"The health care you deserve"

[Inaya]

I was going to bring this up in the ACA thread, but decided it wasn't quite a fit. So new thread. Note: If you don't believe that health care is a basic human right, this probably isn't the thread for you.

I recently saw an ad for a hospital or something that ended with something along the lines of, "and you'll receive the health care you deserve."

We've all seen ads where "you deserve" is used as a marketing device. "The car you deserve." "The vacation you deserve." Et cetera. We've all rolled our eyes because does anyone deserve a car, a vacation, or any other consumer product?

But health care is a different animal. Many in this forum believe that health care is a basic human right. That is, everyone deserves health care. But my question is this: To what extent does any one person "deserve" health care? Is it limited to life saving care? Basic preventative care? End of life care? What about elective surgery that affects quality of life (my own example: I had foot surgery so that I could walk without pain, but it wasn't life threatening)? Cosmetic surgery for burn victims? Hand/face transplants? Transition surgery and medications for transgender individuals? What about mental health care?

I'm curious what you all think.

[MrsPete]

This is a very tough question, and I don't pretend to have a good answer, but I have several thoughts: 

- I also have a negative knee-jerk reaction to the phrase "you deserve this", and -- yeah -- advertising has put that reaction into me.  I don't in any way "deserve" a Big Mac hamburger ... but is health care different? 

- When you approach health care as a human right, you quickly get into the aspect of someone else paying ... and then you approach difficult concepts like "Who decides who gets" and "What's enough" ... you gave a good list in your opening post.  And an off-shoot of this idea is "Should society pay for people who've screwed up their own health"?  I mean, we all know that smoking is awful for you ... so if you choose to do it anyway, why should I have to give up my limited resources to pay for your stupid mistake?  So many nuances here, so many shades of right and wrong. 

- A big part of this question is that health care costs are so very high ... and so very unpredictable.  Even a rather stupid person can get his head around the cost of groceries and can figure out to buy on sale, to shop at the cheaper store ... but not many of us can figure out a way to manage health care more efficiently.  So we're rather at the mercy of "the system", and that's a huge part of the problem. 

[tipster350]

A system like the UK is pretty much what I consider to be the healthcare we deserve, minus some of the most recent cuts. In the UK everyone has access to good care with no frills. All basics are provided. If hospitalized, you're not getting a private room, you'll be in a room with several patients most likely. If your issue is life threatening/urgent/emergent you'll be seen promptly. If your issue isn't, even if it might be causing discomfort, you might need to wait for a while to get it fixed.

Some difficult decisions about who gets what care have been thought out and defined. For example, if you have a brain tumor and are 80 years old they might not pull out all the stops on prolonging your life for another month or two.

If you want private health care, with more frills, better customer service, quick service for non-urgent problems you can pay for it. Some employers offer a form of private insurance as a perk.

[PoutineLover]

I think everybody deserves to have affordable access to enough health care to keep them alive and able to function as best as they can. I think that includes preventative and diagnostic care, lifesaving care, mental health care and dental care, but not voluntary cosmetic procedures. Certain procedures that are not necessarily required should be available, perhaps at a price or with a longer waiting period, but if they improve the quality of life they are still important. A healthy population lives longer, contributes more to the GDP and costs less overall if small problems don't spiral into big ones. I'm Canadian, so my perspective is based on our system, where everybody (theoretically) has access to free health care. In reality, not everything is free, I also have health insurance that I pay for through my job, and for some reason your mouth is considered not part of your overall body and dental care is separate and more expensive (someone please explain why this is so).
The situation in the states is utter nonsense and there's no reason to have such an insanely expensive, ineffective system that is bad at keeping people in good health and alive, despite spending waaay more than any other country. The individualist, lawyer happy, selfish attitude is literally killing people.
There is a balance between being able to provide timely care to everyone and ensuring that everyone has access, and I don't think any country has it down pat yet, but I think studying the different systems, USA needs to smarten up on a lot of measures and won't because of entrenched power of the whole health care industry and the indifference of the elected officials who are all so rich they have no idea what the consequences of their actions are on regular people.

[GenXbiker]

I'm Canadian, so my perspective is based on our system, where everybody (theoretically) has access to free health care. In reality, not everything is free,

Yeah, none of it is free.   If someone thinks it's free, it's just because someone else is paying for it.

[runewell]

I have the right to bear arms, who is going to give me my free gun?

[PoutineLover]

I'm Canadian, so my perspective is based on our system, where everybody (theoretically) has access to free health care. In reality, not everything is free,

Yeah, none of it is free.   If someone thinks it's free, it's just because someone else is paying for it.

