At first blush, it would seem correct that healthcare is a right. However, on reflection it is clearly not an easy answer. Let’s examine.

What is healthcare?

Healthcare is a combination of two issues, health and care.  

Health is a state of being free from illness or injury.

Care is the attention or action towards a situation.

Healthcare then, is the care, attention and or, actions towards remaining free from illness or injury. A process that can be administered through preventive care, self care and or, by someone providing health-related services.

Is healthcare a right, a privilege or both?

Rights are legal, social or ethical principles of freedom or entitlement whereas a privilege is something that is earned. So is healthcare a right or a privilege? This question simply opens doors to many more questions and scenarios. For example, it is easy to see the moral obligation of treating a child with leukemia whose solo mother is vulnerable and without means. But, how do you handle those who make poor lifestyle choices and then demand treatment for their hypertension and diabetes. Is that a right or should that be a privilege? Or, what do you do with someone who demands an unnecessary evaluation such as an MRI for the flu or, demands a treatment such as a transplant or kidney dialysis when these choices would be considered unreasonable by the majority of experts providing that care? What is reasonable and unreasonable and what are minimum or basic healthcare rights?

Is basic healthcare a right?

What is basic healthcare? Is it anything and everything in healthcare? Or, is it just “general” health without cosmetics, infertility or weight-loss care needs? What are the exact limits of general or basic healthcare? How is necessity and reasonableness defined? Is the government morally obligated (through taxation) to do all within its means to ensure that medically necessary care is accessible and affordable to all? Or, will it simply tax its citizens and let a third party like the insurance industry profit from the control of healthcare delivery? What is medically necessary care and how is affordability defined? 

Healthcare rights imply a duty on the part of others.

The rights of one individual necessarily imply a duty on the part of others. Do the rights of a patient trump the rights of a physician? Do patients have the right to expect their physician to be available and work for them in servitude? And, is this right and servitude expected of all the other players in the healthcare arena like the drug industry, imaging centers, laboratories, bio-tech, hospitals, outpatient centers and so on or, just from physicians? Does the patient bear any responsibility for his or her actions? 

Why is healthcare an insurance industry monopoly?

Why is the insurance industry the dominating force in healthcare?

  • Is it right for the health insurance industry to have hospitals sign contracts with “most favored nation clauses” and have providers coerced into signing take-it-or-leave-it (divide and conquer) contracts.
  • Is it right for the insurance industry to control healthcare access with insurance-based rules and pricing?
  • Is it right for the health insurance industry to be protected by State and Federal laws that clearly favor the insurance industry and squelch market forces?
  • Is it right for health plans to use non-medical intermediaries and demand that physicians seek their authorization for proposed tests and treatments?
  • Is it right for health plans to offer care according to what the consumer can afford to pay for a plan?
  • Is it right to offer health plans to consumers that are confusing by design?
  • Is it right for the health insurance industry to waste a third of the $3.6 trillion market on administrative services?
  • Is it right for the health insurance industry to use tax money and then profit at the expense of the patient and the doctor?

What are healthcare’s moral obligations?

Morals are the prevailing standards of behavior or conduct that are perceived to be a right and acceptable. Healthcare is the industry that promotes and protects the health of others. Do the moral obligations of healthcare delivery  apply to all the players in the healthcare arena equally? Are all the players in the healthcare arena tied to the Hippocratic Oath or just physicians? How can healthcare moral obligations be applied equally to all those in the healthcare arena when the fee-for-service business model represents a major conflict of interest in the delivery of healthcare? How can quality, value-based care and moral obligations be effective with the fee-for-service business model for healthcare? What are the moral obligations of the for-profit health insurance industry? What are the moral obligations of the legal industry and can tort reform cut the billions of dollars wasted on defensive medicine? Why is a prescription needed for an X-ray but not for a blood test? Why are prescriptions needed for medicines that are over-the-counter in many other countries? Do only physicians have moral obligations?

Healthcare actions speak louder than words.

How is it possible that the CEO of UnitedHealth can earn $42.1 million dollars in one year and the St. Jude Children’s Research Hospital has to beg for donations in order to treat their sick children? Where are the rights and moral obligations in healthcare here? 

Furthermore, how is it possible that 1% of the population consumes 30% of healthcare dollars while about 50% of the population consumes only 2% of the $3.6 trillion dollar healthcare pie?

Clayton Christensen – “Healthcare is a terminal illness for America’s governments and businesses”, The Innovator’s Prescription – identified two fundamental problems with U.S. healthcare:

  • The insurance coverage of routine office-based care. Almost no other insurances cover routine services as the goal of insurance is to cover only unlikely major or catastrophic events. Your car insurance doesn’t cover the cost of a new tire. If it did, car insurance costs would be in the stratosphere just like health insurance costs. 
  • The fee-for-service business model. A profit-driven model for healthcare where all players make money at the expense of the consumers and physicians. 

Finally, is healthcare a right or a privilege? It’s clearly a dilemma, because there’s been no improvement in overall health under the insurance-based control of healthcare. 

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Written by HEALTHdrum