A politically incorrect and inconvenient truth you will never hear from a politician.

Neither the President nor any member of Congress will ever say it, not if they want to get re-elected. I hold no elected office and as a doctor I am obligated to tell the patient the bitter truth. Health care is not a right. There, I said it.

Health-care-as-a-right distorts behaviors, destroys the possibility of supply balancing demand, and drives people out of working in healthcare. Health care is not, cannot be, and should not be a right.

Health care is not an unencumbered right.
To most people, you don't have to work for a right. It is natural privilege, unencumbered by any responsibility - just like Bill of Rights.

Our Founding Fathers did not elucidate the responsibilities in the Bill of Rights because it never occurred to them that people could believe rights come without responsibility.

Free speech (1st Amendment) means Pro-Choice advocates cannot muzzle Pro-Life proponents and vice-versa. Right to bear arms (2nd Amendment) prohibits citizens from using those arms against other citizens. The Sixth Amendment guarantees the right to a fair and speedy trial, which places a responsibility squarely with the legal system not to hold us indefinitely or without due process.

There is no such thing as an unencumbered right. Rights without responsibilities do not exist. You have a right to police protection. You have responsibility to obey the laws.

Health care cannot be a right.
Health care cannot be a right, unless you want to bring back chattel slavery or at least serfdom. Health care is a service provided by a small group of people for the benefit of a larger group of people. If the majority has a right to demand this service, that means they can require providers to serve them.

Only in the military system can one person require another to act. In all other parts of our society, we are free to accept an order or to reject it from another private individual. If people have guaranteed access to health care, because it is their right, someone must provide that care whether the provider wants to or not. If health care is a right, then the health care worker is no longer free. What if no one goes to medical or nursing school? What happens then to the right to health care? Health care cannot be a right.

Health care should not be a right.
You do not want health care to be a right. You will not like what you get: strict government rationing, a sickly population, and the kind of providers you want to avoid.

Rationing
Call it control of resource utilization, central balancing of supply with demand, or just plain rationing, decisions must be made about how much money, time, people and supplies are used. As there is no natural limit to the demand for health care services, without some limiter or brake, we will literally use up all the resources.

The "rationer" of your health care can either be the government or you. In every country with universal health care, the government balances the services provided with the money expended (rationing). The same is partly true for the USA where MediCare, MediCaid and private insurers all ration care.

We could have a system where the individual controls the flow of his or her health care dollars (not insurance based) just as we do when buying groceries or car maintenance. Interestingly for a consumer-driven system, one blogger recently quipped, "The key element missing in the health care debate is the consumer."

Unhealthy populace
Health-care-as-a-right makes us sick because having no personal responsibility lets us treat our bodies badly and then expect the healthcare system to fix our obesity, our emphysema from smoking, and our cirrhotic (scarred) livers from drinking.

The lack of personal financial responsibility produces unhealthy thinking called the moral hazard: we change our behavior when we are personally insulated from the consequences of our bad choices. In the Atlantic magazine David Goldhill quantified the moral hazard in healthcare. "The average insured American and the average uninsured American spend very similar amounts of their own money on health care each year-$654 and $583, respectively. But, they spend wildly different amounts of other people's money- $3,809 and $1,103, respectively." When the money we spend is someone else's, who cares?

From the purely commercial viewpoint, health care is infrastructure maintenance and repair. The government engages in no preventative [health] maintenance. The entire system is focused on one desire: cutting immediate costs. If we treated our bridges and roads as we do our people, they all would be broken. Why doesn't the government focus on restoration and long-term preservation of our health? Answer: because health care is considered a right.

Providers waiting for happy hour
Health-care-as-a-right rejects people "called to service" in favor of following a manual of policies and procedures and complying with regulations handed down from Washington. If the public treats providers as menials fulfilling the individual's right to health care, then the public will get rote behaviors by individuals who work their shift (and no more) while waiting for happy hour.

Health care should be a partnership.
Effective health care should be a two-level partnership: a voluntary association of two or more people where both partners know their respective roles and where both benefit. The two levels are individual and national.

On the individual level, there should be a doctor-patient partnership. Each has rights and responsibilities. The entire system should be a win-win scenario: when the patient stays healthy or returns to full good health quickly after being sick, the doctor should do well financially.

Further, the patient should pay something out of his or her own pocket to the doctor. The person most likely to economize and to make the best decision is the consumer, not the government. For major medical expenses, there should be a national shared risk pool that should include rate adjustment based on "personally controllable health risk factors."

On the national level, there should be a partnership between the people and the government, again structured as win-win scenario. When the populace "wins" - when we remain healthy and live longer - the country "wins" by greater productivity and spending less on sickness care.

