Monday, October 5, 2009

Should Access to Healthcare Be a Universal Right?

Unless you've been under a rock for the past 6 months you are aware that the US is engaged in a debate over the future of healthcare for Americans. There are many important issues to be addressed, but I am most fascinated by what I see as the fundamental philosophical question: Should access to healthcare be a universal right? As I see it, the healthcare debate is an argument between two fundamental rights. From the Declaration of Independence:
"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable Rights, and that among these are Life, Liberty, and the pursuit of Happiness."

On one side, there is a compelling argument that the inalienable right to life comes first for a reason. Without life, there is no liberty or happiness to pursue. Healthcare is already a collective effort - anyone can walk into an emergency room and be treated independent of their ability to pay - and research has shown that in systems like those in Canada, Britain, and France the overall mortality rate is lower than in the US and for less cost, so why not embrace a single-payer (or pseudo-single-payer, which is really what a public-option is) system? It will allow more Americans access to life. (Check out this argument in the New York Times.)

On the other side, there is an equally compelling argument that the rights to liberty and the pursuit of happiness are compromised by government run or mandated healthcare. The current American system does a better job of providing the best healthcare for those who do have insurance - why should that opportunity be taken away? Shouldn't I have the liberty to choose my coverage or lack thereof? The more the government interferes with healthcare the more it restricts the freedom of doctors and patients. Private healthcare provides more liberty. (Check out this argument in the Wall Street Journal.)

So which one will win? I don't know. To be honest, I'm not even sure which one I'm rooting for. I like life and I like liberty. The trick, as always, is finding the optimal balance between the two.


  1. I wouldn't say universal health care is a right, but neither is an education and yet I bet most Americans think that we are better off having a government that makes sure every American has accesses to a basic education.

    Following similar reasoning, I think the country would be better off if there was universal coverage of some form. To me it isn't about rights, it's about what is best for the country.

    Like our current educational system, I think people need the option to choose between private and government sponsored health care systems. If you don't like public schools send your kids to a private one. If you think the government hands out bad health care go private. This is the beauty with a public option.

    Having a country where everyone has access to basic education and health care is a much better America. But keep the option for people to choose the private sector open.

  2. Actually, I am interested in a new plan by Sen. Tom Carper. "Carper wants to allow states to individually decide whether to create a private-insurance competitor such as a government plan and a nonprofit insurance cooperative, or to open up state-based insurance pools for government workers to every resident."

    So basically the country gets universal coverage but states get to decide which method is best for them.

  3. The issue is, is it a "right"? What constitutes a right? In the past, rights normally were given to individuals so they could seek their own life, liberty and happiness.

    Why stop at health care as a "right"? Shouldn't everyone have a right to transportation? How about ensuring every person gets good food on the table, and so we should be distributing fresh produce to all homes on a daily basis? Free satellite television and internet? Free cell phones?

    I have no problem with health care coverage. I do have a problem when we start naming such things as "rights" or "entitlements." Why? What have we done to deserve such an entitlement? Just be born in the USA, or slipped into the country? Why don't we also give others in other nations the "right" to health care? Don't they have as much of a right as the rest of us to see a doctor?

    Does it make sense to improve our health care program in the country? Yes. It is a mishmash of unworkable sludge. Medicare is heading for bankruptcy. Lawyers are soaking our doctors, who protect themselves by running dozens of unnecessary tests. Insurance companies have monopolies in many states, so competition does not exist. And we subsidize the creation of medicines and medical inventions used in other countries (one of the main reasons they are so cheap).

    So, we can definitely fix the system. But the Obama/Democrat plan is not a fix. It is just throwing good money after bad, in the name of "rights."

  4. What a great post. I'm happy to see you guys addressing it. I must respectfully disagree with Joseph Smidt. Joe said:
    "Like our current educational system, I think people need the option to choose between private and government sponsored health care systems. If you don't like public schools send your kids to a private one. If you think the government hands out bad health care go private. This is the beauty with a public option."

    The problem with this approach is that I still have to pay for someone else's kid to get an education, or in the case of health care, I still have to pay for someone else's health care.

    If health care is a right, then an argument can be made for forcing me to pay for the health care of others. However, if health care is a privilege, then forcing me to be altruistic is not only a bad idea, but horribly immoral.

