Thursday, October 15, 2009

Some thoughts on health care

The Social Principles of the United Methodist Church declare, "Health care is a basic human right." The Principles offer the weakest of justification for the claim, citing only Psalm 146, which "speaks of the God 'who executes justice for the oppressed;/ who gives food to the hungry./ The LORD sets the prisoners free;/ the LORD opens the eyes of the blind.'" I have looked in vain online for a philosophical argument, as opposed to mere assertion, that health care is a human right. haven't found any yet, but I keep looking. However, here are some representative sample of the "pro" side that I have found so far.

As far as I can tell, when someone says that health care is a human right, what s/he really means is, "I want all the health care I want to be given to me free."

Amnesty International merely cites the Universal Declaration of Human Rights, which lists health and health care (both) as human rights, and pretty much lets it go at that. But Amnesty offers no explanation of why health care is a right rather than, say, an achievement. It simply is a right, and that's that. Same for The Opportunity Agenda.

People's Weekly World is, as the name indicates, overtly Marxist, but let's see whether it can offer an actual argument in favor of the position. Umm, nope. It simply cites FDR's proposal of a Second Bill of Rights, which includes, "The right to adequate medical care and the opportunity to achieve and enjoy good health," and let's it go at that.

Roosevelt did make an argument, albeit a very brief one, postulating that the original Bill of Rights, being oriented on political freedom, was no longer adequate for an industrial America. And yet his argument was only pragmatic, claiming that, "People who are hungry and out of a job are the stuff of which dictatorships are made." Which is pretty interesting, seeing as how FDR once fancied himself a strongman ruler if not actual dictator (he actually drew up legislation for Congress to authorize him to rule by edict, but he never sent it to the Hill).

I think that history, however, would show that "people who are hungry and out of a job" bring down dictatorships as often as they enable them. Say, France, 1789 and the downfall of the French monarchy. It wasn't hunger that caused dictatorial rule to return later to France, but chaos. And again: Russia, 1917, the overthrow of the Czar and the establishment not of dictatorship but of proto-democracy, well, until the Bolsheviks got the upper hand. Germany: Hitler was not elected chancellor- twice! - by hungry, jobless Germans, though his elections in 1933 and 1936 did take place in the depression. It was improving prosperity in Germany, combined with runaway nationalism and anti-Judaism, that enabled the Nazis to consolidate their power. Nor did jobless, starving Japanese demand the bushido government that took them into World War 2, although starving Japanese in 1945 would almost certainly have overthrown that government in 1945 had it not surrendered to the Allies first.

However, FDR didn't stop at health care in his Second Bill of Rights. He listed all sorts of ingredients for his rainbow pie. For example, the right of every farmer "to raise and sell his products at a return which will give him and his family a decent living." Growing plants is now a human right? How can there be a "right to sell" without a corresponding obligation for someone else to buy? And just how shall "decent living" be defined? All of FDR's Bill is chock-full of inexactitudes like these, such as, "The right of every family to a decent home." Just what does that mean?

Well, continuing to march: we turn to Ryan Dashek, writing in The Daily Cardinal, that, "Health care is a human right, not a costly luxury." Again, no explanation of why this is so, just assertion and a litany of presumed benefits that would come from nationalized, single-payer health care. Nor, for that matter, is there the slightest recognition that health care is going to be costly whether we classify it as a luxury or not. (The failure to distinguish between cost and price is very common among universalism advocates.)

Well, the National Economic & Social Rights Initiative lets the cat out of the bag.

When visiting a doctor, clinic or hospital, patients should not have to pay. Health care funds should be collected independent of the actual use of care, to avoid creating a barrier to care. Services must be provided based on clinical need, not payment, regardless of the financing mechanism used.
This is so economically uninformed that I hardly know where to begin its rebuttal. It treats medical care as a resource rather than a service. It absolutely makes the bean counters and accountants in charge, not doctors or patients because medical care is going to allocated somehow ("rationed," as we say) and the main important question is how it shall be done.

Contrary to what the NESRI thinks, access to medical care will never be unlimited. I have personal experience with government-run health care. It was a CHAMPUS-run clinic that opened in Fayetteville, NC, while I was stationed at Ft Bragg. (CHAMPUS was the military health-insurance program used when treatment at actual military facilities was not available. It's called Tricare today.) The object was to encourage family members of military members to use this clinic rather than go to the base hospital. The Army contracted with a civilian company to staff and run the clinic.

Being a contract, there was a dollar amount to pay for a specified number of patient treatments. The clinic was overutilized (or underfunded, take your pick). So the company, as allowed by the contract, reduced the number of days the clinic was open and the number of hours per day it was open. Otherwise, it would have continued on until say, the end of July, and then been shuttered until October.

Like Mr. Dashek, NESRI does not understand that price and cost are not the same. Making health care free for patients does nothing to reduce its cost. All it does is shift the small-minority costs to the provider that are presently borne by most, but not all of the patients. But the costs will neither disappear nor be reduced. It will still cost the doctors and hospitals the same to provide the care as before.

What "free" (in scare quotes because, you know, TANSTAAFL), health care will do is increase demand without increasing supply. That always leads to shortage whether we're talking about medical care, gasoline, hotel rooms or any other good or service. Without price movements to bring demand and supply back into alignment, reductions will follow in access to or quality of care or both.

Here's an illustration: I visit many hospitals and occasionally those visits are to emergency rooms. There is a sign in waiting and admission areas I have seen many area emergency rooms. It says something like this: If your illness or injury is not a true emergency, you will be directed to a routine-care facility.

Why that sign? Because federal law requires that emergency rooms cannot charge patients for treatment if the patient says he cannot pay or is uninsured. I don't object to the law, but emergency rooms have become choked with uninsured supplicants for free treatment who are not suffering a medical emergency. I have seen this many times in person over the years. But emergency rooms are called that for a reason, and if you fill your treatment bays with patients who, though ill or injured to some degree, are not facing an actual medical emergency, you are in fact decreasing access (rationing) care for true-emergency patients.

That's what happens when you make medical care free. It will always become over-demanded and under-resourced. Costs will rise and will not be recuperated by monetary price. Hence, price will be paid in other coin, and that coin will always include availability and quality.

Any economist understands this. Pity that so few others do.

Endnote: Philip Barlow, Consultant neurosurgeon at Southern General Hospital, Glasgow, explains why, "Health care is not a human right."

Philip Niles says that the real question is not whether health care is a human right, but "How much health care is a human right?" Good question, since health care is finite.

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