WhiteCoat

Healthcare As A Right

medicaid-use

I was going to take the day off from blogging, but as I was reading the latest edition of American Medical News, an article caught my eye. The article noted how West Virginia is trying to reign in its health care costs by offering benefits to those who adopt healthier lifestyles … and by limiting benefits to those who do not adopt healthier lifestyles.

The map accompanying the article was eye-opening. States provide free medical care for anywhere from 9% to 35% of their populations. New York and California provide Medicaid services to between 25 and 30% of their populations, or (as of 2005) at least 4.8 million and 9.0 million people, respectively.

I don’t believe that healthcare is a “right.” Instead, I believe that people should look upon good health and the ability to receive health care as a privilege. I won’t argue the point because I don’t think that I can do better at illustrating it than other bloggers have done. For example, see Shadowfax, Maggie Mahar, and Kim at Emergiblog.

For the sake of argument, let’s assume that healthcare is a right. Pretend that there is a microscopic footnote in the Declaration of Independence that refers to the back of the document and clearly states that, along with “life, liberty, and the pursuit of happiness,” healthcare is a right to every citizen in this country.

Even the rights that we have been afforded by our forefathers are not absolute.

We have a right to life. We don’t have a right to a life in a $12 million mansion at the expense of the general public. If we murder someone, even our right to an existence on the planet may be forfeited.

We have a right to liberty, but we may lose our liberty if we commit a felony.

Nor do we have the right to a pursuit of happiness if that pursuit involves illegal acts such as drug trafficking, robbery, or rape. Even if our pursuit of happiness is not illegal, we are afforded the right to pursue happiness, not to force someone to make us happy.

The Bill of Rights is a general framework of “rights” each citizen in this country is afforded. In each case, there are exceptions to those rights. We have the right to free speech, but we do not have the right to “shout ‘fire’ in a crowded theater.” We have the right to bear arms, but only if we comply with state laws. We have the right to a trial by jury – unless we are in Tax Court or another court in which there are no juries. We have the right to vote provided that we are not felons and have properly registered to vote.

I may be mistaken, and correct me if I am wrong, but each “right” we have in this country has limitations. There is no “right” in our country that is absolute.

When people in this country abuse drugs, abuse alcohol, smoke cigarettes, eat Bacon McBypass burgers, fail to exercise, refuse to take their medications, and engage in unhealthy lifestyles, should those people still be afforded an absolute “right” to health care?

If health care is going to be available to everyone in this country, we are going to have to become comfortable with the notion that even if health care is a “right,” it is not an absolute right. Why should we treat the “right” to healthcare differently than any other “right” in this country?

Those who abuse their “right” to health care will have their “right” limited. West Virginia is taking a first step in this direction.

A sign of things to come …

13 Responses to “Healthcare As A Right”

  1. Jeremy Miles says:

    If you are drowning in a river, do you have a right that means that I pull you out, even if that’s very inconvenient for me? I’m not sure that that’s a right, but I wouldn’t describe it as a privilege either.

  2. Angela says:

    Some people are born poor, some people are born with brown skin, some people are born with a bad heart. In each case, they should have the same rights as other people who are lucky enough not to have to overcome such obstacles.

    This is not an issue of giving “rights” to some and not to others.
    It is an issue of taking rights away from those who act inappropriately.
    The same “rights” would be taken away from the elite athlete and the person with a “bad heart” if those people repeatedly refused to take their medications, smoked cigarettes, or engaged in other unhealthy behavior.

  3. marcia says:

    I’d like to know more about the limitations the WV plan imposes on people enrolled in the “basic” plan. The example given in the article, allowing access to mental health care but not to crisis management, seems short-sighted and poorly thought out. How do you deny someone who’s actively mentally ill access to emergency psychiatric care without jeopardizing the safety of both the community and the individual?

    Have you seen any other examples of restrictions under the “basic” plan?

    Also, I’m not convinced smokers, drinkers, drug users and morbidly obese people on Medicaid would find access to Weight Watcher’s and Smoke Enders particularly appealing incentives to change. This is usually not a population that’s well educated or highly motivated to abandon ingrained habits (imo), especially if their vices help them cope with stress and hopelessness.

    Making physicians responsible for enrolling people seems a little problematic, also, as it requires more work on the part of an already overburdened medical staff. I wonder if this is something that could be handled by VISTA or Americorps?

    It will be interesting to see how WV’s program works out, whether it actually reduces costs, and how well people who opt in actually comply with requirements.

    I think healthcare policy is fascinating. Isn’t that weird?

  4. pylorus says:

    How do you determine if someone “acts inappropriately”?

    Furthermore, what if someone has acted appropriately (immaculately?), whatever you’ve outlined that to be, and still develops a medical condition? How do you avoid blaming the victim in that case?

  5. Erik says:

    UM – this is not a question of rights or priviliges. This is a question of who pays for someone’s care.

    If I have a right to shelter, I can spend my money and buy a home. Or I can ask the local government to shelter me and I might end up in a housing project or a homeless shelter at someone else’s expense.

    If you want a face lift, or LASIK eye surgery, or a tattoo, you can spend your money and buy what you want. If you asking someone else to pay for you, then that person may say yes or no.

