by Dr. Roy Cordato
Senior Economist, Emeritas
The power to grant a right to health care is the right to deny it. Anyone who doubts the universal truth of this statement need look no further than the case of 11-month-old British citizen Charlie Gard, who had been on life support while suffering from a rare brain disease. Charlie passed away on Friday. Last November, Charlie’s parents petitioned the British government, which we are all told recognizes a universal right to health care, to allow them to bring Charlie to see a specialist in the U.S. for experimental treatment.
I think the first question that should come to mind for anyone who truly cares about health care rights is why Charlie’s parents had to ask the government’s permission in the first place? After all, Britain is supposed to be a free country, which typically would translate into citizens being able to make important decisions about their lives for themselves and their families.
The answer is that in Britain the government owns everyone’s health care and, as the owner, it has the power to decide what kind of health care services people get. This is not peculiar to Britain but is equally the case, indeed necessarily the case, for any country that “guarantees” a right to health care financed by the government, i.e., a single-payer system. Under such a system, it is an inescapable fact that, ultimately, the state will determine what health care is available, to whom it is available, and where and when they get it. In other words, the government will not guarantee the right to health care but determine to whom and at what point that right will be denied.
There is no such thing and cannot be any such thing as a universal right to health care, in the sense that people can receive health care services of their choosing, when and from whom they want it. First, let’s start with the fact that when the idea of a right to health care is discussed, we are always talking about a system where, to one degree or another, the government, through taxes, pays for health care services used by the citizenry. Single payer equals government payer. But because, like all other resources, health care resources (doctors, nurses, hospitals, clinics, MRI and X-ray machines, etc.) are scarce, an open-ended right to health care is impossible. Those resources have to be prioritized and allocated, and in the process, many people’s right to health care will have been denied.
Since there is only a single monopoly payer for health care services that all service providers must answer to, it becomes quite clear who ultimately ends up with all decision-making authority: the government or its authorized agents. It is the government that decides who gets to specify what services will be paid for and therefore what services the citizens will actually have a right to use. Beyond this, it will also determine who has the right to use them.
For example, when President Obama was asked at a town hall meeting on health care before the passage of his Affordable Care Act, whether a 100-year-old woman whose doctor recommended that she receive a pacemaker would be able to receive one, his answer was basically that she should, as an “end of life” decision, take pain killers instead. The implication was that that is a right to health care that, under his preferred system, the government would deny. The point to be made here is that under a system where people have a “right” to health care, paid for by the government, questions like this are ultimately answered by politicians rather than patients and doctors.
It is well known that in countries where people have a “right” to health care, like Canada and Great Britain, what is considered non-urgent surgeries (what is urgent and non-urgent is decided by the government) tend to have incredibly long queues and wait lists. It is not unusual for a person needing a hip replacement in Canada to have to wait more than a year after diagnosis to get into the operating room. What this means is that during this waiting period, which is likely to be a period of pain and suffering for the patient, this person had no right to health care in the form of surgical hip replacement. In fact, the Canadian government, which typically boasts about Canadians having “universal right to health care,” explicitly denies that right.
These kinds of situations are typical of nearly all countries that claim to “guarantee” such rights. Any system where the government can deny access to a wanted health care procedure is not a system that guarantees a right to health care. In fact, the only thing that is guaranteed is that at some point the right to a needed health care service will be denied.
The only right that can reasonably be guaranteed when it comes to health care is the right to freely acquire health care, not the right to acquire it for free. What government can guarantee is the right of consumers to use their own resources to purchase whatever health care services they choose from any provider they choose, using whatever payment mechanism they choose. If a person’s preferred payment mechanism is a health insurance plan, as opposed to direct payment (or some combination of the two), then it should be the plan of their own choosing and not one prepackaged for them and delivered to them by the government, as, for example has been the case under Obamacare.
Such an approach, while erroneously claiming to guarantee the right to health care, in fact, is an attempt to limit people’s health care acquisition rights. Indeed, under Obamacare, where people are forced to purchase health insurance, coverage is not a right but a legal obligation. A corollary to this is the right of health care providers to provide the options that they feel best fit the needs and demands of customers and to compete with other providers on any basis they choose. Governments should not be in the position of determining who can provide what services, when and where, for example, as is the case in North Carolina where strict certificate of need laws control and limit the supply of health care services to the benefit of large incumbent providers. Ultimately, these laws are actually an attempt to limit the rights of consumers to acquire heath care.
To advocate for a universal right to health care is not only meaningless in terms of the stated goal but is dangerous to the health and well-being of the citizenry. In reality, what is being advocated is the total power of government to deny citizens their right to acquire the health care of their choosing.