In a recent discussion someone posed the question, “Is health care a right or a privilege?”
This should be the wrong question! In part, because those opposed to health care, tend to be opposed to any expansion of “rights.” It should be the wrong question, because people should feel embarrassed to assert that health care is a privilege.
Rally in Vermont
The right question is, “Is health care a private good or a public good?”
It is the right question because proponents of expanding health care have already won it, even if those on the other side don’t know it yet.
Health care is a public good
If health care is not a public good, why do we have a Surgeon General and the U.S. Public Health Service?
Why do we have a Center for Disease Control?
Why do we have the National Institute of Health?
Why do we have the Agency for Health Care Research and Quality?
More importantly, why do we have Medicare?
Why do we have Medicaid?
Why do we have the Indian Health Service?
Why do we have the Veteran’s Administration?
Why does Congress pass laws like the Women’s Health and Cancer Rights Act, or the Mental Health Parity Laws?
All of these government agencies point to one inescapable conclusion – the citizens of this country have consistently supported what they thought were expansions of health care. They have consistently stood on the side of the principle that says – keeping you healthy is in my interest. Keeping everyone healthy is in my interest.
As one wag put it, we recognize the state’s role in educating the public, but frankly if I were sitting next to you, it is far bigger concern to me whether you are healthy than whether you are smart.
Health care is not a right
The right to health care grows out of the recognition that it is a public good.
The bible does not ask the sick to stand up and demand to be cared for. No, it says “care for the sick”. “As you did it to one of the least of these my brothers, you did it to me.”
The first hospitals in this country were established not because the sick insisted on being treated, or because they demanded health care as a right. They were established by communities that felt a responsibility to care for those who needed it. Health care was perceived as an obligation, not a business model.
The public good in the private sector
The concept of “public good” extends to the private sphere. Does anyone really think that when employers endorse wellness programs in the workplace, they are doing so to respect some “right” to a healthy life style? No, instead, they recognize that the individual welfare of its employees serves the welfare of a larger group of people; in a sense a broader “public” good. It serves the corporate bottom line by lowering health claim costs, decreasing injuries, decreasing absenteeism and presenteeism. Yes, in this example, it is not quite “public” as an economist might understand it. But it is definitely no longer a “private good” whereby an individual’s actions have no impact beyond his or her own life.
For the same reasons, corporations endorse disease management programs that attempt to engage employees much more proactively in the management of their own chronic conditions. Some employers will go so far as to make participation in such programs mandatory. Isn’t this also a recognition that health care is not a private good? Just because it occurs within the sphere of the employment relationship does not make it less a “public” good.
Employers recognize that they need healthy workers, but keeping the workforce healthy means taking care of them when they can’t work. And that, by definition, cannot occur within the employment relationship. Health care is a public good.
Health care is not a right! It is an obligation. We have a collective obligation to make health care available to others and we also have an obligation to take care of ourselves.
The health care as a right or privilege debate taps into the same common theme – the focus on me. Who is more important – you or me? If we are going to break the conservative ideological hold on debate in this country we need to change the way the debate is framed. The focus should be on we, not me.
Nothing scares conservatives more than the idea that all Americans would share something in common. A national health care system could unify Americans in ways that truly frighten them.
But let’s face it. “Health care is a right” does sell. Just ask the people in Vermont.
Photo credit: Health Care is a Human Right Campaign
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