Can You Mix Inalienable Rights with the Business of Medicine?

    We believe our work is finished. We asked the question, you know the obvious answer. Thomas Jefferson suggested in the Declaration of Independence that American citizens should have inalienable rights including life, liberty and the pursuit of happiness.

    Setting liberty and the pursuit of happiness aside, for now, generally, we divide rights into those which are natural versus legal. Clearly, we have some rights simply because we allow behaviors, and they are supported by our highly malleable laws and legal system. Other rights exist essentially independent of law, current acceptable social manners, contemporary political correctness, and leanings of the present government. These rights are expected or natural. And, that which is natural or universal comes to be viewed as inalienable.

    Rights define our senses of behavioral freedom and sense of entitlement. They circumscribe the expectations of our behavior, that of others, and that expected of corporate entities which are often referred to as if sentient. In our civilization, a body of people of shared civil manners and rights are the bricks and mortar forming the infrastructure of morality, law, and governance we share.

    From this point, you work backward. Considering government the arbiter, the issues pertinent to unalienable rights are then based on the society’s decisions defining our morality. Morality is an essential element because inalienable rights generally address the “good,” by necessity defining the bad, right, wrong, and so on. Of course, different religious/spiritual groups, Atheists, Legalists and those undecided about a source of greatest moral authority never all agree on “the good”. Even inalienable rights are always socially dynamic issues, including the definitions and rights regarding “life”.

    If in the U.S. there is such an entity as an inalienable right to life, then such encompasses the inalienable right to that which keeps you alive. That is, you cannot live without attending to the needs for food, water and all that which protects you from, or is applied in response to the adverse effects of living in our world (AEOL). We do not all have access to ideal food and water, but we shall also be put that aside for now. However, what is society’s responsibility to address the AEOL on people’s well-being? If the effects of AEOL are physical and mental illness, injury, disease, and disability, then it would seem that comprehensive medical care for our citizens is the correct response to addressing this inalienable right.

    Presume that everyone both empowered and relevant to considering the above arguments drew comparable conclusions. In that case, they would agree that every citizen should have access to comparable medical care. The challenges then become 1) access as primarily defined by the distribution of care facilities, appropriate types of service providers, and products, and 2) management of quality and cost of products/services delivery.

    The cost of all contemporary medical products, services, and related insurance rises much faster, year over year than personal incomes and net revenue growth of the average business. So, most Americans and their employers are not ready to handle the costs of medical care on a cash-basis or via insurance. Issues of access and distribution aside, government intervention to address medical care as an inalienable right then means either 1) marked cost capping and controlling consumer fees, 2) subsidizing patient payments, or 3) a combination. Capping and controlling costs would cause an evolution in the business of medicine. All participants (pharmaceutical companies, medical instruments and soft goods manufacturers, sales/distribution organizations, clinicians, insurers, IT services and others) in the industry would need to reconsider their margins, as well as their ability and willingness to stay in the medical industry. However, our government needs to control the sometimes markedly excessive and inflationary medical billing practices. Capping and controlling costs should ideally be tackled first, addressing runaway fees associated with hospital services, pharmaceutical products, surgical procedures, medical hardware, other medical technologies and insurance coverage. All components of the medical system will resist capping and controlling fee schedules.

    Providing patient fee subsidies will always be fraught with inflationary excesses. Deductibles and patient portions of bills need elimination. Even nominal point of service charges could always be a challenge unless the net annual out-of-pocket personal expenditures do not exceed the price of a visit to a fast food venue. Otherwise, the middle and lower economic strata and their [potential] employers would need to consider the cost of medical benefits versus eating, acquisition of other necessities, the true value of different income or revenue opportunities from the employee and employer perspectives. Additionally, clinical fee schedules should be revamped to a less itemized approach that favors intellectual skill, and clinical assessment prowess over procedures performance, technology application, and surgical intervention.

    Nobody would suggest that all have the inalienable right to own a brand new luxury automobile, yacht or personal jet. Likewise, there are many products and services people should not expect to acquire if they have not financially succeeded in life to the extent of their more affluent neighbors. However, if as a society we state that life, including full, high-quality medical care is an inalienable right of American citizens, then we should deliver it, without burdening others. But, there is “no free lunch” medical care. So what does “full, high-quality medical care for all citizens, without burdening others” actually mean? You might define it in two ways: 1) products and services price caps, and 2) society attitude adjustment.

    Regarding society attitude adjustment, as an example, we already deliver military services to protect the entire nation without attempting to offer some stratified, sliding scale, itemized bill to each citizen (separate from personal taxes). Medical services could be addressed in a similarly, particularly considering the many ineffective billions of dollars given to foreign governments that are not even our friends. If medical businesses were all conscripted, essentially indefinitely subcontracted, to deliver care as a uniformed service (e.g., blend of active military care and preferred provider organization models), with a central payer and QA provider, maybe we could do it.

    However, unlike changes in health measures, per capita, government spending on medical services is a poor indicator of the effectiveness of U.S. medical care. Neither was ACA enrollment a measure of care delivery or effective care (e.g., no more than owning season tickets was a measure of NFL game attendance during the 2017-18 season). Throwing taxpayer money at a series of poorly cobbled strategies is not an effective national medical care solution. Inalienable right or not, we cannot deliver broad-based high-quality medical care to all citizens via current medical business models.

ISG Health knows that your good health matters.