OPINION & EDITORIAL
A solution for the uninsured?
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by Michael Cullen
Wednesday, March 12, 2003
As a primer for this week’s national Cover the Uninsured Week, the UW chapter of the American Medical Student Association (AMSA) surveyed first- and second-year medical students with the simple question: “Is health care a right or a privilege?” Eighty-three percent of the 105 respondents consider the services of the health-care industry an inherent entitlement rather than a privilege to earn and respect.
These results are disconcerting on several levels. By definition, a right is something due to a person by law, tradition or nature. Certain rights, including those to speech and religion, are inherent with birth as an American citizen and the expectation to respect the rights of others.
That so many consider health care a “right” implies a misunderstanding of the fundamental principles upon which the health-care system operates. Health care as a right implies entitlement and equal care for all, irrespective of the costs of delivery. Equality and entitlement are appealing to many because they seem fair, and most perceive fairness as desirable.
However, those who consider health care a right fail to realize that in search of fairness and egalitarianism, quality of care, for all, is the ultimate victim. Quality suffers because the only way to place everyone on common ground with respect to health-care delivery is to prevent those who can afford “the best” care from obtaining it. How often do you hear of a Wisconsinite traveling north to Canada for his coronary-artery bypass graft? How often do you hear of a New Yorker hopping across the pond to have his kidney transplant performed in England? Not unless he wants to spend two more years waiting on dialysis.
Providers (the government) in Europe and Canada, in search of the equality and fairness that comes with the nationalized “right” to health care, lack the incentives for innovation and efficiency that provide a foundation for excellent care. According to a report from the Heritage Foundation, those on medical waiting lists in Britain totaled nearly 1.3 million in 1998. From April 1996 to March 1997 in Ontario, Canada, of the over 1500 patients on the waiting list for coronary-artery bypass grafting, over 700 either died or were removed from the list without receiving their “entitled” surgery. The Canadian quality deficiencies extend beyond the operating room. In 1998, the average Canadian waited six weeks for an appointment with a specialist and another seven weeks to receive actual treatment.
These statistics demonstrate that, because of the inability to ration health care by cost in the Canadian and British systems, government providers ration health-care delivery on the basis of time. Ultimately, the “right” to guaranteed health care is anything but that. In the end, the patients suffer.
My semester and a half in medical school has taught me many things, perhaps most important of which is the dedication of those in the health-care system toward the ultimate goal of helping others. The ability to make a fundamental difference and affect meaningful change in the lives of those in need is the reason we chose health care as a profession. As practicing physicians, no one in my medical-school class will turn a truly sick patient away from their clinic doors because the patient does not have insurance. However, it is not the right of the unfortunate patient to see the doctor, but rather the privilege of the patient to be part of a society that has both the dedication and resources necessary to provide for the patient in need.
Many also consider health care a right because of its correlation with quality of life. At the same time, though, humans need food, clothing, shelter, and a variety of other basic material necessities. Do we consider groceries a right? How long before we implement a single-payer grocery system? Just think, the next time you go to Woodman’s, you can leave your checkbook at home.
Bottom line: Despite its faults, America has the highest-quality health-care system in the world. Like other things purely American, it came to be from our predisposition to innovation, diligence, and above all, a sincere dedication by those involved in health-care delivery to provide the highest possible quality of care. The same attitudes that built today’s health-care system must guide it into the future.
While Americans must search for ways to provide broader access, we must not forsake equality to achieve fairness. Americans should feel privileged to have access to the care that they do. Only because of our affluence can we consider ways to provide affordable health care for all. And underneath it all, if you consider nothing else, consider the following: regardless of whether or not you consider access to health care a privilege or a right, at least consider it a privilege to be able to ask the question in the first place.
Michael Cullen (mwcullen@wisc.edu) is a first-year medical student.