    I tend to think that health care is not a right, and we ought not to be forcing people to pay for the healthcare of others. If I choose the private option, in Joe's scenario, I still have to pay my taxes (unless they further complicate the tax code to give me some write-off). I don't see how this is fair by any definition.

  5. jmb275, I'm just wondering, are you against the public school system? Should it be abolished?

  6. jmb275,

    "I still have to pay for someone else's health care."

    Now here is an interesting point because you effectively already are with funding the health care of the uninsured when they go the the emergency room etc...

    You may not believe it, but many argue you are in fact paying more for other people's health care because the uninsured reek havoc on health car costs in this country.

    Now, I know everyone has heard all things things a bajillion times by now and nobody's mind is changing.

    However, here is where I stand, just to be clear:
    1. There is data that shows countries with some form of universal health care pay a lot less money and get a lot better results.
    2. I think all advantages our country has over these countries come from certain benefits from the private sector.
    3. I think it would therefore be good to mandate universal care but always leave the private sector as an option.
    4. I think there may not be a one-size-fits-all-solution so I am very supportive of letting the states individually decide what approach is best for them.

    Now, I take no offense at all for disagreeing with me, and its good people do since I am a little crazy sometimes. But, this is where I stand.

  7. Rameumpton,
    The argument is not that the government should do everything for you, simply that the government can more effectively protect our collective right to live than we can - similar to the way that the government can field an army to protect the country better than if we simply let people buy tanks and ICBM's. Everyone with insurance is already subsidizing both Medicare/Medicaid and the uninsured, and there is solid data showing that countries with single-payer healthcare consistently out-perform the US in both average quality of care and cost. If keeping people healthy were the only concern, a single-payer system would be hands-down the way to go. The real issue is that we want liberty and the freedom to pursue happiness as well.

  8. To argue with myself, I think the biggest reason not to have the government running healthcare is that I fundamentally am opposed to the government doing something for me that I can do for myself. The roughly 70% of Americans that have adequate coverage have the best healthcare in the world and if I choose not to buy insurance, I am choosing poor healthcare. I should be free to do with my money what I want regarding healthcare and then accept the conequences of my choice.

  9. Nick, because you initially phrased this as a philosophical question I will address it as a philosophical question.

    You bring up the Declaration of Independence and mention the big three of "Life, Liberty and the Pursuit of Happiness". I should point out that these three rights are personal rights (or family rights, to put it better). Which means that these three rights can be exercised independent of all other people. This means that if there were no other people on the Earth except for you, you would have these three rights to their fullest extent because by definition there would be no one there to deprive you of those things. In other words these things, or the guarantee of these rights, do not depend on the actions of other people. These basic (or universal) rights can only be violated by the actions of other people.

    In the case of health care, it requires the participation or actions of others to accomplish. This is something that cannot be done by oneself. Because health care requires the actions of someone else it must be considered in a different class than the traditional, or universal, rights mentioned in the Declaration of Independence. The reason why health care cannot be considered a "right" is precisely because it requires the actions of another person to be fulfilled.

    In the case of the traditional rights of life, liberty and the pursuit of happiness, there is a recognition that other people exist and that my actions could violate their rights and their actions could violate my rights. Because of this we, as a society, have instituted a contract to regulate the affairs and actions of everyone. This societal contract guarantees to everyone the same rights. This contract regulates the actions of others if and when they violate the rights of others. But the nature of this contract is such that it does not (and I would strongly argue that it cannot) require someone to act in order to give something (a right, or a privilege) to another person when the terms of the contract (the rights) have not be violated. In the case of my violating the traditional rights, there is a specific and exact punishment that can be associated with that violation. But in the case of health care (and any other action like it, such as welfare etc.) if I do not fulfill that action what can be done to punish me? Would not that punishment then constitute a violation of my rights?

    If health care were to be considered a right then my not fulfilling that need of another person would then be punishable. The problem is that my fulfilling of this right would require my actions, a positive action on my part, to fulfill the right. But the question is, what action am I to take to ensure the rights of someone who is not my self? Who determines what constitutes a fulfillment of that right? The problem in all of this is that in order for me to fulfill this right I must be compelled to action. Something must be done to force me to fulfill that right. I say force, because it is a decision to act that does not come from myself. To answer my question of who determines what constitutes a fulfillment of this right, the answer is not me. In the case of the traditional rights, I determine my rights, or what I am to do with what is mine. I am free to act for myself. But if health care were a right then someone else would determine what to do with that right and I would not be free to act for myself, and I am left to be acted upon.

