In one of my earliest posts, I examined the arguments of those who insist that healthcare is a basic human right. Proponents of this position tend to misunderstand the difference between rights and needs, and to base their arguments on compassion rather than logic. In Healthcare Is Not A Right, I point out that a right cannot exist as long as it creates a corresponding obligation that someone else is required to satisfy. We cannot simply declare that healthcare is a right without trampling the rights of our healthcare providers.

The key to any successful healthcare reform effort will be the development of effective cost control measures. Politicians are reluctant to discuss rationing of medical services, but no nation can provide universal coverage without some sort of rationing mechanism in place. Revisiting The Oregon Plan: The Future Of Healthcare In America examines the issue of rationing, and takes a look at one of the most efficient methods devised to date for the allocation of health services. The original Oregon Plan was reviled by critics for its technocratic approach, but it will not be possible to provide universal coverage unless we adopt a rational system for the allocation of medical resources.

Conventional wisdom tells us the problem with our current system is that too many Americans lack health insurance. What If No One Had Health Insurance examines the question from the opposite perspective and suggests a return to a traditional fee for service model. Modern health plans encourage over-consumption of health services, and provide no logical connection between the price we pay and the services we receive. The most effective way to reduce healthcare costs may be to restore a direct relationship between consumers and healthcare providers.

The bankruptcy of Chrysler and General Motors has focused national attention on the crushing cost burden of employer provided health benefits. While many credit GM with introducing the concept of employer provided healthcare, it is becoming increasingly obvious that a new approach is needed if American companies are going to remain competitive in the global marketplace. With workers changing jobs more frequently, UAW Workers Really Do Make $71.00 Per Hour re-examines the logic of tying health and retirement benefits to our fleeting relationships with employers.

Healthcare reform has the potential to transform our government and our economy more dramatically than anything since the passage of the Social Security Act in 1937. There is no doubt that our current system is badly broken, but we owe it ourselves as a nation to engage in an informed debate rather than basing our positions on partisan talking points. No one knows what form it will take, but major reform of some type is almost certainly inevitable. If we allow the debate to be dominated by lobbyists and partisan operatives, we will have no one but ourselves to blame when the final solution is worse than the current problem. I encourage you to join the conversation here and make your voice heard before it’s too late.

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Is Obama’s Plan A Backdoor Attempt At Single Payer Healthcare

President Obama believes that the political and economic climate of the moment presents the perfect opportunity for him to accomplish what his predecessors have been unable to achieve, but his current proposal falls short of government run universal coverage. This has enraged many of his most liberal supporters, who believe he is their best chance to achieve their utopian ideals. At the same time, it has caused some conservatives to soften their opposition since it does not represent an outright nationalization of the largest sector of our economy. Regardless of our political views, it is essential that we all recognize Mr. Obama’s plan for what it is; a backdoor attempt to impose single-payer universal coverage.

The central point of the President’s program is a government run plan to compete against private health insurance companies. He claims that this is necessary to encourage competition in the marketplace. With over 1300 health insurance companies operating in the U.S., it’s hard to believe that lack of competition is the biggest problem we face. The long-term goal of the government plan is not to encourage competition, but to ultimately put the private insurers out of business. At that point, the government plan will be our only remaining option.

Before you call me an alarmist, I ask you to consider this question. Is it truly possible for private companies to compete on a level playing field against the federal government, when the government has the ultimate authority to determine the rules of the game? Once the government plan is in place, what is to stop the Feds from stacking the regulatory deck in their own favor?

The business of insurance is based on the concept of actuarial risk. Individuals or groups pay premiums based on the risk they represent. In a rational system, young healthy individuals pay substantially lower premiums than older individuals or those with pre-existing conditions. This strikes many as fundamentally unfair, but the business of insurance is not about fairness or need. It is about precise statistical modeling, and the private insurers cannot exist without the ability to place a price on predictable risk.

While private companies have to make a profit in order to remain in business, the government operates under no such constraint. In spite of countless trillions in unfunded future obligations, the willingness of our elected representatives to spend borrowed money apparently has no limits. This fact alone will make it impossible for any private company to compete against the government plan. The government can simply undercut the rates of the private insurers, and our lawmakers will be perfectly happy to add the annual shortfall to our already incomprehensible national debt.

Once the government plan is in place and the regulators do their predictable mischief, the situation for the private insurers will only get worse. It is not hard to imagine new federal regulations that require all plans to offer the same level of coverage as the government plan, or to require private insurers to offer uniform pricing without regard to obvious risk factors. Over time, the increasingly onerous burden on the private insurance companies will drive them out of existence.

