to work for less or nothing then make it cost only 8-10 years grad school and beyond, of their life to become a doctor. Fix insurance and limit their profit margins to “sustainable growth only” and then place restrictions on care benefits for intentionally self inflicted harms. Seek to eliminate Tylenol as an OTC medication as it is the #1 toxic ingestion, cause of liver transplant etc in America. Ban cigarettes as there is no know safe level that does not cause harm to the smoker and those around . Then see how much money is left over and we can give all people “free” healthcare and a nice birthday party.
    Side thought, what if we actually pay people to be healthy instead of sick. How about we give everyone that maintains their health without needing hospitalization for 3 or so years….hmmm… Give them $10,000 every 4 years or so. Then perhaps people will pursue health and doctors that facilitate health and avoid illness and things that are known to cause illness. We could still give healthcare to the ill and unfortunate. But we might encourage people that are broke to be healthy and exercise, not eat fast food so much. Quit smoking or drinking in excess and those things. They would be more eligible for employment and able to pay taxes for those that are ill to get free healthcare. Win!

    1. Anonymous

      Well stated Joe. I couldn’t have said it better. I would only add that in our personal family MY family now has worse healthcare than we did a year ago because of the current so called obamacare. We had top of the line insurance and coverage. Now, we have middle of the line insurance and hefty out of pocket expenses. So, while I am worried about my neighbor (who on all sides of us, get “free” healthcare already) I am more worried about MY family. My neighbor on government assistance had one member of her family receive lasik eye surgery no cost to them, they outright admit that they use they system. They have faked illnesses to get meds to sell them to buy a non necessity. They all smoke by the way and not one of them has a tax paying job. So, since they are already getting free government everything how about working to make the insurance system better and not continue to make people Dependent on others…my other thought would be this, the other countries you mentioned are not America! Our country is unique and we should lead the way in helping people become better people not just giving out what people think they need…. You are all smarter than I but that’s my two cents worth.

  4. Anonymous

    One concern I have with a government run healthcare system currently is the demonization of doctors. They are accused of being rich (a common slur) and greedy by the administration which leads to biased and unfounded decisions. My father-in-law, who has practiced pediatric oncology for many years, tells me that it would be cheaper for the hospital to turn away patients who are on medicare because the government does not even pay the costs of the visit. The people who are using government healthcare frequently don’t show up to appointments because they don’t see the costs. It just seems that the government is discouraging quality healthcare by attacking those who provide it.

  5. I’ve seen healthcare in France firsthand, and was not impressed at all…however, I’ll stick to my two cents.

    I think life is a right. I think comment #1 is more or less my view: whether or not doctors swear to the Hippocratic Oath, they are required legally to preserve one’s life (EMTALA, passed about 30 years ago, plus a plethora of other similar laws). No one is turned away for serious medical reasons.

    True (unsubsidized) costs are lower when put to the free market. I’m with you regarding certain services (interstate in particular). Others, like mail (think DHL), I’m torn.

    Medicare/Medicaid is/was fairly easy to apply for prior to any recent changes, and I don’t think there’s a need to expand the government’s role, particularly when they are struggling to fulfill those limited programs. Expansion leaves it ripe for even more abuse. A parallel program abused is Lifeline. I know people close to me who it greatly benefits. But when thousands of mailers are sent to people who didn’t request it (I got one this week…again), and they include an extra application so you can find a friend to sign up too, it’s gone beyond a safety net, and the program is actively seeking to expand (the funny thing is they offered subsided free cell phones and minutes/text, OR for $30, unlimited minutes/text/data, which is far more than the essentials and doesn’t have any business being subsidized…just like PPACA and vasectomy, and possibly abortion under some readings…). As soon as it’s no longer just a safety net for subsistence, it’s gone too far.

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