Is Health Insurance a Right?

From President Obama on down, we have heard repeatedly in the healthcare debate that Americans have a "right" to affordable health insurance. In my view, this is the critical issue and perhaps the reason why Democrats and Republicans have not been able to (and perhaps never will) reach a compromise.

I don't think anyone would disagree that having health insurance is a good thing and we all support the concept of universal health care. I would add that we probably all support the notion that everyone should have great quality child care, live in a good home, eat healthy food, have a challenging and rewarding career, and be taken care of in our old age.

If healthcare is something that people should have, but is not a right, then the question of who should pay for it becomes paramount. If we can expand coverage at no cost to taxpayers and within the free market system, then it would be a good thing to do.

But if healthcare is a right, then paying for it is an afterthought. And that is certainly how the Democrats in Congress are acting. They are voting for the concept of universal health care with not much information on the long-term implications and costs.

Through history in America, we have developed some societal expenses that are (now) a given and one might say a right for all citizens. Here are some examples:

· Free education through high school.
· A "safety net" of welfare benefits so no one has to be homeless or go hungry.
· We offer forgiveness if someone overextends themselves and racks up debts they cannot pay (bankruptcy).

So should we add universal health care to the list of society's obligations? It looks like we are going to, and I think this is terrible public policy even as I would love to see everyone with health insurance.

I think there are quite a few dangers we are facing, many of which have been discussed during the debate on health care reform. I’ll focus on just a couple.

Former Governor Sarah Palin has used the term "death panels" to stir up opposition to health insurance reform. Her critics have labeled her use of this term divisive and inaccurate. But, frankly, I don't see how logically we won't get to this place sometime soon.

When it becomes society's obligation to take responsibility for everyone's health insurance, who gets to draw the line on personal healthcare?

In a private system, it is the patient, and the patient's ability to pay. If someone wants to pay $200,000 for a transplant (or they purchase insurance which covers such a cost) then they can choose to have the transplant. This level of service would not be available to someone without insurance – it would be too expensive.

But under a government-run system, can we actually afford to give everyone a transplant who needs one? Who will decide? Will it be based on critical need? What if there is a shortage of donors? You can easily imagine several scenarios where efforts to ration care, possibly in order to control expenses or to be "fair" in how scarce resources are allocated, become the norm.

Once health care becomes a "right," then the decision-making analysis changes drastically. Why should a rich person have more access than a poor person if all are created equal? The lack of ability to pay cannot be a basis for infringing on someone’s rights.

This will be the underpinning of regulations that will allow other people (other than the patient, doctor, and the patient’s insurance company) to make these decisions.

Once the government is controlling the compensation levels for doctors (in order to control costs, of course) the incentive for excellence diminishes. This is cause for great concern.

With no disrespect, doctors are not policemen, office workers, teachers, or construction workers. They are highly trained, highly skilled individuals who must excel in school, work very hard for their medical degree, and then do an intensive internship. The cost to society of training a doctor probably exceeds $1 million. The cost to the doctor in hard work and years of study is probably more.

When that doctor is going to spend an hour with me making a life-or-death decision, I want the best possible individual in that position. I want someone who worked really hard and is super motivated and is the most competent.

Up until now, capitalism has provided that in spades. We have the highest-quality healthcare system in the world. If you want the best doctors, you come to the U.S.

Like it or not, making money is the motivator. Some become doctors because of the money, and some because of the prestige that the money helps buy. In a capitalistic society, there is nothing wrong with that. I want my doctor to be able to afford an extravagant lifestyle because they have earned it.

Once the government starts limiting doctor pay, or controlling the ability of hospitals to make money, or stopping insurance providers from paying what they need to pay, or capping what patients can be charged (take your pick of controls), then we start to erode what compensation doctors can earn which will lead to fewer of the “best and brightest” going to medical school. Long term, our health care will suffer.

Why should a bright student work as a doctor when their pay may be capped, when they may be under strict government regulations about how many patients they can see, or when there may be mandates as to who they must accept as patients. If they want to make money, they’d be better off going into law or working on Wall Street.

We are going to see a decline in the quality of students going into medical school, of the level of competition, and of the expertise of rank-and-file doctors under nationalized healthcare.


Is Education a Right

Some of these same points can be made about public education. Certainly the lower salaries makes it challanging to attract and retain top-notch candidates to the field-- and that appears to be your main point.

So should we apply the same approach, then? Do away with public education entirely, and leave education for just those who can afford it? (In fact, we actually appear to be engaged long-term in just this experiment in this country- how do we all think it has been working out?)

Obviously, there is plenty of room for a middle ground here, in both education and health care. But idealogues can never see it. What's important to them is that society conforms to their theories of how they think it should be organized-- no matter what the result.


Is Anything a Right?

Hi Dr. Doug,

I wasn't going to try to go backwards in thinking about the "rights" we already have. I was merely noting that there are several individual rights which really are entitlements but which society has decided should be given to all citizens regardless of ability to pay, and to ask the question whether this should be expanded to include health care.

But educating kids is a bit different. For example, if the U.S. government were to pay for health care for everyone under 18, I think that would be a very different debate than the one we are having now.

I'm not sure I understand your "idealogue" comment. In one philosophy, individuals are responsible for their own care. In another, everyone shares in society's burden. We obviously live in a compromised system with elements of both philosophies strongly at work. Whether we should shift one way or the other on this continuum is hardly advocating something "no matter what the result."

Allen Nitschelm has lived in Acton since 1998 and writes about fiscal issues at the
local and state level. He is a former member of the town's Finance Committee
and is an Associate Publisher of Acton Forum.

A couple of points

The US does not have the best medical system. I think when you look at the health of the US, we are something like #38 in the world and all of the higher 37 countries spend less.

In Canada, they have social medicine but what you do not hear about is that there are doctors that work in a private model independent of the doctors. They have their own hospitals and their own offices. They do not serve the general public and will only take patients with additional medical insurance or private funding.

We will see a dramatic shift to this model and the "general care" will be for the average folks but the "special" folks will take care of themselves.

Not much will change. You start in the general sector and when you can not pay your education costs, you will smarten up, get out of the system and charge direct without the burdens...

I just knew that I would be reading about the death panels because it is so FOX like..

Capitalism will continue to provide selected medical treatment, just like.... last week...

U.S. Healthcare System

Hi Bobc,

Statistics can certainly be misleading. I know the U.S. ranks rather high on infant mortality, yet for the "high end" care that our best doctors and hospitals provide, we are indisputedly among the top.

And I'm sure you are right about more private care doctors for the wealthy. As we switch to a socialized medicine model, people who have money will be less likely to settle for the "average" doctor (because the average quality will certainly decline) and will have to pay double (pay for the average doctor who they no longer wish to see, and then pay for their private doctor) to get the same quality care they get now. I see this as a big step backwards, not forwards.

And if we go back to the public education example, how many "wealthy" residents of Boston send their kids to the public schools? I'm sure it's very few. That's not a good situation but I can see a similar outcome in the medical field.

As far as your reference to FOX, I'm not sure why you like that station so much. I have never watched it for more than 2 minutes, but I hear it is tilted to the right just like much of the mainstream media is tilted to the left. Regardless, do you think that when the government starts to foot the bill, there will be enormous pressure on it to control costs and one way to do this is to discuss limiting or rationing care based on criteria other than someone's ability to pay?

Allen Nitschelm has lived in Acton since 1998 and writes about fiscal issues at the
local and state level. He is a former member of the town's Finance Committee
and is an Associate Publisher of Acton Forum.