Repeal and Replace: With What? - Part 1 - Is Healthcare a Right?

A steady refrain from Republicans ever since the Affordable Care Act was passed in 2010 is that it must be “repealed and replaced.”  With the recent presidential election, that could finally happen.

Assuming the “repeal” part works, we must ask, “What would ‘replace’ look like?”  To date, although various Republican plans include strong elements, in my opinion, none provide comprehensive solutions to healthcare’s enormous complexities.  (I think the plan sketched out by HHS Secretary-designate Tom Price comes the closest.)

In this and the next blogpost, I would like to humbly propose a replacement strategy framework.  It is just that:  a framework and not a fully flesh-out proposal. 

But before we get to the proposed solution, let’s consider a fundamental, underlying question: “Is healthcare a right?”  This is an extremely thorny question.  To embrace the immediate “heart” response of “Yes, of course it is” has far-reaching public-policy implications.  Declaring I have a “right” to something can create a related obligation on someone else to meet that need. 

James Madison, fourth president of the United States and a major influencer on both the U.S. Constitution and the Bill of Rights, believed that people have rights as long as they minimize obligations on others.  The Declaration of Independence states our right to “life, liberty, and the pursuit of happiness.”  It doesn’t “cost” anyone anything to allow me to live my life, exercise personal liberty, or pursue happiness.  So applying Madison’s criterion, none of these compels action or obligations on anyone else.  But identifying a right attached to expenditures does create costs for others.

Some have rightly pointed out that life itself is threatened by lack of access to adequate healthcare services.  Clearly true.  But the same argument can be made for other essentials such as shelter and food.  Every year we hear of people who tragically freeze to death in the Chicago winters because of inadequate housing or heat.  Similarly, no one can live without food.  But the question for all three – healthcare, shelter and food – becomes to what extent my needs create requirements for others to provide for those needs. 

We are blessed to live in a country where compassion, generosity, and caring are displayed daily.  So let’s assume that we should collectively live out our good will and concern for others and declare healthcare a right.  But exactly how far do society’s responsibilities extend?  And what services exist beyond those requirements?  Everyone agrees that someone severely injured in a traumatic automobile accident should receive emergency interventional care.  But what about extensive cosmetic plastic surgery to restore the victim to his or her former appearance? 

Several years ago, the Georgia Department of Community Health came under criticism for paying for Viagra for Medicaid recipients.  Was this criticism warranted?

So assuming we agree that society is indeed obligated to provide at least a basic level of care for all, I will propose in Part 2 a beginning framework for addressing the needs everyone agrees on.  Stay tuned.