Why Health Care in Not a “Right”

Here is another old article that was published in Minnesota’s Metro Docs back in 2007.  The opening quote is from Ayn Rand who is back in fashion in a big way with the growth of government and the recent release of the “Atlas Shrugged” movie.  The article is more relevant that ever with the advent of Obamacare and a recent discussion in the Congress about whether or not health care is a “right”.

health care is not a right“If some men are entitled by right to the products of the work of others, it means that those others are deprived of rights and condemned to slave labor.”

Ayn Rand

“If we can prevent the government from wasting the labors of the people under the pretense of caring for them, they will be happy.”

Thomas Jefferson

 

There are serious problems in American health care.  The issues of double digit inflation and the uninsured cannot be ignored.  It is tempting to believe that by simply putting pen to paper we can create a “right” to health care and solve these problems.  Sadly, such a legislative solution does not address the root cause of the issues and will make things worse rather than better.


In all sectors of the economy outside of health care, consumers restrain their purchases based on price and value forcing providers to drop costs and raise quality.  This does not happen with health care.  With first dollar payment, whether by an insurance company or the government, the patient perceives costs as zero.  With a perception of zero costs, demand is potentially infinite.  Even wealthy insurance companies and governments do not have infinite financial resources.   Patients have no incentive to function as savvy shoppers therefore someone must limit expenses.  Any third party payment system must do exactly that.  This holds true whether it be the British National Health Service, the Canadian Ministry of Health or American insurance companies.  No measure of compassion or “political will” can alter these economic facts.

The current government created third-party payment system has someone other than the patient footing the bill.  Such payers attempt to pay out as little as possible.  Providers bill as much as possible to recoup costs.   The hapless patient without insurance may be saddled with an enormous bill that bears no resemblance to what the costs would be if health care were a marketplace commodity where patients functioned as consumers.  Why not let patients’ control the money they spend rather than having corporate or government bureaucrats do so?  The claim that health care is too complicated is an elitist insult.  Cars and computers are complex also but somehow we can all figure out when we are getting value for our dollar.

One method of attempting to guarantee a “right” to health care is a government run single-payer system.  Under such a system, doctors will not be reimbursed fairly nor will patients have their needs met.  In normal markets, the allocation of resources is determined by the intelligence of the marketplace in which we all democratically partake with the free exchange of dollars.  Instead, in government systems of health care, resources are allocated by those few that can get their hands on the levers of political power.

The United States was unique amongst nations in that it was originally based upon the value of liberty.  Freedom, as originally conceived, was limited to the field of politics.    The term simply meant freedom from the coercion of others.  It certainly was not a claim to the property or labor of others.  The claim that “A hungry man is not free” is absurd.  It confuses the political concept of freedom with the biological fact that we all have needs for food and shelter.  Food is even more necessary to sustain life than is medical care.  Food is not deemed a right and yet virtually everyone in this country gets fed.  In fact, the poor in this country have a problem with obesity, not emaciation.

Liberty requires rights.  Rights originally defined freedom of action.  They were not a guarantee of being provided for.  The original rights were all “negative” rights in that they simply defined the freedom to act.  The only obligation was to refrain from interfering with the actions of others.  On the other hand, positive rights impose an obligation for someone to do something for others.  All rights listed in the Bill of Rights are negative rights.  They simply allow the freedom to act with no imposed obligation.   All legitimate rights are negative rights or liberty rights.

“Rights” such as health care imply that someone must act to provide them.  What of the liberty rights of the providers of health care? They have to be violated and therefore positive rights such as health care are pseudorights.  The liberty rights of doctors, nurses, taxpayers and health care entrepreneurs must be abrogated to provide such care.  Implicit in health care as a “right” is that these people must be coerced.

