Health Care Rights and Responsibilities

What happens when health care is thought to be a fundamental right? That's the question at the heart of David Kelley's January 1994 Reason story, "The Rights Angle."

What happens when health care is thought to be a fundamental right? That's the question at the heart of David Kelley's January 1994 reason story, "The Rights Angle." Kelley's piece examined the large-scale health-care overhaul proposed under President Bill Clinton. Kelley came away worried.

The "plan in its present form involves a massive increase in government control over physicians, insurers, employers, and-last but certainly not least-the patients who are supposed to be the beneficiaries of the plan," he wrote. "Most people will be forced to obtain their health insurance through purchasing cooperatives: government-backed monopolies that collect payments from consumers and set the terms on which medical providers can offer their services." Meanwhile, health providers will "be prohibited from dealing with patients directly," forced instead to work through highly regulated cooperatives-essentially government-run middlemen.

Kelley argued that this upending of the health system was fundamentally the result of a single assumption-"that if people have medical needs which are not being met, it is society's responsibility to meet them."

The Clinton health plan didn't pass. But almost two decades later, under a different Democratic president, another large-scale health policy overhaul did.

For the most part, the debate over ObamaCare didn't explicitly deal with "the rights angle." ObamaCare's mandate was often described as a "responsibility." But the notion of health care as a right didn't exactly go away either.

Like the Clinton plan, ObamaCare attempts to achieve universal coverage by requiring individuals to obtain insurance. There are no government-backed cooperatives in ObamaCare, but there are government-run insurance marketplaces that regulate participating insurers. And thanks to the law's various Medicare payment reforms, which are supposed to create incentives for doctors and other providers to change their behavior, the new health law also ends up giving the government more influence over the practice of medicine.

In other words, the rights angle-and the belief that all unmet medical needs must be served, no matter what-lives on as the subtext of the health policy debate. In March, Health and Human Services Secretary Kathleen Sebelius argued that catastrophic health plans didn't count as real insurance, because they only cover the biggest medical expenses. And in August, Medicare chief Marilyn Tevenner told Congress that insurance isn't "true insurance" if it's not sufficiently comprehensive.