    If there is a limited supply of money (as their almost always is) then some people will get told “No, you can’t have your bypass/operation/pain meds/chemo/whatever”

    We have to pick some criteria. If smokers and drug abusers may have more trouble than pleasant grandparents convincing the treasury, then so be it.

  6. Nurse K says:

    The stuff is pretty basic–“You need to take your kid to get his shots and checkups or the kid can’t have > 4 prescriptions per month paid for.” However, since most Medicaid kids, as the article says, get fewer than one prescription per month, this is really a non-incentive.

    Also, like Marcia said, Medicaideurs, at least the ones I see, are NOT scrambling to join Weight Watchers. Another non-incentive.

    Real incentives include: Higher co-pays if you’re obese, higher co-pays if you smoke, higher (like really high) co-pays for ER use (ie you better be sick enough where your $50 co-pay, which can be deducted from other government benefits or tax refunds, is an afterthought), and lower co-pays for clinic/urgent care use as well as generic medication use.

  7. marcia says:

    “Real incentives include: Higher co-pays if you’re obese, higher co-pays if you smoke, higher (like really high) co-pays for ER use (ie you better be sick enough where your $50 co-pay, which can be deducted from other government benefits or tax refunds, is an afterthought), and lower co-pays for clinic/urgent care use as well as generic medication use.”

    I think you’re exactly right. Out-of-pocket cost is a big incentive to most of us to manage our lives better. I reluctantly switched from name-brand meds to all generics this year (obviously not a choice for everyone), and have not only saved my own money, but the insurance company’s money, as well. The generics have been entirely adequate for my needs.

    Incentives are nice, but disincentives can be more effective sometimes.

  8. ERP says:

    I think there should be a “right” to health care for catastrophic problems for everyone – ie major trauma, ruptured Appy, etc. Such coverage would be cheap for young healthy people. Also, I believe that health care should be MANDATORY. Like car insurance. If someone claims not to be able to afford even a very basic policy, they have to prove it. I have read that nearly 50% of the uninsured could afford basic, catastrophic coverage but chose not too because they think they are invincible or would rather spend their money on partying, a new car, etc. Anything beyond such coverage does not need to be mandated but reasonalbly priced policies have to be created – and I believe people that don’t smoke, keep their weight down, etc should be rewarded with cheaper policies. However, people who develop unavoidable conditions like Parkinson’s, MS, SLE, etc should not be penalised and thrown off policies. Some middle ground has to be reached.

  9. Roger says:

    There are some good idea’s here. One thing that has amazed me when I read about the abuse of the medical system is the seemingly unlimited dollar amounts that can be spent on people. Since all other “entitlements” have a monthly limit or require a spend down for participation, why is this benefit seen as a different animal? In some states there is a time limit for benefits. If you are over 18 then health care should be the same. You have X years to participate in behavior modification counseling for self induced health issues. Don’t participate or exceed that and I think it is no different than suicide. If you expect the state to take care of you, you sacrifice your rights to the state.

    As someone who spends 45% of the family NET income on health care costs, I get pretty tweaked when I hear people claiming this is a “right”. I do understand and sympathize with people who have health issues beyond their control or not of their making.

    I have in-laws that use the emergency department for primary care. Partly because the doctors who take medicare are overbooked and mostly for convenience. I think sitting in a doctors office having a nicotine fit while waiting for their asthmatic child to be seen is the ultimate irony. It is apparently also to much to effort to ask for, to receive free services.

    I think that is the crux of the issue. If it involves no pain or sacrifice, why would they care who pays for it? I know I am very careful when I use my self funded benefits. I have used super glue and duct tape to hold a laceration together to avoid an ER co-pay. But my sister-in-law thinks nothing of taking a child to ER for a one day cough so they don’t miss school and intrude on her “busy” day. Doctor visit, x-ray and prescription free of charge for her. OK enough whining from me.

    Roger

  10. Elizabeth says:

    I think this is a great idea. When I was in high school I worked in a grocery store in a small town in NY. It seemed like 99.9% of food stamp purchases were Doritos, Pepsi and Top Ramen.

    When I graduated and did a few years of classes at our community college I worked days in a local PCP’s office. All my old regulars from the checkout line came into the office for obesity, diabetes, hypertension, yada yada yada. All preventable, many in their 20’s and 30’s- some younger. And guess who footed the bill? The county has a 40% welfare populous. Medicaid. This wasn’t a free clinic, it was the ‘upscale’ office in the county.

    Some of my former coworkers siblings had 6-8 kids to keep the checks coming…

  11. Nurse K says:

    Food stamps should be like WIC–can’t buy crap food with it. If you want Pepsi and Doritos, spend your own money.

    Wouldn’t it be cool if the government issued a card instead of food stamps? The card could block payment for anything that was considered “crap.”

  12. ERP says:

    I actually agree with Nurse K on something for a change. Food Stamps currently can’t be used for ETOH and Cigs – that should be extended to junk food, stuff with high fructose corn syrup, palm oil, and other toxic crap.

  13. lani says:

    I LOVE to follow this blog….it’s one of the only things that helps me get through a shift or go back to work in general….I’m just wondering if I can blow this up 1000% and post it in my department and maybe hand it out on fliers…laminated if need be??? would that be so wrong???

    Sure. I’d be honored.
    Take a picture and send it to me. I’ll blow it up and put it on *my* wall.

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