Health Care: Is it a Right or . . . Is It a Commodity?

Being engaged in the health care debate ever since I first began writing that health care should be a right in the summer of 2008 leaves me to wonder whether there is anything left to be said that all others have not already spoken or written about, either because it is true based on fact and reality, or untrue, based on made-up stuff, like, you know, death panels and killing off grandmas. The other evening my wife, Elena, and I dined with our colleagues and friends, noted Chicago-area cardiologist, Alan Kogan, and his wife, Robin. We were engaged in a variety of topics, but we settled in on, what else, health care reform. I mentioned health care as a right for every single American, and he said that it is either a right, or a commodity, that can be bought, sold, and bartered, like any other service or good. If an American can afford health care, all well and good; if a citizen cannot access or afford health care services with health care insurance, tough luck (this is my description). The more I thought about this, I more I thought this should be not only the beginning of any discussion on health care reform, but also the end point. The doctor friend also equated our need for water to sustain us to health care that keeps us healthy. We pay for water through various governmental and municipal sources, so why not the same for health care? Good questions, indeed.

If we all recall, our system of health care was based for so long on the fee -for-service model -- if you wanted treatment, you pay what the doctor charged. That grew too expensive, so our system morphed into managed care products and services. This new system worked like a charm -- for managed care companies. After all, look at the millions (billions?) of dollars these companies and their executives have made since they were first created close to 20 years ago. The cost of health care services and insurance coverage for those services continue to skyrocket. So, too, this system of care interferes with the doctor-patient relationship every day of the year. Just ask your doctor.

Politicians who oppose President Obama's current plan say that by the government imposing a public plan (or whatever you want to call it that keeps in check insurance company costs, provides for stiff competition and allows another alternative (option) for consumers who seek health care insurance) the insurance industry will be gone as we know it in a blink of an eye. Juxtaposed to this is that leaders of the opposition are now also saying that they stand shoulder to shoulder with the President when he calls out for insurance regulation in the form of, for example, no caps on coverage; limits on out of pocket expenses; and making it illegal to deny coverage based on pre-existing conditions, or rescinding that coverage absent provable fraud after care and treatment has already been rendered. But not for any such public option. But, and this is important for everyone reading this post, all these new regulations will mean increased exposures to the insurance industry; increased exposures mean more expenses and payouts for claims, and less revenues that will go to the bottom line. Without an effective check on insurers with a public plan (again, or whatever you want to call such a mechanism), insurers will be free to raise premium costs to recoup the loss of revenues that these additional exposures will cause. We all will be back at ground zero, so to speak, if regulations without stiff competition come about. If we all think there are catastrophic problems with health care now, heaven help us if we have regulations without real and effective competition with insurers. Mr. President, are you listening?

But if we want the status quo (and it seems that Republicans are for this despite the words their representatives mouth), then we will continue to treat health care as a commodity, as Dr. Kogan mentioned to me at the dinner table.

I prefer to say that health care remains a right for all of us. This is the moral imperative of which Obama spoke when he addressed a joint session of Congress. This is a right that Teddy Kennedy said we all had when he spoke at the 2008 Democratic convention; this is what Obama articulated when he debated McCain on the campaign trail a year ago in Nashville; and even I scribed such words a year ago July. If it is not a right, then why do all industrialized nations besides out country treat health care this way, do not allow their countrypersons to fall into debt and go bankrupt over medical bills, and do not allow them to perish from illness or disease because they cannot afford to pay the charges for necessary care and treatment? Is it that our Republican leaders are intellectually challenged when they oppose President Obama without fact or foundation, or can it be that they just plain don't care whether Americans with serious medical conditions live or die because they can't afford or access our present system? It sure seems like the latter given all their recent rhetoric!

In the end, there must be effective competition together with the insurance regulations such as those being proposed by the President. One other item that should be considered since everything is presently in a state of flux: eliminating the antitrust exemption for the insurance industry. Remember that the opposite of true competition is . . . monopolization (which antitrust laws are intended to protect against). At the moment, insurers don't have a care in the world about this item. It is high time that they should.

