I have had difficulty resolving this question for several years. On the one hand, I do not think that everyone has a right to all health care. For example, most cosmetic surgery is optional.
In all other aspects of our lives we have “maintenance rights” and higher levels of optional spending. We have a right to food and shelter, but we all do not have a right to eat at a 4 star restaurant or live in a mansion. We all can get legal representation, but few are willing to pay the hourly fees of large firms.
Should health care differ from these other issues? Could we provide basic health care for all, and higher levels according to your ability to pay? Is that ethical?
I still am not certain how we should address this issue. I hear and read many opinions. As I mentioned yesterday, I see much inconsistency.
Many of the same people who argue against a public plan then argue that they (not those without insurance) have a right to all expensive care, even if that care is highly unlikely to change outcomes. Let me give a couple of example, admittedly with hyperbole.
Imagine a new cancer therapy with a 15% chance of remission for 2 months. This new therapy costs $1 million. Should the insurance company pay for that therapy? Remember that each person who pays insurance premiums then will have a significant increase in their premiums. What we have here is the tragedy of the commons. Once we pay our premiums, we expect that insurance will cover anything we want.
An 80-year-old patient with several diagnoses becomes terminally ill. They develop an infection and need blood pressure support. Should we provide expensive ICU care for many days? Please read Life, Death and Money in the ICU
Here is the paradox. The same people who would deny basic health care to those currently uninsured, demand expensive and likely futile care. I submit that we have a logical inconsistency.
Every time we spend large amounts of money in futile care, we have continued cost inflation.
Where do I stand? I would like to provide a basic level of health care to all. Since we provide emergency care and hospitalization to all, then we likely would save money if we provide basic health care.
We should have explicitly different levels of health insurance. If you want basic health care you pay $A per month. If you want more options, then your health insurance premiums should increase. Other than the basic level, you would pay a higher premium based on your spending risk, that is, if you smoke or are obese (for example.)
I believe that my position is libertarian. Your desire to spend more or lifestyle that predicts higher spending encroaches on my finances. I am willing to provide basic health care to all, but we must make tough decisions based on limited financing. We cannot afford to do everything for everyone.
I also believe strongly that independent of money, we should not do everything for everyone. I see patients and families suffering during prolonged futile ICU stays. Often such care causes more pain and suffering than allowing nature to take its course.
I would love to engage in a polite debate on these issues. Having had palliative care discussions with patients and families, I know that usually these discussions give patients and families great comfort. Some patients and families want everything done. Most do not.
{ 6 comments… read them below or add one }
The other part of the equation is that the people receiving the care are too often not told about the costs. I have rarely been able to get a physician to tell me what their fees will be until after I have received the services. Hiding the costs from the patient is not acceptable anymore!
I’m sorry but you are simply in error that we have a right to food or shelter. We simply do not. In Canada, there is a right to healthcare. You can look at Canada’s constitution and you’ll see a clear black letter text. In fact, the supreme court of Quebec has ruled that the provincial government was violating its own provincial constitution because of the long delays caused by underfunding.
There is no such text in the US’ body of laws. There are also no such lawsuits successfully forcing governments to enforce the right to food or shelter. Since we are a notoriously litigious society, the absence of lawsuits is a very clear indicator that no such recognized right exists under US law.
Without the right to food or shelter, your post does not work very well. You may want to verify my assertion and, if you recognize I am correct, seriously rethink your assertion that healthcare is relatively unique in being a basic need that is not recognized as a right.
A final note, there is no right to water, air, clothes, or police protection either. The last I know has gone before several judges when egregious cases happened where police did not show up for many hours, even days and serious crime and injury occurred.
In reply to JPB,
I was once on staff at an emergency department where a patients family desired to know the charge of a chest x-ray.
The physician did not know, had the secretary make a few calls — after exchange of a few questions such as “what insurance?” and such. It was discovered they did not have access to a cash price.
When incident brought up in our monthly meeting, you should have seen the expressions of the hosptial’s legal representative.
It was no accident the price was not available, the legal team felt someone chosing not to have something after being informed of the cost; could consitute a liability if we failed to provide the service.
As many readers on this blog likely know EMTALA essentially mandates most emergency departments to treat emergencies regardless of the persons ability to pay.
