All Commentary
Tuesday, April 20, 2010

Do We Really Want a Right to Health Care?

Do you have a right to health care? People want a right to health care because they think it will guarantee them the services they need. But might obtaining health care as a political right rather than a market commodity have a downside?

The government cannot produce or purchase an infinite amount of health care. Decisions have to be made about what the right to health care includes: Does it include free visits to the doctor anytime you want? MRIs and CTs to check out every pain? Dialysis and kidney transplants for all? Free paid leave for every bout of depression? Experimental therapy? Any and all preventive screening tests? We could spend the entire federal budget on health care and not provide all of that to every American. A right to health care does not guarantee you’ll have all you might want or need.

It’s not only knowing how much to produce, but what types of things to produce. We treat K-12 education as a right and expect the government to provide it. As a result, over the last 40 years the amount of money taken by government at all levels to run K-12 education has almost tripled on an inflation-adjusted per capita basis. But national testing in math, science, and reading skills shows no improvement, according to the National Center for Education Statistics, Digest of Education Statistics 2008.

Clearly, while the government provides something it calls “education,” it is not particularly successful at educating students. Making central decisions on how to educate–such as the “see-say” method versus phonetics or having the same teacher for all classes versus different teachers for every subject–leads to everyone’s suffering if good choices aren’t made. There is a lesson here for the more complicated provision of health care, as we talk about “expert panels” determining “the” way to diagnose and treat various medical ailments.

Just because something is a right doesn’t mean in practice it can’t be restricted. The “right” to K-12 education doesn’t include home tutoring or guarantees of tasty lunch choices in the cafeteria. Even if health care is viewed as a right, it may not include the coverage you hope to have.

Rights Don’t Guarantee Access

The Supreme Court clarified, in the 2008 District of Columbia vs. Heller case, that the right to have a gun to protect your own home is an individual right. The Supreme Court was interpreting the Second Amendment, but the amendment had been operative for over 200 years. A right doesn’t guarantee easy access. Plaintiff Heller had to spend several years and over $1 million to clarify what that right meant. And such clarification is by no means over. While you have a right to own a loaded gun in your own home in a federal enclave like the District of Columbia, the Supreme Court has yet to rule whether that right extends to the states–whether, in the vernacular, it is an incorporated right. Chicago has a total gun ban, and it’s taken two years post-Heller for the Supremes to clarify the Second Amendment’s further extent. DC is still arguing that while people may “keep” guns in their home, post Heller, District residents may still not “bear” them, take them beyond their homes. That requires yet further adjudication. So while Americans have a Second Amendment right, and have had it for over two centuries, it’s not yet clear what is included. And of course in the future, depending on the political makeup of the Court, Heller could always be overturned, as Brown overturned Plessy. Or an amendment could be added to the Constitution to nullify the Second, as the 21st nullified the 18th.

A right to health care faces similar challenges. Getting needed care through the political process takes time. Imagine you have a disease with a cure the government thinks is too experimental, too risky, or not sufficiently cost-effective. You have a right to health care, they say, just not that health care. But you need it, so you do what is typically done to defend your rights in the United States: You lobby the government; you write letters to your congressman; you speak before government committees; you encourage friends and relatives to help; you take time off from your job to do all this. You devote your remaining time on earth to getting the coverage; you raise money for candidates who say they’ll support such coverage. And you’re successful. A decade after your quest began, eight years after you died, the government starts to cover the treatment you needed. You had a right to health care, but wouldn’t it have been easier just to buy it (even if it took some charitable donations to help you)?

The last paragraph is more than hypothetical. In April 2005 England’s National Institute of Clinical Excellence (NICE) issued a press release, “NICE Lifts Restrictions on Access to Bowel Cancer Treatments.” It announced that English and Welsh patients could soon receive the same chemotherapy for advanced colorectal cancer that European and American patients had already been receiving for three years.

The bottom line: Expensive medical therapies are typically available in the United States years before they are available in countries with universal health care. Politicizing health care by making it a “right” simply pushes health care decisions into the political process, routinely leading to delays.

The Right to iPods?

People don’t have a right to iPods. They just have iPods. People who want them buy them. They were once expensive, but have come down dramatically in price in a remarkably short time; now much better units–more memory, more functions, smaller–cost less than half what the original units did. Some claim health care is special, that similar price drops can’t happen there. But when the market is allowed to work–in Lasik eye surgery or cosmetic surgery or when patients with health savings accounts shop around–similar price drops are seen. It’s only when third parties, like the government or large, highly regulated insurance companies, pay for health care that prices go up every year.

Is health care a right? Do we even want it to be a right? People fight about rights. Abortion has been recognized as a right since the 1973 Roe decision, but most Americans want restrictions on that right and many want it taken away. That is a risk of making things rights; rights can be modified, restricted, curtailed, or eliminated, depending on the political climate. Do we want people to be fearful that their right to liver transplants–or hair transplants–might also be someday taken away? Do we really want people feeling they must man picket lines on a regular basis to protect their “right to health care”?

Rights are like money. Both are good to have, but inflating them–believing that every good thing must be a right–makes them less valuable. Is health care a right? I hope not.