Opening statement and remarks at Benjamin Rush Society Debate

Is health care a right? We have decided in this affluent, civilized country that everyone is going to have access to health care when they are in need.  EMTALA (the Emergency Medical Treatment and Active Labor Act of 1986) assures that.  The United States is not Calcutta where Mother Teresa literally had to rescue people who were bleeding in the streets (even though many Europeans who are convinced of our barbarism mistakenly think that is the plight of the millions of people without health insurance in this country).

So what does the question, “Is health care a right?”, mean in a civilized and prosperous society?  Does it mean that I have a right to demand that you must treat me whether or not I can or want to pay you?  What would that mean to you as a physician and to your ability to pay your nurses, buy medical supplies, and pay rent on your medical office space if people could demand that you provide services to them without paying?  You wouldn’t be able to stay in business very long, clearly.

So we have decided to filter payment through health insurance and through taxpayer support for public programs to pay for the great majority of health care delivered in this country today.  Politically, this means most people access medical care through private health insurance.  Whether that is the preference of our debating partners here tonight or not, the American people do not want a single-payer health system.  Single payer didn’t even get close to passage, despite a president who said that this system was his preference and a Congress with strong Democratic majorities. 

The legislation that was passed leaves 24 million people uninsured, adds $1 trillion to $2.4 trillion in new spending over 10 years, imposes $500 billion in new taxes, and takes $500 billion out of Medicare to fund new entitlements.  This appears to be the best we can do in a command and control system.  But this puts us on a track to paying doctors in Medicare less than doctors are paid in Medicaid today, and it will put one in five Medicare providers out of business.  This system of reliance on our decades-old tradition of price controls for Medicare and Medicaid will devastate our health sector and people’s access to quality care.

Proponents of a single-payer system would have us believe that we could live in a utopia where we can have everything we want at all times with no responsibility for payment or moderation in our use of health care.   Unfortunately, even the most prosperous nation the planet has ever known cannot afford to provide everyone with all the health care they demand all the time, paid for by someone else.  We live in a world of limits that cannot be legislated away.  Unfortunately, as we see in other countries, the limits are likely to be placed on you as physicians in several ways:

•    Limiting your ability to prescribe the latest and best medicines
•    Rationing access to diagnostics and surgery through scarcity and queues
•    An avalanche of new reporting rules to guarantee that you are providing the care that government has authorized and assuring the quality that government demands.

In Canada, a patient was told there is a three year wait for an operation for incontinence.  Where are this patient’s rights to “universal health care” if she has to put her life on hold for three years waiting for this medical procedure that takes 30 minutes to perform?

Without that right to access care, what good is a promise?  The Canadian Supreme court said in 2005 in Chaoulli v. Quebec that “access to a waiting list is not access to health care.”
The golden rule of government is “He who has the gold makes the rules.”  

Rights come with responsibilities.  But if we try to protect people from their responsibilities to be partners in managing their health care and their health spending, we will turn the reins of power over to government bureaucrats and politicians who will make medical decisions for us.  Is that really a right to health care?  Is that what you are studying medicine for?

We do need to fix the problems in our health care system.  The health care system we have now is an accident, one that no one thought through or planned.  We can make some simple changes to get to where we want to be.  Instead of someone else deciding what health care you get, you decide because you will control the money and the choices. 

The question is whether we will move toward a system that gives more control to doctors and patients or to government, politicians, and bureaucrats.  A system in which government guarantees a right to health care will be the latter.  A system of realigned incentives in which patients are in control of their health care and health spending will lead us to a future that leads to innovation and freedom, with doctors and patients, not bureaucrats, in charge of medical decisions.  Ultimately, that is the only path to a system that respects our individual dignity and freedom. 


Amplified remarks:

•    Rights have costs and consequences.  There are negative and positive rights.

Negative rights:  You are protected so that government doesn’t do something.

Positive rights:  You have a right to something and someone must pay.  This leads to loss of control, quality and money.  You become a line item in somebody else’s budget.  And someone must pay – taxpayers, future generations through deficit spending, or doctors by being under-paid or not paid at all.

We don’t live in utopia but a real world driven by checks and balances and competing political wills. If you give in to this single-payer government system, you wind up losing your negative rights and your positive rights as well.  It isn’t a choice between one or the other; you lose both.  In our system, you gain both power and choices.

We want patients, not the government, to make the rules and decide what kind of health insurance and medical care you want for yourselves and your families.  

•    The system is stacked against you.  Right now, your money is being spent on your health insurance – either through taxes, direct premiums, deductibles, and copayments, or through subtraction of your health insurance premiums from your wages.   The problem is that it’s your money, but not your choice.

•    They are taking your money to purchase health insurance that makes you and your doctor jump through hoops to get care.  We want to change the rules so you see how much money is going to purchase your health insurance — $12,000 to $15,000 or more a year – if you get your coverage through your employer.  This is not a gift from your employer.  This is your money that they are taking out of your pre-tax wages to buy a health insurance policy you may or may not like.  

We want you to get the tax break directly, instead of hiding it through your employer.  We want to expand the rules so we put that money into your paycheck so you can see the money and have your own choices and make your own decisions.  And you should get a tax break directly to you – not hidden as it is today – so you have control.  

We want everyone to have health insurance and access to care.  But we want you, and not some outside bureaucracy, to make those decisions.  We want you to be able to pick your plan.  Everyone should have choices.  

Health insurance has two parts:  

•    Prepayment of routine medical bills

•    Insurance protection against major medical expenses like surgery, hospitalization, or cancer treatment

We think that you should decide how much goes to each.  You, not some bureaucrat in Washington or an insurance company, should make that decision.

•    And we want to provide assistance to people who need help in purchasing health insurance, whether they get it through their jobs, on their own, or through another kind of group, like a church or trade association or union.  There is plenty of money in the system to make sure that happens.  But we need to level the playing field to put power in the hands of patients, not bureaucracies.  

•    About half of health care in the U.S. is financed through the private sector and half by the public sector, funded by workers and taxpayers.  But both private health insurance and public programs operate on a third-party payment system that shields the majority of people from knowing the cost of their health care and health insurance.  The recently-enacted Patient Protection and Affordable Care Act has doubled down on this system.  The system is stacked against patients and in favor of bureaucracies – big government and big insurance – because federal law says they control the money, not you.  

•    The other side will tell you that medicine is just too complex and that people in government who are smarter than us need to make decisions for us.  But which would you rather have? A bureaucrat in Washington making decisions for you or you and your doctor deciding?   Who here thinks you are too stupid to make medical decisions for yourself and would rather a bureaucrat in Washington make those decisions for you?

Government tries to hide its agenda to save money by paying less for your care, rationing it, or denying it altogether.  Do insurance companies do this too?  Sometimes, but we want you to be able to fire them if they do and go somewhere else.  If government is your insurance company, how are you going to fire them?

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