    [Continued in next comment, apparently there is a 4,096 character limit to these comments]

  10. In effect this creates inequality in our society. That is, someone determines the actions of others and demands fulfillment of a "right". Thus a person's existence, personal fulfillment, life, liberty, pursuit of happiness and all other rights then becomes dependent on the actions of another person. This would mean that we are no longer free and independent, which is directly contrary to the nature of our existence (our personal ontology if you will).

    Now does this mean that we cannot provide health care, no. We can and we should. It is part of our society and it is necessary for a well functioning society. But the point is, it can never be a right. It can never be demanded of another person to give health care to another. If so we would deny the nature of our own existence and violate the nature of our personal interactions.

    If we desire a modern, well ordered and stable (and charitable) society we must provide health care as a society. But we must never hold it as a right or something that we can demand or force from another, because by doing so we would violate the very nature of our existence and deny the foundations of our reality.

  11. I actually agree with Ryan, whom I will now refer to as Quantumleap42 as I should, that there are many philosophical reasons why I think it isn't a right. My reasons are different than his, but they lead to the same conclusion.

    I'm not compelled to give out universal health care because I feel it is a right, but that I honestly think *everybody* (admittedly maybe to varying degrees) will be better off for the reasons I allude to above.

    Similarly, I don't think an education is a right but without free public education this country would be in a much worse position.

  12. Quantumleap42,
    I am not qualified to assess your argument on philosophical grounds, but in a practical sense governments exist protect our rights - which I would define as the things we should be able to do, namely live, posses liberty, and pursue happiness. No individual exists in a vacuum - every decision made by other people can impact my ability to live, be free, and pursue happiness. The government exists to protect my rights as much as possible both by preventing others from damaging them (e.g. killing me) and enabling me to maximize them (e.g. building roads to allow me to travel where I want). When I talk about access to healthcare as a right, I suppose I don't mean right in the same sense as life, liberty, and the pursuit of happiness. What I means is more along the lines of "is universal access to healthcare the best way to achieve our rights?"

  13. Great post, and very timely. I think one root of this issue is "what is / should be the role of government in providing for the public good?" I think we can all agree that, all else being equal, it would be really great if everyone had access to the best possible health care. The questions then become "Is a government-run / mandated system the best way to achieve that ideal?" and "What goods (and to what extent) do we, as a society, expect our government to provide / are we, as a society, willing to pay for?"

    The first question is one that can be addressed by facts and data. The second is really a matter of public opinion. I think this is a lot of the reason why this issue is so divisive. Many people in favor of universal health care point to evidence that seems to indicate an affirmative to the first question. (I, personally, remain unconvinced, but interested.) I think there are many good responses and facts in regards to this first question both in favor and against the idea. Most of those in opposition to this course of action point to the second question and proclaim a collective decision that universal health care is not one of those public goods that we expect the government to provide / that we are willing to pay for. In the end, the "voice of the people" must be heard to answer the second question, through those channels set out in the Constitution. I am very interested to see what happens.

  14. For jmb275 :
    “The problem with this approach is that I still have to pay for someone else’s kid…”
    A problem is that if we do not make an effort in order that the others can have less diseases we have more chance to have one, then if it is more efficient to pay in order that there is less ill persons than to go to the physician after, this is a good thing to do. Otherwise for education a minimum of it should help to decrease criminality which costs a lot to some persons ; and if it cannot be at all levels of education, the door for the stairs of the social rank improvement should stay open in order to let the ones who are able to become good without a teacher have the rank they deserve ; and this for the well-being of every body because they can bring to their country some things others cannot, and honestly they are of the real kind of people which is the cause of the greatness of some countries (so of the real heirs of some talents), the people with money are not as much efficient (because money cannot bring some ideas for example, but normally quite a lot of the children of the persons who have money should be of the real heirs of some talents). Finally money should not be a tool to steal what real intelligence deserve by using it in order to push really intelligent persons, and in order to prove them that they are not deserving what some want to keep for them, as communists do.

