There is a lot individual and institutional pain in the budget cuts this year and there is more to come. But so far, Governor Patrick and legislative leaders have largely spared the state’s free and subsidized health coverage programs: MassHealth and Commonwealth Care. Some providers argue that cutting insurance makes more sense than cutting programs for people who are already sick. They may have a point, but the insurance programs have politics on their side. Leaders on Beacon Hill want to, and are under pressure to, continue the success of the state’s health coverage law.
Support for the insurance coverage law here is even more striking when you look at what’s happening as other state’s cope with budget gaps. A “Families USA” report out late last month has this summary: half of the states have enacted or proposed Medicaid or CHIP (Children’s Health Insurance Program) cuts in FY ‘09 and/or FY ‘10.
Here are a few examples:
- in California, Governor Arnold Schwarzenegger proposes to cut the income eligibility for that state’s Medicaid program from 100% of poverty to 72%. The report estimates that 430,000 parents would lose coverage by 2011.
– in Oregon, Governor Ted Kulongoski has proposed to reduce the income eligibility level in that state’s Medicaid plan for some senior citizens and people with disabilities from $1,991 a month to $1,300 a month.
Other states are cutting benefits:
Louisiana is reducing the number of prescriptions allowed adults on Medicaid and delaying the start of some home and community-based services.
Oregon is considering ending dental and vision services.
During Governor Patrick’s budget briefing last week, Administration and Finance Secretary Leslie Kirwan stressed that Massachusetts has made similar cuts in the Medicaid program during prior economic declines but is not doing so this time. Many governors are hoping that a proposed increase in federal Medicaid funding will offset the need for some of these cuts, but many state funded programs will be screaming for their share of additional federal funds, if they arrive.
Martha Bebinger
I would recommend that anyone interested in this debate who wonders why the Mass plan isn’t working, why it costs so much more than anticipated, and why primary care and other physicians are fleeing while patient wait times are going up (if they can even find a doctor to take them) should read this article by Dr. Paul Hsieh:
Mandatory Health Insurance: Wrong for Massachusetts, Wrong for America
The solution to the problem is to get the government out of the health care market. Hsieh concludes his excellent article thusly:
“The solution to disproportionately high health care costs and poor access is for Americans to recognize that health insurance and health care are commodities that can be produced only by means of the long-range thinking, planning, and risk-taking of businessmen acting in a free market, and that individuals and insurers have the moral right to contract with each other as they see fit. Mandatory insurance fails because it ignores these facts and violates these rights.
Although mandatory insurance masquerades as a “market-based solution,” in reality it is just another form of socialized medicine. The Massachusetts plan failed because it suffered from all the moral and practical flaws inherent in any system of socialized medicine.47 Mandatory insurance was not right for Massachusetts—and it is not right for America. It is a rights-violating road to disaster.
If we Americans value our health and our lives, then we must reject mandatory health insurance. We must demand that the government stop violating individual rights and start protecting them. We must demand a genuine free market in health insurance and health care, because only a free market can provide us with the quality, affordable health care that we all need.”
C. August believes health care is a commodity, to be subject to market forces. I believe that basic health care is a right — as do the governments of most advanced societies. Our problem is we don’t know how to define “basic” and we won’t acknowledge that a two-tiered system of care and access to care is unavoidable.
RThompson does hit the nail on the head concerning the core of the issue. He states a belief that health care (at whatever level) is a right. He is also correct that many modern societies take this view, but the key to this is remembering how they differ from America. Each and every one of those societies is more socialist than we are. Each respects core individual rights — life, liberty, the pursuit of happiness, and property — to a lesser degree than ours does.
The problem the concept of “health care as a right” is that it is what is known as a “positive” right; i.e. one which confers a duty upon others to provide it. Therefore, if he is correct, then those who enter the medical profession become duty bound to give their services away. They become slaves.
Health care is not a right, just as there is no right to a car or a right to have your house painted every five years.
I must recommend some key reading on this point, namely an interview with philosopher Leonard Peikoff, “Health Care is Not a Right.” Here is a key excerpt:
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Now our only rights, the American viewpoint continues, are the rights to life, liberty, property, and the pursuit of happiness. That’s all. According to the Founding Fathers, we are not born with a right to a trip to Disneyland, or a meal at McDonald’s, or a kidney dialysis (nor with the 18th-century equivalent of these things). We have certain specific rights–and only these.
Why only these? Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want–not to be given it without effort by somebody else.
The right to life, e.g., does not mean that your neighbors have to feed and clothe you; it means you have the right to earn your food and clothes yourself, if necessary by a hard struggle, and that no one can forcibly stop your struggle for these things or steal them from you if and when you have achieved them. In other words: you have the right to act, and to keep the results of your actions, the products you make, to keep them or to trade them with others, if you wish. But you have no right to the actions or products of others, except on terms to which they voluntarily agree.
To take one more example: the right to the pursuit of happiness is precisely that: the right to the pursuit–to a certain type of action on your part and its result–not to any guarantee that other people will make you happy or even try to do so. Otherwise, there would be no liberty in the country: if your mere desire for something, anythingg, imposes a duty on other people to satisfy you, then they have no choice in their lives, no say in what they do, they have no liberty, they cannot pursue their happiness. Your “right” to happiness at their expense means that they become rightless serfs, i.e., your slaves. Your right to anything at others’ expense means that they become rightless.
That is why the U.S. system defines rights as it does, strictly as the rights to action. This was the approach that made the U.S. the first truly free country in all world history–and, soon afterwards, as a result, the greatest country in history, the richest and the most powerful. It became the most powerful because its view of rights made it the most moral. It was the country of individualism and personal independence.