Well, no it isn’t. But it is a basic human need.
We certainly agree that as a matter of national policy making sure all Americans have access to good health care should be among our highest national priorities. But given the GOP’s failed attempt at sausage making this week, President Obama’s Affordable Care Act will define American health care for the foreseeable future. Senators on both sides of the aisle agree that the Affordable Care Act needs fixing. They just can’t agree on the definition of “fixing.” That’s because neither Democrats nor Republicans dare take issue with the popular narrative that health care is a basic human right.
But is it really a basic human right, or is it even a basic right of American citizenship? Defining health care as a basic right as though it were, or should have been, the 11th amendment of the Bill of Rights has become the narrative de jour today. It is a narrative that corrupts rational discussion and could propel us to irrational national policy. At the risk of sounding indifferent, which we are not, we do not believe health care is a basic human right, nor is it a basic right of citizenship in America. While health care has never been a basic right in America, the vast majority of working Americans, about 85%, were protected by health insurance before the Affordable Care Act was enacted. We certainly agree that the remaining 15% required coverage as well.
Basic rights in America have always protected us from those things our government might do to us or require of us. Our basic rights define, to a great extent, our relationship with our government. Our government cannot muzzle us, even if we want to criticize or condemn it. Nor can the government infringe upon a sane or law-abiding citizen’s right to own a firearm, nor can it require anyone to incriminate himself or herself. No American can be made to prostrate himself or herself before the government and confess to a crime. It is his or her basic right to be presumed innocent and neither he nor she has any obligation to even assist a government prosecutor in making or trying a case. In other words, in America, a citizen’s rights are, essentially, specific restrictions on government’s ability to act against us or require certain things of any of us. In America, citizen’s rights have never required one citizen to give up something of value so that another citizen could exercise his or her basic rights. Until today’s health care debate, rights have always involved personal freedoms the government cannot infringe upon, not material goods or services that the government must provide.
We often hear that America is the only nation in the developed world that doesn’t provide free health care for all of its citizens. And that is true. We don’t consider that an indictment of America or of its values. It is simply a reflexion of how we have chosen to allocate our resources. We’re also the only country that took responsibility for rebuilding Europe after World War Two, and for the defense of what we called the “free world” ever since. President John F. Kennedy articulated what was America’s commitment to the free world in his inaugural address when he proclaimed, “that we will pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival of the success of liberty.” Our post-war commitments largely defined how we would allocate our resources.
Nonetheless, America does, today, provide Universal Healthcare for everyone over age sixty-five, or for millions of lower income families through the federal Medicaid and SCHIP (State Children’s Health Insurance Program). Prior to 2009 eighty-five percent of all working Americans were covered either by employer-sponsored health insurance programs or individually secured health insurance.
America may, someday, very well decide to reallocate its resources and provide healthcare to all its citizens. That’s a course some future Congress and some future Administration might very well choose to follow. At first blush, the Administrative cost of running our Medicare reimbursement program is actually considerably lower than the administrative cost of providing reimbursements through the health insurance industry. Most physicians and other service providers, however, consider the administrative burden to be excessive that has been transferred to them by the government so an apples-to-apples comparison is difficult to make. Of course, the insurance industry also transfers considerable administrative burden to health care providers.
So how much of the nation’s health care is to be provided by government is, ultimately, a matter of allocating resources. Let’s take a look at how we allocate our resources (tax revenue plus debt) today.
There are two very broad budget categories— discretionary spending and mandatory or non-discretionary spending. Discretionary spending is simply that part of the federal budget that Congress appropriates each year. Congress has the constitutional authority (and obligation) to raise and spend money for the federal government. The discretionary budget ($1.244 trillion) includes just about everything except Social Security, Medicare, and Medicaid ($3.850 trillion). The discretionary budget for fiscal year 2018 has two components, department operating budgets (including defense) and emergencies. The Trump Administration has asked for $85 billion for emergencies—think wars, disaster relief and acts of nature like controlling wildfires.
If the government were to pay for all health care, as though it were a basic right, the cost is estimated to be $3.35 trillion or about $10,345 for every man woman and child in the country, with costs estimated to increase by at least five percent annually for the foreseeable future. About five percent of the population (mostly the elderly) account for nearly half of the entire health care bill. Today, about 90% of pre-retirement-age Americans do have health insurance to cover or ameliorate these costs as compared to about 85% who were covered by either employer or individually provided insurance prior to the Affordable Care Act.
Obviously, there is an important role for government in dealing with America’s health care needs. There is also an important role or responsibility for most every family and individual.
When we, as a nation, recognized hunger as a serious problem, we didn’t nationalize the food industry. We provided vouchers (food stamps) to alleviate hunger for our neediest citizens. Perhaps, there is a lesson there for how we should have attacked health care in America by focusing our efforts on the 10% to 15% of Americans who had fallen through the cracks and were uncovered by public or private insurance programs.
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You make me think in ways I never did.
You know how appreciative I am.
I may totally out of it but why can’t we make insurance mandatory as it is for automobiles. Real Competition of Insurance Companies may well make insurance more affordable.
That said, once any “free” a thing is nearly impossible to repeal.
You touched on this but I think it needs to be emphasized. A “right” cannot create an obligation on others. It is another way of saying you cannot have competing rights. Your “right” to health care cannot take away my right to keep my own property. There is no free health care. Someone must pay. This argument goes for all of the other “rights” progressives list that require others to pay for.
Great column, as usual.
You gents possess such a rare charcteristic…..common sense!
Those who suggest that no one should be forced to buy something they don’t want (like health insurance) are saying that the uninsured should either be allowed to die on the hospital steps or should have their care paid for by all those whose insurance premiums have been increased to the extent necessary to cover treatment for the uninsured.
I view health care through much the same lens as social security…..let’s call it health security. We don’t give people the option of whether they want to participate in social security so why give them the option of participating in “health security?” And let those premiums be large enough to pay for the jobless (as long as they’re looking for work) and for those who are unable to work.
And if anyone believes the benefits of this government provided benefit is inadequate allow them to purchase additional coverage on their own hook.
Mr. Marcus’s comments are similar to Judy’s comments regarding mandatory health insurance. And given that 85% of working Americans were covered by health insurance prior to Obamacare, it would seem that a program geared to the those who were previously uninsured may have made the most sense. We do note, however, that the uninsured are not allowed to die on the hospital steps. Public and private hospitals alike are prohibited by law from denying a patient care in an emergency. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 explicitly forbids the denial of care to indigent or uninsured patients based on a lack of ability to pay.
According to the Kaiser Family Foundation, it is the middle class who are getting squeezed under Obamacare. They aren’t getting subsidies and the deductibles under Obamacare are often unaffordable.
The typical Obamacare enrollee has an income of only 165% of the federal poverty level, or $40,000 for a family of four. About 150 million people have insurance through work, paying only about $440 a month for a family plan, while employers cover the rest, or about $1,075. For the 10.5 million enrollees on the Obamacare exchanges, health insurance costs are more transparent. And more of the burden falls on the consumers. This leaves many Americans opting to remain uninsured, rather than shell out thousands a year for premiums and deductibles. In 2015, 46% of uninsured adults said that they tried to get coverage but did not because it was too expensive, according to Kaiser.
The big price spikes for 2017 have current Obamacare enrollees wondering whether they’ll renew their plans next year or opt to pay the penalty of $695 per person, or 2.5% of income, whichever is larger.