In his column one week ago, my fellow Daily columnist Matthew Green said healthcare is an “inherent human right” (A sick U.S. healthcare system, 03/09/09). I thought his language was intense, but nonetheless, his opinion is not unique. The election of President Barack Obama, who promised to provide affordable health care access to all Americans, shows many Americans believe health care should be a right. This belief is partially based on the many horror stories told throughout the country about people unable to cover their medical expenses or afford treatments even when they have health insurance. A 2005 Harvard University study of over 1,700 bankruptcies showed that medical problems caused half of them, even though three-quarters of those bankrupt people had health insurance.
I myself was always lucky to have excellent health insurance. A visit to the doctor only costs me five or ten dollars in copay charges, and I was free to visit the healthcare providers of my choice. When I was young, my family’s insurance completely covered almost all medical expenses. This even included emergency room visits, so my family abused this privilege. Anything from a cough to an earache resulted in a short drive to the emergency room where we received immediate treatment at a time of our choosing instead of making an appointment and working around our family doctor’s schedule. We did this so often that to my young mind, a trip to the doctor was synonymous with a trip to the emergency room.
My family’s health insurance is provided by my parents’ employers, so affordability was a non-issue to us. But free-of-charge care is what led my family to abuse the emergency room and use it for headaches. Predictably, my family stopped this practice when our insurance began to charge us for the emergency room.
As I look at the national discussion to provide affordable health care for all, I worry that the same abuse could occur. If there is no disincentive from going to the emergency room for routine care, then why not use it? It was only after the emergency room wasn’t so affordable that my family stopped abusing it. Emergency rooms are already overcrowded, and some are barely able to handle the patients that come in, so bringing in patients with non-life-threatening ailments will only prevent fast treatment for those who more desperately need care.
Providing affordable health care for everyone allows everyone to then abuse their affordable health care. But it may also allow the healthcare providers to abuse their patients. Just last month, I went on an Alternative Spring Break trip to Baltimore, Maryland. One of the sites at which I worked was Gallagher Services, a home for the mentally handicapped. Gallagher Services is an aspect of Catholic Charities that started in the 1980’s because of the abuse the state-run institutions performed on their patients. Because the patients were living in cells in the institutions, Gallagher was designed to give the mentally handicapped a home, education and meaningful work so that they could be respected as people instead of simply patients.
The mentally handicapped in Maryland are lucky that an alternative to their state-run institutions opened. Others are not so lucky and are trapped within the system given to them. This is the case with the Veterans Health Administration, the division of the federal government that is dedicated to caring for the health of military veterans. It is the sole health care provider the federal government will use for veterans, and the system is frequently lauded for its excellent care and ability to negotiate lower prescription drug prices for its patients. But one of the reasons the system is so successful at negotiating lower drug prices is because it purchases older drugs instead of newer ones. A 2005 report by Columbia University professor Frank Lichtenberg found that the VHA administers older drugs to its patients much more frequently than the rest of the medical industry, which results in worse patient care. According to Lichtenberg, this practice has resulted in a decrease in average patient life expectancy of two months since 1997. The VHA, the only choice the veterans have for their healthcare, is abusing them.
As Green and others around the country begin to think of health care as a right, it’s important to note that this right can be easily abused and can cause abuse itself. In any healthcare system, both disincentives from patient abuse and choice are essential. For my own family, the way to prevent us from abusing the emergency room was simply to charge us for its use. To prevent systems from abusing their patients, patients need the ability to choose their own healthcare provider so that they can move to another if their current provider isn’t providing — because in the end, the system itself should not be a patient’s cause of death.
Patrick Zabawa can be reached at firstname.lastname@example.org.