The ACP Advocate Blog
by Bob Doherty
Wednesday, October 29, 2008
Is health care a privilege, a right, or a responsibility?
One of the most provocative topics during this election year came in the form of a question posed by moderator Tom Brokaw during the October 8 presidential debate:
"Is health care in America a privilege, a right, or a responsibility?"
Senator Obama responded, yes, "It should be a right for every American." Senator McCain replied that "I think it's a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. . . But government mandates I -- I'm always a little nervous about."
The question of whether health care is a right or a responsibility--could it be both?--is explored in excellent commentary by Maggie Mahar. She writes in the The Health Care Blog that "The idea of health care as a 'right' is usually pitted against the idea of health care as a "privilege." Given that choice, I'll circle 'right' every time."
But she notes that defining health care as a right can come across as "shrill and demanding" and cites the views of a Dr. Shadowitz, an emergency physician and self-described "fellow traveler" of the "angry left" who writes in his "Moving Meat" blog that:
"When we use the language of 'rights,' we are generally discussing very fundamental liberties, which are conferred on us at birth, and which no government is permitted to take away: free speech; religion and conscience; property; assembly and petition; bodily self-determination; self-defense, and the like. Freedoms. Nowhere in that list is there anything which must be given to you by others."
Some conservatives are taking this view to create a legal bulwark against government-mandated coverage. George Will writes approvingly in The Washington Post of an Arizona resolution that, if approved by voters on November 4, would enshrine in the state's constitution the right of people to make their own health care choices without government interference. Resolution 101 reads:
"Because all people should have the right to make decisions about their health care, no law shall be passed that restricts a person's freedom of choice of private health care systems or private plans of any type. No law shall interfere with a person's or entity's right to pay directly for lawful medical services, nor shall any law impose a penalty or fine, of any type, for choosing to obtain or decline health care coverage or for participation in any particular health care system or plan." [Emphasis added]
Many doctors, fed up with government price controls that undervalue their services, may like the part about guaranteeing the individual's the right to pay for lawful services. Even so, physicians who believe, as ACP does, that the government must guarantee coverage should be concerned about Resolution 101. It turns the entire rights debate on its head, establishing rights that would limit the government's ability to require coverage instead of creating a right to coverage as health care rights advocates have long argued.
What do you think--is health care a right? A right to affordable coverage? Or a right to make health care decisions without government interference and mandates?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
The Wall Street Journal's blog on health and the business of health.
Health Affairs Magazine Blog
The Policy Journal of the Health Sphere.
The Health Care Blog
Everything you always wanted to know about the Health Care system. But were afraid to ask.
Vignettes and commentaries on the medical profession.
The New Health Dialogue Blog
From the New America Foundation.
DB's Medical Rants
Contemplating medicine and the health care system
Notes From The Road
Bloggers post from medical meetings, press conferences, and policy gatherings from the U.S. and around the world, providing readers with a tasty analysis of the buzz, the people, and the stories that don't get told.
A blog dedicated to medical education, news, and policy as well as career advising.
Disease Management Care Blog
An ongoing resource for information, insights, peer-review literature and musings from the world of disease management, the medical home, the chronic care model, the patient centered medical home, informatics, pay for performance, primary care, chronic illness and health insurance.
Medical Professionalism Blog
The Medical Professionalism Blog was created by the ABIM Foundation to stimulate conversation and highlight best practices related to professionalism in medicine.