What is Healthcare and Who Deserves it?

Today’s news if full of commentary about work requirements for Medicaid. Is work a prerequisite for healthcare or is health a prerequisite for work?

Not to complicate things, but can we even agree on what healthcare is? I don’t think we can, and it largely falls back on what we want to share in paying for.

A patient with an ugly skin lesion can have it removed if it might be cancer or if it bleeds or causes pain. If it is just ugly, it’s considered cosmetic, and insurance won’t pay for it.

A man wants a vasectomy, while another one regrets having one and wants it reversed. Is one procedure more medically necessary than the other and more deserving of societal cost sharing?

Even the most esoteric medical procedures, like freezing embryos or cloning children, could be called healthcare, but may not have society’s support when it comes to being necessary or desirable.

And, even as we speak, what about abortions? Are they healthcare or not?

In many ways, I think life was simpler practicing medicine in Socialized Sweden. The Government paid and the Government made the rules. Here, the Government makes some rules, the insurance industry makes others; the Government pays for some people’s care and the insurance industry pays for others. And the insurance companies all have different rules.

Since healthcare costs twice as much in this country as anywhere else in the world, it seems painfully obvious that we need to talk about what the purpose of healthcare is and, from a moral perspective, what we have a right to expect our fellow countrymen/women (if not citizens) to pay for.

It is remarkable that such an enormous slice of our budget and our life so much lacks definition and almost seems to be taboo to openly try to debate.

If we look at other aspects of cost sharing in our society, can we draw any useful parallels?

If a high school senior wants to repeat his senior year because he had so much fun, should he be able to do it for free? (Just a hypothetical example, I don’t know if anyone would really want to.)

If a child calls the fire department every time she smells smoke from the family barbecue, should the town charge the family or stop sending a fire truck?

If an amateur sailor capsizes every weekend and always calls Marine Patrol, should they keep responding?

In social policy terms, the word entitlement is used to define programs like Medicare and Medicaid. I think that is an unfortunate and very loaded word. Contrast that with another word that I personally keep coming back to: Stewardship.

It is time for a serious conversation about balancing stewardship and entitlement in healthcare. At least as long as it is not all self-pay: Taxes or insurance premiums both imply we want someone else to pay for some or much of what we think of as our personal healthcare.

10 Responses to “What is Healthcare and Who Deserves it?”


  1. 1 Mary Symmes July 15, 2018 at 3:37 pm

    What a thoughtful, clear comment on health care in this country! You have really boiled it down to the underlying principles. I’m forwarding it to everyone I know.

  2. 3 M K July 16, 2018 at 6:29 am

    Great post.
    There’s needs to be a much greater focus on preventative care and more funding spent in this direction.
    Also,many practitioners don’t like to hear this,because they perceive it as a “turf war”,but by funding studies on Herbal Medicine for conditions such as Type 2 Diabetes will decrease the pressure on the Healthcare system.
    In addition,the government should start looking at a more “Lean” approach to the costs of medical training.For example,Surgeon training is extremely expensive and costs could be cut by removing any unnecessary curriculum and cheaper training + removing specialist bodies powers to cap the number of surgeons could result in more surgeons in Australia and therefore lower the costs to patients.
    In addition,introduce a high sugar tax to discourage excessive junk food intake by making it unaffordable and make healthy food more affordable to people from lower socioeconomic backgrounds.

  3. 4 M K July 16, 2018 at 6:32 am

    Oops,my mistake.Thought you were from Australia and were referencing the health care system in Australia.

  4. 5 Jean M July 17, 2018 at 11:21 pm

    Many facially disfiguring lesions are not simply ‘cosmetic’–they have a significant impact on a person’s life in a multitude of areas. As a licensed social worker, now retired, I have seen this impact first hand. Whether or not these lesions bleed, are potentially cancerous, or are congenital or due to accidental injury or because of surgery for cancer is immaterial, and their repair should be covered by insurance. Just because a child with a cleft can still eat does not mean the defect should not be repaired, any more than a child with Treacher Collins or a port wine birthmark should be left to deal with life untreated.

    There is a great deal of difference between such condition and what I suspect you are referencing–what is normally termed ‘cosmetic surgery’ that is done on normal faces to improve aesthetics.

  5. 7 medicalschoolinternshipresidencypractice July 26, 2018 at 12:29 pm

    What is the argument against single payer? H

    • 8 Mary Symmes July 26, 2018 at 7:09 pm

      I understand the AMA was/is against it. Check with them. Otherwise I assume any argument is filed under profit or reflexive “anti-government” or such.

  6. 10 Jessica Parker August 17, 2018 at 7:20 pm

    Great article. I believe that preventative care should be a bigger priority to everyone because of the benefits that it brings. I found an insurance company that helps me keep up to date with my doctor checkups and it has made a world of difference for my health. I went through Insurance Line One and found truly affordable insurance. I highly recommend checking them out.


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