Yes, but I'm willing to pay my taxes to ensure that everyone has access. I think that of all the things government can and should be spending money on, health care and infrastructure and education bring the greatest benefit to the most people and benefit enormously from economies of scale. I don't begrudge children or elderly people who don't pay taxes their health care, because I see it as a greater good that is worth paying for. And it doesn't have to be that expensive if you cut out a lot of the layers sucking up money without adding any value. So I think essential health care should be free at the point of delivery, and paid for by collecting taxes from everyone proportionately to their income.

[Bucksandreds]

I have the right to bear arms, who is going to give me my free gun?

Go kill a bear. Then you can do with it's arms whatever you wish.

[Inaya]

I have the right to bear arms, who is going to give me my free gun?

The military will be happy to. Also, I don't think anyone is asking for free health care. I feel like this isn't the thread for you. If you can't contribute meaningfully to the discussion at hand, please find a thread more suited to your beliefs.

[stoaX]

I have the right to bear arms, who is going to give me my free gun?

I agree with you in principle, the right to something does not automatically translate to the public financing of it. However the money involved is quite different between the purchase of a firearm and the cost of health care.  So for those who, for financial reasons, do not have access to health care, some discussion of how that might be accomplished is warranted. 

But then again, I'm just an underwriter.  I didn't have enough personality to be an actuary.

[tipster350]

I knew it would be a matter of time until the extreme Ayn Randers showed up to crap all over this thread. It's why I generally steer clear of such topics. The OP clearly stated what the question was and what type of feedback he/she was looking for, and it is not your opinion that national healthcare is akin to theft and coercion. Go start another thread if you want to talk about that.  Or find one that already exists. Heaven knows that topic and opinion have been discussed ad nauseum.

[Bobberth]

I really enjoyed this essay about whether health care is a right or not and how we need to work on answering that question first instead of fiddling around instead. There are some uncomfortable questions you have to answer whether you are for or against it, very well written and thought out.

http://www.stonekettle.com/2017/06/the-right-question.html

[VoteCthulu]

I really enjoyed this essay about whether health care is a right or not and how we need to work on answering that question first instead of fiddling around instead. There are some uncomfortable questions you have to answer whether you are for or against it, very well written and thought out.

http://www.stonekettle.com/2017/06/the-right-question.html

I think the worst thing about that article is claiming that if healthcare isn't a right, no one should care how many people have it. This makes no logical sense to me. Just because having electricity or indoor plumbing isn't a right doesn't mean we shouldn't care how many people have it. Things can be very good for people and be encouraged by government subsidies without being a right.

[Tyson]

Health care is a right, just like education is a right. 

[stoaX]

I really enjoyed this essay about whether health care is a right or not and how we need to work on answering that question first instead of fiddling around instead. There are some uncomfortable questions you have to answer whether you are for or against it, very well written and thought out.

http://www.stonekettle.com/2017/06/the-right-question.html

Thanks for providing the link - it was a good read and provokes some good questions and observations (like VoteCthulu's observation above).  I do like that he acknowledged that all that follows after we decide if it is a right or not are BIG details, not little ones. 

[runewell]

Health care is a right, just like education is a right.

I was making a point with my right to bear arms comment until someone else didn't like it and crapped on this thread.

If healthcare is a right, why doesn't it have the same historical mandate from the government as education? 

Getting back to the question at hand, the word "deserve" suggests some merit to earn something.  I don't see how anyone can truly "deserve" health care.  What has Jack done to "deserve" heath care that Jill hasn't done?  Nothing; health care is a service not unlike going to a restaurant, you pay for goods and services.  At the one you pay for food, chefs, and waitstaff; at the other you pay for treatment, doctors, and nurses. 

That's different from wanting everyone to have health care.  I would not be against basic universal healthcare except that I am not convinced that we can afford it with our low level of taxes.   

[PoutineLover]

Health care is a right, just like education is a right.

I was making a point with my right to bear arms comment until someone else didn't like it and crapped on this thread.

If healthcare is a right, why doesn't it have the same historical mandate from the government as education? 

Getting back to the question at hand, the word "deserve" suggests some merit to earn something.  I don't see how anyone can truly "deserve" health care.  What has Jack done to "deserve" heath care that Jill hasn't done?  Nothing; health care is a service not unlike going to a restaurant, you pay for goods and services.  At the one you pay for food, chefs, and waitstaff; at the other you pay for treatment, doctors, and nurses. 

That's different from wanting everyone to have health care.  I would not be against basic universal healthcare except that I am not convinced that we can afford it with our low level of taxes.   

Health care is fundamentally different from going to a restaurant. If you don't get it, you get sick and die. Not going to a restaurant has no negative consequences, except you just don't get some fancy food. I believe that in a country as rich as the states, with a bigger defense budget than the next 10 countries combined, there is no excuse for not ensuring that all citizens have access to care. A baby does nothing to "deserve" health care, but does that mean they should die if they get sick and their parents are poor? How can you even think like that?

