Thursday, August 28, 2014

Health Care Rights and Socialized Medicine

Let me just premise this for anyone who does not regularly read, that I live in Canada.  I have no knowledge working or otherwise of other socialized healthcare systems.  So if you live in say the UK some of what I say may not be applicable.

I recently read a conservative US blog in which the bloggers asserted that healthcare is not a right.  First of all, as a moderate I was dismayed.  And secondly as a Catholic I was appalled.  The United States Council of Catholic Bishops (USCCB) has repeatedly said basic healthcare is in fact a right.

Some of the most common arguments against healthcare is that 1)it's forcing the physician to perform a service and 2) healthcare is a good or service. 

Let's address the second first.  Healthcare, housing, education, and religious freedom are spoken as rights by the USCCB.  When they say rights, they are talking about access.  If for example a person is stabbed multiple times, regardless of the person's ability to pay, they have the right to have access to life-saving medical care that any wealthy person also has.  To deny that person access is to essentially allow for their murder.  This sort of thing rarely happens in the United States because people, regardless of ability to pay, usually are given life-saving care.  Doctors usually don't rifle through wallets to look for money or insurance cards.  So to say things like healthcare is not a right (but rather it's a good or service that is not guaranteed access to) falls a little short.  In a way, the US already has standards of medical care that require access.  At least for immediate life-saving care. 

For basic medical care that is not immediate life-threatening, that is where the USCCB and conservative bloggers disagree.  Which brings up the first point.

Education is the United States is both compulsory and in that vein having access to basic education is a right.  It is provided for by the individual states.  I was a teacher.  It was a career I chose knowing full well that regardless of gender and race and ability to pay, I would educate children.  I also knew that if I wanted to teach a Catholic-based morality I was safer teaching in a private school setting, which is usually to some extent regulated by the state.  Certainly what I would teach them would also be dictated.  To an extent, I can object to what I teach.  As a music teacher, if I find myself suddenly thrust into teaching P.E.  I could object since that's not what I signed up for.  If I find my working environment not very good (for whatever reason), I'm not a slave.  I'm free to quit and pursue a different career.  And since I know longer work as a teacher, I did quit and pursue other interests, namely staying home with my children.

Likewise being in the medical field has some inherent restrictions.  Doctors and nurses understand this when they sign on for employment.  If a Jehovah's witness wants to be a family doctor, they know that 1) they can't exactly refuse life-saving care to the stabbing victim if they cross paths but 2) they can refuse blood transfusions during surgery since they are trained family doctors, not surgeons.  They also aren't slaves.  They can quit. 

It seems a bit disingenuous to claim doctors are being forced when they know exactly what it is they are getting into and can opt out.  Unfortunately for the stabbing victim, they can't opt out.  They'd die.

This leaves one in a quandary when the medical field is largely privatized and education (which is equally a right) is largely public.  To combat this in Canada, they make basic healthcare something the government takes care of.  This has a number of problems:  1) what is basic and who decides this and 2) loss of freedom of choice.

In Canada what is considered basic has not been strictly defined by the government.  Rather it's the voters of the individual provinces who dictate what is basic or not.  In Ontario, for example abortions are considered basic healthcare even if people object because of religious reasons.  Oddly, things like prescription drug coverage (even for life saving drugs), dental care, and vision care for adults is not considered basic.  In other words, you have to have supplemental insurance that you pay for or pay for it out of your pocket. 

All of this is paid for by taxes.  You cannot opt out.  And what is basic healthcare coverage is the same for all persons (exception made for children who have vision coverage).  This means you loose the freedom of choice.  Someone did tell me that not to long ago Alberta allowed people to opt out of healthcare coverage and instead have their own privatized insurance.  But that loophole has since been closed.

How is that applicable to the US as it moves closer and closer to socialized medicine?

Well I don't think socialized medicine is necessarily a bad thing.  I think that having the voters dictate the type of covered benefits is crucial since I don't think abortion is a basic healthcare right.  I, however, believe that people should have the right to opt out.  The Amish, for example, are allowed to opt out of Medicare and Social Security.  It can just as easily be anyone who has an objection to the type of socialized care to opt out.  Currently we have a system where insurance is privatized and only those who are too poor or above a certain age have the ability to opt into a public healthcare insurance.  Why not open that option to all persons?  Why do we continue to try and run our healthcare as largely private instead of the other way around?  Cannot the two systems work together in a large population that the US has?  A number of countries have done a number of different things to help their healthcare including making insurance private but non-profit based.  Would that also help people gain more access and lower premiums? 

At any rate, basic healthcare is a right according to the USCCB, and Catholics need to be figuring out better ways to open up access to more people.  Obama thinks he knows how, but I disagree with his course of action.  Forcing people to have insurance is a restriction of freedom.  How about the government loosening it's reigns on healthcare instead?  At any rate, having a physician deny seeing you because of an ear infection and lack of funds is silly and potentially dangerous.  We shouldn't be forcing people to wait to the point that they clog emergency rooms.  Something needs to change.

3 comments:

  1. One problem with our current state of affairs is that while in the case of, say, a JW doctor, he can choose to not be a surgeon and deal with blood transfusions, a Catholic doctor has ever-increasingly-limited areas in which he can specialize. It's becoming more and more common for docs who won't prescribe BC and won't refer for abortions to get sued out of practice even if they have their policies stated plainly in the waiting room for anyone to see. Sure, Catholics have the option of not going into health care, but do we want a situation in which there are no Catholic OBGYNs, for example?

    I quite agree also with several of your conclusions: opting out should be allowed by anyone who wishes to, and a better system has got to be in place someday. I wish I had more definite ideas as to how to deal with it, though.

