I'm James Maxey, the author of numerous novels of fantasy and science fiction. I use this site to discuss a wide range of topics, with a heavy emphasis on cranky, uninformed rants about politics and religion and other topics that polite people attempt to avoid. For anyone just wanting to read about my books, I maintain a second blog, The Prophet and the Dragon, where I keep the focus solely on my fiction. I also have a webpage where both blogs stream, with more information about all my books, at jamesmaxey.net.


Saturday, September 12, 2009

Health Care is a Right. Feel Free to Use It.

In the context of the health care debate, I've been hearing a lot of people assert that access to health care is a fundamental human right. During my years of following politics, I've heard any number of things proposed as rights that aren't specifially spelled out in the US constitution. Among some of the more common ones:

A right to work.
A right to housing.
A right to nutrition.
A right to an education.
A right to privacy.

Now, I suppose I could play strict constructionist and argue that if it's not written down by the founding fathers, it's not a right. However the ninth amendment says, "The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people." It seems to me easy to accept that the founding fathers would acknowledge that people had some or all of the rights listed above. Even if the founding fathers wouldn't, we certainly can today come together and agree that everything on this list, including a right to health care, is important to living a good life in today's world.

So, I'm willing to agree that you have a right to health care, a house, food, education, and privacy. It's now up to you to go out and excercise them. A right is not the same thing as a guaranteed service. It doesn't mean that you are owed anything, or given anything. It merely means that, if you choose to excercise a right, no government can stop you from doing so.

For instance, at the top of the bill of rights, you are granted the right to free speech, and freedom of the press. Note that this right doesn't mean the government has to provide you with a printing press and free paper. It doesn't have to provide you with blogs or billboards or megaphones. If you want to use your right to free speech, you have to do the work of writing your blog, or publishing a newspaper, or plugging in your ham radio set, or going down to the town hall and shouting till your throat is raw.

Next on the bill of rights is the right to bear arms. After two centuries of fence straddling, the Supreme Court has finally said that, yes, this guarantees the right of an individual to own a firearm. It does not, by any legal theory or argument, mean that the government has to mail you a voucher to go out and buy a rifle. You have a right, but to take advantage of it, you'll have to spend your own money.

You have a right to housing. While at one time there were definitely discriminatory practices against blacks or jews or catholics or what have you, none of that is legal today. There is no governmental force standing in the way of you going out and getting all the housing you can handle. You can own five or six or seventy houses if you so choose, and take the neccessary financial steps to make it happen.

You want a right to work? Well... what's stopping you? People who don't speak english, who can't read our want ads, and who have no social security cards come across our borders in waves and mow our lawns and diaper our children; they pick our peaches and package our pork. There are no barriers to most people's ability to work beyond their dignity. I'm not knocking dignity! I work at a desk, not in a ditch. But, a right to work doesn't mean that the goverment is obligated to give you full employment in the trade of your choice. I want to make a living writing fiction, but I don't expect the government to guarantee me a living wage while attempting to do this.

You want an education? You're in luck! Every state in the union provides one for free. Most towns have libraries where you can study up on any subject you want. Again, it wasn't that long ago that armed men would line up around a school house to keep children of the wrong color from walking through the door. But today, if you aren't getting an education, you really just aren't trying. We have more information at our finger tips than ever. So why do I keep running into cashiers who can't count correct change?

Which brings us to health care: I think costs are insane. I think it's unfair that sick people should lose their houses and their livelihoods. But, again, the right to health care is a right that individuals have to excercise. The vast majority of American's get the treatment they need without losing everything they've earned because they've made life choices that saw that they would have insurance. It's not always easy, but it's not impossible. The statistic Obama quoted the other night was that 33 million Americans have no insurance. That means roughly 267 million Americans are excersizing their rights to obtain health insurance in some form or fashion. It's not impossible.

I'm not so naive to think that all men are created equal. There are people out there who have had the bad genetic luck to be born without the intelligence to function independently. There are others who are going to encounter really awful luck; young mothers get the phone call in the night and learn that their husband's plane has crashed, or heathy, twenty-year old college students who get diagnosed with bone cancer. A kind and caring society will band together to assist these people in difficult times.

Still, for those people who are arguing that health care is a right, I'd like to say that I agree with you. I certainly won't stand in the way of you going out and getting some. I won't stop you from getting a gun, a megaphone, or printing press, either. I'm just not completely clear, however, on why anyone else has a moral obligation to spend money to pay for you to use rights you already possess.


Loren Eaton said...

James, you may like this article in The Atlantic about reforming health care. It's by a Democratic businessman who lost his father to an easily preventable infection. Be warned, though: It's long.

James Maxey said...

