Dr. Conrad Flick, noted North Carolina family physician, recently appeared on a panel discussion on healthcare conducted by the North Carolina Academy of Family Physicians. During that forum Dr. Flick raised a nagging question.
Flick said it was time America declared whether healthcare is a right or a privilege. This question gets to the essence of today’s healthcare debate because, as the noted theologian C. S. Lewis wrote in an essay on the subject, “You can’t get second things by putting them first; you can only get second things by putting first things first.” America’s healthcare system has been built putting second things first. The first is whether healthcare is a right of each citizen or just a privilege for those who can afford it?
We made the decision that a “sound basic education” was the right of each child. We even decided it was right to provide police, fire, defense and other public services, with taxes paying for them. What about healthcare?
We sidestepped the fundamental question in the 1960s, passing Medicare and Medicaid legislation that declared the government as the payer for healthcare for the poor, disabled and elderly. We compounded the issue by requiring that anyone who shows up at the hospital emergency room will be treated, regardless of insurance coverage or ability to pay. The Affordable Care Act, or Obamacare, was another thinly disguised extension of an answer. By requiring everyone to have health insurance, then expanding the list of those who could receive partial or full subsidies for that insurance the country took another big step toward a declaration.
Step by step we have made a de facto decision that healthcare is a right. We are so far down that path that we would have anarchy if we attempted to unwind previous decisions and take benefits away from people already receiving them. Whether you think the solution right or not the reality is correct. So let’s acknowledge the truth and own it: healthcare is a right in America.
Then we can get about the redesign of our healthcare system because nobody would deliberately create our current public-private, cost shifting, finger pointing and unaccountable healthcare system. Panelist Peg O’Connell simplified the mess by explaining that the person getting the service and the person providing the service are disconnected from the person paying for the service. Worse still, the person who is paying the person who is paying for the service, the employer, is even further disconnected, aside from worrying how to afford the insurance.
The next decisions are tougher. How do we guarantee equal access to healthcare, how do we ensure adequate resources in all areas and who pays for healthcare? If a single payer system is preferred and that payer is the government do we even need health insurance? What levels of professional training are necessary for various levels of care?
Do we provide care to all or just American citizens? Do we provide just primary care or specialty care, organ replacements, cosmetic or elective treatments? What about end-of-life care, when the most difficult and expensive decisions must be faced? And what role does personal responsibility and accountability play in healthcare? Should all pay for the consequences of those who overeat, smoke or indulge in poor choices?
Campbell is the executive producer and moderator of NC SPIN, a weekly panel discussion on state issues that airs on WMYT “MY TV12” at 10 a.m. on Sundays and on WJZY “CW46” at 6:30 a.m. and 11:05 p.m. on Sundays and on WFMY-TV at 5:30 a.m. Sundays.
Until we claim the truth that healthcare is a right we have not put first things first.