Health care a right or privilege

Jolie, BSN · Mar 6, 2012

Perhps you could start off the conversation. It's an interesting topic, sure to stir a lively debate, but we don't like to do other peoples' homework.

neatnurse30 · Mar 6, 2012

Anything that cost is not a right. Healthcare is not a right, it is a commodity because it costs. If you go to the mall, or grocery store you know that you have to pay, nobody is arguing with the cashier about not paying. For some odd reason, when people go to the hospital, or a doctor, they don't want to pay the bill and believe that they can get healthcare services for free. Granted, health insurance is expensive and medical services are expensive, but people should be able to pay at least partial cost.

great_bu · Mar 6, 2012

I am a UK nurse who has worked in the National Health Service (NHS) for my whole career (why am I posting on allnurses.com ? because I am in the process of emigrating to Baltimore to work at John's Hopkins), so I have a great familirarity with universal free (at the point of delivery, anyway) healthcare.

The biggest issue with delivering 'free'* health care is that there is a significant gap between the ethical ideal which we would like to be true and the reality of human nature.

In an ethically ideal world, the best solution for healthcare provision would be to have an NHS style system whereby universal taxation (based on ability to pay, i.e. the rich pay more than the poor) is used to fund a universally available healthcare delivery system (based on health need, i.e. the sick get more than the healthy, regardless of personal finances).

In the real world, unfortunately, this leads to the significant problem that healthcare is regarded as a right instead of a privilege. This means (and has meant for the NHS in the UK) that you are faced with significant problems in providing universal healthcare as the financial cost of that heathcare provision must still be met. The amount of money required to provide all the heathcare needs of every person that is eligible for it is far greater than the available funds raised from taxation.

This leads to the government having to choose between raising taxation to pay for it (and immediately losing the next general election) or somehow restricting the 'universality' of the 'free' healthcare.

As a result of this we have an organisation in the UK called the National Institute for Clinical Excellence (NICE) who's job it is to decide whether any given treatment is financially viable and the way they do this is (in a simplified form) to work out how much longer any given treatment will extend your life against how much that treatment will cost to administer and if each year of extra life costs more than a certain amount, then that treatment is not provided by the NHS. This seems like a good solution if you are a tax payer or your illness falls into the provided NHS treatment but would seem vastly unjust to a person who has paid tax into the NHS system for their entire life only to be told when they need care that it will not be paid for as the particular illness they have is too expensive to treat (even though there are treatments in existence for it).

This raises even more ethical issues around whether free NHS treatment should be given to people with what are perceived** as 'self inflicted' illnesses, such as smokers with lung cancer or IV drug addicts with endocarditis or overweight people with cardiovascular disease etc (and furthermore, where do you draw the line at what is 'self inflicted' ? Smoking ? Alcohol ? Joggers needing knee replacements ? Mountain bikers who fall off and break their legs ?)

Universal healthcare should be a right but in reality the cost of providing it means that it will never be an accomplisheable (is this a real word, only time will tell.....) goal.

My impresion is that at least a privatised insurance based system, whilst unequal across society on the grounds of personal wealth, at least encourages personal responsibilty for your own health as you will be billed for whatever the health consequences of your actions lead to (but on the other hand, doughnuts are nice.....).

*Not really free, of course, you pay for it with your taxes instead of directly.

**Perceived by society, not nescessarily by me.

jcasablanca · Mar 6, 2012

Thank you, but may I further clarify. The actual assignment is to post a question using social media with the responses used during a class debate. With the advent of social media, the world has become very small, allowing interaction between individuals who may have never had that opportunity. Participation is not doing "other peoples' homework". It gives you a chance to weigh in on as you described "an interesting topic". It generates additional questions such as is health care an actual commodity, as described above.

Posted responses from individuals working in countries who have nationalized health care is an invaluable insight that I may not have had access too. (The problems in the UK health care system are the same problems the US will encounter as the health care dollar shrinks.) So, the participation of everyone is greatly appreciated and will help to illuminate this difficult topic.

Woodenpug, BSN · Mar 6, 2012

Thank you, great_bu. That is the best argument against universal healthcare I've read. I'm still in favor of universal health care, but your point is understood.

