Healthcare: A right or a privilege?

Published January 24, 2014

By Tom Campbell

by Tom Campbell, Executive Producer and Moderator, NC SPIN, January 23, 2014.

Dr. Conrad Flick, noted North Carolina family physician, recently appeared on a panel discussion on healthcare conducted by the North Carolina Academy of Family Physicians. During that forum Dr. Flick raised a nagging question.

Flick said it was time America declared whether healthcare is a right or a privilege. This question gets to the essence of today’s healthcare debate because, as the noted theologian C. S. Lewis wrote in an essay on the subject, “You can’t get second things by putting them first; you can only get second things by putting first things first.” America’s healthcare system has been built putting second things first. The first is whether healthcare is a right of each citizen or just a privilege for those who can afford it?

We made the decision that a “sound basic education” was the right of each child. We even decided it was right to provide police, fire, defense and other public services, with taxes paying for them. What about healthcare?

We sidestepped the fundamental question in the 1960’s, passing Medicare and Medicaid legislation that declared the government as the payer for healthcare for the poor, disabled and elderly. We compounded the issue by requiring that anyone who shows up at the hospital emergency room will be treated, regardless of insurance coverage or ability to pay. The Affordable Care Act, or Obamacare, was another thinly disguised extension of an answer. By requiring everyone to have health insurance, then expanding the list of those who could receive partial or full subsidies for that insurance the country took another big step toward a declaration.

Step by step we have made a de facto decision that healthcare is a right. We are so far down that path that we would have anarchy if we attempted to unwind previous decisions and take benefits away from people already receiving them. Whether you think the solution right or not the reality is correct. So let’s acknowledge the truth and own it: healthcare is a right in America.

Then we can get about the redesign of our healthcare system because nobody would deliberately create our current public-private, cost shifting, finger pointing and unaccountable healthcare system. Panelist Peg O’Connell simplified the mess by explaining that the person getting the service and the person providing the service are disconnected from the person paying for the service. Worse still, the person who is paying the person who is paying for the service, the employer, is even further disconnected, aside from worrying how to afford the insurance.

The next decisions are tougher. How do we guarantee equal access to healthcare, how do we ensure adequate resources in all areas and who pays for healthcare? If a single payer system is preferred and that payer is the government do we even need health insurance? What levels of professional training are necessary for various levels of care?

Do we provide care to all or just American citizens? Do we provide just primary care or specialty care, organ replacements, cosmetic or elective treatments? What about end-of-life care, when the most difficult and expensive decisions must be faced? And what role does personal responsibility and accountability play in healthcare? Should all pay for the consequences of those who overeat, smoke or indulge in poor choices?

Until we claim the truth that healthcare is a right we have not put first things first.

January 24, 2014 at 11:07 am
Norm Kelly says:

Tom gets to the heart of the matter immediately in his post. A sound basic education, fire, police, even defense at a certain level, are all decisions made at the STATE level. That's the most important point about the feds taking over the health insurance industry. This is a decision made by the central planners, contrary to law, beyond their scope, and beyond their ability to manage. The decision of whether health care and/or health insurance is a right or a privilege MUST be determined at the STATE LEVEL. Yes, all 52 states! (according to libs anyway!)

Just because the people currently receiving benefits would riot if their benefits were changed/removed is NOT a valid reason for doing the right thing. The benefits Tom mentions are NOT best handled by the central planners. The benefits Tom mentions ARE best handled at the state level. Instead of eliminating these benefits, it would be logical to return these programs to the states. It's much easier for the states to manage these programs, experiment with what works & what doesn't, and tailor the plans to the people who actually live in the individual states. The cost of the programs could be turned over to the states (from the feds), with a gradual reduction in the amount the feds pay and more that the states pay. Of course, this would also mean that the feds would have to stop stealing so much money from each state. If the feds are no longer screwing up that particular market/program, then they have no need to steal the money from the states. If the feds simply left the money in the states to start with, all the states would be able to afford the programs.

