Health Care is Not a Right

[Tetra]

Before we get into it, I'm going into first year nursing... but I'm not some young kid. I'm 34, married with a family, studied philosophy in my early 20's, and lived well below the poverty line for my entire life. I'm saying this to avoid any fallacious arguments stemming from status or authority.

Now that's out of the way...

Why is health care not a right?

It's not a right because it requires others to fund your health care costs. You do not have a right to the money of other people.

What about those in need of health care?

We all love helping people, and that's important. Which is why there are countless organizations, churches, synagogues, companies, online charitable organizations, and other opportunities for your access.

If health care is a right, it's immoral.

A socialist view of health care requires the theft of citizens money through taxation to fund your health care needs. Just because I need health care does not mean I can take money of others, even when done through governmental force.

What's the difference between access to things like fire services, and health care services? They're all services aren't they?

The difference is that citizens who pay for services should receive services. Taxation pays for fire services, people are therefore owed that service.Consider, outside of municipalities where services aren't paid for, firefighting is volunteer, or paid for out of pocket. At least that's how it works in Canada...

When is health care a right then?

When you pay for it, however, it's a contractual right. Not a human right. I'm owed the service because I paid for it, that's it.

Who's responsible to take care of me then?

You are. Crazy idea right?

Are there exceptions?

Obviously, those with zero capacity to care for themselves.

I suspect heading into a Canadian nursing program with my views will be an interesting experience.

[MunoRN, RN]

Has anyone here seen someone refused care in the US due to lack of insurance?

Lack of insurance is a known cause of death, the larger study on the subject shows a mortality risk increase of 25 percent, which is significant. However that doesn't reflect those who don't die which is often far worse.

Consider someone with heart disease, with insurance they have access to care that manages their disease and treats it using proactive measures. Without insurance treatment is only required to be provided once you are essentially at the verge of death, at which point treatment is not only much more expensive,but it's also less likely to be effective and often results in adverse events such as stroke, neurological impairment, etc.

So basically we don't want to provide universal care because we don't want to spend the money, yet we spend far more due to a lack of universal coverage.

[operations]

I think you're making a lot of assumptions about my political worldview, and myself in general. I'm hardly far right, I'm right leaning on some issues, left leaning on others. When did I ever suggest that I'm interested in discriminating against anyone?? I think you'd be hard pressed to find a single post.

You want to decide who gets healthcare based on ability to pay. That's discrimination. You can Wikipedia the definition in case you need evidence.

[NotReady4PrimeTime, RN]

Several things have occurred to me as I worked my way through all 25 pages of this thread. Some I will not put voice to for fear of being called nasty names. But one thought that has recurrently popped into my head is that although Tetra has repeatedly stated - sometimes quite vociferously - that health care is not a fundamental human right, he has not provided examples he feels ARE fundamental human rights. Is it a right to espouse an opinion? Is it a right to have access to this forum (where some premium members have actually paid for the privilege) and wage ongoing attacks on the fundamental ethical constructs of nursing TOWARD nurses? Perhaps, perhaps not. I can wear a Leafs jersey, but that won't make me a hockey player any more than tossing out $10 words and the odd Latin phrase is necessarily a sign of intellect.

I have some trouble with the notion that someone who has, knowingly or unknowingly, willingly or unwillingly, benefited significantly from various parts of Canada's social safety net can be so bold as to denigrate one of the major advantages we Canadians enjoy, our non-discriminatory health care system. I do feel that someone who does not value those social benefits, such as our (heavily-taxpayer-subsidized) post secondary education system, makes no bones about his intention to use it to its fullest, then take his (heavily-taxpayer-subsidized) education to another country, is a bit disingenuous. Like health care, post-secondary education is not cheap; if it's truly more moral to pay for one's own personal health care, is it not also more moral to pay the entire freight for one's education? As one would if one chose to be educated in the (foreign) country where one intends to live and work? Does it not also follow that once the die has been cast, relinquishing that oh-so-abhorent Canadian citizenship, with all that implies, should be accomplished posthaste? To do otherwise would be somewhat duplicitous.

