Health Care – What is it?


Question-Mark-820x1024One 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?


  1. It’s increasingly clear to me that the only thing that is standing between the American people and universal care is the profit motive of insurance companies. If we had the government’s power to bargain better prices for drugs and services – and also didn’t have to pad for profit, we could have a world class system for far less money. In answer to your original question, I think healthcare is a right. It’s sort of like breathing in my opinion. Everyone needs air. Everyone needs healthcare.

    • Mary Gottschalk says

      Claire … thanks for stopping by. I’m not sure the profit motive is the ONLY thing between us and universal health care … the U.S. Congress has consistently voted against it since the 1930’s … but it’s got to be one of the biggest factors right now. One of my next posts will be about the drug companies and what they are doing to the prices of generic drugs.

  2. Welcome back to this space, Mary! Between the travelogue I’ve observed on your Facebook pages and re-appearing here, you have been very busy preparing for your course. Now you are educating your blog readers too.

    I’ll defer to others to leave a reply to your probing questions near the end. Meanwhile, I’m getting an education about our health-care system.

    • Mary Gottschalk says

      Thanks Marian … I do hope you’ll put in your comments at least occasionally, as you are someone with a lot of good insights, and I’ll be covering a lot of different issues.

      Have a great Thanksgiving!

  3. Tough questions, Mary, especially since I just turned 73 and am heading in the direction of possibly needing medical health care in the future. I just had a discussion with a friend about the fact that aging and death are getting much more complicated than they used to be. In the olden days, as I called them when I was younger, people simply got sick and died. There were not numerous ways of treating chronic illness or sudden diagnoses like cancer or heart problems.

    I have no answers to any of your questions. I can only tell you what I want as I get older and near death. If I am diagnosed with a terminal illness or one that will keep me from living a life in which I can contribute in some way, I want to be able to choose to die with dignity. Meaning I want to be able say enough is enough, swallow a pill or two and be gone. Hanging on to life, when I cannot enjoy it because I’m in horrible pain, am making life difficult for my family who may be spending thousands of dollars to keep me alive is not my idea of a good death. My idea of good death is accepting the inevitable, especially in my later years, and living life to the fullest, loving every minute, until it’s time to go.

    I am a strong supporter of preventive medicine and have worked for years to keep myself as healthy as possible. I believe that both food and exercise are medicine. I get eight hours of sleep a night, see my dentist for cleanings, have an yearly physical and so far have been very lucky. I believe it takes a village to help take care of my body and spirit. Mine includes my massage therapist, my acupuncturist, my homeopath, my yoga teacher, and my pilates teacher, along with my primary care doctor and dentist.

    I don’t believe enhancement as described above should be covered. That is up to the individual to take care of. A very wealthy relative of mine who has now passed, used Medicare to pay for her plastic surgery to keep her from looking old. I was horrified.

    Your questions are extremely important as the population of the elderly grows and the number of doctors grows smaller. So many of the decisions that need to be made about future health care are political and economical issues that I don’t believe our government is equipped to make given the history of division in our country at this time.

    I would like to include the link to this post in my monthly newsletter in which I discuss some of the issues, including aging, that I write about in my upcoming memoir. Please let me know if that is alright with you. The next issue will go out next Tuesday, December 1st.

  4. Mary Gottschalk says

    Joan … thanks for a very thoughtful response to what are definitely some sticky and controversial questions, particularly for those of us entering or in our eighth decade and facing the prospect, sooner or later, of needing the health care system in a significant way.

    I’d be honored to have you put in a link to this …. I shall look forward to your newsletter.

  5. Hi Mary, so nice to have you back to get us all thinking about the important issue of health care options. As you know I can see it from both sides as patient and as a health care provider and from just about any angle you can imagine. Yes, of course, access to health care, both preventative and curative is essential. I strongly believe that we, as individuals are responsible for doing our part to care for ourselves and our health. I see health care providers as partners in achieving maximum outcomes. As as aside, I am currently the throes of dealing with my mother’s cancer diagnosis and treatment in hospital and skilled nursing facilities and am amazed how much effort it has taken my three siblings and myself to ensure my mother is getting what she needs. I think of the poor patients who do not have family to advocate for them. Our health care system is cumbersome and fraught with loop holes and obstacles and the insurance and drug companies set the rules. I don’t have the answer because increased government involvement can take away personal choice. I’ll be tuned into the ongoing discussion.

  6. Hi Mary, I found your post in Joan’s newsletter and appreciate the clear way you describe the issues. My mother is 89 and in relatively good health. My father died on the morning of his 55th birthday. So I’ve had two very different experiences with the health care system. I know that I want to minimize my contact with hospitals and trust hospice more when it comes to end of life.

    If you are interested in a short, helpful book written by a doctor, I recommend Living Joyfully/Dying Well by Dr. Glenn Miller.

    All best,