Does America have a right to basic health care? I hear it everyday. Affordable access to basic health care should be a right.
Could someone please define to me what constitutes basic in the basic health care argument? I want to hear examples of what is basic health care and what would not be considered basic and why you have a right to one and not the other.
Why should we have a right to health care but not health? Should we not have a right to stay healthy? Should we not have a right to free gym memberships? How about a right to free vegetables. If you have a right to basic health care, we should also have a right to services that prevent the break down of health as well.
Right?
I do not like the sloganeering either; it is counterproductive.
ReplyDeleteHowever, what about this scenario:
45 year old man, self-employed, no insurance, walks into er with 2-3 day history of right lower quadrant pain. He is diagnosed with appendicitis and is advised he needs admission and surgery. He agrees but says he is completely broke and has no ability to pay (which may or may not be true). Does this guy have a right to have an appendectomy or do we as physicians have the right to demand payment upfront before anything is done (like oral surgeons)?
Honestly, I think this guy has a right to have this problem fixed, regardless of his ability to pay. Can we have a society where those in need of care are turned away because of inability to pay?
Maybe for elective procedures.
But not for essential care.
What about a 55 year old woman with rectal bleeding for 6 months, and again no insurance. Finally, she goes to the ER where the diagnosis of anemia due to colon cancer is quickly made. Should this patient be turned away or does he have a right to care?
If we all have a right to free health care, then we certainly have a right to even more basic needs of life. Therefore, we all are entitled to food for free, because we can't live without it. Likewise we have a right to free shelter, etc, etc.
ReplyDeleteThe argument as presented is simply a gateway for the gov't and those who "know so much more than we do what is right" to enter into new areas of control
By "basic health care," they are referring to the George W. Bush "just go to an emergency room" health plan (actual Bush quote, not made up).
ReplyDeletehttp://www.nickscrusade.org/george-w-bushs-health-care-plan/
I'm sure EDs everywhere were thrilled by that statement.
There are a lot of things we take for granted -- clean water, sewage treatment, uncontaminated needles for IVs and sterilization procedures before surgery.
ReplyDeleteThese are PUBLIC HEALTH measures that have greatly affected our quality of life. So much so that their effects are practically invisible.
When we say "basic," I think of something along the lines of "do or die." There are a lot of things that factor into this... obviously someone with untreated hypercholesterolemia and diabetes for 40 years who comes in with a heart attack could have received appropriate intervention before this life threatening event.
The question is this: What OUGHT to be covered?
Primary prevention: healthy living (free gym memberships, shelter, access to fruits and veggies)
Secondary prevention: screening for CAD risk factors (checking lipid panel per ATPIII recommendations or just total cholesterol per USPSTF.)
Tertiary prevention: intervening after disease is detected to prevent complications (starting off treatment with statins and metformin.)
A lot of people would argue that it is fully within the scope of medicine to intervene with Secondary and Tertiary preventive measures (which SHOULD be covered as basic health care to some degree.)
Primary prevention... like the rest of PUBLIC HEALTH falls more under the scope of the government in my opinion, not accounting for the occasional harassment by a PCP to "eat right and exercise." As needed, I'm sure there are a number of excellent docs who can go more in depth into personalized primary preventive measures but when this is not reimbursed... not many will opt to do it with all their patients!
What are the fundamental models?
ReplyDelete1. People get whatever health care they can pay for directly. The most severe form is you pay up front. No pay, no service. The less severe form is to provide services and then bill, expecting the bill to be paid. A middle ground could be to do a credit check before treating -- people with poor credit histories are denied treatment. People with good credit histories are treated and then billed.
2. People purchase insurance, which hypothetically spreads risk, and they get whatever health care their insurance provides and whatever they can pay for in addition. The most severe form of this is a limited number of insurance options, almost all for-profit companies, who strictly limit who they cover and what they pay. The more generous version is non-profit insurance companies who cover a wider range of people and spread the risk widely.
3. Health care is provided as part of the commons, and is available at no charge, as with public schools.
4. Health care is provided as part of the commons, and is available at something approximating "cost", as with trash pickup, drinking water, and sewage.
Others?
I think we should have a right to healthcare that benefits society as a whole. A gym membership gives you good health. Treating infectious diseases means better health for all of society.
