Should access to care be based on ability to pay?
Is access to healthcare a right that should be shared by all people regardless of socioeconomic status? Or is it a privilege that belongs to those who can afford to pay?
Growing up in Canada, all I ever knew was a public healthcare system. There is no charge to see a doctor or to be treated in a hospital. There isn’t universal access to all health care services — psychotherapy isn’t covered, and there’s no national pharmacare program, but basic healthcare is available to all.
In stark contrast is the system in the United States. The healthcare you can access is dependent on the money/insurance you have. There are Medicare/Medicaid programs for people with disabilities and/or those who are low income, but from what I’ve heard those are far from perfect.
It seems like in the U.S. there’s a longstanding distrust of government that presumably dates back to the American revolution, and this has a significant influence on people’s attitudes toward healthcare. It goes further than that, though; an article on The Federalist site argues that guns are a way for citizens to protect themselves from the government. In Canada we may not entirely trust our politicians, but we’re not planning trips across the border to get a few AR-15s to take down Justin Trudeau and his fabulous hair. Anyway, I digress.
I came across a forum on Debate.org in which people had posted their views on this topic. The majority of people expressed their belief that healthcare is a privilege, and here are some of their answers:
“Healthcare is a privilege, Not a right. Nowhere in the constitution does it say anyone has a right to healthcare… It’s not societies or governments responsibility to provide it for you.”
“It seems to me that the want for better health care for your family is a good incentive to work hard, Innovate, And succeed in life — if health care is right provided by government then the incentives for personal achievement will become diminished by some amount.”
“Health care is a privilege because the government should not get involved in private business. The government does not get involved in car insurance or home insurance so why fiddle with health care. We are a free market country and we need to stay a free market country.”
A story in the New Yorker raises the interesting point that some people view rights as protections from government rather than protections provided by government. The article also mentioned that some people feel a sense of resentment towards Medicaid recipients, as they don’t like the notion of subsidizing someone else.
This fascinates me on a few levels. If I had to choose between trusting government or trusting insurance companies or other for-profit businesses, I would pick government hands down. And in terms of subsidizing others, isn’t that essentially what insurance boils down to? A bunch of people pay into it, but not everyone needs the service, and actuaries crunch the numbers to decide how much people have to pay in for everything to even itself it out (plus put profit in the insurance company’s pocket). I would certainly rather pay tax dollars towards public health care than massive insurance premiums to large corporations whose fundamental purpose in a free market economy is to generate as much profit as they can.
The idea that healthcare is a privilege and a service no different from any other feels very foreign and unpalatable to me. My personal belief is that even if access to healthcare is not a constitutional right, as a society we have a moral obligation to ensure that all of our citizens are able to access healthcare when they need it. If all citizens are to have equal, unalienable rights to “life, liberty, and the pursuit of happiness” as laid out in the U.S. Declaration of Independence, restricting health care access to those with means knocks out all three of these elements. I fail to see anything liberating about people paying massive insurance premiums or going bankrupt because they happen to get sick and either don’t have insurance or their insurance won’t cover them.
If our society places a value on universal access to education for children, as well as police and fire services, I’m not sure how healthcare should be any different. I prefer to live in a country where universal access to healthcare is seen as a moral imperative, and where supporting one another is seen as a good thing rather than a burden. All people deserve to have their basic needs met, regardless of the disadvantages they face. The fact that so many people seem so adamant that this should not be the case is frightening to me.
Originally published at http://mentalhealthathome.org on June 18, 2019.