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Saturday, June 17, 2017

The Right Question

Wrong Question. Wrong questions get wrong answers.
-- Master Gregory, Seventh Son, 2014


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Is healthcare a right?

You know, a right?

With all the many ideas we Americans consider rights, you’d think we would have an answer for this.

Obviously, here in America anyway, healthcare is not an enumerated right like Freedom of Speech or Freedom of the Press. But is it one of those other rights? The ones not specifically mentioned in the US Constitution but implied by the 9th Amendment: The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

In December of 2012, the United States along with dozens of other nations signed United Nations agenda item 123: Global Health and Foreign Policy, which among other things encouraged all nations to adopt “sustainable health financing structures and universal coverage” for all people. The resolution also reaffirmed all member nations’ commitment to the idea of “the right of every human being to the enjoyment of the highest attainable standard of physical and mental health, without distinction as to race, religion, political belief, economic or social condition.”

Do we believe that? 

Is healthcare a right?

Well, is it?

That’s the question I asked this week on Twitter.

Twitter is a weird place, the howling wild frontier of social media. But it’s pretty good for this kind of thing, polling the public mind. I have a large audience there, large enough to get a good sample across the spectrum of opinion, and so I asked: Is healthcare a right?

Not just here in America, but everywhere. Do you believe healthcare is a basic human right?

Now that seems to me a straightforward question.

And it seems to me that it’s the critical question.

Everything in America’s ongoing debate over healthcare depends from the answer to that simple question. Everything. Until you answer that question, until we agree on the answer to that question, the rest of the argument is largely irrelevant – or at least putting the cart before the horse.

Is healthcare a right? Yes or no.

That’s the question we need to settle first.

But that question is the one never put to America. Never asked. Never answered.

In all the debates over healthcare in America, from debates surrounding Medicare in the 60’s and Medicaid in the 70’s and Hillary Clinton’s efforts as First Lady in the 90’s and right on up to the Affordable Healthcare Act and the American Health Care Act, that’s the question we keep avoiding. If you look back, if you wade through all the millions of comments made about healthcare in America, that’s the one question that is never asked. The one question never debated in congress. The one question never discussed by all the talking heads on all the TV shows. That’s the one question never settled.

That’s not a coincidence.

It’s by design.

Why? Because it’s not the question we can’t face, it’s the answer.

We’re all afraid of the answer.

The press is afraid of the answer.

The public is afraid of the answer.

The politicians are terrified of the answer.

The people who don’t believe healthcare to be a right are afraid of their answer.

And the people who do believe are afraid of their answer too – maybe them most of all, because they put the most conditions on it.

The answer to that question, yes or no, has consequences, big ones. If we don’t ask the question, then we don’t have to face the answer. Not as individuals, not as politicians, not as a nation. We can just keep arguing.

Nevertheless, that’s where it all begins, right there. With the answer to that question.


Is healthcare a right?


What if the answer is no?

Look at Scott Walker’s tweet up above.

Obamacare is collapsing. If nothing changes, 28 million Americans will lack insurance by 2026 under Obamacare (according to CBO)

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Look at John Cornyn’s comment:

Obamacare has left about 30M uninsured and individual market is in a death spiral.

And it’s not just conservatives:

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Those are three examples of literally thousands of similar remarks made by politicians on both sides of the debate.

Essentially: If X happens, y number of Americans will lose healthcare.  Swap in Obamacare or Trumpcare for x and 10, 20, 30, 50 million for y. The sides and the numbers and the plans don’t matter. If x happens, y number of Americans will lose healthcare.

That’s the drum both sides, left and right, Republican and Democrat, keep beating. Millions will lose healthcare.

Millions will lose healthcare.

Millions will lose healthcare.

Millions will lose healthcare.

So?

So, they go without healthcare.

So maybe the quality of their lives is diminished.

So maybe they die as a result.

So?

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So? So what? I mean, so long as it isn’t me, why do I care? Why should I care?

As an American, why should I care?

If healthcare isn’t a right?

If healthcare isn’t a right then why should I care how many people don’t have it?

Why would any politician give a damn about how many people lose healthcare, if healthcare isn’t a right?

No, really.  If healthcare isn’t a right, isn’t a right of all citizens, then why does Scott Walker care? Why does Nancy Pelosi care? Why should Donald Trump care? Why should anybody care? If healthcare is just a privilege, something nice to have, but not a right of every American, then why should anybody care? The argument, Oh no! Millions will lose healthcare! just doesn’t hold water – unless you believe that every single person is entitled to healthcare as a right. Not deserves it. Not can afford it. Is entitled to it as a right, as an American, as a citizen, as a human being.

It is a simple black or white answer. Yes or no. Either healthcare is a right, or it’s not.

Everything else in this argument depends from that one fundamental ideal. Everything.


Either you believe people are entitled to healthcare as a right or you don’t. The rest is just details.


Now, before we go any further, let’s get something straight:  I don’t care if your answer is no.

I don’t. Really. I’m not going to condemn you for it. I spent most of my life in the military defending your right to see the world how you want. If you don’t believe that healthcare should be the right of every human being, well, I fully support your right to that viewpoint.

If you’re embarrassed or ashamed to admit your answer is no, that’s on you.

If you don’t believe that healthcare is a right, then at least have the goddamned courtesy to be honest about it.

Own it. Don’t pretend otherwise or try to make it sound like you do when you don’t. Don’t blow smoke up my ass. Don’t move the goalposts. Don’t dismiss the question. Don’t try to rationalize it.

Let me give you an example: a large number of people responded to my question by saying, well, I don’t believe that healthcare is a right per se, but I want you to know that I do believe we should have universal healthcare.

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What? How’s that work?

If healthcare isn’t a right, then why do we have a duty to provide it?

If healthcare isn’t a right, then why would society and community have any obligation to provide it?

I mean, what’s the impetus for universal healthcare if it’s not a right?

If providing healthcare is the right thing to do, if it’s some kind of moral imperative, then why isn’t it a right?

Now don’t get me wrong here. Sure, a rational civilization should obligate itself to provide healthcare for all its citizens, because healthy people make for better citizens if for no other reason. Just as a rational civilization would obligate itself to provide quality education, adequate food, clean air, clean water, decent housing, energy, and so on.

We don’t live in that rational society.

And if healthcare isn’t a right, then what’s to keep your universal healthcare system from denying healthcare to certain people? For good reasons and for bad?

That seems an odd definition of universal, doesn’t it?

Yeah, said the responders, but, see, you set up your universal healthcare system so that it can’t deny healthcare to anybody…

Can’t deny healthcare to anybody? Well, haven’t you then made healthcare a de facto right?

Stop playing games. Stop acting like you’ve thought it through when you obviously haven’t.

Look here, if the answer is no, then own it.

Just own it. All the way. And stop pretending that you give a shit about how many people don’t have healthcare. If you don’t believe that healthcare is a right, then don’t use the fact that people don’t have healthcare as an argument. Because you’re insulting not only my intelligence, but yours too. And that kind of cowardice irritates me.

If your is answer is no, that’s fine.

But I want to hear you say it.

Is healthcare a right? Yes or no. Everything else is just details.

If we all agree that healthcare is not a basic right of human existence, then we must acknowledge that healthcare is a privilege.

And not everybody is privileged.

That’s the whole definition of privilege. Some people have it, some don’t.

If the answer is no, it’s not a right, then healthcare is a privilege and we are not obligated to guarantee every person will be able to get healthcare. The privileged get it. Those of lesser fortune don’t.  Simple as that. Oh sure, we might provide some charity, some help for the non-privileged, but we are by no means under any moral obligation to do so.  If we’ve got extra money, if we’re feeling generous, sure. What the hell. But otherwise, no.

If you can afford it, you get it.

If you can’t, you don’t.

And you should at least be honest enough to admit that’s what you’re up to. I want to hear every politician, every candidate for office, go on the record, yes or no. And if it’s no, if you believe healthcare is a privilege of those who can afford it, then have the guts to look into the camera and say so. And if you’re voted out of office as a result, or stripped of your privilege by the mob, well, that’s just too goddamned bad.

If healthcare isn’t a right, then it’s just another line item in the budget, next to bridges and warships and farm subsidies.

And the only argument is where we draw the line between the haves and have-nots – and the best part about capitalism is that we don’t have to draw the line ourselves, the free market will do it for us. Leaving our hands clean.

You just have to hope that you’re privileged enough to be on the right side of the line.

And that the line doesn’t move.

And you never lose your privilege.


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What if the answer is yes?

Well, hang on. We can’t just say yes, can we?

Not without caveat. Not without conditions.

We need to know some things first. Before we say yes.

Because as it turns out, it’s really difficult for a lot of people to say yes.


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What was it Anatole France said? The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.

They want to.

They want to say yes, that healthcare is a right.

But they need to know things first. What kind of right? Like fundamental? Inalienable? Enumerated? Civil? Human? What kind of right, man?

What kind of right?

What are we talking about here? The kind of high ideal we give lip service to but don’t have to follow up on? Well, sure, Jim, I believe healthcare is an inalienable right, like life, liberty, and the pursuit of happiness.  Just like that. Nobody can keep you from pursing healthcare if you want it. Go ahead. Sure. No problem. No action required on my part, on society’s part. You have at it. Pursue away. The government can’t stop you. Pursue that healthcare. It’s a “right.” Wink. Wink. 

Like that?

As soon as you define the kind of right, you can start finding ways to weasel out of it, to find ways to deny that right to others.


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Some people seem to think rights only exist if they’re specifically enumerated in the Constitution. I don’t know if they think other countries don’t have rights, or if they even bothered to think it thought that far. And I wasn’t inclined to ask. They are also apparently unfamiliar with the 9th Amendment.

For them, the paperwork comes first, rights second.

I’m not sure how they think the Constitution was written in the first place, i.e. your basic chicken and egg problem, and more on that in just a minute.

A lot of folks were reluctant to answer the question without the exact parameters of the right defined.


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Define “Freedom of speech.”

Define “Freedom of religion.”

Define “Right to peacefully assemble.”

Define “Right to keep and bear arms.”

Those rights were enumerated without definitions by the Framers and put into the Bill of Rights.

In other words, the rights came first. And we’ve spent two hundred and forty years since figuring out the details.

And we’re going to have to keep figuring out the details and how they apply to our time.

Why? Because the details are dynamic. How we define those rights changes over time.

The limits of the rights change depending on evolving context. Society, civilization, community, are a living things and so are rights. For example: The Framers never envisioned how Freedom of Speech would apply to social media, because social media didn’t exist when they enumerated the right and they couldn’t peer across time into the future. It’s up to us, in the moment, to figure that part out.

This is the mistake gun rights advocates keep making. Rights are not absolutes.


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Of course, this being America, rights always seem to come down to … money.


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Predictably, I got hundreds of responses like this one.

If healthcare is a right, how do you pay for it – OR – essentially, we can’t afford it.

It amuses me when people explain how rights are “God given” or “natural” or some other lofty idea – then they want to hang a price tag on it.

Funny thing, these same people never say, whoa, hang on. This right to keep and bear arms, how much is that going to cost us?


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When it comes to healthcare, they always bring up money. How much is it going to cost? Then they bring up the freeloaders and start quoting Heinlein, TANSTAAFL.

They want everybody to pay for their own healthcare, which is fair enough I suppose, but like the woman in this example, they don’t want to pay people enough to afford to buy their own healthcare. Again, making healthcare a privilege of the affluent.

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It is a matter of priorities. And if you don’t believe healthcare is a right, then there’s no reason to make it a very high priority, is there?

But at least she was honest. 

Horrifyingly so.

For her, rights are about money.  For her, healthcare isn’t a right. It’s a privilege for those who can pay for it. And if you can’t pay, then you’re a cockroach.

She’s not the only one. This is by far and away the most common response I got, how are we going to pay for it? How?

As if rights were some commodity, like gold or corn or nuclear aircraft carriers.

This is the kind of thing that once led ultimately to civil war in America. Because when you believe rights are dependent on money, those that have no money have no rights. Q.E.D

And from there, it’s a damned short hop to the idea that people are property.

We went to war here in America once upon a time because the South didn’t believe it could afford to free the slaves. Because the South’s entire economy was based on the idea that rights belonged to those who could afford them, otherwise, you were property. If black people gained rights same as everybody else, the Antebellum South would be out of business. And they spent millions upon millions of dollars, and thousands upon thousands of lives, trying to maintain that economic model.

When rights depend on money, those who can’t afford rights, well, they’re just cattle. Or cockroaches – the same term the Nazis used to describe Polish Jews.

But then there’s this:

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No one says food is a right.

Well, actually, a lot of people do think food should be a right. But even if it was, shoplifting would still be a crime.

Americans have the right to keep and bear arms. That doesn’t mean you can just take any gun you happen to come across. Stealing a gun is still a crime. You still must pay for a gun and for the bullets. There’s still freedom of choice, you can choose not to have a gun, you can choose what kind of gun you want.

This argument is stupid.

But (and there’s always a but, isn’t there?), for a truly ridiculous argument you have to go full Ayn Rand:

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I got hundreds of responses like this one.

Most from self-proclaimed libertarians.

The logic goes that if healthcare is a right, then healthcare providers become slaves.

If healthcare is a right, they say, then I (for example) am entitled to the labor of doctors and nurses and they cannot refuse me. If healthcare is a right, according to these Randian libertarians, then any doctor, any nurse, any healthcare provider must provide me with their services free of charge at any time. Because it’s my right, you see?

Which is a damned good example of why Atlas Shrugged should be regarded as a tediously mediocre science fiction novel and not a blueprint for civilization.

In America, guns are a right. The right, in a lot of ways. But you can’t just walk into a gun store and demand a gun as your due free of charge – not without getting shot, probably. The government isn’t obligated to provide you with a gun. Hell, we don’t even have subsidies for poor people who want a gun and can’t  afford one. And instead of turning gun manufacturers into slaves, it made them fabulously wealthy.

Look here: in America, you have the right to legal representation. If you’re accused of a crime and you cannot afford a lawyer, then one will be appointed to you by the court. Does that make you entitled to another’s labor? Yes. Yes it does. That’s what Public Defenders do. They’re not slaves, they chose to do that job and they’re paid for it. And just because you’re entitled to legal representation doesn’t rob lawyers of their rights.

This argument is idiotic to a degree that boggles the rational mind.


I received thousands of responses to my question. The responses are still coming in a week later.


And despite all of the above, the resounding, overwhelming answer was YES.

Yes. Healthcare is a right.

