A politically incorrect inconvenient truth you will never hear from a politician.

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Neither the President nor any member of Congress will ever say it, not if they want to get re-elected. I hold no elected office and as a doctor I am obligated to tell the patient the bitter truth. Health care is not a right. There, I said it.

Health-care-as-a-right distorts behaviors, destroys the possibility of supply balancing demand, and drives people out of working in healthcare. Health care is not, cannot be, and should not be a right.

Health care is not an unencumbered right.
To most people, you don’t have to work for a right. It is natural privilege, unencumbered by any responsibility – just like Bill of Rights.

Our Founding Fathers did not elucidate the responsibilities in the Bill of Rights because it never occurred to them that people could believe rights come without responsibility.

Free speech (1st Amendment) means Pro-Choice advocates cannot muzzle Pro-Life proponents and vice-versa. Right to bear arms (2nd Amendment) prohibits citizens from using those arms against other citizens. The Sixth Amendment guarantees the right to a fair and speedy trial, which places a responsibility squarely with the legal system not to hold us indefinitely or without due process.

There is no such thing as an unencumbered right. Rights without responsibilities do not exist.

Health care cannot be a right.
Health care cannot be a right, unless you want to bring back chattel slavery or at least serfdom. Health care is a service provided by a small group of people for the benefit of a larger group of people. If the majority has a right to demand this service, that means they can require providers to serve them.

Only in the military system can one person require another to act. In all other parts of our society, we are free to accept an order or to reject it from another private individual. If people have guaranteed access to health care, because it is their right, someone must provide that care whether the provider wants to or not. If health care is a right, then the health care worker is no longer free. What if no one goes to medical or nursing school? What happens then to the right to health care? Health care cannot be a right.

Health care should not be a right.
You do not want health care to be a right. You will not like what you get: strict government rationing, a sickly population, and the kind of providers you want to avoid.

Rationing
Call it control of resource utilization, central balancing of supply with demand, or just plain rationing, decisions must be made about how much money, time, people and supplies are used. As there is no natural limit to the demand for health care services, without some limiter or brake, we will literally use up all the resources.

The “rationer” of your health care can either be the government or you. In every country with universal health care, the government balances the services provided with the money expended (rationing). The same is partly true for the USA where MediCare, MediCaid and private insurers all ration care.

We could have a system where the individual controls the flow of his or her health care dollars (not insurance based) just as we do when buying groceries or car maintenance. Interestingly for a consumer-driven system, one blogger recently quipped, “The key element missing in the health care debate is the consumer.”

Unhealthy populace
Health-care-as-a-right makes us sick because having no personal responsibility lets us treat our bodies badly and then expect the healthcare system to fix our obesity, our emphysema from smoking, and our cirrhotic (scarred) livers from drinking.

The lack of personal financial responsibility produces unhealthy thinking called the moral hazard: we change our behavior when we are personally insulated from the consequences of our bad choices. In the Atlantic magazine David Goldhill quantified the moral hazard in healthcare. “The average insured American and the average uninsured American spend very similar amounts of their own money on health care each year-$654 and $583, respectively. But, they spend wildly different amounts of other people’s money- $3,809 and $1,103, respectively.” When the money we spend is someone else’s, who cares?

From the purely commercial viewpoint, health care is infrastructure maintenance and repair. The government engages in no preventative [health] maintenance. The entire system is focused on one desire: cutting immediate costs. If we treated our bridges and roads as we do our people, they all would be broken. Why doesn’t the government focus on restoration and long-term preservation of our health? Answer: because health care is considered a right.

Providers waiting for happy hour
Health-care-as-a-right rejects people “called to service” in favor of following a manual of policies and procedures and complying with regulations handed down from Washington. If the public treats providers as menials fulfilling the individual’s right to health care, then the public will get rote behaviors by individuals who work their shift (and no more) while waiting for happy hour.

Health care should be a partnership.
Effective health care should be a two-level partnership: a voluntary association of two or more people where both partners know their respective roles and where both benefit. The two levels are individual and national.

