The “Right” To Health Care 

The debate over healthcare has been framed for us by the left; their declaration that healthcare is a “right” rather than a “privilege” carries the implication that anyone who does not accept this definition is therefore mean spirited and cold hearted, and is willing to consign “the poor” to lives of sickness and misery.  This is a favorite technique of the left - rather than having an intelligent debate, they prefer to define a victim group, and then depict anyone with a differing opinion as stupid, mean-spirited, and not worthy of being taken seriously. 

The more correct debate would be whether healthcare, or rather access to healthcare, is a right or an entitlement that should be provided to everyone in America. 

If we accept the definition of rights as framed in the Declaration of Independence, then healthcare definitely fails this test. Rights are conferred on us at birth, and no government can give them or take them away; free speech, religion, self-defense, self-determination, and so on.  Entitlements, however, are granted by government.  They may be granted to all or to defined groups, and they may change over time as social and economic conditions change.  They are usually economic in nature, and they are generally paid for by someone other than the beneficiary.  A free public education is an entitlement in America, as are Medicare and Social Security. 

So should healthcare in America be an entitlement for all?  A strong argument could be made for this if free healthcare for all would guarantee a disease-free population.  The left strongly infers that this is the case; in their view people are only sick because we as a society won’t grant them  access to healthcare when they need it.  They also ignore the effects of lifestyle choices - obese people tend to have more than their share of diabetes, heart attacks, and strokes; smokers tend to have more than their share of lung cancer, emphysema, and heart attacks; alcoholics tend to have more than their share of liver and kidney failure. (They also victimize their own victim’s group when they impose punitive taxes on smokers, who are disproportionately poor.) 

The left also greatly distorts the statistics on Americans without health insurance.  They don’t tell us that the 47 million “uninsured” figure they use so often includes over 10 million who are not American citizens, that over 9 million have incomes over $75,000 but choose not to buy health insurance, and that about 19 million are between the ages of 18 and 34 and may not feel that they need health insurance.  They also don’t tell us that most of the people who clog our emergency rooms have health insurance provided to them through Medicaid and SCHIP, but won’t schedule a doctor’s visit for preventive care.  

As I said in Part 2 of this series, those of us in America with access to health insurance, and who take personal responsibility for our own health, enjoy the best healthcare in the world.  However, no amount of “free” healthcare will create a sense of responsibility.  It doesn’t do so for the crowds in our emergency rooms, and it won’t do so for the 30 year old who is eligible for health insurance and declines it out of a feeling of invincibility, not because he can’t afford it.  And the truth is, with Medicaid and SCHIP covering low-income families and COBRA covering the recently unemployed, the biggest cause of children not receiving quality health care is parental neglect. 

So is everything rosy in American healthcare?  Of course not.  There are four major areas where our healthcare system definitely needs overhaul - multi-tier pricing, insurance practices that discriminate against individuals, Medicare and insurance practices that encourage higher billing, and medical malpractice law. 

Multi-tier pricing

I wrote about this in Part 2.  When you go to a doctor, hospital, or other medical services provider you are charged the provider’s “normal” rate.  If you have health insurance the actual payment to the provider is much less - usually about 40 percent of the original charge.  However if you don’t have insurance, or go to an out-of-network provider, you’re stuck with paying 100 percent.  Why the difference?  Why can’t you get the same break the insurance company does?  If you talk with the provider’s billing department (and I’ve done this many times) you will be told that the provider’s contract with the insurance company prevents them from discounting their bill to you, and that if they did give you a discount they could lose their insurance contracts.  If true, this amounts to restraint of trade.  

No one, including the government, should tell a doctor how much to charge.  But the price for one should be the price for all, just as it is for any retailer. 

Discriminatory Insurance Practices

More than anything else, who you work for and the health insurer and plan that your employer chooses for you have more to do with your healthcare access and affordability than any other factors.  But is this right, since all employer-sponsored plans are subsidized with taxpayer dollars?  Should my taxes subsidize a better plan for you than I have available to me? 

When I lived in Texas my health insurance (provided by a Virginia employer) was excellent.  Then I moved to Southeast Missouri and the same plan was terrible.  Even though I did not change employers and we moved to a city with two large and excellent regional medical centers, in-network providers were unavailable without traveling almost 100 miles.  Why?  Because my insurance company was dominant in Texas but had very little presence in Missouri. 

How should we change health insurance?

• Stop subsidizing employer-sponsored group plans through tax deductions. Admittedly this would increase the employer’s cost and would force many employers to drop this benefit.
• Stop providing group health insurance as a benefit of government employment. We should pay our government workers a fair wage so they can afford to buy insurance, but they should not be entitled to generous benefits that aren’t available to their employers (the rest of us).
• Restructure health insurance to be like homeowner’s and renter’s insurance. When you buy homeowner’s insurance you choose a standard plan, and can add or delete coverages. The rate is based on actuarial tables and the insurer’s risk is spread over many thousands of policies. 

Medicare and Insurance Practices

Medicare and the insurance companies pay providers for the procedures they perform.  Untold numbers of procedures are performed that may or may not be medically necessary for a particular patient in a particular circumstance, but are normal or customary for a given diagnosis.  In other cases they may not be reimbursed, or have difficulty collecting, for procedures they deem necessary that aren’t normally associated with a given diagnosis. 

The doctor must always be the one to determine the proper course of treatment for each and every patient.  However, we must also find a way to be sure our reimbursement policies and practices don’t encourage performing and billing for unnecessary procedures. 

Medical Malpractice Law

Lawyers maintain that limiting malpractice claims will do little if anything to reduce the cost of medical care.  However, it is undeniable that malpractice insurance premiums have gone down in states where malpractice claims have been capped.  Probably the biggest expense associated with the lottery mentality with today’s malpractice lawyers and many patients is that doctors and hospitals are forced to practice CYA medicine.  If a doctor thinks that a lawyer could conceivably ask the question “why did you not order xyz test?” in a jury trial, he will order the test even if he is sure of his diagnosis without it. 

More states should enact caps on malpractice awards.  Moreover, peer review boards, not juries, should be used to determine whether malpractice actually exists.  

Stay tuned for the next post on Healthcare In America. 

Please send this on to everyone you know.  This is an issue that no American can afford to ignore.  This year Congress will enact, and the President will sign, legislation to dramatically change health care delivery in the America.  With all of its shortcomings, American health care is still the best in the world.  Let’s not let them take it down to the Canadian and European “ideal”.