Is Healthcare a "Right" or a "Moral Obligation"?

I have to admit I often have found the language of healthcare “rights” off-putting.  Yet the idea of healthcare as a “right” is usually pitted against the idea of healthcare as a “privilege.” Given that choice, I’ll circle “right” every time.

Still, when people claim something as a “right,” they often sound shrill and demanding. Then someone comes along to remind us that people who have “rights” also have “responsibilities,” and the next thing you know, we’re off and running in the debate about healthcare as a “right” vs. healthcare as a matter of “individual responsibility.”      

As regular readers know, I believe that when would-be reformers emphasize “individual responsibilities,” they shift the burden to the poorest and sickest among us. The numbers are irrefutable: low-income people are far more likely than other Americans to become obese, smoke, drink to excess and abuse drugs,  in part because a healthy lifestyle is  expensive, and in part because the stress of being poor—and “having little control over your life”—leads many to self-medicate. (For evidence and the full argument, see this recent post).  This is a major reason why the poor are sicker than the rest of us, and die prematurely of treatable conditions.

Those conservatives and libertarians who put such emphasis on “individual responsibility” are saying, in effect, that low-income families should learn to take care of themselves.

At the same time I’m not entirely happy making the argument that the poor have a “right” to expect society to take care of them. It only reinforces the conservative image (so artfully drawn by President Reagan) of an aggrieved, resentful mob of freeloaders dunning the rest of us for having the simple good luck of being relatively healthy and relatively wealthy. “We didn’t make them poor,” libertarians say. “Why should they have the ‘right’ to demand so much from us?”  Put simply, the language of “rights” doesn’t seem the best way to build solidarity.  And I believe that social solidarity is key to improving public health.

Given my unease with the language of rights, I was intrigued by a recent post by Shadowfax, an Emergency Department doctor from the Pacific Northwest who writes a blog titled “Movin Meat.”  (Many thanks to Kevin M.D. for calling my attention to this post.)  Shadowfax believes in universal healthcare.  Nevertheless, he argues that healthcare is not a “right,” but rather a “moral responsibility for an industrialized country.”   

He begins his post provocatively: “Healthcare is not a right...I know this will piss off” many of my readers, “but I wanted to come out and say it for the record...My objection may be more semantic than anything else, but words mean things and it is important to be clear in important matters like these.”

Anyone who says that words are meaningful has captured my attention. I’m enthralled. After all, words shape how we think about things. Too often we automatically accept certain words and phrases, without realizing that they define the terms of the argument.

Shadowfax then quotes from a reader’s comment on his blog:  “Jim II said it well in the comments the other day: ‘rights are limitations on government power.'

“Exactly,” writes Shadowfax. “When we use the language of ‘rights,’ we are generally discussing very fundamental liberties, which are conferred on us at birth, and which no government is permitted to take away: free speech; religion and conscience; property; assembly and petition; bodily self-determination; self-defense, and the like. Freedoms.  Nowhere in that list is there anything which must be given to you by others. These are freedoms which are yours, not obligations which you are due from somebody else. There is no right to an education, nor to a comfortable retirement, nor to otherwise profit by the sweat of someone else's labor.”

Normally, I would object: Americans do have a right to an education. But Shadowfax is defining our “rights” in a very specific sense: our constitutional rights make us, as individuals, free from something—usually, interference by government, our neighbors, or the majority in our society.

Shadowfax then turns from the idea of rights to what people deserve: “some societies, ours included, from time to time decide that its citizens, or certain groups of them, should be entitled to certain benefits. Sometimes this [is] justified by the common good -- a well-educated populace serves society well, so we guarantee an education to all children. Sometimes this is derived from humanitarian principles -- children should not go hungry, so we create childhood nutrition programs. Healthcare would, in my estimation, fall into the category of an entitlement rather than a right..."

Here, we are no longer talking about our rights as individuals; instead, Shadowfax is asking us to think collectively about what we all deserve simply by virtue of being human.  These are what I would call our “human rights,” which are quite different from our constitutional rights as individual citizens.   