Thanks for the link. It was long, but insightful. I thought it was particularly useful that he pointed out the distinction between health insurance and health care. I confess I'm one of the people who swirl both things together as if they are synonymous.

One irony of health care is that sometimes, if you're sick, the most dangerous place you can be is a hospital. Laura had immune system problems due to chemotherapy--yet, pretty much weekly, she was walking into a hospital filled with people who had infectious diseases. I turned into Howard Hughes (minus the money) during that period of my life. I'd wash my hands so often, it's a miracle I still have fingerpints.

I think hospitals shoot for good sanitation and hit it 99.999% of the time. But, due to the sheer concentration of problems under one roof, problems are going to rise.

rastronomicals said...

I think your argument would have been stronger had you in fact taken the constructionist tack, and simply denied these undoubtedly inexpressed rights.

The biggest problem with your argument as stated is that in its essence it reduces to "you have the right to buy whatever you can afford."

True as far as it goes in this country and in this world, but not very useful when trying to delineate the things our society should or shouldn't do on behalf of its members.

Consider for a second that printing press you've so graciously allowed me. Let's say that Congress, after deciding that they shall not under any circumstances abridge the right of a free press, then decided that a straight tax of one million dollars should apply to all printing presses sold in the USA.

If I had been in the market for one, I'd say that in the latter, Congress had violated the spirit of the former.

And I'd be right, too, even though Congress had at no point passed any laws explicitly curtailing any freedoms of the press.

Funny, huh? I think that what's going on here is that there is a test of reasonability that we have decided these things must pass. The inalienabe Rights shall be enjoyed equally by those on the bottom of the economic scale is how it might go.

If only millionaires can own and operate printing presses, then what rights have the poor actually been provided with? Guns have always been cheap, but what if they wanted six figures for that Glock?

To quote from a source smarter than I, it's still we, the people, right?

You write that people say they have a right to housing.

No, they don't. The right to housing is understood.

What people say is that they have a right to affordable housing. And our society has by now found itself in agreement with these people. It's not in the Constitution or anything, but we've got 70 years of New Deal legislation regarding subsidized housing that suggeests we as a nation feel affordable housing is not something that might be nice but in fact is a right to citizens of this country.

And if the welfare state scares you off, consider something that I thank my stars for every December: the Homestead laws, where a community decides to protect its residents from being property-taxed out of their own homes. Not only do we have the right to housing, we have a right to be able to afford it!

This is not an opinion; like it or not, this is what we as a nation have decided.

Now consider healthcare in this light. Costs ARE insane, as you admit. I myself have a house but no insurance plan. I could reverse the two conditions if I wanted, but I choose not to. I would submit that I am neither lazy nor stupid for not doing so.

I will instead hold out hope that the government (and the people) finally decide to guarantee not my right to healthcare--but my right to affordable healthcare.

James Maxey said...

"I myself have a house but no insurance plan. I could reverse the two conditions if I wanted, but I choose not to. I would submit that I am neither lazy nor stupid for not doing so."

I completely agree. Odds are excellent that, if you are an average person under the age of 50, you aren't taking an insane gamble by not having heath insurance. It's kind of a reverse lottery: A small percentage of younger people will get hit with a life-threatening or chronic illness, or get severely injured in an accident, and suddenly incur medical liabilities that run into hundreds of thousands of dollars. However, the vast majority of people younger than 50 probably could pay for all their medical treatment out of pocket without undue suffering. I have a friend who's about to go in for some surgury. It's not cheap--it's going to cost about $20k, and it's not guaranteed that his insurance is going to pay for it. It's a huge bill to take in one hit, but people spend more than this on a car. It's not going to be a financial apocolypse in the way that a diagnosis of cancer might be.

I'm 45 and have personally never spent a night in a hospital, had any surgury, or suffered any really big injury. I'm guessing that my life time medical costs, excluding dental and vision, total under $10k. I've had insurance most of this time; really, I think I've probably paid more into insurance than I've gotten out.

Not having health coverage if you're young isn't something I regard as crazy. The odds are probably with you.

Here's what I'm wondering about your reaction to health care reform: Many of the bills feature a mandate for coverage. If your employer doesn't provide insurance, then there will be a government mandate that you provide it for yourself. There will be subsidies for low income people, but I imagine that, if you're in the middle class, the subsidies won't amount to much.

The logic is, a big chunk of young, healthy American's don't get insurance because they are willing to play the reverse lottery, often quite successfully, for years. If we make everyone, even people in their 20s, buy insurance, then the young, healthy people drive down the premiums for older, more at risk individuals.