I believe his choice of career path is one largely based on economics. A philosophy degree doesn't have many lucrative purposes in the real world. We nurses make a decent living; NPs have the ability to direct-bill for their services and can thus increase their income more or less at will. The road to that lofty goal won't be an easy one for this man. To be a fly on the wall... How do libertarian principles intersect with Maslow's Hierarchy of Needs? (Speaking of nursing theory.) The next several years should be very interesting.

[herring_RN, ASN, BSN]

Here is the Canadian Nurses Association's Code of Ethics for Registered Nurses.

It was updated in 1997 and again in 2002 because nurses had become more autonomous in their practice as a function of the development of nursing knowledge and research and changing patterns of care, greater opportunities to provide benefit to people and communities through integrated team work requiring clear and effective communication, the emergence of communicable diseases, once thought conquered, and new infectious diseases that created serious public health challenges and reinforced the reality of the global community, nurses need knowledge and ethical guidance help our patients/clients to make well-informed choices about the appropriate use of many of the advancements in biological, genetic, and reproductive medicine, and to keep the focus of healthcare on the person's health rather than the business interests.

I've attached it for you to read. Here is a very basic quote of the outline:

Quote

The Code of Ethics for Registered Nurses is structured around eight primary values that are central to ethical nursing practice:

• Safe, competent and ethical care
• Health and well-being
• Choice
• Dignity
• Confidentiality
• Justice
• Accountability
• Quality practice environments

Code of Ethics for Registered Nurses

Code of Ethics for Registered Nurses.docx

[Tetra]

NotReady4PrimeTime said:

Several things have occurred to me as I worked my way through all 25 pages of this thread. Some I will not put voice to for fear of being called nasty names. But one thought that has recurrently popped into my head is that although Tetra has repeatedly stated - sometimes quite vociferously - that health care is not a fundamental human right, he has not provided examples he feels ARE fundamental human rights. Is it a right to espouse an opinion? Is it a right to have access to this forum (where some premium members have actually paid for the privilege) and wage ongoing attacks on the fundamental ethical constructs of nursing TOWARD nurses? Perhaps, perhaps not. I can wear a Leafs jersey, but that won't make me a hockey player any more than tossing out $10 words and the odd Latin phrase is necessarily a sign of intellect.

I have some trouble with the notion that someone who has, knowingly or unknowingly, willingly or unwillingly, benefited significantly from various parts of Canada's social safety net can be so bold as to denigrate one of the major advantages we Canadians enjoy, our non-discriminatory health care system. I do feel that someone who does not value those social benefits, such as our (heavily-taxpayer-subsidized) post secondary education system, makes no bones about his intention to use it to its fullest, then take his (heavily-taxpayer-subsidized) education to another country, is a bit disingenuous. Like health care, post-secondary education is not cheap; if it's truly more moral to pay for one's own personal health care, is it not also more moral to pay the entire freight for one's education? As one would if one chose to be educated in the (foreign) country where one intends to live and work? Does it not also follow that once the die has been cast, relinquishing that oh-so-abhorent Canadian citizenship, with all that implies, should be accomplished posthaste? To do otherwise would be somewhat duplicitous.

I believe his choice of career path is one largely based on economics. A philosophy degree doesn't have many lucrative purposes in the real world. We nurses make a decent living; NPs have the ability to direct-bill for their services and can thus increase their income more or less at will. The road to that lofty goal won't be an easy one for this man. To be a fly on the wall... How do libertarian principles intersect with Maslow's Hierarchy of Needs? (Speaking of nursing theory.) The next several years should be very interesting.

If you've actually read all 25 pages, you'd see this argument comes up countless times. You're argument is essentially that I can't be critical of the Canadian system because I benefit from the Canadian system. That's silly. In your mind, when can a Canadian be critical of the Canadian health care system? They have to relinquish their citizenship, fly to another country, and now they're permitted?

[herring_RN, ASN, BSN]

Most Americans trust their healthcare providers to be honest and ethical, but few other professions fare so well in Gallup's annual look at honesty and ethical standards among various fields.

