Obamacare

Health-Care Rights and Wrongs

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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. 

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  1. …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.

    Uh… If you need health care, you go to an ER.

    He apparently is confusing health care with health insurance — a very expensive error and not quite as defensible as a moral obligation.

  2. How can you say that a society that has a life expectency of 78 years, where premature death from non accidental causes is almost unheard of is not meeting its obligation for minimum healthcare? “but I suspect we’re currently falling short of it.”

    Why? Friedersdorf doesn’t seem to know, but he susspects. And for that reason, we clearly need to let smart people like him and Andrew Sullivan run our lives. What a dickhead.

  3. Providing basic health care services: 1) eliminate prescriptions — make everything over the counter; 2) pharmacies provide FAQs and other technical support to customers; 3) if you’re feeling generous — throw in a voucher system for the poor.

  4. there is a moral obligation to ensure that every citizen has some minimum level of health care,

    I’ll agree with that, if he’ll agree that moral obligations to provide charity to others should not be converted into legal obligation.

  5. “Blogging for Andrew Sullivan”

    How lazy ya gotta be to have someone blog for ya???

  6. there is a moral obligation to ensure that every citizen has some minimum level of health care

    Since Friedersdorf does not do anything as simple as actually make the argument that this right exists, I am curious where he finds the morality to take money from some people in order to pay for this “right” for others?

  7. Property is not a right like health care is.

    Unless, of course, that property is a drug that you’ve researched. In that case, I have a right to that drug that you’ve researched.

  8. I only made it through the first part since the thoughts of those two don’t matter in the scheme of things. However, just out of curiousity, did Suderman mention Cato’s new “gruel and workhouses” proposal? I think that’s a winner.

  9. I only made it through the first part since the thoughts of those two don’t matter in the scheme of things.

    You’re certainly entitled to your own opinion, Lonewacko, but I’d like to know how much revenue you derive from your writing and blogging. Suspect that it’s not much. In the marketplace of ideas, Sullivan is cleaning up. You?

  10. it’s relatively easy to figure out what food people need to survive and stay healthy.

    Actually, depending on who you talk to, even that is up for major debate.

  11. And that Lisa Walford? She’s a maaaaaaan baby!

  12. I came here to say what the David Kelly link says.

  13. I came here to see what the Chris Kelly link says.

    Just kidding! Shut the fuck up, LoneWacko.

  14. Michael Edelstein referred me to career counselor Marty Nemko, who lists health policy specialist as a hot career —
    http://www.usnews.com/articles/business/best-careers/2008/12/11/best-careers-2009-health-policy-specialist.html

    If only I could figure out how to get a job in it.

  15. “Actually, depending on who you talk to, even that is up for major debate.”

    But the difference between the high end and low end on food (or shelter, or clothing, if we assume that style is a luxury) is not nearly the difference between providing everyone in society aspirin and band-aids and providing everyone a new body cloned from their stem cells every 5 years.

    Health care is an inherently illiberal issue — most people (that actually think about things) accept that society cannot rationally have a theoretically unlimited obligation to anyone, much less everyone. Rationing is necessary. It will be cold and cruel, because the world that causes the need for healthcare is cold and cruel. We’ll be stuck debating the method of rationing, and why the politically well-connected seem to be favored.

    On a totally unrelated note, all welfare-type payments (including health care, which is what started me thinking) could be considered an interest-free debt. While it wouldn’t matter to the permanent underclass, the government could use the outstanding principle as an adjustment to the income tax liability, brackets, or rates. Assuming they actually want to increase revenue, it would provide some incentive to promote class mobility rather than permanent dependence.

  16. That permanent dependance seems to provide a bit of job security for a lot of government employees. The government, I suspect, sees the dependance as a perk, not a bug in the system.

  17. Where in the Constitution do they cover ‘kissing boo-boos?’

  18. I wonder why those opposed to universal health insurance resort to such statements such as “Where in the Constitution do they cover ‘kissing boo-boos?'” and other similar foolishness. It is beneficial to society for even the indigent and the working poor to be able to get basic health services not provided in the emergency room – such as prenatal care, basic dental care, immunizations, etc. These do not include aspirin, bandages and various OTC products. Why do we as a society have such an ingrained “I’ve got mine and you don’t” attitude? Yes. Rationing is required. Basic health care does not include all the most extreme/newest treatments. It does not include elective surgery and a whole host of other procedures. As to how to do this without a government run program, research the system in the Netherlands. The Dutch are very pro-competition. And it works.

  19. This leads to cases in which people are denied treatment because the government has decided that their lives just aren’t worth enough.

    Add a provision requiring that this be tattooed on the forehead of everyone who gets their healthcare paid for by Obamacare, and I will drop my opposition:

    “Do not provide any care to me if a bureaucrat determines that my life just isn’t worth enough.”

  20. Why do we as a society have such an ingrained “I’ve got mine and you don’t” attitude?

    Well, there’s that whole property rights, thing.

    But you do Americans a serious disservice by imputing this attitude to them. We give more to charity than any other country.

  21. Butch,

    would the government be any better at administering health care than they are in administering criminal justice?

  22. If I have a moral obligation to help provide his health care, I have an equal claim on telling him how to live his life. Does the fool really trust me with that?

  23. nice post..
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