What I'm curious is, how much would you pay out of pocket for insurance and feel like it was a good deal? If there was a government mandate that you had to purchase a policy at, say, $500 a month for a family of four, would you feel that this is fair? What would you feel if you choose not to obey the mandate and they responded by withholding more from your check to purchase it for you? I personally want to hear some of these hard numbers before I throw my weight behind a bill. If I was told that there was a mandate, and the premium for an individual would be capped at $250a month, I'd quit my day job tomorrow. If the premium would be $1000 a month, I'd be more lukewarm. So far, I haven't heard what this is going to cost.

As far as your rights argument goes that rights should be affordable, I think your million dollar printing press tax does exist, only instead of a press, it applies to TV and radio bandwidths. The average citizen can't afford these things, but it still doesn't mean they don't have a right to these things if they decided that was their life goal and went out and raised the money somehow to do so.

And, finally, if government manages health care for disadvantaged people with the same wisdom it oversees public housing, or even programs such as fannie mae and freddie mac, then we may be in for rough days ahead.

Mr. Cavin said...

I sort of like your argument rastronomicals, but at the same time feel your analogy is pretty awkward. I mean, a printing press that can do any sort of real day's work does cost a hundred thousand dollars or so. How is that not the same as a million bucks, in the long run, when I gross forty grand a year? While I am indeed guaranteed the freedom to speak, no one is out there subsidizing my ability to create a newspaper.

The realities of exercising my right to publish opinions in popular media, at least before the internet came along, are that it’s priced pretty far outside my ability to participate. So the right to free speech is most widely exercised by corporations who can secure that million dollar bill. If I am talented and lucky, I can then secure that corporate interest itself in subsidizing my voice.

So what does this first amendment right really mean to me? That I can hang a letter-sized flier criticizing the US government on the local laundromat corkboard without going to jail for it. This was not a right in the last country I lived in. In that country, a person could go to jail for anything opinion-related. You could only trust the newspapers to publish content sanctioned at some governmental level. And then later, when the usual departmental infighting took place, those journalists were jailed for following the dictates of the wrong governmental faction. You can bet that the best and the brightest avoid journalism class like the plague, opting for the relative safety of government class instead. Those misfortunate enough to find themselves on the wrong end of loaded information keep their heads down, cross their fingers, and tow the current party line.

So, no, I do not have to own a printing press to know that the right to free speech has been extended to me here. Even if my income will never support any expansive exercising of these rights, the environment created by their summary implementation affects me in an intransitive way.

Please note that I am only disagreeing with an analogy here. Your greater point about the prohibitively expensive nature of health care muddling any sense that it is currently a right enjoyed by the people is something I very much agree with.

James Maxey said...

Cavin, thanks for chiming in; the perspective you have coming back to the US from Vietnam probably does make the whole "freedom of speech" issue look a little different.

Ras, I've been thinking a little more about your argument in regard to housing. In the US, the quality of housing you get is entirely dependent upon your income. We accept that millionaires are going to live in different neighborhoods than factory workers. When we talk about providing housing assistance to people who don't have it, we generally aim low in what's provided.

But, we already have a situation where the wealthy and the poor have access to the same quality of health care, at least in my experience. Laura had very little income in the last few years of her life. On paper, she was living at the poverty level. On the other hand, she did have health insurance. She was treated at UNC hospital by Dr. Lisa Carey. Elizabeth Edwards, wife of John Edwards, John Kerry's running mate, isn't living in poverty. They have a house near Chapel Hill worth about 8 million dollars. John's net worth is well north of $8 million. Elizabeth, famously, discovered she had breast cancer immediately after the campaign. She had the wealth and resources to afford the very best health care on the planet. Her choice of doctor? Lisa Carey of UNC hospital.

We have a system where a former grocery store worker and part-time day care teacher can get the very same level of care as a millionaire former senator's wife.

The reason our health care system is so scary isn't that the poor don't get the same care as the rich. I think, in most cases, they do. The scary part is, the poor are charged the same prices as the rich.

In some ways, this isn't a debate over health care. Everyone in the US already has a right to be treated. This is really a debate over wealth care. We are trying to retain the guarantee that everyone the same treatment, but without the spectre of bankruptcy looming over anyone's head. It will be interesting to see if the final bills do anything at all to get us closer to this.

Loren Eaton said...

One irony of health care is that sometimes, if you're sick, the most dangerous place you can be is a hospital.

Yup. If you have a good doctor and are forceful enough, you can actually get medical folks to visit you at home should you have a chemo-related complication. It isn't easy, but it's possible. Also, the cleanliness of hospitals scares me; one family member got MRSA three times during various hospital stays.

Lazy Bike Commuter said...

Good post, I've been saying that kind of thing myself.

You have rights, but you're responsible for using them.