Healthcare – A Moral Right?

“I hope that all physicians, including those who are members of Congress, other health care professionals, and professional societies would speak with a single voice and say that health care is a basic right for every person, and not a privilege to be available and affordable only for a majority. The solution for how to achieve health care coverage for all may be uniquely American, but it is an exceedingly important and worthy goal, emblematic of a fair and just society.” – Howard Bauchner, MD, Editor in Chief, JAMA, January 3, 2017

When it comes to rights as constitutional protections, many of them are not specifically listed in the constitution. Some come from the Ninth Amendment which provides for such unemunerated rights such as the right to privacy, the right to travel freely, the right to associate with others, the right to property and many others. These are negative rights in the sense that the government cannot interfere with them.

Positive rights, on the other hand, do require the action by the government. Such rights include police protection of person and property, and the rights to employment, national security, social welfare and environmental protection. All of these require government expenditures paid by taxes, fees, and other sources.

Of course, government policies have a heavy impact on how resources are to be allocated to these positive rights. For example, we should have a fundamental right to clean air, clean water and land protection. Yet the laws and regulations to protect us from pollution that threatens human life and the environment are unsettled. The reason is simple; government at all levels are loath to raise taxes to pay for the necessary mitigation of such threats.

But minor costs do not seem to be a problem. For example, part of the Miranda warning says, “You have the right to an attorney. If you cannot afford an attorney, one will be provided for you.” In other words, you have a “right” to legal representation at government expense.

That brings up healthcare. If healthcare is deemed a positive right, then government involvement is required and cost becomes a secondary issue.

But, the fact that healthcare is a fundamental part of the social contract is evidenced in virtually all industrialized nations – from Australia to Japan to Canada to Europe and beyond. The impetus in those countries is based on the humanitarian imperative to provide health services to all of their citizens. In fact, many international treaties include provisions for universal healthcare:

Article 25 of the Universal Declaration of Human Rights –“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…”

Article 12 of the International Covenant on Economic, Social and Cultural Rights –“… the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”

Article XI of the American Declaration on Rights and Duties of Man –”Every person has the right to the preservation of his health through sanitary and social measures relating to food, clothing, housing and medical care, to the extent permitted by public and community resources.”

The United States is a signatory on all of these treaties, yet it fails to honor it’s commitment to healthcare within its own country.

Even the first Geneva Convention, established in 1859, provided for medical care for wounded prisoners of war and protection for medical workers. Of course, our active duty military personnel get free medical care for themselves and their immediate families. Even those in our prisons get free healthcare. So, if you want free healthcare, join the Army or commit a felony.

Then there is Medicaid. This program is a joint effort of the states, with partial funding by the federal government to provide health service to poverty level individuals and families. Once a patient is qualified, medical services are provided free (thanks to taxpayers.) Medicaid is thereby a de facto socialist healthcare system.

Of course the controversy over healthcare is about health costs. The policy position for this industry has been and continues to be that it should be left to free enterprise, where Adam Smith’s invisible hand will keep markets competitive and give consumers choices they would otherwise not have. But, because our health system is based on that capitalistic notion, it has become very inefficient and costly. The sad truth is that health services in a socialist system are actually cheaper than those same services under a capitalist system.

In fact, the countries with universal healthcare have lower per capita health costs than the U.S. The Organization for Economic Co-Operation and Development reports that in 2015, the per capita cost in the U.S. was $9,507. The average per capita cost for the 35 OECD countries was less than $4,000.

And, embarrassingly, those countries have better health outcomes than we do. The 2016 Legatum Prosperity Index ranks the U.S. 34th out of 149 countries in its Health Index,which measures a country’s basic physical and mental health, health infrastructure, and preventative care. Other surveys have similar results – the U.S. rarely makes it into the top 10.

The bottom line here is that citizens of this country are overpaying for healthcare; spending more and but getting less. We acknowledge that healthcare is a right, but only in other countries and then only through international treaties. And we are too arrogant to admit that healthcare is not an industry that can function efficiently in the marketplace.

So, what we have here is a variation of old adage that a camel is a horse designed by a committee. And by committee, I mean Congress. Our healthcare system can be fixed if it’s treated as a moral imperative – a right – but it will take a herculean effort. Reminds me of what the GI’s in WWII said about such things – FUBAR.

This is a Revised and Expanded version of an Op-Ed published in the Joplin Globe August 13, 2017. It may also be read as a supplement to the Life, Liberty and the Pursuit of Health Care Op-Ed of April 30, 2014, which is provided herein.