The language of rights applied to health in the U.S.

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Last night there was a question in the Presidential Debate on whether healthcare should be a privilege, a right or a responsibility in the U.S. McCain gave a nuanced answer -- but said it was a responsibility and Obama said he considers it a right for U.S. residents since we are a wealthy society. It is a really interesting question -- especially if you are like me -- a wanna be economist/philosopher. For those that want a long but illuminating blog post on the topic of rights and obligations -- see Maggie Mahar over at THCB.

Before we get to the question of rights however - we need to take a short detour into the world of economics. During the debate and throughout the policy community there is a conversation about employer paid health insurance, vs. universal government paid health insurance vs. individual paid health care (or insurance) along with the entitlement programs we already have -- Medicare and Medicaid, SCHIP and not to mention disability payments and other programs. People -- there is no free lunch here! One way or the other, individuals/citizens/consumers are paying for health care, period. There is no other funding source. YOU are paying for health care...maybe not when you consume the service -- but you ARE paying for health care. Here is how we pay for health care:

  • Lower wages so employers can pay the premium on health insurance
  • Medicare tax on wages
  • Partial payment of premiums, co-pays and other out of pocket expenses
  • Other taxes (income or real estate) so the States can fund their portion of health benefits for employees and for their entitlement programs
  • higher prices on goods/services from businesses -- so that the businesses can pay their taxes
  • and so on

So the individual citizen is paying for health care today -- whether directly or indirectly. It is too bad politicians or journalists don't make this point more often. So the question really comes down to one of who pays for whose health care? As a taxpayer and citizen -- in addition to being accountable for my families health needs -- how many additional folks should one be accountable for? The looming Medicare funding crisis is precisely this -- in the future the folks paying into the system won't be enough to cover the folks taking services out. (there should be a whole sidebar discussion of insurance here -- but later).

The economic detour was necessary to frame the philosophical question properly. Talking about healthcare as a right -- without understanding that it is an economic good that has to be provided and paid for -- is wrong. It is not like "free speech" or freedom of religion...which may have economic implications as 'rights' benefits of a better more transparent society) ...but certainly don't require specific resources to have the right or to compete for economic resources the way healthcare does.

I like to think I am as compassionate or more so than most people. I would love for everyone to have more economic goods -- more healthcare, more health, more economic security, more food, lower gas prices, lower house prices (well maybe not) -- but you get the idea. But the system of incentives you choose to deliver these goods (capitalist or socialist or communist) matters and matters a lot -- to the quality, quantity and prices of the goods available to share. We have learned that the form of economic incentives matters to the outcomes for society -- and directly to what society can invest in redistributing. While the concept of capitalism may be taking a beating in the popular press today -- I have yet to see evidence of system that works better -- and we should better remember that when we try to learn the real lessons from today's crisis.

More importantly -- healthcare is really complicated as an economic good in lots of ways. But the one that matters for this argument is that -- many of the behavioral choices an individual may make -- like smoking or not being compliant taking your drugs -- can dramatically increase the healthcare economic goods required over one's life. If healthcare is a right -- do I have the right to ALL the healthcare I can consume and NO accountabilities to society on how I consume it? If not, who decides? Hopefully you can see where this leads.

I may continue this thread at a later time -- so comment if you have something to add.

Calling healthcare either a right or a moral obligation -- won't help us think clearly about the path to reforming the system to deliver more value nor will it help us understand the harsh economic realities and incentives required to build a better, healthier society. We really aren't learning any good lessons -- economic lessons -- from the current financial crisis.