President Obama has not put forth a single payer plan because he knows that he cannot muster the political support to nationalize our entire healthcare industry in one fell swoop. He has learned from the mistakes of the Clinton’s, and he is savvy enough to realize that what he cannot accomplish directly through legislation, he can achieve indirectly through so-called competition. If the government plan becomes a reality, it’s a safe bet that a single-payer system will not be far behind.

Even as a dyed in the wool free market capitalist, I am fully prepared to admit that our current system is badly broken. The cost of healthcare services continues to rise much faster than the rate of inflation, and there are far too many people for whom coverage is either unaffordable or completely unobtainable. Most Americans agree that it is not acceptable for anyone to be deprived of basic medical care in the most prosperous nation in the world. Where we disagree is on the reforms necessary to solve the problem.

Our current healthcare system has massive implications for our future role in the global economy. As the sad plight of the Big Three automakers clearly illustrates, American companies are going to find it increasingly difficult to compete as long they are saddled with the crushing burden of employee healthcare costs. Since we are the only major industrialized nation without some form of government run healthcare, it is only a matter of time until our employers find this burden to be unbearable.

There is no question that significant reforms are needed, but there is widespread disagreement as to how we go about designing a system that provides adequate coverage for everyone, without creating tax obligations that will stifle future economic growth, and without a complete government takeover of the largest sector of our economy. Perhaps more so than with any previous government policy, healthcare reform requires vigorous open debate based on reason and reality. A nationalized health service will fundamentally alter the nature of our economy and our democracy forever.

For decades, those in favor of a government run system have spoken of healthcare as a basic human right. Our President is among those who have publicly stated their belief in this right to healthcare. Unfortunately, it is simply not possible to hold a rational debate over a policy reform of this magnitude when our starting point is a flawed assumption. The delivery of healthcare services to those in need is an absolute necessity, both on an individual and a societal basis. The aggregate economic impact of failing to provide these services is staggering, and we must take this cost into consideration as we consider our reform options. What we must not do is succumb to the foolish notion that we have a right to healthcare, or that such a right can even exist.

Our founding fathers had a clear understanding of the inherent nature of rights, and of the fundamental difference between rights and entitlements. They understood that the pursuit of happiness was an individual quest, and that the outcome was not guaranteed. They recognized that by exercising our rights to freedom of expression, or religion, no cost or burden is imposed on any other individual or group. When we declare that healthcare is a right, however, we automatically create a corresponding obligation for someone else to provide it. Under such conditions, a right cannot exist.

It has been said that the hardest thing to kill is a government program. Not since the passage of the Social Security Act in 1937 has a reform proposal had the potential to reshape our lives and our economy as dramatically as nationalized healthcare. Reform is probably inevitable, but we must demand that it come about in the light of day. We cannot allow any program to be crafted in the same manner as the economic stimulus package that no one read until it was too late. If we tolerate the passage of a poorly conceived partisan plan, thrown together in haste to take advantage of a narrow window of political opportunity, we will suffer the consequences for generations to come.

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What If No One Had Health Insurance?

The $71.00 figure is the total wage and benefit cost borne by these companies for active hourly workers. While the average base wage compares favorably with the foreign manufacturers, the rest of the picture shows a stark contrast between the UAW workers and their non-union counterparts. Overtime, shift premiums, vacation pay, and holiday pay, boost the average UAW worker’s earnings to nearly $40.00 per hour in cash compensation.

The most significant difference between union and non-union autoworkers is in the cost of their employer paid benefits. GM reported that in 2006, 46% of total compensation to UAW workers was paid in the form of benefits. These include hospital, surgical and prescription drug coverage; dental and vision benefits; group life insurance; disability benefits; supplemental unemployment benefits; unemployment compensation; and the employer’s share of payroll taxes. It is important to note that the total benefits cost also includes contributions to workers pension accounts to be paid out at retirement.

During the bailout hearings, the UAW has repeatedly claimed that the $71.00 figure includes pension and healthcare benefits for retired workers. As this report by the Heritage Foundation indicates, this claim is patently false. Since GM has roughly double the number of retirees to support for every active worker than Ford or Chrysler, it would naturally follow that their hourly cost per worker would be substantially higher if the payments to retirees were included. The actual difference in hourly costs per worker between the 3 companies does not support this claim. While the $71.00 per hour figure does include the cost of future retirement benefits for active workers, it does not include any payments to those who are already retired.

