Heath Care: Right Or Privilege?

The Declaration of Independence declared that "life, liberty, and the pursuit of happiness" are "unalienable" rights. So where does health care fit in to that? Can one "pursue happiness" without health? Does each of us have a right to see a doctor and get care when needed? When does that right end and responsibility begin?

These are not easy questions. For instance, do I have a right to be treated for serious head injuries, at huge expense, because I refuse to wear a helmet as I ride my Harley? Should very elderly people be eligible for stem-cell transplants at public expense?

Already I have introduced the backdrop, which is economics. Someone has to pay for doctors, nurses, medications, therapies, and hospital beds. At the same time, having an unhealthy population is a major drag on economic activity -- i.e., that costs money too. All of us are at risk for ill health, regardless of how much we exercise and follow the latest "healthy diet" advice. Obamacare has vastly increased the number of insured people, but with highly unpopular aspects to the law. So before considering the cost/benefit questions above, we need to figure out just what right, if any, each of us has to health care.

To return to the Declaration of Independence, its idea of human rights depends upon the Creator: we are equal in the sight of a loving god, who desires us to "have life, and have it abundantly" (John 10:10). Besides food, drink, clothes and shelter, good health is necessary to enjoy these, which are a function of one's work. Since medical care is necessary to maintain good health, it follows that each of us must have access to it. That is, health care is a right.

Take away the notion of a loving creator, and make it a deity indifferent to our fate, or no god at all, and what happens to this right? Oddly enough, most states have religious exemptions from health care for children. So even if one shares the Founders' belief in a deity guaranteeing human rights, one of those rights today includes exempting children of certain believers from receiving health care, in some cases even if death ensues. On the other hand, the law requires that prisoners have access to health care. It is also required for military personnel, firefighters and police officers.

So a right to health care is more complicated than at first glance. Followers of Ayn Rand, that newly-fashionable proponent of extreme individualism, would shrug, and say that it does not exist. You get what you pay for, and if you can't pay, oh well. A more utilitarian approach would point out that raising the level of health across the board supports enterprise and industriousness, thus raising the general level of wealth. Then the question becomes, again, who pays?

It really is difficult to try to define a right to health care apart from economic questions. This is because the cost is absolutely dependent on factors well beyond the need for health care. What level of care is available? A shaman? A barber doubling as surgeon? A nineteenth-century physician? Are we talking the First World or the Third World? People die at hospitals in the Congo and elsewhere because they do not have the cash up front to pay for the care. And Americans know all about how hospital emergency rooms function as the health care of the poor: once the minimum necessary has been provided, the patient is released. And it is hugely inefficient medically and financially.

Let us say that there is a minimum level of health care to which any person is entitled. For a Westerner like me, this should mean being able to see a physician, purchase medication, have routine surgery, wound and disease care, and rehabilitation. Plus some psychiatric care, as well. Why should this depend on my geographic location, income, race, religion, political allegiance? Obviously, it does, but is that acceptable?

And I think that is where the idea of a right to health care begins to become clear. Whom do we want to deprive of the possibility of good health? Never mind what can actually be done for this or that person: what ought to be provided?

To return to my Harley example, my head injury needs to be treated. The 90-year-old's cancer has to have a therapy, as well. But now the question of funding comes in. If I expect treatment for a common motorcycle injury, I should be willing to wear a helmet to palliate a possible skull fracture, or else pay for an special insurance policy. Unless the senior can pay $250,000 for a stem-cell transplant, that level of effort is inappropriate to require of public or private insurance providers. There is responsibility that comes with a right.

Once it is admitted that everyone has a right to basic medical care, then the question is how to provide it. The growth of modern medicine rests on centuries of development of practice, schools, studies, including Florence Nightingale's development of nursing. Except for the outlier hypothetical cases I've cited, we are talking about the level of care that is available now. Therefore the question is how to fund this right.

It's banal. We all know it. The United States has a poor health care system, compared to dozens of other countries, by all statistical accounts. It begins with infant mortality rates, and it ends with decreasing life expectancies for certain categories of citizens. The huge growth of publicly-traded health care companies has twisted the reason why medical care exists. Those companies are naturally more focused on shareholder value than their clients' health.

This is the single greatest reason, out of a myriad of complexities, for the fact that Americans spend the highest percentage of national wealth on health care but have worse health overall than literally dozens of other nations. And healthiness follows economic inequality: the richest get the best care. The poorest live in "food deserts," where fresh produce is unavailable, and so have diets that promote illness. They live in medical deserts as well, where access to a physician is impossible other than visits to the ER, the costliest and least effective means of access to basic medical care. Both the poor and the country as a whole suffer as a result.

Yes, access to health care is a basic human right. And since that is so, like all the other rights we have, enforcing this right is the business of all. We are individually responsible for keeping as healthy as possible. We are as a nation responsible for making basic health care available to all.

It follows that we all need to pay a fair share to make this happen. We already do with Medicare -- a purely socialist medical plan, by the way. I am not advocating a particular plan or even an economic philosophy, at least not here. Whatever replaces Obamacare, we must all contribute financially to make health care available to all. It is a basic human right. As Jefferson might have said, it is unalienable.