Saturday, June 11, 2016

Health Care: A Right or Privilege?

By Rudy Barnes, Jr.
            Health care is in transition.  Once considered a privilege for those who could afford it, health care is now considered a right.  It is still provided by the private sector, but unlike other essential services provided by the private sector, health care has inadequate cost controls.  The result is a complex, costly and often dysfunctional health care system in need of an overhaul.

            In 2008 candidate Obama promised cost controls before making health care a right, but later reversed his priorities.  Obamacare (The Affordable Care Act) provides universal coverage without adequate cost controls, and the problem is exacerbated by the unneeded and costly function of health insurance companies in primary care.  Also, costly advertising by health care providers should be controlled, beginning with prohibiting expensive ads for prescription drugs. 

            The increasing cost of health care is caused by an aging population, new developments in medical technology and drugs, and unreasonable public expectations.  Structural changes are needed to fix a dysfunctional health care system and control costs, and cost controls are resisted by health insurance companies, hospitals, pharmaceutical companies and other providers.     
            Free enterprise is essential to our economy, but it has no place in primary care services provided as a matter of right.  Another systemic dysfunction is a separate VA health care system that creates unnecessary issues of quality and expense.  Veterans would be better served by a merged system that would allow them to see a doctor of their choice. 

            Republicans in Congress have consistently opposed Obamacare but offered no substitute for it.  They would deny health care for those who cannot afford it until they qualify for Medicare, unless they are poor enough to qualify for Medicaid.  Bernie Sanders has proposed to extend Medicare with its cost controls to all ages.  It is an alternative to Obamacare that should be given serious political consideration, but it would be resisted by private health insurers.           

            With the escalating costs of health care and increasing public expectations for it, resort to surgical procedures should be minimized and emphasis put on preventive health care and less invasive medical procedures.  The emphasis on prolonging life should be tempered by efforts to minimize suffering, and death with dignity should be considered for the terminally ill.

            Lawsuits against health care providers not only increase medical costs but can also distort choices on medical options, since doctors often choose more extreme procedures to minimize potential liability.  Limiting the liability of health care providers by prohibiting punitive damages could reduce the cost of health care and encourage doctors to choose less extreme procedures.    
            Since health care is a right provided by private providers, they must be regulated and their costs controlled by government to ensure public accountability.  That is the case for public utilities that are regulated by public service commissions.  Unless a Medicare model with built-in cost controls replaces Obamacare, health care costs must be regulated by a government agency.  The laws of supply and demand don’t work for essential services.

            The evolution of health care from a privilege for those who could afford it to a legal right has created many issues.  Is there an age limit for expensive life-saving procedures?  Are doctors ethically required to prolong life at any cost, no matter what the prognosis?  What about physician-assisted death, or euthanasia?  These are issues with religious, moral and legal implications that will challenge policy-makers for years to come.

            Abortion and euthanasia are contentious political issues that arouse religious passions, but neither are addressed in the scriptures or teachings of the great prophets of Judaism, Christianity or Islam—perhaps because they were primarily concerned with spiritual matters that transcend mortal life.  Today’s emphasis on the sanctity of life is more secular than religious.

            Abortion has polarized politics along partisan lines, and euthanasia is likely to do the same.  On June 9, California became the fifth and largest state to allow physician-assisted death.  Perhaps there will be a Roe v. Wade decision to address simmering disputes over euthanasia, but that Supreme Court decision did not resolve the abortion issue.

            The greatest commandment to love God and our neighbors as ourselves is a moral imperative for Jews, Christians and Muslims that can provide guidance for making hard decisions in health care and even in deciding life and death issues.  Applying love for others to health care and life and death issues can be problematic, but there is no better religious or moral standard available—and we have learned that laws don’t always resolve the issues.          

Notes and References to Related Blogs at

See Religion and Reason, December 8, 2015; The Greatest Commandment, January 11, 2015; The Kingdom of God, Politics and the Church, March 15, 2015; Faith as a Source of Morality and Law: The Heart of Legitimacy, April 12, 2015;  Who Is My Neighbor?, January 23, 2016; The Politics of Loving Our Neighbors as Ourselves, January 30, 2016; The American Religion and Politics in 2016, March 5, 2016; Standards of Legitimacy in Morality, Manners and Political Correctness, April 23, 2016; The Relevance of Religion to Politics, April 30, 2016; Religion and a Politics of Reconciliation, May 7, 2016; The Arrogance of Power, Humility, and a Politics of Reconciliation, May 14, 2016; and Christianity and Capitalism: Strange Bedfellows in Politics, June 5, 2016.

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