On the individual level, there should be a doctor-patient partnership. Each has rights and responsibilities. The entire system should be a win-win scenario: when the patient stays healthy or returns to full good health quickly after being sick, the doctor should do well financially. Further, the patient should pay something out of his or her own pocket to the doctor. The person most likely to economize and to make the best decision is the consumer, not the government. For major medical expenses, there should be a national shared risk pool that should include rate adjustment based on “personally controllable health risk factors.”

On the national level, there should be a partnership between the people and the government, again structured as win-win scenario. When the populace “wins” – when we remain healthy and live longer – the country “wins” by greater productivity and less spent on sickness care.

The good CEO protects the assets that give the company sustainable competitive advantage. For Corporation USA, people are the prime asset. Those who manage our Corporation, what we call government, should protect the people’s health and restore health when they are sick. That is not a “right.” That is just good business.

System MD

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1 comment so far ↓

#1 Nerdse on 10.05.09 at 7:54 am

How about this:
How about if physicians quit treating every illness for which they have no definitive tests, treatments, or cures, as if they are the fault of a lazy, good for nothing person who doesn’t want to work, hysterical female, goldbricking guy who doesn’t want to work, or malingering veteran of military action who wants to live on disability their entire life. Maybe some of us would like to, oh, WORK with at least fewer symptoms? Maybe that’s why we keep “bothering” your Royal Highhandednesses?
How about you realize there are people in 3rd world countries, who can’t find one meal a day, who are obese & diabetic? That being so, how about you find a REASONABLE cure for obesity – follow the viral disease model for a while insead of ridiculing those researchers who do so? How about an option that is not a pill that makes people leak stool, or one that ruins the heart worse than obesity would? Or one that doesn’t involve an expensive surgery with a high morbidity & mortaility rate which has good results for maybe 5 years, after which you all quit following these people as their health goes down the toilet from rapid aging, &/or they regain the weight anyway.
I know of a kid who was size slim, but in 1 year, without additional food intake or a reduction in activity, gained 2 sizes & went from slims to husky size. When he developed type I (not type 2, type 1) diabetes 6 yr later, the endocrinologist said he got diabetes that year he went up 2 sizes & from slim to husky in one year. How about you follow THAT idea? What if type 1 AND type 2 diabetes cause obesity, not the other way around?
While you are all so compassionate about HIV/AIDS, which, with the exception of needlestick transmission & tainted blood, is the most preventable disease in the world, you abuse people who are fat, or who have things like chronic fatigue syndrome or fibromyalgia. or Gulf War Syndrome, as if they are lazy. Women are automatically labeled as hysterics because they come to see you BEFORE their conditions become serious, because unlike you men, we have to keep going; we can’t sit on our butts in bed or the recliner, whining about colds, expecting to be waited on hand & foot. That’s why you don’t see men in practice until they’re seriously ill most of the time, unless the wife hassles them to come in. You have built in servants/nurses in the women in your lives. Instead of being grateful, you’re a bunch of sanctimonious, sexist pigs. We might as well wait until the last minute; we’re not really going to get the care for which we’re billed (as is our insurance, fraudulently, I might add, since you’re not doing a thing for female patients most of the time). Back up to get THAT money when it comes. No wonder you see slow pay/no pay. Women process the claims & they know what care those female patients likely are NOT getting.
Oh, while we’re at this: stop with the “hysterical mother” stuff when moms are worried about their kids. There are way too many tales out there of kids who died because their mothers were ignored or even accused of Munchausen’s by proxy in some cases. Or that we’re “enabling” kids to be sick so we can keep them dependent on us. PUH-LEEZE! We’re already considered free healthcare for the entire system, from sick kids to sick spouses to elder care. The bill to the healthcare system if women refused to do all this caregiving would run in the billions of dollars. You all get a huge free ride from women. The least you could do is actually try to find out what’s wrong with us – you advise preventive medicine. RI-I-I-GHT. Just try and actually GET it. Go for a physical, most doctors don’t even look at you. They just write down what you say. A brand new graduate nurse from a 2 year school can do a better assessment than most physicians. But they’re ignored, too. After all, most nurses are female; why would you listen to a hysterical female just because they’re educated, look things up, & actually both assess & LISTEN TO patients?