Some have credited General Motors with inventing the concept of employer paid healthcare and retirement benefits. At the time these policies were put in place, they made perfect sense given that lifelong employment and economic protectionism were both common practices. The world has changed since then, but the auto makers and the UAW have refused to adapt. The programs that were once held up as a model of progressive business now threaten the very existence of the company. In a global economy, it is simply not possible for any business bearing the crushing burden of retirement and healthcare costs to compete against those that do not. This is not simply a problem faced by the Big Three, but one that we must address on a national level, sooner rather than later.

Over the last few decades, the majority of American companies have abandoned traditional defined-benefit pension plans in favor of defined-contribution programs such as the 401k. This has eased the burden on employers, but placed the retirement security of workers in doubt. Many employees fail to participate, and those who do often make poor investment decisions. Even those who have done everything right have seen their savings decimated in the current market crash. Many retirees who sacrificed to ensure a secure future are now finding themselves in dire straits, and given the bleak economic outlook for the next several years, many will not live long enough to see the financial markets rebound.

As if massive market fluctuations aren’t enough of a problem, Motorola announced today that it will discontinue matching employee contributions to 401(k) plans on Jan. 1, 2009. This will have a much more substantial long-term impact on the employees than a simple wage reduction, but management probably viewed it as the lesser of two evils in terms of employee morale. Before the current economic crisis is behind us, many more companies will probably follow their lead. There is no guarantee that once these contributions are eliminated they will ever be restored.

Employment trends indicate that people entering the workforce today will probably work for ten or more companies in the course of their careers. Even those of us with many years of work experience will find that our relationships with individual employers will be shorter than in the past. Whether we like it or not, many of us will spend large portions of our careers as independent contractors or self employed freelance agents. Given the changing nature of the relationship between employers and employees, it simply does not make sense to continue to tie our healthcare and retirement security to a series of fleeting jobs.

While our elected leaders flail helplessly at the economic problems we face today, no one in Washington has the courage to address the longer-term issues we will face tomorrow. Our retirement and healthcare systems are badly broken, and just like the Big Three, nothing short of a wholesale reorganization will make them viable.

The most common proposals to reform the system include legislation that would require employers to provide coverage, expanding eligibility for existing government programs, or the creation of a government run single-payer system. All of these proposals are based on the idea that routine health care expenses are somehow different from any other item in our family budgets. Where did this notion come from? Maybe the question we should be asking ourselves is not how can we increase the number of people with insurance, but what would happen instead if no one had health insurance?

By definition, insurance is intended to compensate for catastrophic losses that we could not otherwise afford to bear. It makes perfect sense to insure ourselves against the potentially devastating financial impact of a major illness or injury. Unfortunately, what we call health insurance in this country has been transformed through legislation and consumer activism into something that no longer meets the traditional definition. We are insuring ourselves against runny noses and sniffles. What we really have today is a system of non-refundable prepaid medical care. With the exception of certain cell-phone plans, there is no other product or service that we purchase on a prepaid basis, so why should medical care be any different?

The average annual cost for an individual policy is rapidly approaching $5000.00, while families pay nearly $13,000.00 for healthcare coverage. The reality is that the overwhelming majority of us pay for substantially more medical care than we actually consume, so why do we pay for it in advance? Even more curious is why we continue to pay so much more every year for services that most of us do not use. Health insurance costs have increased 27% from 2004 to 2008, and a whopping 119% since 1999.

One of the major problems with the current system is that employees are woefully ignorant of the true cost of their health benefits. While companies have passed an increasing share of the premium cost onto their workers in recent years, the bulk of the burden is still borne by the employers. On average, employees only pay 16% of the total premium cost for a single policy, and 27% of the cost for a family policy. That means employers are paying nearly $9500.00 toward the cost of a family policy, and in many cases the employee is never aware of the contribution. The reason that wage growth is stagnant is that healthcare benefits represent an ever increasing portion of total employee compensation. Most workers never consider the fact that their cash compensation would be substantially higher if their employers did not cover the cost of health insurance premiums.

Prepayment is not the only peculiar aspect of our current system. What other product or service do we ever buy without knowing the price in advance? We would never fill our grocery carts or purchase any other product without a clearly marked price, yet those of us with insurance never inquire about the cost of routine medical procedures. There would be far fewer unnecessary tests performed, and far more generic drugs prescribed if there was a logical connection between the price we pay and the medical services we receive. That connection is completely broken under our current system.