Now, I don’t pretend that my survey was scientific. And I don’t pretend that my twitter feed is a non-biased representative sample of America or the world, but I’m looking at thousands of people who believe that healthcare is a basic human right. A basic human right. Without caveat, without condition, without question. Yes.

And I agree, without reservation.

How will we pay for it? I don’t know. How do we pay for every other right? For guns. For the free press? For freedom of Religion? We’ll find a way. How do we keep this right from becoming oppression? I don’t know. How do we keep guns and freedom of speech and freedom of religion from becoming oppression?

Those are just details. Big ones, sure. But just details nonetheless. Just like every other right.

If we agree that healthcare is a right, a basic human right of not just all Americans but of all people, then we’ll find a way. We’ll figure it out. We’ll keep figuring it out, just like every other right.

And it matters.

It does.

Because right now, right this very minute, as I write this, as you read it, as the world wonders at Donald Trump’s next Tweet, and Congress chases after threats to the Republic, and the crises of the day fills the headlines, right now, a handful of powerful men are secreted away from the public eye, working in confidence, working in collusion with those who profit from misery, deciding the fate of healthcare in America. 

I don’t know for certain what their priorities are, because healthcare is not a right and as such their motivations are secret and I as a citizen am not entitled to know. You are not entitled to know. They’ve locked the doors and they are deciding our fate. And from their track records I am forced to guess that the focus of this law is not my rights, not your rights, not the rights of humanity.

No, I am forced to suspect this committee’s priorities are money and privilege.

And I suspect that this law they are currently penning will reflect that when it finally emerges into the light of day.

And that is the point of this entire essay.

That, that right there, is the point of the question.

Because when healthcare is not a right, then it becomes a privilege doled out by a handful of powerful men hidden away from accountability and the consequences of their actions. You don’t even have the right to question them.

And you had better damned well hope that when it comes, you and those you love are privileged enough to be on the right side of the line.

And that those men don’t one day move the line.

And that you never lose your privilege.

Is healthcare a right? Yes or no. Everything is just details.

But some of those details will kill you.




Correction: Originally the article said Hillary Clinton was First Lady in the 1980s. That has been corrected to the 1990s.

247 comments:

  1. Brilliant. Utterly brilliant. Thank you, Jim from a clinical scientist who believes healthcare is a right. It states right in the preamble to the Constitution: "promote the general Welfare" - how do you do that if the majority of your citizens are sick or dying?

    With that said, in terms of how to pay for it: any alleged policy wonk discussion that does not start with single payer (http://www.pnhp.org/ ) as the necessary first step is already pre-compromised in denying what the actual mainstream health economics and health system are saying as matter of best economics and systems policy. Add to that mainstream polls showing over 55% of the population support universal government based insurance (aka: single payer), and Aaron Carroll's peer reviewed academic paper showing 59% support among physicians, and you begin to realize that it is ONLY our corrupted national politics and corrupted mainstream media that are keeping single-payer off the table as the necessary, albeit not sufficient by itself, first step in getting to a healthier America.

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    1. Well stated response to a well stated Stonekettle post. Though the "corrupt media" argument is getting tiring. Misinformed or uninformed, maybe, but, at least in the media I follow, I think it's not right to call corrupt in the case of healthcare. Then again, I worked at a major academic medical center and have a dad who did cost accounting in healthcare systems. So, make that "corrupt for profit insurance companies" and you're closer to the point.

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    2. "Corrupted Media", not "Corrupt media." The media and its intents have been corrupted in general, but is not in itself corrupt.

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    3. Considering that 90% of media is owned by 6 corporations I would agree that much of our media HAS been corrupted, with (as usual) profit being the ultimate goal instead of providing accurate reporting of information. Stories that tend to have negative impacts on other corporations stay in the dark until it is judged that public outrage will increase market share, some stories don't ever see mainstream exposure. In Flint Michigan people are being threatened with eviction from their homes over water bills for water they still cannot safely drink or wash in due to the lead content...that's one easy example of stories that are judged not to capture as much of the market share as the latest 4am bathroom tweet from POTUS.

      I am in agreement as to healthcare being a right, with the same evidence of the Preamble of the Constitution. The gigantic For-Profit healthcare system we have today was not possible until the 1980's when President Reagan deregulated much of the system to create an Industry based on profit, part of his "Trickle-Down Economics" plan that (in my opinion) the start of the shift of wealth from the middle to the top over the last thirty or so years.

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    4. I'm old, but I remember paying, my whole working life, 15% of my salary to the IRS and having that split with the medicare, thingy. Why can't the money taken from paychecks and split with the medicare thingy just all be used for medicare for all. I mean, everyone is already paying for it, right? Or is that really an ignorant response? I am taking pills for dementia, after all, and have a modicum of an excuse.

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  2. It's not a right, in the same way that car insurance isn't a right, but it is beneficial to society that it exists. I've gotten healthcare without insurance, and most providers offer a significant discount for cash, even if you choose to make payments. Which begs the point: the "retail" price charged to insurers to game the system allowing said providers to be paid more seems to be the crux of the issue. Without that systematic overcharging, the true cost of healthcare, especially the cost of health insurance, becomes a lot less.
    If health insurance were sold like car insurance, most of the overcharging would go away, as the marketplace would have more effect on the prices. With health insurance being considered by many working folks a gift by employers (or at least portions of it), most of the country doesn't scrutinize it was they would if it were their auto policy.

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    1. There's nothing so tedious as the false equivalency between auto insurance and health care. Or, for that matter, auto insurance and health insurance.

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    2. Are you seriously equating your body to a car? It is absurd, but I will bite. If your car insurance cost $500 per month, you can take it to the bank that the demographic of folks that own cars would shift up the food chain. Cities would swell. Commuting would be for the affluent only. The moving of the line, as Mr. Wright calls it.

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    3. Where your argument about free market forces falls apart is that everyone -- EVERYONE -- eventually needs health care. Car insurance is in no way the same thing. I could decide to not have a car (it would be difficult, but possible). I only wish I could "decide" not to have a pre-existing condition. Market forces cannot work on something which everyone eventually needs, and many times needs without the luxury of shopping around. If I fall to the floor clutching my chest, no one is going to go online and see where the best heart surgeons are. So health providers and insurers have us over a barrel; they know we will pay anything and everything, declare bankruptcy, do whatever it takes, to stay the hell alive. Which is why every single civilized country on this planet provides health care as a right to its citizens.

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    4. You are conflating healthcare with car insurance. Jim never mentioned health insurance, which would answer to your point. He's talking about healthCARE. That has zero to do with insurance. And yes, it is a right.

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    5. That's exactly not how it works. Providers contract with insurers to provide services at pre-defined rates. What gets billed is not what gets paid.

      Insurers will charge customers the maximum of what they can legally charge, and negotiate to pay providers the least possible amount they can, because it's a business and their primary responsibility is to return profits to their shareholders.

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    6. Actually, car insurance is a REQUIREMENT in this country if you are going to own and operate a vehicle. Having spent 15 years in the insurance industry, I can assure you that ALL Insurance (car insurance, home insurance, health insurance, business insurance, etc.) sold in this country falls under the same business plan- The PRIME OBJECTIVE is profits for the investors and upper management of the company, an minimizing what must be paid out in claims. And that has driven the cost of everything up (car repairs, home repairs, products, health care) while eroding the value of what the consumer gets for the premium they pay. BTW- the ACA actually DID force health insurance companies to begin marketing more, with comparison of policies available on the exchange sites, advertising to those who purchase outside of the exchanges (and yes, that means marketing to employers). But all of this is actually outside of the scope of Mr. Wright's essay.

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    7. Firstly, comparing health CARE to car INSURANCE is not a valid comparison. I don't believe the question asked was about insurance, it was about CARE. Second, the thing about car insurance is that, sure, you can choose not to have it. But only if you don't want to also register your car and drive it legally. Thirdly, one of the reasons the price hospitals charge to insurers is higher is to recover their costs that go unpaid because of patients' lack of insurance.

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    8. Well, interesting argument. I remember the language from the PA Driver's exam I took over 50 (good lord, I am getting old!) years ago. Short and simple: "Driving is a privilege, not a right." I also know that having that privilege REQUIRES me as a Pennsylvanian to have insurance. But this is NOT at all related to healthcare. we the People can determine if healthcare is a right. We are supposed to be guided by the founding documents, and one says "Life, liberty and the pursuit of happiness." Healthcare maintains life, making it possible to have liberty and pursue happiness. Without life, the others simply cannot exist. So, why is healthcare, which is at its very core life-sustaining, not a right? And don't start a "freedom" argument. Your other points have some validity, but, please, car insurance is equivalent to healthcare and health coverage? Hardly.

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    9. I ran a healthcare practice for almost 30 years. You are wrong on so many levels but I don't have the time, desire or fortitude to correct all of them. I'm not going to instruct you on ICD 10's and CPT codes. However, suffice it to say, every healthcare provider has a contract with the insurance company. That is the amount they are paid. They can charge any amount they would like but they will write off the difference between what their contract allows, and what they charge. Cash pay is a completely different animal. It's worth it to the provider to charge less because he doesn't have to go through so much paperwork.

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    10. I've found that providers give discounts to insurance companies that have used their unified bargaining power as a large customer to negotiate/force down the price to the barest minimum and then pass that cost on to their uninsured customers . That was a few years ago and of course your milage may vary

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    11. The question wasn't whether or not health insurance was a right. The question is whether health care is a right. Do people have the right to medical care. Two completely different things.

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    12. Healthcare is not health insurance. Air insurance? Water insurance? In some ways we're heading there: http://host.madison.com/ct/news/local/govt-and-politics/election-matters/high-capacity-wells-bill-on-track-for-wisconsin-assembly-vote/article_2207ff06-b3b9-53e3-81f9-f21c4847e121.html

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  3. In America, health care is a business. Those who can afford it, get treated. Those who can't, don't. If health care is a service, then everyone gets treated, and should. Yes, health care *should* be a right. No one says, "Gee, I think I'll have a heart attack today. No, wait. Got that meeting at eleven. I better wait till next week." Bad health happens. Pain happens. You want someone to make you feel better, maybe even save your life. Should you die because you don't have enough money to pay for treatment? Because you're not paid enough or your parents were poor? Are we civilized or are we not? The bigger issue is whether or not all people have value. If you think they do, then health care is a right. If we can afford endless wars, we can afford health care for all. As you said: priorities.

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  4. Healthcare rights don't apply to citizens. They only apply to the bottom line of health care insurance companies.

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  5. Health care is a fundamental right. As our ability to diagnose and treat various conditions and problems has expanded, the right has become more difficult to address (everything was a lot simpler when a few herbal brews and some stitching or bone setting was about all that was available). But if we are to remain civilized, then protecting and preserving the health of all, and treating the illnesses and injuries of all, is absolutely essential.

    How am I to look my neighbor in the face and say, "I can have an appendectomy because I can afford insurance, but you must die in agony"? How am I to look at myself in the mirror and say, "My neighbor is dying of a treatable cancer but can't afford the treatment, too bad, shoulda worked harder and had a better job"? The very fact that we have many programs for the poor, the elderly, children, the uninsurable, so that they *don't* die of curable conditions, is prima facie admission that health care is a right.

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  6. I say yes. My view has been shaped by living and working in the UK for a number of years, where the NHS is a government run program paid in part (not in full) by taxes. And if you lose your job and are no longer paying taxes you are still covered. We CAN do it if we really want to (universal health care or universal coverage, whatever term you like). The countries of Western Europe, plus Japan, Australia and New Zealand, plus Canada, ALL have some form of either government run health care or universal insurance coverage. The exact formula varies by country but what is "universal" is that they all do it for about half the per capita cost of the US, with much better health outcomes. The US falls below all of these countries.

    I hear arguments that the US is too big, therefore it won't work here. The UK is about 65 million people in population. France is 67 million and is more distributed than is the UK. Germany is 81 million, and again more distributed than the UK. These countries are large in population. While they are smaller geographically, they all still have distinct regions with differing attitudes, just as we do in the US. These are the countries of the world that are the most like us. They are all democracies of varying kinds. They are all well to do on the world scale.

    There seems to be a hesitancy to copy something from another country. We know best. They are different. What works there won't work here. We should not be so proud that we can't mix and match from what we think are the most promising methods of other countries and make it work here.

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  7. I believe healthcare, competent healthcare, is a right.

    Most of what we argue about in this country is health *insurance,* and the price of health insurance is determined by many things: profit for health insurance stockholders, giant paychecks for health insurance executives, and doctors' bills. Those bills are, in turn determined by the cost of the doctor doing business, the doctor's educational debt, and malpractice insurance.

    But think again. If we provided adequate, competent medical care to everyone, would there be so many malpractice suits (so people can get healthcare)? If we chose to subsidize some, most, or all of doctors' educations, would they barge so much money? Any if our government (we) paid for healthcare/insurance, would we have health insurance administrators collecting obscene salaries? Would we have to think about shareholder profits?

    It's a nobrairer for me: healthcare is a right.

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  8. Jim, this is just gorgeous. Thank you.

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  9. Yes. Healthcare is a right.

    Fat people, smokers, gays, straights, men, women, children, Muslims, Christians, vegans, bikers, the rich, the poor, the old, Americans, people who live elsewhere, the educated, the illiterate and even that slacked-jawed moron who cleans his loaded gun and shoots his dick off ... they all have a right to healthcare.

    All the word weasling, definition demands and dicking around with details come from people who are looking for a way to start the conversation by exclude some people from exercising a right to healthcare.

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    1. And who knows how many of these "Fat people" are fat because of the having to hang onto a miserable job just to keep their puny health insurance? People on Medicare can change (or lose) jobs without losing health insurance. Less stress.

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    2. I agree. And with health care available to all maybe we can all stay healthier which is good for everyone. Making sure people with low, middle and all income levels are covered and can see a doctor regularly is cheaper, way cheaper than going to the emergency room. When a person defaults on the whopping ER
      bill who ends up covering that loss? Yep. We all do. Penny wise, pound foolish that is.

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  10. Excellent! You have earned your whisky, sir.

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  11. Aaand this is why I donate monthly. Great job as usual...I'll try to remember this for when the time comes.

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  12. An important point that you don't mention explicitly, is that the current debate is about health *insurance*. You are talking about health *care*. Big difference. The insurance companies have made a lot of money by simply not paying claims.

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    1. Yep. I believe the economic model will have to change to provide universal health care. I suspect that is a major stumbling block.

