THE BLOG
05/07/2009 05:12 am ET | Updated May 25, 2011

Health Care and Its Reform: A Right vs. A Service?

It occurred to me from a conversation I had with a professional colleague recently that what I have previously written about health care being a right for all Americans may not be precisely what it is. In previous blogs, I scribed that health care is a right, for, without it, we are not of value to ourselves, our families, our communities, and, in the end, the American economy. Just the opposite would be true -- we would be a drag on the economy by having the health care system treat and care for us, particularly if we could not afford to pay for these services.

From my recent conversation, it may not be totally appropriate to declare that health care is a right, because everyone could claim something as a right. For example, those who favor a pro-life stance may claim that after there is always a right to life. Those who favor freedom of choice for the woman could certainly claim that the woman has the right to choice. Ditto for all those seeking housing, i.e., can't there be a right to affordable living? And certainly we all have a right to procreate within the four walls of our abodes? The list can go on and on, of course. There then may well be a dilemma in saying that we all have a right to health care, as I have penned in my posts here previously. Though I have written that most "rights" are not constitutionally based or in the Bill of Rights, a right could engender issues of what is proper in a moral sense. So, with all the hullabaloo surrounding health care reform, what is the proper springboard for changing our health care system? Well, why not view health care as a service, as my recent discussions led me to seriously consider. After all, if it is a service (to which we would all be entitled), there is no moral dilemma about it being a right. Concomitantly, in the book he wrote about his experiences and last days after acquiring a terminal disease (The Last Lecture), Professor Randy Pausch of Carnegie Mellon (with Jeffrey Zaslow) wrote that rights come from the community -- as if to say that a right is a service which a community requires to function. Let me put this notion somewhat differently.

How many of you reading this blog receive water services in your community? How about garbage pickup? Or certainly utilities (gas, heat, electric) for where you live? Certainly, we all receive these types of services. We need them. But, are they rights? According to the likes of Professor Pausch, we would say they are rights, because they arise out of needs required by the community. But we should not receive them because we have a right to them under some sort of moral perrogative. Likewise by clear analogy, we need our health because, without it, we can't function either. But if viewed as a service, then there exists no moral dilemma for us to consider. Certainly there will be some of those reading this piece that say I am just "splitting hairs", so to speak. But the distinction is critical, because a service has no moral implications.

Moreover, we know that health care is a business. As with any business, decisions are predicated upon what makes the business more efficient, and thus more profitable. If business decisions intersect with issues of morality, like health care being a right for everyone, then mountains of problems arise, certainly in the moral sense. But, if the community requires a service, like health care, then the dilemma only becomes how much it will cost to provide that service --again, just like gas, heat or electricity.

With all the struggle going on currently with how to revamp our health care system (see, e.g., Iglehart, "The Struggle for Reform...." (http://content.nejm.org/cgi/content/full/NEJMp0902651?query=TOC), perhaps President Obama should declare health care a service for all Americans rather than as a right as he did when he debated Senator McCain last fall in Nashville.