Health Care as a Right Opens Pandora's Box

Intrinsically, we would all like to say that every human being has a right to health care. With that, however, follows certain dilemmas and, in fact, deeming it as a right distracts us from the goal of expanding access to quality care.

A right is both intrinsic to your being and extrinsic to unwarranted limits. It is also free of obligation. Your right to worship does not require me to build you a church; your right to speak does not oblige me to listen. Your right to health care, however, does necessitate a provider with years of training, knowledge, and experience. In short, what you consider a right is an entitlement to another human’s time and energy. Unless we are now conscripting physicians to fulfill this new right, they are justly entitled to compensation for their time. As such, this right also forces society to subsidize it.

As society will be funding this new right, its scope will need to be clearly defined, lest we bankrupt ourselves. Just how much leeway will individuals have in exercising it? Will we have unlimited access to any and all health services we desire? Will expensive diagnostics be available on demand? How about experimental treatments? A right to health care implies that someone must determine where that right ends. Who will have that power: insurers or government? How about patients?

How do we cope with the incentives that a right to health care provides? It is commonly understood that the third-party payer system and the tax exclusion for employer-provided insurance are among the root causes of rising costs. Paradoxically, the reason health care is so expensive is because it is so cheap, at least at the point of service. Further divorcing the provision of care from the associated costs will exacerbate this trend. Patients demand far more care when it is free or at the margin; numerous studies have chronicled this fact (here, here, here). It is an established truth of both economics and human nature.

This is why Medicare is exploring cost sharing; it is why consumers are increasingly choosing more affordable Consumer Directed Health Plans (CDHP) that put them in charge of their dollars, not insurers, hospitals, or the government. As we have seen, if health care is a right then someone must control its scope. The question is: Should that someone be patients, insurers, or the government? I side with patients.

Finally, creating a right to something does nothing to solve the problems of resource allocation. The political process is exceptionally poor at keeping pace with shifting needs. Furthermore, experience in other countries demonstrates that those with means typically enjoy a greater right to health care by virtue of their ability to affect the allocation of medical resources. We see a similar trend in public schools, where wealthy areas enjoy the highest quality teachers and equipment while the poor find themselves trapped amidst inadequacy.

The question of health care as a right is one that opens a Pandora’s Box of considerations, unintended consequences, and policy choices, and is too often speciously answered. The question of whether a wealthy nation has a moral obligation to provide basic care to all who need it is quite separate from the question of whether something is a fundamental human right, and the question of whether a scheme of “universal coverage” is the most efficacious method of providing uniform access to care is something else entirely. But one thing is certain: Thinking of health care as a right will bring us no closer to that worthwhile goal.

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