With all my talk about health being a right, Dr Kogan, I think you were really onto something the other evening when you planted the notion in me that opponents of reform think health care is only a commodity.

 

 

Comments

[Virtual Deux]

In a country which can toss out so much money to fight a war in another country unasked for, nor needed, which tosses money out the window in so many programs for so few, to say that the cost to keep our citizens healthy is just to much is almost sickening.

[milesz]

Your point of view is right on. Why is it that the cost of the Iraq war is not the subject of such a heated and acrimonious debate on such a precious thing as a system to preserve our health?

[GradKid]

My passion for public service lies within the need for the transformation of health policies. This topic is crucial to my being because of my innate belief in the need for universal healthcare. Heathcare is a basic RIGHT for all citizens! The rising cost of medical care and health insurance has surpassed all socially acceptable levels. Not only is it outrageous but it is blatant classism. The leaders of the United States government have allowed a healthcare system to arise that provides the rich minority with the best care while the middle and lower class majorities face the inability to pay for necessary medical treatments.

In an idyllic situation, the new policies would provide all citizens with superb coverage. Unfortunately, that is unrealistic because the healthcare system is also a business that must be profitable. I believe a sensible goal would be to construct a healthcare system that is not completely controlled and financed by revenue driven organizations or propelled by the relationship between one’s employment and health benefits.

Americans are required to support the government by paying local, state and federal taxes. With the rising cost of living and unemployment, I question when will the government provide the universal healthcare system that its citizens are in desperate need of.

[milesz]

I would hate to think "when" the government would wake up and ensure health care for all. Unfortunately, the role of government has typically been reactive (like in the Wall Street debacle) rather than proactive. This time around, we are at fail safe when it comes to health care, so proactive the government MUST be.

[GradKid]

This topic is crucial to my being because of my innate belief in the need for universal healthcare. I am wholeheartly sure that healthcare is a RIGHT! The rising cost of medical care and health insurance has surpassed all socially acceptable levels. Not only is it outrageous but it is blatant classism. The leaders of the United States government have allowed a healthcare system to arise that provides the rich minority with the best care while the middle and lower class majorities face the inability to pay for necessary medical treatments.

In an idyllic situation, the new policies would provide all citizens with superb coverage. Unfortunately, that is unrealistic because the healthcare system is also a business that must be profitable. I believe a sensible goal would be to construct a healthcare system that is not completely controlled and financed by revenue driven organizations or propelled by the relationship between one’s employment and health benefits. This nation has become so morally corrupt that some public officials truly believe that the health and well being of a human life is means for bargaining. When did my life become so insignificant?

Americans are required to support the government by paying local, state and federal taxes. With the rising cost of living and unemployment, I question when will the government provide the universal healthcare system that its citizens are in desperate need of. Hopefully, now.

[bruja]

Have said this forever. Access to basic health care should be a right and not a commodity to be bought and sold. There is no need to change the Constitution for this. The Constitution was written in the late 1700's and has been ammended as necessary. Folks want to throw this argument in but to me it is irrelevant. UNIVERSAL SINGLE PAYER OR BUST!!! State waiver/option to whatever comes out federally. We in New Mexico have a plan and want to be able to pass it in our state.

[milesz]

Your viewpoint on health care as a right could not be stronger. Keep it up!

[CalCool]

Though the rhetoric of this piece is excellent, I must disagree with your assertion that health care is a right and not a commodity for the simple reason that health care cost money, and whether this money is spent out of pocket or by the government does not change this simple fact. For something to be a right (eg, your right to freedom of speech), it must be something that the government can't do to you (in this case, silence you) rather than something the government must do for you (eg, if health care is a right, pay for your operation). With money involved, the result is by nature scarcity (this is the textbook definition of economics) and therefore not a right, and certainly not something enjoyed by all equally.

This does not mean that health care should not be paid for by the government, just that such a priviledges is just that, and not a right, similar to how K-12 public education is a priviledge that Americans by concurrent action currently enjoy, but may nonetheless be rescinded at any time.