[mathlete]

I think that healthcare access for all is a really nice thought. I'm hesitant to call it a "right" though because it involves compelling humans to provide it for you, which interferes with much more fundamental rights.

Thinking of it as a "right" is a bit pernicious anyway, because while many in the USA are supportive of some kind of medicare for all like solution, and would cite healthcare as a human right as the reason, comparatively fewer people would probably want to guarantee this so-called right for everyone else in the world. People receiving substandard care in developing nations are still human, and thus, no less deserving.

If I'm going to be less philosophical, and more pragmatic though, I think that the USA should guarantee something close to NHS standard of care for all Americans, regardless of what they can afford to pay. On top of that, I think that we should step up foreign aid contributions to help those in other countries.

[Tyson]

A right is whatever we decide is something that everyone in our society is entitled to.  We can make changes as we see fit.

For example, in the past, gay people did not have the right to get married.  Now they do.  In the past, women did not have the right to vote.  Now they do.  In the past, black people did not have the right to get paid for their work (if they were slaves), now they do. 

Healthcare will just be another right (in a long line of rights) that we decide to put in place. 

[neil]

It is nearly impossible to get this discussion solely into the realm of philosophy for so many reasons, but I believe if you could get the world to sit down and list what would be great for each person to have, you would come up with a very long list which would include a whole range of things from the immoral (murder bad) to personal need (water, food, shelter, health) and some very nice to haves (education, internet, power).

We can take that list, and try to order it (with literally millions of disagreements) and then try to draw a line where rights starts (and have millions of more disagreements).  It is worth a discussion, but as a matter of practicality, it is a waste of time from a governing standpoint because nothing would get done.  (And nothing is getting done because we insist on having this argument.)

If you take the singular stance of saying health care is a right, this statement alone doesn't mean anything.  It immediately implies that it also must be provided (since health care is not naturally occurring) and it starts slamming against other rights that are almost certainly higher on the list, particularly freedom (because at some point healthcare has a supply issue).  This is even before we start discussing other practical elements.  I have a hard time accepting something is a right if there is a service element, because I see no other way of providing it unless I force someone to do it.

It rings very hypocritical to me to call healthcare a human right and then discuss how a government should provide this human right to a small subset of the human population.  This, to me, is the wrong discussion entirely once we move into practical elements.

However, if allowed to dip into practicality for a moment, the government provides many services that have nothing to do with rights.  Not all, but most are an attempt to run society more optimally.  I think healthcare is a component of this but I am not smart enough individually to figure out the best way to do it.

[Inaya]

I guess I didn't phrase my original post well enough. My original OP rested on the assumption that health care IS a right. Thus the bolded text. The question I posed was how far does that right goes.

Emergency care is already guaranteed, so that's included. But what else?

Discussion of whether health care is a right has its place. But I would really prefer if we stick to the original question I posed, which assumes that it is a right for the sake of this discussion.


ETA: I do appreciate most of the responses so far, even if they were off topic. But thank you especially to those who did answer the question.

[jeninco]

I think that healthcare access for all is a really nice thought. I'm hesitant to call it a "right" though because it involves compelling humans to provide it for you, which interferes with much more fundamental rights.

Thinking of it as a "right" is a bit pernicious anyway, because while many in the USA are supportive of some kind of medicare for all like solution, and would cite healthcare as a human right as the reason, comparatively fewer people would probably want to guarantee this so-called right for everyone else in the world. People receiving substandard care in developing nations are still human, and thus, no less deserving.

If I'm going to be less philosophical, and more pragmatic though, I think that the USA should guarantee something close to NHS standard of care for all Americans, regardless of what they can afford to pay. On top of that, I think that we should step up foreign aid contributions to help those in other countries.

Rwanda, Algeria, and Burkina Faso seem to think it's a "right" for their citizens...
https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care and https://www.nytimes.com/2017/07/18/business/economy/senate-obamacare-rwanda.html?_r=0

(I am aware that there are still plenty of blank spots on the map, but thought I'd point out that not all countries providing some level of universal health care are first -- or even second -- world countries.)

Does health care somehow not come under the "Life, Liberty, and the Pursuit of Happiness" clause -- that part at the very beginning?

(Edited to add -- sorry, Inaya. I want to think about your big questions more!)

[mathlete]

I guess I didn't phrase my original post well enough. My original OP rested on the assumption that health care IS a right. Thus the bolded text. The question I posed was how far does that right goes.

Emergency care is already guaranteed, so that's included. But what else?

Discussion of whether health care is a right has its place. But I would really prefer if we stick to the original question I posed, which assumes that it is a right for the sake of this discussion.

Whatever $6,935 in per capita healthcare dollars gets us (indexed to GDP growth) after switching to a system where the government does a great deal more price setting than they do now.

