MCMS Physician Summer 2017 - 5

mon t m e d s o c .c om

Is Routine Care Your Right?
Which brings us to the question of whether health care is
a right. I have several problems with this concept. First of all
"health care" is not such an easily defined entity. For example,
there is a difference between "routine" care and "sick" care.
I define routine care as care provided to a well individual to
help prevent future health problems. It includes such things
as a periodic history and physical exam, vaccinations, cancer
screenings, etc. Should patients have a right to routine care?
What about sick care? How much health care should people
have a right to? Should it be unlimited care? If so, how do we
provide for all? If not, what care should patients have a right to?
Routine care? Lifesaving care? How do we distinguish?
What about a colonoscopy? It is preventive in nature
and meets my definition of routine care. What about a knee
replacement in a patient with severe arthritis? This is not
lifesaving, but certainly can provide improved quality of life.
What about biologic agents for patients with rheumatoid
arthritis? They can be life changing but are very expensive.
Chemotherapy? Kidney transplant in a 90-year-old? Just where
do we draw the line and who draws it?
If we say that someone has the right, i.e. is entitled to,
health care, we are then mandating another individual to
provide it. Is he obligated to do so for free? What about his
rights? We do not mandate grocers to provide food for free.
Should health care be different? Who pays for all of this? If we
say that the government should be the one to pay the provider
for his services, where does it get the money from?

Access to Care vs. Health Insurance

contributions to help those less fortunate? In my opinion, too
many people want health care for all as long as they do not have to
play a role in providing it. We have seen that already with the
objections to the individual mandate of the Affordable Care
Act.
This inherent conflict is difficult because different people
have different priorities and different rights that conflict with
each other. Any "solution" is going to provide rights to one
person at the expense of another. There just is no way around it.
One man's rights end where another's begin and the declaration
of health care as a right to which all are entitled fails to
recognize this point.
In my opinion we do need to do everything in our power
to help to provide access to care for all, but that does not
include declaring health care a right. I do believe that we have
a moral (but not legal) obligation to try to provide health care
to as many people as possible. What's the difference? Moral is
voluntary, legal is mandatory. We need to cut costs, remove the
middleman, decrease bureaucracy, and provide better education
to patients, all of which will enhance health care, but declaring
health care a right merely enhances our society's sense of
entitlement and is a laudable but not a viable endeavor.
What do you think?

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Furthermore, a right to health care is different than a right
to health insurance. Is the latter an acceptable alternative?
The Affordable Care Act seeks to provide every patient with
reasonably priced insurance but it does not declare health care
to be a right that all are entitled to. We must remember that
having insurance is not the same as having access to care and
not the same as receiving care. What should the insurance
cover? Vaccination? Routine screenings? Elective surgery?
Catastrophic events? All of the above? How do high deductible
policies play into this? After all, if a patient has a right to health
care, he should not have to pay for it. It should be provided
for free. We must also ask whether the patient should bear any
responsibility, financial or otherwise, in terms of receiving care.
Should those with poor health habits be differentiated from
those who take better care of themselves? Who decides this and
how would it be policed?
So what can we do? First, we must be transparent. If we
declare that health care is a right, then we are infringing upon
the rights of others by mandating that they provide it. If we say
that providers will be compensated for providing health care,
then someone has to pay for it. How do we do that? Increase
taxes? Is it acceptable for our government to mandate charitable

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MCMS PHYSICIAN 5 SUMMER 2017
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