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?

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11 Comments :

Blogger stucker said...

Pretty narrow box you are trying to create by giving us only three choices.

Assuming however these are my choices I think health care is first and foremost an individuals responsibility.

Getting it paid for is a privilege.

While I am in favor of some 'guaranteed
' basic minimum menu of health I am opposed to calling it a right as I am in general opposed to "entitlement" programs. ( all good intentioned almost none without severe unintended consequences.

We need more discussion later about coming out f the closet about rationing.

Steve

October 29, 2008 at 5:55 PM  
Blogger DrJHO7 said...

It is all of the above. Our states have established laws that emergency rooms may not turn away a patient who desires to be evaluated for whatever medical concern they have. That establishes a legal "right" to "health care", in one of its forms. It does not address the issue of who pays for the care, what the cost will be, or to an extent, what the scope of services will be, but it establishes the legal precedent. When the "right vs privilege" question is asked in the context of how/whether to provide a package of health care services to everyone in the usa, it raises many more questions. What's in the package, how much should those services cost, who is going to pay for them, who is going to provide them, what is the responsibility of the system, what is the responsibility of the individual. The word "privilege" could imply the dichotomy of 'the rich can shop for their health care' while 'the poor can suffer increased morbidity and mortality of more advanced stages of disease until they crash into the ER', or
"privilege" could imply that all us citizens, provided with basic health coverage for a package of health care services, can have the freedom to choose the locations and provider(s) of those services within the health system. Philosophically, we have a responsibility to ourselves to take steps to promote our own health (diet, exercise, periodic medical visits, take meds if needed, followup on medical recommendations), to promote health within our families, and to assist our neighbors when they are in need. More practically, we have a responsibility to use the health care resources that are available to us in prudent manner such that they are not wasted or used in excess, or unnecessarily. Practicing physicians are well aware of the consequences of irresponsibility on the part of patients when it comes to health care, and that reponsibility is difficult to enforce.

October 29, 2008 at 7:19 PM  
Blogger bturner said...

Health care is both a right and a responsibility. Americans have the right to health care services that prevent and control disease. When this care is not available, avoidable disease or even death occurs. Denying the right to health care can result in the loss of the right to live. This clearly trumps the right to bear arms (to protect one's life). But then it is the responsibility of the individual to avail him or herself of health care services once cost and access barriers have been reduced. If an individual with hypertension does not take advantage of this care, they not only harm themselves but also place a burden on the rest of society, who must pay for the renal and heart disease that result. Thus, we need to educate our fellow citizens to take advantage of their right to health care wisely.

October 29, 2008 at 8:27 PM  
Blogger wretan2900 said...

Seems to me that all rights are provided by others. The rights to life, liberty and the pursuit of happiness are "endowed by the Creator". Civil rights, the right of women to vote and so on are conveyed by law. The right to drink alcohol wasn't questioned any more than the right to breath...until a constitutional amendment took it away...and another gave it back...except in some jurisdictions.
The right to health care is a right of the citizens of every major industrialized country, conveyed by the laws of each country...except the United States. And that omission ought to change.

October 29, 2008 at 9:44 PM  
Blogger Antonino said...

In a civilized society, the health of its citizens is the most basic concern.
If we were to define Health Care as the mean to achieve this objective, which we haven't, then Health Care would be the right of each individual,a societal endeavor and government responsibility. Government should pay for every penny which is necessary to spend: from the necessary investments in preventive care to the coverage of all necessary and affordable therapies.
As individuals we must be responsible of course. But we shall not be responsible in great numbers, if a great number of us are unaware of the basic scientific truths of what individuals can do to maintain health and prevent diseases.
Our society however as not yet defined what Health Care is. We do know that there is a "Health Care Industry", and most of what we hear on the science and discoveries of medicine are the commercialized "translations" fed to us by the big players of this industry, every moment of every day in continuous barrage of stupidities and misleading novelties.
Imagine for a moment that our society would let the big defense contractors define our national defense strategies, and let them decide what we should buy from them. Well this is exactly what is happening now in "Health Care" in the USA.
We certainly need a National Entity(ies) charged with defining a national strategy for the health of our nation. Once a consensus is reached. on scientific and budgetary grounds, on what is and what is not "Health Care" then only the first should be considered for implementation.
I believe that a definition of health care must precede the debate as framed in the ACP Advocate blog. If it doesn't we shall just go bankruptcy while talking of privilege, rights or responsability.

Antonino T DiMarco

October 29, 2008 at 10:00 PM  
Blogger Jose said...

As an international fellow of the College I congratulate Bob Doherty for inaugurating this blog with a topic of universal relevance. I think that health care is a responsibility both of the state and of the individual. Individuals elect goverments for the common good, and part of this is health care, as is education, housing, etc. It is remarkable that those countries where health care is voiced as a right,are the ones with worse effective health care.

October 30, 2008 at 12:24 PM  
Blogger Jason said...

I agree completely with Steve.

Health Care is a broad term. To care for one's own health is a personal responsibility.

However, I think few would disagree that we have a moral duty to care for one another, whether grounded in spiritual beliefs or ethical reasoning.

But to say that health care is an individual's "right" doesn't make sense. That means that I am justified in expecting (demanding?) my fellow citizen to care for me. To provide the resources and money for my health care. Who of us has justified claim on another's well-earned resources?

I don't believe that a moral duty to provide relief to one another translates into an individual's right to health care.

October 31, 2008 at 12:12 AM  
Blogger The Happy Hospitalist said...

Nobody has a right to take from another what is rightfully theirs.

November 1, 2008 at 8:38 PM  
Blogger james gaulte said...

Is it not possible to guarantee medical care for all and still allow individuals to purchase whatever other services they wish ? The NHS and private care coexist in Great Britain.

November 5, 2008 at 11:01 AM  
Blogger Andrew said...

This comment has been removed by the author.

November 7, 2008 at 11:43 AM  
Blogger andrew said...

According to Article 25 of the Universal Declaration of Human Rights, approved by the UN General Assembly in 1948: (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Why look at the right to health as a basic human right? In the United States, we have not wavered from our protection of the rights to life, liberty and the pursuit of happiness. Indeed, we have fought wars in their defense and exported these ideas to other parts of the world. But how can you have a lively, liberated populace in a democratic society without certain measures aimed at protecting these rights? Take education, for example. Few would argue with the idea that an educated populace that is able to access the marketplace of ideas and posit their own thoughts is central to our government. Having "bad luck" is not something we take into account in the US when deciding who gets an education and who does not because we realize that once we fail to provide this basic right, and once education becomes concentrated in the hands of a few, our democracy loses its meaning.

But this is something that we regularly do with access to health care. Health care is also central to the preservation of democracy and our government's ability to guarantee life, liberty, and the pursuit of happiness. Illness that goes untreated because a patient can not access even basic primary care services destroys life, prevents individuals from being able to work, and often leads to economic ruin. Emergency rooms are ill-equipped to serve as primary care offices, and the costs to our health care system and to the patients who wait until symptoms grow severe are immense. Moreover, a few "unlucky" individuals who lose their jobs or insurance coverage and suffer from a catastropic illness succumb to that illness because they can not access treatment options.

Again, the emergency rooms are not an adequate safety net. With health care, like education, so vital to the protection of the human rights that our country holds so dear, how can we fail to protect the right to quality health care as well?

November 7, 2008 at 12:45 PM  

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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.

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