BTW. Actionable is a word in the U.S.A.: Accomplishable - definition of Accomplishable by the Free Online Dictionary, Thesaurus and Encyclopedia. And, thanks again for a rational, well thought, response. Even though, I'm not taking that master's course.

great_bu · Mar 6, 2012

This thread just struck a chord with me as when I had my original telephone interview for the post I am coming to at JHH, the interviewer was at some pains to emphasise the significant amount of pro-bono work that JHH provides (a good thing) as she clearly thought that as an NHS trained nurse I would be in favour of universal free healthcare. I am a supporter of the priniciple but unfortunately I have yet to come across a system that would be properly fair and viable without unlimited funds.

Another related issue that arises for the NHS is one of abuse of the system - UK citizens are aware that the NHS cannot turn them away if they arrive at a hospital sick, and many less pricipled members of our society will present at hospitals and complain of symptoms which are indicative of hard to diagnose conditions (general abdominal pain, chest pain, that sort of thing) which they know will guarantee that they are admitted to hospital for a few days of free meals, clean bedding and warm heating (and the timing of these admissions often bears a striking similarity to any scheduled appearances in court that they may be due, as soon as the court date passes and in re-scheduled, they are miraculously cured and discharge themselves - this from my actual experience on more than one occasion, and I suspect the willingness to do this would be significantly impaired if we billed them the ~$1000 per day it costs the NHS just to keep them as an in-patient (never mind any actual tests we might foolishly want to do on them)).

On top of this, we also enjoy a rising tide of 'Health Tourism' - foreign nationals who just happen to develop an expensive to cure disease within hours of stepping off of the airplane on their holiday to the UK, knowing full well that even if we know they are foreign nationals with no right to free NHS healthcare we will treat them first then try to bill them for it, at which point they are straight back on the 'plane home, never to be seen (or paid from) again. On the flip side, of course, I know that as a UK citizen I am never more than a plane ticket away from a free heart bypass, however many doughnuts I scarf when I get stateside (Drive-Thru' Dunkin' Donut stores tht are open 24 hours a day and take credit cards !!!! That's civilisation ! )

Don't get me wrong, there are many excellent advantages to nationalised universal healthcare - no-one* ever went bankrupt because of health costs in the UK, the inequalities in life expectancy due to wealth are significantly smaller here than in the US etc. but the illusion that US politicians are trying to sell Americans about how wonderful the NHS is is a politician's truth**.

*except the government

** a lie

Woodenpug, BSN · Mar 6, 2012

Great_Bu, your most recent post is about a problem that exists, likely to a greater extent, in the privatized system here in the US. In fact, it's a very old problem. The fifth or sixth edition of the Merk manual, before it became useless, had a diagnoses "hospital bums."

I would hope that eventually, we will reduce those leaches on the health care system. Under the privatized system the only difference is who pays. Now the hospitals get no compensation, under universal health care the hospitals would be paid. Currently, in the US, those people pass along their costs to those who pay for insurance. Under universal health care the taxpayers would pay for those people. Likely, the same people paying the bill, but I hope it will make it more obvious.

Jolie, BSN · Mar 6, 2012

Thank you, but may I further clarify. The actual assignment is to post a question using social media with the responses used during a class debate. With the advent of social media, the world has become very small, allowing interaction between individuals who may have never had that opportunity. Participation is not doing "other peoples' homework". It gives you a chance to weigh in on as you described "an interesting topic". It generates additional questions such as is health care an actual commodity, as described above.
Posted responses from individuals working in countries who have nationalized health care is an invaluable insight that I may not have had access too. (The problems in the UK health care system are the same problems the US will encounter as the health care dollar shrinks.) So, the participation of everyone is greatly appreciated and will help to illuminate this difficult topic.

Thank you for clarifying. We'd still like to hear your input :)

MN-Nurse, ASN, RN · Mar 7, 2012

It is a privilege. But it is a privilege of living in an advanced society.