$6,935 per capita is Switzerland's 2015 healthcare spending.

[jjandjab]

I would agree with the sentiment that healthcare is a "right", we just need to determine what that level of care includes. I have always thought education is a great comparison, actually.

I think every child should have free basic care to the age of 18, including dental.

Everyone should then have access to a Medicare (or Canada or UK) like system where basic and lifesaving care is provided, especially the catastrophic type care. A medical catastrophe should not be able to completely ruin the finances of a person/family as it can now.

Most people share the cost of employer based plans to get coverage. If you took all of that money, both the employer contribution, employee contribution and the Medicare taxes -  combined with the efficiencies to move to a single payer for the provision of a universal "basic" insurance for all, I think that it could be done for essentially no change in cost (obviously I don't know that for sure).

The problem is most Americans don't see the employer contribution as a business tax, and their own contribution as an employee tax. If someone broke that out separately, in this day and age, it is suddenly labeled a new tax...

Then any extra procedures can be paid for out of pocket. And yes, we would have to grapple with the crazy cost of end of life care and decide what is appropriate and what is not.

I often think of just how many more people in the US would go back to those mom-and-pop stores or be more entrepreneurial if they knew they did not have to worry about health insurance and take that corporate job (or stay there longer than they want)

* saying emergency care is included is not quite true - you have to be treated, but you can be stuck with bills for 5 or 6 figures if a major trauma

[mathlete]

Rwanda, Algeria, and Burkina Faso seem to think it's a "right" for their citizens...
https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care and https://www.nytimes.com/2017/07/18/business/economy/senate-obamacare-rwanda.html?_r=0

(I am aware that there are still plenty of blank spots on the map, but thought I'd point out that not all countries providing some level of universal health care are first -- or even second -- world countries.)

Hence my comment about providing healthcare to people currently getting "substandard" care. Per OECD and the WHO, the United States public (government) spending on healthcare is over 4x Algeria's spending in total (public and private). Apples and oranges.

Does health care somehow not come under the "Life, Liberty, and the Pursuit of Happiness" clause -- that part at the very beginning?

The "liberty" part is the sticky point. If you're compelling someone else to render you services, you're interfering with their liberty.

[shenlong55]

I really enjoyed this essay about whether health care is a right or not and how we need to work on answering that question first instead of fiddling around instead. There are some uncomfortable questions you have to answer whether you are for or against it, very well written and thought out.

http://www.stonekettle.com/2017/06/the-right-question.html

The "liberty" part is the sticky point. If you're compelling someone else to render you services, you're interfering with their liberty.

If you take the singular stance of saying health care is a right, this statement alone doesn't mean anything.  It immediately implies that it also must be provided (since health care is not naturally occurring) and it starts slamming against other rights that are almost certainly higher on the list, particularly freedom (because at some point healthcare has a supply issue).  This is even before we start discussing other practical elements.  I have a hard time accepting something is a right if there is a service element, because I see no other way of providing it unless I force someone to do it.

I particularly liked this part of that article...

Look here: in America, you have the right to legal representation. If you’re accused of a crime and you cannot afford a lawyer, then one will be appointed to you by the court. Does that make you entitled to another’s labor? Yes. Yes it does. That’s what Public Defenders do. They’re not slaves, they chose to do that job and they’re paid for it. And just because you’re entitled to legal representation doesn’t rob lawyers of their rights.

[mathlete]

I particularly liked this part of that article...

Look here: in America, you have the right to legal representation. If you’re accused of a crime and you cannot afford a lawyer, then one will be appointed to you by the court. Does that make you entitled to another’s labor? Yes. Yes it does. That’s what Public Defenders do. They’re not slaves, they chose to do that job and they’re paid for it. And just because you’re entitled to legal representation doesn’t rob lawyers of their rights.

Payment of public defenders interferes with the liberty of those paying for them.

At the risk of getting into semantics, I think this is a distinction between a "basic human right" as OP first described, and other uses of the word "right".

This is fine though. Having public defenders is a good thing. As is a trial by a jury of your peers. As universal care is (or would be).

We cede personal liberty for the greater good all the time. It is what it is though.

[WhiteTrashCash]

America is about to get the "health care it deserves" because lots of people of my original social class voted to outlaw their own health insurance. It's exactly what America deserves to get.

[golden1]

It’s not an easy question.  I would say at a bare minumum, people “deserve” a level of life saving catastrophic care for illnesses beyond their control. 

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?  Or having unprotected sex?  I definitely believe that people should not face a death sentence for these poor choices, but there definitely needs to be some sort of incentive to avoid these behaviors before they become so bad that there needs to be costly health interventions. 

