Healthcare reform, specifically Obamacare “repeal and replace,” was a prominent campaign issue and is now a legislative priority for President Trump and Congress. While there is debate over subsidies, mandates and preexisting conditions, a more fundamental question looms. Is healthcare a right or a privilege?
Rights are enumerated in the Constitution. There is no “right” to medical care in our founding documents. Then again, there is no right to abortion, same-sex marriage, transgender bathrooms or affordable housing in the Constitution, but courts and legislatures have deemed otherwise.
Healthcare as a right is another term for universal coverage, which 60 percent of Americans favor based on a recent Pew poll. The political left favors universal coverage.
The political right wants the government out of healthcare. Certainly, the federal government. Turn it over to the states via the 10th Amendment or leave it to the free market. Meaning healthcare as a privilege.
If a privilege rather than a right, what about the child with cancer whose family cannot afford six-figure cancer care? Or my working diabetic patient needing a $2,000 injection in each eye, every month, for several years, to maintain vision for driving and supporting her family? Or the millennial blowing out his knee at Vail who doesn’t have insurance or family support to pay for surgery?
Conversely, if healthcare is an entitlement, then how much is enough? Is every new drug or treatment available on demand? Should gender reassignment surgery be paid for by taxpayers, as is currently being proposed in Wisconsin? If the government provides a free meal, should it be a burger and fries or tenderloin and lobster?
Until these two competing approaches are reconciled, healthcare reform spins its wheels in a patchwork solution trying to satisfy both sides of the argument, but in the end satisfying neither.
Most developed countries solve this dilemma with a parallel public and private medical system. A public system covering everyone with minimal or no out-of-pocket expense to patients, but with limited treatment options and long wait times for care. And a private system where individuals can purchase private insurance, without subsidies, tax breaks or government interference, or else pay for their care directly.
The public option as a “right” and the private option as the “privilege.” Think of K-12 schools. A public option at no cost to students or their families, for most a good and more than adequate education. And a free-market private-school option for those who so choose and have the financial means. Two parallel systems, take your pick.
Each system has advantages and disadvantages, but they are separate and distinct. Imagine trying to combine public and private schools into a single government-run program. That’s Obamacare. Or Ryancare. Or whatever finally emerges from Congress. The worst of both systems and the best of neither. No universal coverage and limited freedom of choice.
Why not create a dual system in the United States? Then, my question wouldn’t need an answer. Rather than forcing elected officials to come down on the side of “right” or “privilege,” which they will never do, simply choose both. A public system providing the “right” and a separate private system providing the “privilege”.
The blueprint is out there. Look to the United Kingdom or New Zealand for a model. Not perfect, but certainly better than the mess we currently have, with no forthcoming solution from Washington, D.C.
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