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Is health care a right? Two views on a touchy subject (Part 1)

There is an old question still sparking debate in the blogosphere (see Kevin MD’s links): is health care a right or a privilege? I think it’s worthwhile to consider both sides of the argument, as one’s position on this issue actually provides the foundation for how one proposes to “fix” this broken health care system.

I have searched the Internet for some of the best quotes on the subject (and I’m sure I have missed most of them) to frame the debate. Today’s post is devoted to the “health care is NOT a right” position. My next post will provide quotes from the “health care IS a right” camp. I hope that you will provide your own views pro or con as comments.

Mr. Robinson wonders if (based on the US Constitution) one can classify health care as a “right:”

By definition, rights can not extend past the boundaries of one’s own person.  One can not, for instance, exercise one’s right to free speech by demanding that one’s neighbor cease speaking, for by doing so, one would deny the neighbor’s right to free speech.  Given that healthcare, for the most part, is the product of someone else’s knowledge, labor, capital, and equipment, it is not within the boundaries on one’s own person.  Healthcare can not be a right because it makes demands on other people.

This analogy by Dr. Peikoff sheds some light on what would happen if healthcare were treated as “a right” by the government:

Take the simplest case: you are born with a moral right to hair care, let us say, provided by a loving government free of charge to all who want or need it. What would happen under such a moral theory?

Haircuts are free, like the air we breathe, so some people show up every day for an expensive new styling, the government pays out more and more, barbers revel in their huge new incomes, and the profession starts to grow ravenously, bald men start to come in droves for free hair implantations, a school of fancy, specialized eyebrow pluckers develops — it’s all free, the government pays. The dishonest barbers are having a field day, of course — but so are the honest ones; they are working and spending like mad, trying to give every customer his heart’s desire, which is a millionaire’s worth of special hair care and services — the government starts to scream, the budget is out of control. Suddenly directives erupt: we must limit the number of barbers, we must limit the time spent on haircuts, we must limit the permissible type of hair styles; bureaucrats begin to split hairs about how many hairs a barber should be allowed to split. A new computerized office of records filled with inspectors and red tape shoots up; some barbers, it seems, are still getting too rich, they must be getting more than their fair share of the national hair, so barbers have to start applying for Certificates of Need in order to buy razors, while peer review boards are established to assess every stylist’s work, both the dishonest and the overly honest alike, to make sure that no one is too bad or too good or too busy or too unbusy. Etc. In the end, there are lines of wretched customers waiting for their chance to be routinely scalped by bored, hog-tied haircutters some of whom remember dreamily the old days when somehow everything was so much better.

This attorney wonders where the “rights” begin and end in the health care environment:

If we speak of a right to healthcare, we need to ask: What kind of healthcare? Perfectly healthy people seek healthcare simply to confirm that they are healthy. Some people seek treatments—vaccines, nutritional and hormonal supplements, surgery to eliminate genetic cancer risks—as preventive measures in order to preserve their health. Some people seek healthcare for conditions that others would not, such as minor colds, common balding, or sports performance enhancement. Few of us would be willing to recognize, or finance, a “right” to whatever kind of healthcare a person might think desirable.

A physician gives an example of what can happen when consumers demand their “rights” to health care:

“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.

A patient continues the refrain:

What’s so special about health care? Why not rights to higher education, job training, clothing, computers, child care, cars, etc.? There are a lot of things that will improve a society if everyone had them. This doesn’t mean that we should establish positive rights to provide all these things for those who can’t afford them. We need to keep incentives in place (and perhaps provide education) to encourage people to spend and save their money wisely and to nurture a solid work ethic. Encouraging people to help themselves seems to be a solution for the long-term, not trying to get everyone else to buy the necessities for them.

Do you think that health care is a right? 


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Why I worry about a government-sponsored universal coverage system

Within the past few years the Centers for Medicare and Medicaid Services (CMS) chose to enforce a rule (casually known as the “75% rule”) that resulted in denial of services to many heart, lung, and cancer patients requiring rehabilitation therapies.

CMS was looking for a way to cut costs in rehabilitation facilities, and decided to create a rule whereby these facilities would lose their approval status if they admitted too many patients with certain conditions. The CMS arbitrarily decided that 75% of all patients admitted to inpatient rehabilitation facilities had to have one of 13 diagnoses, or else the rehab facility would not qualify for Medicare reimbursement. Many important diagnoses were not included in those 13, including cancer, heart and lung disease, and many types of orthopedic injuries.

What does this mean? It means that getting admitted to a rehabilitation facility is no longer based on need, but on diagnosis code. Because of the financial pressure exerted by CMS (Medicare is the primary payer for most facilities) these rehab centers cannot afford to be delisted. So they turn away patients in need, for patients who have the “right” diagnosis.

What has this rule done?

  1. Limited clinical decision making by doctors – a physician is no longer able to recommend patients for acute inpatient rehabilitation purely based on their need for it.
  2. Decreased choice for consumers – people recovering from heart attacks, cancer or COPD (to name a few) will generally not be offered the opportunity to be rehabilitated in an acute, inpatient setting.
  3. Reduced quality of care – rehabilitation facilities specializing in oncology or cardiopulmonary rehab will need to divest themselves of aggregated expertise. Since these centers would no longer qualify for Medicare funding, they can’t afford to remain centers of excellence in these fields of medicine. Instead, they will need to turn their attention to the 13 diagnoses that qualify for inpatient rehabilitation.
  4. Puts lives in danger – patients who are not admitted to acute rehab will be forced to recover in nursing homes (also known as “sub acute facilities”) that do not have the level of expertise to take care of them safely.

The 75% rule is one example of the kinds of decisions that a government sponsored universal healthcare system will make. When one payer (government or non-government) develops a monopoly, their decisions can single-handedly limit consumer choice, prevent physicians from exercising clinical judgment, and decrease quality and safety of care. What will Americans say when the decision to fund organ transplants for people over 65, for example, is denied across the board?

When medicine is no longer applied in a personalized (case by case) manner, and population-wide rules are in effect, we will face ethical dilemmas far surpassing those we already have. A system that serves the needs of many still fails the needs of some – and when we lose the flexibility to “bend the rules” for the exceptions we will lose the best of what American medicine has to offer.

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Healthcare predictions for 2007

Dr. Richard Reece’s latest blog post lists “12 health care predictions for 2007” – I looked into his crystal ball and was quite intrigued. Here are some highlights (see his blog for the full transcript):

  1. The home care market will boom
  2. Obesity will eclipse smoking as the #1 public health issue in America
  3. Web based patient education will become extremely popular
  4. High deductible health plans (powered by health savings accounts) will dramatically expand their reach
  5. Employee wellness and prevention programs will bloom…

What other trends do you think he missed? Do you disagree with any of his predictions?


This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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