Tom also gets it right in the end. Do we provide medical care at no cost for non-citizens? The obvious answer, the logical answer, and the RIGHT answer is: of course not! How can we afford to pay for medical care for people who don't contribute to the system. Again, this is a decision that is best left to the states. Example, assuming all states have implemented their own version of socialized medicine: NC has declared that only citizens of NC will be covered by our plan, or that the state where you reside will compensate NC for your care if you are a resident of another state. Further, California, because it is a socialist state, sets up their plan so that anyone who shows up at a medical care facility will be taken care of at no cost. What happens in California? Their system goes broke, but they are socialists so they don't recognize it. Second, people who are not citizens leave NC to move to California so they can get free medical care. This means that NCs decision to not cover non-Americans had two desired effects: non-Americans find it necessary to move out of NC, California gets the influx on non-payers that they desire - their socialist state is improved by their ability to prove to the rest of the nation that socialism really does work. NC saves money by not paying for non-Americans, and gets to set other policies to make the market more efficient. NC can decide FOR ITSELF whether cosmetic surgery, voluntary surgery, and the like are covered or at what rate they are covered. Decisions made at the most local level to be the most effective for the most local people. So you see, state run plans are more efficient than central planner-run fiascos. History of the past 50-60 years shows us clearly that socialism, central planning, fails EVERY TIME it's tried, even when it's the Demoncrat party in charge/control. Also, the more local the decisions are made, the more impact individuals can have on the decision of whether there is such a thing as 'personal responsibility'. This is one major flaw in EVERY central plan - they refuse to acknowledge there is such a thing as 'personal responsibility'. Take Hillary's idea that it takes a village to raise a child. Her idea is that the village exists only at the central planner level. Much like most of Europe has implemented. If it takes a village, then the village is at the most local, smallest, community-level possible. Central planning fails before it starts because it is not possible to take into account any variation between groups of people or locality differences. Central planners are incapable of recognizing any individual situation. Take again Hillary as a perfect example. She's usually a perfect example of what's bad about politicians and policy. Her response to the disaster in Benghazi comes to mind. She ignored the request for additional security. She refused to recognize the real situation and went along with the Obama lie that it was video related. Then when in front of Congress answering questions about her role in this disaster, her role in making the wrong decisions, her response amounted to 'what difference does it make?'. Four Americans died because of her decisions. Because it was now an event in the past, she asks what difference it makes? What an arrogant butt-head! It matters for two reasons. First because she was responsible but refused to recognize it (a typical demon/socialist response). Second because it proves that central planners are incapable of making the proper decision when individual lives are on the line. Group decisions are made at the central planner level, but individual decisions are not capable of being made in such a large, disconnected, unfeeling organization. Which describes the central planners exactly: large, disorganized, disconnected, unfeeling. Why would we want them in charge of anything?

January 24, 2014 at 12:12 pm
David Coster says:

Very thought provoking as always Tom!

Two thoughts from my perspective...First, "healthcare" is not a right. Check the Constitution. It is as simple as that. Second, "healthcare," is a meaningless and dangerous term. It has come to mean everything(ironically perhaps) from sex-change surgery to abortion, from drug addiction counseling to medical marijuana. Yes, there is a justifiable public purpose in providing access to primary care to all, as well as some sort of catastrophic coverage. But lines must be drawn, skin must be in the game for all and poor lifestyle choices must have consequences...otherwise the healthcare system, while clearly benefitting many, will also be another way we foster dependence rather than encourage independence. Many seem to believe some sort of utopian system can be devised that would provide comprehensive care to all, while being paid for by only some.

Americans in general, and conservatives in particular, do not object providing assistance to people in need, but they do object to unending assistance with no strings attached. We must separate our public policy arguments from moral ones. Public policy must necessarily be constrained by the limits of fiscal prudence and the functional capability of governments. Moral arguments do not account for such things. Thus, the reason why some things that may appear "right" from a moral point of view, simply go beyond what is appropriate in public policy.

My two cents anyway! Thanks for doing what you do!

January 24, 2014 at 3:49 pm
Richard Bunce says:

Healthcare cannot be a right as it requires someone elses time, talents, capital to provide it to you. Paying your healthcare bill can be a government benefit although as with all government programs it will be inefficient and better provided by the private sector so over time there will be a two tier healthcare finance system and providers will generally gravitate to the private system that better rewards them for their efforts.

January 24, 2014 at 7:07 pm
Wayne Rivers says:

The most basic component of healthcare is nutrition. Therefore, let the Feds pay for our groceries first. Then we need shelter; let the Feds provide us shelter. We also need clothing; let the Feds provide us with clothing. Thank goodness for the limitless capability of the government to pay for and compassionately provide for all our needs!

January 28, 2014 at 3:07 pm
James Bass says:

The fire department isn't a right either, but when we hear about private fire departments letting folks houses burn because they aren't members, it sure sets up a howl. Protection by law enforcement isn't a right either, but we sure howl when our houses get broken into.

In almost every community, we have made the de facto decision that law enforcement and fire protection are equal to rights, and made the rational decision to "put first things first"; everyone pays in and all are covered. Is that socialism?

Why sholdn't health care be decided on by the same analysis?

January 28, 2014 at 4:05 pm
Richard Bunce says:

Police and Fire protection are not rights, they are paid for services whether via government or private. Yes government can provide healthcare as a service, whether it be both the finance and provider side as in the VA for all or just the finance side as in Medicare for all. It is not a right however as until the government hires someone to provide police, fire, or health protection or at least pays a private party to provide police, fire, or health protection you will not get these services. I have speech rights, the government does not have to provide a service for me to speak and cannot infringe upon me doing so.

February 1, 2014 at 11:42 am
Barbara Reno, MSN, RN, CCM says:

Your questions regarding health care in our great country are right on target. I commend you for printing them and wish our law-makers would ignore the lobbyists and show us all the moxy it will take to solidify the right of health care.

It would behoove our legislators to include clinical staff working on the front line in their discussions of how to move forward. The current "set up" saps valuable resources for those truly in need of care.

Again, thank you for your article. I hope the right people will take it to heart.