The United States is unique because of the complex, sometimes hidden, and frequently unintended ways it rations care. The United States is also unique among affluent nations because it does not officially recognize a right to health care. Apart from the right to assistance in an emergency room (which has existed only since 1986, and even then only requires that patients be stabilized), Americans have no legal or constitutional right to medical care. Many other nations include a right to health care in their legal or constitutional documents, and virtually all affluent democracies other than the United States provide universal health coverage as a matter of right to their citizens. The scope and definitions of these rights to health care differ, and countries have created many different kinds of health care systems to help enforce them, but what they all have in common is that rights to access and / or coverage are universal, applying to all citizens of the country. The few rights in the US health care system—such as the right to emergency treatment and the rights of senior citizens and veterans to health coverage—apply only to particular groups of the population or to particular types of care. These selective, limited health care rights are another way that coverage and services are rationed in the United States, although we seldom talk about it this way.
Despite the lack of universal health care rights in the United States, the argument that health care should be a right is a powerful one in a country where "inalienable rights" are central to citizenship and national identity. Presidents from Franklin D. Roosevelt to Barack Obama have declared health care to be a right, not just a privilege. Opinion polls for several decades have shown broad public agreement with the statement that access to health care is or should be a right.
This book tells the story of rights and rationing in the development of the American health care system since 1930. Since the United States recognizes few rights in the health care system, while refusing to recognize that rationing takes place at all, this is a challenging task. To uncover the history of rationing, the following chapters focus on the parallel themes of access to health care and the denial of health care. They tell the story of how Americans have sought access to medical services since the 1930s and how the system grew dramatically with the goal of bringing the benefits of modern medicine within reach of everyone. At the same time, the denial of access, and the refusal to make the benefits of health care available equally, have also defined the system. The history of access and denial is the history of the American way of rationing, and of a health care system whose impressive benefits are available to some, but not all.
The clash between the ideal of access for all and the reality of the denial of health care also helps uncover the history of health care rights in the United States. "The reason why there is a fuss over rights to health care is because so many are left out," writes the medical ethicist Larry Churchill.
Excerpted from Excerpted from Health Care for Some: Rights and Rationing in the United States since 1930, by Beatrix Hoffman, with permission from the University of Chicago Press. Copyright © Beatrix Hoffman, 2012.
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Add CommentThe EPA and the Department of transportation ration too. EPA cost of a live is about $9 million, for Dept. of Transp. about $6 million.
Reply | Report Abuse | Link to thisTrue, of course. There are practical limitations involved in health care just as for any other endeavor. The Right brought up Government rationing to capitalize on Government phobias held by many. The Left used denial rather than attempting to explain that rationing is already being done – largely by insurance companies that will continue to thrive under healthcare ‘reform’ being established.
Reply | Report Abuse | Link to thisTrue enough - healthcare in the US is rationed, primarily by ability or willingness to pay. Like anything else, most goes to those who are the most productive in our society. Rationing by the government will be, on the whole, worse than the current system because it will burden the system with additional cost and regulation which will consume resources that could be better used in providing care.
Reply | Report Abuse | Link to thisPlease read the excellent article by Peter Singer on the subject.
Reply | Report Abuse | Link to thishttps://docs.google.com/document/d/1XExjwbab_7tm61IKhWBBwz-5Y_CAGLi_t7O3Sul2StA/edit
Study what hospitals need to do when children are born with untreatable conditions.
Health care mostly "goes to those who are the most productive in our society...." Not quite. Unless you think that someone who inherits several million dollars and lives on the investment is more productive than a cashier at Walmart who works 32 hours a week and has no benefits. It is a common mistake to think that economic rewards follow ability or social worth. A career that you love and that contributes to society is more often than not under-compensated. Think social worker, teacher, personal care assistant, carpenter, etc. I get really tired of people who think that anyone who makes less than $100K must be a slacker. It takes everyone off the hook of needing to provide universal health care, which is what the rest of the civilized world does.
Reply | Report Abuse | Link to thisExcellent comment, thank you. It reminds me of the ethics principles my Mother taught me.
Reply | Report Abuse | Link to thisTHE AUTHOR'S FATAL FLAW
Reply | Report Abuse | Link to thisWhen a pregnant illegal immigrant heroin addict from a car accident can stumble into an ER and charge up $250,000 to U.S. taxpayers -- that is not a "right."
