Healthcare. A Right or A Commodity?

By Sterling Smith

Before assuming universal healthcare will solve the healthcare crisis, it is vital to account for possible negative side effects, both logistically and morally.

As the baby boomer generation ages, the need for elderly care will increase exponentially. The demand for care in an industry that is almost 100% paid for by Medicare and Medicaid will leave our generation with a massive bill to pay. The proposed single payer solutions sound simple and enticing, however, there are deeper morals at play and the solution may not be as clear as we think it to be.

Genesis of Healthcare

Since it was reintroduced in the Renaissance, Humanism has been dissected and deeply contemplated. Writers and thinkers all over Europe contemplated very seriously the notion of 'life' and the consequences of societies reaction to its value. John Locke was one of the pioneers of concepts such as conscious and cognitive humans(1). Such concepts proved the great worth of each individual. The revival of such concepts in the Romantic period led to the development of the study of medicine.

Throughout the Romantic period, healthcare advanced and became more effective and accessible. This trend introduced a new dilemma; is healthcare a right, or a commodity? Such a dilemma has been a major chapter in a debate between two ideologies (that also originated in the Romantic period), Classical Liberalism which favors individual sovereignty/autonomy and Socialism which favors collective welfare.

Socialism vs. Classical Liberalism

To Socialists, healthcare-- in this instance care for the elderly or funding for nursing homes-- should be government funded and run on a single-payer system. Classical Liberals believe in the rights and responsibilities of the individual and that healthcare should part of a laissez-faire economic system where healthcare is paid for by individuals or other means of private non-profit organizations. As someone who grew up in Canada and now lives in the US as a US citizen, I have experienced both a single-payer and mixed payer systems.

Healthcare in Canada

While in Canada my sister had leukemia when she was very young. The single-payer system lifted the burden of costly medical procedures. However, many Canadians lose their lives to cancer waiting 6-12 months for an MRI or other important medical procedures. I have never experienced a case that severe myself, however, I once broke my leg and spent 5 hours in the emergency room only to be told to come back the next day when I could get a cast. Family doctors have been on a steady decline over the past decade because more doctors want to be specialists because of higher salaries in the private sector (optometry, podiatry, dermatology, etc.).

Healthcare in the US

Since working in a Skilled Nursing Facility in Salt Lake, I have been exposed to the publicly funded side of the US healthcare system. Majority of the residents in the facility have their stay paid for by Medicare or Medicaid which are both publicly funded by the US government. But the facility is part of a for-profit corporation. US Nursing Home corporations operate with a 1% profit margin(2). Even though the corporate tax rate has been significantly decreased, taxes limit funds for employees on the front lines of care, structural updates to facilities, and other improvements meant to provide higher quality care for those who are the most vulnerable.

Healthcare in Sweden

Sweden is a country typically associated with Socialism, however in response to rising healthcare costs and the burden it placed on the public, Sweden has been introducing private enterprise to their healthcare industry(3). After privatizing a portion of the industry the Swedish National Board of Health and Welfare surveyed over 2000 nursing facilities that were for-profit private, non-profit private, and public. Out of the 14 categories of quality that were measured the private facilities outscored the public ones in 12 out of the 14. Some of the indicators measured were screenings for falls, pressure ulcers, malnutrition, employee competence, and employee turnover. There was also no statistical difference between non-profit and for-profit private facilities in the 14 categories(4).

A Solution

Even as an advocate for privatized nursing homes (and healthcare), I am not naive to the flaws that come from privatization. I believe it is important for the government to protect seniors and intervene through specialized regulation. One potential intervention is giving all providers of medical care tax-free status, but mandate that a certain percentage of what would have been taxed put back into the quality of care. That way tax money wouldn't be whittled away as it trickles through the chains of bureaucracy.

Now you say, "why not just cut defense spending and put it towards 'Medicare for All'?" The logistical debate could really continue forever. Each side has studies they can reference, and statistics that prove their claims. But the real debate lies between two ideologies: Socialism and Classical Liberalism. Collectivism and individualism.

According to John Locke's Second Treatise, an individuals property is the result of their own work(5). According to Locke, are not entitled to the work of doctors just like we are not entitled to the work of plumbers, or mechanics. Doctors, nurses, and other medical professionals should not be forced to serve you at a price set by the government.

But its a necessity of life? One of the hallmarks of Classical Liberalism is its value for human life. Food is also a necessity of life but because of private enterprise, it is offered at an affordable price. Incentivisation through privatization increases supply thus decreasing cost. If someone honestly cannot afford their cancer treatment, I would be more than happy to band together with a group of friends to raise enough money for their cause as would most of the general public.

Classical Liberal values like these maintain humanity's willingness for generosity, not taxation by compulsion. From a psychological perspective, care isn't provided from the public to the collective, it is provided from the individual to the individual.


 Sources

(1) Tsouyopoulos, Nelly (1982). K.E. ed. "Andreas Roschlaub und die Romantische Medizin" Medicin in Geschichte und Kultur. 

(2) Regan, Tim (2017). "SNF Occupancy, Operating Margins Continued to Drop in 2016" Skilled Nursing News.

(3) Ranci, Pavolini (2013). "Reforms in long-term care policies in Europe: investigating institutional change and social impacts" New York: Springer.

(4) Winbald, U., Blomqvist, P., & Karlsson, A. (2017). Do public BMC health services research. 
nursing home care providers deliver higher quality than private providers? Evidence from Sweden.

(5) Locke, John. "Second Treatise." The Two Treatise of Government.

*Images courtesy of creative commons