The Reality Behind the “Right” to Healthcare

By: Richard G. Fessler, MD, PhD

“Access to comprehensive health care is a human right…”¹

Health care is a human “right”! Virtually every government that has instituted a system of national health insurance has made this proclamation, but what exactly does that mean, and how many of those countries have actually achieved it? “In fact, there is no such right in any sense that people ordinarily understand the meaning of the term.”² What this “right” actually means is no more than everyone in that society having the right to get whatever service the government decides to provide for “free”. However, the government, in fact, is under no obligation to provide any specific treatment, and if it does not provide a service, the individuals in that society have no “right” to sue for it, in the sense currently available in the United States. Citizens in Canada or the UK, for example, have no “right” to see a doctor in a timely fashion, they have no “right” for a CT or MRI scan, and no “right” for needed surgery! Some “right”! Yet in 1980’s Canada, if the government did not provide a service, it was illegal for the individual to pay for that service out of his pocket”! So much for human “rights”! At the same time, some Canadian hospitals were advertising in the United States for paying patients because of their strapped financial system. During that time, it could be argued that citizens of the United States had more “rights” in Canada than their own citizens! Even today, it would appear that pets have more rights in Canada than humans, in that patients can purchase an MRI for their dog, but not for themselves.³

In today’s world, all governments, including the United States ration health care in one manner or another. In single payer systems, normal market forces are totally removed, thus giving the perception that health care is “free”. Of course, it isn’t, and higher taxes are the mechanism of payment. However, since there is no “point of service” payment, the perception of free care is there nonetheless. This results in increased demand and over-utilization of health care resources. Rationing, in these systems, is implemented by restricting access and availability. In Canada, for example, nearly one million people out of a total population of 31 million, are waiting for medical care of one sort or another at any given moment.⁴ In New Zealand the average waiting time for elderly patients in need of hip or knee replacements is 300 and 400 days, respectively.⁵ Many wait much longer. The London-based Adam Smith Institute estimates that people currently on the National Health System waiting lists will collectively wait over 1 million years longer than deemed medically acceptable by their doctors for their needed medical care!⁶ In UK, it has been reported that 20 % of the cases of colon cancer considered curable at the time of diagnosis, are incurable by the time these patients “wait” for their treatment.⁷ In Ontario, Canada, 121 patients were removed from a waiting list for coronary artery bypass over a twelve month period because they became too sick to safely undergo the procedure during their waiting period.⁸

To be fair, health care rationing also occurs in the United States. This is probably especially true in public hospitals that provide care to the poor, and to patients on Medicare and Medicaid. These programs face the same pressures described above for countries in single payer systems. For example, it is estimated that as many as half of the patients on dialysis in the United States could benefit from treatment 6 days per week. However, because Medicare covers a maximum of 3 treatments per week, few receive it.⁹ The real question then is, how does rationing of health care in the US compare to that in single payer systems? Data taken from an analysis by Cathy Schoen is presented below.¹⁰

Patients Having to Wait More Than Four Months for Surgery

United States 5%

Australia 23%

New Zealand 28%

Canada 26%

Britain 35%

What this table clearly shows, is that, even with all patients included (i.e. uninsured, Medicare, Medicaid, as well as insured), waiting times for surgery in the US are much, much shorter than any country using a single payer system. In short, rationing of health care is no-where near as prevalent in the US health care system then in any examined single payer system.

So what does that mean in relation to the original statement above, that health care is a human “right”? Despite the ideological rhetoric expounded by some, from scrutiny of the data available, it apparently means that in a single payer system you have the “right” to extended waiting periods prior to receiving inferior, and more extensively rationed, health care. Frankly, I think I would rather keep my current reality, and skip ideology.

Reprinted with Permission by: www.healthandsharing.com

¹ Steffie Woolhandler, et al, “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance”, Journal of the American Medical Association 290(6)798-805, 2003.

² Goodman, John C., Musgrave, Gerald L., Herrick, Devon M., Lives at Risk: Single-Payer National Health Insurance Around the World. Rowman and Littlefield, Inc. 2003. pp 17.

³ Jeff Harder, Hospitals Profit from Pets, CNEWS, December 18, 1998.

⁴ Nadeem Esmail and Michael Walker, “Waiting Your Turn: Hospital Waiting Lists in Canada, 13^th Edition”, Fraser Institute, Critical Issues Bulletin, October, 2003.

⁵ “Purchasing Your Health, 1996/97”, New Zealand Ministry of Health, March, 1998

⁶ Matthew Young and Eamonn Butler, “The Million-Year Wait”, Adam Smith Institute, 2002

⁷ Anthony Browne, “Deadly Rise in Wait for Cancer Care”, The Observer, March 3, 2002

⁸ “Canadian Health Care-A System in Collapse”, Fraser Institute Backgrouder, 1998

⁹ Peter Landers, “Longer Dialysis Offers New Hope, But Poses Dilemma”, Wall Street Journal, October 2, 2002

¹⁰ Cathy Schoen, Robert J Blendon, Catherine M DesRoches, and Robin Osborn, “Comparison of Health Care System Views and Experiences In Five Nations, 2001”, Commonwealth Fund, Issue Brief, May, 2002

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