[milesz]

Try this on for size. What if health care was a service like the electricity that heats our home, or oil/gas that warms where we sleep? Services like this cost money too, and that are generally supplied through publicly-run companies. So, if you don't want rights (or services) to cost money, then how freezing in your pajamas at night in the cold weather, and read by candlelight?

[babina]

How do you explain a public education? It is 100% a right, not a priviledge. You have that wrong. In fact, your logic is flawed with any public program, anything socialized, as they all cost money and all are a right.

[milesz]

There is no right to an education in our country. But what is allowed for, as President Obama has stated, are public colleges in each state financed in part by tax dollars, that compete with private colleges. And, ya know what, they all exist harmoniously. When have we heard that private institutions are being driven from scholarship by those publicly run? Obama and his speechwriters came up with quite an analogy when he spoke of the public option in terms of our higher education system.

[babina]

You articluated one of my biggest concerns perfectly. Health is not a commodity. Its not corn or butter. Its not a handbag or a pair of shoes. Its not a car or a boat. Its a condition. We do not choose to get sick.

When then candidate Obama said he believed health care was a right at the debate in Nashville it brought tears to my eyes as I never thought I would hear a candidate for the presidency say it so firmly, clearly and with passion.

I hope he is successful for all our sakes.

[milesz]

Three cheers for you! Thank you for your kind thoughts and observations.

[babina]

Thank you Mr. Zaremsky. I posted this comment on August 10:

"What will be the result of health care reform that provides every American with some basic consumer protections, e.g., prohibit insurance companies from denying coverage due to medical history, not be allowed to drop coverage if insured gets sick, not be able to water down coverage when needed most, no longer able to place arbitrary cap on the amount of coverage in a given year or in a lifetime, placing a limit on how much you can be charged for out-of-pocket expenses, etc. No public option though? What would be the result of that? How are the for-profit private insurance companies going to make up for all the revenue and profits they will lose due to the proposed consumer protection restrictions without a public option? I wonder if premiums would increase at a more rapid pace and higher percentage rate each year for both employer and private plans. I wonder if more people will be rejected for private insurance if they lose or quit their job. I wonder how many ways the health care insurance industry will find to continue to earn the profits they do now with restrictions being proposed without a public option. The credit card companies are the perfect example of having no trouble finding ways to make up the revenue lost due to the "consumer protections" imposed on them. All to the detriment of the middle class."

[milesz]

Thank you again for your August 10 post. It is as sound today as when you wrote it last month. But keep in mind with additional regulations, like no pre-existing condition will bar coverage, the insurance industry will have to cover more exposures that they never have before. BUT, without a public option to hold them in check, they can recoup these additional exposures by, what else, raising premiums. Think about it and you'll see the fallacy about not needing a public option if we have these new insurance regulations. Again, however, health as a right must be a starting point to get real reform!

[mamalisa38]

For profit health insurance is immoral. The only way to maximize profits, and that's what Wall Street demands, is to raise premiums and deductibles and deny claims. The insurance companies are the death panels we already have. They pay bonuses to workers who cancel policies when someone gets seriously ill and files costly claims no matter how many years they have been paying premiums.

The top twenty health insurance and drug executives earned $285 million in 2008. Just 20 people!

PER HOUR PAY FOR HEALTH INSURANCE AND DRUG EXECUTIVES:

Miles White - Abbott - $17,395
Fred Hassan - Schering-Plough - $15,677
Bill Weldon - Johnson & Johnson - $13,022
Ron Williams - Aetna - $12,656
H. Edward Hanway - CIGNA - $6,373
Angela Braly - WellPoint - $5,127

For Americans to continue paying billions of dollars a year for obscene salaries, bonuses, perks and profits is unconscionable. I never thought our elected representatives would work so hard to destroy something that would help every single American. But, then again, why wouldn't they? They take millions of dollars from these same companies. We arrest street walkers for taking far less than these clowns do.

Shame on them for putting money before the lives of their fellow human beings.