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  13. Rights, even life, liberty, and the pursuit of happiness do not exist as some sort of platonic ideal outside of ourselves. Rights exist because we decided they exist. Every child has a right to an education because we decided so. (Indeed, unlike most rights education is an obligation as well. We used to have truancy officers to enforce that obligation.) Note that education is not listed in the Bill of Rights. But it is a right and obligation none the less. Healthcare is a basic human right, just as soon as we decide it is. Or rather it will become the right of every American just as soon as we pass a law, or amendment to make it so. We will, under our own system of ethics and international law, have no right to force other countries to honor that right anymore than we can compel North Korea to honor the Right of Free Speech. So asking "Is it or isn't it?" as if the answer was independent of us is wrong. Do we want it to be a right? Yes. We still must then take action to make it one. Which we could do by passing an amendment to make it a basic right and sweat the details later, or by passing a universal healthcare bill and making it a de facto right like education.

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    1. You said it perfectly. It's time to make it a right.

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    2. Saved. Perfect. Jeanne

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    3. I do not agree. The words "...endowed by our Creator with certain unalienable rights..." implies that the creators of the Declaration of Independence felt there *were* natural, a priori, indwelling rights. They have an independent existence to which we are responsible.

      This is the definition of "right" I believe health care falls into. It is indwelling, independent of policy, of governmental decisionmaking--it merely *is*. It is not an American right, it is a human right, a quality of being human, a quality that cannot be taken away (the essential meaning of "unalienable"--not able to be made foreign to people).

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  14. Healthcare is a right. Healthcare is a societal imperative.

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  15. I believe that healthcare is a right.

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  16. Well said. Healthcare is a right - I would say it is one of the purest expressions of the social contract, which I think is also fundamental to the discussion of the very fundamental nature of democracy.

    Is the social contract a valid ideal, do we have a duty to our fellow humans? If the answer is no, I'd argue that democracy is not really possible - cooperation and common weal are the basis of civilization. Any society that demands that every transaction be the result of an explicit contractual relationship is a society based on fear of the other, rather than trust, and is inherently hostile to rights and freedoms.

    So yes to healthcare is a right - and to the social contract which provides philosophical impetus for it.

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  17. Thank you - this has solidified my position for me. Healthcare is a right, and the US system of private health insurance and profit model healthcare and drug delivery are the most perverse way I can imagine to ensure that right.

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  18. I believe it is a right, or should be, since it is not currently treated as such. In the essay at one point you seem to struggle with this also, by saying you agree it is, without reservation, but then later "because healthcare is not a right". If it's a right, we need to use language consistently to reinforce that it is a right and that those people are denying us our right by acting in ways and treating the situation as though it is not a right.

    I also struggled a little with one of the paragraphs in regards to guns, especially when reconciling the healthcare issue with "The government isn’t obligated to provide you with a gun." If drawing parallels with healthcare, one could also say then the government isn't obligated to provide us with healthcare, however the difference is that we don't actually have a simple right to guns as you wrote, we have a right to "keep and bear". I think the difference here is probably important to distinguish.

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  19. healthcare is a right. we actually already treat it that way, but draw the line at the wrong place. emergency healthcare cannot be denied by hospital emergency rooms. we're just too cruel, corrupted, and stupid to move the line to single-payer, universal coverage.

    if you want the privilege of fancy, gold-plated care, then maybe there's still a place for secondary insurance.

    how do we pay for it? we already know the answer.
    1. universal single-payer.
    2. nationally negotiated pharma pricing
    3. strict limits on profit % of private care corporations.
    4. public medical schools with tuition reimbursement for x years as a community GP

    Remove the primary insurers and save billions.
    Fix drug pricing and save billions.
    One price book, one pay-master, one payer - save billions.

    You're already paying for that care for the most part for 1/3 of the country. Factor in the employer and employee and individual premiums, copays, deductibles, and 10 other things and we're paying more than universal single-payer would cost ALREADY.

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  20. What you are proposing is coming down to knowing your own presuppositions and owning them. As a Lutheran Pastor, I subscribe to the Bible being the Word of God and the only source for faith and life. That is a pretty overwhelming statement when you start to unpack it and apply it to daily life. So, in the interest of making things easier for my limited ability to understand and apply to every situation, I also subscribe to Luther's Small Catechism as a good summary (think Cliff's Notes for my generation or SparkNotes for all the cool kids) of what is taught in Scripture.

    So to answer the question "Is healthcare a right?" I agree that it is a right. What informs me of it being a right is Scripture. To make it easier to understand I appeal to Luther's Small Catechism and the 5th Commandment "You shall not murder/kill" What does this mean? We should fear and love God so that we do not hurt or harm our neighbor in his body, but help and support him in every physical need.

    The key understanding of is healthcare a "right" is help and support in every physical need.

    Now I am ready to start debating the particulars of cost and access to healthcare because I have established it is a right through my own presuppositions.

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  21. Car insurance isnt a right, its a law. You get no choices there.
    I believe that health CARE is a right for all human beings.
    I appreciate your writing so much, Jim. I always feel more informed after reading. Thank you!

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    1. You do get choices with auto insurance, have it or don't drive. That's a choice.
      Health care isn't a choice, we all, every one of us will get sick, we will get old, and we will need health care in order to live.

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  22. Is healthcare a right?
    Yes.
    Full stop.

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  23. Cut the defense budget in half and tax the churches....there, now we have a few extra bucks for healthcare.

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  24. To those that believe it is not a right - If I am one of the millions that cannot be alive without healthcare and I am unable to afford what I need to be alive, then it must be a 'right'. The Constitution specifically says I have a right to 'life'.

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  25. Yes, it's a right. Since it's a right, we are obligated to regulate and constrain the impediments.

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  26. If life is a fundamental right, healthcare is, by extension, also a fundamental right. Why is this so hard for people to understand?

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  27. Healthcare in America should be a right for everyone, not just the privileged, that is my belief. Life, Liberty, and the Pursuit of Happiness covers it as a right in my eyes, "the rest is just details"~ your words Jim.

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  28. One might say that healthcare is not a right, but that providing a base level of care for its citizens is a duty of the federal government under the "promote general welfare" clause- just like providing for the common defense. Of course, what constitutes the government's duty under the "general welfare" clause is open ended- perhaps purposely so. Does that also include housing? Does it include basic income? Perhaps not necessarily. Some would say it certainly could, and it all would be contingent on how much the budget puts toward it, just like welfare.

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  29. Short answer- yes, it is a right and should always be one. Long answer below


    I'm fortunate that this has never been a question in my life, from the moment I was conceived all the way through until now, I have received the best healthcare. I will continue to do so, not because my family is rich, we aren't connected to anyone who is rich. I have that simply because I am Canadian.

    It is alien to me to think that any country would destroy its own populace by denying them care, or making it so expensive they have to choose between healthcare and paying the bills.

    Healthcare is a right, the insurance companies refuse to see it that way, from here the biggest stumbling block to universal health care is them, they don't want it so until they are brought under control it can't happen.

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  30. I followed the thread when you asked you this question on Twitter. I was amazed by some of the goofy responses you got. I certainly believe that healthcare AND reasonable health insurance should be a right. As I write this comment, a dear friend is in hospice due to cancer. Three more are in treatment for cancer. Most of them will suffer tremendous financial setbacks as result of treatment. One has already opted out of some treatment because they can't afford it. No one, I don't care who you are should have to suffer and die because they cannot afford treatment.

    Great writing, as always. Keep it up.

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  31. Just as a point of interest, can anyone think of another country where medical treatment is provided by a "Health Care Industry"?

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  32. Thank you for this topic, Jim. I am a regular reader (for the last couple years) and a retired attorney as well as a retired social worker. I think I answered on Twitter, but to make a short answer long:

    I view the Constitution as a living document. I agree with your use of Art. 9 in its application. As our country and society evolve so do "rights" both enumerated and unenumerated evolve.

    When the US was founded there were few "rights" to much because we were largely a frontier society without much. You can't have a "right" to a doctor or medical care if there are none within so many miles you'd die before you got there.

    However, our society has changed, and the Constitution flexes (slowly and sometimes painfully) with those changes.

    In 1776 there could have been no unenumerated right to medical care. Today there can be because it is considered a societal norm to provide at least basic health care. When I lived in Australia I had the benefits of the health care there as a US citizen - no questions asked.

    It is in our best interest to provide health care that makes this country safe to live in no matter who is treated: Immunizations for all with no questions asked, treatment for TB and other serious and contagious diseases with no questions asked (these are public health issues that can be controlled or allowed to spread like wildfire).

    As life rolls along (and you and your readers will probably be rolling long after this old gal is gone) we may someday believe that basic health care includes eye-lifts or other things considered non-essential today. And we'll have to figure out why they are essential then (or you will, unless I live to be the ancient of days).

    All genetic and disease based problems as well as preventative health care need to be a basic service. There are tons of valid, logical reasons for this in terms of keeping our society healthy, people gainfully employed, and bankruptcies at a minimum due to medical bills. I'm a firm believer in parity and treating addiction and mental illness (both brain disorders) as if the person had cancer and needed help. It does no good for society to have these people suffer, die, or be a burden to the rest of us. Other countries do it better than we do. I used to be an addictions counselor and treatment belongs in decent centers, not in high-priced prisons where there is no treatment and everything only gets worse.

    Yes, we will have to make decisions about what is and what isn't covered. We do that now by denying millions any access. The hoo-ha about death panels doesn't reflect the fact we already have them through lack of access to health care.

    I'm for single payer. I'm old enough to remember when mid-level management took over health care and I said: Holy shit Batman, this is going to be a disaster. And it was. It made companies and people insanely rich, helped drive up prices and got us to where we are today. So I'm ready for the same socialized medicine the developed countries in Europe and Oceania have - and the military has. Because flawed as they may be - they are better than what is happening in the US. ACA was only a start.

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  33. I think the important question to answer is whether any putative right I have to eat implies the enslavement of a farmer, or whether any putative right I have to health care implies the enslavement of a health care provider. With money as a disintermediator, there is a third alternative, tax the rich enough that someone unable to pay has food or medical care, but the farmer or heath care provider is not enslaved to provide the service without just recompense.

    And then: how far can you carry tax the rich? As Maggie Thatcher says, Socialism is just fine, until you run out of other peoples' money.

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  34. 1. It.IS.A.Right. 2. Constitution calls for the Govt 'to promote the general welfare', if providing basic healthcare to its citizens isn't 'providing for the general welfare' then what is? 3. How do we pay for it? Gee if only there were some successful models we could modify and adapt? You know, take the best parts and fix the parts that don't work, the 'ol american way (france, germany, canada, UK, pretty much every 1st world country out there). Sigh...

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  35. Yes. Healthcare is a right of every human being. Universal healthcare now, dammit. Period.

    Thanks for your always welcome insights.

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  36. Healthcare is a right period. Like the air we breath people need and deserve HC - read my type - It Is A RIGHT. That being said it will never be solved as long as our world is based on a monetary economy there will continue to be wars, poverty, famine, elite rich vs poor etc. An alternative is something called the Venus Project if people are really interested in trying to make a difference or solve anything and move forward as a civilization

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  37. Yes, healthcare is a right. Period.
    For everyone. Period.
    How do we pay for it? We get to work on it.
    We made up the current doesn't-work mess , we can change it.
    What the hell has happened to the can-do! attitude we used to pride ourselves on?
    More and more , I think a huge portion of the every (hu)man is an island phony personal responsibility crap is just a chickenshit method of avoiding tackling tough issues. Don't have to if you decide it is someone else's problem, ennit?

    Excellent essay Mr Wright. Thank you.

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  38. Glad you asked Jim - good column. The decision for the basic right of universal health care is a moral one. England, for an example among more than a hundred, adopted universal care or at least made it available, as a moral decision that was well documented in its proposal during the second world war.

    Also, my own opinion is that here it is covered in the Constitution, plainly in the preamble, "promote the general welfare". In any event, no matter how nutty and passionate the discourse is, it is coming. No turning back now. Thanks,
    Bill

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  39. Yes, healthcare is a right. That is all.

    I'm Canadian and our system is flawed and no doubt corrupted in areas but when you need it, it's there. Yes, some choose to go outside the country for elective procedures but that is their choice. I'm well acquainted with arguing the points of my country's healthcare with those who do not feel healthcare is a right but who, incidentally, happen to have excellent insurance and can argue from a position of security. It's almost like they feel that if EVERYone has healthcare, then what THEY have isn't special anymore. They EARNED that healthcare. What did the lesser humans ever do to earn it?? Wrong. Everyone has a right to basic healthcare.

    The reason people don't want to commit to a Yes or No to healthcare being a right is EXACTLY what you said in your essay.

    I've had a mom and sister dealing with breast cancer last year. They were tested (incl genetic testing, several panels) diagnosed, treated with surgeries (mastectomies and lymphectomies), radiation, chemo, related mental and physical support groups and therapy. Total costs for both family members: $0.00 If they choose to have reconstruction of breasts lost to cancer that is also $0.00 (You want bigger boobs because you don't like your perfectly adequate, cancer-free boobs? You pay)

    They would be financially destitute if they lived in the US. So would the rest of us because we would have felt compelled to contribute to their support because that's what you DO for your people.

    It's why we willingly pay more taxes. It's why I don't mind my taxes going to support fellow citizens who require healthcare when I don't.

    All the civilized countries are doing it. Join us.

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  40. Yes, Health care and being healthy is a right. The phrase "Promote the general Welfare" in the Preamble to the Constitution implies this. Access to affordable health care is just one aspect. Having clean air and water is another aspect. Having good food and enough of it to sustain good health is another aspect. Do we really need an Amendment to spell all this out? Amendments 9 and 10 should be enough.

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  41. I believe healthcare is a right. No ifs, ands, buts, or Ayn Rand about it. There's plenty of countries that have made it work and it's only our self-isolated jingoism that makes people say the USA shouldn't have this. There's a weird logic that gets rolled out--we shouldn't have it because Canada, the United Kingdom, France, Germany, and Japan have it and DAMMIT WE ARE BETTER THAN THEY ARE. Hell if I can follow that logic.

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  42. I read the article. I don't believe healthcare is a right. I believe it is like roads. No one would suggest roads aren't necessary, but they're not a right, they're just something we almost universally agree upon as benefiting almost everyone, even if only indirectly, more than it costs them to have it. If we could find the level of healthcare that benefits everyone, even those who don't need to make use of it, more than it costs them for it to exist, then I think we'd be onto something.

