(Essay) Health Care in the United States: Right, Privilege, or Responsibility?

(Essay) Health Care in the United States: Right, Privilege, or Responsibility?

Total word count: 3,636
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The United States has been one of the world’s leading countries for many years, excelling in areas such as natural resources, economic power, and income per capita. However, with the United States leading in many aspects, some would argue that it is still lacking in health care when compared to other developed countries. According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth largest economy, second to that of France, and is larger than the total economy of Italy” (Sultz and Young xvii). Furthermore, the US has doubled health care expenditures in “a single decade, a rate considerably higher than the growth in our consumer price index or in the median worker’s income” (Sommer 77).

However, with this enormous amount of money going through the health care system, many would argue that there is plenty of room for improvement. Our current health care system is more focused on cures rather than prevention, and only focused on those within the system while “ignoring the more basic health service needs of the larger population outside of it” (Sultz and Young 60). According to Lawrence R. Jacobs and Theda Skocpol, in their book Health Care Reform and American Politics: What Everyone Needs to Know, “The existing U.S. health-care financing system relies on partial government programs and patchwork private-market arrangements to protect many citizens, but far from all of them” (2). They go on to claim that as of early 2010, working-aged families are not currently assured of health insurance coverage. Businesses are struggling to pay raising insurance premiums to cover their employees, which can lead to the entire business failing to compete on a global market with businesses in countries that have government-assured health care (Jacobs and Skocpol 2).

One way that employers have compensated for this is to charge employees more through “benefit buy-downs”, which is a fancy phrase for the employers “reducing the scope of benefits, increasing copayments and/or coinsurance, and increasing copays for prescription drugs” (Sultz and Young 238).

Some scholars also argue that there is a level of corruption among the inner workings of insurance companies. In the same book, Jacobs and Skocpol claim:

Private health insurance companies in the United States have grown into industry giants arranging coverage in negotiations with big employers on the one side and hospitals and doctors, on the other side. But insurance companies have strong incentives to protect their profit margins by dumping people who get costly illnesses, such as cancer. They also hike rates or avoid offering coverage to segments of the population, occupational groups, or parts of the country likely to have high health costs. (2)

So overall, Jacobs and Skocpol argue that reform is needed in the private health insurance sector because of these private companies taking advantage of citizens for profitable gain in the company.

Senator Tom Daschle also agrees. In his book Critical: What We Can Do About the Health-Care Crisis, he argues that many Americans who are insured, when injured or ill, find out that their health care policies do not cover the care they need, or “cover so little they are forced to run up huge medical bills” (149).

Not only that, but some would also argue that America has “done poorly in our long-term efforts to build a health care system that is responsive to the needs of our people”, and that “a major reason for our disparate performance is our failure to pay attention to prevention and public health” (LeBow 77). LeBow argues that instead of doing what we can to prevent illnesses such as heart disease and diabetes, we have developed expensive technologies that cure or alleviate the diseases once they occur (78).

Our health system has its ups and downs, and without reform will continue to decline in quality and number of Americans covered. In order to reform the health care system, one question must be asked that delves into the very root of our health care system. Is health care in the United States of America a right, privilege, or responsibility?


Health Care as a Right

The word right has multiple meanings and uses, but for health care purposes, right can be defined simply as “something to which one has a just claim” (merriam-webster.com). In this case, on the subject of health care in the United States, we can say that the argument would be that the citizens of the United States have a just claim to health care. Many scholars and politicians would argue that health care is a fundamental right as citizens of the United States of America, and that the government is responsible for making sure that citizens are given this right. For instance, Barack Obama, in a debate with John McCain, was asked that same question: “Is health care in America a privilege, a right, or a responsibility?” (Linkins). Obama answered by saying:

I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills — for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they’re saying that this may be a pre-existing condition and they don’t have to pay her treatment, there’s something fundamentally wrong about that.

Obama has since helped to spearhead the Patient Protection and Affordable Care Act, helping to give Americans “new rights and benefits, by helping more children get health coverage, ending lifetime and most annual limits on care, allowing young adults under 26 to stay on their parent’s health insurance, and giving patients access to recommended preventive services without cost” (healthcare.gov). This legislation passed most likely because congresspersons at the time must have believed that the U.S. health care system is a fundamental right of the citizens.

Sen. Bernie Sanders, an independent U.S. Senator from Vermont, also argues that health care is a right, and not a privilege. This senator has some interesting points. He cites a recent study that found medical problems to contribute to “62 percent of all bankruptcies in 2007” (Sanders). He also argues that health care should be treated as a right, and not a privilege, which is “the way every other major country treats health care and the way we respond to such other basic needs as education, police and fire protection” (Sanders).

