NO RIGHTS HEALTH CARE.

• Author: Orient, Jane M.
• Position: MEDICINE & HEALTH

A "RIGHT TO HEALTH CARE" is a seductive idea that many Americans accept without thinking, but we need to take a closer look at what this means. The total program being pushed by "right-to-health care" cheerleaders--primarily Democrats--is full of mandates. A mandate means you have no right to opt out, except possibly through some limited exemptions. It starts with controlling the money, but increasingly involves your body--the treatments you may receive, the ones you may not have, and the ones that you must take, especially vaccines.

The old, if little-known, news is that seniors have no right to turn down Medicare Part A--unless they forgo all Social Security benefits and refund any they already have received. Seniors enrolled in Medicare have no right to spend their own money on covered services, which may be unavailable or of poor quality at the Medicare-controlled price--unless they see an opted-out or nonenrolled physician.

Under the Patient Protection and Affordable Care Act, Americans have no right to opt out of costly "minimum essential benefits" and buy a low-cost catastrophic-only plan, derisively called "bare bones" or "junk" insurance--without paying a penalty. (The penalty thankfully has been reduced to zero dollars under Trump's tax reform, but the benefits mandate remains, so true insurance remains outlawed.) People and businesses have no right to opt out of paying for other people's lifestyle choices, such as abortion and contraceptives--with limited, hard-fought exceptions.

A patient enrolled in Medicaid has no right to choose how to use his or her benefit. That individual cannot buy a private catastrophic-only plan plus a health savings account (HSA) or join a Direct Patient Care (DPC) practice, a new, noninsurance model in which patients pay a monthly membership fee. Generally, Medicaid patients get stuck with a limited choice of physicians and may get auctioned off to the lowest-bidding managed-care plan. There are state waivers, but these are rare and hard-fought.

"Insured" patients--managed-care enrollees--have no right to go out of network without paying a financial penalty that may be severe. They have no right to access services in a competitive marketplace. Many independent physicians have been driven out of practice by Medicare, Medicaid, or health plans that limit payments to below cost, while richly rewarding hospital-owned entities with a generous facility fee. Free-standing centers may have been prevented by...