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  43. OK, Jim, Since I am called in your article, I am going to respond in more characters than 140. I did answer that health care is a right in my twitter reply. I still think it is the wrong question. However, to be clear, Yes I do believe health care is a right. I think people have a right to determine how they live and die. It is a basic human right. The reason I think it is the wrong question, is that in the debate of health care, the question is really who has to provide it. Every other right is on the individual taking advantage of the right. Gun ownership, speech, etc - I get my own gun, I decide what I want to say. The problem with health care is that it crosses the line to where other people have to help provide it. If I can't afford insurance, it becomes a privilege. If I can't afford going to a hospital, it becomes a privilege. Because of that, because of the economics of health care, society has an obligation to provide it. In general, it is better for the common good to ensure that the members of society are more healthy. It is economically, cheaper to provide preventative medicine then wait to go to an emergency room. I absolutely agree that people need to be on the record with their answer. I am going to stand by my response that it is the wrong question. Society needs to make this determination. When it does, single payer health care will come into being.

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  44. Yes. Yes. Yes. Healthcare is absolutely a right. Everyone should have access to decent healthcare, not just those who have more money to spend. Life, liberty, and the pursuit of happiness. Guess what happens if you don't have access to healthcare? You don't get to LIVE.

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  45. Brilliant! I appreciate the way this essay pushes my thinking, bracing me for more more coherently defending why I believe health care is a right. Thanks for all the work that this essay represents.

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  46. I'm not on Twitter, so, I'll just deliver my response here: Yes.

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  47. It's nit-picking, I'm sure, but I -have- to make a two part answer. It is not currently a right...it takes only a quick look around for the proof (not you personally Jim, you're clearly aware of that). However, it -should- be.

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  48. Well analyzed, as always.

    I'm going to push back just a little bit, but mostly because I'm studying for the bar right now and fundamental rights are kind of a thing there.

    You're exactly right to say that the debate should very much be about whether or not we consider health care a right. And I wholeheartedly agree that the answer is yes.

    There is a deeper question beyond that though. Some rights are liberties. Others are entitlements. There *is* a difference.

    Liberties are direct limitations on what the government can do. Free speech, assembly, press, even the right to bear arms, these are liberties. We protect these liberties from government interference. Government is not allowed to make laws that restrict these liberties.

    Affirmative rights, or entitlements, on the other hand, are generally much harder to define. Access to the courts has been found to be one, the right to counsel, the right to confront witnesses and accusers. These are rights where the government must actively do something to ensure the right is protected. National security, education, social security, we've decided these things are entitlements. Constitutionally, this gets a whole lot fuzzier.

    Most often we only find these to be implicit in the Constitution when they are preservative of other rights. The right to have a lawyer present would be meaningless if you couldn't afford one, and the stakes of not having one are pretty high. So, on balance, due process requires that you have to be provided one to protect that greater right to due process.

    If we view health care as a liberty, then we go down a line of inquiry that becomes one of how government cannot interfere in your obtaining it. Congress wouldn't be able to make a law prohibiting you from getting health insurance, for example, or from getting a colonoscopy.

    If we view health care as an entitlement, however, a right whose protection involves government actively providing something, then we go down the road you're suggesting. (And one that I would gladly go down with you.) I think it's reasonably arguable that it's protective of the right to life. If the right to life is to be meaningful, then it must include access to medical care.

    My constitutional law professor illustrated this kind of question as a ditch and a wall. The government often has a duty to make sure not to build any walls in your way, but usually doesn't have to fill in a ditch so you can get across it.

    Even within the broad spectrum of things we call "health care" we might have to consider what's a liberty and what's a right. Abortion, for example, is a liberty when we look at in law. The government can't step in to abridge it (for the most part) but it equally has no duty to fund or provide it. No walls, but don't have to fill in the ditch.

    I agree with you that we ought to have the conversation about whether to consider it a right, and I think people would almost universally agree that it is of some nature. The next question simply becomes whether we view it as a liberty or an entitlement.

    Insightful essay, as always. Keep up the good work.

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    1. thank you for this response. It is what I was asking Jim to clarify for me, but didn't word my question well enough. you have helped me with your elucidation.

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  49. If healthcare, food, and housing are not rights, then you must accept sick, starving, homeless people in our streets and not help them. In America, you are only guaranteed these benefits in prison.

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  50. As a Registered Nurse, this issue is one I struggle to come to terms with. Some think the fact that I am a nurse and that I do struggle with it makes me a horrible person; that I am obligated by my profession to believe that healthcare is a right. Here's the thing, though. I don't struggle with the yes or no of it, but with the definition of healthcare. What is healthcare? Is it only the care required to save life, limb, or organ in an emergency? Is it preventive health maintenance? Is it only care that is sometimes arbitrarily declared "medically necessary?" Is the definition of healthcare defined by the individual recipient or by the collective or by a panel of experts or on a case-by-case basis? Does "healthcare" include the right to have the same level of access to an emergency appendectomy or cancer treatment as to laser hair removal or breast augmentation? Before anyone reflexively proclaims that laser hair removal and breast augmentation are not "medically necessary," what about access to birth control or abortion or gender reassignment? Does the right to healthcare include the right to abstain from healthcare? For example, can I choose to have a natural birth at home vs. institutionalized perinatal care in a hospital? Can I choose to vaccinate my child? (For the record, I am pro-vaccine.) Can I decline a blood transfusion for my child on the basis of religious freedom? (I am pro-transfusion, for the record.) If I have a right to healthcare, then so does my child. Does declining treatment on my child's behalf automatically mean I am depriving my child of his right to healthcare? Who decides who gets to make those decisions when minors are involved? Say my child has a right to healthcare, but I don't want my son's pediatrician prescribing him Cipro or Levaquin for an infection because my son is an athlete and I don't want to markedly increase his chances of tendon rupture (a known risk with fluoroquinolone antibiotics). Does the fact that healthcare is a right make it compulsory? Public education is a right, and education up to a certain point is compulsory. (I am pro-education, just to be clear.) If I refuse to educate my children in one way or another, I can be punished and have them taken away, right? Do physicians and other healthcare workers get to become benevolent dictators of the healthcare that my children receive? How much autonomy over my own body and over the bodies of my children do I get to retain? Do I get to choose my own healthcare providers? Do the plastic surgeon and the aesthetic dermatologist suddenly become as equally accessible as the emergency physician, the internist, and the pediatrician?

    Is healthcare a right? I used to say no. I confess that. I used to say and believe that healthcare was not a right. I have changed my mind. SOME healthcare is a right. Only SOME. The question for me, and for all of us, is what does that "SOME" encompass?

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  51. "Hillary Clinton’s efforts as First Lady in the 80’s" She was First Lady from Jan 93 to Jan 01.

    Loved the essay, but the "if it isn't a right" seemed long to the point of beating a dead horse to me. I suppose you were belaboring the point for the slow on the uptake?

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  52. Also-

    This may be one of my most favorite of your essays.

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  53. Actually a far better question is: "Assuming that it is socially desirable for all members of a country's population to have access to high quality health care, what is the lowest cost, highest efficiency, mechanism to cover the costs.

    Liberals have fallen into a trap when they assume that the best approach is to try to convince everyone that everyone should have health care as a right rather than focusing on the most efficient way to pay for it.

    Insurance works because large insurers manage risk more efficiently than small insurers (See "Standard Errors: Our Failing Health Care (Finance) Systems And How To Fix Them" at http://www.standarderrors.org/). Everybody ought to know this by now. But the real key to health care finance reform is that this is true no matter how large the insurers are.

    The largest possible insurer, for any population, is always going to be the insurer that covers the entire population. A not for profit, national health insurer, can provide higher benefits, at lower cost, with lowest chance of financial ruin than ANY collection of smaller insurers.

    Virtually every American can obtain better insurance, at lower cost, if we simply shift to a single payer. This is mathematics/statistics/probability theory/accounting not ethics or politics.

    Medicare for All however, fails to live up to this because it actually transfers a good deal of the insurance risk most people think it manages, to health care providers, such as physicians, hospitals, nursing homes, and home health agencies. This destroys most of the benefits of having the Medicare program, reduces the quality of care provided and increases costs.

    Americans need to wake up and pay attention to the math...

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  54. "Hillary Clinton in the 90's", I think. Although you may have already been deluged on FB with corrections.

    I like your incidental micro-review of "Atlas Shrugged".

    I have watched rich / middle class people fortunate enough to survive disease or disability long term, simultaneously insist private industry knew best for health care while signing up for Medicaid because private insurance always runs out. I won't automatically attribute malice to all private insurance companies, but it's an inevitable outcome of a deeply flawed business model.

    Yes, it's a right. You may have already had your health impacted by financial dictates you never knew existed. Hospitals routinely run short of trained staff partly because "anybody can change a bedpan", ignoring the necessity of trained eyes and ears assessing the bedpan's user (and contents. 'nuff said).

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  55. When a baby is born, people generally agree that it has a right to be taken care of. Even the most craven of Randian individualists is unlikely to shrug and say, "Well, whatever -- take care of it if it suits you."

    There was a time when a black motorist involved in a car crash in the Jim Crow south could be denied life-saving treatment before reaching a "Colored" hospital or doctor. I would venture that for most Americans now, that would be unthinkable.

    Details change with public opinion and political whim when healthcare is only for the privileged.

    Is healthcare a right or not? A resounding YES from this quarter.

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  56. This is so well written and thought provoking, guessing it will be used to start many conversations for folks. Hope all that share your wonderful words attribute you as the talented author you are. Cheers!

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  57. I believe health care is a right, and that the obvious way to secure that right for all is single payer, or some form of medicare for all. Will that increase taxes? Yes. But factor in what people WON'T be paying for insurance (both individuals AND employers)and I think most if not all people will come out ahead. And those who don't, well - we all pay some measure of taxes for things we don't necessarily support, or directly benefit from. I don't see how I benefit from subsidies to oil companies, but I pay my taxes anyway. That's how the system works. A healthy population is a more productive population, too. Wellness care save health care costs. I think it actually benefits all of us as a society to provide health care for all.

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  58. Yes I believe healthcare is a basic human right. We manage to pay for wars I would rather we were not in so I don't see why we can't manage healthcare. On another note the medical people as slaves argument was weird. We have a right to an education and I don't see any slave collars on teachers. (well unless they're into that in their private life and that is non of my business)

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  59. If you're ever in my neck of the woods, I will buy you the finest shot of whiskey I can find. Or five. You've earned it, right here. In the meantime, I'll do my bit to help keep you in cheese sandwiches. To answer your question: Yes. It's a right. As you said, everything else is just details and we figure out how to pay for it the way we figure out how to pay for anything else, because that's what we do.

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  60. Before I answer your question, I need to establish that my answer may be considered (by other) biased. I have spent the last couple of years of my life formally studying your question from a Global Health perspective, and I hope to graduate from the program next year. Hence, I surmise that, "Is health care an 'inalienable' right," to be your real question, and my answer to that is a resounding "YES!" And here is why:

    The United Nations is the global governing body whose purpose, among many, is to maintain international peace and order, protect human rights, help nations in times of emergency by providing humanitarian aid, and help nation states establish and sustain development of their infrastructure. This includes establishing and maintaining a strong health care infrastructure. There are currently 193 nation states who are members of the UN, and as such those countries have agreed to abide by the international governance of the UN, including but not limited to Article 25, which you highlighted at the beginning of your essay.

    One of the ways that the UN turns words and international treaties into action is to hold conferences like the Alma Ata International Conference of 1978. This is when the agreed-upon tenet, Article 25, came into being. In other words, as a member of the UN, the US has agreed to the tenets of the Alma Ata Conference, even as the UN has not provided official guidance as to how a nation state should go about achieving those goals. However, high income countries (HICs) are, by their nature, much more capable of providing universal health care for their citizens as opposed to low/middle income countries (LMICs). Paradoxically, The US remains the ONLY HIC that has failed to provide universal health care for her citizens. And that is no small accusation in the face of some health care achievements of LMICs.


    For instance, Cuba was the first country to successfully develop and maintain an effective response to HIV/AIDS. Furthermore, they were so successful that they were also the first country to establish a negative infection rate – meaning that they have effectively stopped the spread of HIV/AIDS. Cuba has effectively moved into the realm of prevention and health care maintenance for those living with HIV/AIDS, with the blessings of the World Health Organization (WHO). And they accomplished this feat despite the lack of resources available to them because of the embargo that was still in effect.


    Consider the implications of that for a minute, please. An LIC, with a sustained economic embargo against it, managed to do what NO HIC could, and they did so in a miraculously short period and with extremely limited resources.

    But I digress; however, I now realize that I could write a never-ending tirade about why healthcare is an inalienable right of EVERY SINGLE citizen of the world. So, I will somewhat shorten my response to reflect my personal values solidified during my studies, and which echo the values of Paul Farmer, Tony Benn and the UN.



    • No one human life is more, or less, valuable than another – despite our degree of privilege
    • The question of funding is spurious; funding killing people in the form of war, means we can fund universal health care
    • Healthy people are easier to educate
    • Educated people have incentive to remain healthy so they can contribute to the global economy
    • Having healthy neighbors is good for everyone because healthy people contribute to the economic stability of their homeland, which helps to stabilize neighboring economies
    • Lack of health, lack of education foments local discord, which foments national instability creating pockets of violent revolution
    • Violent revolution is successful because demoralized, uneducated people in poor health have their fears exploited and by default are easier to govern

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    Replies
    1. "• Violent revolution is successful because demoralized, uneducated people in poor health have their fears exploited and by default are easier to govern."

      This point struck me hard. Substitute 'violent revolution' with Trumpism and you have described those vast stretches of red in the electoral map of the US in 2016. "I love the uneducated", remember?

      The sad fact is that most smaller US communities are hurting and have been for a long time. Jobs are scarce and low-paying when available; schools struggle to keep up with tech, maintenance, and benefit cost spikes while forced to pay 6-figure salaries for administrators that are often semi-competent* while trying to educate their students with the remaining leftovers; and more and more churches follow either the prosperity gospel or hard-core Calvinism, which is demoralizing to all but the chosen few. No wonder they voted for the 'rebel candidate'! And it doesn't appear that the party in control of Washington wants to do a damn thing about it, because they're too busy exploiting those people for dollars and votes.

      R.l. Fewell

      * My sons' school district paid its superintendent $129.000/yr plus benefits for a school district with about 1000 students K-12 in a county with an average income of about $45,000/yr

      Delete
  61. Is healthcare for all a right?

    I believe that Americans who die or go broke because they happen to get sick represent a fundamental moral decision our country has already made. Despite all the rights and privileges and entitlements that Americans enjoy today, we have never decided to provide medical care for everybody who needs it.