Furthermore, Audrey R. Chapman, in her book Health Care Reform: A Human Rights Approach, uses the tenets of human rights to argue that health care should be a fundamental right, saying that government needs to make sure that their goals is to provide a “right to health care rather than as a right to health”, and that it “seems logical” to do so (9).

The United States health care system is currently set up “not to provide quality health care for all, but to make huge profits for those who own the companies” (Sanders). Sanders believes that this is morally and ethically wrong, and that major reform is needed to fix this. Sanders also believes there is a corruption in private insurance companies:

Private health insurance companies spend an incredible [amount] (30 percent) of each health care dollar on administration and billing, exorbitant CEO compensation packages, advertising, lobbying and campaign contributions […] Public programs like Medicare, Medicaid and the VA are administered for far less” (Sanders).

In the end, Sanders believes that a national health care program will ultimately be set in place just like women’s rights and other grass-roots efforts. It’s just a matter of time.

But if the health care system in the United States is a fundamental right, what will this entail for the way that the health care system is run? Jeff Jacoby, a columnist for The Boston Globe, offers some insight to how the government health care plan would be set up. He claims that if health care is included as one of the “certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. –That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed” (US Declaration Ind.). But do Life, Liberty, and the pursuit of Happiness include health care? Jacoby goes on to examine this question:

A great deal depends on the answer, for the Declaration’s very next sentence affirms that the purpose of government is to “secure’’ those rights against infringement. If access to health care is deemed a fundamental right, then the government must be obliged to guarantee that access to every citizen. Medical treatment would have to be available on an equal basis to anyone seeking it, regardless of age or physical condition or ability to pay.

Jacoby appears to be arguing that if health care is a right of the people, and solely a right, it should be treated the same as the people’s other unalienable rights, in that health care should be administered equally between all citizens, and no citizen should have more health coverage than any other citizen of the United States.


Health Care as a Privilege

According to the online legal dictionary, the word privilege is defined as “a special benefit, exemption from a duty, or immunity from penalty, given to a particular person, a group or a class of people”. In the case of U.S. health care, only those who are “privileged” enough to afford health care can receive it. So is this what health care in the United States is and should be?

Rep. Zach Wamp stated, in an interview with MSNBC reported by Domenico Montanaro, that health care is “a privilege” and that allowing universal health care (as a right) would be “a fast march towards socialism, where the government is bigger than the private sector in our country and health care’s the next major step.” He also argued that the current health care system is not fully taken advantage of, and that reform is not needed (Montanaro). Of the 47 million uninsured, Wamp argued that half opt out of their employer’s provided health care. By arguing this, he ultimately implies that if the current system is fully taken advantage of, there will be no problems with the health care system.

Former Gov. Arnold Schwarzenegger of California also holds the same stance. He stated, after a veto of Senate Bill 840 (this proposed bill would have created a state-wide universal, publicly funded health system that covered all Californians), that “Health care is not a right, but its cause is a government interference in the healthcare system. The solution is to leave doctors, patients and insurance companies free to deal with each other on whatever terms they choose, not to socialize American medicine” (Russo). Schwarzenegger continued by saying that this proposal for universal health care would cost the government too much money, and that it is not the answer for health care reform (Russo). However, the public and medical reaction to this veto was overall generally negative. CNA President Deborah Burger, who endorsed the bill, accused that “Gov. Schwarzenegger is abandoning millions of Californians to health insecurity and potential financial ruin from un-payable medical bills” (Korcok). Sen. Sheila Kuehl, the senator that wrote the bill, stated in a press release that “It’s important to understand that vetoes of health reform legislation have very serious consequences […] Because of these vetoes, there will continue to be very little regulation of the runaway health insurance market and no protections for consumers” (Keuhl).

Dr. Leonard Peikoff also agrees that health care is a privilege, and not a right. He states that:

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.

His argument is that health care should only be given to those who work for it, and should not be given away for free. This mindset appears to be on the side of elitism, but for argument purposes, Peikoff does have a point. If you haven’t worked for something, you shouldn’t be given it just because you need it. That, however, would contradict the fundamental American value that hard work pays off.

Therefore, if health care in the United States is indeed a privilege, it entails the fact that those who cannot afford coverage are left to fend for themselves, since only those up high enough on the social ladder can afford health care. From a moral standpoint, this would be currently offensive to most people, but from a purely logical standpoint, it makes sense to only give health coverage to those wealthy enough.

