I don’t like saying “I told you so”, but I did, and the failure of the first phase of “repeal and replace” will make it all the more difficult to do so. But rather than wander into the weeds of policy options and tactical moves at this point, I think that there is a larger philosophical issue that has become central in a way that it really hasn’t throughout the debate until now. Charles Krauthammer picked up on it recently as follows: “……..there is an ideological consideration that could ultimately determine the fate of any Obamacare replacement. Obamacare might turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist–it is universalizing the idea of universal coverage. Acceptance of its major premise–that no one be denied health care–is more widespread than ever.”
It’s the age-old question–is health care a right? And Krauthammer is correct; the notion of health care as a right is more firmly entrenched than ever, even though we have never really had the national debate on this question, at least in the open. When Franklin D. Roosevelt rolled out his “second bill of rights” in his January 1944 State of the Union address, one of the eight additions to the original ten was “the right to adequate medical care and the opportunity to achieve and enjoy good health”, and probably not many people flinched, but there was also not much debate about the enormous implications of these new “rights”, at least outside the ivy-covered walls of the philosophy departments of academe.
I looked back at the failed attempt by the Clintons to install Hillarycare in the early days of their administration and discovered an interesting chapter in “The President’s Health Security Plan” entitled “Ethical Foundations of Health Reform”, which listed the values and principles that shaped the proposed new health care system. At the top of the list of 14 principles was “Universal Access: Every American citizen and legal resident should have access to health care without financial or other barriers”. Stunning, but I don’t remember a lot of debate on it.
My point is this–for every right there must be an obligation to defend that right, and in this case fund it, and we haven’t yet really had the national debate we need to have before we put in place a health care system in which a right to health care is the centerpiece. Maybe the conclusion will be in the affirmative and I don’t have much doubt that would probably be the outcome, but if so, then the resulting health care system will inevitably and soon evolve into a universal single-payer system. And does anyone believe that there will not be rationing of care? And who will do the rationing? Maybe we should spend some time discussing the implications of these points and even brush up on the philosophy of rights.