    ACA was designed to increase coverage substantially — but it really didn’t work. In the debate over the ACA, efforts to increase coverage tended to get derailed by arguments about “big government” or “free enterprise” or “socialism” — and the essential moral question got lost in the shouting.

    And the essential moral question is this:
    Do we believe that healthcare for everyone as it is implemented (more or less) in the United Kingdom, Germany, France, Japan, and Canada (pick one) is a right not a privilege?

    If the answer is “no” then it will never happen.

    It really is that simple. I can argue ethics, religion, economics, domestic policy, political theory until I am blue in the face. The only thing that will happen from that is that the goalposts will continuously move.

    But while your contemplating that, consider that If you do what ya done, you're gonna get what ya got. We CANNOT afford to NOT change.

    "Health spending is projected to grow 1.2 percentage points faster than Gross Domestic Product (GDP) per year over the 2016-25 period; as a result, the health share of GDP is expected to rise from 17.8 percent in 2015 to 19.9 percent by 2025."

    https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.h

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  62. Even if it is not considered a right by our governance, inequity to access to care still exists and it is just wrong. Private medical practices struggle with this value everyday. In oncology for example, patients are referred from ERs with new diagnosis- lets say lymphoma so no one can say "they brought it on themselves". Having to turn away these people, who are un or underinsured creates a huge amount of distress for everyone! So whether we consider it a "right" or not, I believe our society remains basically caring and compassionate. Who pays for it? WE do. Just like we are now. The money we already direct towards commercial health insurance premiums/companies (paid by individuals and employers), our taxable health districts, etc combined would pay most if not all of it. It is not complicated. Medicaid and Medicare, City, County and non profit indigent care budgets would cease to exist. "Defensive Medical Billing" practices will be suspended. Who benefits? All of us including Doctors and other health care providers. I don't think anyone wants to diminish the value of competent medical care here. It is just not that complicated.

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  63. IMO, healthcare IS a right, rather than a privilege. We are granted the right to LIFE, liberty, and the pursuit of happiness. Denying anyone healthcare will quite often result in the shortening - the taking away of - of their life. Not by commission of a "crime." Not necessarily murder. But at best, by omission, like negligent homicide.

    How do we pay for it? How (and how much) do we pay for our defense? How many people are killed every year by our enemies? How many by diseases we have long known how to cure or control? Where is the greater need?

    Healthcare should be a part of the social contract upon which every society - no matter how small or how large - depends for its very ex9stence. When we accept that our healthcare is as deeply ingrained in our rights as is our national defense, we will find a way to pay for it, just as every other developed nation finds a way. And until we acknowledge that basic right as being consistent with our other rights, and develop a healthcare system that guarantees our right to life, and that defends us from our most dangerous enemies, we cannot in good faith call ourselves a civilized society. We might just as well be honest and stick our elderly on an ice floe when they are no longer useful, and dispose of our poor when their ability to live begins costing us a little bit of what we earn.

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  64. Yes, healthcare is a human right.

    I’m a Canadian living in the US. When I was first attacked by cancer I was still in Canada. I didn’t have to worry about how much treatment was going to cost which freed me up to concentrate on healing. I spent 20 days in hospital and underwent weeks of chemotherapy, including a new type which was very expensive but got covered.

    Then I moved to the US and was attacked by cancer again. Now I was worried about the bills. I needed to check to make sure they were accurate. I needed to make sure they got paid. I needed to make sure we had enough money to pay them. I couldn’t spend all my time concentrating on healing; I had to worry about many other things. And we had good insurance at the time.

    The third time cancer attacked, my husband was laid off just prior to diagnosis. I had to worry about how to get onto COBRA in a timely manner because we weren’t allowed to start it before a certain date and that date happened to be my surgery date. Luckily the hospital was wonderful and helped us out. Then I was hit with an infection that led to a 5 week stay in the hospital. The bill before insurance payments was more than our house was worth. Again, I spent time worrying about bills instead of concentrating on healing.

    No one should have to do that. No one should have to make a choice between eating and getting the health care they need to stay alive and have a productive life. No one should wait until they are almost dead because going to the Dr is a luxury.

    Anyone with any shred of human decency should be able to understand this.

    Yes, healthcare is a human right.

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  65. Before I answer your question, I need to establish that my answer may be considered (by other) biased. I have spent the last couple of years of my life formally studying your question from a Global Health perspective, and I hope to graduate from the program next year. Hence, I surmise that, "Is health care an 'inalienable' right," to be your real question, and my answer to that is a resounding "YES!" And here is why:

    The United Nations is the global governing body whose purpose, among many, is to maintain international peace and order, protect human rights, help nations in times of emergency by providing humanitarian aid, and help nation states establish and sustain development of their infrastructure. This includes establishing and maintaining a strong health care infrastructure. There are currently 193 nation states who are members of the UN, and as such those countries have agreed to abide by the international governance of the UN, including but not limited to Article 25, which you highlighted at the beginning of your essay.

    One of the ways that the UN turns words and international treaties into action is to hold conferences like the Alma Ata International Conference of 1978. This is when the agreed-upon tenet, Article 25, came into being. In other words, as a member of the UN, the US has agreed to the tenets of the Alma Ata Conference, even as the UN has not provided official guidance as to how a nation state should go about achieving those goals. However, high income countries (HICs) are, by their nature, much more capable of providing universal health care for their citizens as opposed to low/middle income countries (LMICs). Paradoxically, The US remains the ONLY HIC that has failed to provide universal health care for her citizens. And that is no small accusation in the face of some health care achievements of LMICs.


    For instance, Cuba was the first country to successfully develop and maintain an effective response to HIV/AIDS. Furthermore, they were so successful that they were also the first country to establish a negative infection rate – meaning that they have effectively stopped the spread of HIV/AIDS. Cuba has effectively moved into the realm of prevention and health care maintenance for those living with HIV/AIDS, with the blessings of the World Health Organization (WHO). And they accomplished this feat despite the lack of resources available to them because of the embargo that was still in effect.


    Consider the implications of that for a minute, please. An LIC, with a sustained economic embargo against it, managed to do what NO HIC could, and they did so in a miraculously short period and with extremely limited resources.

    But I digress; however, I now realize that I could write a never-ending tirade about why healthcare is an inalienable right of EVERY SINGLE citizen of the world. So, I will somewhat shorten my response to reflect my personal values solidified during my studies, and which echo the values of Paul Farmer, Tony Benn and the UN.



    • No one human life is more, or less, valuable than another – despite our degree of privilege
    • The question of funding is spurious; funding killing people in the form of war, means we can fund universal health care
    • Healthy people are easier to educate
    • Educated people have incentive to remain healthy so they can contribute to the global economy
    • Having healthy neighbors is good for everyone because healthy people contribute to the economic stability of their homeland, which helps to stabilize neighboring economies
    • Lack of health, lack of education foments local discord, which foments national instability creating pockets of violent revolution
    • Violent revolution is successful because demoralized, uneducated people in poor health have their fears exploited and by default are easier to govern

    ReplyDelete
  66. It's a great article. I got lost on the whole freedom of religion or freedom to own a gun, etc... being something we don't get provided to us, but rather it's a right to go buy it, or be it, but costs the government nothing really. We have right to own a gun, but we still are responsible to pay for it... which is essentially back to the privileged can afford it, the poor can't, doesn't matter if it's a right, we still have to pay. It seems like you're making that argument ... so I kind of got lost, because I also hear you saying it's a right and we (government) would pay for it, for everyone, as a right to healthcare. I believe it should be so, because apparently I'm a liberal globalist snowflake to be derided because I care about all people having a decent quality of life. Shame on me (I guess). When we ask how we'll pay for such a thing... I keep wondering why no one is asking about how we'll pay for our "right" to have a military, or build a fricken wall, or all the things we pay for that aren't necessarily helping people live a better quality of life. We're so caught up in warmongering that we can't seem to imagine a world without wars where we all helped each other live better. If we didn't spend all that money on wars, sending good men (and women) out to get killed or damaged, maybe we'd have plenty of money to attend to other things, like healthcare and food for the poor? What if our nations goal became creating things to help other countries flourish, like water for Ethiopia and other nations without enough water, or electricity that could be free, or better models of many things we use. IF our goal wasn't this frickin capitalistic model of greed, how could we work together and help each other and make friends instead of enemies of the other countries in the world? But in answer to your question, I say yes... it should be a right for all.

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  67. Simple answer: yes.

    From a legal standpoint the ninth Amendment to the Constitution says it all, as it has and does for many other rights that are not specifically enumerated. As Jim so accurately said, all the rest are just details.

    Those who fear such an answer usually are protecting something they cherish, money, power, prestige, their opinion, etc.

    Jim another master piece sir, thanks!

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  68. Simply put, yes. A basic human right -THE basic human right. Money is always found to pay for weapons or congress's and president's salaries, so money can be found for healthcare. It's a matter of political will. It's a matter of waking up the citizens not only of the USA, but the world.

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  69. Of course it's a right. The million or so inmates we have locked up for murder, selling drugs to our kids, rape and whatever else, are entitled to healthcare. I'm sure that's been established in courts. If they get it why should I have to throw a brick through a window, or start shooting, to get it?

    The overblown costs of health care are a separate issue. And more thorny.

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  70. It's absolutely a right! Covered under "...life, liberty, and the pursuit of happiness..." No healthcare for many precludes life, period, much less happiness. Our Constitution specifically says we have a right to life. Definitely without any fuzz or any kind on it. The rest of the discussion is BS window dressing and justifying taking that fundamental right away.

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  71. Yes, it is a right. As you stated in the 4th paragraph it is not one of the rights enumerated in the Constitution, but the Declaration of Independence state that life, liberty, and the pursuit of happiness are rights. I think a strong logical argument can be made that the right to healthcare can be inferred from those rights.

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  72. Yes, health care is a right. Although I'm from the States, I've lived in Canada for the last 30 years. We pay for health care through our taxes. People simply don't look at it the way they do in the States, that their taxes "are paying for someone else's health care," although technically, that's true. In the same way that people who are in higher income brackets pay a higher percentage for police, fire departments, roads, etc. It's funny that people who will never have a house fire don't mind supporting the fire department, but God forbid a percentage of Dwayne's taxes go to support Cindy's childhood leukemia. Health care is a right in the same way that not living in abject poverty is a right. Although conservatives complain mightily, and liberals acknowledge it's not a perfect system, welfare means we no longer have children starving to death in tenements. We decided, as a society, that this was unacceptable. At some point, the US will join every other country in the developed world and decide that curing a 4 year old's cancer, or setting her broken arm should not be based on whether or not daddy has stock options.

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  73. One question I always have about this, not so much a prior question, as a parallel one, is this: "Is there enough health care to go around?" Because, if there is not, right or not, someone is not going to get it, and all any laws can do is pimp health care to those who are privileged to receive it, for whatever reason. This is one of those "details," but it is a pretty fundamental one, because if there is not enough health care to go around, and if we decide it is a right, then we need to get us some more health care providers.

    As for the simple part of the question, is it or isn't it, I agree with Mr Reinlieb above, mostly because I have a particular definition of "right," and cannot answer the question in abstract. Frankly, I think the only abstract right we have is, as Mr Hutcheson put it, the right to our own consciences, and Government is working sure-enough hard to regulate that one, too. All the others are just privileges that we extend to other citizens at pleasure.

    -- EMH

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  74. Jim, I admire your work, but dammit, you need a good editor! As ex-PFC Wintergreen would say, you're too prolix.

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  75. Absolutely a right. Well done Jim.

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  76. Thank you for writing this. I had to "retire" at 45, very reluctantly from a career I loved, because of serious health issues. I'm now disabled. I require daily in-home IV therapy and other treatments in order to stay alive. I have been told, to my face as well as in writing on sites like Facebook, that I should just die and just costing the country money. I've heard it more and more often over the last 18 months. Am I not human? Do the contributions I have made to our society--and still do my best to make--no longer count? America has become a very scary place when someone can look me in the eye, with my 13 y/o daughter by my side, and tell me, "You don't deserve any money from my pocket so you can live."

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  77. One question that I always have about this issue, not so much a prior question as a parallel one, is "is there enough health care to go around?" Because if there is not, then all we can do is pimp health care to those who are privileged, for whatever reason, to receive it. If we decide it is a "right," and there is not enough of it to go around, then we need to see about creating more of it, right away.

    To answer the "simple" yes or no question is impossible for me,
    because as with Mr Reinlieb above, I do not believe there are such things as abstract, absolute Rights. The closest we can come to such is what Mr Hutcheson characterized as "the right to one's own conscience," which so far cannot be invaded by government or business (although I suspect they are sure-enough working on it). All other rights I consider to be privileges that a government extends to its citizens at pleasure.

    With that caveat, considering the question of Right as meaning a privilege on the level of that "Life, Liberty, and Property" of classical moral philosophy, I consider that health care is a right derived from the right to Life, in much the same way as, say, Freedom of Expression is derived from Liberty.

    -- EMH

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  78. Yes in the same way we treat education. It benefits society when we can all read, write, and do at least basic math. We find the money for education, we could find the money for healthcare. We would need to define what constitutes fundamental healthcare and what is elective. Not a simple task, but it could be done.
    A healthy population in the long run, benefits society in many way including financial. Let's face it, when people without healthcare get sick, they end up on Medicaid to pay hospital bills & aftercare. Bills they might not have incurred if the went to the doctor regularly.

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  79. It comes down to inclusion or exclusion. Some people think they are int he position to judge who gets and who doesn't. I'm for inclusion. I say all Americans deserve healthcare as a basic American right.

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  80. If "Life, Liberty and the pursuit of Happiness" are inalienable rights, so too are the means to sustain these rights. I believe that healthcare is a right, not a privilege. If I thought otherwise, I would be turning my back on all of the people who stood up, or sat down, or fought, to ensure these rights.

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  81. At the risk of sounding like Bill it-depends-on-what-is-is Clinton, my answer is a qualified yes. IF the definition of "health care" is "the maintenance and/or restoration of a person's mental and physical integrity, using proven therapies," then my answer is a resounding yes! Cure the sick, heal the lame, provide pre- and postnatal care, perform surgery, vaccinate, etc. In other words, let's pay for and do the things that work; technologies/drugs/therapies that haven't been proven effective would not be covered. Anyone wanting more than basic health maintenance/restoration (i.e. - plastic surgery, gender reassignment, most gene therapy, etc), would have to dig into their own pockets, borrow, or set up a GoFundMe account for it.

