Asking whether health care is a right or not is a key question. At the beginning of our nation, we set out some basic concepts for the creation of the nation such as life, liberty, and the pursuit of happiness. We also formulated a government based on the following:
We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.
Article I. Section 8. The Congress shall have power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States; but all duties, imposts and excises shall be uniform throughout the United States;
It is interesting that a right to education is not included specifically after these words, but no one would deny a child the right to education, even the most complicated and costly of children. Schools can best be justified based on the general welfare duties. Health care is similar to education and the argument is made based on the same reasons.
An Amendment may also be applied: Amendment XV
Section 1. The right of citizens of the United States to vote shall not be denied or abridged by the United States or by any state on account of race, color, or previous condition of servitude.
Section 2. The Congress shall have power to enforce this article by appropriate legislation.
We have added social programs and economic development and higher education and a number of other items that many would argue to be considered rights. Entitlements have also obtained this status.
Arguments for health care as a right under the general welfare concept:
Schools, health care, utilities, economic programs, social programs, and other services have been supported by the federal government. Few would dispute the rights of those in our nations to some if not all of these programs.
Equity argument: Certain groups and populations and areas have not had access to services in a number of these categories, whether rights or not.
Strength of the nation argument: Not providing such services relegates the United States to a lower status of nation, not competitive with others in the world. Health care impacts on public health, mental health, business efficiency, productivity, the number of disabled individuals, the prison population, and a number of other areas.
Long term cost argument: We know that many health services that are put off end up costing more in the long run. Those in the 55 - 65 age range know this all too well, as do those who finally gain disability and Medicare, but die months later and faster than they should have. Decreased access to services can have great impact on certain populations, such as children, mentally ill, and disadvantaged populations. Minor impediments to care such as restrictions on the number of prescriptions can cost 17 times what was anticipated to be saved in pharmacy costs in such populations. When health care is poor or not accessible and education is also lacking, these areas breed further poverty, continued poor economics and services and hopelessness. An entrenched culture of poverty can develop that is very difficult to restore. To me this is the real final frontier of restoration of these populations.
School argument: Both health care and education impact greatly on those in poverty. Numerous studies demonstrate significant compounding that impacts health status. In education, the larger the school district, the more likely that kids in poverty will do poorly. This has been show in numerous states. Perhaps this is what has happened as health care has gotten so big and systematized as well. Cost vs quality curves apply equally well to these large systems, with quality increasing with expenditures, then leveling off.
Rural reflections: Rural health again is the bargain with quality right at the flattening of the curve. The question is how much is needed to get to this point, in education, mental health, public health, and drug and alcohol. Nebraska is in the bottom 5 in all of these areas. Rural areas get one-third the public health funding when compared to urbans. Not having many people do such research asking such questions also hampers attempts to fund more equitably. I laughed at the columnist that berated the heartland for all of the farm subsidies. You can look at almost any federal program and find great rural-urban disparities with rural on the short end. Add to that the fact that some rural areas have low tax base and high corporate or outside the state ownership and ....
Good questions to ask:
Why were schools and health not included in the original constitution? Literacy and schools were not as important in the 18th century. Trades were learned by apprenticeship. At a time when accidents, infection, childbirth, and the major causes of death were shared by everyone, health care was not as important, especially when compared to public health. Frankly there was little that could be done regarding health. Those with mental problems or in prison were basically in hell on earth.
Now we know that health and education and economics are important determinants of the status of the nation, and the ability of the nation to work with other nations in the world. In many ways schools and health have become a top priority.
We can certainly argue that we have become dependent on the government for certain areas, perhaps too dependent. We do, however, need government to provide support for a basic level of health and education for all in this nation.
One other item to throw out to chew on. Why do we cover prenatal care so well when studies of Medicaid have not shown an impact such as improved outcomes? Only one Canadian study showed any relationship of access to care to outcomes, and this was the per capita physician number. The status of the mother at the time of conception has more to do with the outcome than anything related to prenatal care. It seems to me that we are being sympathetic instead of rational with many if not most of our government programs, encouraged on by the media.
This final example makes the argument for coordinated and balance services of health, education, and social programs. Spending too much in one area keeps needed dollars from another area and insures no progress for those in need. All of the areas working together can restore. The key is coordination and communication and willingness to work together and try to understand such complex matters. This is something that we are all too willing to leave to others.
Robert C. Bowman, M.D.