Monday, April 18, 2011

On the freeway - still Day One

Okay, as we ease into traffic and join the herd stampeding down the freeway, let's expand the conversation a little.

The original question, in case you missed it, was simple.

Do you believe that health care is a "right" or a "privilege?"

I deliberately left that pretty vague.  I wanted you to think, without any directions about how to think about it.  A couple people left me notes here and there, taking various positions on what they perceived was the question.  That's great.

There are two things I want to explain.  First, this conversation is not heading towards some discussion of Obamacare, or whatever you want to call that.  That's not where we're going at all, so you can leave any issues you have with that when we make the first restroom stop.

The second thing is that from time to time I'm going to help "direct" the conversation, hopefully without trying to impose specific answers or conclusions.  If the process works, we should be able to end up at a similar location.

With that in mind, let me explain what the question means.  After I've done that, I'd like you to consider your thoughts further.  I'm not looking to change your mind, just make sure we're on the same page.

Various historical documents that go back to the founding of what became the United States speak to Rights.  The Declaration of Independence said there were unalienable rights, and that "...among these are Life, Liberty and the pursuit of Happiness."  The word unalienable is important.  While many people assume it means that can't be taken away, it doesn't.  It actually means you can't lose them or give them away.  Obviously there is a difference.

Now, the whole concept of governance is built upon the concepts that People have Rights and Government has Power.  The purpose of a Constitution is to identify what power the Government is given, although it may be expressed in the negative...i.e. "Congress shall make no law...."  For the most part, rights are never actually spelled out, except where they are limited in some way.  For example, in the US people don't have the right to mint their own money; that's a power granted to the government.  Of course, that means the Government and the People are free to consider whether specific Rights exist, such as the never-ending debate about abortion.

So, nowhere will you find a specific Right to health care mentioned.

As societies evolve, they tend to grant or limit Rights.  We know, for example, that some societies have severe limitations on Religious Rights.  Those limitations may or may not be part of the Constitution or laws of the country.  In some places, tradition is more important and powerful than the published laws, and in some societies religious leaders may have more power than secular leaders.

So, what does the original question mean?  What did I mean it to ask?

If Health Care is a Right, then that means, as a society, we believe that every member of society should have equal access to some level of care, be that preventive or palliative.  There might be limitations on the Right, but they would apply universally.  In the most basic terms, it means that, as a society, we think everyone should be able to go to the doctor.

If Health Care is a Privilege, then that means that if you can't afford to go to the doctor, the doctor isn't obligated to see you.  If you are sick, or injured, then you either pay the bill or you can't go.  In theory, the doctor is free to refuse to help you if you can't demonstrate your ability to pay the bill when the visit is over.  In this respect, it's no different than going into a store to buy something.  You're expected to pay before you leave.  You can buy as much health care as you want, assuming you can afford it.

Neither of these options preclude some "charity" for providing service to those unable to pay.  Society often finds ways to deliver things that only a portion of society believes important.

So, take a moment and consider the question again.  Do those descriptions change your opinion or affect your thinking on the matter? guys in the back seat are going to clean up that mess.  I'm not digging out all those Cheeze-its you've spilled!


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