This is what Jim II is referring to when, after defining “rights” as “limitations on government power,” he writes: “That said, I think it is immoral for someone's access to healthcare, politics, or justice to be dependent on how good a capitalist he or she is. And therefore, I think we should use the government to ensure that people from all economic classes are treated equally in this sense.”   
In other words, a person’s access to medical care should not turn on just how skilled he is as an economic creature.  While some of us are smarter, taller, and quicker than others, as human beings we are equal.

In the economy, the swift will win the material prizes; but in society, human possess certain “inalienable” rights to “life, liberty and the pursuit of happiness” simply by virtue of being human. These are different from a citizen’s “right” to free speech—a right that no government can take away.  The framers of the Declaration of Independence believed that these “inalienable rights” are bestowed upon us by God. To me, this means that we have moved from the rule of law in the public sphere to the private sphere and those moral rules which begin “Do unto others . . .”

When Jim II argues we should “use the government” to oversee healthcare, and to “ensure that people from all economic classes are treated equally in this sense,” he is saying that government should oversee that moral compact among men and women who recognize each other as equals.  Here I would add that, when comes to the necessities of life, a society that seeks stability and solidarity strives for equality.

Shadowfax  goes on to point out that “our nation has long defined health care as an entitlement for the elderly, the disabled, and the very young. We are now involved in a national debate whether this entitlement will be made universal. As you all know, I am an advocate for universal health care. Though there may be an argument for the societal benefit of universal healthcare, or for the relative cost-efficiency of universal healthcare, I support it almost entirely for humanitarian reasons. It needs to be paid for, of course, and that will be a challenge, but as a social priority it ranks as absolutely critical in my estimation  . . .”

On this point, I don’t entirely agree.  In my view there is a very strong argument to be made for the societal benefit of universal healthcare; if people are not healthy, they cannot be productive and add to the wealth of the nation. And there is an argument for cost-efficiency—if we don’t treat patients in a timely fashion, they become sicker, and charity care becomes more expensive. But I would add that even if we are talking about a person who cannot be expected to add to the economic wealth of the nation—say, a Downs’ syndrome child who will need more care than he can “pay back” over the course of a lifetime—he is entitled to healthcare for humanitarian reasons. As healthcare economist Rashie Fein has said: “We live not just in an economy, but in a society.” And as a human being, that child can contribute to society, by bringing joy to his family, or by being in a classroom with children who will learn from him.                      

What of the “Rights” and “Obligations” of Doctors?

Shadowfax’ argument then takes a shocking turn. Without fanfare, he acknowledges that he has some sympathy for “the common line of argument against universal healthcare” which declares that, “with any good or service that is provided by some specific group of men, if you try to make its possession by all a right, you thereby enslave the providers of the service, wreck the service, and end up depriving the very consumers you are supposed to be helping. To call ‘medical care’ a right will merely enslave the doctors and thus destroy the quality of medical care in this country [...] It will deliver doctors bound hands and feet to the mercies of the bureaucracy.”

Here, Shadowfax  is quoting  from a speech by Alan Greenspan’s moral mentor, Ayn Rand, released by the Ayn Rand Institute in 1993 as a comment on the Clinton Health Plan.

In that speech, Rand denies that healthcare is either a right or an       entitlement: “Under the American system you have a right to health care if you can pay for it, i.e., if you can earn it by your own action and effort. But nobody has the right to the services of any professional individual or group simply because he wants them and desperately needs them. The very fact that he needs these services so desperately is the proof that he had better respect the freedom, the integrity, and the rights of the people who provide them.

“You have a right to work,” she continues, “not to rob others of the fruits of their work, not to turn others into sacrificial, rightless animals laboring to fulfill your needs.” 

If I find the language of “rights” troubling, I find Rand’s language terrifying. ) Shadowfax admits “There's a lot not to like about this sentiment.  But,” he argues, “it has some limited validity.  . . .”

Shadowfax then turns to the predicament of his cohort—emergency room doctors. Under law, they are required to at least stabilize patients—even if those patients cannot pay.  And most often, physicians go well beyond stabilizing them, treating them and even admitting them to their hospitals. 

