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Welcome to STop, the Seattle Times Opinion blog where our editorial writers and editors share their evolving thoughts on a variety of issues. STop is a place where opinion writers and readers can exchange views and readers can learn more about how editorial positions are formed.

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July 01, 2005

A Right to Health Care?

One question: Why are you entitled to better health care than me just because you have more money?

Steve Nesich, Seattle

My answer:

Because it's my money and I can spend it on myself, just as you can spend your money on yourself. What's money for, if you can't spend it on your own health?

His reply:

What if you have one million to spend on your health care and I have zero? And what if my health condition is the same one you have and I require the same care? What makes you more important than me? Why is your health more urgent than mine?

Money entitles you to a bigger house than mine, or a better car or more meals at fancy restaurants. Your private stash of cash can buy you all the vacations you want at any cost you want to pay. But should it determine everything?

Do you get the police if you need them and I don't? Do fire trucks respond if there is a fire at your home but not mine?

Essential, life protecting services are meant to be shared equally by all of us.

Why should you get to see a doctor when I can't?

And if we both have children why would your kids be more entitled to health care than mine, or vice versa?

My reply:

The answer is a matter of political opinion, and I’ll try to explain mine.

You are arguing that medical services ought to be like police and fire because “essential, life protecting services are meant to be shared equally by all of us.” Why?

“Essential” is not an obvious category. Food, clothing, shelter, education and transport may be essential, in some measure, to biological life, or physically healthy life, or happy and fulfilled life. Much of today’s medical treatments didn’t exist 50 years ago and now are arguably essential. If everyone has a right to essentials, we create a huge incentive to come up with things that are declared essential, like drugs that cost $1,000 a month.

You list police and fire protection, which are socialized, as essential. But the reason police and fire protection are socialized everywhere is that by protecting your house from fire we protect the whole community from fire, and protecting you from a robber protects the whole community from him.

If you’re sick, the value of medical care goes to you, not the community (exception: epidemics). It’s the same as if you’re hungry and you buy food, or homeless and rent an apartment, or naked and buy clothes. The value goes to you individually. And in those things you pay for yours and I pay for mine, because only under that system are we each free and self-responsible.

The cost of most medical procedures can be borne individually. Some treatment costs too much but can be borne by insurance. Most people could buy insurance if it were not inflated by state mandates, defensive medicine and by covering little stuff that we should be paying for ourselves.

Treating medicine as a private good allows people to choose different levels of medical coverage and care, which is compatible with individual freedom. It is part of that freedom. With socialized medicine you get one level of care. In Canada that means queues and a lack of new drugs. The Canadian system is OK for routine care, but if Canadians need a new drug or an MRI or a triple bypass (in a hurry), they come to the States and pay cash.

The Left wants health as a social right. But we live and die, and experience health and sickness, as individuals. Our health depends a lot (but not entirely) on our decisions as individuals. And even if we want a certain degree of socialized risk, most of us can buy insurance as individuals.

You may object that my health-care coverage is part of my compensation at the Times. So it is; some may think it is hypocrisy to have these benefits and think as I do, but I am not going to throw the benefits away (would you?) and I am not going to change my political opinions on account of an employee benefit plan (would you?).

With socialized medicine comes politics. The compensation of doctors and nurses, and the level of patient care, become never-ending issues to support candidates on, and to vote on. It is that way in Canada. With private medicine, the compensation of doctors and nurses is set in the market, which I think is a more rational realm.

You ask what happens when someone is sick and can’t pay. One answer is charity care. Another (very common today) is to agree to pay and stiff the doctor later on.

To your question: Why is your health more urgent than mine? I ask, urgent to whom? Mine is more urgent to me and yours is more urgent to you. One of us may become more urgent to a specific physician because one of us can pay him and the other can't. And then maybe that physician won't care and will treat whoever is sickest. His skills and time belong to him, and the decision is his.

Respond to Bruce.

 
Posted by Bruce Ramsey at July 1, 2005 03:14 PM



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