Rights and Benefits

As Monique insisted, last night, healthcare is not an "inalienable right." Because it requires other people (doctors, et al.) to provide services, it is actually a consumer good. It's a vital one, to be sure, and one for which people will exchange significant percentages of their resources, but that doesn't make it a right.

It does, however, make it an attractive target for people who would like to control your life, such as the current collection of Democrats and their armies of government bureaucrats, who believe doing so to be their right. The ideological distortion of the nature of healthcare serves no purpose but to disguise the fact that government cannot provide this "right" at a lower cost than people can procure it for themselves. If the Democrats' motivation were otherwise, their solution would exclude all of the interference and fluff and provide for the government to grant healthcare to those who want it but can't afford it, and deliberations would consist of a debate about what aspects of "healthcare" are rights, and which are extra. Instead, the objective of legislation has clearly been to determine who controls the industry and how.

Recasting the structure of healthcare "reform" with the assumption that healthcare is a right shows the notion to be nonsense. What other "right" do we require citizens to purchase? What other right requires that people provide the services and that employers offer access to those services as a benefit? Again, rights aren't the sort of things subject to determination of cost effectiveness.

Ezra Klein makes a related point when he suggests that "health-care coverage is not a benefit. It's a wage deduction":

Cost control is not, in fact, all pain and no gain. It's some pain in return for a fat raise. A 2006 study, for instance, by Harvard's Katherine Baicker and Amitabh Chandra used malpractice payments to estimate the effect of premium increases on wages. They found that a 10 percent increase in health-care premiums "results in an offsetting decrease in wages of 2.3 percent" and an increase in unemployment of 1.2 percentage points. Compensation is basically a set sum for employers, and they don't seem to care much whether it goes into wages or into health-care costs.

Assessments of value exist all along the healthcare service chain. Doctors become doctors because the career presents an opportunity to earn the standard of living that they desire through an occupation in which they have an interest. Employers provide health insurance because it helps them to attract and retain employees more effectively than simple cash remuneration. Heretofore, as with all benefits, workers could presume the exchange to be worthwhile; they were giving up part of their natural pay in order to gain something that would cost them more were they to pay for it individually. If one spouse's employer provides better value, the couple switches. If the employee is healthy, he or she opts to take the money instead. The legislation on track to become law merely layers on disguises that enable citizens to ignore the fact that healthcare has a cost.

Back to Klein:

When Americans rejected managed care [such as HMOs], in other words, they didn't know they were ending wage increases, too. But since 1990, wages have tracked changes in premiums more closely than they've tracked the growth of GDP. Maybe if more workers knew that, they would be more interested in efforts to control health-care costs.

Anybody who has watched unions negotiate their contracts can appreciate the point. They'll give up wage increases if their negotiators believe that health insurance benefits will ultimately result in a greater transfer of wealth, and vice versa. What legislators who profess the healthcare-as-a-right doctrine are effectively doing is declaring that somebody must pick up the bill for extensive coverage without reference to the exchange in wages or economic activity or whatever else the burden will land on. And because those ultimately paying the cost won't know the dollar amount (indeed, they probably won't realize they are paying it at all), the bill can only increase.

Personally, I see it as more appropriate to insist that we have a right not to pay more for a service than we are willing to pay for it.