yes that is right I don't believe that health care is a right in the same way that free speech is a right. I do however believe that it is part of the social compact. The key difference is that the social compact unlike rights requires mutual obligations and responsibilities. This distinction is important if we are going to deal with the problem of unaffordable health insurance.
I have written in an earlier diary that part of the reason that health care costs so much is because we use so much of it often for inefficient and wasteful purposes. This point was brought home more vivedly after watching a program on PBS dealing with sickle cell anemia and the efforts of finding a treatment/cure.
Sickle Cell anemia along with other autosomal recessive ailments such as Tay Sachs, cystic fibrosis etc all share one thing in common- they are 100% preventable. Let me repeat that, THEY ARE 100% PREVENTABLE! With the right public policy we could eliminate them completely. They are preventable because in order to contract the ailment it is necessary that both parents have at least one defective gene at which point the odds that a child born to those parents will have the disaese is at least 1 in 4.
Thus in order to prevent the disease all it takes is for parents (if both are carriers) not to have children or if they are going to have children be prepared to terminate the pregnancy if the fetus is found to have two regressive genes. Within the Orthodox Jewish community by reducing the carriers who marry they have seen a marked decline in children born with Tay Sachs and have avoided any ethical dilemmas.
Research dollars spent of developing cures/treatments might be better spent on developing cheap effective tests (as in the case of Tay Sachs) so that one can prevent conception of children with the ailment. Perhaps rather than requiring a syphlis test prior to get a marriage license we would be better off requiring tests for autosomal recessive disaeses e.g. 1 in 35 caucasians has the recessive gene for cystic fibrosis (which means that on a random basis 1 in 5000 children born to caucasian parents will have cystic fibrosis. Perhaps we should consider not giving a marriage license if both carry the recessive gene- after all there are plenty of states that don't allow first cousins to marry for essentially genetic reasons.
This brings me back to the social compact part of health care. We as society have an obligation to provide health care and in this particular example provide the genetic tests for free and invest in public awareness so that people have the necessary knowledge to make the responsible decision. In turn I believe that people have a responsibility for conducting their affairs in manner that reduces the cost of the obligation that the rest of us have to provide health care to fellow beings. If parents decide to go ahead and have children they should not expect the rest of us to have to pay for the care of the child because their vanity compelled them to have a natural born child.
Wait a minute some of you will say - what happened to the "right" to have children. In a world where there are millions of children looking for a loving adopted parent I am not sure that such a right exists. But even if such a right exists as with all rights it is balanced by other rights e.g. free speech doesn't mean that one can yell fire in a crowded theatre. I would remind those who would like to find such a "right" for parents both of whom are carriers the odds 1:4 that the child will be born will a terrible and painful disease- in the program the children suffering from sickle cell described the pain as somebody shoving a knife in them! I have no doubt that those who would argue for this "right" will be just as loud in arguing for strict standards on e.g. lead in childrens toys. The odds that a child will suffer serious health problems as a result of lead in toys is significantly less than 1:4. Frankly for those of you who would argue for such a "right" to be consistent you would also have to argue for the right not to put children in a car seat or any of the myriad child protective laws that we have. All of which are designed for risk thresholds whose probabilities are substantially greater than 1:4. I don't belive that there is any legal activity (other than the conception of a child to parents both of whom are carriers) in the United States whose risk of death or serious injury is 1:4. Parents, who in the face of such odds, decide to go ahead and have children are in my judgment guilty of child abuse not some noble pursuit of a natural right.