Is healthcare a human right? Smart people argue both sides of that question in a search for the best answer for US citizens. What about the European model? Has Singapore found a way that is much less expensive than European healthcare? We take a look as the ACA (‘Obamacare’) seems to be on the verge of collapse, and the US Senate comes up short of answers for this question, again.

Healthcare as a Right?

“It’s a great applause line, isn’t it, to say that “health care is a universal human right.  But after the applause has died down, we’re left with the question that the left rarely takes time to answer: what is health care?” — from a Forbes article on “Yes, Health Care is a Right — An Individual Right”

A piece published in the New Yorker by Atul Gawande, surgeon and public-health researcher, argues that healthcare should be a right based on how technological change has extended average lifespans and needs for medicine: “Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can’t afford the requisite care get sicker and die sooner. Yet, in a country where pretty much everyone has trash pickup and K-12 schooling for the kids, we’ve been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that’s open to all.”

The counter-argument for healthcare as a right is made in an article in The Washington Times entitled, “Healthcare Is Not A Right.” It is written also by a physician — Roger Stark, the policy analyst for Washington Policy Center’s Center for Health CareFirst. Noting that, “every citizen of Canada has government-paid health insurance, but the long wait times for treatment, most notably for specialty care, would be unacceptable for Americans,” Stark also observe that no one expects the government to provide for food, shelter, and clothing. It also notes that:

“Because of budgetary constraints, the demand for healthcare is much greater than the supply in virtually every county with a government-controlled healthcare system. Even Medicare, essentially a single-payer plan, is not financially sustainable.”

Stark concludes that healthcare is “an economic activity like any other”, and so, “society should work toward putting patients in charge of their healthcare, reducing the role of government, and focusing on access, not healthcare as a supposed ‘right.'”

Physicians tend to have strong opinions about healthcare as a right.  Daniel Summers writing in the New Republic observes, “As a pediatrician in private practice, I have grave concerns that implementing a rapid transition to a single-payer system would be far more disruptive to many Americans’ health care than Sanders cares to discuss.”  He believes the plan put forward by Bernie Sanders (‘Medicare-for-all’), would reduce payments to doctors and hospitals.

What are the pros and cons of healthcare as a right?

A cursory read of ProCon‘s argument page on US healthcare yields a list of the major points with concise arguments for each proposition:

  • The purpose of the US Constitution, as stated in the Preamble, is to “promote the general welfare,” not to provide it. vs. According to former Congressman Dennis Kucinich (D-OH), as part of efforts to “promote the general welfare,” healthcare “is a legitimate function of government.”
  • A right to healthcare could increase the wait time for medical services. According to a 2012 Government Accountability Office (GAO) report, 9.4% of Medicaid beneficiaries had trouble obtaining necessary care due to long wait times, versus 4.2% of people with private health insurance.  vs. A right to healthcare could save lives. According to a 2009 study by Harvard researchers, “lack of health insurance is associated with as many as 44,789 deaths per year,” which translates into a 40% increased risk of death among the uninsured.
  • A right to healthcare could make medical services affordable for everyone.  vs. Providing a right to healthcare could raise taxes. In European countries with a universal right to healthcare, the cost of coverage is paid through higher taxes. 

“…putting everyone on the same plan without acknowledging restricted choices as an inevitable consequence isn’t telling the whole story.”  — from “I’m a Doctor. Here’s Why I Oppose the Single-Payer Revolution”, by Daniel Summers in The New Republic

We noticed the word ‘could’ used for each point in the list about healthcare as a right from ProCons above because a lot depends on whose figures you believe. Meanwhile, Avik Roy in a thought-provoking piece for Forbes offers some startling figures that at first seem to be an argument against government provided healthcare. He tells the story of a young boy who died of complications from a toothache in the US even though he was insured by Medicaid. The reason?  “Here in Connecticut, Medicaid pays 63 cents for every dollar that a private insurer pays a doctor to treat someone. In New Jersey, Medicaid pays only 33 cents. In New York and Rhode Island, it’s 29 cents. Doctors here face the impossible choice of treating these indigent patients, and bankrupting their practices, or not treating them at all.”  What about those that want to pay the difference to a Doctor between what the government pays and what the care actually costs?  The startling answer is that “for those enrolled in government-run health insurance, it is illegal to try to gain better access to doctors and dentists by offering to make up the difference between what healthcare costs, and what the government pays.”  Roy continues:

“That basic right—the right of a woman and her doctor to freely exchange money for a needed medical service—is one that 90 million Americans have been denied by their government.”

What are some smart solutions to healthcare coverage?

The Forbes article quoted above also cites an example from Singapore, where “Singapore spends one-seventh of what we spend on healthcare and one-quarter of what Europeans do. And yet Singapore has managed to cover everyone, with health outcomes that are as good or better than the rest of the world. They’ve done it through a system of universal health savings accounts, in which every Singaporean saves for his own routine health expenses while gaining insurance coverage for catastrophic events.”

Another Forbes article asks, “What if hospitals provided you a tailored solution to plan, save and pay for non-emergency medical procedures such as those related to pregnancy, eye care, dental, plastic surgeries, orthopedic, genetic testing and so on? That’s what Affordplan does. As Step 1 Affordplan allows a prospective patient to choose a hospital of your choice & decide the amount you need to save. In Step 2 it allows people to save on a daily, weekly, or monthly basis, as per their chosen plan, and then make regular payments either by online transfer or depositing money at hospitals. Once a patient completes the savings plan, you can easily avail the medical treatment at your selected healthcare facility without the burden of upfront one-time payment.It is an Innovative Financial Savings Platform.”  We reviewed the Affordplan website and saw they are working with a network of hospitals to enable patients to “pay for their treatment expenses in advance through flexible & convenient payments. Not only does this ensure affordability for the patients but also guarantees zero credit risk for medical institutions.” It’s a systematic way of generating advance cash flow from the patients for the hospitals.

The Intercept has an article which while advocating single payer notes that “MARYLAND IS THE only state in America where all hospitals must charge the same rate for services to patients, regardless of what insurance they carry. There’s some variance between hospitals, but every patient in a particular hospital pays the same. Other states experience huge, seemingly random differences in hospital costs, depending on the insurer (or lack thereof).”

According to a recent article in VOX, the bottom line for healthcare as a right is the reality that, “the amount you pay doctors (and hospitals and drugmakers and medical device manufacturers) is, in so many ways, what determines what a healthcare system looks like.” It’s a tough reality, and this article offers no definitive solution. Instead, the realization that “American doctors have planned careers (and often gone into significant student loan debt) around our current healthcare prices. Hospital systems have built multi-billion dollar businesses, often the largest employer in a rural area, around them. A significant reduction in healthcare prices would near certainly lead to layoffs in those systems and fewer jobs in healthcare overall, a sector that currently employs one in nine American workers.”