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Tuesday, November 20 , 2018, 6:37 pm | Fair 59º


Harris Sherline: Is Health Care a Right?

Whatever we decide, our current system of no limits simply cannot be sustained.

Here’s a hypothetical: Someone close to you has a very serious illness, diagnosed as terminal, say cancer, and the doctors are recommending aggressive treatment with chemo-therapy or radiology, or major surgery, or some combination thereof. What should they do?

Harris Sherline
Harris Sherline
On the surface, the answer may seem obvious: get the treatment, of course.

But, what if it produces extremely harsh side effects that are so debilitating the patient is barely able to function for weeks or months. And, although the treatment may buy the patient some time, perhaps a few months or a year, it is clear that he or she will not live much longer. Add to the equation the fact that the care will cost $200,000 or $300,000, perhaps much more.

Does this patient, or any patient for that matter, have an absolute “right” to treatment (health care) regardless of prognosis or cost? How do we decide? And, who should make the decision? The family members, the doctor or the hospital or the rules of the health-care system?

These are never easy decisions, and they are complicated by an overlay of personal factors. I have seen families confronted with such situations reach the point of open conflict over whether to “pull the plug.” It can be a gut-wrenching decision, often involving deep-seated feelings about a parent, a spouse or perhaps a child. In 1998, the highly publicized Terri Schiavo case thrust this issue into the public domain at the time. The Florida woman was diagnosed as being in a “persistent vegetative state,” and the argument between her former husband and her parents made headlines for weeks.

The issue is further complicated by cost considerations, which is where those societies that have socialized or nationalized health-care plans encounter problems: They can’t afford extraordinary health-care costs for many elderly or gravely ill patients. As a result, health care is rationed, denying it to certain classes of patients, such as those who may be extremely obese, or smokers, or who may have an incurable disease or condition.

In 1901, average life expectancy in the United States was approximately 49 years. Over the last 100 years, it has dramatically increased to 77.9 years. This provides testimony to the advances in health care that have been made, but costs have escalated along with longevity.

If health care is a “right,” should there be a limit? If so, what should it be? Is it possible to provide all the health care that everyone needs or wants on an open-ended basis? With the Medicare and Medicaid programs already operating at a substantial deficit, where will the money come from to further expand the scope of the coverage? The Peter G. Peterson Foundation has reported that if the federal government stopped the Medicare program tomorrow — collecting no more payroll taxes and allowing no further accrual of benefits — it would still owe about $34 trillion to those people who are already entitled to health-care benefits.

Furthermore, the highest percentage of health-care costs are incurred by the elderly. People in general require more health-care services as they age.

A 2005 Denver Post editorial, “Medicare: a real fiscal crisis,” noted: “Last year, Medicare’s Hospital Insurance Trust Fund, which pays hospitalization costs for the elderly, reached a foreboding tipping point, paying out more to recipients than it collects in payroll taxes, comptroller general David Walker told the House Ways & Means Committee earlier this month. By some projections, the trust will be depleted by 2019. The forecast comes as 79 million baby boomers get set to retire in the next two decades. To avoid a fiscal wreck, Congress should act now. Yet, Medicare is not even on the table ... Since Medicare was created in 1965 it has grown to a $325 billion program serving 42 million beneficiaries. Medicare costs are projected to increase 9 percent a year through 2015. (Medicaid, the federal-state insurance program for low-income and disabled people, also is under enormous cost pressures.)”

“The potential remedies to keep Medicare solvent are none too popular — raise payroll taxes, increase the age of eligibility, or hike seniors’ premiums, deductibles or co-pays. Controlling costs by reducing the reimbursement rates has occurred regularly and hurts beneficiaries when doctors and hospitals refuse to see Medicare patients.”

So, the question remains, “Is health care a right?” Or, perhaps the question should be “How much health care is a right?” And, how do we decide how much and for whom? How should the equities between individuals be balanced out?

There are no easy answers, but treating health care as an absolute “right” without limit is clearly not the solution, if for no other reason than the fact that it can’t be sustained.

Harris R. Sherline is a retired CPA and former chairman and CEO of Santa Ynez Valley Hospital who has lived in Santa Barbara County for more than 30 years. He stays active writing opinion columns and his own blog, Opinionfest.com.

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