Is Healthcare a Right...Yet?

A recent CNBC segment posed the question of whether healthcare is a right. They brought on commentators to argue in favor and against, one from the Cato Institute and one from the National Physicians Alliance. (you can see the clip at curethis.org).

The host started by posing the question to the conservative commentator, Michael Cannon. “I think it should be a right,” he replied. “And therefore I think physicians should work for nothing.” Sarcasm notwithstanding, his point was clear: healthcare cannot be a right because it involves payment. The exchange of goods and services for money equals capitalism, which puts healthcare squarely in the category of commodity.

Mr. Cannon backed up his point by contrasting healthcare with other things we commonly think of as human rights, like freedom of speech and religion. No one has to be paid in order to let us speak freely and worship freely, he implied, which is why they are rights and healthcare is not.

This argument is persuasive. We like to think that a human right is something you are born with, not something that has to be given. The very phrase ‘freedom of speech’ suggests its simplicity: just let people speak! It’s not that hard! Healthcare, on the other hand, is not accomplished by standing aside and letting citizens exercise their freedoms. For healthcare to be your human right, something has to actively be done to you.

But is it true that freedom of speech requires no involvement by the government? Let’s imagine taking a trip to place where there is very little government, for example Somalia. You might have the basic human right to freedom of speech there, but it’s not worth much. If you stand on a milk crate (assuming you can find one) and give a speech that others find disagreeable, those people may choose to gag you, stuff you in the trunk of a car, drive you 20 miles out of town, and perhaps kill you. The government has done nothing to take away your freedom of speech, but they haven’t done anything to protect it either.

We often ignore the role of infrastructure, such as our police force and civil and criminal court system, in allowing rights like freedom of speech and religion to flourish. The U.S. legal system is a highly complex bureaucracy, and it plays an important role in keeping the right to free speech alive.

The same principles apply in healthcare. We have a complex bureaucracy in place — doctors, nurses, hospitals — to protect our right to health. There’s no difference, in principle, between free speech and healthcare, so why is one an unquestioned human right while the other is relegated to a commodity?

In fact, no matter what human right you can name, there is an infrastructure in place to protect and defend it. And the professionals who manage that infrastructure need to get paid. So it’s foolish logic to argue that since doctors are paid a salary, healthcare cannot be a right.

Now, an opponent of the idea that healthcare is a right could argue that sure, the legal system keeps freedom of speech alive. But it also does other things. We would need cops and judges around to deal with violent crime, even if society had no right to free speech. So the added cost to society from having freedom of speech is pretty minimal.

But the same argument could be made for healthcare. The medical industry has to exist regardless of whether healthcare is a right or not. Once again we can see that healthcare and freedom of speech are identical.

Still, let’s be generous. Let’s say we do accept the distinction that Mr. Cannon was trying to make when he drew a bright line between healthcare and freedom of speech. I think what he was trying to get at was that there are two types of rights. And actually, he’s correct. Philosophers and ethicists commonly refer to them as “positive” rights and “negative” rights.

In the U.S., we are very comfortable with the latter category. Negative rights are when a person has the right not to have something done to him. For example, the right not to be tortured, not be persecuted for your religion, and not to be thrown in jail for disagreeing with the government.

Healthcare falls into the category of positive rights, for obvious reasons. (i realize, by the way, that i’m not using the strict philosophical definition of these terms. If you really care about the subtleties, check out this.) We Americans, when polled on this subject, have always been uncomfortable with positive rights. Positive rights seem to imply whininess, laziness, petulantly asking others for help.

But positive rights are actually a strong part of our tradition. Universal public education was introduced in the U.S. in the late 1800s, and today it is as American as apple pie. Ask any fourth-grader if she has a right to go to high school, and you’ll get a quizzical look because the answer is so obvious. We still fight about ways to improve education in the U.S., but no one has seriously proposed abolishing the public school system. Why? Because we understand what an incredible boon to our country it has been to have a well-educated workforce.

So we’ve established that healthcare, from the standpoint of principles, is no different than other accepted human rights. And from a practical standpoint, we see that Americans already support rights that are very similar to healthcare, like education.

So it seems to me that healthcare is a right. Other people, of course, can disagree. What they can’t do is pretend that there are objective, empiric differences between healthcare and other accepted human rights.

Should we pay primary care docs more?

Read and think about it, quiz later.

The Latest in Cancer Treatment

IV drugs administered in the doctor's office are covered. But the same medicines in pill form are not.

I hardly need to comment on this. So I won't.

This Fight Will Get Dirty

In case you thought the private insurance industry was going to sit back and let healthcare reform happen....well, check out this article in a local Massachusetts paper:

"I did not write a letter to the editor. It's not from me," said Gloria Gosselin, 75, of Lawrence.

Gosselin's name was on one of three strikingly similar letters touting the Medicare Advantage program that were sent to The Eagle-Tribune.

...

The letters were, in fact, composed and sent by the Boston office of [Dewey Square], a national political consulting firm, attempting to create the appearance of a "grass-roots" movement for Medicare Advantage.

America's Health Insurance Plans, an industry trade group, hired Dewey Square to defend the Medicare Advantage program.

It gets worse:

The Eagle-Tribune received a call from a man who turned out to be an intern at the Boston office of the Dewey Square Group, a national political marketing and consulting firm.
The man, who identified himself as Noah, wanted to know if Gloria Gosselin's letter had been published. Asked what interest he had in the letter, Noah replied that he was Gosselin's grandson.