By the way, not everything that’s wrong with a woman is related to the phase of menstrual cycle from pre-menarchal to post-menopausal, either.
The men & women of the military may or may not see combat, but they have joined to serve & are always at risk of being called up into battle. I don’t give a hoot if you agree with the conflict or not. If the conflict came to your fancy office door, you’d be glad to have them helping defend you. But you treat them like garbage, especially if they get out & need help but can’t get a job. Jobless rates for vets are double digits; they’re worse than the horrid rates of unemployment & underemployment among the disabled.
You doctors have a lot to answer for. You are part of the reason for high costs, but NOT BECAUSE OF FEES – because you refuse to listen, to treat people (especially women) as if they are human beings instead of some sort of slave force for your pleasure. Because of this, & because you’d rather blame people for being sick instead of figuring out why, you are raising the costs of medicine sky high. Everyone knows preventing problems costs less than solving them.
Quit kissing up to the AIDS lobbyists. Cancer is caused by being alive, for pete’s sake; quit blaming the patient, saying there was something they must have done wrong about their health practices or they’d be cancer free. I’m a nurse. I’ve worked in many areas of endeavor, including cancer; I got so sick of hearing patients blamed for cancer I was ready to choke most of the physicians, so I moved to another specialty, where I heard people who ran marathons & ate a vegetarian diet blamed for familial hypercholesterolemia – called liars when they weighed maybe 140 lb at a height of 6 ft tall.
Sure, a lot of obese people got there from pigging out. But why do they want to while others don’t? And have you ever seen a fat “eating contest winner”? I haven’t – they’re all thin, & they all pig out constantly & rarely exercise. THAT alone should tell you something is going on besides laziness. A lot of thin people are out of shape, too.
And why do people want to smoke? It STINKS, for heaven’s sake? We found the genes for addiction to drugs & alcohol. We even give drunks a new liver if they stay dry for a year, & do nothing if they start swilling the booze again after they’re discharged. We even give them ANOTHER liver at times. But we just blame smokers, we never ask why.
Plus, since you lovely doctors spent so much time denying that sickle cell anemia was real back in the mid 20th century, people used drugs & alcohol a lot in the African Americal population – DID IT EVER OCCUR TO YOU THAT WAS THEIR ONLY PAIN RELIEF? No. They just got called lazy, good for nothing drunken N-words. Now, you know better – but now, there’s a whole bunch of people who are pushing drugs & booze in ghettoes who got their foothold back when SCA was “imaginary.” Score another for the wonderful doctors.
Now, we have women with chronic pain syndromes who, after being denied pain care, have actually lied & claimed a non-existent heroine addiction to get methadone for pain treatment. These women lose any ability to hold any sort of license or certification or to be bonded in any way, so if you’re wondering where some of the nurses went, congrats. They know about methadone clinics. Desperate for help & knowing they had little if any chance to get it from the doctors, they now are often homeless, branded as addicts when they’re not, because they hurt but no one believes them.
You could save a lot of money by actually investigating things…like, how many tainted units of blood spread HIV to innocents because you all didn’t possibly think it could be spread by transfusions despite the fact it was detectable in the blood? A little prevention would have decreased the danger.
Nope, I don’t think you have any right to complain. You have made healthcare a right by your refusal to take responsibility for true scientific investigation. And just like Dr. Semmelweiss, you drum people out who insist on using the scientific method before deciding there are no options or that there is no reason to change your practice.
Finding a cure for this stuff, or at least treating it before it destroys lives, would save a lot of healthcare dollars, but instead, you charge money for services not rendered & complain that you don’t get enough.
Until you start finding valid tests & cures, until you listen, until you actually ASSESS patients (you remember: Inspection, Percussion, Ausculatation; Signs & Symptoms?) you have no right to complain.

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