One of the goals of the Affordable Care Act was to expand access to regular and affordable health care for Americans. Underpinning this goal was a hard-to-argue-with notion that the nation, individually and collectively, is better off when its citizens are healthy.
Is that the same as saying that that all Americans have a right to health care? Even those who instinctively nod “yes” might qualify their answer, depending on how you define health care. Some types of health care are critical to good health, while others seem of marginal benefit. Under the best of circumstances, the boundaries are far from clear. And most types of health care are in limited supply, based on the availability of equipment, medical staff, facilities and drug supplies. We can’t all have everything.
A starting point for the discussion might be the definitions given by the President’s Council on Bioethics in 2003:
- Therapy: treatment of “known diseases, disabilities or impairments in an effort to restore a normal state of health or fitness.” Included in this category are things like repair of broken bones, antibiotics for infections, surgical removal of tumors, pacemakers, and chemotherapy or radiation for cancers.
- Enhancement: treatment “to alter the ‘normal’ functions of the human body or psyche so as to augment or improve native capacities and performances.” In this category are such things as discretionary plastic surgery, botox injections to remove wrinkles, or steroids to improve athletic performance.
This simple model, however, leaves many questions unanswered.
- How do we classify vaccinations, annual visits to the dentist for cleaning, or periodic screenings for breast or prostate cancer? What about vitamins and exercise regimens, or anti-smoking campaigns. None of these quite fit the definition therapy or enhancement, but they are included in what is now called Preventive Medicine, a set of strategies to maintain health rather than cure illness.
- Another challenge to this binary model is Palliative Care, which covers the spectrum of physical, emotional, spiritual, and social suffering that often accompanies illness. Drugs and medical treatments are considered palliative if they relieve symptoms without having any beneficial or therapeutic effect on the underlying disease or illness. Examples would be dialysis for kidney failure or Aricept for early-stage Alzheimer’s, both of which make life more manageable for a time, but do nothing to cure or reverse the underlying problem.
- Yet another complication comes with Long Term Care, particularly for the elderly. While everyday tasks like feeding, bathing and dosing out medications do not ordinarily constitute medical care, their absence leaves those with chronic illnesses and/or limited mobility prone to accidents or malnutrition. These in turn lead to diseases or illness that may require acute or chronic medical care.
It seems reasonable, at first glance, to make therapeutic medical care available to all Americans. But should I have a right to any and all therapeutic treatments, regardless of my ability to pay? Should I have the right to any and all procedures—a kidney transplant, for example—if I already suffer from multiple or chronic illnesses from which I will never recover? Should I have the right to any and all procedures even if I am responsible—alcohol or drug additions, for example—for my condition? And should the standard of “normal” be the same for a 40-year-old as for an 85-year-old?
If your answer to any of these questions is “no,” you are left with even harder questions. What types of procedures should be restricted or prohibited … and under what circumstances? Who should decide? Based on what criteria?
Similar questions apply to things that fall into the category of enhancement, preventive care, palliative, or long-term care. Most would agree that pain-medication is a palliative treatment that should be available to anyone who needs it. But what about Viagra, when it is used to offset a “normal” decline in physical function, but may help to restore emotional health.
What do you think? Should health care be a universal right, regardless of the ability to pay? Regardless of other health conditions? If so, how would you propose to pay for the rapidly increasing costs associated with the aging baby boomers? If not, what criteria would you use to decide who gets what?