Let’s get serious about recognizing healthcare as a right. Here’s how.
One of the major topics dominating recent US presidential debates is healthcare. The Democratic candidates take Medicare for All as a given; the only point of debate is whether any other form of insurance should be criminalized immediately, or if private insurers should be permitted to remain at large a few more years.
Either way, the subtext is clear: Obamacare has failed. The once-in-a-generation reform went into effect only five years ago with a promise to cover all Americans. The NIH reports it has delivered statistically significant increases in access to care. There’s obviously a big gap between that and “all”, which is why all the 2020 candidates are promising a redo.
It need hardly be said that the “affordable” part of the Affordable Care Act hasn’t materialized either. Cost was always a secondary goal of the ACA, which hoped to solve access first. But it did include provisions intended to “bend the cost curve.” If you remember your calculus, that means the second derivative gets lower. If you don’t, that’s beltway-speak for “it’s going to keep getting more expensive.”
While technology is making everything else on the planet cheaper and more widely available, Washington has somehow created a reverse economy in health care, where the bigger the providers grow and the more they automate, the more expensive they get.
Healthcare will be the defining issue of the 2020 election. Everyone agrees it’s a problem, and Democrats are winning support for framing it as a right. We should hold them to it.
What it means to be a right
Nobody does rights like America. The country was founded on the idea that people are endowed by nature with certain inalienable rights, which governments cannot legitimately abridge.
The Constitution gives that idea teeth in the Bill of Rights, which forbids the government from infringing citizens’ sovereignty over our speech, religion, gun cabinets, and other aspects of our persons and effects. Congress may not interfere with your autonomy in these areas; neither do your fellow citizens get to vote on what you may say or what church you may attend.
If we’re serious about making healthcare a right, that starts with adding it to the list of things that can’t be metered out by bureaucrats or voted away by our neighbors.
Before we pass another 10,000-page central planning edict, I offer a 28th Amendment to the Constitution, of a modest 63 words:
The Access to Healthcare Amendment
All persons being natural owners of their own bodies, Congress shall pass no law, nor any other jurisdiction within these United States, encumbering the provision of medical services on any grounds whatsoever. Not national security. Not presumed efficacy or safety. Not equity for disadvantaged communities. Not to “make them pay their fair share.” All such laws are immediately nullified, all enforcing agencies disbanded.
The Access to Healthcare Amendment (AHA!) doesn’t prevent government from subsidizing care for people who otherwise couldn’t afford it, but it does toss the layers of legally-mandated middlemen onto the street and return your health to your control.
That isn’t the end of the subject, of course, that’s not how rights work. Freedom of the press doesn’t mean someone owes you a laser printer, freedom of religion doesn’t ensure your prayers will be answered, and freedom to seek medical treatment doesn’t put doctors at your disposal.
Recognizing a right of citizens to healthcare isn’t sufficient to keep us all healthy, it’s merely a vital precondition. The government has been trying to improve healthcare for a century and succeeded only in creating an affordability crisis, with no one in particular responsible or able to fix it. It’s necessary for politicians to adopt the same rule that guides doctors: first do no harm.
Your body, your choice
Most critically, AHA takes the government out of the business of deciding what’s safe and enough and effective enough for you to do with your own body.
In principled terms, and simply by the definition of a human right, a right to healthcare can’t be metered by a Food and Drug Administration or any other government agency. If an act of Congress or an executive order or a decision in the DHS can forbid your medical treatment based on someone else’s judgment, you don’t have a right at all.
In practical terms, the government’s paternalism balloons costs and demolishes access. You can’t take a drug until and unless it has been FDA approved (at great expense), you secure an expensive permission slip from a government-authorized doctor and you buy from an expensive government-certified pharmacy. To bring the cost down to something reasonable, you need to have bought expensive coverage from a health insurer, and you must get the insurer’s authorization to buy the drug as well. There must a government-licensed pharmacist on duty when you buy it, who must ask you if you have any questions about the medication.
That’s a lot of mouths to feed. And those are just the ones I can see as a consumer/patient, and just in this one transaction. Many more work behind the scenes, detectable only in the price tag.
No one would go through this expensive, cumbersome channel for drugs if the government didn’t aggressively shut down all the others. It imposes a regime of patent and import laws, customs inspectors with x-ray machines, Coast Guard and DEA agents scouring the land for renegade drugs, and prisons bulging with nonviolent but unauthorized drug sellers.
You can’t have a P.O. box unless you’ve identified yourself with the government, because you might receive drugs there. You can’t carry $10,000 around unless you’ve notified the government, because you’re probably laundering drug money. If they even suspect you of moving drugs, they can seize your assets with no due process.
The costs the government imposes are staggering: wasted dollars, ruined lives, trampled civil liberties, devastated communities. And of course unaffordable healthcare.
And all to make sure you don’t take something unsafe. Safety sounds like a modest, reasonable constraint to impose on healthcare providers, doesn’t it? But in practice it’s a blank check for a ruinous bureaucracy and the most ravenous police state on the planet.
The cruelest part of the joke? It doesn’t even work.
Is it a right or not?
Do we really dare for government to leave people to make their own healthcare decisions? What if they decide wrong? What if bad doctors are allowed to practice? What if a drug is unsafe? What about the opioid crisis? The free market works okay for oatmeal and socks, but health care is too something-something….
Anyone raising these objections is saying they don’t recognize healthcare as a right. If you have a right to make your own decisions, my speculations about whether it’s good for you or how you might affect opioid statistics aren’t relevant. I don’t get a vote on your healthcare. I can object only if you violate some right of mine — for instance, you can’t demand I donate a kidney.
Once reframed around decisions you actually own, those questions become specific enough to answer. How far do I trust this advice from this doctor? What’s the safety record of these pills? What will I do if I experience this side effect? As a social engineer I couldn’t answer these questions at all, but as a patient I can simply google them.
Where do you stand?
Is healthcare a human right, which each individual has both a right and an obligation to make their own decisions about, and to live with the consequences? Or is it a collective project like building a highway, where we all get to vote on a single system that everyone will live or die with? Or perhaps it’s more like an IT project that a few experts craft, withhold from users until they think it’s ready, and then install on your machine whether you want it or not? You’ll need to make your own call.
Where does your favorite candidate really stand on the issue? Do they really believe in healthcare as a human right, under the natural authority of each individual? Or do they see your bodily autonomy as something politicians ladle out to you — in effect holding your health hostage in exchange for your vote, and disguising the deed under the language of rights?
Is it important candidates for high office understand what it means for something to be a right held by citizens? If they have a really good plan for taking more control over your healthcare, is it okay if they fib a little and describe it as more rights for you?
Healthcare is a life-or-death issue for us all. If there were ever an issue to consider these questions carefully, this is it.