The Right to Healthcare

Recently, I was asked if I felt that health insurance was a Constitutional right.  My answer was simple:

No, it is not.

Constitutional rights, as written by the Founding Fathers, were created to help protect the citizens of the United States so their natural rights could not be taken away without due process.  By definition then, all natural rights can be declared Constitutional rights, implicitly, since those are the rights that the Constitution is protecting.

There are many natural rights, often broken down into three categories (life, liberty, and property).  The first of these includes the right to be free from intentional harm.  The right to healthcare falls squarely in this area.  Therefore, healthcare is a Constitutional right.

But health insurance is not the same as healthcare.  Health insurance is a concept that has been around for approximately 100 years (life insurance,on the other hand, was documented 2100 years ago in Ancient Rome) as a way to ease the unexpected costs of medical emergencies.  In this regard, it has aided people in being able to receive the health care they need.

So why do we hear about the right to health insurance every day on the news?  What has caused health insurance to grow into a $800 billion dollar industry in less than a century?  Again, a simple answer – capitalism.  Healthcare is a huge, sprawling industry, and, like all industries in the United States, is subject to the free market.  There are many branches of this industry, from research to equipment to personal care, and each is working hard to make a profit.  With the rapid growth in technology and medical knowledge, the income required to make a profit is rapidly growing as well.

This money has to come from somewhere.  In a free market economy, it ultimately comes from the consumer, and this is where health insurance has been a needed ally.  As I already mentioned, the original purpose of health insurance was to ease the unexpected costs of medical emergencies.  Very few consumers can afford the cost of all of their health care needs.  According to Kaiser, $6800 was spent per capita on healthcare costs in 2009.  Someone who gets injured or becomes sick can easily spend four times that amount.  If they have a chronic condition, the costs can be astronomical.  Health insurance spreads those costs out among all of the members of the plan, making healthcare more affordable.

However, insurance has also been the cause of some of the price increases.  Because the reimbursal rates for different healthcare costs are negotiated directly between the suppliers and the insurance companies, the suppliers can charge more for their products than they could if they were working directly with the consumer.  Without the insurance companies as middlemen, the average price for a consumer would be less.

The Patient Protection and Affordable Care Act (PPACA) attempts to move the healthcare industry back towards the natural right of healthcare for all citizens.  In effect, it is pulling the market towards the consumer end.  Any outside force working on a system causes disruptions.  In the case of PPACA, the fight is about a free-market economy versus a natural right.  Both sides are adamant about their priorities, and both sides make valid points.

What should be done?

PPACA tries to solve the problem of health care costs by spreading it out among the entire population.  In some ways, it is very successful.  However, it doesn’t truly guarantee health care to all citizens while it does disrupt the economy.  There has to be a better solution.

The most important part of PPACA is the essential health benefits (EHB) clause.  The law attempts to define the minimum health care that all citizens are entitled to, including preventative care, in-patient treatment, emergency room care and prenatal and postnatal care.  These benefits, along with the other EHBs, should be the basis of a new health care system.  Because these are essential to providing each citizen his or her natural rights, they should be available to all citizens regardless of income or need and administered by the government.  Above this level, citizens should be able to purchase additional insurance based on need, desire, and affordability.  Funding for the essential insurance would be paid for by a tax, calculated by actuaries, that would cover the expected costs of the plan.  If a person signs up for additional insurance, their portion of the tax will go to the insurance company they are enrolled with to help defer their costs.  In exchange, the private insurance company would then be responsible for the patient’s essential needs (similar to how Medicare Advantage plans run now).  This process will assist in coordination of benefits for the patients.

For the private insurance, some regulations will still need to be in place to ensure that all citizens have the right to insurance.  There would still be no maximum benefit for health insurance plans.  Plans would be offered once a year during an open enrollment period as they are now with no pre-existing condition clauses.  These two rules will increase the cost of the plans offered slightly, although they would be less than the current premiums as they are now.

Let us make health care the right it is, and do it in a way that is responsible, politics free, and truly available to everyone.