Is Medical Care A Right?
Faced with the possibility that the Supreme Court may overturn the entire Affordable Care Act, there have been a quite a few articles which outline possible replacement plans for Obamacare. It is fascinating that the extensive coverage of this subject has made healthcare “experts” of so many people. I find it amusing that for most, the qualifications to opine on how to fix healthcare simply amounts to having had to wear a gown and get a shot.
It is troubling that so many people believe that the major problems with our healthcare system stem from misaligned incentives for doctors who are rewarded by doing procedures that may not be indicated. It is true that this occurs at times, but this is a minor issue among the problems in our healthcare system. I also cringe when I read that the government needs to find more efficient ways to take care of people.
As a physician who takes care of a considerable number of patients on Medicaid or with no medical coverage, I believe that my understanding of what the problems in the healthcare system are better than most authors of opinion pieces on this topic.
If one is serious about fixing problems in healthcare, it is critical to define the problems. The first and most essential question is whether medical care is a right. Progressives have done a good job of controlling the narrative on this issue. It feels good to say that we should take care of everyone. European countries do so, and our failure in this regard makes us less civilized and less compassionate than they. Fortunately, we are not Europe, and America is founded on a different set of principles. We only have to open the newspapers to see what the European welfare system is doing to the fabric of their economies. In fact, in countries like England, they are moving their healthcare system away from socialized healthcare, because it is impossible to provide everything to everyone without rationing care, and patients simply will not stand for it.
Medical care is not a right, but in a civilized society, it is a responsibility. This responsibility falls not on the shoulders of physicians who bear the greatest burden of this problem, but on everyone. This means that government- both State and Federal- does not act like an insurance company, but instead helps to make it possible for individuals to receive proper medical care. There are many ways that this can be done. Laws can be created that make it easier for doctors to deliver care to patients, not more difficult as has been the case for quite some time. These laws can work to reform outdated and cumbersome policies as they pertain to insurance companies. Currently individuals cannot purchase insurance across state lines or over the internet. Insurance companies also do not have to abide by the same anti-trust laws that everyone else must comply with. Medical liability is another area where serious reform is needed. The current system fails the patients who have been injured by the medical system, and disproportionately rewards insurance companies and trial attorneys.
There was a time when indigent patients or patients with complex or chronic diseases received their care at county and charity hospitals. This care was actually quite good and more reliable than the haphazard care that uninsured patients receive today. Much of this dysfunctional healthcare system is the fault of the federal government when they created EMTALA (Emergency Medical Treatment and Labor Act) and made it illegal for a hospital to send such a patient to the county hospital if they showed up in their emergency room. This law also was in large part the reason why costs are shifted from patients who could not pay for their care to those who could. The government was responsible for creating this huge unfunded mandate and used their police powers to compel doctors and hospitals to give away care without any compensation.
Finally, there is the issue of personal responsibility. There would be no need for a mandate to purchase healthcare insurance if patients were reconnected to the costs of medical care. Currently, the cost of health insurance is astronomical and people have come to regard it as a prepaid healthcare policy and do not want to pay any more out of their own pockets. With health insurance reform, these policies can be tailored to meet patients’ needs and will become more affordable when ridiculous mandates such as hair transplants or yoga are no longer required benefits. The costs of these policies will plummet. If patients were required to pay for the first dollar of their medical care as is the case with health savings accounts, patients will become better consumers of healthcare dollars. This same concept can be applied to Medicare and Medicaid under the premium support system as popularized by Paul Ryan.
There are solutions to the problems facing American healthcare. Obamacare failed to solve them and merely magnified them. A bold new plan is needed and is possible if bona fide experts in healthcare- those who deliver it every day- are at the center of its creation.
Hal C. Scherz, MD is the Founder and President of Docs4PatientCare, VP of Georgia Urology, and Associate Clinical Professor Urology- Emory University.