    Why? Because merely saying yes to everything that might loosely be considered 'health care' (i.e. - homeopathy) is a recipe for disaster. Companies would be touting new 'therapies' that people would demand in spite of their lack of efficacy simply because they're being paid for by the government. (You think those drug commercials are annoying now? Oy.) More money would be spent with no improved health outcomes.

    As a society, we have to draw the line somewhere. Even people in the UK and Canada don't get Cadillac coverage. I'm happy to pay to make people whole, keep them healthy, and ensure that future generations get a healthy start in life. I'm not willing to fatten the pockets of people who prey upon those who are desperate.

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  82. There is enough wealth in this world to provide every human born with clean air, clean water, food, shelter, and yes, health care and education. That is why we form societies--why we have governments. That is where our priorities should lie. No one should go hungry, naked, sick without our care, our concern, our help. Why is that no obvious? We are in this together. We only have one Earth. We need to take care of each other. Period

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  83. Okay, this is largely a confusion of terminology.

    First, no, Healthcare is not a right.

    But Healthcare isn't a privikege, either.

    Healthcare us a public good.

    There are lots of public goods that we provide without calling them "rights," and yet we don't ask why should I care?

    Think of it. Roads. Bridges. The Post Office. None of these things are "rights," but we provide them because doing do makes our entire society work better.

    Unlike rights, public goods can change over time. We may need one accommodation at one pt in our history and another at another point.
    And a public good not possible at one time may be possible at another.

    Making sure all of us can get our medical needs attended to, especially in catastrophic and chronic circumstances, actually makes life better for everybody.

    And in this case, the market cannot provide a comprehensive service, because the incentives are wrong. Market systems depend on consumers who are willing to make compromises--this car is cheaper than that car, so I'll give up some bells and whistles to keep my costs down.

    I've seen two people through terminal cancer. Trust me, this is NOT the way they think about their doctors. They don't ask: who is the cheapest? They ask: who has the best five year survival rate?

    And they should.

    We should provide health care for everybody for the same reason we prov8devroads, bridges and fire departments--because it is a good that cannot be adequately provided any other way and the existence of which positively impacts virtually every single member of the public.

    And recognizing that health care is a public good and not a right pushes back a little at the dilution of the definition of "right," which under this constitution has a definite and highly constrained meaning: a restriction on government power.

    When everything is a "right," nothing is, and suddenly real rights like freedom of speech and conscience are up for grabs.

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  84. All I know is no one should die because they can't get proper health care. No one should suffer chronic untreated health issues because they are too poor to have insurance or afford medical care. When a 12 year old dies from an abcessed tooth left untreated due to a lack of affordability, there is something very wrong with our moral character. On a more personal note my daughter had corrective jaw surgery when she was around 14, about two years ago a hole appeared in the side of her face, it would flare up and drain, and it has been a repetitive cycle. Then about 6 months ago a screw appeared inside her mouth, having worked through her gums. After finally getting through to the original surgeon. The hardware from that surgery has failed. The hole in her jaw was from a screw that worked it's way out through the side of her face. The continued infection is due to the body reacting to the hardware failure. My daughter has no insurance, her husband is on full disability from diabetes that has progressed because he was not diagnosed until his sugars were above 1000, he has 3rd stage kidney disease, neuropathy etc, because of diabetes that wasn't diagnosed early enough because he couldn't afford to go to the doctor because he just didn't feel good. He is unable to work and my daughter is full time caregiver for him. Is it a right, damn straight, no one should have to suffer from chronic mental or physical diseases because with proper preventative care these problems could have been stopped or at the very least greatly improved. No parent should have to feel guilty that they can't help their child get health care. No parent should have to worry that they are going to outlive their child because they will die from a run a way untreated infection.

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  85. Well, American taxpayers have the right to pay $266 billion to service the national debt for the year 2016 and not a whimper about it. They also have the right to pay $592 billion for healthcare insurance that year too and not a whimper. So, the generally accepted principal that single payer would cost about half what capitalist healthcare costs and it would cover everyone it would not only be a right but it would be mandatory. All Americans getting healthcare for less than half of what some of us are paying for now? A right? That debt? That interest paid? Yeah! we are getting nothing for it. Yes, they are running the government like a business alright.

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  86. Well, American taxpayers have the right to pay $266 billion to service the national debt for the year 2016 and not a whimper about it. They also have the right to pay $592 billion for healthcare insurance that year too and not a whimper. So, the generally accepted principal that single payer would cost about half what capitalist healthcare costs and it would cover everyone it would not only be a right but it would be mandatory. All Americans getting healthcare for less than half of what some of us are paying for now? A right? That debt? That interest paid? Yeah! we are getting nothing for it. Yes, they are running the government like a business alright.

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  87. At first, I didn't buy in to the necessity of answering whether healthcare was a "right." Should we provide it? Yes! Why? Because we can. However, you have convinced me. Healthcare is a right. (I also believe providing healthcare is in our best interest, but arguing enlightened self-interest seems useless in the current political climate.) So thanks for a terrific, thought-provoking article.

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  88. Yes. The rest is(as you say)just details. Details that will be used to deny this right to some, thereby defining it as privilege.

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  89. Healthcare is not a right. It is not enumerated by the Constitution. The requirement to treat sick people in the ER regardless of ability to pay only happened when Reagan was in office.

    I think it should be a right. I think is the smart thing to do. It is certainly the moral thing to do.

    We invest in Americans. We educate them. We build roads and homes for them. We subsidize the medical education system. Why?

    To be productive. To be competitive. It makes sense to protect that investment. Why?

    For the same reason you change the oil in your car. To protect your investment.

    It also fosters innovation rather than corporate slavery. People can quit their job to pursue ideas without killing their kids

    It's smart policy. It's why everyone else does it.

    Disagree? Who pays for the dying? How shall we deal with the suffering and death? What is your plan?

    Here is my thought: if the GOP pass this putrid bill, every one of them should have to drink poison. They should suffer and be decimated. And they should be denied care.

    Be glad I don't think their families should do it first while they watch.

    That would be cruel and preventable. Like the suffering the GOP inflict on most Americans.

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    Replies
    1. or if they pass the bill maybe they all should just have their health insurance taken away. And it's damn good health insurance.

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  90. Thanks for very thought provoking article. Comments very helpful too -- especially the insurance vs care issue, very helpful

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  91. This is one of your best, Jim.

    The question of if "healthcare is a right or a privilege" seems to be a very different one than the question of if "healthcare is a right." But it's the same question, and thank you for explaining why. Ask a basic question, then show us how people will jump through hoops to try to not answer it. Use that process to explain how it's one or the other.

    Finding a way to get the politicians to admit that they're picking one or the other? Good luck.

    I can see why you took some time off when the Facebook comments had nothing to do with your article but had everything to do with "Look! Some guy named Jim gave me a place to post my opinion about healthcare!"

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  92. Thank you, Jim!

    Yes I believe healthcare is a right.

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  93. Hitting it out of the park, AGAIN. Thank you.

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  94. Short answer, YES.

    C.H. Weaver

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  95. I think you're right that it's a right. But it is somewhat different from the right to a lawyer or to bear arms or even car insurance, due to the fact that we all will need health care at some point in our lives whether due to disease, accident, injury, vaccination and even just being born. Some people might choose not to use healthcare services, but that is part of their right too. Haven't there been lawsuits/legal charges brought against parents that deny health care to their own children due to their religious beliefs? I was wondering how those legal findings might support the case for health care as a right.

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  96. My takeaway from this essay is that if we can provide public defenders to those who can't afford a lawyer, we can provide basic healthcare to those who can't afford healthcare. The problem I see with this analogy is this: how do we determine what constitutes basic healthcare? What about the person who needs extraordinary healthcare and can't afford the "privilege" beyond basic healthcare? Before reading your essay, I hadn't considered the comparison of basic healthcare as a right with the right to a public defender. Having looked at the issue of healthcare as a right from this perspective, I don't see how basic healthcare can be denied to those who can't afford it. A lot of people can't afford an attorney and they are provided an attorney at no cost, and those who can afford an attorney are not able to rely on the service of a public defender. It seems as though it should be possible to have a system funded similarly to Temporary Aid to Needy Families (TANF), Medicare, and Medicaid, all of which are funded through the U.S. Department of Health and Human Services (yes, based on taxes). It does seem that those who have the privilege have insufficient capacity to recognize that everyone doesn't have the same privilege.

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  97. We are Paying for Healthcare but we aren't receiving what we pay for. Every dollar of Profit taken by the Insurance Company Middlemen is a dollar that NEVER reaches the Providers. Get rid of the Insurance Middlemen by setting up a Single Payer system. Start with that first.

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  98. As a Canadian it amazes me that "Is is a right?" is a question that still needs to be answered by Americans. How will you pay for it? Instead of paying co pays, instead of payroll deductions to pay your insurance companies you'll pay about the same amount in additional taxes. I know, I know that you hate the word taxes, but taxes pay for good stuff. Roads, and schools, water, sewers, all sorts of services that we just take for granted b/c they are there for you when you need them. Is single payer perfect? No of course not. I have to wait sometimes for tests. Sometimes I can't get something I want here and have to travel a bit. But my mother had a massive stroke three months ago. She spent thirteen days in a stroke unit. Then two months in palliative care. Now she's in a complex care unit. We have paid nothing. No co pays, no questions about our incomes, nothing. If they can take her to rehab we will still pay nothing. We will start paying when they move her to long term care. That will be based on her yearly income. B/c it's low... we will still pay nothing. My stepfather will keep his house and his car. We won't be hounded. We will pay nothing except our taxes. The reality you have to wrap your head around is that sometimes you do pay a bit more than your fair share. But with single payer when you need medical care, it will be there, and you won't lose your home, your car and your shirt to cover it. I should correct myself. We will have to pay 45.00 Canadian for the cost of her ambulance ride to the hospital. "Is health care a right?" My heart hurts for all of you.

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  99. The slavery argument is particularly stupid.

    I have a right to be protected from violence and theft and other antisocial behavior. Even most libertarians believe that.

    By their own argument, then, they must consider police officers, judges, officers of the court, and prison guards all to be slaves. I wonder if they really believe this is the case.

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  100. Excellent essay, Jim. Nations that have universal healthcare grapple every day with the details of how to maintain the right to healthcare. No right is unlimited, lest it usurp all others, and arguments that the right put forth are strawmen of the worst sort. I had to laugh out loud at Rand Paul's 'slavery' argument. Yet many on the left are also afraid to admit that healthcare is a right because they have partially bought into the strawman argument that healthcare as a right means no limits at all. It seems few want to admit that healthcare might share an equal footing with life, liberty and the pursuit of happiness. And thanks for mentioning the Ninth Amendment. Even I sometimes forget that one when people start to limit our rights to those already spelled out in bold letters on ancient parchment.

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  101. Great essay. I had a lot of 'Yes, but...' reactions, but kept reading, and you addressed most of them.

    Rights do require resources in order to guarantee, and society has limited resources. And as you say, rights are not absolute.

    Rights are a matter, it has always seemed to me, of dedicating some amount of social effort and resource to ensuring that the right is protected against incursion, both by government and by everyone else.

    It's kind of weird to think that we might consider health care a right when we don't consider food a right. Except we do. If you can't afford food, we provide WIC and basic assistance and all sorts of other programs specifically *to provide food*.

    The gun argument is a little weird, except that, well, we don't guarantee a right to have a gun, we guarantee a right to "keep and bear". The right to purchase and then own. If we similarly guaranteed a right to "keep and bear" healthcare, it would just be guaranteeing that health care would be available for purchase. That's not what we're talking about. You cover it, but obliquely.

    Most rights, also, are odd in that most rights enumerated in the Constitution are enumerated in such a way that they are activities one might choose actively to do, but which a government might be prone to restrict, and the BoR is a guarantee that the government won't restrict those activities. That's only one form of "right", of course, but part of the confusion is that for a lot of people that's the kind of "right" they're used to.

    But there are other sorts of rights and they're even more basic -
    some smart people even called them "inalienable'. Guaranteeing rights to things like life, liberty, and the pursuit of happiness - and yes, dammit, those are rights - is very, very different than putting limits on government. While government might interfere with those rights, right there in the Declaration it says the reverse - that governments are instituted among men to *SECURE* these rights. "secure" means, in this context, to go out and get those rights for people and take action to make sure they keep them.

    "life" and "the pursuit of happiness" are among those rights, and health care is what those are.

    Why didn't we have health care in 1789? Because we didn't have f-ing medicine in 1789.

    anyway, enough rambling. The text box is too small to make sure anything longer than this is even minimally coherent. Great essay. You should, like, do this for a living or something.

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  102. Great article!
    Yes, I think health care is a "Right" in our current civilization.

    My main point in this comment is to point out that the federal government of the US agrees that health care is a right---but only for certain groups.

    Active duty military have free health care as do retired military and veterans. Once you reach age 65 you also have free health care.

    There is much more that can be said about the hypocrisy in elevating these persons above the common lot and providing health care for them, especially the over 65 bunch. The military folk could be felt to have "benefits", but the Medicare folks are rewarded for just staying alive? (I am former military, BTW)

    It's time to fill in that gap with healthcare for everyone. I suspect this would also change the current ratio of 50% of health care dollars in the US going to 5% of the population (according to a recent Atlantic article).

    All the best,
    Steve

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    1. Greg - ETC(SW) USN - RetiredJune 18, 2017 at 2:18 PM

      Retired Navy here and as a retiree, I pay $500+ annually for the family (premium for Tricare Prime). It's not free, but it's one hell of a deal (especially for our family with some of the wife's medical conditions. We also pay co-pays for Dr visits, prescriptions (unless filled at a military treatment facility), medical equipment.

      When I originally enlisted, retired military DID get free healthcare, but that's changed over the years. Granted I'm biased, but I don't see it so much as a "benefit" (in terms of an entitlement - I know that's not what you said, but just making a separate point) as I see it as deferred compensation. It was part of the overall compensation package at the time I served. Which also makes me sensitive to some tweaks that have increased costs, etc., and additional discussions on increasing premiums/copays and/or reducing benefits smacks of the same sort of broken promises that I see from a lot of public/private industries whose pensions are often lost during debt restructuring.

      Having said all that, I agree that healthcare is a Right. Although I talked about it, above, in terms of a benefit, or deferred compensation, that's because that's how it's currently working, for me, today. I'd be more than happy to go to a single payer, universal healthcare system (ala many of the European models) and pay the taxes into a pool that pays for the whole thing for everyone. I think that's part of the being able to carry the yes/no decision to its logical conclusion. I'd sort of like to see some kind of "Star Trek" attitude where that's something that's just sort of taken care of so that people can pursue other things without worrying about it. I know that's sci-fi drama, but it's still a goal worth achieving, IMHO.

