11/15/2009 05:12 am ET Updated May 25, 2011

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.