This is one of the issues I find that really frustrates me when we discuss rights on both the left and right hand side of the spectrum.  Rights mean nothing without RESPONSIBILITIES.  They are two sides of the same coin.  If you have a right to something, you also have a responsibility to do your best to not abuse it.  If you have a right to health care, you have a responsibility to take care of yourself to the best of your ability.  If you have a right to a gun, you have a responsibility to get training, and keep it safe and locked up when not in use. 

[shenlong55]

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?  Or having unprotected sex?  I definitely believe that people should not face a death sentence for these poor choices, but there definitely needs to be some sort of incentive to avoid these behaviors before they become so bad that there needs to be costly health interventions.

I don't think we need a manufactured incentive for people to do that, I think that already exists.  Just because the healthcare system might be able to fix my cancer after I get it that doesn't mean that now I'm perfectly fine with getting cancer...

[CheapScholar]

As a lawyer, I can't help but chuckle.  If healthcare is a right in the US, where exactly does that right come from?!

Not saying I am against single payer or national healthcare, but if you want something to be a right then work on amending the constitution.

[PoutineLover]

It’s not an easy question.  I would say at a bare minumum, people “deserve” a level of life saving catastrophic care for illnesses beyond their control. 

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?  Or having unprotected sex?  I definitely believe that people should not face a death sentence for these poor choices, but there definitely needs to be some sort of incentive to avoid these behaviors before they become so bad that there needs to be costly health interventions. 

This is one of the issues I find that really frustrates me when we discuss rights on both the left and right hand side of the spectrum.  Rights mean nothing without RESPONSIBILITIES.  They are two sides of the same coin.  If you have a right to something, you also have a responsibility to do your best to not abuse it.  If you have a right to health care, you have a responsibility to take care of yourself to the best of your ability.  If you have a right to a gun, you have a responsibility to get training, and keep it safe and locked up when not in use. 

The problem I have with this is that you then have to start judging people's choices based on incomplete and arbitrary information. How do you define "poor quality diet"? How do we determine if someone got an STD because of their choices, or bad luck? If I have unprotected sex with my partner because I trust them, then I get an STD because they cheated, do I still deserve care? If my parents smoke and I get lung cancer from the second hand smoke, do I deserve care? Do type 1 diabetics get care but not type 2? What if my cancer was due to air pollution? I can stop there, just wanted to point out that when you start trying to assign blame to health conditions, you will inevitably exclude people who got sick through no fault of their own, and condemn people to die based on judgement calls that are impossible to make fairly. Yes, people should take care of themselves, but it's incredibly cruel to deny them health care based on their lifestyles.

[Inaya]

It’s not an easy question.  I would say at a bare minumum, people “deserve” a level of life saving catastrophic care for illnesses beyond their control. 

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?  Or having unprotected sex?  I definitely believe that people should not face a death sentence for these poor choices, but there definitely needs to be some sort of incentive to avoid these behaviors before they become so bad that there needs to be costly health interventions. 

This is one of the issues I find that really frustrates me when we discuss rights on both the left and right hand side of the spectrum.  Rights mean nothing without RESPONSIBILITIES.  They are two sides of the same coin.  If you have a right to something, you also have a responsibility to do your best to not abuse it.  If you have a right to health care, you have a responsibility to take care of yourself to the best of your ability.  If you have a right to a gun, you have a responsibility to get training, and keep it safe and locked up when not in use.

This is tough. On one hand, maybe you do incentivize good decisions. For instance, my health plan charges smokers a surcharge on their premiums. But how do you place a surcharge on bad health habits? How do you show improvement to get the surcharge removed? How do we not slide down the slippery slope back into "preexisting condition" territory?

On the other hand, is this ultimately THAT different from the argument that SNAP is bad because some people make bad decisions (freeload)? Should we get rid of SNAP just because of a few bad apples abusing the system? (Hopefully this doesn't send us too far into the weeds.)

Or maybe we can assume that with increased access to regular preventative care, including mental heath care, that some fraction of these "self-inflicted" illnesses will go away?

[Inaya]

As a lawyer, I can't help but chuckle.  If healthcare is a right in the US, where exactly does that right come from?!

Not saying I am against single payer or national healthcare, but if you want something to be a right then work on amending the constitution.

We can pretend, for the sake of this discussion, that we, as a country, have decided it is a right and codified it in some way (constitution or whatever). And we can pretend that we are at the point of deciding where to draw the line between what is and is not covered under a "right."

Some are fairly obvious (i.e., most people would agree), such as pediatrics and preventative care. Some are fairly obvious in the other direction--few would argue that cosmetic surgery for its own sake is a right. But there is a lot of grey area. For instance, from my OP, what about cosmetic surgery for somebody with severe facial scarring? Or what about breast reduction surgery for somebody whose breasts have caused them to have severe spinal problems?