      Greg Levy - ETC(SW) USN - Retired

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  103. I freely admit that I misunderstood the context of your poll. I voted that it was a privalege, because currently that is what it is here in the US. As for my personal belief, it is a basic human right and I wish I could change my vote. I watch people suffer, lose the ability to be productive members of society, and even die because currently it is not considered a right, whether the politicians admit it or not. Every time I read some politician arguing about why we can't make any changes to the healthcare system, or why we need to go backwards from the mark of the ACA, what I really hear is "certain people don't matter and money does." And that tells me in an instant who NOT to vote for next cycle.

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    1. "Every time I read some politician arguing about why we can't make any changes to the healthcare system, or why we need to go backwards from the mark of the ACA, what I really hear is "certain people don't matter and money does." And that tells me in an instant who NOT to vote for next cycle."
      - Angie Shoemockery

      Quoted for truth. Great line and well said. Hope its okay to quote this with credit & share on fb?

      Putting money ahead of people's lies is a defining trait of douchebaggery.

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  104. Yes. It is a fundamental human right. As is education, food, and shelter. Sometimes we need honest protection--law and order. Justice. Those principles were determined, long before Marx.

    God is love.
    Happy Father's Day.

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  105. Yes. It is a right, and what sort of right doesn't matter so much. The Founders were clear that education is important for the success of a democracy because critical thinkers choose better representatives. On the same line, people who are not suffering from disease and illness are better able to concentrate on the issues. How to pay for it? Many countries have a tax to pay for universal healthcare. We already pay taxes for Medicare and Medicaid, and premiums for health insurance. The cost wouldn't be new, just renamed.

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  106. Thank you, excellent article! We already have socialized medicine in This country: medicaid, "free" clinics and misuse of Er etc... Could we please do it more efficiently and just go for single payer? How do we pay for it and another 20 questions??? The same way the rest of the industrialized world does!!! Let's stop dragging our feet and acknowledge the inevitable. Oh, one more thing...is it a right? Yes,for every single person, not just Americans, everyone!

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  107. I can't read all the comments, but what is the deal with copays, deductible and out of pocket maximums? Are they trying to de-incentivize people from seeking healthcare? Healthcare is a right, but even the insured cannot be assured that the insurance will cover them. It is to the point of being assured of payment in writing before seeking a health care provider. Providers are not able to answer you if the service is covered or not. If the insurance fails to pay the service provider will hold you financially liable. Then there is the risk of going bankrupt and or getting medical bills that will lower you ability to provide for you family. The choice is not to pay, but they will ruin your credit. I don't know how many Americans have low credit scores due to medical bills, but I would guess it is a lot.

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    1. In the USA, copays or OOP do discourage people from seeking healthcare—even those of us with "good" employer based insurance. We make a comfortable living even by California standards and an employer-provided insurance that covers some things very well (major surgeries and eyesight) but not others (dental and lab tests or visits to specialists). I found myself putting off getting dental work done because even 50% of a fee for certain procedures was prohibitive.

      The US healthcare "system" is woefully inadequate and while Obamacare addresses a good many crucial issues (covering adult children and preventive care without copay—yay) it does not address everything of importance and in some states the ACA was completely hamstrung by the state government's decision to undermine the law because of its source. (Which ultimately hurt no one but the citizens of the state.)

      For the record, Obamacare/ACA is alive and well in CA because the state government was ready, willing and able to give it a sincere shot. This should not be a liberal or conservative issue, and I find the politics that some people—including politicians—attach to it inhumane, indeed, inhuman.

      The sane, rational thing to do would be what other nations have done—systematically research healthcare systems in the rest of the world and either choose something that will work here, or design something using the best features of those other systems that, as a bottom threshold, covers every human being in the country. I did a series of blogs about this pre-ACA and regret that we are not there yet.

      As Jim notes, though, we do not live in that rational society ... but we could.

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  108. Thank you, Jim. Considering Enzi and Barrasso are my two senators, and they're probably going to let me die (I was born with a genetic defect that gives me a 90% chance of cancer without carcignogen exposure before I'm 50), it's heartening to hear that at least strangers on the internet give a shit.

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  109. Thank you for another thought provoking essay.

    I submit that, much like an attorney appointed for legal representation, soldiers or law enforcement are provided for those that cannot afford a gun.

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  110. Beautifully said. Been wrestling with this for awhile. The "right to life, liberty, and pursuit of happiness" seems to me to be more than health care, The right to life is also a right to access clean water, clean air, and non-poisonous food.

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  111. Right off the bat I can scuttle this debate because healthcare is absolutely a right because there is a federal law that says it so. If you are sick or injured and can get your body to a hospital they have to treat you regardless of your ability to pay.

    So now the only debate should be, what is the simplest way to pay for it and how do we get the most for our money. Treating people at death's door is highly costly and ineffective. Putting money into regular medical exams, early interventions, affordable medication/therapy to manage conditions and equalizing access is the only reasonable way to provide equitable coverage as well as the only way we make that it affordable.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1305897/

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  112. I call it an imperative for a very simple reason: as a society, we are only as healthy as those around us, with us, among us. the issue of health care is a most elegant opportunity to serve ourselves by serving others. it is a nexus where self-interest and altruism meet...for the common good. it is ridiculous and suicidal to consider it otherwise, especially in today's densely populated world. time to be good to others and to ourselves. selfishness and dissociation will not serve.

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  113. Using the logic libertarians apply to healthcare, I've pointed out to them that they can't have the right to a gun, pretty much the way you draw it out. You can have a right to defend yourself but you cannot have a right to a weapon, the product of another man's work. Their response generally has been to declare that argument pointless, because without a gun you are defenseless. They apparently haven't heard of kitchen knives and baseball bats.

    Doctors take an oath. They are required to treat the injured, within their ability to do so. To not offer help when it is needed, when it is available, is inhumane. To the extent that healthcare is generally available, it is a right of the citizenry to seek it. Just like food and shelter, healthcare should be provided to those in need.

    The problem with conservatives and capitalists is that they seem to think that you can gain wealth through social austerity. That isn't how modern economic systems work. Money is a debt instrument. If they want people to pay for things then give them the money to spend in enough quantities to meet their needs. Then we'll know what the price and demand for goods and services really are, because everyone who needs a thing will be able to pay the market price to get it. I'm convinced that public health is too important to be treated as a commodity, but anything outside of public health concerns (screenings, inoculations, hospitals, research) should be fine treated in this way. Just as long as those in need are not required to do without.

    That is the problem that zero sum game types can't wrap their heads around. With millions of Americans and billions of people on this planet, there is little we cannot do if we set our minds to doing it. We created these systems out of whole cloth in previous generations. There is nothing keeping us from maintaining them in perpetuity aside from our own lack of will. Our own greed. We've let the greedy run this country for far too long now. It's time for a change.

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  115. A question from a bemused reader outside the USA: why is it take as a given that universal healthcare in the USA would cost more money? The USA's per capita expenditure is the third highest in the world, pipped only by Norway and Switzerland. It's more than 1.5x Australia, France and Germany, more than twice the UK and more than five times Canada. All of those countries have universal healthcare.

    For the amount of money the USA throws at healthcare, it should be enjoying the best healthcare system in the world, not arguing about whether poor people should have healthcare at all.

    Data from the World Bank: http://data.worldbank.org/indicator/SH.XPD.PCAP.

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    1. This indisputably true. I suspect that US residents are, overall, still too parochial to see their policy issues in a non-USW-centric context.....

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    2. I did some blogging on this as the ACA was being rolled out (http://www.mayabohnhoff.com/?p=159) and found that nations that have created universal healthcare systems provide care to ALL of their citizens (and often non-citizens) for far less than we spend to insure only some of ours.

      To put this into perspective, at the time I wrote the series of which the referenced article above is a part, the USA spent 17% of its Gross Domestic Product on healthcare. Taiwan, which revamped its “out-of-pocket” non-system in 1994-1995, spends 6% of its GDP. To look at a it a different way, France spends a little over $3,000 annually per capita for healthcare; we spend over twice that. Germany, which uses the hybrid non-profit, privatized Bismarck system (yes, that Bismarck), spends 11% of it's GDP on healthcare.

      Taiwan went looking for a solution to its problem in a logical and systematic way and designed a system based on other successful systems that was tailored to its population. If we're so darned exceptional here in the USA, surely we can do the same.

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    4. Thanks, Maya. Taiwan is another great example though of course it doesn't appear on a World Bank list because China might get cross.

      My question stands though: I've discussed this with a fair number of Americans and you are one of the very few who don't assume that universal healthcare would cost more money. I'm trying to understand why that is?

      I do realise that the USA couldn't switch to a French or Taiwanese system overnight, even if there was the political will to do it. But the USA is an outlier in international terms. No other country spends anywhere near as much for so little coverage, and it's worth mentioning that the Commonwealth Fund ranked the quality of the US system below all of the examples I mentioned above: http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror.

      I stand bemused!

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  116. First, no, health care is not a right.
    Second, even if it were, the way it is paid for and the guidelines regarding who is eligible for what coverage would still be in the hands of those evil Congresspersons who decide how the Country's money is spent.
    So whether you consider it a right or not, nothing changes.
    But thank you for a very thought-provoking argument.
    You are very good at this.

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  117. Yes, it is a right - of all humans everywhere. This is worthy of a new amendment to make it absolutely clear to Americans, as we have done with other rights issues.

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  118. Hello again, from the Great White North. (which isn't so white anymore thanks to Global Warming. :( )

    I say it's a right, so do nearly all of my countrypeople. A politician who tried to 'defund' medicare would be strongly reminded that the voters will not tolerate that.

    I mentioned that old term "the Great White North", I remember its origin from an old comedy show; SCTV. I do think that it's the weather up here that has made us want to watch out for our neighbours. If you're alone up here, you can die; far too easily. We know, and have always known, that we're a society of individuals that need the support of our neighbours for far more than mere company.

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  119. And, wait for it, in a few decades we will have this discussion about income.

    Is a living wage *not* based on performing work a human right ?

    What if all work *you* can perform has been taken over by robots ?

    Jesus had the beginning of an answer to this question (the parable of the workers of the 11th hour).

    Are *we* willing to think this through ?

    [ Remember, the job with the highest occurrence in the Mid-West is "truck driver". ]

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    1. Greg - ETC(SW) USN - RetiredJune 19, 2017 at 11:46 AM

      Wow!! Cool interpretation/application of that parable. I wouldn't have thought about it that way before, but in re-reading it, I thought BFD (Blinding Flash of DUH) and it was obvious.

      Greg Levy (ETC/SW) - USN - Retired

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  120. Definition of "right"
    noun
    a just claim or title, whether legal, prescriptive, or moral:

    Nice debate frame of right vs. privilege in the above article. Healthcare is no more a privilege than automobile care. Healthcare is a commodity, so the answer on whether it's a right is no.

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    1. I hope you mean that as in "no, right now it's not treated as a right, but should be". Unlike Jim, I'm willing to pushback at people who don't think the right to be cared for when ill or injured is a right that goes along with "party" affiliation—that party being Humanity.

      Here in the exceptional USA, healthcare is treated as a commodity, yes. It should not be. And we are the only "first world" nation that treats it as if it were. I would argue that, on that basis, alone, we have no right to consider ourselves a "first world" nation. Anyone familiar with the situation in Appalachia as only one example, gets what I mean.

      Moreover, if our attitude toward the health of our citizens is an evidence of American exceptionalism, it's an exceptionalism we should do without. America, without the priceless assets that are its people, is merely real estate. America IS its people and if we fail to take care of ourselves (meaning each other), all our touted exceptionalism is meaningless.

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    2. While you're at it, you may want to look up the definition of "commodity," but:

      *or moral*

      You seem to have missed this part. And humans aren't automobiles; taking your kid or ailing grandmother to the doctor ain't nothing like taking your car in for a tuneup.

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  121. I'm technically a politician (though I resist the label; I consider myself an activist who got elected. Still, I hold a seat in the NH House of Representatives, so, yeah...) and I'm on record from WAY back as saying, out loud and in public, that health care is a human right (in fact, my go-to phrasing (of which the more proper of my colleagues disapprove) is "single payer, right fucking now").

    As for how to pay for it? Well, it's not going to be neat or easy or pretty (or cheap) because we've become so entrenched with insurance companies and ponzi schemes, but if we can devote gazillions of dollars to 'national defense,' we can figure out how to pay to restructure our health care system so that everyone gets - not just "accesses" but actually GETS - the care they need.

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    1. If you move to Ohio district 15, I'll vote, and campaign for you until my voice is gone, and lick envelopes until I'm put on an IV for dehydration.

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  122. While I think that providing healthcare is a good idea, I don't consider it a right, for two reasons:

    1. Rights are generally expressing what government can't do to you. They can't infringe on your freedom of speech, of religion, of defending yourself, etc. To put it to the test, think of someone on a desert island. They can exercise freedom of speech and religion, of press if they have something to print with, to peaceably assemble if there's someone to assemble with, etc. What does it mean that they have a right to healthcare?

    2. With vanishingly rare exceptions, your rights don't cost me anything. I don't have to pay for your freedom of speech or religion. But I do potentially have to pay for your healthcare (which I don't personally mind - I'm just making a point). I don't think anyone has a right to anything that someone else has to pay for.

    And once you say it's a right, what does that mean and where do you draw the line? We have a high-end clinic here in the DC area that will screen you for every possible ailment. They boast about how much their clients' death rates are reduced as a result. I have no idea how much that costs, but I'm sure it's many thousands of dollars. Does everyone have a right to that level of healthcare? If so, how do we pay for it? How do we even find enough doctors to provide that level of healthcare?

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    1. 1-There is a valid distinction between negative and positive rights. Freedom of speech, religion, et al being negative rights. Positive rights are entitlements to something- which is what Mr Wright is proposing here.

      Overarching arguments about what supports ANY notion of rights generally turn on status based or instrumental.
      https://plato.stanford.edu/entries/rights/#6

      America has generally relied on status based rights- natural law theory being a biggie- but instrumental rights seem to underlie our notions of many issues in modern times. I think both arguments have value and the tension between them is of value as we sort out what we want of our culture and our selves.

      2- As regards limits/ form/ substance of healthcare as a right, are we really going to do the Senator Murkowski (one of our AK Senators)thingy of not doing anything because we haven't dreamed up the perfect system yet?

