I try to avoid extensive engagement in political issues on this blog. I also try to avoid potholes. But sometimes stuff happens. Healthcare is an important topic. We all seem to agree the system out of control, with skyrocketing prices and declining value. Everyone I talk with seems equally passionate about developing a U.S. healthcare system that provides the highest quality care to the most people possible. What no one seems to agree on is how to do it.
INTRO TO THE ISSUE
I personally believe that much of our conflict about a solution arises from a misunderstanding of healthcare itself. What is healthcare? In particular, do you believe that healthcare is fundamentally a BASIC HUMAN RIGHT that belongs equally to all human beings or is healthcare a PRODUCT which some choose to purchase and others may not?
How we go about providing & fixing healthcare depends, as I see it, almost entirely on what we think it is. We will always disagree on how to fix a car if I mistakenly identify it as a cabbage. What it is matters. And how we go about distributing, improving and repairing it will depend heavily upon what we think healthcare is. If healthcare is essentially a basic human right, then compassionate people will go about seeking to institute social reforms and programs to improve access and quality. If healthcare is basically a product, then compassionate people will institute smart business models that will improve access and quality. Here is, in my opinion, where liberals and conservatives disagree. And here, in my opinion, is where they both go wrong.
I’m about to make some generalizations. This is always dangerous and necessary. If you disagree, please comment below and share your thoughts. That’s what “comment” boxes are for.
Liberals tend to call healthcare a basic human right. By that they seem to mean that a good society, however you decide to define “good,” does not have people routinely dying from preventable illness when treatments are readily available.
All things being equal, healthier people mean a healthier nation (healthier economy, academics, defenses, etc.).
Our vaccination programs are an example, to some degree, of the benefits of this sort of mindset. Virtually everyone gets them. Virtually no one is dying from those preventable illnesses now.
Conservatives usually see healthcare as a product. By that they mean that people should be left free to decide on their own whether they want it and from whom to purchase it. Market competition should, in this view, be the primary force utilized to improve access and lower costs.
This makes sense too. Healthcare, in some senses, looks very much like a product.
- Healthcare, like most products, is a limited resource. There are only so many doctors, so many hospitals, so many tablets of penicillin to go around.
- Healthcare, like most products, costs someone significantly to provide. A pharmacist went to school for 6 years, a manufacturer spent millions developing a drug, an investor emptied her savings account to fund the development of a new medical device.
- Healthcare, like most products, is needed more by some people than others.
- Healthcare, like most products, comes in varying degrees of quality.
- Healthcare, like most products, cause some to go bankrupt in their attempt to provide it while others become wealthy in doing so. In other words, like most products, the development & distribution carries risks and rewards.
You have heard of the “Duck Test.” It was originally attributed to the mid-19th century American poet and author James Whitcomb Riley who said “When I see a bird that walks like a duck and swims like a duck and quacks like a duck, I call that bird a duck.” Healthcare, conservatives say, walks like a product, swims like a product and quacks like a product. Therefore it is a product.
My own view of healthcare, and of how we go about fixing it, begins by referring to healthcare NOT as a right, NOR as a product, but RATHER as a privilege. I do not believe this is just semantics. I believe it makes all the difference in the world.
I believe that calling healthcare a “right” fails to appreciate the sacrifice that someone else has made on my behalf. When the surgeon worked on my daughter to help correct a birth defect, I did not think I had a “right” to his services. He gave up a lot of his life and money to be there when I needed him. It was a privilege.
I believe that calling healthcare a “product” introduces a strategy to the system that, although entirely appropriate for business, is inappropriate in a good healthcare model. A good businessman will try to put his competitor out of business, will cut staff if necessary to survive, and will have to sometimes sacrifice a bit of quality to improve margins. That’s business. That’s not wrong. But that’s not healthcare in my opinion.
When we view healthcare as a “privilege” a whole new perspective and plan comes into view.
First, if something is a privilege then we will be sure that those providing that privilege are treated well. Reimbursements below cost, excessive delays in payments, inhumane working conditions are not consistent with the delivery of a service we deem it is our privilege to enjoy.
Second, if something is a privilege we expect those receiving it will demonstrate their appreciation by some tangible contribution.
Third, if something is a privilege, we respect the right of the patient to make choices. “Privileges” are not forced down your throat by mandates.
Fourth, privileges should be transparent. A gift that you cannot understand can hardly evoke gratitude. If healthcare is a privilege, we should know what we are getting and how much. A “confusing” privilege makes no sense.
Finally, compassionate people will want this privilege to be available to as many who want it, without losing any of the other characteristics of a privilege in the process.
How do we do this? How do we move toward a healthcare model that accurately, in my opinion, identifies it as a privilege of society – not simply a right or a product.
Well, that will be the subject of an upcoming post. Stay tuned…