“Only problem is,” Shadowfax writes, “I and my colleagues are not caring for you out of the goodness of our heart, nor out of charity, but because we are obligated under federal law to do so. While this isn't exactly slavery, this coercion of our work product is essentially compulsory if you work in a US hospital.”

What I like about Shadowfax is that he then moves from complaint to a potential solution:  “Universal health care, or, more precisely, universal health insurance, might improve upon the current state of affairs by ensuring that doctors are always paid for the services we provide, rather than being obligated to give them away to 15-30% of their patients as we now are… The typical emergency physician provides about $180,000 of free services annually,” he adds, “just for reference.”

I’m not sure that the average ER doc should be paid $180,000 more than he is today. (I would agree that, when compared to many specialists, ER docs are not overpaid—and theirs is a very demanding job. But $180,000 seems a large sum; I don’t know whether taxpayers could afford it.) Nevertheless, I agree that the current law regarding ER care is an unfunded mandate—and one that hospitals located in very poor neighborhoods cannot afford.  Moreover when ER doctors feel that they are being forced to deliver free care, many will be resentful.  This is understandable, and does not lead to the best care.

On the other hand, in a society where so many are uninsured, I do believe that physicians have a moral obligation, as professionals, to provide some charity care.  They have taken an oath to put patients’ interests ahead of their own. The problem is that the burden falls unfairly on those who are willing to work in emergency rooms or neighborhood clinics while many doctors in private practice simply shun the poor. We need a system that is fairer, both for patients and for doctors.

The answer, as Shadowfax suggests, is universal health insurance that funds ER care for everyone who needs it—and, I would add, health reform that restructures the delivery system so that Americans don’t have to go to an ER for non-emergency care.

In the end, I agree with Shadowfax that  reformers need to think carefully about the language they use: “When advocates of universal health care misuse the language of universal rights to push for health care for all, we fall into the trap of over-reaching and provoke a justified pushback, even from some who might be inclined to agree with us. Universal health care is, however, a moral obligation for an industrialized society, and will not result in the apocalyptic consequences promised by the jeremiads.”

What I like about calling healthcare a “moral obligation” is that it presents healthcare, not as a right that “the demanding poor” extort from an adversarial society—or even as an obligation that the poor impose upon us. Rather, Shadowfax is talking about members of a civilized society recognizing that all humans are vulnerable to disease—this is something we have in common—and so willingly pooling their resources to protect each of us against the hazards of fate.

Comments

[Carlo R.]

