Is healthcare a collective right or individual privilege?

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

We, the people, must have an open debate and come to resolution on healthcare: Is it a right or a privilege? A right is something guaranteed, supplied and defended by a higher power. The founding fathers and framers of our country, forcibly seceding from a toxic aristocracy, believed that individuals had rights that were either intrinsic within each individual and/or came from a supreme power or God.

We were endowed with freedom and liberty, but must bear the individual responsibility of eternal vigilance to prevent the “necessary evil of government,” from inverting individual rights to government mandates and tyranny. The inversion of “rights” isn't merely a problem found in dystopian novels; such as “Animal Farm” by George Orwell, “Brave New World” by Aldous Huxley and “Atlas Shrugged” by Ayn Rand. [There are real life examples of how this turns out -- Cuba, Soviet Union, Venezuela -- and it never turns out well.]

Previously, rights had come from aristocracies. Dictatorships, military states and other governments ruled by physical might and power. It was much later in history that leadership came from a mandate from the masses establishing rights were inherent to the citizens as a group. The United States was different as it was founded upon individual liberty, freedom and the pursuit of happiness.

The U.S. government and mass media tend to conflate terms and use “healthcare,” “health insurance,” “health” and “government health policy” interchangeably when they are certainly not. The new dangerous fad of “population health,” looking at health of individuals in aggregate as groups, becomes superimposed by those in power over “individual health,“ the state of health of individual people, which is the standard from Hippocrates to the present day. They confuse “health policy” with potentially unrelated health outcomes. Spurious correlations become willful ignorance to further an ideology and/or political agenda.

We must have the open debate whether healthcare, a paid service by individuals and collectives, is to be a right or a privilege. If healthcare is a right to a service, it necessitates rules on who gets which service, when, how often, who pays for it and how it will be documented to prove it was needed; and ask “Why?” for each of those questions. Governments throughout history grapple poorly with the philosophical question and the devil (is certainly) in the details. Human action shows that given theoretical unlimited access, no risk, or cost, people will use more of the service. Who will pay for and provide unlimited services? There will always be someone who dies because of the rules were adverse to them. 

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