Is health care a right? Should everyone in our society have access to health care? Should this access be free? Equal? Or, should it be based upon need, or an individual's ability to pay, or some other category of restriction (e.g., the relative contributions people make to society)?
These are the fundamental questions about health care that we, as a society, have not yet fully addressed. Currently, our health care system functions upon a sickly jumble of half-answers.
It is easy to say that everyone has a "right" to health care, but very few absolute rights exist. Most rights are accorded with exceptions or with responsibilities and obligations placed upon the recipient. (More about obligations and responsibilities another time.)
What are the exceptions to an individual's right to health care? In our society, most exceptions concern the nature and extent of care one can expect.
By virtue of EMTALA, all individuals regardless of ability to pay have a right (see entry of 9/3/07) to a medical screening in an emergency room of a facility that participates in the federally-funded programs of Medicare and Medicaid to determine whether or not s/he is experiencing an emergent condition requiring treatment and/or stabilization and transfer. However, one does not have a right to demand certain treatments or interventions, even if another person may receive these.
In essence, one has a right to treatment for emergencies, but one does not have a right to an MRI for a headache, or a bone scan for "brittle bones," or a heart/lung transplant for organ failure.
Just as one has a right to free speech, one cannot utilize this right wherever and however one wishes. There are restrictions and exceptions.
In the emergency room, what is prudent and customary care for the condition a patient is experiencing and not simply the patient's ideas and desires or even their ability to pay, determines the sort of care they receive. It is the right of the patient to have what is prudent and customary (sometimes called the "standard of care").
But this is not a right transferable to the private sphere of health care. Just because one has a right to such treatment in the ER doesn't mean they have the same rights at the local Family Medical Clinic, or Dr. Joe's, or even at for-profit, privatized hospitals. These services can be exceptions to the right of health care.
In fact, one of the reasons ERs are often saturated with individuals who are un- or underinsured is because physicians and other clinicians in private practice aren't obligated to fulfill an individual's right to health care. Many private practice physicians only accept patients on Medicaid as a small percentage of their overall clientele, and virtually none accept uninsured patients unless they have cash up front. This is sometimes referred to as The American Way.
What this effects is a two-tiered (actually, multi-tiered) system of health care in which privately insured individuals and those with retirement-age or disability-qualifying Medicare can usually access private health care, while poorer individuals who can't afford private insurance or don't work at jobs that are required to provide it (e.g., part-time, seasonal, small businesses, etc.) must rely on Medicaid or no insurance at all.
These latter individuals are those who the New York Times apparently has a problem with gumming up the ERs. Where else are they to go?
If health care is a right with exceptions and restrictions, then these sorts of problems are going to acutely inconvenience even those at the top of the system. However, I suspect these problems inconvenience those at the bottom more often, in fact, chronically.
Inject for-profit motives of private insurance companies, and these problems multiple precipitously. The system, the entire system, is in need of an overhaul.
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5 comments:
As you said, one problem is that the health insurance industry is a profitable industry. Just like the casinos at Vegas, people over pay for the benefit they receive.
Is there a way to create a market that doesn't incentivize that profit margin? One solution would be a government regulated single payer system, but the profiteering would likely just move to peripheral industries, like medical supply manufacturing.
Another solution might be do deregulate the entire industry and try to let the market readjust the price to the true cost of medical service -- providers need consumers just a much as consumers need providers. This doesn't address your observation that helathcare might be a right, and allowing a free market would almost certainly ensure that some people would be denied that right.
A third, compromising solution might be a mix. The state pays for what it considers "essential services" (probably those covered by the EMTLA and your family doc) and the market determines the going rate for premium services like, say, boob jobs. This might make it so that the rich can keep fighting over their money and their precious healthcare market, while the poor get essential services.
One thing does seem certain: Medicare/Medicaid style government regulation isn't going to do much to reduce medical costs. At least not if you take into account the transaction costs, bureaucratic costs, and litigation costs associated with getting services covered . . .
http://www.nytimes.com/2008/01/15/washington/15appeal.html?ref=health
Another good example of exceptions to the right of health care.
I'm not sure why that's an example of the expectation to a right of healthcare?
The issue was whether people had a right of access to experimental drugs such that, by denying them access, the FDA had violated the Due Process Clause. You have, for example, a right to access your children, the public streets, etc., which the Government can not take away without due process of law. The question was whether experimental drugs are like public streets or children in that sense. The appeals court said, "no," and the Supreme Court tacitly agreed. but I don't think that means either court thinks the issue was whether people have a right to access health care services. Unless I missed something . . .
I'll email you the circuit court en banc opinion, and head notes.
You did miss something.
You missed the fact that I said this court case is a good example of an EXCEPTION (not "expectation") to the idea of health care as a right.
In my entry I mentioned that despite what some people may think about the right to health care, one cannot dictate the contents or methods of that care.
This court case illustrates that people do not have a right to experimental drugs, ergo an exception to the idea of health care as an absolute right.
Oh. Uh, right.
That's what I get for trying to dink around on the Internet AND take notes in class . . .
I am sorry about that. :)
(The case is still an interesting read, though!)
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