Health Care – is it a right or a privilege

18 August 2011

I think when people say healthcare is a right, or ought to be a right, they don’t always have the same thing in mind.  I think everyone would agree that you shouldn’t be denied healthcare on account of race or religion or ethnic origin, or sexual orientation.  Well, maybe everyone wouldn’t agree, but it’s not what people usually dispute about.  The question is whether you can get healthcare if you don’t have money to pay for it.

And you know that question is still not so clear.  Does it mean that you have a right to healthcare even though you can’t pay for it, but you still get billed and have to deal with it one way or another eventually?  That’s pretty much the current situation; if you’re broke you can go to an emergency room of a publicly supported hospital and get taken care of, and then maybe get a bill for $20,000 a month later. 

Or does it mean that healthcare is basically free, in the sense of covered by taxes with no debt or out of pocket charge to the recipient, the way it is in some other countries?

As I understand Obamacare, which hadn’t yet passed when we recorded this program, the basic answer the U.S. is going to provide about rights is that things stay unchanged.   You have a right to get healthcare, in that you don’t have to pay for it up front, but you still have to pay for it, or at least be in debt for what you get.

The big new change is that it's not going to be a right but a duty; everyone has to have health insurance.  So it seems to be that we have a right to healthcare without paying cash out of hand, but we have a duty to be able to pay for it, and this means having insurance.

But that is an important change, that affects our rights, namely our right to have health insurance.  You can’t have a duty to buy insurance, unless you can buy insurance.  And right now, we don’t all have that right.  Some people can’t buy insurance at all, and others can’t buy decent insurance at a reasonable price.  So if the plan is to make sense, the duty to have insurance will have to be paired with affordable, available insurance for everyone.

So our new right won’t be to healthcare, but to affordable insurance.  At least, that’s the outcome some people are hoping for.

In Western Europe, people by and large have healthcare covered by taxes.  We'll have something quite different -- healthcare covered by insurance; a duty to buy insurance; and a right to affordable insurance to buy.

There is still a lot of unclarity.  Given that I have the right to healthcare, the duty to buy insurance to pay for the healthcare I get, and the right to have affordable insurance -- still, there’s the issue of what level of healthcare I’m entitled to.  We include a lot of things under healthcare.  From setting broken arms to labia reduction surgery; from stitching up a child’s wounds to ten years of psychotherapy for a philosopher with writer’s block…

Consider the analogy with education.  Everyone is entitled to a high school education that covers basic subjects.  But some people, who live in richer school districts, or go to private schools, have smaller classes, and a wider variety of subjects.  Do we have a right to basic healthcare, like we have a right to a more or less basically adequate education?  Or does everyone have a right to healthcare that’s equal to everyone else’s?

It sounded so simple: right or privilege?  But it’s a mess.  We need help.

And we’ll have it.  Laurence Baker, a Professor of Health Research and Policy joins us in our conversation about right and healthcare.