August 15, 2010
The 'Right to Health Care' Can Be the Right to No Care
If you read British newspapers, you know their universal health care system is cutting more and more services. There, everyone's right to health care is becoming the right to no care. Do we want that in the USA?
Health care as a right means that people are entitled to medical care services, just like free speech and the right to assemble. We do not have to do anything to get them. They are ours by right, and they are free. We have no responsibility and therefore no personal control and/or need to make decisions.
In all societies without exception, supply must equal demand. This may be done by nature, as in hunter-gatherer societies, by the free market in capitalist nations, or by the government in socialist or communist countries. But someone or something must balance the two. Another word for balancing supply and demand is "rationing."
"Ration" comes from the Latin ratio (to reason or think) and can be defined as "allowing an individual a fixed amount of a commodity." If health care is a right, the "allower" or balancer of supply and demand is the government, which must and will ration health care. That is what occurs in all universal health care countries, including France, Germany, Scandinavian nations, Taiwan, and Japan. Consider Great Britain with its National Health Service (NHS).
Because Great Britain cannot afford its current level of demand for health care, the NHS is cutting services. Services already deleted or to be cut include heart surgery over the age of 65, kidney dialysis over 55, much hospice care, many cancer treatments, and most nursing homes.
The NHS has a commission (department) called NICE, the National Institute for Health and Clinical Excellence. As an aside, note that the president's choice for Director of Medicare, Dr. Don Berwick, is an admirer of the NICE and wants to import to the USA.
The responsibility of NICE is to determine which medical treatments have the best cost/benefit ratios for the nation, to approve payment for those, and to deny payment for all other treatments. Note what the italicized words mean (to them). Cost considers only the immediate outlay and does not calculate avoided costs, or productivity gains or losses. The benefit is national, based on the entire population and not the individual's best interest. If a specific patient needs something that does not work in the majority, the specific patient doesn't get it.
The non-payment for specific treatments, either because of age or based on NICE criteria (talk about an acronym that means its opposite!), is effectively a death panel. Remember the fierce denial of the Democrats that Obamacare (HR 3590 or PPAHCA) would have any such thing? Read the Patient Protection and Affordable Health Care Act: It assigns $650 million for cost/benefit analyses. What happens when the answer is negative? Answer: No payment for that care, and therefore no care -- just like Great Britain.
Nations with "universal health care" have a dirty little secret that is highly relevant to those in the USA who want to import their systems: They are not universal. Non-citizens are excluded. If you are an illegal resident, you are not part of the "universal care" and have no right to health care. Recall that the White House said that all Americans are entitled to health care and that HR 3590 will cover the "30 million uninsured Americans." The quote is another WMDc (weapon of mass deception).
Check out the GAO report from January 2010 that clearly and publicly shows that there are over 45 million uninsured people in the USA, 12 to 15 million of whom are illegal residents. Should they be included in the "health coverage for all Americans" or not? Note how smoothly the president sidestepped this political third rail by cutting their millions out of the number of "uninsured Americans." The issue of health care for non-residents remains our dirty little unresolved secret.
The conclusion is clear and inescapable: health care as a right leads to government rationing of health care. If that is what you want, fine. But do not be fooled by snake oil salesmen in Congress or the White House who say otherwise. If you believe that health care is a right, you cannot and will not have the care you want or need.
Finally, what happens to your right to health care -- rationed or without limit -- if there are no doctors or nurses? Since 1995, applications to U.S. medical have fallen off 20%. At present, over 500,000 nursing positions are unfilled. A right to health care is meaningless if no one chooses to be or stay a care provider.
There is a small ray of hope. Eleven states have sued to block HR 3590 on the grounds that you cannot penalize someone for not doing something, like not paying insurance. Of course, Washington is totally opposed and has filed papers seeking summary dismissal. The first State case -- Virginia -- to reach federal court was just decided. The judge upheld the State's position and rejected dismissal.
Deane Waldman, M.D., MBA is the author of "Uproot U.S. Healthcare," host of upcoming internet radio show "Your Health, OUR Healthcare" (October 2010), and Adjunct Scholar for the Rio Grande Foundation.