      Jeez- the framers of the Constitution should have just chucked up their hands and walked away because it might not be perfect?

      We can and will do this like we do every other human activity- build it, run it, analyze it, adjust it, etc.
      And we have a number of decent examples in Europe and just to our north(my southeast) in Canada to look at and study for how tos and what tos. We do not have to reinvent the wheel.

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  123. I read your article, and I'm not on Twitter, but I'll chime in here:

    Yes (no caveats). Healthcare is a right. Work out the details however is necessary, but define it as a right FIRST.

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  124. The Democratic Party has considered health care to be a right in many of its platform documents. Some examples ...

    In 1992, the party platform said "All Americans should have universal access to quality, affordable health care—not as a privilege, but as a right."

    In 2008, the party platform said "We believe that quality and affordable health care is a basic right."

    In 2016, the party platform said "Democrats will never falter in our generations-long fight to guarantee health care as a fundamental right for every American."

    Perhaps not all of America has been asked if health care is a right, but the Democratic Party has been asking that question and has been answering YES for decades.

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  125. Can you submit this essay to mainstream media with some leverage that will force the question to be addressed?

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    1. Oh pretty please?, with sugar on top??
      I would love to see both sides try to hem-haw and spin it not being a right.

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  126. Excellent column Mr. Wright.
    I Agree that "reasonable" societies would treat Health Care as essential in order to maintain the health of that society. We could also state Education as essential. But, could Health Care be a guaranteed right? I don't have much confidence in Congress actually adopting that classification. The Left says yes, the Right says so long as you can pay for it yourself.

    In the end, I agree that Health Care ought have designation as a right. Caviot: there are differing levels, how far do we take the right?

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  127. It's not a right in the sense that the right to vote or to speak freely or assemble in public is a right. But it SHOULD BE a benefit of citizenship, like defense of our borders, infrastructure (yah, I know they're letting us down on that one), and police and fire protection are benefits of being a citizen. We pay for all of those benefits, of course, and we'd have to collectively pay for health care, as do all other civilized countries. But access to health care should not be restricted by anyone's individual capacity to pay for the health care they need RIGHT NOW.

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    1. >a benefit of citizenship

      So tourists, visitors, etc. would have to pay if they got sick or injured while in country?

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  128. Probably already mentioned, but, in a sense we already have a form of universal coverage (a very inefficient and expensive form) in the Emergency Medical Treatment and Labor Act (EMTALA), a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Since its enactment in 1986 it has remained an unfunded mandate so the burden falls on the providers (and ultimately each of us and our insurers).

    I feel that some level of healthcare is a right. By "level" of healthcare I mean that it should be based on doing the least harm and most good for the most people (a bit like the algorithm for triage in a mass casualty incident). That should be the basis for discussion.

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    1. Greg - ETC(SW) USN - RetiredJune 19, 2017 at 5:47 PM

      Forgive me for playing devil's advocate for a minute. The federal law talks about treatment to stabilize (which may not cure the cause, or cover any follow-up care, unless it becomes acute). If someone were to have to determine what the appropriate "level" of healthcare was - let's say using the terms least harm, most good, for the most people - as yet undefined (but let's say the algorithm for triage in a mass casualty incident - for starters), isn't that, in effect, a death panel?

      Again, I don't propose to have the answers to the questions, but I think part of Jim's point was to think our answers through to the conclusions that are implied by those answers.

      Greg Levy - ETC(SW) USN - Retired

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  129. All of this is well and fine. And excellent article that covers everything about health care in this country.
    Now comes the question. How to get the question asked beyond this article.
    I myself am going to send this to my Senator and Congressmen. (I don't expect and answer from either one. The question still will be asked.)

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  130. Awesome article, Yes a right. (as most here seem to agree.)
    Now I wish we (the US) would talk about how to reduce costs,
    and not how many will or won't be covered

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  131. Thought provoking post and question. A right becomes a right when we, as a society, interpret it is a right and define the details. Those wise old framers wrote the Second Amendment because a firearm was another tool in the frontiersman's, settler's, farmer's, militiaman's shed. For 250 years we have quibbled and continue to quibble about the details. We can do that with access to health care, too, if we choose, as a society, to stop making it a social, economic, political football that we can kick down the road to the next generation, administration, etc. To add to your question, we also must ask ourselves what kind of society we want to be. As long as we have a "caste" that is willing to exploit other humans for fun and profit, we are in deep trouble.

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  132. I'm sorry Mr. Wright, you make too much sense for 2017. Only hyperbole and sensationalism are allowed this year. Please pack up your blog and move to a year where reasoned argument is acceptable. Or better yet, don't.
    As I read your post my initial thought was "no" not a right, a privilege, warts and all. Then I got to the...you have the right to an attorney...part, and I realized I was wrong. Though, as you may know, in our Justice System, you are better off being rich and guilty than poor and innocent.
    I was wrong, because it is (in general) better to be poor and innocent with an overworked & underpaid public defender to talk to the prosecutor (who may care more about conviction rate than justice), than to go it alone.
    Just like it is better to have health care provided by a trained professional (what do they call the doctor that graduates last in their class from med school?...Doctor) than ignoring things until it is too late.
    I just hope we (humans) don't become as callus to bad healthcare as we are to bad legal representation.

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  133. Yes. Yes my view is that healthcare is a right.

    I think the vast majority of Aussies, Brits,Canadians, Europeans and others agree on this too.

    One of my favourite United States of America derived quotes is from their (Aussie here) Declaration of Independence :

    "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

    Maybe its a stretch or maybe not but that Right to Life seems to implicitly include a right to healthcare to me.

    Ditto, maybe more a stretch but still, the latter two inalienable rights there apply to healthcare - what kind of Liberty do you have when you are sick, what kind of Happiness do you have or have a hope of pursuing if you are miserably ill and in pain and cannot be treated for it?

    I'll add that I think most Aussies, Europeans, Canadians and others in the Developed world have long been horrified and appalled by the inhumanity of the US healthcare system especially pre-Obamacare era.

    Australia has had our national Medicare pretty much all my lifetime; the UK has National Health I think its called; most other First World and even quite a few Second and Third world systems have had good national healthcare systems set up for many years. The fact that superpower USA has been - hell, still is, so bad to its own people on this is something I find truly baffling, sad and mad.

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    1. There are tons of comments so I started at the bottom, and lo: you've already stated exactly my view here. :)

      "'We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.' ... that Right to Life seems to implicitly include a right to healthcare to me. Ditto...what kind of Liberty do you have when you are sick, what kind of Happiness do you have or have a hope of pursuing if you are miserably ill and in pain and cannot be treated for it?"

      I'm an American and that there is debate has always baffled me precisely because of this. I believe the argument is that since the phrase is not Constitutional or otherwise codified as law, it doesn't technically count. To which a rebuttal is: see the 9th Amendment and "Secondary Legal Resource" (if the Constitution is the foundation of the Democratic Republic, the Declaration is the bedrock the foundation stones were cut from and counts as guiding material). There is also the small matter of Constitutional Article 1 Section 8's "Congress...provide for the common defense and *GENERAL WELFARE*" [emphasis mine] phrase to account for. So I've always thought there was a pretty solid legal argument for it being a right. Though, that the argument has to get this technical/legal to begin with is mind-boggling; taking care of people just the right thing to do and all.

      There must be (well-monied) counter-interests at work, I guess. That's the only thing I can come up with. The shortcomings and moral bankruptcy of for-profit healthcare and the insurance systems are well known and widely documented. That people who benefit from this system actively fight to keep it in place is the only thing that makes any sense to me.

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    2. Well, since health care lobbyists were an integral part of the Senate gang crafting the latest incarnation of Trumpcare, your statement in the last paragraph is validated.

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  134. Wrong question.

    Healthcare is a neccessity for the nation to survive.

    Or the first biowar attack will destroy it. Or even a natural pandemic.

    In the face of that fact, philosophical discussions about rights are irrelevant.

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    1. I 'd be pleased if I could think of comebacks to idiotic arguments like' if healthcare is a right doctors will be made slaves' as well as you do. I will keep reading.

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    2. How about "If justice was a right, judges would be slaves"?

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  135. I fucking hate twitter speak.
    Grammar and spelling are so far out the window and that is a pity.
    I appreciate your eloquence, Jim.

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  136. A big reason why the right question is a tough question is that back in the Enlightenment, when the Rights of Man were first conceived, there really wasn't any health care worth having, at least in the west, beyond tooth extraction and amputation, both performed by barbers, and midwifery, and there wasn't much of an issue around having or not having those services, because they were the kinds of things that when they had to be done they had to be done; there just aren't a lot of stories about midwives or barbers refusing to help people in need. In fact none of the rights that were discussed back then required money to secure, in the sense that they were mostly rights either to be left alone or rights to engage in certain behaviors. So Health care, which is expensive, doesn't really fit the old discourse. To further complicate things, what the conversation in the U.S. is really about is do people have a right to Heath Insurance, which is not the same as, albiet is related to, health care. The nearest thing we do have to the kind of health insurance that citizens either do or don't have a right to, is social security, which could be called pension insurance. Do we have a right to a state pension? We do by law, but very few people discuss a state pension as a fundamental right inherent in the fact that we are human beings. Myself I think we fall down badly as a country, and as a civilization, if we don't provide Universal Health Insurance, that provides health care free at the point of service. Any developed country that doesn't so provide health insurance, to all its citizens, is a failing country. We know it can be done, the rest of the developed world does it. Anyone who doesn't want to do it is just being selfish and greedy in my view, and fuck them.
    But does is that the same thing as saying Health Care is a right? I think in a practical sense, no, but in a theoretical sense probably. I'd rather look at it as a non-negotiable responsibility of any government of any developed nation. I'd like to say that any decent human being who votes has a non-negotiable duty to vote for universal health insurance and health care free at point of service for every citizen. And then I'll leave it to the philosophers to try to parse whether that means I think it's a right or not. We might actually need a new word for what kind of obligation the need for health care imposes on societies, or else we need a new reading of the word 'right'.

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  137. A little OT, but: I find the "Who will pay!!!" comments somewhat sadly humorous. I believe that concern to be mostly genuine. I think a lot of people have had the experience of being blown away by the totals on medical bills they've received or they've seen family or friends receive. We all have stories in that regard; or know people who've filed for bankruptcy or lost a car/house to medical expenses (I can't begin to express my thankfulness for the VA in the last years of my father's life; he earned it, I know, but we would have been lost without them). And people multiply those stories by "300 million Americans" in their head when the subject comes up and the rest of the discussion happens in a fog of borderline panic at the possibility of the U.S. bankrupting the planet like that.

    But beyond the "who will pay" demands, cost is never really part of the discussion, have you noticed? No one talks about *why* health care costs in the States are what they are. This was my main problem with the ACA actually, that it did nothing to address costs (which are obscene to the point of moral objectionability, and - as far as I've been able to find out - basically pulled out of a hat). Why do we suppose that is?

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  138. The role of the government first and foremost is to protect it's citizens. In that view, yes, healthcare should be a right.

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  139. Jim,
    I don't do Facebook, or Twitter because I value my privacy, and they're too much of a time suck.
    I do however want to be counted as a voice for healthcare as a right, and would vote for any candidate who says it is. If one adds housing, safe water, and food in with healthcare as a right, I'd knock on every door, and spread every pamphlet like a motherfucking PSYOP bomb!
    M.Sgt M.Alvardo U.S. Army (Ret.)

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  140. I find that the manner of our capitalist/fascist governments,
    to privatize everything under the sun, to be a major factor. Your
    elected judges own shares--in the very penitentiaries that they sentence the people to do time in. Mostly ill, addicted and poor. Very, very poor people.

    Also, add clean water to my list- and, I'm wondering why Schneider isn't in prison? Fall Guys?

    We have a problem with clean water here, on the First Nations land. It's very third-world. Sky-high food prices. Addiction. Lost hope, for many. We're committed to changing it. It's a slow deal.

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  141. Yes, healthcare is a right. Yes, yes yes. Vaccines. Annual visits. Cancer Treatment. It's ALL our right as human beings.

    That said, however, like all rights, it's limited. Free Speech is a right, but yelling "fire" in a crowded theater, or stating demonstrable falsehoods about public figures are not protected instances of that right.

    1st line cancer treatment should absolutely be a right. 2nd line, probably, if the patient's performance status is good. Should aggressive cancer treatment be covered for someone who is frail and bed-bound with advanced disease? Medically speaking, at that point the recommendation would be for hospice. Perhaps at some stage, all that should be covered is hospice. The question, of course, is who decides when that point is reached.

    Similarly, think about aggressive treatments for people with progressive neurologic decline (ie, advanced dementia). At some point, it is more cruelty than kindness to perform uncomfortable procedures on someone who is unable to understand why, for the hope of buying them more time. Again, the question is who decides when that point is reached.

    Those are all details, however. The fundamental point is that YES, healthcare is a right.

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  142. Your very own argument about the 2nd Amendment disproves that healthcare can be a right (not to mention the fact that government can only deny, never grant, rights).

    Yes, I have the right to keep and bear arms. No, I do not have the right to take someone else's, i.e. their money, to obtain said right.

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  143. I would agree with a previous comment that healthcare is a public good rather than a right. However, our "exceptional" society has become so warped and our citizenry so twisted that public good has largely gone the way of the dodo. States cut taxes to the point where their children are only going to school 4 days a week (4 long days that I feel can't be beneficial for developing minds and bodies), paved roads are being replaced by gravel, and streetlights are shut off to save money. A frighteningly large percentage of the population is fine with this situation, which makes the debate about whether healthcare is a right largely meaningless.

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  144. Healthcare is a right. Period. It's enshrined in the basic principle of the founding of our republic, expressed by Thomas Jefferson. "We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness."

    How can I have a right to life if I cannot get to a doctor to medicate (or operate on) my failing heart; to excise a cancerous tumor; to cure an infection?

    If you take away the unalienable right to healthcare, you take away their right to live.

    Yours crankily,
    The New York Crank

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    1. That's a sweet argument, but, alas, Thomas Jefferson would not have recognized it. I'm on your side (see my post above at June 19, 10:18 am) but it's important not to put ideas into the mouths of people from other ages who never considered this problem even a little bit, because while that might seem a clever way to win a skirmish, it's an easy way to lose the war. No list of rights of man that ever occurred to Jefferson would ever have included anything resembling health care. That's not a slurr on Jefferson, it's only a recognition that human life, and human economic relations, and for that matter medicine, evolves.

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