Why Conservatives Shouldn’t Sweat Our New Right to Healthcare

Posted on October 27, 2008
Filed Under A right to healthcare |

In response to a couple of recent posts (here and here) defending the declaration by President-Nearly-Elect Obama that healthcare is a right, several readers have offered comments indicating that simply declaring healthcare to be a right is not very useful, unless you also clearly say what you mean by “healthcare.”

This is indeed the question. Exactly how much healthcare are you entitled to if you have a right to healthcare?  Do you have a right to certain specified healthcare services, to a certain dollar amount of healthcare per year or per lifetime, to whatever healthcare it takes to achieve perfect health, or to some other limit or non-limit?

The question of limits (whether we should have them or not, and what should they be) has been a central theme of this blog and of DrRich’s book.  To reiterate the fundamental problem: 1) In America we believe that it is wrong to limit healthcare in any way, that everyone is entitled to the very best healthcare, that any bit of healthcare that offers even a small potential of benefit should be provided, and that death itself is merely a manifestation of insufficient research (or actionable incompetence, or systematic discrimination against the unwealthy, or corporate greed).  2) But against that closely held belief, we must balance the unremitting law of economics which tells us that there is simply not enough money in the known universe to buy all the healthcare that might potentially offer some small amount of benefit to every person.  Healthcare spending has to be limited, or it will become a fiscal black hole.*

Our insistence upon simultaneously balancing these two utterly incompatible factors (the rock-solid belief that there are and can be no limits vs. the unalterable law that limits are unavoidable) requires us to do the necessary rationing of our healthcare (that is, withholding at least some potentially useful healthcare from at least some of the people who might benefit from it) covertly.

So, our entire healthcare system, from all three branches of the government, to health insurance companies, to hospitals, to doctors, to individual Americans (at least when they themselves are not actively patients), are fully and extravagantly and enthusiastically engaged in covert rationing, by a thousand different mechanisms, some of which have been chronicled here.

One reason DrRich is not as reluctant as some to accede to the notion that healthcare is a right is that such a declaration might, at last, move us closer to the day when we will actually be forced to engage in a public discussion of what we mean by healthcare; that is, will move us closer to deciding what should be the limits of healthcare.

Consider: When we have tens of millions of uninsured Americans who don’t have ready access to regular and routine healthcare, then it’s relatively easy to pretend that “healthcare” should include everything we might want it to include.  By using the uninsured as a huge fiscal safety valve for our dysfunctional healthcare system - a valve that can be opened, as needed, to increase the number of people ineligible to consume routine healthcare - we can shore up the fiction that “healthcare” ought to have no limits. (Indeed, steadily increasing the number of uninsured Americans has become perhaps our most effective mechanism of covert rationing). This simple expediency alone goes a long way toward enabling us to avoid having to consider or discuss limits.

But once healthcare becomes a right, then presumably those (currently) 47 million Americans will suddenly have a claim to equal access to whatever it turns out we mean by healthcare.  The severe fiscal stress produced by this sudden influx of entitled Americans will likely force us, finally,  to explicitly define the limits of what we should expect from our healthcare system.

Defining those limits will be extraordinarily painful, and will very probably traumatize our social structure. However, the process is necessary, because if we fail to set those limits the resulting fiscal tsunami - which will utterly dwarf the economic trifle we’re dealing with today as a result of the mortgage crisis - will leave us without any social structure to traumatize.

If declaring healthcare to be a right causes us to engage in this painful exercise now, before it is too late, then DrRich is in favor of it. Even American conservatives ought to be thanking Mr. Obama for doing his bit to bring the issue to a head.

*In contrast, our national, de facto declared right to affordable mortgages for everyone, no matter one’s credit risk, will result in some finite, limited amount of national debt, since every home has some finite, limited value. Even if the final cost to society is very, very large, a national right to home ownership in fact results in a fiscal obligation for society that is limited and quantifiable, and in one way or another is therefore ultimately manageable.

Anyone who insists that there must also be similar inherent limits on what we can spend on healthcare should simply consider that once we have artificial hearts, artificial kidneys, artificial livers, and can indefinitely preserve brain function sufficient to, perhaps, plug aged-but-medically-preserved bodies into some sort of virtual reality where they can frolic like virtual children forever (DrRich does not really know what medical immortality will turn out to look like, just that it is the ultimate goal of medical research, as any real American can tell you), then the amount of money we can spend on any given individual’s healthcare becomes limitless.  It is indeed nearly limitless with just the stuff we have today.

Comments

6 Responses to “Why Conservatives Shouldn’t Sweat Our New Right to Healthcare”

  1. Liz on October 27th, 2008 9:42 pm

    DrRich’s vision of immortality reminds me of the unforgettable Star Trek episode, “The Menagerie.”

  2. Annie on October 27th, 2008 11:00 pm

    Where’s everyone? Does no one realize you’re back from vay-kay?

    I’m looking forward to having a robust national discussion about the definitions and about allocating scarce resources (rashering the bacon *pork pun alert*).

    My biggest concern as a one note Jennie is that nurses get left out of the discussion as a stakeholder. I think this time will prove to be the crisis of opportunity and whatever plan gets developed and adopted will be the way of the world for many years to come. If nursing is excluded this time, I think it may be for all time.

    I’ve been knocking on the doors of Obama’s health policy advisor and my senators (both of whom have been in the news about healthcare policy over the weekend), and so far, I’ve struck out.

    I don’t think it’s a glass ceiling. I think it’s bulletproof, Sun-worthy thick wavy inpenetrable glass.

    Where’s the way in? /rant

  3. Dr. Val on October 28th, 2008 10:57 pm

    Hawaii learned a quick lesson: http://getbetterhealth.com/hawaii-learns-tough-lession-free-childrens-health-insurance-program-abused-by-wealthy-parents/2008.10.27

    How long might “healthcare for all” last? About 6 months. :)

  4. The Happy Hospitalist on October 30th, 2008 11:21 am

    Since America is not ready to say no, I propose that the “poor” contribute their fair share by not allowing them any discretionary spending until a universal health care plan is paid for. How’s that for a solution.
    a href=”http://thehappyhospitalist.blogspot.com/2008/10/america-wants-its-cake-whos-going-to.html”>How’s that for a solution?

  5. Okulus on October 31st, 2008 8:50 am

    In the end, this right is like the right to trash removal, someone has to pay the guys on the truck enough to do the job, or all the screaming about the right to service will be so much hot air. Paying taxes, strange as it may seem, might make people feel as if they have a right to services, but unless the taxes paid actually go to those delivering the service, and enough to make doing the job worthwhile, all they are is taxes paid to the government that has returned “promises” for the money.

    I am not going to work any harder unless the money comes to me for doing so. No one should.

  6. Sofia on November 7th, 2008 6:58 am

    Before debating about money spent with sick people, maybe you should be talking about what makes them sick in the first place.

    American lifestyle and the fast-buck extra-spiced franchise industries help a lot generating diseases otherwise avoidable with some education and restrictions to certain marketing techniques.
    I could go on here beyond food, but I won’t for the sake of the argument.

    Taking care of health should be a priority before being sick, not after. State priority is to educate, not to sponsor bad life styles and then melt with the expenses. This is not responsible.

    Just 2 cents.

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