I’m going to pretend I’m in group therapy. I say pretend, but it’s actually true. I’m in group with all my fellow humans.
I’m a liberal. Probably a raging, bleeding heart liberal at that, but I need to confess something. I think I may have been wrong about healthcare.
I’m a physician, a business owner and arguably a real estate developer, so I’m often contacted by conservative groups who believe I’m a slam dunk for donations and believing that healthcare should be deserved not given, that taxes need to be lower especially for the rich, that inheritance tax is evil, that gun-ownership is some kind of God-given right, yada yada yada. And I have to constantly search for creative and courteous ways to gently let them down. I say gently, because I’m a liberal and we liberals don’t want to be like those angry, red-faced, uneducated and confused people. We want to be the epitome of loving-kindness.
So this is where I am wrong. Healthcare. As a physician, this is perhaps the most important thing to me, especially with how the weak, the poor, the oppressed and the vulnerable are treated. I have posted on social media, sometimes resulting in legal action as many of you are aware, about how every urgent care ought to accept Medicaid and that the clinics who don’t are greedy and bad physicians etc. Maybe I was a little harsh, but I needed to make a point. I needed to provoke a reaction. If I didn’t, then the status quo would remain. This is how to upset the status quo - you have to piss people off!
Is there a right to health care? Or is it a privilege? Or is it a duty? Or a necessity?
Many posts and articles about health policy frequently highlight this very question.
My fellow liberals have resoundingly said ‘yes of course it’s a right’, while the conservatives have typically said ‘no of course it isn’t’.
The questions keeps on coming up, so I feel the need to address it, by admitting that I was wrong.
The problem is, whether healthcare is a right vs a privilege is a terribly worded question. Every human I know agrees that all humans should have access to basic healthcare. Yes, even the conservatives.
When those conservatives say that ‘healthcare is not a right’, they don’t mean it in the way that my fellow liberals object to. And when we liberals say ‘healthcare is a right’, we’re often met with ‘but what about…’ questions regarding the responsibilities of the state or physicians in general. People go off on tangents about why med school isn’t a right as well and so on.
But that’s what badly worded questions cause: digression. Nobody stays on point and nothing is achieved.
Using the word ‘right’ means different things to different people. Freedom of speech is a ‘negative right’ for example, and it really means the right to speak without being muzzled and gagged by the state, meaning the government shouldn’t interfere and should refrain from doing something.
The right to social security if you’re 80 years old, on the other hand is a ‘positive right’, meaning the government should actively do something.
By calling healthcare a ‘right’, it implies the positive right, wherein the government has a duty to simply give each person the right to free healthcare. I put the word free in italics because, as we all know (liberals and conservatives alike), nothing is really free. It really just means taxpayer-funded, and this is what annoys the conservative the most. We can talk about that later. Whenever I use the word free, it implies ‘taxpayer-funded’, but maybe I’m wrong to even use that word too!
However, perhaps the ‘right to healthcare’ is better described as a government (federal, state, city, whatever) that has an obligation to the people to encourage and endorse market conditions and legislative strategies which result in everyone having all their genuine medical needs addressed. Notice, this is not saying that every poor person gets the right to go to the ER 50 times a year with a toothache or for a med refill. It’s that vision which really upsets my conservative brethren.
No, it’s saying that if someone has a real need, as defined by us physicians (because even conservative physicians don’t want that being defined by legislators), then it will be attended to and addressed by the state if it cannot be paid for by the patient. Obviously the definition of ‘ability to pay’ and ‘medical need’ are subject to lots of irritating debate, but I do feel it brings the two sides of the aisle closer together than we were before. Both the conservatives and the liberals use very good but opposing rationale about the best way to proceed, and the wise on both sides do indeed recognize such logic and are inspired by it.
The government can and should directly provide health services and health insurance in the form of universal healthcare. The government should also provide free medical care to the homeless.
How much freedom should an individual have to make her own healthcare decisions? Should a citizen have to worry about money problems that result from receiving necessary healthcare? As almost 2 million veterans use Medicaid instead of the VA for their healthcare needs should these people, who sometimes gave their limbs and compromised their health for the freedoms we enjoy, be denied medical care by an urgent care facility that whines that it’s simply not profitable enough to treat the veterans?
These discussions and the inevitable differences of opinion are important, but all of agree that we need to come up with a way to address the basic medical needs, and yes, I put that word in italics deliberately as I do for all loaded words.
I used to believe that a right to healthcare meant that it would only be possible if we had universal healthcare and a governmental guarantee that healthcare will be provided for free to each person no matter what their social and financial conditions are. I had that viewpoint because I grew up in England where I observed the NHS treat everyone equally and well, no matter how rich or poor they were, or what they looked like. But even the NHS is having its problems, because of the same right-wing vs left-wing rationales that go on over here.
I was wrong. There is a middle way.
The right to basic healthcare for every person’s needs is indeed possible without creating a welfare state.
Yesterday I posted on a closed Facebook group of Emergency Physicians, asking everyone whether they thought healthcare was a right or a privilege. Although a slight majority of the comments said it was a ‘right’, I was surprised to see so many post the word ‘privilege’, without even an explanation. Of course, there’s a posting bias at work here. Some folks won’t post their opinion because they [correctly] perceive me to be one of those crazy liberals. However, I realized that I was perhaps in the wrong because I’m asking the wrong question.
I write this piece on a beautiful rainy Sunday morning, which many in America are unable to enjoy because of a medical condition that they cannot afford to get seen. I write it so that my conservative brothers and sisters can see that I am willing to admit when I am wrong. I write it so that my fellow ‘bleeding hearts’ may consider changing the discussion from ‘healthcare is a right’ to ‘the right to healthcare’.
We won’t change the status quo unless we all realize that we are one country, no matter our color, creed or bank account, and that we are in this together. And we won’t change the status quo unless we are all willing to take baby-steps which means that we all need to be willing to admit when we are wrong.
So in case there’s any confusion, I’m a liberal-minded physician and I was wrong to call out those who disagreed with me when I said healthcare is a right. Instead, I’m going to do better by listening better.