Nurses top the list with 84% of the public rating their standards as "high" or "very high,"...

http://http://www.gallup.com/poll/200057/americans-rate-healthcare-providers-high-honesty-ethics.aspx

[shibaowner, MSN, RN, NP]

If you've actually read all 25 pages, you'd see this argument comes up countless times. You're argument is essentially that I can't be critical of the Canadian system because I benefit from the Canadian system. That's silly. In your mind, when can a Canadian be critical of the Canadian health care system? They have to relinquish their citizenship, fly to another country, and now they're permitted?

What has repeatedly been pointed out to you is that you are a hypocrite. That greatly reduces your credibility. Also, you were the one who claimed that "healthcare as a right" is immoral. Canada believes healthcare is a right. Personally, I would not participate in a system I felt was immoral. So, evidently, you are not only a hypocrite, you are OK with participating in an immoral system when it is expedient to do so.

BTW - you did not respond to me when I said that we do not accept your premise about healthcare not being a human right because it is "positive." You definitely have not responded to many arguments and your responses lack depth or evidence. I wonder how you were able to graduate if you studied philosophy - your arguments here would be a C at best.

This is a nice article from The Economist regarding libertarian healthcare:

"People have no obligation to perform labor for others. I may not force a surgeon to save my mother at gunpoint. (To be sure, I might. But society would justly punish me for doing so.)

This is indeed a fundamental libertarian assumption. The problem is, it leads directly to the conclusion that "if you don't have any money, you shouldn't be entitled to any medicine." This is not a quibble. It's a very basic point about the trouble libertarians have with arguments about fairness in health-care distribution.

Essentially, libertarians don't believe in positive rights. They believe that no matter how rich a society may be, no member of that society has a right to demand a minimal share of basic goods from that society. People have the right not to be interfered with, but they don't have the right to actually get anything. One can think of the position in terms of a desert-island castaway analogy. Let's say two castaways wash up on a desert island, along with their trunks. One is fantastically rich, and he has several trunks full of tinned meat, a water filter, and so on. The other guy just has a carry-on bag with a toothbrush. The question is: is the rich guy morally obliged to share his water filter with the poor guy? Does the poor guy have a right to potable water, given that the filter makes adequate water available for everyone? Or would it just be a nice thing, but not a rights-based moral obligation, for the rich guy to share his water?

Libertarians believe the poor guy doesn't have a right to the water. Liberals believe he does. If there's enough water to ensure nobody goes thirsty, then the poor guy has a fundamental right to get a decent share. There may be arguments over how large that decent share is, but fundamentally, people have the right to adequate water in a society where there's enough water to go around.

This is the same approach liberals take to justice in health care. In the debate over what constitutes "just" health care, liberals have taken a Rawlsian "fairness" approach or an Amartya Sen "capabilities" approach. Back in 1980 Alan Enthoven, a health-care economist, argued that people have a right to a "decent minimum" of health care. Philosopher Norman Daniels replied that the "decent minimum" idea isn't really sufficient, and that what health institutions need to do is to try to ensure people can access the normal range of opportunity in a society. To do that, you need to have your cavities filled when you're growing up, get the bones set properly when you break your arm, get insulin if you develop diabetes, and so forth. You can't get a decent job if your teeth are screwed up from adolescence, you can't play sports or take a warehouse job if breaking your arm would mean lifelong deformity, and you will simply die if you're a diabetic and can't get insulin. Our society has plenty of dentists and doctors who can fill cavities and set broken arms, and we have plenty of insulin. So if you're too poor to afford these things, then society has to find a way to make sure you get them, or you are being shut out of the normal kinds of opportunities that life in our society is supposed to entail. Mr Daniels and J.E. Sabin elaborated this argument in their 2002 book, "Setting Limits Fairly: Can We Learn to Share Medical Resources?"

Ms McArdle embraces the "decent minimum" idea, but in a very different form, in another one of her priors:

Societies should strive to organize themselves so that everyone in the society can, if they desire, acquire the means to provide their basic needs.