Health Care as a Responsibility

Google dictionary describes responsibility as “The state or fact of being accountable or to blame for something”, or “The state or fact of having a duty to deal with something.” Looking at health care in the United States, the term responsibility appears to be somewhat ambiguous. If health care is a fundamental right, then it is the government’s responsibility to provide options for health care. If health care is a fundamental privilege, then there is no responsibility involved, since this ideology entails the fact that those who are poor should not receive help. Therefore, if health care is a responsibility, it can be assumed that we are implying that it would be the responsibility of the people to help those who do not have the means to afford health care. This appears to border on socialism, but isn’t a bad idea, if people were more caring and willing enough to give to others, take in their elderly, help those in poverty, etc.

Health care as a responsibility can also be seen as patients needing to make sure that they take responsibility for their own health, and don’t rely on the systems in place if they don’t need to, by taking preventative measures rather than ultimately paying more to cure something that could have been prevented. For instance, the American Association of Retired Persons (AARP) did a demographically widespread survey on patient responsibility in health care, and found that ultimately:

More still needs to be done to encourage [retired persons] to schedule [preventative procedures], or take the reins of their own or their family’s health by compiling and regularly updating a family health history. By taking responsibility for their own health – as patients – and working closely with their health care professionals, many midlife and older adults can remain healthy and independent for years to come. (Keenan 9)

The AARP in this study found that those retired persons who utilized preventative procedures thought themselves healthier than those who did not. Also, through this survey the AARP found that the respondents generally believed that if people took steps towards living healthier lifestyles, and took more responsibility for their health, the nation’s health care costs would decrease (Keenan 8).

Also, there have been certain innovative ideas developed to make individuals more responsible for their health care. In a peer-reviewed article, Steven D. Pearson and Sarah R. Lieber found that “as health care costs continue to rise, an increasing number of self-insured employers are using financial rewards or penalties to promote healthy behavior and control costs” (845). This provides employees with an incentive to eat healthier, exercise more, and live healthier lifestyles to ultimately not cost the employers as much money for insurance. This is one example of forcing people to take responsibility for their health when they wouldn’t have before. However, these programs that provide incentives have concerned some that holding employees responsible for their own health is a violation of individual liberties and can be discriminatory to those that aren’t as healthy (Pearson and Lieber 845). But overall, this incentive program can be put in place to help motivate people to live healthier and ultimately cost the company less money.

Cecil B. Wilson, MD, President of the American Medical Association (AMA) advocates for a strong individual responsibility in the health care field. She believes that if individuals take more responsibility for their health by enrolling in health insurance, this will decrease the number of uninsured while making popular insurance market reforms possible. This will improve the health of Americans and prevent any hidden costs from surfacing because those who are uninsured are using tax dollars that could be spent on other things (Wilson). However, Wilson misses a very apparent point that if people cannot afford health insurance, how are they to pay for it and become part of the system?

Overall, health care does fall on the shoulders of the people and the government, and it is their responsibility to make sure that the system is successful. Also, if the government is a responsibility of the people, then we can also argue that health care is the sole responsibility of the people.


So what can ultimately be decided after reviewing all of these arguments for and against health care as a right, privilege, or responsibility? If health care is solely a right, then health care should be administered equally between all individuals, and no citizen should have more or less coverage than any other citizen in the United States. If health care is solely a privilege, then only those who can afford it should be able to have access to the health care system, leaving those less fortunate to fend for themselves. And if health care is solely a responsibility, then people should take more active steps to prevent health complications, and also take more responsibility by helping other who do not have health care.

Ultimately, I have come to the conclusion that health care takes a part of all three concepts, but leans more towards a right than a privilege or responsibility. For instance, health care will always be a responsibility. If health care is a fundamental right, then it is the responsibility of the people to pay taxes in order to fund health care, and it is the responsibility of the government to administer those tax funds to those in need. However, some people will always have more money than others, and some doctors will always be better than others. Those that have more money will want to go to the better and more specialized doctors for their specific complications. This ultimately gives those with more money a privilege over those with less money, making the health care system in the US a privilege for some as well.

Overall, we must utilize all three concepts (right, privilege, and responsibility) as long as they are used in a way that balances the three factors of cost, access, and quality in the iron triangle. If health care is going to succeed without draining valuable resources, losing access, or losing quality control, then we need to have systems in place that allow everybody to have access to quality coverage, which ultimately will make health care in the United States more of a right than a privilege or responsibility. I believe that doing so will ultimately help the US economy by not draining as many resources as previously described, and provide better, more affordable access to health care for all U.S. citizens.

-Brandon Skenandore



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