It is insane for everyone involved. No sane country would tolerate that kind of rampant idiocy, except the USA.
So, Ivory Tower & NYTimes: please attempt to grip reality. Thank you.
I think your scenario involves too many other social failings on the part of U.S. Immigration, primary health care and assuming that an individual has complete authority to "charge" anything in an emergency department.
Reply | Report Abuse | Link to thisDrug addiction (especially in pregnant women) is a growing concern even among U.S. CITIZENS.
A lax grip of reality indeed.
T, why, of course, it is much more 'noble' with illegal immigrants are involved.
Reply | Report Abuse | Link to thisNot. Just ask the legal American trades-people who lost their jobs to illegal immigrants.
Thanks for making my point, on the fatal flaw of the author. Every little bit helps.
there is a difference when health care is rationed with the involvement of those to whom it is rationed to versus via the very blunt hand of government. Having worked in the public health setting the I can tell you that main force behind rationing is how politically connected the patient is. There is no rationing for those deemed important by the bureaucracy versus those who are not (that would be you and me). If you doubt this I reference you to two articles:
Reply | Report Abuse | Link to thishttp://www.dailymail.co.uk/news/article-2161869/Top-doctors-chilling-claim-The-NHS-kills-130-000-elderly-patients-year.html
http://www.dailymail.co.uk/health/article-2161489/Nine-10-NHS-Trusts-rationing-operations.html
Be sure to read the comments on these stories the detail how people are really treated by the british NHS.
I agree and I can attest to even worse!
Reply | Report Abuse | Link to thisI used to work for a large EMS Service in Tucson, AZ. The company was paid b the Government to transfer Mexican Nationals from Nogales, AZ to Tucson for medical care that they could not get in Mexico.
We would transport the patients into Tuscon and the people woud get their medical care. And, if they did not have transportation back, we would transport them back to Nogales when they were discharged.
All of this was at no cost to the patient or their family. Yet, we had local citizens of all races and backgrounds that could not get medical care because they could not pay.
It is a shame that you don't understand American economics. The productive are the people that produce. Typically, with the exception of row crop agriculture, these are the the lowest paid at any given company. There are the occasional rare exception. Over all, the most valuable in society get paid very little or not at all.
Reply | Report Abuse | Link to thisI'm not poor although I was for a decade or so. Now I'm firmly middle class. My opinion that healthcare is a right is based on the wisdom of the 1800s Kaiser Friedrich Wilhelm of Prussia. Before he died of cancer and his son became the worst (and last) Kaiser in history, he established government health care for all workers. This was a man who was among the richest in the world so this has nothing to do with social status or income. It is all about basic human decency, which you, soccerdad, seem to lack.
Just be honest and admit that you are very self centered and don't really care about others. I much prefer an honest sociopath to a dishonest saint.
This goes back to the post by tsurman7 - there are numerous other failings occurring long before universal healthcare comes into play.
Reply | Report Abuse | Link to thisFirst of all, it is far too hard for a legitimate immigrant to become a tax paying citizen and we have absolute limits on how many can enter. In addition, the wealthy that ruthlessly exploit the illegals don't face the massive fines, decades of incarceration and loss of citizenship they should. If no one will hire them they won't come.
Second, we are doing a terrible job of preparing our children for the modern economy. I'm not talking about the middle class and rich. I'm talking about the millions of low income children who, with proper education and emotional support could become major contributors to our economy. Instead we shoot down their dreams, tell them to have athletes and entertainers as role models even though those people don't do anything useful and then warehouse them until they die, drift into organized crime or go onto welfare.
We have several million USA workers that can't find jobs because the greedy outsourced the work to slave labor countries. I have no problem with building the economies of other countries as long as it doesn't hurt us at the same time. If we required outsourcing to pay the same wage and benefits to the foreign workers that American workers would get then I'd have little problem with it. The more money other countries have the more they buy from us. Works for me but don't screw my neighbor over to pad your pockets and expect me to respect you.
In total taxes the Germans pay about what Americans do but they get a longer lifespan and universal heath care. Why is anyone contented with the USA being second rate?
However, if you read the first link, it talks about and extra 14 months a certain patient gets, he is an a wheelchair and has all kinds of trouble, health-wise. I would not want to live those 14 months under those circumstances, my wife knows that and a living will spells it out.
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