Defining Health Care

We ended class on Tuesday asking if health care is a human or civil right, a market commodity, public good, privilege or responsibility?

Human Rights can be defined as basic rights of all human beings to life, liberty and the pursuit of happiness (as the US Constitution provides). Although usually thought of basic liberties -- freedom of speech, freedom of religion, right to associate freely -- as well as the right to a basic standard of living. Health care arguably is necessary for the enjoyment of all these freedoms and the ability to participate in the life of a nation. From my perspective, healthcare is a human right that everyone is entitled to. I believe the only way to have a fair society is to provide universal health care for every human being no matter what income level, race or age. Something as serious as ones life should not have to be gambled on and health care should be considered a basic necessity. Basic necessities such as electricity and natural gas have been made available to every citizen at reasonable rates regardless of economic status. Utility subsidies, both at the state and federal law have made this possible. So why should health care be any different?

Regarding civil rights, these are also thought of typically in terms of the rights of people to participate in the civil life of their countries. For example, the right to vote, to eat at public restaurants, to not be discriminated against because of skin color, gender or ethnicity, etc. but basic economic rights are also considered to be part of this. The right to seek employment and obtain loans, without facing discrimination, and so forth. Again, not having access to health care can be worse in many respects than facing discrimination or being denied the right to participate in public life. People without health insurance can face financial ruin if they get sick in addition to becoming sicker if they cannot get the care they need. Similarly, people who have health insurance through their employers may face difficult choices regarding employment if the job they would like to switch to do not come with health insurance.

Health care has been treated as a market commodity in recent years and competition by health care providers and insurers can serve to improve health care. But the problem with using the "market" to allocate health care is that it inevitably will leave some people without care because they are either unable to afford it or unwilling to pay for it if they perceive themselves as healthy. Without getting too technical, every "market" has a market-clearing price where supply equals demand. The part of the demand curve to the right and below of this price point represent people who are not able or willing to buy health care insurance. In most markets we don't care about this. For example, in the market for luxury cars, there will be many people who choose not to buy or cannot afford such a car.

But the problem with this scenario is that everyone will eventually need to access the health care system. And what usually happens is those people are treated in emergency rooms or in other ways even though they do not have insurance -- probably because as a society we treat such access as a human or civil right, or the moral equivalent of that. This combination of uninsured individuals plus our society's impulse to provide health care services to these individuals, give health care the key characteristic of a "public good", a good that we cannot really exclude an individual from without creating a barrier to others receiving it. In other words, the existence of the very large US health care system, and our ethic of providing care to the uninsured anyway, creates not only great difficulty excluding people from it, but also creates a classic "free rider" problem, characteristic of public goods, that means that those who could afford health insurance may choose to wait until they get sick before accessing the "free" system. This is why it is important that real reform of the health care system have a mandate requiring all people to buy health insurance.

I find it a bit inconsistent to argue that health care is a privilege given the preceding discussion. But good health often depends as much on an individual's personal dietary, exercise, and lifestyle decisions as it does on the quality of health care people can access. In other words, the patient needs to accept responsibility for his or her health. Good health is something one "earns" and in that sense it is a privilege, it is the result of many personal decisions as well as access to good health care. That said, we really cannot deny health care services even to those who make poor personal choices and in that sense it is probably a stretch to think of health care as a classic "privilege." It would be more productive to think of a quality health care system as one that would encourage and reward (even financially) good personal choices regarding diet, exercise and lifestyles.