Health Care: Privilege or Right, Research Paper Example

While the figures vary, there is no doubt that there are tens of millions of people in the U.S. who do not have medical insurance or access to health care. With the passage of the Affordable Care Act, it seems that the U.S. is moving closer to providing coverage to most Americans. The mechanics of the ACA, however, and the mandate to purchase medical insurance, are both controversial and fraught with difficulties. The ACA has not yet been fully implemented, and it remains to be seen how it will work in terms of enforcing the mandate and providing subsidies for those who cannot afford to meet its obligations. The passage of the ACA, however problematic it may be, is at the heart of an ongoing debate in this country: is health care a privilege or a right?

At the time the U.S. Constitution was drafted, the health care system as we know it today was practically nonexistent. The guaranteed rights to “life, liberty, and the pursuit of happiness” did not specifically mention health care, though the costs of health care in the early years of the U.S. were remarkably low as compared to contemporary costs. In the 18^th and 19^th centuries, most health care consisted of visits to family doctors, the costs of which were usually low enough for most people to afford (Haft, 2003). Lengthy hospital stays could be costly, but generally speaking health care was something most people could access at least to some degree. In the early 20^th century, as health care costs began to climb along with advances in medicine and technology, access to health care was often out of reach for lower-income individuals and families (Haft, 2003).

In response to these rising costs, insurance companies began to offer policies that spread the costs of health care among those who did and did not end up using the services available through the policies. Employers began offering prepaid services to employees; these programs paid fees to physicians who then offered services to the company’s employees (Haft, 2003). In the mid-20th century health care costs began to rise again as the costs of hospitalization, medical tests, and access to improvements in medicine and technology drove prices up (Bosek and Savage, 2007). By 1965 the U.S. government recognized that large segments of the population, particularly children and the elderly, were without access to health care, and the Medicaid and Medicare programs were established to provide health care to these segments of the population (Murphy, 1986). It was clear that, at least to an extent, there was a determination made that health care was not a privilege, but a right, for these members of the population.

Despite the coverage afforded to children and seniors, access to health care remains out of reach for many millions of Americans. HMOs and other health-care related insurance schemes are becoming more expensive, and employers are cutting back on the level of coverage they provide to employees. At the same time, proponents of alternative solutions to the problems of access to health care posit that health care is a right, and not a privilege, and should be made available to all citizens (Hoffman, 2012). The reality of the situation is that health care is expensive, and any proposals about how health care can be made available to everyone must deal with this reality. Whether health care should be seen as right or a privilege is somewhat moot in the current system; the fact remains that health care is currently a privilege, as it is only available to certain segments of the population. Philosophical debates about seeing health care as a right must contend with the fact that someone has to pay the costs.

Because health care in the U.S. has historically been treated as a commodity, the market-based components of the current system are seen by many as being valuable (Smith et al, 2005). By this logic, free-market competition drives innovation and improves quality of health care. As Hoffman notes, “the idea that health care is a product to be bought and sold in the marketplace contradicts the notion that it is a public service to be provided on the basis of right” (2012). There is no question that the private system of for-profit companies that manufacture drugs or provide health insurance has made high-quality health care available to many people; the question remains, however, as to whether this system that excludes so many is the best, or the only, approach to the provision of health care.

When President Barack Obama proposed the Affordable Care Act (ACA), many of his political opponents decried the ACA, claiming it would lead to calamity in the U.S. health care system. Some of the concerns raised by opponents were that the ACA would lead to “rationing” and “death panels,” and that the costs would drive up overall health care costs (Hoffman). The reality is that the U.S. system of health care is already based on rationing. Just getting any access at all is rationed to those who get insurance from their employers, those who can afford to pay for their own insurance, or those who are covered by programs such as Medicare and Medicaid. Those who do have some form of coverage find that insurance companies often deny various treatments or tests, meaning that their health care is also rationed. If nothing else, the effort to expand coverage through the ACA will lessen the aspect of rationing that precludes some people from getting any coverage at all.

Medical ethicist Larry Churchill states that “the reason why there is a fuss over rights to health care is because so many are left out” (Hoffman). That, in the end, is what continues to drive the debate about whether health care is a right or a privilege. If the current system served to provide health care for most people, and left very few out, the question of right vs. privilege would be largely beside the point. As it stands, the move to include the bulk of the uninsured in the U.S. is built around taking advantage of, rather than dismantling, the current system of private health insurers. The basic premise of the ACA is that, by expanding the coverage pool, health care costs can be further spread among those who do and do not utilize their insurance and health care services (Hoffman). The broken system that the ACA intends to fix was built on the notion that health care is a privilege; as the costs of that approach threaten to collapse the entire system, it may turn out that making health care a right is the only thing that will save it.

Bibliography

Bosek, Marciaa Sue DeWolf; Savage, Teresa A. The Ethical Component of Nursing Education. Lipincott Williams & Wilkins. Philadelphia, PA. 2007.

Haft, Howard. Is Health Care a Right or a Privilege? Physician Executive. January-February 2003.

Hoffman, Beatrix. Health Care for Some: Rights and Rationing in the United States Since 1930. The University of Chicago Press. Chicago, IL. 2012.

Murphy, Ellen K. Health Care: Right or Privilege? Nursing Economics. 4(2). March-April 1986.

Smith, Michael Ira; Vertheimer, Albert I.; Finchman, Jack E. Pharmacy and the U.S. Health Care System. Hawthorn Press. Binghamton, NY. 2005.