This appears to be different from having a "right" to a decent minimum of health care. Ms McArdle is saying that it would be good if the guy with the water filter and the guy with nothing were to organise themselves such that the guy with nothing might be able to access some potable water, perhaps by trading something for it, if he had anything to trade. If no such arrangement can be worked out (possibly because the rich guy couldn't care less), and the poor guy suffers from thirst or water-borne disease, then that's bad. But it's not a matter of anyone's rights being violated, on this view.

Currently, America ensures some measure of health care for its poor in several ways. First, there is the federal law that obliges hospitals to provide emergency care regardless of the patient's ability to pay. This is quite literally an obligation that could force a surgeon to operate on Ms McArdle's mother. Then there are programmes like Medicaid and CHIP, which provide insurance to the poor and to needy kids using taxpayer funds. Taking Ms McArdle's view that "there is no right to health care", if America were to eliminate Medicaid and the CHIP programme, and as a result lots of poor people and kids suffered easily preventable diseases, that might be bad. But it wouldn't be a violation of anyone's rights.

And it's hard to see how Ms McArdle could view this any other way, as long as she maintains that "people have no obligation to perform labor for others." To give her the benefit of the doubt, I'll assume that she would grant some obvious exceptions to this rule: clearly parents have an obligation to feed their children, and people drafted by the Army have an obligation to report for duty. But to say that no diabetic should die because they can't afford insulin is to say that health-care workers have an obligation to treat penniless diabetics, and that taxpayers have an obligation to work a little extra to pay for it. To say that they don't have such obligations is to say that it is better to allow penniless diabetics to die than to force anyone to treat them or pay for their treatment. And that is exactly what Mr Holbo says Ms McArdle must believe: "If you don't have any money, you shouldn't be entitled to any medicine."

In fact, Ms McArdle does not believe penniless diabetics should be allowed to die. Like most Americans, she actually believes that people should get basic health care, even if they cannot afford to pay for it. How do we know this? Well, this is where things get really weird. Ms McArdle ends her post by proposing her own preferred programme of health-insurance reform. The programme would provide federal subsidies so that anyone could afford to buy health insurance on the private market. And it would mandate that everyone buy health insurance, to avoid adverse selection. In other words, it is a programme for universal health insurance that looks much like the one currently making its way through Congress. What Ms McArdle appears to be doing is proposing a programme for universal health insurance, while insisting that on a theoretical plane people don't really have a right to such insurance, because libertarians don't believe in positive rights. If that is the bargain libertarians want to strike, it is one which most liberals would be happy to accept."

https://www.economist.com/blogs/democracyinamerica/2009/09/libertarians_health_insurance

[suzil]

I think you're making a lot of assumptions about my political worldview, and myself in general. I'm hardly far right, I'm right leaning on some issues, left leaning on others. When did I ever suggest that I'm interested in discriminating against anyone?? I think you'd be hard pressed to find a single post.

Your words speak for themselves. Now you are trying to backtrack. I think you don't have the experience in the real world. You are just reciting rhetoric. Just my opinion. I've encountered people like you before.

[shibaowner, MSN, RN, NP]

I've dealt with the majority of these arguments at some point or another in this thread... I mean jeepers, it's 25 pages long. Not to sure what you mean by "point by point" specifically, but I did respond to you in the manner I'm guessing you're looking for a half hour ago:

https://allnurses.com/nursing-activism-healthcare/health-care-is-1117311-post9566592.html#post9566592

You might not like what I wrote, that's fine, but I most certainly responded to you.

However, right now I'm super tired and have class in the morning. I'll be more than happy to respond tomorrow. Anyways, have a good night.

No you have not dealt with the majority of my arguments. Your argument is sloppy. If your premise is based on libertarian views of negative and positive rights, then you have to get the rest of us to buy into that. Well, we don't, and you have not offered even a feeble attempt to defend your premises of negative and positive rights.