Sort of like clean air, clean water, a sewer system, armed forces, police, firefighters, education and many other things we value are privileges.

jcasablanca · Mar 9, 2012

Thank you bu for your insightful, well thoughout answer. It is fascinating to hear an alternative view of a nationalized health care system. When I am faced with this question I have a difficult time being all for one or the other. I believe health care is not a commodity such as food and housing. It is easier to budget for food and housing, one has a general idea of what it will cost you at any given time. However, health care under the current system in the US is not something you can budget for. One can live and choose to do all the right things, but can not change their genetics. (And one can choose to spend every waking moment at Dunkin Donuts-because they taste good) However, catastrophic illness can strike at anytime. If your insurance plan only covers 80%, you are still responisble for 20%, which can cause financial ruin with one hospitalization. In the past, one could be uninsurable if they had pre-existing conditions.

Back to right or priviledge- I would like to believe that everyone has the right to a minimum amount of care, but who decides what is a minimum, I do not have the answer for that. In this age of the shrinking health care dollar difficult decisions are going to have to be made. Should the US move towards "universal health care" and if so how do we pay for it. As an interesting side note the World Health Organization reported that the US spends a higher portion of its gross domestic product on health care but ranks 37 out 191 countries studied (There has been quite abit of negative press written about the actual ranking system) But, the fact remains that the US does spend more and the outcomes are not always better than other countries that spend less. So, maybe the argument should be less about right or privledge and more about how to provide quality cost effective care that is affordable for all (including the government).......lets hear it for Nurse Managed Healthcare Centers. (And no I am not an NP, nor am I planning on that educational pathway)

romie · Mar 10, 2012

While I was in nursing school we were trained under the idea of social justice and that access to healthcare is a universal human right. Now as an experienced RN who has worked with both the well off patients and patients from very low socioeconomic situations I think I understand the issue better. Turning philosphy into policy and practice is an entirely another issue, but one that should be informed of this universal truth. The worth of any society is not based on how fabulous the wealthy and priviledged are, but on how well that society takes care of its most vulnerable members. Ideally our society should be perceived through the lens of how good our schools are, how healthy and happy our children are, how well we take care of our elders, how well we empower disabled individuals to reach their fullest potential and not on the consumeristic Real Housewives of Atlanta/ BH/ NYC and how much our CEOs are getting paid.

Take education for example. Our founding forefathers believed that in order for a democracy (pseudo democracy/ republic) to work, each member of the democracy has to have a minimum education in order to understand the issues and be informed voters. Here in lies "free" education for our children in the US. (The quality issues and ensuing debate could take up warehouse full of servers).

Even from a capitolistic free market perspective it makes sense that healthcare is a social justice issue and should be a right and not a privelege. More and more employers are recognizing that by investing in preventative healthcare for their employees and offering discounts for health improvement behaviors, they see improved productivity, reduced absenteeism, and greater loyalty.

I disagree with the notion that because something "costs" something that it is a priveledge. The logic is faulty because everything "costs" something. The US legal system is very costly but everyone has a right to due process. Who pays for public defenders? Who pays the judges? Who builds the court houses? Who pays the law enforcement officers and the lawmakers? It costs a lot of money to prosecute an individual, even to write up a parking ticket, but you have a right to appeal that parking ticket and you have a right to an attorney in criminal cases. As far as our "free"education system, you home owners in some school districts know precisely who is footing the bill, even if you don't have any children.

Safe drinking water costs a lot of money, but it is a right. If your child developed cancer because she drank contaminated water, in the US you would have the right to engage in litigation to preserve your child's right to safe drinking water. Sure it costs money and all of us pay for the drinking water through our rent, our taxes, our water bills, but if someone needed drinking water and was on the brink of dehydration failure to provide drinking water would probably land you in jail even if that person did not have the ability to pay.

Just to complicate the issue. Medicare is a program designed to provide healthcare coverage for older adults. If there was a 80 year old man who was worth over 10 million dollars, should he be denied MEDICARE because he CAN afford to pay? Shouldn't we just bill him at the market rate and expect him to pay for his CABG and extensive rehab in a SNF out of pocket. Or does he have a right to Medicare?

This is a wonderful topic and I thank the OP for presenting it. I especially appreciate the input from the NHS nurses. Just as an aside, would you alter the quality of your care for your patients based on their ability to pay and your perception of their right to healthcare?