Your analysis has several deficiencies. First, you improperly characterize the rights question. The analysis refers to positive versus negative rights. The 14th amendment refers to certain inalienable rights (life, liberty, and pursuit of happiness). These are negative rights: persons are protected from infringement of such rights by government. Moreover, a government, through various amendments and legislative acts, decides additional negative and positive rights. Those additional negative rights include freedom of speech, freedom of religion, and the like. Moreover, the positive rights are those entitlements afforded to persons by the government.
The difference between negative rights and positive rights is this: our government must respect one's negative rights, while our government has the responsibility to allocate positive rights to each individual equitably. The Constitution does not provide for the positive right to health care. However, our legislature has provided persons in our nation with a positive right to a medical screening exam in an emergency room for purposes of stabilization (EMTALA). In contrast, a patient cannot demand medical care from a physician in a private office or clinic, for example. The non-ER physician has a right to refuse to treat a patient, thereby not creating a patient-physician relationship.
Thus, our government must furnish a reasonable means for hospitals and physicians to comply with EMTALA. But to require physicians and hospitals to comply with this positive right, and not provide a fair structure in which to do so, is unreasonable. Note all the confusions of the current EMTALA rule, and its poorly defined parameters.
What is the upshot here? Healthcare is an entitlement insomuch as our legislature decides. Currently, there is no law that makes healthcare a right to all persons; this statement embodies the current health care debate. This begs the question: should healthcare be an absolute, positive right? My answer is no. Let me explain.
Health care is a shared responsibility, just like all entitlements. Any government entitlement, if dispensed without caution, will run out. (Consider social security.) Currently, our nation does not have unlimited financial or health care resources. A resource cannot be a positive right if the resources are so limited that it is not possible for every person in the nation to have access to it. To characterize health care otherwise is unrealistic and short sighted. Claiming that all persons have a positive right to our current health care system deprives physicians of personal and professional autonomy. You basically say "You must treat this patient, and not demand pay." No other business industry is expected to comply with such a request. I find it interesting that you have some special authority to state that an ER physician should not have to be paid for his or her services. Also, I find it interesting that you can say that physicians should engage in some charity work. To require ER physicians to work without the ability to demand payment would no longer be charity work, but rather become compulsory work. Again, no other business industry is given such demands. We don't tell insurance agencies to insure everyone even if they don't want to. We don't require retailers to give some of your clothes away. We don't require educators to teach without pay, or lawyers to represent without pay. We know that charity is conducted in these fields, but our government does not require it.
Your comment that the poor are more prone to disease is interesting, and may or may not be true. But I fail to understand your conclusion from this. Should we, as a society, remove all financial responsibility from a person that he or she has diabetes, or obesity, or drug abuse, or coronary artery disease, because he or she is poor? I do not follow your logic. You merely state that the poor have more problems, then conclude that they need health care more, and therefore they have a right to it.
To conclude, to describe health care as a right, removes financial responsibility from the individual, which drains our health care resources, and ends up being an empty statement without any reference to a plan or scheme to provide universal health care to all persons. On the other hand,to describe health care as a responsibility places the onus on each individual, as well as on our government, to seek reasonable solutions and hopefully a means to pay for it.
To take the professional autonomy from physicians will deplete the physician pool and make health care more scarce. This will make your statement of health care being a right more and more of a fantasy, because a scarce resource cannot be a positive right if it cannot be provided to everyone.

[quiact]

It's both a right and a moral obligation.

The U.S. system would cost less if it was universal health care, studies have shown. Most other countries concur with this premise.

[Maggie Mahar]

KSDescartin-

Thanks very much for your kind words--

[KSDescartin]

"What I like about calling healthcare a “moral obligation” is that it presents healthcare, not as a right that “the demanding poor” extort from an adversarial society—or even as an obligation that the poor impose upon us. Rather, Shadowfax is talking about members of a civilized society recognizing that all humans are vulnerable to disease—this is something we have in common—and so willingly pooling their resources to protect each of us against the hazards of fate."

Thank you for pointing this out Maggie. More clarity and important perspective like this educates many of us and helps bring into consciousness and action how we live out our so called moral principles that prevailing voices in society likes to harp about but lacking in energy to realize.

[Maggie Mahar]

Tim--

Thanks very much. You wrote:
"I'd like to think than as a society we're better than allowing people to get really sick or go bankrupt because they are lower income and uninsured/underinsured."

I agree completely. And I think it's very important to think about healthcare collectively "as a compassionate, civilized society" rather than individually ("my right".)

Countries that have much better health care systems think collectively.

[Tim]

Glad to see this article from the standpoint of people supporting universal care. Too often I hear "health care is a right," and it makes me cringe.

A true right can be exercised, in my opinion, without requiring the taking of life, liberty and property from others.

With that definition (about which I'm sure there will be disagreement), health care is NOT a right.

However, I do believe it something that an affluent and compassionate society should strive to provide. Even if health care isn't a right, I'd like to think as a society we're better than allowing people to get really sick or go bankrupt because they are lower income and uninsured/underinsured.

[Maggie Mahar]

Elilzabeth-

I have to disagree. Both the posts on this blog and many of the comments are filled with well-reserched facts.

As for the government not being able to produce successful programs . . .
Medicare is far from perfect, but it's a very popular program.

As for FEMA--well we know how the director of FEMA was chosen.

