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President's Page By Samuel Wilson, M.D. Should Healthcare be a Right?
A right is defined as a natural entitlement. The Declaration of Independence delineates the most basic of human rights as inalienable: "Life, liberty and the pursuit of happiness." Because they are an entitlement, not a privilege or favor, we do not owe anyone gratitude for their recognition of our rights. The purpose of rights is to protect individual autonomy, however, every right confers on someone a responsibility or obligation. There is no free lunch. Liberty rights protect unencumbered effort and choices, as far as the rights of others are not encroached on. The responsibility for protecting our individual right to liberty rests largely on the state's police power, which is dedicated to protect the citizenry from physical harm. The right to the pursuit of happiness is to some extent synonymous with the right to own property. The right to the accumulation of property does not confer an entitlement to be given wealth though the government in general guarantees that an individual will not be deprived of his property and sometimes even provides incentives for people to accumulate property. This right obviously has the corresponding responsibility of individual ingenuity and hard work. Many other rights have since evolved since these basic rights were enumerated. Among them education, housing, and public assistance - better known by its outmoded term: welfare. Welfare rights guarantee certain results - housing education and food -- and provide protection from unfair barriers to obtaining these resources. This right evolved from the existence and recognition of "Brutal Need." By analogy, some argue today that healthcare is a right because it is needed. Any right to medical care imposes on someone the obligation to provide care to those who cannot provide it for themselves. Besides the obvious questions, too complex to tackle in this article - questions regarding the nature of the socio-economic entity that would bear the corresponding financial burden of guaranteeing and protecting the individual's right to health care - what are the outer boundary limits regarding access to, as well as determination of eligibility for advanced procedures. It stands to reason that if one is deemed entitled to resources because one is needy, there is created a clear incentive to engineer the circumstances to effect eligibility. Is healthcare a right? In a 1989 survey for the Harvard Community Health Plan, 90% said that everyone should have a "right to the best possible health care - as good as a millionaire." Our government sometimes wants to guarantee results in the interest of the nation's well being. Incentives are offered for home ownership through loan interest tax deductions, and there are similar incentives to encourage business activity and entrepreneurship. It is likely that early childhood education and access to health care have been given the status of rights because the argument could be made that it was in the nation's interest to do so. The government will also guarantee certain results because of the political clout of the stakeholders involved...geriatric healthcare and long-term care have the status of rights probably because of the political clout of the stakeholders involved. When people are given rights inevitably there is an increase in the consumption of the goods that the rights entitle. Offering free or heavily subsidized care will inevitably increase overall use of the health care system. People tend to come to the emergency room much more frequently when there is zero co-pay (no out-of-pocket costs for that healthcare consumer), however, a co-pay that is too high means people will delay seeking help, to their detriment. An increase in consumption means an increase in the cost, but so do delayed care and complications. If government cannot afford the increased costs, then there is an increase in taxation or a shifting of responsibility to private industry. As consumers, everyone has to pay the higher prices caused by the inflation of demand for medical services, together with the increased costs of regulation and paperwork. People with certain status often view their rights as reasonable entitlement but the rights of others with different status and interests as undeserved charity. How can we bring these points of view into alignment? Where is the common ground, and where are the boundaries? We are in an economic climate where jobs that guarantee healthcare coverage are decreasing because employers no longer can afford costs that continue to spiral upward, partly because of unnecessary consumption, the cost of new technology, and the cost of a capricious health care liability justice system. As more people lose their status of being insured against health costs, there will be increasing pressure to come to terms about what we are entitled to and what incentives government should guarantee or provide. Should a 58-year-old administrator who is ready to retire after
30 years be forced to continue working (to keep his insurance)? He has a chronic
illness and requires ongoing medical care, and insurance companies won't pick
him up as an individual even if he can afford the premium (because he has a prior
condition). I was intrigued in the recent bicycle race Tour de France that these competitive cyclists displayed certain courtesies to each other. When the race leader fell they all slowed their pace until he got up and resumed pedaling. By analogy, is it not possible that an ethic could be encouraged where industry, governments, and insurance companies remain in the game and be encouraged to display certain courtesies to their employees and the society that supports their existence? In the same vein, incentives for gainful employment and healthy lifestyles should be extended to individuals. On a societal level, restraint on liability "lottery" payments, protection of access to inexpensive medication, and the incorporation of technology to make self-care and access to information easier should be encouraged. If healthcare is a right, as a community we have to consciously decide the limits of eligibility, who will decide, and the corresponding responsibilities that should accrue. As always, I welcome your comments and opinions. Please write to me at mailto:admin@sbcms.org. Sources
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"Doctor,
this guy states he has a bleeding brain tumor and wants a CT scan of his head,"
the emergency department registration clerk announced as I entered his room. He
looked me in the eye and intoned, " I want a CT scan of my brain. I have
a bleeding brain tumor." "Do you have a headache, neck stiffness, loss
of strength?" "No," he responded. I proceeded to examine and finding
no neurological deficit I inquired why he thought a CT scan was needed. He informed
me that a relative had suggested that the numbness he felt in his scalp might
have been a sign of a tumor. He was furious when I told him a CT scan was unnecessary
and indignantly took my name to make a complaint to the administrator. I had denied
him his right.
