Last night there was a question in the Presidential Debate on whether healthcare should be a privilege, a right or a responsibility in the U.S. McCain gave a nuanced answer -- but said it was a responsibility and Obama said he considers it a right for U.S. residents since we are a wealthy society. It is a really interesting question -- especially if you are like me -- a wanna be economist/philosopher. For those that want a long but illuminating blog post on the topic of rights and obligations -- see Maggie Mahar over at THCB.
Before we get to the question of rights however - we need to take a short detour into the world of economics. During the debate and throughout the policy community there is a conversation about employer paid health insurance, vs. universal government paid health insurance vs. individual paid health care (or insurance) along with the entitlement programs we already have -- Medicare and Medicaid, SCHIP and not to mention disability payments and other programs. People -- there is no free lunch here! One way or the other, individuals/citizens/consumers are paying for health care, period. There is no other funding source. YOU are paying for health care...maybe not when you consume the service -- but you ARE paying for health care. Here is how we pay for health care:
So the individual citizen is paying for health care today -- whether directly or indirectly. It is too bad politicians or journalists don't make this point more often. So the question really comes down to one of who pays for whose health care? As a taxpayer and citizen -- in addition to being accountable for my families health needs -- how many additional folks should one be accountable for? The looming Medicare funding crisis is precisely this -- in the future the folks paying into the system won't be enough to cover the folks taking services out. (there should be a whole sidebar discussion of insurance here -- but later).
The economic detour was necessary to frame the philosophical question properly. Talking about healthcare as a right -- without understanding that it is an economic good that has to be provided and paid for -- is wrong. It is not like "free speech" or freedom of religion...which may have economic implications as 'rights' benefits of a better more transparent society) ...but certainly don't require specific resources to have the right or to compete for economic resources the way healthcare does.
I like to think I am as compassionate or more so than most people. I would love for everyone to have more economic goods -- more healthcare, more health, more economic security, more food, lower gas prices, lower house prices (well maybe not) -- but you get the idea. But the system of incentives you choose to deliver these goods (capitalist or socialist or communist) matters and matters a lot -- to the quality, quantity and prices of the goods available to share. We have learned that the form of economic incentives matters to the outcomes for society -- and directly to what society can invest in redistributing. While the concept of capitalism may be taking a beating in the popular press today -- I have yet to see evidence of system that works better -- and we should better remember that when we try to learn the real lessons from today's crisis.
More importantly -- healthcare is really complicated as an economic good in lots of ways. But the one that matters for this argument is that -- many of the behavioral choices an individual may make -- like smoking or not being compliant taking your drugs -- can dramatically increase the healthcare economic goods required over one's life. If healthcare is a right -- do I have the right to ALL the healthcare I can consume and NO accountabilities to society on how I consume it? If not, who decides? Hopefully you can see where this leads.
I may continue this thread at a later time -- so comment if you have something to add.
Calling healthcare either a right or a moral obligation -- won't help us think clearly about the path to reforming the system to deliver more value nor will it help us understand the harsh economic realities and incentives required to build a better, healthier society. We really aren't learning any good lessons -- economic lessons -- from the current financial crisis.
The current discussion on healthcare should not be focused on moral rights and obligations. The current financial crisis in some ways mirror the next explosion -healthcare. There is no transparency in terms of what employers and consumers are really paying for. There is no transparency in terms of what they may pay in the future. Nnne of the solutons are based on determining the impact of health risk on financial risk for those paying for it. Widening market forces or creating mandates with blindfolds on is destined for doom.Economic incentives do matter- I agree and more importantly hoe we align those incentives to the right folks and know if its actually working.
Point on Peter. Our society was built upon rights with responsibilities. Unabaited rights to health care without commensurate responsibilities is not in keeping with our country's founding principles.
Clearly, the most opportunity for cost mitigation lies in attacking the root causes of medical expenses -- personal health behaviors. Perhaps if people understood and agreed with the rights vs. responsibility concept, they would migrate toward healtier behaviors.
Well stated. Yes, we are already paying for healthcare for the uninsured, however, access is difficult and functionally impossible for many.
The economic hand-wringing is over the cost of health insurance, with no consideration to the cost of healthcare services. We could save 20 to 40% of our costs by adding price competition into the mix.
You get votes by telling people what they want to hear. They want to hear that *access to* healthcare is a right, so it's a right.
It may not be as fundamental as freedom of speech or property protection, but all of us grow up with enough 'public' structures around us that we mix up the distinction (eg. public highways). In many ways though, viewing healthcare as an economic good is a uniquely American phenomenon when it comes to 'industrial' countries. However, Americans haven't done a better job managing it (for whatever reason).
Growing up in Canada, the issue of healthcare as an economic good isn't a question at all. For Canadians, on average, it's a right, period. However, what Canadians lose from having that egalitarian view of healthcare is unclear to Canadians and Americans alike. To some people though, the cost of having access to something at the price of losing efficiency and productivity is a worthwhile cost. If the end result is mediocrity for all instead of a much better solution for most, then so be it. You mentioned the current financial crises. For many people I spoke with, the lesson is that sometimes the shot at being best through market-regulated competition isn’t worth the risk (of choking productivity / innovation / competition due to regulation). If you apply the same reasoning to healthcare then you get support for a public system giving universal access to mediocre healthcare rather than the risk of some people not having access to a much better system.
It is evident from your commentary how the parts making up the whole for health care and the health of American Society requires stakeholder participation. There is much confusion here in Canada as well as in the USA on the issue of privilege, a right or a responsibility.
The debate of who will pay for medical services is driven through the economics of health care. It is interesting to me how health care is one the the last areas of business services with improvements in technology where the costs of delivery continue to rise.
Peter your comments are enlightening to fuel further discussion on creative solutions. In the mid 90's we have an All American Ross Perot who discussed the issues with the Medicare & Medicaid Trust in his book "Intensive Care: We Must Save Medicare and Medicaid Now". This is a quick read as the issues facing these universal plans for qualified Americans is now in the forefront once again.
Thanks you for your insights!
James R. Taylor
jtaylor@lifescale.com