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For example, the proposed Clinton Health Security Act of 1993 was based on compulsion.  The word prison shows up seven times in the legislation.  Penalty 111 times.  Fine six.  Enforce 83, prohibit 47, mandatory 24, limit 231, obligation 51, require 901.  The Republican counter proposal was also based on forcing people to do what government believed to be the right thing.  Prison was used once.  Enforce 37 times, penalty 64, fine 12, prohibit 19 and require 482.[i] It is simply inescapable that the government provision of goods and services is based on government compulsion of its own citizens.  Countries based upon coercion of its citizens, rather than liberty, have not fared well.  The lesson has been well demonstrated in the Soviet Union, China and North Korea

In my home country of Canada, their system of government medicine started merely as a payment system.  Because no government has infinite resources, government in Canada has had to insidiously take over and control all of health care.  This necessitates a system of Soviet-like centralized planning and co-ordination of the resources.  Such a model is a proven failure with the collapse of the Soviet economy.

Simply look at food production and distribution in the former U.S.S.R. versus the availability of food on Manhattan Island.  In the U.S.S.R. people were starving and waiting in lines for basic items like eggs, milk and flour.  On Manhattan Island, you can get any type of food 24/7 whether it be Peking duck, take-out lasagna or a diet caffeine-free Coke.  This illustrates the clumsiness of central planning versus the agility of free markets.  Market solutions work brilliantly and socialism is a dismal failure.  It is often mistakenly believed that health care is so important that we cannot entrust it to free markets when the reality is that because it is so important we must entrust it to free markets.

Just as importantly, in a government system, reimbursement is on a fixed fee schedule.  This is a form of wage and price controls. As Milton Friedman had said, “Wage and price controls lead to shortages – always.”  That is why 16.8% of the Canadian population has no access to primary care[ii] and the average wait to see a specialist is 18.3 weeks[iii].

Those that really care about the current state of health care in America should abandon claims of health care as a right or demands for a single payer system.  We do not want to further empower clumsy government or privileged insurance companies to spend our money.  The truly thoughtful should demand that patients, in conjunction with their doctors, be empowered to spend their own money as they see fit to obtain the services that are needed.  This can be achieved by using insurance as originally intended for unlikely events and not for first dollar coverage of routine and expected care.  Deregulated high deductible insurance, and HSA’s are the path to marketplace innovation and lower costs.  Look at the prices for Lasik surgery.  Lasik is not covered by most insurance policies.  Costs have plummeted and ophthalmologists are paid precisely what the marketplace sees as fair payment.  Public monies currently used for the poor could be redirected into HSA’s for them.   Such strategies could unleash the awesome productive power of the marketplace that has created the wealth, abundance, and low costs prevalent in every other sector of the mighty American economy.  Best of all, no one will have to have their liberty sacrificed for a bogus right to health care.

Lee Kurisko MD FRCPC is a diagnostic radiologist from Canada working in Minnesota and is Chief Medical Officer of Medibid.  www.medibid.com is an online portal for buying and selling medical goods and services without the intrusion of third parties.  He is also author of “Health Reform – The End of the American Revolution?”


[i]Browne, H., Why Government Doesn’t Work, St. Martin’s Press, 1995, p. 101.

[ii] Canada AM, CTV website, July 4, 2007,

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070704/immigration_doctors_070704/20070704/

[iii] Waiting Your Turn.  Hospital Waiting Lists in Canada. 17th Edition, N. Esmail, M.A. Walker, October 15, 2007, http://www.fraserinstitute.org/commerce.web/publication_details.aspx?pubID=4962

3 responses

Outstanding post.

The very same group of people demanding that health care is a right, is the same group of people telling us that sometimes they’ll have to deny us that right, against our will and perhaps to our detriment, but only so they can continue to provide us with that “right”.

For all it’s faults, the US health care system is far more open to accepting the newest technology, even if it’s created in another country. Canada may have good docs and hospitals like every other country but our system is dominating by bureaucracies. Even prestigious hospitals in Canada are struggling with bed shortages and specialist shortages. Funding crisises abound in Ontario and Canada.

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