[econ101lab]

More uniformed hyperbole. Last year the top 6 health insurance providers in the US had profit margins below the S&P average. The #1 in customer satisfaction, BCBS of Alabama, had margins of about 2%.

And the discussion always centers on what the left thinks is "right" versus reality. There are 800,000 doctors in the US with another 25k new per year. 45% say they will consider leaving the profession if Obamacare is passed http://www.ibdeditorials.com/IBDArticles.aspx?id=337909690110379 . Let's add 30-47 million people to the mix with no new doctors or nurses. How many people have every waited in a doctors office for an hour or two? Hmmmm? If, as is done in all national health systems, physician income is limited, you will drive people out of medicine, you will no longer attract the best and brightest, and we will end up importing foreign doctors (as they do in Britain and Canada). Rationing WILL occur and the quality of care WILL decline. We need to deal with reality, not with fantasy. What you want is irrelevant. Let's figure out what will work. Obamacare won't work.

[tompoe]

You're actually quoting numbers provided by insurance companies as proof of some idiotic argument that insurance companies run on a 2% profit? What investor is going to invest in such a company? Amazingly uninformed response.

[cheeriogirl]

My guess is you failed econ 101, since the numbers you provided simply do not align with the facts.

[milesz]

Then, if you do not believe "Obamacare" will work, as you say, then let's leave everything alone. I only hope you never get sick or ill, because you will never regain your health since to do so will be too expensive, or, there will be no doctors around to treat you.

[milesz]

You are absolutely correct in your viewpoints. Al that we can do is inundate our elected officials to stop all this nonsense and stand up for ALL Americans!

[milesz]

You are absolutely correct in your views here. All you (nee, we) can do is hound our elected officials until they do something right for the American people. And our health care is the personal and precious item any of us have.

[Grannywizard]

The pay they are receiving is obsene and they are taking it right out of our pockets! It's a slap in the face of every single person in this country that is working to make a living. Some of them make more in 2 hrs than my husband does with a masters degree teaching higher level math AND his second summer job. My God it's like the wealthy have taken over the United States and I for one am sick of getting the short end of the stick. Where the hell did our slice of the pie go? I was brought up to think if you worked hard you would be rewarded and have a pretty stable life. It is not possible anymore because the wealthy have taken it away from us. Now they don't even want us to have Health Care. I'm mad as hell and I'm tired of being ripped off.

[GeriNV]

We have Medicaid, Medicare, VA, DoD, Community Health Clinics. What is being discussed is a new national health care program, not a modification of existing free programs.

Consider if we were discussing a new Water program because everyone was watering their lawns and the water bills were rising. They aren't adjusting existing free programs, raising the income eligibility for Medicaid or lowering the Medicare age eligibility or the VA service requirement. They want to create a new program.

That's government waste and inefficiency from day 1.
We should analogous to water, ration the health care that currently exists, modify Medicaid so more people qualify but at a rationed amount that provides basics. Water basics to sustain life when there is a drought, don't allow such water or healthcare waste.

[milesz]

The error in your logic is that rationing goes on every day in the present health care delivery system. Much of the debate surrounding health care reform misses the point that what Americans find unsatisfactory with reform goes on already. Do we want more of the same, or a chance to reform what "ails" us?

[econ101lab]

The point YOU are missing is that the vast majority 70%+ of Americans like the healthcare they have now. You are talking about ruining the 70% to fix the 30%...irrational.

[GeriNV]

We die without water, when do I get free water?
If I get free water, how much free water is each household allowed? Can I waste it watering my lawn all day?

If healthcare is a right, does it include plastic surgery? Collagen injections? Chemotherapy for advanced stage 4 cancer? Where do you draw the line as to what is a right and what is a luxury? If we provide free healthcare, let's make hospice mandatory in advanced cancer cases and among those with advanced chronic conditions. Bring back paternalistic models of healthcare, let doctors ration care to limit waste. Those who demand an MRI or CT scan ... what do we do about them? What about those who waste our money laying intubated in the critical care units? We should have the option of mandatory hospice for them.

