Friday, July 31, 2009

Health Care is Not a Right

The United States Bill of Rights grants rights to its citizens. Those rights prescribe freedoms for self-determination. For example:

What Rights Give:
- The right to choose to speak.
- The right to to choose to assemble with others.
- The right to choose to bear arms.

What Rights Don't Give:
- The right to force other people to listen to you.
- The right to force other people to hang out with you.
- The right to force other people to run a gun store to provide you weapons.

I'm making a point about the distinction of rights.
A right gives you the freedom to choose something, but it doesn't force other people to do things for you.
I can't perform a coronary bypass on myself, so I need other people to do so. Is it a right to force doctors to do that on me?

Health Care is a privilege, not a right.


Hammerspace said...

Sounds good, but strikes me as a bit of a straw man argument.

First nit: the government, at various levels, does choose to provide services to the public in order to directly or indirectly support rights to life, liberty, and the pursuit of property (or happiness, if you prefer that version).

We enjoy the protection of armed services, police, fire departments, and lifeguards, indirectly supported by taxes and provided by federal, state, and local governments. As the recent Cambridge issue shows, we see many points of concern about performance of these services from time to time, but generally speaking, no one complains about the basic model. Perhaps there are some who want to hire a private Fire Department, because they feel the existing one is weighed down too heavily by the irresponsible masses, but I've never heard any complaints. (That's just a little joke--of course.)

I do not necessarily agree with nationalized healthcare, but would assert that productive discussion of the issue must be based on specific arguments about what is effective, fair, and affordable for the nation. But no, its not clear that nationalized health care is the best answer. Unfortunately, convincing and sincere arguments are lacking on both sides.

Second nit: I would say that rights are recognized, not given.

Bob Gandhi said...

I agree with your distinction in the broad sense. On a similar note, you can say that the right to eat is a corollary to the right to live. However, that doesn't mean that the government has to grow food.

Unfortunately, it's the end of the question. Healthcare is tricky because it's also related to the right of equal opportunities for everyone.I still think government must make sure that the conditions are there for our rights to blossom.

I would recommend this book

Joseph Greiner said...

As a developed nation, ethically we should find a measure to care for those who are incapable of caring from themselves. This burden should be voluntary; however, in a capitalist society altruism is generally non-existent unless there is some form of non-financial benefit.

I agree that health is not really a right, nor should it be an entitlement, however, as a civilized society we should find a financial approach to housing, feeding, and clothing our elderly and disabled.

Like all investments, I find this health insurance bill as a temporary fix for something much much larger.

The following questions should be answered first:

1. Why are Americans comparatively less healthy than other advanced nations? (evaluation of FDA food classifications, obesity, work balance, and care cycles)

2. What cost control levers are available to reign in pharmaceutical / prescription drug costs? (lawsuits, FDA policy, patent protections (longer or shorter), drug re purposing, marketing, etc.)

3. What cost control levers are available to reign in health services and administration? (Technology, Resource Optimization, Structural barriers, Competition, Doctoral Education)

Overall, there is an explicit tendency to prescribe the symptoms and not the root cause. This is the problem, not only with the health care, but decision making processes in general. Investment dollars should be aligned in the areas that will yield the highest returns, or in this case - SAVINGS.

Hammerspace said...


Your position makes sense.

The pharma piece (your #2) is a very difficult, but interesting business problem--How to reign in costs without dampening investment in important R&D, or without causing leading firms to completely exit in favor of friendlier markets?

I get so tired of the trite "red pill blue" argument, aka "Why can't we just all buy generic drugs/drugs from Canada?"

Joseph Greiner said...

Overall, my biggest criticism of a private / public based insurance system is as follows:

1. Subsidies: The current employer based system assesses risk based on a pool of employees. The older and higher risk work forces spread costs to the cheaper / less risky. This process restricts efficient uses of health services and buries cost. It also allocates a larger portion of costs to those who make less or are younger / healthier.

2. Short Term Approach: The only efficient method of gaining access to lower risk pools is by participating in high deductible accounts which means you pay less for relatively less service. Overall, value is reduced by risk spreading and pooling. Theoretically, older and higher risk patients should pay proportionately more for health services based on their level of consumption.

3. Lack of Transparency: Institutionalized health insurance reduces the transparency into your individual risk profile and cost structure. The real cost of care is an unknown factor.

Whether private or public, I am a big proponent of long term health savings (tax-deductible) and an individual policy approach. Unfortunately the system would not function either in a competitive environment if risk premiums were not spread to those less risky. Less risky participants have no incentive to exhibit health behavior because in a institutional environment my premiums later in life will be passed on to healthier individuals.

All in all, institutionalized health insurance (public or private)does not encourage long term health behavior, long term health savings, and cost reductions.

Anonymous said...

do you think you made an argument there? Inference has no logical value

Friday, July 31, 2009