While policymakers remain focused on the idea of providing private insurance coverage for everyone, there is another idea that is worthy of consideration. Perhaps the answer is to dismantle the current system of prepaid care and return to a traditional fee for service model for routine medical services. Under this scenario, everyone would be required to have insurance against catastrophic illness or injury, but the cost of such a policy would be quite small in comparison to the current all-inclusive prepaid plans. By reestablishing the connection between the price we pay and the services we receive, we would all become more rational consumers of healthcare services.

Skeptics will claim that the cost of routine care is simply too high to be borne out of pocket by the average family, but the average family with private insurance is already paying nearly $13,000.00 in annual premiums. Costs would fall rapidly when rational consumers force medical service providers to compete on price, and when the providers are no longer responsible for the huge administrative burden associated with processing billions of insurance claims. Prescription drug prices would fall dramatically for the same reasons. The most effective way to control healthcare costs is by restoring a more direct relationship between consumers and healthcare providers.

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Senator Obama wants us to believe that every American will have access to the same healthcare coverage provided to members of Congress, and that it can be paid for by raising taxes on only the top 5% of income earners. Given that the top 5% already pay over 60% of all federal income taxes, how realistic is it to expect that this small group of taxpayers can also foot the bill for what would certainly turn out to be the most expensive government-run program of all time? Faced with the impending meltdown of our Social Security and Medicare systems, are we to believe that our government can take on an even more costly program without sacrificing the quality and quantity of care currently available?

While there are diehards who still maintain that we have the greatest healthcare system in the world, the fact remains that there are far too many people who lack access to basic health services. On the other hand, critics tend to wildly inflate the actual number of uninsured Americans to bolster support for government run universal coverage. As is usually the case, the truth lies somewhere in the middle, and before we throw the baby out with the bath water, we owe it to ourselves to take a closer look at the facts.

Who Are The 47 Million?

The often cited figure of 47 million Americans without healthcare coverage is taken from a census bureau report titled Income, Poverty and Health Insurance Coverage in the Untied States: 2005. The figure of 46.577 million cited in the report is actually broken down into a number of sub-groups which require closer scrutiny before any meaningful conclusions can be drawn.

While the report does not distinguish between non-citizens who are here legally versus illegal aliens, it does count 9.5 million non-citizens among the uninsured. It is interesting to note that while non-citizens only make up about 7% of the total U.S. population, they represent more than 20% of the uninsured. Unfortunately, no distinction is made in the report between non-citizens who are permanent residents versus those who are here on a temporary basis.

The report also provides a detailed breakdown of the uninsured by race. Of the 46.577 million uninsured, over 29% are identified as Hispanic. Without a more detailed examination of the facts it is impossible to draw further conclusions, but there is ample reason to speculate that a very large number of illegal immigrants are included in the total figure. In other studies, the census bureau estimates this number to be as high as 5 million. Immigrants living and working legally in this country should certainly be entitled to the same benefits as citizens, but the idea that illegal immigrants should be granted these benefits is very difficult to support.

Another very large group included among the 47 million are the voluntarily uninsured. These are people who have the financial means to purchase health insurance and simply choose not to do so. The majority of these are young people in very good health who are betting that their out of pocket expenses for healthcare will be lower than the cost of insurance. Their choice may be foolhardy, but it is a conscious choice nonetheless, and these people should not be counted among those to whom coverage is not available. Included in the total figure of uninsured Americans are 8.3 million people living in households with incomes between $50K and $75K, and another 8.74 million with household incomes above $75K. These people represent 36.5% of the so-called 47 million Americans without healthcare coverage, and when combined with the estimated 5 million illegal aliens, these two groups make up close to half of the total.

The 47 million figure also includes a large number of people who are already eligible for existing government run insurance programs, but who for some reason have not enrolled. Included in this group are approximately 8.3 million children under the age of 18, and roughly half a million seniors over the age of 65. Many of these children would be eligible for the Children’s Health Insurance Program, and virtually all Americans aged 65 and over are eligible for Medicare. The fact that these people have not enrolled indicates a serious problem with the existing government programs, but it is not sufficient evidence to support a new one.