Gosselin does not have a grandson named Noah working in Boston. Her only grandson is a student at Central Catholic.

Got it? The fight will be dirty. AHIP knows that to block healthcare reform, they will have to get rough. And they're not going to sit back and let the groundswell of support for healthcare reform wash over them.

Conservative estimates are that AHIP has $100 million set aside to fight against healthcare reform. And they seem to have every intention of playing dirty with it.

So this is it. We've been warned. Consider this a shot across our bow. It's going to be a serious, heavy-duty fight.

And if we fail to reform the system because we don't fight back hard enough.... well, i was going to say we have no one to blame but ourselves. But we can always blame the big bad insurance industry. We can fail, and then we can comfort ourselves that they had more money, and they played dirty.

But I'd rather not comfort myself. I'd rather win. And we can. We have the truth on our side, and better arguments, and oh yeah, history is on our side too, both in the U.S. and around the world. Those are far more powerful than a willingness to play dirty.

Smears can always be defeated by the truth. But someone has to speak that truth. Unfortunately, the truth never speaks for itself.

multimedia

I was on WBAI this afternoon, talking about the upcoming battle over healthcare reform. Check it out.

March 23, 2009: Health Action
http://archive.wbai.org/

Why It's Time IV: Stay Ahead of Your Illness

Okay, I'm not the only doctor out there who supports healthcare reform. I'm sure plenty of us docs have anecdotes that highlight the need for universal healthcare. And I don't want to be immodest.

But I gotta say, it's hard to imagine a better argument for universal healthcare than Juan Avista (not his real name).

Three years ago, Juan started having headaches. He tried Tylenol and Ibuprofen, and when those didn't work he went to his doctor. A slight loss of vision in his lateral fields, known as homonomous hemianopsia, led the doctor to get a CAT scan of the head.

Which is when they found the mass growing in his pituitary.

This sounds bad. But it's not as bad as you might think. Juan's mass is known as a prolactinoma, meaning a hormonal tumor that secretes prolactin. The treatment is not to open up Juan's brain and tinker with it, but to give him medications that block the effects of the hormone and thus prevent the mass from growing larger.

I'm writing about healthcare reform, so you can see where this story is going. Juan's medication cost $40 per pill, and since he worked part-time for UPS, he had no health insurance and had to pay out of pocket. He made an effort to take the medicines for a few months, but he was raising two children on $11 per hour and eventually he couldn't find the money for it.

When I admitted Juan to the hospital three days ago, he had been off his meds for five months. He had been having headaches again, and his vision was so blurry that he could barely tell how many fingers I was holding up. The CAT scan showed that the mass had almost doubled in size, and was pressing down on his optic chiasm, the place where the nerves that connect his eyes to his brain cross.

If Juan had been over 65, Medicare Part D would have covered at least part of his medicines. But he is 45. Now, maybe this doesn't need to be said, but let's say it anyway: if we kept the same Medicare structure, the one that senior citizens consistently give high ratings, and extended it to people between 18-65, we could solve all of Juan's problems, and those of thousands of other people caught between a diagnosis and a paycheck.

If we do nothing? Well, then Juan will continue to not afford his medicines, his pituitary mass will grow larger, and he will go blind.

At that point, or maybe slightly before, the neurosurgeons will decide to operate on him to remove the mass. He will have to undergo a very dangerous operation, since the pituitary is exactly in the center of the head, and is difficult for a surgeon to reach no matter what route is taken. Juan will require a long hospitalization and possibly further surgeries.

Who wins and who loses under this current healthcare system? The hospital wins, gaining reimbursements for multiple admissions and operations, rather than simple outpatient visits. The surgeons win: they only get paid when they operate, so preventing the need for surgeries is not likely to be a high priority of theirs. The big HMOs win too: since Juan didn't have a job that provided health insurance when he got his diagnosis, none of the HMOs will have to pay for his expensive care.

(By the way, it's worth noting that Juan had a full-time job with complete healthcare benefits from 1999 to 2004, but was laid off as the result of a merger. So none of the giant healthcare conglomerates --- not Aetna, US Healthcare, Tenet, or Humana, each of whose profits were greater than $1 billion last year --- will have to pay a cent to treat Juan's disease. But one of them collected between $60,000 - 80,000 from him in premiums. Does that seem fair?)

So there's our list of winners. Who are the losers? First, and most important, there's Juan: he would prefer to control his disease with a daily pill and be able to see his daughter's face, rather than undergo risky surgeries and hospitalizations.

The other loser is us, the taxpayers. We're the ones paying for Juan's expensive care, and the care for many other Juans out there who have fallen through the cracks.

It's our tax dollars and our health. (Not to use scare tactics, but any of us could find out tomorrow that we're Juan.) So why don't we use those tax dollars wisely, and ask our government for a healthcare system that emphasizes cheap prevention of early disease, rather than expensive technological treatments of late-stage disease?

It's time for a publicly accessible healthcare plan, that allows all U.S. residents access to the medicines they need. Does it really seem like too much to ask?

Down This Road?

The Boston Globe (fairly in touch with events in Massachusetts) recently declared the Mass. healthcare reform effort a failure:

Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system. What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.

The state's plan flunks on all counts.

Sad but true. We can continue to fear "socialized medicine" irrationally, or we can rationally embrace a simple solution: extend Medicare to all U.S. citizens.