What has made me so angry about this whole discussion is that you have openly admitted you have been living below poverty level and you and your family have used all the social benefits Canada provides, yet now you want to condemn other people who do the same when it comes to healthcare. And you want to bite the hand that feeds you (the Canadian system). This demonstrates not only hypocrisy, but a serious moral disconnect between you supposed beliefs and your actions. You have not responded to the fact that the nursing code of ethics in the USA does view healthcare as a right. It is very troubling to most of us to see someone enter either nursing or medicine when their personal philosophy is in such conflict with their profession.

You also fail to understand that your philosophy informs your actions and reflects on you as a person. If I said I believe murder is ok, what would that say about me as a person? What if I said I thought slavery was ok? If I espoused these positions, people would be rightfully horrified and condemn me.

Please reconsider your choice of career. There are other careers that would be more in line with your philosophy. Perhaps you can take a cue from Ayn Rand's "Atlas Shrugged" and being the so smart special person you are who demands payment for everything, you can just disappear and go live with your own kind and leave the rest of us alone.

[shibaowner, MSN, RN, NP]

I'm sorry if I missed it, what follows is the privatization of health care.

I have repeatedly asked you how to implement a libertarian healthcare system in the real world. You just won't answer this, so I assume it is because you do not have a clue.

"Why shouldn't we embrace the dream [of libertarian healthcare]? Like all utopians, libertarians talk a good talk. A free market would lower prices and increase individual choice, they say. And who doesn't like the sound of that? The problem is that, like all utopians, libertarians also have a big problem explaining how to get from our world — a world in which two years ago a local hospital billed my insurance company $52,000 for a minor bit of outpatient orthopedic surgery on a broken wrist — to one in which the wonders of competition and self-rationing will (supposedly) deliver quality care to those who need it without driving significant numbers of them (let alone 24 million or more of them) into bankruptcy.

If we could start the world over from scratch, we might have a fruitful debate about whether to set up a free-market system of health care (though even then it would probably be far better for the rich and the healthy than the poor and the sick). But in the world we inhabit, such a debate is worse than fruitless — because it allows libertarians to use an imaginary great option as a sledgehammer to smash the flawed but perfectly acceptable (and eminently fixable) option we already enjoy in ObamaCare." (And I interpret the last sentence to mean in addition the libertarian notion that healthcare is not a right).

The GOP's health-care fantasy is a libertarian delusion

[heron, ASN, RN]

You don't understand why universal healthcare was set up, do you?

Hips fractures are emergent and performed STAT in my province. Electives usually within 6-9 months. Pay to jump the queue, have complication? You get treated as an emergency and the province pays.

You'd be surprised at what employment extended insurance pays for in Canada.

Can you explain why American insurance companies can veto, delay American doctors decisions on care?

The insurance companies don't actually veto the treatment - they just refuse to pay for it, rendering it unaffordable for most people.

[Tetra]

What has repeatedly been pointed out to you is that you are a hypocrite. That greatly reduces your credibility. Also, you were the one who claimed that "healthcare as a right" is immoral. Canada believes healthcare is a right. Personally, I would not participate in a system I felt was immoral. So, evidently, you are not only a hypocrite, you are OK with participating in an immoral system when it is expedient to do so.

What the heck, when have you ever heard of anyone making a criticism, not on the basis of morality? If we thought the system we lived in was moral, there would be nothing to criticize. So your argument is that I can only critisize the health care system if I agree the health care system is right? How does this even make sense?

BTW - you did not respond to me when I said that we do not accept your premise about healthcare not being a human right because it is "positive." You definitely have not responded to many arguments and your responses lack depth or evidence

What you're talking about is a rejection of the definition of positive rights. The distinction of positive and negative rights might be popular among libertarians, however, the distinction is accurate. You just seem to simply dislike the definition.

The entire article was actually a good read, but it's incorrect. Libertarians are not against positive rights... with a single caveat, the positive rights were established though mutual consent. The article presupposes libertarians are just simply against positive rights in general, and it's not true. This is why I said in my OP, positive rights being a form of contractual right. I actually answered this very question regarding the nature of positive rights from the beginning.

Anyways, got to go to school. Peace.