[Elizabeth Moore]

Like most liberals, the cause and effect relationships are turned around and the arguements are illogical. Government mandated healthcare will always be inadequate. Innovations and hard work should be rewarded by the ability to profit. We as humans can and should donate to charity based healthcare options for those who choose not to take care of themselves. St judes is much more effective than any government run facility and the red cross is far superior to FEMA. I have never understood why lilberals feel better about having the government take money by force than to have it given freely. Conservatives dont think that we shouldn't care for others we just dont believe the government shaking down workers is the way to accomplish anything. Do you like how what the government did to the mortgage industry? Social Security? anything? I want to choose and monitor what charities I fund, the government takes money and then uses it for many unacceptable causes.
You have the right at any time to send your money to whatever you feel is important just dont tell me what to do with mine.
Like most liberal points of view facts never get in the way of your opinions

[Maggie Mahar]

Colin & Barry--

thanks for your comments--

Colin-- I agree, a society should be judged by how we treat the least among us.
It's good that you're reporting on what happens to low-income people. For a long time, we've been essentially ignoring the poor in the country. They've become almost invisible . .

As we move into very hard economic times, sometimes has to be throwing a spotlight on what is happening to the poor . .

Barry--
I wish that doctors would turn their backs on these marginally effective drugs, even for people who can afford to pay for them.

That is the only way drugmakers will get the messag: we need to have them focus their resources on developing affordable, effective drugs, not bleeding-edge drugs that might given someone an extra couple of months . . .

[Colin]

What great comments on a very good post. I too think the question is way oversimplified when it is defined as a right or responsibility. It's not either/or, but rather both as well as a moral imperative for a society that likes to think of itself as civilized. People have a basic responsibility to look after themselves and their families, but they also have a right to decent care when they are ill or injured.

Every day in my work covering the news for low-income populations, I come across story after story about adults and kids dying or suffering from problems that are treatable.

If you want to look at it from an economic standpoint, those unable to get decent medical treatment or advise are going to be less and less productive. This harms our economy.

But the bigger issue is morality. We can only be judge as good as we treat the least among us.

Thanks for a nice discussion.

[Barry Carol]

The most recent issue of the AARP Bulletin has an interesting article titled “Million-Dollar Medicines” which is about the high cost of specialty drugs. I will pass on a small segment of it which is relevant to this discussion. Here it is:

Some drugs are highly effective but others offer what Caplan (Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania) calls “limited and debatable” benefits – extending life by weeks or months – at a cost of $200,000 for treatment. Now doctors who once took pride in not knowing or considering the price of a therapy “are recognizing that discussing the cost of a drug should be an important part of providing good care,” says Neal J. Meropol, M.D., an oncologist with the Fox Chase Cancer Center in Philadelphia.

He says the medical community is moving to a cost-effectiveness approach that will weight a drug’s cost against a year of quality life. “There is a groundswell of demand now for studies that tell the physician how much bang you get for your buck with these drugs,” Meropol says.

This is good news and long overdue, in my opinion.

[Barry Carol]

“I really wish everyone was asked to fill out a living will”

Maggie,

Not only do I completely agree with this but I’ve been pounding on it since I started participating in healthcare blogs in early 2006. My preferred approach would be to encourage people to execute a living will as part of the process of enrolling in Medicare, Medicaid, and employer provided health insurance or health insurance obtained in the individual market. As you say, a central database that would be easily accessible to medical professionals should store the information and process updates and changes. If there is no living will and no family member, friend or relative empowered to make medical decisions for patients who no longer can, I think the default protocol should allow doctors to apply common sense depending on circumstances.

If doctors in Western Europe and Canada had to operate with our litigation environment and our demanding, entitled patient base, I think their costs would be far higher than they currently are no matter how good they are at primary care and prevention.

Lisa,

I think one can always find examples of unusual cases where people make miraculous recoveries to the astonishment of medical professionals. That does not mean that patients should be able to demand any treatment they think might be marginally useful no matter how expensive and even if doctors don’t think it would do any good. Of course, if you would like to spend your own money on such treatments, go right ahead. I say again that every country sets limits on healthcare one way or another. We need to as well but we need to do it in a fairer and more ethical manner than ability to pay.

