Tuesday, February 5, 2008

Do We Really Have a Right to Universal Healthcare?

Since most of the material I’ve been reading regarding Universal Healthcare starts off with an argument that we each have right to good health the question seems like a good place to start my survey.

"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." – Universal Declaration of Human Rights

If I tell you that I have a right to good health, just what does that mean? According to dictionary.com that means that I am due good health. “Due” implies that if I can’t achieve it on my own then someone else owes me good health. How cool is that? I’m now declaring that I have a right to half of Bill Gates fortune and I expect the government to collect it for me. That seems pretty silly doesn’t it? Just because either I or some self-appointed or even an elected group declares they have a right to something doesn’t really mean that I’m automatically obligated to support their claim. They have that right only if I, out of good will or under duress, grant it to them. Said another way – they get what they want if I give them what they want or they can make me.

The US Declaration of Independence declares certain rights inalienable. This means that the rights claimed in the Declaration of Independence cannot be repudiated or transferred to someone else. Specifically – life, liberty, and the pursuit of happiness. So after these inalienable rights were declared how long did it take for the black community to enjoy some of these rights? If I remember correctly, a large portion of our nation had to be forced to give the black community what they expected - or at least the desire to work where they wanted. Additional desires such as being treated equally came through later combinations of force and legislation.

I‘ve concluded that the concept of “right” is just something we desire for ourselves and “universal rights” are generally noble desires – something that most people would want for everyone. What happens if there are obstacles to our being able to achieve our desires? If there are no obstacles we can just take what we want – the "I found it so it's mine" principle. If there is an obstacle then for us to be able to claim our right (get what we want) then we need to overcome the obstacle. If the obstacle is something other than another person we simply lay waste to the obstacle, relocate it, or work around it.

However, if the obstacle to achieving our proclaimed rights is another person who is also trying to achieve their own then we need to pursue our desires with a more delicate strategy. First, we try to negotiate with them so that we either achieve or come close to getting what we want in exchange for them achieving or coming close to their own desires. Failing that route of negotiation we then take them to court and try to convince the court that "our rights" are more important than the other persons'. If we aren't convincing then we try to figure if we are strong enough to get what we want by force. We can go to the government and have new laws passed that give us our desires or if we are strong enough and enough of us have the same desire then we can group together and take what we want by force.

Declaring what we want a “right” may make us feel better about it, but it doesn’t change the fact that if achieving my “right” (i.e. right to health) conflicts with a “right” you expect (i.e. right to property) then the discussion is not really about working together to achieve our individual rights – it’s about who wants what they want the most and is willing to fight hardest for it.

I couldn't help but laugh to myself when Wikipedia referenced the United Nations “Universal Declaration of Human Rights” as proof that Universal Healthcare was a right. There are many other so-called rights listed in that document that a good percentage of the member nations ignore. This clearly highlights the futility of assigning a label of “a right” to something that is nothing more than something most of us would like to see for all peoples.

So if Universal Healthcare isn’t a right, then what is it?

To answer the question for myself I painted a little picture. An HD family where the husband develops symptoms early but it goes undetected until he’s been fired from his job, he's spent the family savings on speculative stock options, two of their four children develop juvenile HD and as a result their medical bills go through the roof. The family has to file for bankruptcy. After losing their health insurance the mother develops breast cancer.

Does she have a right to health care paid for by someone else? Let’s not be silly and call it free healthcare. Healthcare is NEVER free. Someone is going to pay for it. As callous as it seems on the surface, no - she does not have a right to it. She wants it and it is even clear that she NEEDS it.

But the more appropriate question is do I have a duty to pay for it? Will I personally meet her needs? As a Christian my answer is – without question. But a catastrophic illness such as breast cancer is certainly not something I could pay for out of my pocket, and possibly more than a small local community effort could raise funds to cover. So the cost would need to be covered as part of a larger community program – state or national.

If the family were here illegally would I want to cover the cost? In this case I believe I would first try to send the family back to the country that they chose to maintain their citizenship with so that they could take advantage of their native country’s universal healthcare system. But if it were an emergency room situation I would take the “Good Samaritan” route and vote to cover the costs – if needed.

So I agree that the need for a Universal Healthcare system of some type is a valid need that I could support. I don’t consider it a right, but I don’t see how anyone can close their eyes to the healthcare needs of those who have lost their healthcare insurance or could never afford it – for whatever reason. By calling it "a right", I believe that the proponents of Universal Healthcare do themselves a disservice. Claiming something as "a right" almost guarantees a war.

Instead they would do well to call it a vision of compassion for the United States – a nation of "Good Samaritans".

Monday, February 4, 2008

US Healthcare - The Time for Reform is NOW!

On January 31, 2008 the American College of Physicians (ACP) kicked off their advocacy initiative with the goal to improve the US Healthcare system. Their mission is to have a system put into place that is "second to none". The elements of the vision that they have for this system include:

  • Everyone would have affordable health coverage.

  • Everyone would have access to a primary care physician to help guide them through the health care system (patient-centered medical home) - supported by public policies to assure a sufficient supply of primary care physicians.

  • Physicians' compensation would be based not just on how many services are provided, but also for their effectiveness in improving quality, coordinating care, and for preventative services.

  • Primary care physicians would receive higher compensation commensurate with their critical role in helping patients get high quality and efficient care.

  • Patients would be able to receive unbiased information on quality and cost and be rewarded with positive incentives to use health care wisely.

  • Paper claims would disappear and be replaced with a simple electronic billing system that all insurers would honor - just like all banks honor ATM cards.

  • Patients and their physicians would have electronic health records to provide them with evidence-based treatment guidelines, laboratory and diagnostic test results, medication lists, and medical histories at the point of care.

  • Patients and doctors would be able to choose among different treatment options based on independent research on their clinical effectiveness, costs and benefits compared to each other.

  • Patients and physicians would have access to the latest medical advances resulting from scientific research.

They've put together a "candidate's pledge" on these points and their asking all political candidates to sign it. Of course, none will do so - but that's not the point. The point is to make them aware that this new lobbying effort is in town and their job performance will be measured against this checklist.

With healthcare now at the forefront of political dialog I thought it would be fun to explore, in depth, the issues related to healthcare - who's proposing what and how will it impact HD families? For obvious reasons, the ACP's initiatives are biased toward the medical profession and seem to center around making sure that the primary care physician is the governing body in the domain of healthcare - and paid commensurate to the importance of their role. At this point I don't see any reason to disagree with this as long as patients can change primary care providers easily, privacy can be respected, and medical records can be transferred easily when requested by the patient.