The legal team did not wish to make a distinction between willingness to pay versus inability to pay. Thus we were banned from giving patients the charges they might incurr.
We should not forget most of the problems of cost shifting have arisen because of government mandated care that is non funded or govenrnment funded care that is underfunded.
These are my thoughts on whether there is a right to health care, first posted at http://doc2dochealthcarereform.com :
Is There a Right to Health Care – or a Right Attitude?
During the current debates over health care, there has been argument that health care is the right of every American, if not every human being. Is it?
Certainly everyone needs health care. Everyone wants everyone to have it. Everyone I know wants anyone who cannot access health care to have it made available at the expense of others.
Does this make health care a right?
I’m a doctor, not a lawyer. But my understanding is that rights are what government is required to guarantee equally to all, to protect, and to supply if wanting.
Some argue that rights do not emanate from government, but from human nature, nature, or God: universal or inalienable rights. Such rights are few in number. Some governments deny their people liberty, the pursuit of happiness, and sometimes even life. Do their citizens still have these rights; do they exist in name only, nonexistent in reality?
Here at home, other, derivative rights, including those to privacy, to quiet enjoyment, and to safety, all seem reasonable. Their definitions are determined and legitimized by courts – that is, by government. Once anything is deemed a right, it is incumbent upon government to supply it to those who do not have it in adequate supply. Since government becomes the source, the individual no longer needs to strive to secure it. In fact, it is appropriate to demand that government give you your rights and, further, to give you more if you have less than someone else: equality of rights. Politically, as well as through the courts, government decides what is the proper amount of a given right for individuals or groups.
Recently those who are differently-abled have been guaranteed rights, including access to transportation, public spaces, and mainstream education. Since these are higher on Maslow’s famous hierarchy of human needs than health care, shouldn’t health care be a right as well?
Consider food, clothing, and shelter. These are necessities, more fundamental even than health care. Governments provide food (food stamps, school lunches, surplus give-aways) and shelter (public and Section 8 housing, FHA loans) to those who are otherwise without. Charities help immeasurably (food banks, food pantries, Habitat for Humanity) and also help with clothing (Goodwill, Salvation Army, churches and hospitals).
Yet food, clothing, and shelter are not broadly accepted as rights. They are considered responsibilities. This is not just a difference of semantics. It is a difference of attitude.
Individuals are still expected to feed, clothe, and shelter themselves. The government can help in time of need, but this provision is not generally expected for a lifetime. Most on food stamps strive for the day when they no longer need them. Many I have known in public housing scrimp against difficult odds to afford a place of their own. Even though the government provides, they maintain parallel efforts to provide for themselves.
If government – or private charity – supplies something they are not required to give, the response is gratitude, not entitlement. Responsibility remains with the individual. If the government provides free cheddar and not a properly aged Gorgonzola, there is little impulse to complain. This would not be true if free cheese were considered an American right and if a vast government bureaucracy existed to supply it.
I want everyone to have health care. As necessary, I want government to help people have it. [But there are many political, structural, and practical changes that can be made before it is necessary for government to be a direct provider.] I certainly want charities and other benevolent organizations to help too: Church-based free clinics and endowments for the unfunded are examples.
It is the nature of health care that each person’s potential demand for services is essentially limitless. It is not reasonable for people to demand, as a right, that the public – that is, taxpayers – pay more and more without expectation that they contribute themselves. Under such a system, outcomes – both clinical and financial – will be poor.
Finally, if healthcare is considered as a subsidiary right, to be defined and expanded by government, it can also be limited and denied by government, through rationing or arbitrarily.
Healthcare must remain a responsibility.
George Carlin said it best.
“There are no such things as Rights, only temporary privileges.”
What we mistaken for “rights” are only the privileges that we as a society have decided to bestow on ourselves.
Healthcare will only be a “Right” when US Citizen’s decide to spend the money on it and not on the largest army in the world.
We have to pick and choose our “rights”
When it comes to End of Life.
I find it interesting that many people want “everything” done as long as someone else is paying for it.
but if you offer to do “everything” but explain to them that their Great grandchildren will be paying for it. They wouldnt want it.
That is EXACTLY what we are doing right now.