[Maggie Mahar]

Thanks for your comments--

Let me begin to respond regarding extending life--

Barry: You ask "Suppose someone is seriously injured while committing a major crime. Or suppose an 85 or 90 year old with severe dementia needs heart bypass surgery or has Stage 4 cancer. "

First we just aren't doing bypass operations on severely demented 85 or 90 year olds. That isn't happening.

We are, however, keeping some people alive whose quality of life is very very low. A major problem here is that many people in this country are reglious--and at this point in time, separate of church and state seems to be dissolving.
Both presidental candidates frequently speak in relgious terms.
This makes it very hard (probably impossible) to pass laws protecting doctors or hospitals who don't do everything possible to extend life (partiicualrly if that's what the family wants.)
The fact that the government intervened in the Terry Schiavo case tells you what we're up against.
I really wish everyone was asked to fill out a living will-- maybe forms can be made available along with income tax forms. And people could send it in with their taxes where it would be filed somewhere that it could easily be found in an emergency.
Of course you couldn't force people to do a living will. But making it easy and available would be a start And I think that most people in this country agree that the individual has a right to decide whether he wants extreme measures used to keep him alive.

Though we have to accept the fact that, in this country, some people will want extreme measures . .

On the criminal who is injured in the course of committing an accident. Of course you treat him. What are you going to do, let him bleed to death on teh sidewalk?

You treat him, and then you try him and if found guilty you put him in prison. That's the rule of law.

[Lisa Lindell]

Barry, Don...do you want some nameless, faceless bureaucrat deciding what care you recieve when you're sick or hurt? Deciding whether you live or die? I don't. There was an example of this a couple months ago in our recent paper. Here in Texas families don't get to decide whether their loved one lives or dies. A teenage girl, due to a surgical error, was left in vegetative state. The hospital decided not to prolong her life, against the family's wished. Family got a lawyer, got their daughter out of the hospital, and she's home today and she's not a vegetable. The medical error didn't kill her, but the law almost did.

[Barry Carol]

Lisa,

With all due respect, I think there are many millions of people in our country, especially among the elderly, lower income and less educated who are what doctors call passive patients. That is, they will basically go along with whatever treatment strategy their doctor recommends, especially if they don’t have to pay anything for it. Moreover, in end of life situations, middle class children will often insist that everything possible be done for their loved one including ventilators and feeding tubes even when their loved one doesn’t want that care but can no longer communicate that fact and there is no living will or advance directive. At least part of the children’s motivation is that they have not yet come to grips with their own mortality. Every developed country sets limits one way or another whether it’s restricting the supply of expensive imaging equipment and hospital beds, refusing to pay for treatments deemed too expensive based on QALY metrics or other criteria, denying invasive treatments to people based on age or just making people wait longer for treatment than they would here. Your comments implicitly reject the notion that resources are finite and that there are numerous other worthwhile public and private priorities that we need to pay for. Moreover, as I said in my earlier comment, I also think we as a society have a moral obligation to live within our means for the benefit of the next generation if nothing else. We simply cannot afford to provide every intervention that might be marginally useful to everyone who might want it.

[Don Levit]

Lisa:
Let's assume you made "responsible" decisions in what seemed to be a very difficult situation.
If so, I applaud your reasoning and ethics.
I don't think your sample of one is an accurate indicator of how the general population would respond.
Are you suggesting that the insurance company should pay out whatever the patient requests, because it should believe the patient is as responsible and ethical as you?
Don Levit

[Lisa Lindell]

Hey, where's Martha on this one? I love your posts, Martha. Still love yours too, Barry.

[Lisa Lindell]

That is to say I think when folks are given a choice I believe they'll make the right one.
By the way for anyone that's followed any of my posts here and/or has read my book, I'm going back to my old job, same one I had when my husband got hurt. (applause*applause) Laissez Les Bon Temps Roulez

[Lisa Lindell]

"next of kin without any concern about the effectiveness and the cost to the insurer or the taxpayer is a bit arrogant, imo."
I have more faith in folks than that, I don't think patients/next of kin make foolish choices and I think effectiveness and cost are factors they would include when reaching a decision...maybe not so much cost but effectiveness for sure. There were many, MANY procedures and tests offered to my husband (blank check, wouldn't have cost us a red cent) that we declined repeatedly because they offered no relief and would have been pointless and painful.

