Jon Cohen

Is Healthcare an Individual Right or a Responsibility? The Massachusetts Universal Healthcare Plan

The recent bill passed in Massachusetts has accomplished more that just insuring the residents of that State, it has taken the electricity out of the third rail of politics: Universal Healthcare. The central problem in the healthcare crisis continues to be a lack of a set of guiding principles that would serve as the basis for policy development. We continue to substitute fiscal policy and fiscal solutions for real health policy and continue to dodge the central question of whether healthcare is a "societal good", to be priced through an open market, or a basic right afforded to all citizens. We as Americans have recognized healthcare as a right for the elderly (Medicare), for the poor (Medicaid) and specifically guaranteed for prisoners based on a 1976 Supreme Court interpretation of the 8th amendment (Estelle vs. Gamble).

Who the law requires to be insured is important in the context of The Massachusetts plan for universal coverage. In Massachusetts, they have recognized that covering everyone is critical but do not define it as a right. They are mandating that individuals obtain coverage and define it as an individual responsibility since it will be affordable and accessible. If government provides you with access, is it a right (although you have to pay for it) or an individual responsibility?

The plan implies that there is an inherent fairness to an individual mandate as it is unfair to the rest of us to cover the costs every time a young adult or wealthy individual shows up in emergency room without insurance? In addition, young healthy people use fewer resources thereby spreading the risk for the insurance pool which drives down the costs for the rest of us.

Employees of small businesses make up a large number of the uninsured. The Massachusetts plan addresses this by making insurance more affordable to the small business owners; although the plan does not mandate that the employers provide it to their employees. Is it fair that most big businesses offer healthcare and subsidize those companies that don't offer it? In this country, the majority of people get their health insurance through their employer. Should there be an employer mandate whereby all employers have to provide insurance as many states are now contemplating?

Some states are increasing the age of family dependents allowing parents to extend coverage to their older children. Arkansas is experimenting with offering Medicaid to small businesses. The good news is that there is momentum gathering towards universal coverage. The bad news is that we still haven't figured out what we really want in this country as a real healthcare policy.

We have agreed to the principle that every child should have a 12th grade education, we said it, we made it the law and we paid for it. Should we agree to the principle that everyone should have basic healthcare, should we say it, should we make it the law, and who should pay for it?
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Jon Cohen, M.D. Chief Medical Officer, North Shore Long Island Jewish Health System

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Posted at 9:20 AM, Apr 17, 2006 in Health Care
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