Health-Care Rights and Wrongs

Blogging for Andrew Sullivan, my friend and former colleague Conor Friedersdorf says he believes that "there is a moral obligation to ensure that every citizen has some minimum level of health care, in the same way that society has decided everyone should have some baseline level of food. I find it difficult to pinpoint what level exactly, but I suspect we're currently falling short of it."

The idea of a moral right to health care (which I think is inherent in the idea of a society-wide moral obligation) sounds nice and simple in theory. We're a rich society. Our citizens ought to be guaranteed a certain level of care. Right? 

But the reality is substantially more complex and less pleasant. With food, the example Conor gives, it's relatively easy to determine an appropriate minimum. You can figure out the required number of calories and an appropriate mix of nutrients; these can be reevaluated every so often as the consensus evolves, but for the most part, it's relatively easy to figure out what food people need to survive and stay healthy.  (It's also worth pointing out that, unlike health care, the food market—buying, selling, distribution, and production—is mostly private, and consumers largely bear the costs of their decisions themselves. And what government assistance we do see comes in the form of voucher-like programs that keep the purchasing power with the consumers, even if they do sometimes direct that purchasing power somewhat.) 

With health care, on the other hand, you end up with a far more complex set of calculations. Determining a minimum is tough. And once you've determined that minimum, figuring out how to achieve it is tougher. Do people deserve treatment of minor, non-life-threatening ailments? What if treating those ailments might prevent their spread to others? What about injuries and diseases that are serious but probably not life-threatening? Maybe we can all agree that individuals have a right to potentially life-saving treatments. But what if a treatment isn't guaranteed to be effective? And what if a person is in the last years of his or her life, the treatment is phenomenally expensive, and it's only likely to prolong his or her life by a few months? 

It's easy for a family member or a close friend to take the position that any potentially helpful treatment, no matter how expensive or how unlikely to work, is worth the cost. But an impersonal government bureaucracy can't do that. And I'm not sure most people really want them to try. When governments have to make these choices, they end up using cold, economically determined metrics like the quality adjusted life year (QALY), which determines a standardized value for each lived year of life, and then calculates whether or not a treatment is worth it from there. This leads to cases in which people are denied treatment because the government has decided that their lives just aren't worth enough.   

Because that's how governments make decisions. Determining a government-set health-care floor necessarily entails this sort of chilly calculus, which, even if you agree with in theory, opens up room for all sorts of additional disputes. So I'd argue that, at the society-wide level, it's not just "difficult" to pinpoint what the minimum level of care should be, it's impossible—and no matter what, I'm pretty sure it's not something I want the government even attempting. 

Ron Bailey looked at the role of money in health care here. And back in 1994, David Kelley also questioned the "right" to health care.