[Maggie Mahar]

Some interesting comments--and I'm glad you're talking to each other!

I'll be back later today or this evening to respond . . .

[Don Levit]

Lisa:
Thanks for providing your input.
I would agree with you that we put value on human life, but that value is conditional, based on the circumstances.
For example, the value of bereavement fares may have been reduced, due to the profitability problems airlines are facing.
To say that the choice of treatment should reside with the patient or next of kin without any concern about the effectiveness and the cost to the insurer or the taxpayer is a bit arrogant, imo.
To place this in a religious context, man was made in God's image.
Man is not God, and thus, his worth is substantial, but not infinite.
To claim otherwise would be idolizing man.
Don Levit

[Lisa Lindell]

Quite a debate raging here, and a scary one at that.
"I’m sorry but human life does not have infinite value in a real world of finite resources and I reject the notion that only God can decide when the end of life comes."
We as a society DO place infinite value on human life. Some examples: There's no statue of limitations on murder. Airlies offer bereavement fares. Police escort funeral processions. Deceased are revered and respected... even those that were despised in life. We reach out to the poor, sick and hungry in less priveleged parts of the world because we value human life, and we value it a great deal.
Should the woman with dementia not have her cancer or heart ailment treated? Even if it won't prolong her life? Well of course she should because we, as a society will learn and advance our treatment for other cancers and heart ailments.
My husband was a burn patient. I read a book called "Burn Unit" and it contained a fascinating history of burns. My husband was treated for his injuries because, throughout many generations, other burned people, people who could not be saved, were treated and what was learned was processed and retained for the future...this is the evolution of treating burn injuries...no doubt the evolution of almost everything in medicine.
If we're not going to treat people who "can't be saved" anyway, then what's the point of all this advancement.
I think it's ultimately up to the patient or their sound-minded next of kin whether or not they're going to treat dementia grandmother's heart disease or cancer. That's not something that should be decided through legislation in a free country.
Somebody asked if having a child was a right or priveledge...maybe not if you live in China. I would say it's a right "liberty and the pursuit of happyness."
Driving a car is a priveldge.

[Barry Carol]

I think one could argue that healthcare is a moral obligation in that everyone should have health insurance and access to health care. However, it’s not as straightforward as that. I also think we have a moral obligation as a society to live within our means and to try to pass on to the next generation a world and an economy that will enable them to live at least as well and, hopefully, better than we did.

When it comes to healthcare, it means we need to set limits and we need to set them in a fair and ethical manner. It means that the treatment strategy for an elderly person with severe dementia who also has heart disease or cancer should not be the same as for an otherwise healthy middle age person with heart disease or cancer. Personally, I like QALY metrics conceptually. We implicitly apply these all the time in other aspects of life including the development of environmental regulations. For example, how much in air pollution mitigation costs should we impose on business and consumers in order to avoid one premature cancer death? I’m sorry but human life does not have infinite value in a real world of finite resources and I reject the notion that only God can decide when the end of life comes. While humane comfort care should always be in order at the end of life, I don’t think we have a moral obligation to throw everything that medical science has to offer in end of life situations when the prognosis is grim and the patient has already lived well beyond a normal lifespan.

Finally, on the general subject of taxpayers helping the poor whether it’s with health insurance, food stamps, housing vouchers, welfare or whatever, I think a lot of people are more than willing to help those who were simply dealt a bad hand in life such as a child born with a severe physical or mental handicap or someone who is badly injured in an accident that is not their fault. By contrast, people who just made poor or dumb choices generate less sympathy rightly or wrongly.

[order medications online]

healthcare is both right and moral obligation. Concern about people's health is really an important matter. is it an obligation because we should protect ourself.

[jenga]

One downside you don't mention about Employing Physicians. They are then legally allowed to unionize. A real functioning, work slowdown/stoppage union. If you think the AMA is a guild. You ain't seen nothing yet and yes it would be a team sport. The physicians on one team with exponentially increased bargaining power and all on the same side.