The good CEO protects the assets that give the company sustainable competitive advantage. For Corporation USA, people are the prime asset. Those who manage our Corporation, what we call government, should protect the people's health and restore health when they are sick. That is not a "right." That is just good business.

 

 

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Comments

[jhNY]

And yet, throughout the nations of western Europe, the right to health care is a citizen's right. Here it is most of all an opportunity: an opportunity by those with the wherewithal to do so to profit on the sickness of fellow humans, either through insurance flimflammery, marking up the value of services rendered, or the exorbitant pricing of required medicines. Those who can do this without having their stomachs turn on reflection of their handiwork are in the first ranks of their professions, though they are morally indistinguishable from vampires. And here in the USA, the executives presiding over all the blood-imbibing, and the doctors whom the system makes millionaires are looked upon with admiration, because after all, if they weren't so good at what they do, they couldn't be so rich.

[jealousmonk]

There are no such things as "rights." You have to fight for everything you get. Those in power will only cede benefits (and let you call them rights) to keep from losing power (i.e. it is more cost effective). If you want it, fight for it.

[whawhawha]

As long as the government grants corporations the ability to harm my well being, I demand the ability to protect it. Besides, many of the existing rights you mentioned are protected by the public through taxes.

Here's the simple truth: If we had socialized medicine, all American's would pay into the system (of course) but not at a level that destroys lives or prevents people from making a living. The more payers you have, the less people pay.

Yes, more people would be going to the doctor. Yes, you might have to wait from time to time for this or that. Using the issues that come along with socialized medicine as reasons to avoid it is to imply that our current system doesn't have problems. Oh my gawd, you have to wait for elective surgeries in Canada and the U.K. Guess what? I would trade their problems with our problems any day. ANY DAY.

The way I see it, if we had a single payer system. The American public, in order to stem costs, would CHOOSE to implement preventive medicine guidelines, to incentivize regular visits to the doctor and more healthy behavors. But I'm a dreamer.

[TryToBeFlexible]

Hmmmm. So, we have a right to a speedy trial. I guess that make judges, lawyers, court clerks, etc. chattel slaves of the majority?

We have a right to life. So, defenders of that right, like cops, are also slaves of the majority?

So, the way you see it, in the USA, if we get universal health care, doctors will have chains put on them and be forced to treat patiens or be whipped to death?

Yet, other countries with universal coversage don't seem to have that issue...

[Deane Waldman - Huffpost Blogger]

You think we disagree...but we do not.

I support making the provision of health care and the position of health care providers more like judges, lawyers, policepersons, firemen (forgive the sexism but firepersons sounds truly silly), etc.

You may call police protection or legal adjudication a "right' but really it is a social contract between the individual and society.

In all of the circumstances listed there are a) a set of agreed upon principles guiding the specific system, and b) agreed-upon, written-down rules and responsibilities governing the relationship of the individual to the provider (judge, policeperson, etc.)

That is EXACTLY what healthcare needs.

[BarryS]

nonsense. People have the right to not be ripped off. The ins cos give essentially underpriced insurance to congress [as a bribe] and then make the rest of us pay through the nose. There is a right to be treated equally and fairly. We all pay for it already. There are subsidies galore for the chosen few and for those that make us guilt-ridden. All we ask for is some equality. No one is asking for free care. I just want to pay what the GOP hucksters pay [not their share, the cost] I want to pay no more than the co-adulterers of these so-called paragons of [religious] virtue pay. no more no less. I want the same policy they get at the same price. I don't feel I should pay 3-5X as much for a policy that is garbage and can be cancelled at whim.

So I don't want healthcare as a right, I want healthcare to be fair. I dare ANY GOP SENATOR OR REP to trade my policy for theirs. Open dare. Do it on Larry King tonight. No takers? of course not.

[vlm1948]

Exactly.

[PlaceboStudman]

Hmmmm..interesting dichotomy....Heath Care cant be a right, because rights have responsibilities and human nature almost forces us to abuse or neglect the responsibilties ourself, thus taking away that right for someone else

The same way a gun ban law is supposed to work. If everyone used their guns responsibly, there would be no need for gun band, but as soon as someone does use a gun irresponsibly, it forces the government to begin to take more and more steps to restrict the guns from everyone, and what is the point of having a right if there is no ability to exercisee it

I think the difference here goes to two phrases. the difference between

Everyone SHOULD have affordable (we can forget high quality, that doesnt exist) health care

and

Everyone MUST have affordable (not high quality) health care

We can not allow a situation where everyone must have affordable healthcare, or no one will have affordable health care. We must have a system where people have what they NEED, not what they want, and if that means going without luxury medicine, so be it