[stoaX]

It’s not an easy question.  I would say at a bare minumum, people “deserve” a level of life saving catastrophic care for illnesses beyond their control. 

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?  Or having unprotected sex?  I definitely believe that people should not face a death sentence for these poor choices, but there definitely needs to be some sort of incentive to avoid these behaviors before they become so bad that there needs to be costly health interventions. 

This is one of the issues I find that really frustrates me when we discuss rights on both the left and right hand side of the spectrum.  Rights mean nothing without RESPONSIBILITIES.  They are two sides of the same coin.  If you have a right to something, you also have a responsibility to do your best to not abuse it.  If you have a right to health care, you have a responsibility to take care of yourself to the best of your ability.  If you have a right to a gun, you have a responsibility to get training, and keep it safe and locked up when not in use.

This is tough. On one hand, maybe you do incentivize good decisions. For instance, my health plan charges smokers a surcharge on their premiums. But how do you place a surcharge on bad health habits? How do you show improvement to get the surcharge removed? How do we not slide down the slippery slope back into "preexisting condition" territory?

On the other hand, is this ultimately THAT different from the argument that SNAP is bad because some people make bad decisions (freeload)? Should we get rid of SNAP just because of a few bad apples abusing the system? (Hopefully this doesn't send us too far into the weeds.)

Or maybe we can assume that with increased access to regular preventative care, including mental heath care, that some fraction of these "self-inflicted" illnesses will go away?

And even if we could accurately judge who truly, knowingly and willingly inflicted their condition on themselves, the costs of a bureaucaracy to determine that might well exceed the cost of just treating it.   

[Tyson]

It’s not an easy question.  I would say at a bare minumum, people “deserve” a level of life saving catastrophic care for illnesses beyond their control. 

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?  Or having unprotected sex?  I definitely believe that people should not face a death sentence for these poor choices, but there definitely needs to be some sort of incentive to avoid these behaviors before they become so bad that there needs to be costly health interventions. 

This is one of the issues I find that really frustrates me when we discuss rights on both the left and right hand side of the spectrum.  Rights mean nothing without RESPONSIBILITIES.  They are two sides of the same coin.  If you have a right to something, you also have a responsibility to do your best to not abuse it.  If you have a right to health care, you have a responsibility to take care of yourself to the best of your ability.  If you have a right to a gun, you have a responsibility to get training, and keep it safe and locked up when not in use.

All the more reason to implement universal health care - so those people at risk can have access to good preventative care BEFORE they develope one of these conditions.

[GuitarStv]

Access to health care is a basic human right.

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?

Is there any evidence at all that suggests that people in countries with free health care are more obese, do more drugs, or drink more than those in countries without?  Maybe this fear is completely unfounded.

[mathlete]

Access to health care is a basic human right.

But what if someone’s lifestyle choices are contributing to them becoming ill, as in eating a poor quality diet and becoming obese, or doing drugs or drinking too much?

Is there any evidence at all that suggests that people in countries with free health care are more obese, do more drugs, or drink more than those in countries without?  Maybe this fear is completely unfounded.

Yeah.

There is a connection between an unhealthy lifestyle and your expected healthcare costs (though not as much as some might think).

That being said though, no one makes the choice to eat themselves into obesity or get strung out on heroine because they know that the social safety net will be there to treat them if and when they encounter medical issues.

That's just not the way human beings make decisions. 

[Morning Glory]

Definitely a UK style system where everyone gets no-frills care for free, and there is optional insurance to pay for extras. Nobody "deserves" a private room with 100+ cable channels and room service, which I'm sure is what this marketing gimmick is getting at.

 I was born in the UK and my 2 brothers were born in the US; my mom said the birthing experience was actually better in the UK. She got to stay in the hospital a whole week and had nurses visit her at home afterwards to make sure everything was going ok. When she had my brother three years later in New York she was out the door within 24 hours.

[phil22]

http://www.stonekettle.com/2017/06/the-right-question.html

great link -- helpful essay.  establishing health care as a constitutional right and worrying about the details later sounds like a good first step.

i do like the point in the essay about food, which is not a right and is not provided to everyone "for free" but perhaps food is cheap enough that it's not worth discussing as a right.  perhaps 100 years from now the same will be true for healthcare.

the point about firearms is interesting.  AFAIK there are no government programs to provide assistance for purchasing guns and ammo but we recognize the right for qualified citizens to own them.  similarly, you have a right to free speech but that doesn't entitle anyone access to free services of private companies.  it appears that healthcare is not the same type of "right" as the right to bear arms.

as far as costs go, mandating routine preventative care could dramatically lower how much the country as a whole pays for health care.  perhaps skipping mandatory screenings, vaccinations, and checkups would waive someone's right to certain types of care.  as has been said here, if healthcare is a right then responsibility comes along with it.

the declaration of independence declared "life" an "unalienable right" so it doesn't seem like a huge stretch to me to interpret "life" to mean both "not executed without a trial" and "not left to die because you went bankrupt trying to pay for medial care."  and it doesn't seem like much of a stretch to get some version of that established in the constitution.