When most people hear about 47 million Americans without health insurance, they automatically assume that this number represents people who are permanently uninsured. The reality is that the report counts as uninsured anyone who was without coverage at any point during the calendar year. This means that anyone who changed jobs and was temporarily without coverage is counted among the uninsured. In fact, only about half of these people lacked coverage for the full calendar year. The uninsured population is not static, but a constantly changing group of people in transition through their careers and life stages. Based on a closer examination of the facts, it is obvious that the situation is not as dire as critics would like us to believe, but there are still an unacceptably large number of people who lack access to quality healthcare.

It’s Not Insurance At All

What we call health insurance in this country has been transformed into something that doesn’t much resemble insurance in the truest sense of the word. According to Webster’s, insurance is defined as follows:

The act, system, or business of insuring property, life, one’s person, etc., against loss or harm arising in specified contingencies, as fire, accident, death, dismemberment, or the like, in consideration of a payment proportionate to the risk involved.

The key phrase here is “proportionate to the risk involved”. When we purchase automobile insurance, we expect that a 17 year old driver will pay a substantially higher premium than a 37 year old, based on the actuarial evidence that the younger driver represents a higher risk. Smokers and non-smokers pay dramatically different rates for life insurance for the same reason. The same concept holds true for insurance on our homes and businesses. The higher the risk an individual policyholder represents, the higher the premium they will pay for the same coverage. This is the fundamental nature of insurance.

For some reason, when we discuss health insurance in this country, we tend to forget this basic concept. We have no problem with the idea that we should pay varying rates based on risk for other forms of insurance, but when health insurers apply the same standard, they are vilified. In many cases, they are also forbidden by statute to price risk according to actuarial evidence. When lawmakers require insurers to ignore pre-existing conditions and other risk factors, the result is higher premiums for everyone to cover the additional cost of the higher risk policy holders.

One of the common elements of virtually every healthcare reform proposal is a requirement for universal participation. This means that the 17 million young, healthy and voluntarily uninsured would be required by law to purchase health insurance coverage whether they want it or not. This is not because these young healthy people are endangering themselves by failing to purchase health insurance. These people represent the lowest actuarial risk of any group, and the premiums they would be required to pay are intended to offset the cost of higher risk participants. The only way that universal coverage can be remotely feasible is by mandating universal participation.

A problem already faced by many government-run health plans is that those who can afford better quality care will purchase services outside of the system from private providers. When physicians can earn more money by treating fewer patients outside of the system, the quality and quantity of services available to those who rely on government provided healthcare is diminished. Hillary Clinton was well aware of this problem when she crafted her ill-fated 1994 plan, and one of the most controversial aspects of the Clinton plan is that it would have effectively outlawed the private practice of medicine on a fee for service basis. This seems like a draconian measure, but if the goal is to provide truly equal access to health care services for all Americans, it is probably unavoidable.

The Reality Of Rationed Care

Healthcare is a finite resource, and this basic fact cannot be overlooked if we wish to have a meaningful debate over national policy. Private insurers offer varying levels of coverage depending on what their customers are willing and able to pay. Under a nationalized plan, this would not be the case. While there is no practical reason that such a multi-tiered plan could not work, it would never be politically feasible to implement. With this in mind, any nationalized health care system would require some rational method of allocating limited resources to ensure universal access to essential services. Politicians would never call it rationing, but that is exactly what it would be in practice.

Under a nationalized plan, politicians and bureaucrats will be forced to make difficult decisions regarding the allocation of healthcare resources. These will be the same kind of decisions that private insures are vilified for making every day. The simple fact that a treatment exists for a given condition does not mean that the resources are available to administer it to everyone who wants it or needs it. Those people who believe that universal coverage will mean unlimited access to an unlimited array of medical services are in for a rude awakening.

When faced with the choice between vaccinations for thousands of children, or a single organ transplant operation, someone will have to decide which expenditure provides the greatest aggregate benefit. The emotionally charged nature of life and death decisions will complicate these choices, but ultimately the choice must be made. The key to a successful and economically viable universal system will be the mechanism by which limited resources are allocated.

Revisiting The Oregon Plan

Perhaps the most notorious scheme devised thus far for allocating healthcare resources in this country is the Oregon Health Care Plan. Beginning in 1987, the state of Oregon dramatically reformed the funding mechanism for Medicaid by attempting to create a purely rational method of allocating treatment resources based on cost benefit analysis and statistical ranking of various treatment & outcome scenarios. The plan was both praised by supporters and reviled by detractors for it’s unemotional technocratic approach.