It is no suprise that the US government gave millions of dollars to expand hospice and palliative medicine programs within the veteran healthcare systems in the past year. They realize the cost savings that exists through these programs, now we need to just make them mandatory in a nationalized healthcare program!

[XME]

Yes, you do get free water if you cannot afford it. Just like people who cannot afford to get food are eligible for FOOD STAMPS.

In America, there are some things it's not OK to withhold simply because someone doesn't earn enough to pay for it. This includes, food, water, and yes...health care.

[GeriNV]

There is also free medical care for those who can't afford it ... it's called Medicaid.
The question is the enrollment threshold for Medicaid.
We are Medicaid, Medicare, VA, DoD, Community Health Clinics. What is being discussed is a new national health care program, not a modification of existing free programs.

Consider if we were discussing a new Water program because everyone was watering their lawns and the water bills were rising. They aren't adjusting existing free programs, raising the income eligibility for Medicaid or lowering the Medicare age eligibility or the VA service requirement. They want to create a new program.

That's government waste and inefficiency from day 1.

[milesz]

You are absolutely correct!

[milesz]

Your points are well taken.

[S1m0n]

It's neither a commodity nor a right.

Like fire departments, police, and sanitation departments, accessible healthcare is a basic piece of public infrastructure that nations which aspire to first world status should have in place, because it's alternatives are less effective and much more costly, bleeding a significant portion of the GNP out of the economy while providing no enhanced value in return.

[milesz]

Your observations have been made before in that health care, just like fire or police services, should be viewed as a basic SERVICE without which we cannot exist and live in a first rate country. But regardless of how health care is viewed, if the status quo remains then health care will be nothing more than like a car or loaf of bread - - - if we want it, we have to pay for it; if we can't pay for it, we don't get it - - - but with our health, the end result does not mean we go without bread or that new car, but with illness, disease, or . . .death. The latter is, obviously, totally unacceptable! Thanks agan for your comments.

[Romulus]

Because they CHOOSE to treat health care as a right. We can make that choice also if that's what the majority want to do. But there is nothing in the Constitution that nakes health care an "unalienable right". We have to pass a law making health care a right for it to be so.

[Romulus]

My comment above is in response to this question:

"If it is not a right, then why do all industrialized nations besides out country treat health care this way?"

[milesz]

You are correct that health care is not specifically found in the Constitution. But, so are many other items within our lives that cannot be found in the constitution. For example, who said we can procreate in the privacy of our homes without interference? Or, what about decisions from our court system that says we have a right to do this or that? Finally, what about what Thomas Jefferson penned - - - that we have a right to life, liberty and the pursuit of happiness? Wouldn't the right to health care fit within these general words? Thanks again for your insights.

[mydwyf]

If life is a right, then health care is also.

Why are the right to lifers the most adamant that health care is a commodity ?

(I am not saying that life is a right, it may very well be a commodity but that is not a popular opinion).

[milesz]

You provide interesting comments. However, you draw about a juxtaposition of ideas worthy of comment in the popular media (besides in Huffington Post here). If those who support the notion of "right to life" are ones who oppose Obama's plans to reform the health care system, they are the same ones who want the status quo (= health care as a commodity?) - - - which destroys life because health care is not accessible and affordable by everyone. Thanks for your observations.

[econ101lab]

Your logic chain isn't valid. Life is a right guaranteed in the Constitution along with liberty and the pursuit of happiness. Healthcare isn't in there. That being said, why does everyone on the left put up the straw man that conservatives don't want all LEGAL residents to be covered. What we want are market based solutions with emphasis on choice, personal responsibility, with the gov't only being involved with those who cannot take care of themselves. But some of the things being proposed are ludicrous. Why should someone who takes care of themselves, eats right, doesn't smoke, exercises pay the same as a fat lazy slob? Everybody pays the same??? Nutty.

[milesz]

The private market has been given 100 years to get it "right". They have failed at it. Once and for all, change must come about.