US health care: entitlement or privilege?

Abstract

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — —The Declaration of Independence of the Thirteen Colonies, July 4, 1776 These words of our founding fathers succinctly congeal the aspirations of all Americans. Although the reference to freedom is unambiguous, the reference to “life” has both figurative and literal interpretations. Was the intent an entitlement to healthcare services? In a country based on free enterprise driven by market forces with an emphasis on consumer choice, was the intent of our forefathers to define health care as unalienable right? Support for this intent may have been provided by the US Congress in 1965 when “first-dollar coverage” was introduced with the inception of Medicare. And yet, in virtually all other sectors of American life (except health care), financial responsibility enables freedom of choice. In buying a house or car, choosing a hotel, or dining at a restaurant, consumers choose what they are willing to pay, and market forces determine the price. This free-market, consumer-driven process implicitly values the quality of goods and personal services provided. Hence, the common adage, “You get what you pay for.” Recent advances in medical technology have had a significant salutary effect on the morbidity and mortality rates associated with atherosclerotic cardiovascular disease. Furthermore, primary preventative measures and techniques for early (preclinical) detection have evolved. Public news media have sensationalized medical advances. A better-informed and educated public comes with higher expectations for their care. In parallel, the cost of research and development for new drugs and devices has escalated. Indeed, both the cost and time to market for a new medication have increased over the past decades. The ardor for clinical …