While political pressure prevented the plan from ever being implemented in its purest form, the original Oregon Plan is a model that deserves serious consideration as we debate healthcare policy on the national level. It is based on the fundamental recognition that in order to provide the greatest benefit to the greatest number of people, we must allocate our healthcare resources based on cost and effectiveness. In order to do this, we must somehow filter out the purely emotional factors surrounding treatment decisions.

While most current state and federal healthcare programs attempt to keep costs under control by manipulating eligibility requirements, the Oregon Plan takes a completely different approach by limiting the array of medical services offered based on cost effectiveness and statistical success rates. This enables the state to offer essential medical services to a much larger population. The trade-off is that wildly expensive treatments and those with low aggregate success rates are not offered.

The original plan was designed by a commission that was organized to study treatment cost and benefit data on over 10,000 medical conditions. The commission prioritized these condition/treatment pairs and came up with a ranked list of 709 services that would provide the greatest aggregate benefit to the population of Medicaid recipients. The idea is that the Oregon legislature controls the overall cost of the program by drawing a line in the list, and only those services above the line a funded.

There are many excellent articles available detailing the specifics of the Oregon Plan, so I will not attempt to go into further detail here. For more information on the subject, try here and here. What I do suggest is that anyone interested in the subject of nationalized health care should study the original Oregon Plan and become familiar with the rationing mechanism. It’s clearly not perfect, but it may well be the best attempt to date to rationalize the allocation of medical resources. When we finally move beyond political posturing, there’s a good chance we will end up with a national program that looks a lot like the Oregon Plan.

Sadly, the polarization of the electorate has made it more and more difficult to debate practical, effective, and affordable solutions to the problem. What we get instead are slogans designed to inflame the passions of one group or another. While both sides contribute equally to the breakdown of civil discourse, the most insidious statement on the issue of healthcare always comes from the left. Every four years, without fail, some democratic presidential candidate will proclaim that “healthcare is a basic human right.” This kind of statement is either the worst form of political pandering imaginable, or it demonstrates an incredible ignorance on the part of the speaker. Either way, it only serves to make meaningful debate more difficult.

Our founding fathers had a clear understanding of the inherent nature of rights, and of the fundamental difference between rights and entitlements. They understood that the pursuit of happiness was an individual quest, and that the outcome was not guaranteed by any government program or agency. They recognized that by exercising our right to freedom of expression, no cost or burden is imposed on any other individual or group.

When we declare that healthcare is a right, however, we automatically create a corresponding obligation on someone else’s part to provide it. Supporters of a right to healthcare will simply claim that this responsibility belongs to the government, as if the answer is so obvious as to require no further explanation. When we look beyond this simplistic answer, however, we realize that healthcare services aren’t actually provided by the government, but by highly trained, highly skilled individuals who choose to make their living as healthcare providers. The only role the government can play is to tax its citizens to pay these providers for their services.

Now we must assume that the millions of individual healthcare providers in this country would continue to offer their services under a government controlled system. Without their cooperation, no government program could function, and it is simply foolish to assume that there would be no change in the quality or quantity of medical services available under government control. A significant number of older individuals would elect early retirement, while younger professionals could opt to change careers. In the short term, however, many providers would be locked in by their years of training and experience, and have no choice but to participate in a government run system. The one option that many of these individuals could and would exercise is to significantly reduce the number of hours they are willing to work as government employees or contractors. This can only lead to shortages and rationing of healthcare services.

In the longer term, the situation would be dramatically different. Faced with less freedom of choice and diminished earning potential, fewer young people would opt for careers in healthcare in the first place. Our best and brightest students would seek out other career fields, and admission standards in our medical schools would be lowered as a result. The percentage of foreign trained doctors would also rise, as American students seek out more desirable career fields. In the UK today, after six decades of nationalized healthcare, roughly 40% of practicing physicians are foreign born and trained. The fact that these foreign doctors represent 150 different nationalities raises legitimate concerns about the quality and consistency of their medical training, and the language skills required to communicate with their patients.

If healthcare is a right, then someone must be responsible for providing it. When our healthcare professionals are not willing to deliver their services under a government controlled plan, what options do we have to ensure that this right is not violated? Do we draft our brightest students into medical schools and require them to render their services in the name of preserving our rights? Does our right to healthcare entitle us to trample the rights of our healthcare providers?

Proclaiming a basic human right when none exists only serves to make a productive debate less likely. We cannot hope to solve our problems without rational civil discourse. Healthcare is clearly not a right, but it is a fundamental necessity, and it must be viewed as such if we are to solve the problem.

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