The Right To Health Care

Much of my recent writing on health care has been about the economics of the various means of providing health care. I haven't really focused on the more macro, theoretical.

It is easy to state that it is immoral to deny medical care to a person who needs it. I'm willing to bet it's very difficult to find anybody who would disagree. Shit, FLG agrees. And, with a simple use of logic, it is easy to reach the conclusion that people have a right to medical care, but that's a bit more problematic than that.

For many, especially on the Left, it is that simple -- People have a right to health care and the government has the duty to provide it. In fact, many regard health care as a purely moral issue and it angers them that politics and economics are even playing a role in the debate. Even for those who accept the reality that politics and economics will always play a role in government action, they want to press forward and figure out how to pay of it later. But it really isn't so simple.

For example, how do we define need? This is a crucial definition. Some things are easy. A person severely injured in a car accident needs surgery. No brainer. Alternatively, nobody needs cosmetic surgery. But then what about reconstructive surgery. Often it's not need for survival. So, is it needed? Does a 90 year-old need a hip replacement? Presumably, these are the decisions we would cede to the government bureaucracy.

My point here is that our compassion for other human beings is a noble and good aspect of human nature. When we hear that somebody has cancer we don't want to hear about bills, we want them fixed up to the best that is available. Furthermore, our compassion informs our morality. But morality, good feelings, and compassion don't translate into policy as cleanly as we want, and it's not a function of politics being ugly or economics being heartless. It's a function of our material world is not ideal and doesn't always conform to our desires.

So, to return back to the statement above that it is immoral to deny medical care to somebody who needs it. The definition of need is important. We cannot afford to give everybody every medical procedure they want. This isn't heartless economics or accounting, but the irreducible dilemma that we have infinite wants and finite resources.

Somebody has to decide what are medical needs and what are medical wants. If that's decided in large part by the government, which is what Obama is trying to do when he is talking about cost cutting and ineffective care, then that's going to increase the power of government. Increasing government power isn't in and of itself necessarily a bad thing, but FLG distrusts it.

What's most interesting to FLG about the current health care debate is that Obama pretty much conceded his strongest point in support of his plan from the get go. While the argument that it is immoral to deny medical care to somebody who needs it is problematic because it all hinges on the definition of need, it remains a compelling moral statement. If Obama had pressed forward with a moral justification, then it would've been harder to argue against.

Ah, but he had to include cost control. At that point it is no longer a seemingly simple moral case. It's no longer about health care being a right. It's about what the word need actually means. It's about the limits of the right to health care. It's about budgets and policy, not morality.

Some say, and I'm apt to agree, that the current system is problematic in its incarnation. We acknowledge the immorality of denying care, but alternatively don't recognize the right to it either. Therefore, we don't provide care until the last minute, when the patient is in the emergency room. And some argue that this care is more expensive than preventive care and consequently a more rational approach would be to recognize the right to medical care in the first place rather than simply acknowledging the immorality of denying care. But, surprising even to FLG, increasing preventative care requires increasing coverage, which rather than saving money will cost more.

I'm feel like I'm going round in circles, but even if we all agree with the statement that it is immoral to deny needed medical care, that still doesn't help us decide exactly what needed care is. One could say, well, let's let the doctors decide, but then there aren't any controls on cost and we can't pay for everything everybody wants. Finite resources versus infinite wants thing again. So, in the end, somebody must decide what is a want and what is a need. Some would prefer to leave that to the government because they believe the distribution would be more equal and therefore more moral. Some, like FLG, would prefer to have a variety of private plans that offer varying levels of coverage at various levels of cost. You know, market forces determine what will be delivered while acknowledging that health care has positive externalities and therefore the market will provide care below what is socially optimal.

And again I am back to where I always am with positive rights -- too often they seem like very simple issues, but upon closer examination they are very complicated. It's easy to say that everybody has a right to a great and equal education, but great and equal are in conflict. It's easy to say that people have a right to health care that they need, but somebody will have the power to define what "need" means. And that's a lot of power. Also, positive rights, like all provision of goods and services, run into the fundamental dilemma that we have finite resources and infinite wants.

All this is not to say that we cannot reach some sort of generally acceptable understanding of what is needed care and what isn't that can then be used as the guiding principle for health reform. But I will say this -- if your argument for more coverage is simply that human beings have a moral right to health care, then you may be correct, but you are dangerously oversimplifying the issue involved.