August 19, 2011
Health Care – is it a right or a privilege
I think when people say healthcare is a right, or ought to be a right, they don’t always have the same thing in mind. I think everyone would agree that you shouldn’t be denied healthcare on account of race or religion or ethnic origin, or sexual orientation. Well, maybe everyone wouldn’t agree, but it’s not what people usually dispute about. The question is whether you can get healthcare if you don’t have money to pay for it.
And you know that question is still not so clear. Does it mean that you have a right to healthcare even though you can’t pay for it, but you still get billed and have to deal with it one way or another eventually? That’s pretty much the current situation; if you’re broke you can go to an emergency room of a publicly supported hospital and get taken care of, and then maybe get a bill for $20,000 a month later.
Or does it mean that healthcare is basically free, in the sense of covered by taxes with no debt or out of pocket charge to the recipient, the way it is in some other countries?
As I understand Obamacare, which hadn’t yet passed when we recorded this program, the basic answer the U.S. is going to provide about rights is that things stay unchanged. You have a right to get healthcare, in that you don’t have to pay for it up front, but you still have to pay for it, or at least be in debt for what you get.
The big new change is that it's not going to be a right but a duty; everyone has to have health insurance. So it seems to be that we have a right to healthcare without paying cash out of hand, but we have a duty to be able to pay for it, and this means having insurance.
But that is an important change, that affects our rights, namely our right to have health insurance. You can’t have a duty to buy insurance, unless you can buy insurance. And right now, we don’t all have that right. Some people can’t buy insurance at all, and others can’t buy decent insurance at a reasonable price. So if the plan is to make sense, the duty to have insurance will have to be paired with affordable, available insurance for everyone.
So our new right won’t be to healthcare, but to affordable insurance. At least, that’s the outcome some people are hoping for.
In Western Europe, people by and large have healthcare covered by taxes. We'll have something quite different -- healthcare covered by insurance; a duty to buy insurance; and a right to affordable insurance to buy.
There is still a lot of unclarity. Given that I have the right to healthcare, the duty to buy insurance to pay for the healthcare I get, and the right to have affordable insurance -- still, there’s the issue of what level of healthcare I’m entitled to. We include a lot of things under healthcare. From setting broken arms to labia reduction surgery; from stitching up a child’s wounds to ten years of psychotherapy for a philosopher with writer’s block…
Consider the analogy with education. Everyone is entitled to a high school education that covers basic subjects. But some people, who live in richer school districts, or go to private schools, have smaller classes, and a wider variety of subjects. Do we have a right to basic healthcare, like we have a right to a more or less basically adequate education? Or does everyone have a right to healthcare that’s equal to everyone else’s?
It sounded so simple: right or privilege? But it’s a mess. We need help.
And we’ll have it. Laurence Baker, a Professor of Health Research and Policy joins us in our conversation about right and healthcare.
August 19, 2011 | Permalink
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I don't know guys. Rights and privileges get confusing. Relativism tends to push us toward whatever the current popular morality is selling. I lived in Canada for about seven years. Fortunately for me, I did not get deathly ill (when you are in your twenties,you are less likely to need catastrophic healthcare. So it was with me.) But my point is this(and, I have asserted it before): Big countries, with bigger populations; i.e. the United States, China, India---cannot fund and support large public healthcare programs. Those who try to do so find the costs unabsorbable.And then came 2008 and beyond...
I would welcome the opportunity to live in Canada again. And die there. But, like a fool, I re-invested in the United States. There were extenuating circumstances. Well---you'll just have that. Sometimes.
Posted by: Harold G. Neuman | Aug 20, 2011 5:21:37 PM
A single-payer system, like those in Canada and the rest of the industrial world, would've avoided this phony right/duty dilemma because everyone would pay into the system with their taxes. Harold makes some good points, but his argument falls apart when he says that public healthcare programs are "unabsorbable" in big countries and goes on to compare India and China, two rapidly developing countries, with the U.S. How is universal healthcare "unabsorbable" for the richest country in the world, which will eventually squander $4 trillion on pointless wars in Iraq and Afghanistan? The real issue is whether we want to have a society whose citizens are committed to mutual assistance, or a predatory libertarian hell where wealth and power are concentrated in a corporate plutocracy. As Berdyaev wrote: "Bread for myself is a material question. Bread for my neighbor is a spiritual one."
Posted by: Mickey | Aug 21, 2011 2:46:04 PM
It is our own responsibility to take care of our own health, self-health, but looking around I would say many have ignored this self-care and as a consequence now look for others to take of them for them.
Health-care should start with self-care.
In the event that someone needs medical care beyond their own care the cost must be affordable to all who need it.
How can we make healthcare affordable to all?
Rather than insuring everyone no One should be insured.
By removing the insurance company’s profits from the cost of healthcare, the cost would come down to a price we all could afford. Supply and demand would make it so.
And perhaps doctors would even make house calls again.
Posted by: Michael J Ahles | Aug 22, 2011 2:56:45 PM
I live in Italy and lived in Canada also.
Both counties have healthcare although canadian is much more efficient to my opinion.
Maybe because it has been normal for me all my life, I believe that healthcare should be a right in all countries and I think that the evolution of humanity will reach a point one day where it will be normal.
