Deseret News, Thursday, March 07, 2002
Health care not a right, Koop says
By Twila Van Leer
Deseret News staff writer
Americans have no constitutional right to health care, but the perception is so strong that such care should be a basic right that the country is likely to have a socialized system sometime in the near future, Dr. C. Everett Koop said Thursday.
The former U.S. surgeon general, who in the 1980s took on such battles as the AIDS epidemic and the growing evidence that tobacco causes illness, spoke to an overflow crowd in the Huntsman Cancer Center auditorium. The occasion honored Dr. Dale G. Johnson, a pioneer in pediatric surgery and longtime physician at Primary Children's Medical Center. Johnson trained under Koop, also a pediatric surgeon, and they worked together for a time.
The Salt Lake physician recently stepped down as head of the division of pediatric surgery in the University of Utah medical school.
Answering the question raised in the title of his talk, "The Right to Health Care: Has the Time Come?" Koop had an emphatic "no. The time never will come when health care is a right."
No basic American document gives people that right, he noted. In fact, the Bill of Rights appended to the Constitution was designed to "protect people from government, rather than establishing a right to expect something from government." The preamble to the Constitution, he said, "provides" for the common defense but only "promotes" the general welfare.
Regardless, public polls have shown increasingly large numbers of Americans who believe health care should be a basic right, he said. "And they think they should get health care as good as a millionaire gets."
The problem with the attitude, he said, is that "someone has to provide for that right. Health care costs a lot. There would be a very heavy price tag."
Medicare, a social health program for the elderly, has been an effective laboratory for highlighting the problems of mass entitlement, Koop said. The impression is that Medicare covers the cost of care for the elderly at no cost to them. In fact, Americans have to pay into the program for a long time before becoming eligible, and the services don't cover many vital medical costs, including prescriptions.
"Only about 45 percent of the health-care costs for the elderly are paid," he said. And Medicaid, a state-sponsored program for the poor, is even less effective, he suggested.
Initially, Medicare provided "as much as you want," and the medical community acclimated itself to that premise, Koop said. Everyone benefited "from the Medicare goose laying many wonderful golden eggs . . . If I said you didn't have to pay for a new car, what car would you buy?"
The result was runaway inflation in health care and a shift to managed care that now rewards the medical system for providing less treatment. Paying patients have long subsidized those in the government-sponsored programs, he noted.
"If there is a right to health care, someone has to provide it. That means higher premiums and higher taxes or both. And as popular support grows, there is a popular aversion to facing the hard questions" such as who, how much and how to control the costs. "Health-care reform is a never-ending problem. Each solution becomes a problem."
To counterbalance those problems, Koop urged those in the medical ranks to "take the high road of professionalism," to adopt the higher ethic of self-sacrifice. He recalled that in his early days as a surgeon, only 30 percent of his work was compensated. "Do the right thing for those for whom health care is not yet a right," he said.
© 2002 Deseret News Publishing Company