Health Care: Right or Privilege?

Part of the reason we find it difficult to have rational discourse on health care reform in this country is that we all speak different languages. What I mean by that is we hold different assumptions and beliefs from which we operate, and therefore we can't figure out why the person who disagrees with us is such an idiot. Well, he or she is probably not an idiot; he or she simply holds a different set of beliefs than we do, causing them to see the world differently.

One of the basic issues that we have to be at least aware of, if not in agreement with, is whether health care is a right or a privilege. If health care is a right, then, ultimately, we have to provide a certain level of health care to everyone, regardless of their ability to pay for it . . . which means government-run health care. If health care is a privilege, or perhaps more accurately, a responsibility, then we can allow the free market to provide financing options for health care and people may choose to purchase coverage or to pay as they go. And if they end up needing more health care than they can afford, they just have to live (or die) with the consequences of their decision (not to buy health insurance).

I happen to think that virtually every American actually agrees on this issue. Virtually everyone I speak with about health care believes the same thing: that he (or she) has a right to health care, but as far as everyone else is concerned, it's a privilege. Even the most die-hard libertarians who rant about being coerced by the government to pay taxes to fund social welfare programs suddenly become very nearly socialist when, for instance, after smoking two packs a day for 30 years, they develop lung cancer, find themselves somehow uninsured, and turn to Medicaid to pay for treatment. I have never seen a free-marketer turn down government-run health care when his own life was on the line.

The truth is that we are schizophrenic about this issue, and our actions betray our confused beliefs. As a nation, we seem to believe that some basic level of health care is a right, as borne out by the Medicare and Medicaid programs, and EMTALA legislation that requires emergency departments to treat patients with life- or limb-threatening illnesses, regardless of their ability to pay.

On the other hand, we also seem to believe health care is a privilege, as evidenced by the different levels of health insurance that we can purchase, or choose not to purchase at all. The fact that 15% of our nation's citizens have no health care coverage, and we as a society tolerate this inequity, is further proof that we consider health care a privilege.

I think we would be best served by putting this issue squarely on the table, and coming to some sort of majority agreement (consensus is impossible in our current environment) as to what level of health care is a civil right, and create the infrastructure for providing that level of care to our citizens. Then, persons who want more than the basic level of health care coverage can choose to purchase additional coverage. In a sense, this is what we already have for the poor and the elderly with Medicaid and Medicare, respectively.

NOW A COROLLARY TO HEALTH CARE AS RIGHT OR PRIVILEGE

Americans, in general, confuse the right to health care with the financing of health care. A popular argument currently being bandied about against reform goes something like this: "I don't want some unelected bureaucrat making my health care decisions for me. That's for my doctor and me to decide."

Here's the problem with that argument: you can already decide for yourself what kind of health care you want. The question is whether you can afford it. If you're worried that you are going to lose the freedom to make your own health care choices under "ObamaCare," you should open your eyes. That train left the station years ago!

The fact is, your freedom of choice has already been limited by the private sector! If you are uninsured you'll discover that you can't afford anything beyond the most basic care. If you are insured you will discover that your insurance company will have the last say on whether they will pay for your choices, in which case, if you choose a plan of action that your insurance company considers medically unnecessary, you're back to the first scenario . . . you're basically uninsured.

Let's use an example from my world - cancer care. Let's say you're a man, and you get diagnosed with prostate cancer. You and your doctor decide together that the best option for you is proton-beam therapy . . . the most expensive form of radiation therapy, available in only a handful of centers. In this case, you'd be lucky if you were the victim of government-run health care (i.e. if you were a Medicare beneficiary) because Medicare pays for proton-beam treatments.

But let's say you decided to purchase the cheapest insurance you could find, with a low monthly premium. You know that the insurance company can charge such a low premium because they make up the difference with high deductibles and copays. At the time you bought the policy, you weren't planning on getting sick, and so you didn't think much about it. You also didn't bother to read the exclusions and conditions and the other fine print.

Now you have prostate cancer. And you want to go to Loma Linda for proton beam therapy. You make the appointment and fly out for the consultation, only to be told that you will have to pay $50,000 (or more) up front because your insurance plan doesn't cover proton beam therapy.

Read this next part very carefully: Your insurance company never said that you could not get proton beam treatments. You are perfectly free to get proton beam treatments if that's what you and your doctor think is best. All your insurance company said is that they aren't going to pay for it. And they don't have to. Because health care, at this level, is a privilege, not a right.

At this point, you might beg or plead or even demand that the good folks at the Loma Linda facility treat you for free, or for a greatly reduced price. But they are not obligated to give you a price cut. Just because you are free to choose this expensive treatment doesn't mean the provider has to give it to you.

So you are free, in theory, to choose whatever health care you and your doctor think is best. But if you can't afford the treatment, are you really free? And if your insurance company refuses to cover the treatment, are you really free?

We are in a place in this country where we can't speak to each other rationally or, for that matter, civilly, about health care reform. And we will never get out of this place until we can find some common ground, or as they say in the music biz, sing from the same sheet of music.

One of first issues with which we have to come to terms is whether we believe there is a basic civil right to a minimum level of health care. If we do, how will we provide that level of care? And if we don't, how will we be able to turn those people away at the Emergency Room door who can't afford to pay?