Posted by: Patrisha | Aug 23, 2011 12:35:32 AM
Is healthcare a right? I am not sure. I do feel that the for profit system is toxic. If there are ten people needing the same operation, with 1 able to pay a million dollars, the bottom 3 able to pay 10,000, and the others somewhere in between, this inflates profit and price to a point that the bottom three will just have to suffer. Sure, there will be competing hospitals, but this isn't food. The competition aspect we are accustomed to is weak and to me seems unethical.
LIFE, liberty, and the pursuit of happiness? Certainly, if you can afford them.
Posted by: Russell Greenlee | Aug 23, 2011 5:46:51 AM
Couldn't say it better than Mickey did.
Posted by: FrankZ | Aug 23, 2011 8:18:12 AM
Mickey makes good points and answers hard questions with questions of his/her own. The 4 million dollar query reinforces what I had said about the size issue.
And so, whether my 'argument' falls apart or is moot is very much a matter of one's point of view. Perhaps unabsorbable was a poor choice of word. I have heard another phrase that might capture the dilemma better: cultural intractibility. Deconstruct that if you wish. I'm just trying to make sense of the insensibility of the twentieth and twenty-first centuries. Never thought I'd live to see the transition. But, sometimes you'll have that...
Posted by: Harold G. Neuman | Aug 23, 2011 3:14:39 PM
This is a great blog. I'm a neuroscientist who's interested in brain/mind (and other philosophical) issues. I'm also blogging in a non-academic (informal) way about (sometimes) serious topics. I'll be back.
Posted by: Jon Horvitz | Aug 24, 2011 7:17:59 AM
Call me a communist if you like or an idealist if you prefer, but I subscribe to an entitlement/needs-based approach. People who work for their living or have worked for same do have a right to healthcare. They are(or were) participants in this hodge-podge of rights, privileges and responsibilities we wistfully call The American Dream. If we can 'afford' to wage incessant wars (Mickey's rant), we can afford to take care of our productive citizens (mine).
Since I'm not a social worker and did work for most of my life, I am ambivalent towards our welfare system (as we now know it). But, my ambivalence notwithstanding, I suppose we cannot just allow people to die when they cannot afford healthcare. The not-so-easy answer would be: abolish warfare and save your money. But in our acrimonious world, that would just never do.
Posted by: Dave the Carpenter | Aug 25, 2011 6:43:01 AM
My partner lives in Spain, and so we're there for a month every summer and winter. I go with her to the hospital and clinic (in Santiago de Compostela, northwest Spain) for her doctors appointments. Even though we both live in NYC, she continues to have most of her medical appointments done in Spain. That may be her comfort level with a system that she's accustomed to. As a casual observer, talking to her, sitting with her waiting for appointments, it sure seems to work well. There's a psychological comfort, I think, from knowing that no matter what happens, you will not be ruined financially by an illness. If you need to be an in-patient for 1 week, or 2 months - there's no charge. I don't want to sound naive, I know there are probably pros and cons - and it's probably too late for the U.S. to ever have a single-payer system. But I sure like the idea. A 'right' to health care -- I don't know if that type of terminology is necessary - but if you do have universal health care, I believe that it affects the way a country perceives itself. The we're all in it together idea appeals to me, but it may not be what some consider 'real American'.
Posted by: Jon Horvitz | Aug 25, 2011 5:01:49 PM
This is actually about the conundrum discussed on this particular show. (Although I am in favor of broader access to health insurance.)
Brief overview of conundrum: Man finds diary page written by elderly neighbor and can't decide to return it to her or throw it away. Suggestions centered on return (moral courage) or throw away (moral avoidance).
There is a third option: shift the responsibility. Go to the woman and use a well-crafted altruistic lie in this form: Ma'am, we threw away your diary page, but it got stuck to the bottom of the garbage can. I noticed it is still there and will be picked up by the garbage man on the next round. Do you want me to get it out of the garbage can and give it to you, or do you want me to leave it there so the garbage man will take it away?
Posted by: Wallygator | Aug 25, 2011 9:20:07 PM
This is never an easy question. Why should someone who doesn't take care of themselves and abuses their body through smoking, drinking, drugs etc. get free health care that people that do look after themselves have to pay for? But then why should someone who does look after themselves have to fork out a huge amount of money who becomes ill for no fault of their own? There needs to be a balance and any advanced society should look after the health and well-being of its citizens. If there wasn't so much blatant corruption in corporate business and government we would have a health care system that everyone could utilise and be proud of.
Posted by: Daniel | Sep 1, 2011 5:23:43 PM
I have been following, with great interest, the comments on this post. New contributors have delighted me and probably each other, as well as JP and KT. This is a peripheral concern, perhaps, but I have been following the growth of a proprietary 'medication'---if medication IS a correct characterization.
I am cursed with memory---sometimes accurate, sometimes, not so much. Years ago, I REMEMBER a rodenticide called Warfarin. If memory serves (it may not, as I have admitted...), Warfarin poisoned rats and mice by causing them to die from internal bleeding.
Flash forward thirty or forty years (I am estimating.) There is now another substance (or the same compound?)called Warfarin, being used as a blood thinner by the medical profession. Now, I don't know much about therapeutic properties of certain compounds. I do know that snake venoms and frog poisons are being used to do some amazing things. It has given me pause, however, to think that I might someday be given rat poison to regulate my circulatory health. I take certain medicines now to control cholesterol and triglyceride levels in my blood. I wonder if any of those have analog relationships to rat poison...
Posted by: Dr. Sardonicus | Sep 2, 2011 4:21:55 PM
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