[Re3iRtH]

This is a tough one.

I am a physician, and I am honored to care for the military and their families. Given their voluntary sacrifice, I believe they have earned the RIGHT to quality healthcare. My salary is fixed regardless of how many procedures I do or patients I see. So, I will do the best job that I can. Medical school was free and I was reimbursed very well throughout my entire training.

However, if I was a civilian doc, who had to go to school for 13+ years, come out of medical school with $250K in debt, earning a barely livable salary as a resident, gave up my entire 20s to be able to do this, do the patients' then have a RIGHT to healthcare? Maybe, but the reimbursement has to be appropriate for the level of sacrifice, training, and risk. The question is, who then is responsible to pay? I'll leave that one to you guys as I have no interest in politics ;)

[2Cent]

Right to healthcare can be interpreted so broadly that it can mean anything from free care no matter how expensive or useful, and just the right to go to hospitals, but you have to pay eventually. Society needs to find the balance between affordability, quality, freedom and efficiency.

Fun fact: In Japan companies get a fine when employees are overweight. So if you make the government responsible for something, they will also get authority over that thing. That's where the freedom comes in. Or those doctors in the UK who decided a baby could not get an experimental treatment (which the parents would pay for).

I think most people would be willing to pay for basic care as long as there is not much abuse. And I suppose child care is one of the things that should really be free as you can't expect children to pay. Elderly care however I feel is over funded in most places due to politically active elderly.

Another thing that is really bad in the US is the lack of impartial diagnosis. It is like the doctor is also a salesman. It would be good if government would enforce a financial separation between the diagnosing doctor and the hospital. When someone is very sick they can not always be smart consumers, and are at the mercy of the doctor.

[Goldielocks]

I have a similar question.

I deserve nutritious and healthy food.


-- Who should be responsible for ensuring that I get it?   Who defines what constitutes "nutritious and healthy"?  Who should pay for it?  In what manner should it be delivered / prepared / received?   Is it my responsibility to take actions to learn about how to care for my own food needs in a pre-planning sort of way?  If I chose to live 8 hours drive away from any town or village, is it my right that it is provided to me within a 20 minute walking distance?  etc.

In thinking this through, and living in a country that provides government provided health care, I think it is wrong to consider health care as a basic right and not think about health care as a commodity service.  I am a strong believer that  group insurance (or government regulated / provided) is needed to ensure everyone gets the basics.  BUT. There needs to be caps and limits on how much government provided anything one gets... and likewise, the government should not restrict people from being able to top up or buy what they want, by paying with their own money.

We each play a role in contributing to our own food needs and health care needs, alike.

[Million2000]

I think that healthcare access for all is a really nice thought. I'm hesitant to call it a "right" though because it involves compelling humans to provide it for you, which interferes with much more fundamental rights.

Thinking of it as a "right" is a bit pernicious anyway, because while many in the USA are supportive of some kind of medicare for all like solution, and would cite healthcare as a human right as the reason, comparatively fewer people would probably want to guarantee this so-called right for everyone else in the world. People receiving substandard care in developing nations are still human, and thus, no less deserving.

If I'm going to be less philosophical, and more pragmatic though, I think that the USA should guarantee something close to NHS standard of care for all Americans, regardless of what they can afford to pay. On top of that, I think that we should step up foreign aid contributions to help those in other countries.

I've come to the same conclusion as well. Rights are natural and inherent, not "given" by some outside force. As Jefferson says "endowed by their Creator with certain unalienable Rights".

But like you I do believe it would be in the interest of the society as a whole to provide a standard base level of care for everyone in that society and that the state should be the one insuring that standard is met. I think almost all of the European models are in many ways better than ours. I think a system that allows private insurance alongside a public system would be beneficial, as many of our fellow Western nations have. While not a perfect system I think it allows the maximum amount of freedom to choose while providing that standard level of care.

As to that standard (OP's question), I think the Kimmel test would be a good start: no family should be denied medical care because they can't afford it. Whatever services are medically necessary (as decided by a medical professional, not a pharmaceutical company, insurance firm, or a bureaucrat) to save and/or ensure the maximum possibilities of a beneficial outcome for that patient. That's pretty broad but it's what I'd want when I go to the hospital.

[jjandjab]

This is a tough one.

I am a physician, and I am honored to care for the military and their families. Given their voluntary sacrifice, I believe they have earned the RIGHT to quality healthcare. My salary is fixed regardless of how many procedures I do or patients I see. So, I will do the best job that I can. Medical school was free and I was reimbursed very well throughout my entire training.