    I have heard many nightmare stories about England's NHS, mostly centering around gross neglect because neither the staff nor the institutions are liable for their mistakes.

    For example, I read recently about a baby who died a week after he was born in the UK due to a perfectly treatable and preventable infection: his umbilical cord wasn't kept properly clean by the staff, he then developed sepsis, but the midwives at the hospital refused to test him for sepsis or then give him antibiotics until he was too far gone. None of them lost their licenses, no staff members were fired, and the family had to fight even to get an apology. If this were a private hospital that carried liability, the kid probably would have been better cared for. Sad that it would be partly out of concern for the liability rather than the kid, but having a more tangible investment in the situation usually makes a hospital shape up their act lest they get sued into oblivion.

    At the same time, our malpractice system has gone so far overboard in the opposite direction from the UK that it's grossly abused, too.

    I know doctors who refuse to take Medicaid patients because many of them, statistically, will not comply with doctor recommendations pertaining to lifestyle decisions. (Drug and alcohol use is NOT a problem exclusive to Medicaid patients, but it is disproportionately represented in them.) When their labor doesn't go well and their baby is sick during and after birth because of these things, the doctor gets sued, and usually the doctor's insurance company will settle out of court rather than go to the expense of taking it to court and risk losing more money. However, then that doctor a) has been found "guilty" in the eyes of his employers of malpractice, and b) will have his insurance rates go still higher even though he objectively did nothing wrong! You can explain to a pregnant woman until you're blue in the face that binge drinking is a bad idea in general and a terrible one while pregnant, and you can offer her rehab referrals and counseling ad nauseam, but if she refuses to stop binge drinking and then sues you when her baby is born with fetal alcohol syndrome and your malpractice insurance company then gives her a hefty settlement AND doubles your rates...well, you get the idea. It would be good to have a system where a doctor wouldn't have to worry about such a stupid situation in taking on problematic patients so that they could do all the good possible on their end for such people without worrying about losing their livelihood in the process.

    Sorry for the long rant! I spent a fair amount of time in the medical world, and saw massive abuses on both sides of the system. At the very least, we can agree that major changes are needed. I hope that someday a better system is in place, a sort of happy medium between the two.

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    1. 1) In Canada from my understanding, there are private doctors and public ones. They all get reimbursed by the health care system so I'm not sure what the difference is. I know that recently in Ontario they were asking the public about modifying the current rules. Basically if you are a private doctor in Ontario, you are not obligated to violate your religious beliefs. In this case there were three doctors who refused to prescribe birthcontrol in Ottawa. Ottawa being the capital is fairly large. So even in a socialized system doctors can practice medicine and still hold their religious beliefs.

      2) In Ontario, it's called Ontario Health Insurance Plan. People usually call it OHIP and forget that is in fact insurance. The difference is that it's regulated by the government and is public. So you pay a special tax/fee, the government runs whats reimbursed, and the doctor's still have to submit forms. It reminds me a bit of medicaid. I'm not sure how NHS compares.

      3) I also don't know if doctors can be sued. I image if they are practicing privately than they can be. The biggest problem in the Canadian system is the lack of doctors. Since the government controls the fee scale, the doctors really aren't allowed to charge more or less for a particular service. There's no built in competition other than to find a good doctor that you like. To get our current doctor I had to fill out paper work and wait a month. In the meantime if we had any medical issue we had to use urgent care. It's not very cost effective.

      3) Since we were immigrants, we initially had a 3 month waiting period. We had to pay for our own insurance. We could have continued to do so but this would have been problematic because a) most doctors do not use private insurance carriers and will refuse patients who do so and b) we are still paying for OHIP through our taxes. We literally cannot opt out because we object to their covering abortions.

      4) My deepest concern about OHIP is actually the opposite. In Canada they really push good health. It's a bit disconcerting to get stuff about routine exams from the government in the mail. So as I said I can't confirm but I imagine more people use the system for little things since it's "free." Particularly since you are usually on a waiting list. My husband did say that he heard that if someone goes in thinking they are having a heart attack and it turns out to be indigestion they will fine you. Course this is all word of mouth. More people are concerned about issues arising from lack of doctors and therefore lack of treatment.

      As you say something has to change. I'm not entirely sure what, but it has to be something. The raising premiums on insurance in the US is ridiculous. I understand how we got on this employment-based insurance system, but I think it's high time we got off. At the very least require that insurance is non-profit. Perhaps phasing in some sort of public insurance for all children? Not sure.

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  2. Wow, item 1 one your list would REALLY clear up a lot of the problems I cited--i.e., the conscience ones! Honestly, that really seems like the perfect solution; in fact, it was kind of the solution here until not that long ago (i.e., a doctor could refuse to prescribe BC or refer for abortions, and that would be that).

    The insurance situation here is akin to the education system here, I think: once something becomes subsidized, it's going to get more and more expensive in order to get more and more subsidies. Back in the day, my father could work all summer (admittedly long, hard hours at two jobs, but still...) in order to pay for a full year's tuition, room and board at his college in September. It's now impossible to do that because of government subsidies via grants and loans. Again, I'm not entirely certain what the solution is, but it shouldn't involve requiring anyone who isn't well-off to take out huge loans. I digress. ;)

    As you mentioned in your previous post, it sounds as though Canada and the UK "do" socialized medicine very differently--the former very well, from the limited and anecdotal information I've heard, and the latter very badly. I'd probably be more in favor of it if I could be sure that we'd "do" it like Canada rather than the UK, and if there could be a recourse for the sort of horrendous malpractice I described above. Because, as you say, something has got to change.

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