THE DURHAM HERALD-SUN Aug 7, 2009
Guest Columnist, John David Lewis: There is no moral 'right' to health care
After 50 years of increasing government coercions, through a maze of agencies that control nearly half of all medical dollars, the costs of health care continue to skyrocket. The Obama plan, far from a socialist innovation, is merely an extension of the overall policy of government intervention we have embraced for three generations.
But rather than assume that more coercions are the answer, should we not at least consider that the source of the problem may be those very interventions? Shouldn't a serious discussion of the issue include that possibility?
Historically, the huge rise in health care costs began in the 1960s, when Medicare and other programs distorted prices by throwing billions of federal dollars into the industry under reams of new laws. Fiscally, Medicare is now approaching insolvency on a monumental scale.
To create another bureaucratic labyrinth now -- which, after juggling the figures, advocates are proud to say will cost less than a thousand billion dollars over 10 years -- is to add to the very cause of the rising costs. This all but guarantees an even greater crisis in the next decade. Economically, this is hard to dispute.
But economic arguments have not stopped the train to further government intervention, and we should ask why.
The answer is that the advocates of government medicine are upholding health care as a moral right. Desiring to mandate this "right" by law, they have been unwilling to face the cause-and-effect relationship between government actions and rising prices. That is because the moral goal of a "right" to health care has overpowered the economic arguments.
As a result, calls for more programs -- to enforce the "right" -- have continued, even as prices rise. Greater price distortions have fueled calls for more interventions, leading to higher prices and demands for more coercions. This vicious cycle is blinding people to the fact that the fundamental cause of the problem is the government interventions themselves.
Again, even a cursory look at the evidence shows the cost problem as beginning in the late 1960s, when the government set out to enforce this "right."
And if one thinks that England is health care utopia, one may not know the reality of six-bed wards in National Health Service hospitals, of patients waiting over a year for heart operations, or of refrigerated trucks in hospital parking lots to store the bodies during the flu season (all of which I saw when living there).
The "right" to health care in England is contingent on bureaucratic approval.
To address spiraling medical costs we should challenge the premises behind the government actions. The first premise is moral: that medical care is a right. It is not. There was no "right" to such care before doctors, hospitals and pharmaceutical companies produced it. There is no "right" to anything that others must produce, because no one may claim a right to force others to provide it. Health care is a service, and we all depend upon thinking professionals for it. To place doctors under coercive bureaucratic control is to invite personal and national catastrophe.
The second premise is economic: that the government can create prosperity by expropriating billions of dollars from the most productive citizens. This is the road to stagnation and bankruptcy, not universal prosperity. The truth of this is playing out before our eyes, as medical prices balloon with every new intervention, and we face the largest deficits in human history.
If Congress wants to address health care issues, it can begin with three things:
1) tort reform, to end the ruinous lawsuits that force medical specialists into
insurance costs of hundreds of thousands of dollars per year; 2) Medicare
reform, to face squarely the program's insolvency and its effect on prices
across the board; and 3) regulatory reform, to roll-back the onerous rules that
force doctors, hospitals and pharmaceutical companies (who are pilloried for
producing the care that many people demand as a "right") into satisfying
bureaucratic dictates rather than solving patients' problems.
John David Lewis is an associate professor in the Philosophy, Politics and Economics Program at Duke University. © 2009 by The Durham Herald Company. All rights reserved.
Health Care Bill HR 3200, ‘‘America’s Affordable Health Choices Act of 2009”: What It Says
Dr. John David Lewis August 6, 2009
WILL IT RATION MEDICAL CARE? See pages 284-288, SEC. 1151:
‘(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.
Will IT punish Americans who try to opt out? Pages 167-168, section 401:
‘‘(a) TAX IMPOSED.—In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent
wILL HEALTH SAVINGS ACCOUNTS BE ILLEGAL? Pages 26-30, SEC. 122:
(A) IN GENERAL.—The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package . . .
Will IT destroy private health insurance? Pages 149-150, SEC. 313:
(a) IN GENERAL.—A contribution [a tax on business, with payrolls over $400,000 per year] is made in accordance with this section with respect to an employee if such contribution is equal to an amount equal to 8 percent of the average wages paid by the employer during the period of enrollment (determined by taking into account all employees of the employer and in such manner as the Commissioner provides, including rules providing for the appropriate aggregation of related employers). Any such contribution—
[Business that now provide health coverage will be encouraged drop the plan, enroll their employees in the government plan, and pay the 8% “contribution.”)
DOES THE GOVERNMENT set FEES FOR SERVICES? Page 124, Sec. 223:
(d) CONSTRUCTION.—Nothing in this subtitle shall be construed as limiting the Secretary’s authority to correct for payments that are excessive or deficient . . .
(e) CONSTRUCTION.—Nothing in this subtitle shall be construed as affecting the authority of the Secretary to establish payment rates . . .
(f) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review of a payment rate or methodology established under this section or under section 224.
CAN the government SEE OUR private FINANCES? Pages 195-196, SEC. 431
‘‘(A) IN GENERAL.—The Secretary, upon written request from the Health Choices Commissioner or the head of a State-based health insurance exchange approved for operation under section 208 of the America’s Affordable Health Choices Act of 2009, shall disclose to officers and employees of the Health Choices Administration or such State-based health insurance exchange, as the case may be, return information of any taxpayer . . .
[and] ‘‘(v) such other information as is prescribed by the Secretary by regulation as might indicate whether the taxpayer is eligible for such affordability credits . . .