Tuesday, May 11, 2010

Health Care as a Right - the Showdown Approaches

All developed countries except the U.S. recognize a right to health care. Now twenty states, led by Florida's Attorney General, have brought suit against the Patient Protection and Affordable Care Act (the official name of the health reform bill) to establish a new right - the right not to have health insurance!

Florida has been chosen to lead the charge because the case can be filed in the Pensacola court (part of the conservative 11th Circuit of the U.S. Court of Appeals), where it will be heard by a Republican appointee.

From the perspective of ethics and common sense, the suit comes straight out of Alice's Wonderland!

Reduced to its essence, the states are saying - "get off the backs of individuals and state governments!"

With regard to individuals, the states argue that requiring individuals to obtain health insurance or pay a health tax encroaches on basic liberties. We'll soon be seeing the pithy language on Tea Party placards:
"In effect, the Act compels said persons to have healthcare coverage, whether or not they wish to do so, or be subject to sanction. The Act thus compels persons to perform an affirmative act or incur a penalty, simply on the basis that they exist and reside in the United States."
With regard to the states themselves, the argument is essentially that the Act will require substantial state effort and expenditure. This is true.

The key question is - what is the alternative to imposing requirements on individuals and state governments?

There are two essential choices. If we continued to declare that it's OK for 15 - 20% of the population to be uninsured, we wouldn't have to mandate new responsibilities for individuals and state governments. But if we elect to join the civilized world and recognize reliable access to decent health care as a societal responsibility, the only viable alternative to the Patient Protection and Affordable Care Act is a system supported by direct federal taxation. This could be a single payer Medicare for all program or a tax supported multiple insurer system.

Only wacko libertarian extremists will be ready to assert that individuals who want health care should be responsible for creating their own access, without any outside support. It's one thing to recognize the right we all have to refuse unwanted care. It's another to say "tough luck" to all those who want decent care but can't afford it.

The brief filed by the states makes no mention whatsoever of the moral requirement for a civilized society to ensure access to care for its citizens. The spirit of the argument is entirely "leave us alone." I'm sure the individuals who filed the brief are caring people in their personal lives, but the argument they make is callous and cruel.

(The 23 page suit is intelligible to the non-lawyer - if you have time I encourage you to read it. Also see Kevin Sack's informative New York Times article.)

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