ReplyDeleteThe biggest health-related drains on society are infectious disease and long-term disability (because the individual cannot work and contribute to society, and needs to be cared for by someone). Anyone who is not a moron can keep from being fat to the point of disability, no gym membership needed; being overweight is not usually a disability. Setting a bone prevents permanent disability; preventing blindness or deafness and giving out cochlear implants do the same. Prenatal care is the best way to prevent long-term draining disability. You can recover from a lack of food or housing. You won't recover from terminal cancer, but you won't be disabled and drag down society.
So if you'll die from it with no chance of partial recovery, or you'll recover on your own with no permanent damage, or you'll be equally disabled regardless, and no one else will be infected by it, we don't need to cover it. But if treating it is the difference between self-sufficiency for the individual and having them be a permanently negative impact on society, we should treat them for our own sake.
Mental illness is a good example. A huge percentage of homeless people, criminals, and people on welfare are individuals with an untreated mental illness. If we made mental health care universal (and had the staff to manage it) we would alleviate an enormous drain on society and produce a huge number of productive citizens.
Why should free gym membership be considered basic healthcare? I don't need a gym to stay in shape - I can easily walk or run outside. I can do sit ups and other exercises without equipment...
ReplyDeleteIf I have a right to healthcare, that means I (or, more usually, the government) can FORCE someone or some facility to provide it to me. When someone is forced to provide a service, it's involunary servitude, aka slavery. When a business is forced to provide a service, that's fascism.
ReplyDeleteIt would be a lot simpler if we agreed simply that I have a right to as much healthcare as I can afford.
"Forced to provide a service"?!? Isn't that what EMTALA is?
ReplyDeleteI thought physicians had a duty to help those in need. Hmm....
Dr. Parker,
ReplyDeleteCould you say more about how a health care system based on a premise that people have a right (only?) to as much health care as they can afford would work?
I am not Dr. Parker, but I imagine the system would work exactly as stated...remove artifcial pricing which has resulted from third party payors (ie, as in prior to WWII) and let people shop around for doctors, hospitals, tests, and meds the same way that Bill Gates and I shop to our respective bank accounts and therefore drive different cars and eat different food, and yet others ride the bus and eat top ramen. Please don't tell me it cannot work, as it DID work until 60 years ago, and the only things that have changed are the technology, the price of the technology, and the sense of entitlement in this country.
ReplyDeletePattie, RN
Dr. Parker,
ReplyDeleteLet me ask a more specific question. One of my nieces was born prematurely, and spent her first three months in a NICU. Part of the cost was paid by my brother's insurance. The rest was picked up by Medicaid. How should this specific type of scenario play out, in your view -- pregnant woman at the hospital, child born very early, parents have insurance but not enough insurance or enough financial assets to pay the anticipated bill?
Many premature infants are left with significant health and developmental problems that add greatly to the cost of keeping them alive. How should that scenario be handled?
And do you believe that doctors as a group would be able to switch to a culture where they refuse to provide care when there aren't financial resources to pay for it? And would doctors be involved in counseling people on how to manage their dying process if the consequences of not being able to afford a surgery or a medication was likely death?
How many individual people can afford to pay for:
ReplyDelete1. cancer treatment
2. organ transplant + follow up medications
3. multiple traumatic injuries, as in a car accident
I know I couldn't afford to pay for them, and I know that even though I am insured, my insurance would run out.
Are physicians and health care administrators willing to give up providing much of this kind of care, if the capacity to pay for it goes way down? Would hospitals maintain trauma units, if most of the people coming through the door couldn't pay for the care?
I want my free health care. I deserve and am entitled to the services of doctors, nurses, and technicians because I can't pay for it. Its not my fault that I am 100 pounds overweight and smoke. The tobacco companies are just too persuasive with their advertisements and cheetos are too delicious. Those rich doctors that earn six figures in medical school and residency are overpaid.
ReplyDeleteI couldn't agree more-those that stay healthy and save the system money should be rewarded somehow. Give them a tax break or a stimulus check in the mail. There are too many studies that confirm many illnesses are preventable so to believe that it's just rotten luck or genes in the family tree is just wrong. What we are entitled to is education and information-not commercials pitching medication like a vending machine. "Ask your doctor about.......staying healthy." God, I'd love to hear that.
ReplyDelete