Is Healthcare a Right or a Privilege?

Providing care to all will be a costly but necessary venture. Resources and priorities must shift to primary care, care coordination, prevention, and wellness and a change in how providers are paid by rewarding care management and coordination (Mason et al., 2012, p. 124). The quality of care services must be rewarded instead of the quantity (Mason et al., 2012, p. 124).

The evolution of health care financing will focus on quality care that should be given without discrimination. I have already seen improvements in the standard of care at the small community hospital where I am employed as it prepares for the future governmental changes. The hospital has been known for giving traditional care by older physicians that are now forced to follow protocols and guidelines for best practices with core measures. The hospital is incorporating evidence-based practices to stay competitive with closer teaching hospitals in the area. As a result, the physicians are decreasingly ordering unnecessary tests, images, and procedures. The uninsured are receiving care supported by best practices and the insured are no longer being subjected to unnecessary testing just because they can pay.

Highest standard of care, using state of the art technology, should always be provided to human beings regardless of cost, because health care is a right not a privilege.

Nurses pride themselves in regards to patient empathy, holistic care, and aesthetic knowing. What kind of profession would nursing be if we selectively treated patients for pain? The same concept applies for providing safe, effective, high quality care to all people regardless of ability to pay. Mason, Leavitt, and Chaffee (2012) mention that nearly 17% of our population does not receive regular care due to lack of health insurance (p. 153). No particular group or population deserve oppression.

This nation espouses a belief that there will be liberty, justice, and opportunity for all. Are we succeeding when we deny basic health care coverage to the vulnerable, the frail, or the working poor? And what kinds of opportunity exist for those who cannot walk, eat, drive, or speak because they have suffered strokes, heart attacks, or loss of limbs that could have been prevented with better access to primary and preventive care? (Turka and Caplan, 2010, p. 934).

It is important that nurses lead the way in ensuring the public access to health care services. While some other countries have viewed health care as a social good, the United States (U.S.) has viewed health care as a market-based commodity for those who can afford it (Mason et al., 2012, p. 135). “The reform initiative affords nurses a prime opportunity to collaborate with professional colleagues to redesign our health care processes to provide high-quality, efficient, and cost-effective care to all people in the U.S. (Mason et al., 2012, p. 132).

Why should a liver transplant be granted to someone who abused alcohol for half their life, was unable to work due to their addiction, lacks a support system that was eliminated due to a lifetime of addictive behaviors, and therefore will not be contributing financially? It does not happen and the same financial responsibility could be applied to other procedures. According to the World Health Organization in 2000, the United States ranked 54^th in terms of financial contributions toward health care; an issue that has shown no progress (as cited in Mason, Leavitt, & Chaffee, 2012, p. 123). The United States spends more than any other developed country in the world (Holtz, 2008, p. 4).

Health care costs are continuing to rise and interventions must be found. Massachusetts has included in its 2006 state health reform law the responsibility of employers to provide health insurance or pay a penalty fee (Mason et al., 2012, p. 137). Also in Massachusetts, an individual mandate was instituted requiring individuals to have health insurance or pay a tax penalty (Mason et al., 2012, p. 137).

Health care policy change lies in the voice of the people. Policy change has begun with President Obama, but must continue towards a unified solution from those who have recognized the issues and strengthened their political will. Mason et al. (2012) mentions that lobbying efforts will not be sustained longer than one election cycle due to the loudness of voices of the currently enfranchised nonsystem (p. 152). Clinicians, hospitals, suppliers, employers, and insurance companies fear the loss of autonomy and tough price negotiations, motivating them to argue loudly against universal health care, even though they will benefit financially (Mason et al., 2012, p. 152). Mason et al. (2012) states “and there is no way to achieve true universality, or a truly national system, without that single national voice” (p. 152).

The issues are interrelated for access and insurance. Mason, Leavitt, and Chaffee (2012) define access as “the ability to obtain needed, affordable, convenient, acceptable, and effective health care in a timely fashion” (p. 124). Rural areas do not have the number and diverse specialties of health care providers as do the more populated areas. Medically underserved areas of the country may lack well-equipped facilities, convenient hours of operation, and culturally sensitive providers (Mason et al., 2012, p. 124). An individual with health insurance will suffer from the same disadvantages as the uninsured when challenged with these issues.

Mason et al. (2012) state “access is a euphemism for adequate health insurance coverage” (p. 124). Insured persons have a greater chance of finding accepting physicians, even in a rural setting. Insurance companies may limit the providers to a certain group, but the number is still greater than those accepting public aid. For example, in my area we have an excessive number of dentists. I can choose from over 400 dentists in a 30 mile radius according to my insurance. An acquaintance of mine receives public aid, lacking health insurance. None of the dentists in the area accept public aid and the only dental care she can receive is through a clinic offered twice a year. So, do we see how access and insurance issues can be separate but related?

The nonprofit community hospital where I am employed is incorporating best practices into their protocols and standing orders. Some standing orders prevent providers from ordering alternative costly medications without extensive documentation of need that meets research guidelines. The case managers also are collaborating with physicians and other providers to shorten length of stay, utilize outpatient services, and eliminate tests that are costly and unnecessary. During a recent Joint Commission visit, the hospital received awards for excellence with core measure compliance. The community is noticing the differences. They are seeing the awards, going home sooner, paying less, receiving patient education, communicating with providers, and witnessing collaboration between the many disciplines and their primary care provider. Patients are saying they can come to the local hospital, not park as far, not walk as far, know who the physician is that is treating them, know the staff taking care of them, and know that the same level of care is given without all the glitzy billboards.

To move away from a market share based competition, we must first embrace the issues that prevent universality such as cost, intrusion into freedom of choice, abhorrence of paternalism and a demand for more individual responsibility. We must realize that health care is a right and consider it a social good. Turka and Caplan (2010) compare universal health care coverage to the system of universal education:

It is the right of all Americans to obtain a basic education. It is also their responsibility to obtain it. One cannot simply “opt out” of being educated, because we as a society consider it, as a matter of utility, too important to have an educated populace. Is it less important to have a healthy populace? We may not agree on how much to spend on health insurance. And we must concede that health insurance is no guarantee of access to quality health care. But it does not take much of an education to see that leaving 50 million Americans without health insurance makes no sense. (p. 934)

I experience moral difficulty in equating financial value with human life. Although I have mentioned that health care should be viewed as a social good, human life is much more than that. Rutherford (2008) states “human life has a unique value which should be viewed differently from goods” (p. 348). Kant (1785) further explains “whatever has a price can be replaced by something else as its equivalent; on the other hand, whatever, is above all price, and therefore admits of no equivalent, has a dignity” (as cited in Rutherford, 2008, p. 349).

Holtz, C. (2008). Global health care: Issues and policies. Sundbury, MA: Jones and Bartlett.

Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2012). Policy & politics in nursing and health care (6^th ed.). St. Louis, Missouri: Elsevier Saunders.

Rutherford, M. M. (2008). The how, what, and why of valuation and nursing. Nursing Economics, 26(6), 347-351. Retrieved from https://www.nursingeconomics.net/ce/2010/article26347352.pdf

Turka, L. A., & Caplan, A. L. (2010, April). The right to health care. Journal of Clinical Investigation, 120(4), 934. Retrieved from EBSCOhost.