  15. P.-S. : A problem is as well to find the limit of the contribution, because some want always more.

  16. I'm not sure what the best answer is to this. I've lived under both systems, and both have their strengths and weaknesses.

    I do object to referring to the government plan as an "option" to "compete" in the market. How could private insurers ever hope to compete against an entity with infinitely deep pockets and that sets reimbursement rates by fiat?

    If more competition is the desire, then the government could simply allow the current private insurance companies to compete across state lines. But they don't, which I think is instructive.

  17. Mephibosheth ,

    "government could simply allow the current private insurance companies to compete across state lines."

    I keep hearing this and I haven't been told a convincing answer why people don't want this. If anyone knows why I would be happy to hear the reason.

    (Please don't say something ignorant like "Obama just loves big government" because behind all of his actions there is an intelligent reason. (Same went with Bush). That doesn't mean he is choosing the right policy since there are well-motivated intelligent reasons behind a variety of policies.)

  18. I think there are things we do for the national interest. Eisenhower built highways, which have vastly increased our commerce.
    Education is encouraged (ever since Thomas Jefferson), as a way to help people out of poverty.
    Health care can and probably should be in the national interest.
    That said, we need to look at such issues in an engineering sort of way. One has to be results based. Create a base line, experiment with different ways to accomplish it, create new baselines when we get to something better.

    Public education does not work that way (nor does Medicare). There is no true baseline for good education, and experimentation is built upon experimentation, never returning to the baseline, nor creating new baselines from which to build a better program.

    So, in California for over a decade, they had a program of strict memorization of words for reading. It was based upon some leftist education guru's concepts of learning. Someone finally woke up and realized that the kids were graduating as illiterates. Even if they recalled all the words they had memorized, they would only know perhaps 2000 by the time they graduated. They ended up bringing back phonics, on demand from parents. The guru's explanation? They hadn't spent enough money for the program to succeed. Phonics was/is much cheaper, and has better results.

    Public schools in many areas are tragic. I raised my oldest kids in Alabama, where the schools were terrible. I could not afford private schooling for them, and so ended up home schooling them in the evenings to supplement the illiteracy of their public school teachers.

    What works? In Washington DC, they gave the poorest kids vouchers to attend the schools of their choice. Over the decade+ they've had this benefit, the kids showed a huge increase in learning and excelling. The current Democrats have shut down that program and only proves that they and the teachers' unions that bribe them have an agenda to keep kids ignorant and stuck in the welfare cycle.

    Keep public schools if you like. But give kids all a voucher to attend school of their choice, in order to force competition and quality in our public schools. It is an engineering practice that has proven itself in the communities where it is used.

  19. Joseph,
    The health insurance companies do not want competition. They have a huge lobby that is keeping Congress from allowing competition to be opened up across state lines.

    Obama has little or nothing to do with the current health care plan, as he's left it almost entirely in the hands of Congress to handle. Perhaps some Presidential hands-on effort might push enough Congressmen/women to pass a bill with less pork and more solution.

  20. rameumptom,

    "so ended up home schooling them in the evenings to supplement the illiteracy of their public school teachers."

    You have no idea how hard this made me laugh. :) That was funny.

    You may have something there with school vouchers. I hear people saying it would destroy public schools but I am open to the idea they could use a good kick in the pants.

    However, voucers or not, I want everyone to have access to education. Not because it is a right, but because all Americans having a basic education makes a much better America for several obvious reasons.

    If you can point to data, which it looks like you have, supporting the idea vouchers work than I say maybe we should give it a try.

  21. "The health insurance companies do not want competition. "

    That's interesting. I had never thought they would be against this, but if they are I'm sure they have a strong lobby indeed. Thanks for pointing this out.

  22. Joe,
    I do not know all of the reasons why the federal government does not permit insurance companies to work across state lines, but one reason they don't is that currently state laws covering everything from patient privacy to malpractice to licsensing requirements to prescription drug availability vary widely from state to state. Medicare/Medicaid are largly immune to these laws, but private insurers are not.

