The Republican-led repeal of the health care bill in the House has been met with the predictable cheers coming from the Right and the equally predictable groans coming from the the Left. Yet underneath the political surface surrounding the bill, a fundamental question remains largely unexamined, save for those largely from the left side of the political spectrum who answer yes, reflexively. The question is: Do Americans have a Constitutional right to health care?
If one is to take the Constitution as written, there is no such thing as a codified right to health care. On the other hand, one would have to be naive to think that certain rights cannot be extrapolated from certain clauses in the document. Perhaps nothing illustrates this better than the 1973 Supreme Court decision declaring abortion a Constitutional right; it was a decision largely based on the Fourth, Ninth and Fourteenth Amendments’ explicit and implied rights to privacy and liberty.
Thus, the “right” to an abortion, whatever one’s position is on the matter, is seen, like many of our Constitutional rights, as something connected to empowering an individual to act on his or her own behalf. Making health care a Constitutional right, therefore, is something else altogether. If one is entitled to be made well when one is sick, then that right is based on the idea that it supersedes someone else’s right to choose whether or not to provide goods and services to the ill individual. In other words, as totalitarian as it might sound, the “right” to health care implies that one can, for example, compel a doctor to operate, a nurse to perform certain hospital procedures, or a drug company to manufacture a live-saving medicine.
Right now, despite all talk of rights notwithstanding, we are not at the point where, aside from laws which codify that which one must adhere to in the process of providing health care, no one can be forced to provide it per se. This is not to confuse laws in most states which require hospitals to accept and treat anyone who shows up in the emergency room. Such a requirement is based on the idea that if one wants to operate a hospital certain rules apply. But no one is required to operate a hospital. Similar laws regulate the conduct of doctors and drug companies, but again no one is required to become a doctor or open a pharmaceutical business.
Understanding the distinction here is critical. For many years progressives and their followers have long insisted that health care is a right without bothering to explain how a such a right is implemented without the consent of those who administer health procedures. One suspects that such confusion arises from the misunderstanding of the difference between having access to health care and receiving health care itself.
Nothing emblazons this misunderstanding more clearly than the progressive political rhetoric which insisted that Obamacare was an absolute necessity because “45 million Americans had no health insurance” and this bill provided insurance to 32 million of those uninsured. If the goal of Obamacare is providing more Americans with health insurance, one can find no fault with such an argument. On the other hand, if providing Americans with more access to health care itself is the goal, Obamacare is seriously wanting.
First, as Americans staring at fourteen trillion dollars of national debt have learned, and as Ronald Reagan so eloquently explained, “if you want more of something subsidize it.” In the case of subsidizing health care, Americans have learned you definitely get more of it. A Senate Joint Economic Committee report issued in 2009 illustrates how much more:
–Medicare: in 1965 the House Ways and Means Committee estimated that the hospital insurance portion of the program, Part A, would cost about $9 billion annually by 1990. Actual Part A spending in 1990: $67 billion. The entire Medicaid program? 1967, the House Ways and Means Committee predicted$12 billion in costs by 1990. Actual Medicare spending: $110 billion.
–Medicaid DSH program. 1987 estimate of costs by 1992: $1 billion. Actual costs: $17 billion.
–Medicare home care benefit. 1988 projection of costs by 1993: $4 billion. Actual: $10 billion.
This are many more projections all with similar increases, but the point is made. And the reasons for such exponential increases are simple: government has made health care seem like a right. More importantly, it has made it seem like a right that can be exercised without any compulsion to exercise it responsibly because it is “free.” (One could make the argument that Americans themselves, via such injudicious use of the system, are underwriting the kind of eventual rationing they claim to despise).
Second, more and more doctors are opting out of accepting patients with Medicaid because government payments for treatment are below reimbursement rates, meaning doctors actually lose money treating patients with government health insurance. In other words, government-run health programs are literally disincentivizing the very people needed to make them functional. And that’s before Congress deals with the additional 23% cut in those payments as required by law. Perhaps Democrats can explain how adding 32 million people to the insurance rolls, even as more and more doctors refuse to accept that insurance, translates in greater access to care itself.
Which brings us to the reality that genuine access to health care itself can only be accomplished by one of two means: incentive or coercion. Incentive can take many forms. Patients making some sort of realistic co-payments for services rendered, to doctors pledging terms of service for reimbursement of medical school costs, are two which make sense. Doubtless there are many others, all of which could be based on the simple idea of promoting responsible behavior on both sides of the medical equation. Incentive, however, presumes something that most progressives find troubling: health care itself (as opposed to access to it) is a privilege, not a right.
Which brings us to coercion. Once health care is deemed a right, it is like any other in the sense that the full force of government is behind its maintenance and enforcement. If health care is a right, doctors can be compelled to treat patients, or suffer the consequences that attend any violation of Constitutional rights, be they civil or criminal.
Yet even if American were to reach some point in time where doctors would be required to treat patients according to government fiat, as a condition for obtaining a license to practice medicine, for example, such a solution would be short-lived at best. Even now, without such fiats, a July 2010 article in the Washington Post reports that ”40% of doctors are 55 or older,” a “third of all nurses are over the age of 50 and about 55 percent announced an intention to retire in the next ten years,” and that there will be at least “100,000 fewer doctors in the workplace than the 1.1 million the federal government projects will be needed in 2020 under the health-care overhaul.”
And all of this avoids the fundamental question regarding government coercion: how does government force someone to become a doctor in the first place?
There is no question the health care debate and its solutions will consume much of Congress’s time and much of public’s attention in the coming years, with profound disagreements over what is the best course of action to pursue in a field which is open-ended: every new medical procedure discovered is one more Americans will want access to, which is the biggest problem facing medical care today. Yet there is precious little to be gained by declaring health care a right. Unless it is attended by government force–which might be the impetus behind much of the progressive insistence that it is–it is a privilege. One for which Americans should be grateful, warts and all.
Arnold Ahlert is a contributing columnist to the conservative website JewishWorldReview.com.