July 10, 2009

Rights vs Expectations

Even though I disagree with a lot of what Happy Hospitalist writes when he waxes political, I find myself drawn to his blog. Perhaps it gives me something to react against. In any case, he wrote the following short bit yesterday:
Does America Have A Right To BASIC Health Care?

I hear it everyday. Affordable access to basic health care should be a right.

Could someone please define to me what constitutes basic in the basic health care arguement? I want to hear examples of what is basic health care and what would not be considered basic and why you have a right to one and not the other.

Why should we have a right to health care but not health? Should we not have a right to stay healthy? Should we not have a right to free gym memberships? How about a right to free vegetables. If you have a right to basic health care, we should also have a right to services that prevent the break down of health as well.


My response in the comments section:
There are a lot of things we take for granted -- clean water, sewage treatment, uncontaminated needles for IVs and sterilization procedures before surgery.

These are PUBLIC HEALTH measures that have greatly affected our quality of life. So much so that their effects are practically invisible.

When we say "basic," I think of something along the lines of "do or die." There are a lot of things that factor into this... obviously someone with untreated hypercholesterolemia and diabetes for 40 years who comes in with a heart attack could have received appropriate intervention before this life threatening event.

The question is this: What OUGHT to be covered?
Primary prevention: healthy living (free gym memberships, shelter, access to fruits and veggies)
Secondary prevention: screening for CAD risk factors (checking lipid panel per ATPIII recommendations or just total cholesterol per USPSTF.)
Tertiary prevention: intervening after disease is detected to prevent complications (starting off treatment with statins and metformin.)

A lot of people would argue that it is fully within the scope of medicine to intervene with Secondary and Tertiary preventive measures (which SHOULD be covered as basic health care to some degree.)

Primary prevention... like the rest of PUBLIC HEALTH falls more under the scope of the government in my opinion, not accounting for the occasional harassment by a PCP to "eat right and exercise." As needed, I'm sure there are a number of excellent docs who can go more in depth into personalized primary preventive measures but when this is not reimbursed... not many will opt to do it with all their patients!
This made me realize that the Rights argument is very progressive (in more ways than one.) We all expect some certain unalienable rights to Life, Liberty and the Pursuit of Happiness.

What does it mean to have a "right to Life"? This draws an issue like abortion (ugh! let's keep that at least 10 feet away for now) to the forefront when really, there is a much more fundamental right that this draws upon... one that I have not seen clearly defined or reflected upon. Is it a right to a healthy life? A right to live?

I think it is a Right to Live as others live. There is an element of Expectation to this as well. We expect that we can all live equally in a democratic society.

Access to healthcare is becoming more of an issue than our forefathers expected because our medical knowledge and power to intervene has increased dramatically. This has created new power relationships and health deficits in socioeconomic status that cross generations! It goes beyond doctors and hospitals. That's why the government must play a role "to Secure these Rights," "deriving their just Powers from the Consent of the Governed."

I expect this from my government. A lot of people are afraid that the government will mess this up and want it to stay out of the Healthcare debate as much as possible. This is not a dig, but merely an innocent question: Republicans/conservatives in congress, if you distrust government so much and are afraid of its collective incompetence, why are you in office? I would much prefer it if you created some solutions rather than saying "the best thing we can do is to stay out of it."

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