  23. Rameumptom and Joe,
    I happen to live about a mile away from the #1 rated charter school in the western US according to US News. It is a fabulous school and I have heard nothing but great things about it both in statistics and from parents and students - however it also leaves several other high schools in eastern Boulder county with a disproportionately high number of kids with low parental support, low income background, English as a second language kids, and kids with learning disorders - basically all the best and brightest have left the public high schools. This leads to one fabulous high school and 2-3 mediocre-to-poor ones. On average, test scores and graduation rates for the area were higher before the charter school opened.

    Here again it's an argument between what is best for everyone on average (public schools) and what provides the most freedom (charter schools). And that, like healthcare, is a hard problem.

  24. Rameumptom and Joe,
    While no industry wants more competition, I think it's unfair to demonize the insurance companies. They are simply easy targets since healthy people hate paying premiums and sick people want better care. To give you an idea, one large healthcare company, Kaiser Permenente's profit margins for the last 3 quarters have all been below 3%. Compare that with profit margins for ExxonMobil over the same time, which have been 5.3%, 7.1%, and 9.2%. Healthcare companies are not out there robbing us blind - in fact they tend to be a less-profitable (if more stable) investment than pretty much anything else out there.

  25. Nick,

    You always bring up good points and yes, people have a bad habit of demonizing some sector and throwing all the problems on it. (I'm sorry if I gave that impression.)

    It's evil insurance companies...
    It's evil Wall Street...

    This is an age old problem. Every society in history finds some scapegoat to put all the problems on.

  26. Joe,
    You're right about finding a scapegoat. Smart politicians have always found ways to pit themselves against "the bad guys". Nero did it with Christians, George W. Bush did it with Osama bin Laden and Saddam Hussein, and both Democrats and Republicans are fighting to be the real opponents of the insurance companies while both accept big donations from insurance industry lobbyists. It's a smart political move - anyone looks better standing next to the ugliest person in the room - but it masks the real issues.

  27. Nick, I wasn't scapegoating the insurance companies. I was just stating a fact. Why should they compete, when they can have near monopolies? That they have a strong lobby to protect their own interests shouldn't be strange, as most industries do the same. However, what is best for a company or industry, is not always in the best interest of the nation.
    AT&T used to have a monopoly on telephone service. You couldn't even own the guts to your phone. Breaking up the monopoly hurt us in the short term, but without it, we would not have cell phones, high speed internet, etc. All of that came due to competition. Same with the insurance companies if we make them compete across state lines.

    As for charter schools lowering the curve for the other "normal" schools, we need to be careful that we do not harm everyone, simply because some get a better deal. The goal should be to convert all schools into special/charter schools, where all can get a quality education. But you have to start somewhere, and charter schools is one place where it is beginning.

    If the system is broken, you have to take steps to fix it. Charter schools is one attempt to do this. The idea is, it is better to have at least some quality for some students than to have poor quality for all students.

    Why are there not more charter schools? Usually because Teacher's unions fight them. They don't want to compete against quality. For this same reason, the unions fight against home schooling.

    Another problem is that the unions' efforts keep school from transforming themselves. Instead of hanging onto a system that goes back to agrarian days, we need to look at what is needed in the 21st century. Not every kid is going to go to college. Not every kid needs extra math, English, etc. It is time we begin having a dual pathway for high school: one headed towards college, and the other towards skilled trades. Some high schools actually teach college credited courses, so 18 year olds going into college often can start with a year or two of credits under their belts already. Meanwhile, imagine graduating from high school with the skills to begin as a journeyman carpenter? Why graduate, and at 18 wonder how the heck you are going to do school and feed yourself?
    These are just more reasons to re-engineer the school system.

  28. rameumptom, I'm really glad you have commented because I think it is really healthy to see all these different sides to the argument. You present your side very well.

    Bye the way, just in case there was confusion, I wasn't trying to accuse you of scapegoating. I was just trying to make a general statement that it happens all too often and I wanted to be careful I wasn't accidentally falling down that path.

    Lastly, I am interested in hearing more data about charter schools and whether they work or not. (When I mean work I mean is there any data if we slowly converted all schools to such a system could it work.) If you can think of any good references or things to read on this subject shoot them my way.

  29. Well i personally think that everyone should have this right if Government have promised so.As i don't know much so i will keep looking around for more information.


To add a link to text:
<a href="URL">Text</a>