However, if I was a civilian doc, who had to go to school for 13+ years, come out of medical school with $250K in debt, earning a barely livable salary as a resident, gave up my entire 20s to be able to do this, do the patients' then have a RIGHT to healthcare? Maybe, but the reimbursement has to be appropriate for the level of sacrifice, training, and risk. The question is, who then is responsible to pay? I'll leave that one to you guys as I have no interest in politics ;)

Actually, for the sake of argument, you are being very political when you use the phrase "honored to care for the military and their families. Given their voluntary sacrifice I believe they have earned the RIGHT..." 

I know I might be in the minority and creating controversy in this current social/cultural environment in US where military (and to some degree police/firefighters) are revered, especially since 9/11, but I don't really feel that military personnel, in general, have any more of a "RIGHT" to healthcare than the rest of the citizens. The key is "voluntary". And it is not always a "sacrifice." It is a chosen job/career.

Those truly injured in combat, I absolutely agree have earned their benefits, no doubt. And we as a society should help care for them. But all personel with more than 2 years of active duty service, including without dangerous deployment or injury, are given lifetime healthcare for something that they know they are signing up for?

Sure you can call it an earned benefit and in many ways they are smart for doing a job that ends up with lifetime benefits and a pension. But it does irk me when it seems the knee-jerk reaction these days is to instantly revere everything military related and that making that career choice suddenly gives more "RIGHTs" than other citizens. A right is something that should apply to all.

[Bosco4789]

Definitely a UK style system where everyone gets no-frills care for free, and there is optional insurance to pay for extras. Nobody "deserves" a private room with 100+ cable channels and room service, which I'm sure is what this marketing gimmick is getting at.

I certainly do deserve it if one of my perks of employment is this level of care. Should it be taken from me because your insurance doesn't cover it?  Should you get it via the government because I have it?

[Morning Glory]

Definitely a UK style system where everyone gets no-frills care for free, and there is optional insurance to pay for extras. Nobody "deserves" a private room with 100+ cable channels and room service, which I'm sure is what this marketing gimmick is getting at.

I certainly do deserve it if one of my perks of employment is this level of care. Should it be taken from me because your insurance doesn't cover it?  Should you get it via the government because I have it?

It's fine if your employer wants to pay for the perk, I just think it would be easier to pass and pay for a single payer system if these frills we're not included. And yes, there is an argument for private rooms from an infection control standpoint as well. Government money should go towards things that actually improve outcomes.

[Tyson]

This is a tough one.

I am a physician, and I am honored to care for the military and their families. Given their voluntary sacrifice, I believe they have earned the RIGHT to quality healthcare. My salary is fixed regardless of how many procedures I do or patients I see. So, I will do the best job that I can. Medical school was free and I was reimbursed very well throughout my entire training.

However, if I was a civilian doc, who had to go to school for 13+ years, come out of medical school with $250K in debt, earning a barely livable salary as a resident, gave up my entire 20s to be able to do this, do the patients' then have a RIGHT to healthcare? Maybe, but the reimbursement has to be appropriate for the level of sacrifice, training, and risk. The question is, who then is responsible to pay? I'll leave that one to you guys as I have no interest in politics ;)

Actually, for the sake of argument, you are being very political when you use the phrase "honored to care for the military and their families. Given their voluntary sacrifice I believe they have earned the RIGHT..." 

I know I might be in the minority and creating controversy in this current social/cultural environment in US where military (and to some degree police/firefighters) are revered, especially since 9/11, but I don't really feel that military personnel, in general, have any more of a "RIGHT" to healthcare than the rest of the citizens. The key is "voluntary". And it is not always a "sacrifice." It is a chosen job/career.

Those truly injured in combat, I absolutely agree have earned their benefits, no doubt. And we as a society should help care for them. But all personel with more than 2 years of active duty service, including without dangerous deployment or injury, are given lifetime healthcare for something that they know they are signing up for?

Sure you can call it an earned benefit and in many ways they are smart for doing a job that ends up with lifetime benefits and a pension. But it does irk me when it seems the knee-jerk reaction these days is to instantly revere everything military related and that making that career choice suddenly gives more "RIGHTs" than other citizens. A right is something that should apply to all.

Actually this is a good point - the military already gets free healthcare in this country.  Why not just extend that model to everyone else?

[runewell]

Actually this is a good point - the military already gets free healthcare in this country.  Why not just extend that model to everyone else?

Because it costs a lot of money?  Because the VA doesn't have the infrastructure to treat the entire country?

[Tyson]

I mean that with the military example, we have a model for getting universal healthcare in place.  Obviously it needs to be properly funded.

The other model that's in place is medicare.  We could simply extend medicare to everyone.  Again, it would need to be properly funded.