Is health care a human right?
What about health care that doesn't work?
This weekend, I met with Adam and John and we recorded some educational videos for SM (coming soon). It reminded me about the evidence base of many therapies.
Dr. John took to task the Watchman device. We discussed IVC filters. A half dozen chemotherapy drugs came up. Paxlovid, removing the primary tumor in metastatic disease, cancer screening, bone marrow transplant for myeloma, MRIs for dubious purposes, etc. etc. A laundry list of things that don't work.
Our conversation reminded me of the core challenge in health care. We have some interventions of indisputable benefit, some that are preference sensitive and an ocean of things that don't work or have harms exceeding benefits— and our system pays for everything, all the same. If anything, the last category puts food on the table.
Different people can agree or disagree on whether health care is a human right— that society should be taxed to pay for. But no one can possibly think people have a right to health care that doesn't work. No one can possibly believe that we should tax people to pay for IVC filters and watchman's that do more harm than good. Yet that is precisely what we are doing.
It is clear that federal and state governments are not capable of paying for things that work, let alone prioritizing high value medical services. It is clear that doctors can't do it either. Patients are often confused about what to believe. Vendors only care about their sales. Hospital administrators are trying to put the profit in non profit.
In such an environment, where we cannot stop interventions that don't work, where spotting real scientists from snake oil salesmen is a game of Where's Waldo, the best thing we can do is to stop subsidizing health care.
Health care, as it is practiced in 2026 America, is not a human right. It's a tax penality on our ignorance and wishful thinking.
Vinay, Brilliant Piece.
There is plenty of blame to go around. But the foundational bad actors are the providers and the reason is the incentives put in under Obamacare make such actions almost impossible to resist. Providing full dollar coverage to everyone for everything is the road to ruin -- and it is unreasonable to think that people will look at free money and just ignore it.
Health plans make money, but there are limits on what they are allowed to make...unlike providers where there are none. Pharmas are their own problem, but under the Trump administration they actually have retreated on many of the drugs that are most used, bringing prices down substantially and, one hopes continuing to do so because of the new inability to differentially price from other countries....MFN is a great way to lower costs.
The foundational issue is the complete decoupling of patients from ANY financial decision with regard to their health. This puts large numbers of people (not including the unfortunate middle class that cannot get free insurance like illegals, anyone that claims to be poor, etc.) in the enviable position of requiring every procedure known to man for every ache and pain every day. I could tell you stories that would make your blood curdle.
The health systems have a spigot that always pays -- the wonder of government. In fact, the only modest impediment is health plans who try to restrict payouts, usually to the hew and cry of everyone who is agitated that great grandma is not getting her third hip surgery.
Remove the government intervention and this all self cures easily. Go back to selling catastrophic insurance....there are catastrophes and it is good that they can be covered. But that is NOT the expensive part of health. Let everyone (not just high deductible plan folks) keep an HSA where they can put discretionary dollars away for health.. They can then spend it on more insurance, the gym, doctor's visits -- what ever makes sense to them. And return to Direct Primary Care (really taking off...no insurance involved) for better, family-oriented care at at fraction of what is being spent now.
When offered an MRI with a 0,1% chance of finding something, patients will likely say no if it is their first dollar to decide; today they say yes because why not? When offered exactly the same colonoscopy with exactly the same anesthesia/doctors/etc. as an outpatient for $1000 or as a "hospital outpatient" for $15,000 (fairly real numbers) they will likely take the regular out patient option if they are paying first dollar. Today, the hospitals make a ridiculous amount of undeserved money from the HOPD business (with these kinds of price differentials for, essentially, indistinguishable services) and there is nothing to stop it because the actual consumer has no skin in the game. Heaven knows the insurers have tried. Doctors cannot fix this because Obamacare forced them all to be hospital employees so they just nod their heads and watch the impossibly overpriced colonoscopy feed $$ to the administration for important things like DEI officers and very high salaries.
In short, people are not mad enough because they control nothing. The substantive changes to fix this are not that difficult. But they will take away a lot of wealth transfer and thus a lot of cheap votes. As long as Obamacare forces me to buy a sex change inclusive policy (as Obamacare does) and insists on full coverage of anything someone in the mental health industry (yes it is an industry) decides to label in the next DSM as a disease instead of living normal life, this will go on. The question is, will anyone upset the apple cart? You are trying, so this should give you more directions to think through.
I believe that as Americans, we have asserted, and defended three fundamental rights: the right to life, to liberty, and to the pursuit of happiness, although, surprisingly, some of our fellow citizens would even dispute the first, most foundational right. I certainly do not believe we are given by God the right to rob Peter to pay Paul. Amiright?