I’ve been doing a lot of reading of Allie’s recent posts on healthcare since she’s now in what looks like a very interesting class on public health policy.
In her first post, she responds to the question of whether or not health care is a right or a commodity and answers that it ought to be a right:
“It’s not a question of economics but a question of morals. The United States spends more of its GDP annually on helath care than any other developing [I assume she meant developed] country yet it is the only one that does not have universal health care. This indicates that the United States health providers and policy makers do not consider that health is a right for every single human being. Who says a single mother working two part time jobs and raising two children doesn’t have the right to access effective health care (preventative and treatment) but the soccer mom in the suburbs whose husband works in a firm that provides a family health plan does? What about illegal farmworkers that are subjected to the toughest conditions and toxins every day, do they deserve healthcare? Did you know that those who belong in the 20s age group has one of the highest rates of uninsured because they’ve just come out of college and do not have a steady job or cannot hold jobs that gaurentee health care.“
I think it’s a very problematic position to take.
- Statistically, we can argue back and forth for days about just how bad access to health care is. I can cite reasonable studies from the Cato Institute among other organizations which point out that the numbers of “uninsured” oftentimes cited are also composed of those who have rationally chosen to forego insurance (because they assess the risk to their health as not high enough to justify paying premiums) or who are between jobs and have insurance coverage for the mjajority of the year or who are Medicaid/Medicare eligible, or an NEJM study that the advent of insurance has kept it so that the actual out-of-pocket expenses per person as a percentage of income have not changed all that much. Of course, this doesn’t deny that there is an access problem. I’m not trying to pretend that everything’s fine and dandy, but just that most estimates of how bad the problem is are probably overstating the problem and hence I don’t think its a sufficient case to demand that healthcare ought to be a “right”.
- The United States has the finest healthcare system in the world. I’m not aware of any serious questioning of that. I think this is a testament not only to the dedication of the many doctors and scientists in the US, but also to the market system which efficiently allocates resources and talent to maximize productivity and efficiently matches patient’s desires with willing and able healthcare providers. Fundamentally then, its the concept of health care as a “commodity” which has enabled this. Who cares if the conception of something as a commodity is somewhat repulsive (I’ll freely admit that I find the idea of healthcare as a right has a much more “feel-good” feeling to it) if it gets the job done?
- If healthcare is a right, and not a commodity, then certain questions have to be answered — questions which have traditionally been answered by governments very poorly: Who gets the best doctors? Who gets the worse doctors? How much do doctors get paid? Should a person with more money be allowed to pay for better healthcare or extra services? Should we have privatized health spending at all? What qualifies as a healthcare consideration and what doesn’t (ie nose job vs reconstructive surgery, anti-schizophrenia drugs vs “i’m feeling depressed, can you give me meds?”)? Not everyone’s going to answer these questions in the same way, and not everyone is going to be happy with how other people answer this.
- The big question — WHO PAYS FOR IT!? If health care is a right that must be paid for, then are we not just trampling on someone else’s right to property to force them to pay for someone else? Or, if redistributive questions don’t bother you, what if there is a health procedure that I find morally objectionable (ie circumcision, abortion, birth control, or if I’m Tom Cruise — painkillers)? Should I be forced to put my money into something that I don’t want to sponsor? On a more traditional economics level, if people no longer have to pay their doctors, then what is to reward good doctors? What is to punish bad doctors? What is to keep patients from ordering too many tests or overly-expensive meds? I think most doctors would argue that the doctor-patient dialogue ought to be what determines healthcare choices, but at the point healthcare is a right which the government must provide, then we reach a point where that dialogue cannot ever (for reasons that I hope are patently clear) take first priority.
Just because there are problems of equity and just because most humane and rational individuals would agree that increasing access to health care is a good thing doesn’t mean that rational solutions can begin by deeming health care as a right as opposed to a commodity. In her second post, Allie does back off from the purely idealistic positioning to talk about practical issues, but from my (I’ll admit, limited) understanding, it seems to me that “health care as a right” is not the idea that one ought to begin with as it forces problems which lead to compromising quality.
I would even go so far to argue that most countries with universal health care systems are only able to maintain quality in the face of the fact that the United States and India and China maintain a mostly privatized, non-universal systems of health care and cheap research and development with the ability to reap large rewards and gains from innovation and good service.
This, however, shouldn’t be interpreted as a defense for the current state of healthcare in the United States. There are serious problems both with regards to equity and with efficiency/quality in the current system. This is solely an objection with starting from the position that “healthcare is a right”.