April 11, 2008 — On April 9, the Miller Center of Public Affairs at the University of Virginia, in partnership with MacNeil/Lehrer Productions, held the fourth event of its National Discussion and Debate Series on the resolution: "Americans have a fundamental right to health care, and it is the obligation of government to secure that right."
 
The archived video is online at: millercenter.org/debates/healthcare

Supporting the resolution were:

• JudyAnn Bigby, MD, Secretary of Health and Human Services for the Commonwealth of Massachusetts
• Regina Herzlinger, Nancy R. McPherson Business Administration Chair, Harvard Business School

Opposing were:

• Dick Armey, chairman, FreedomWorks, and former U.S. House Majority Leader (1995-2003)
• Richard A. Epstein, James Parker Hall Distinguished Professor of Law, University of Chicago Law School

The moderator was Susan Dentzer, health correspondent for "The NewsHour with Jim Lehrer."

More information, including PBS broadcast information in Virginia (it will air on PBS analog and digital channels nationwide in the coming weeks; check local listings for details), is available online at www.millercenter.org/debates. 

Some debate highlights:

• On controlling health care costs and the role of government:

REGINA HERZLINGER: If [people] got efficient, effective care, our health care costs would go way down.

So, how do we get sick people to lower the costs of health care? Well, first of all, we've got to make sure they're insured. The top 1 percent of U.S. spenders spend $36,000 a year on health care. The average family income in the United States is $60,000. You don't need a CPA to figure out that sick people cannot afford to buy their own health insurance.

So how can we make it affordable?

Well, the best way is to have universal coverage, where the well subsidize the sick. That's what insurance is all about.
 
But we have to do it in a way that gives the sick control over the system, so that they can choose the providers who give them the quality of health care they want at a price they can afford.
 
Do we want universal coverage? Absolutely.

What is the role of the government? Not to run the health care system. It is to do what our government is meant to do, and that is to help the poor, help the infirm, help the sick, make sure that the system is run in a decent way, and then get the heck out of the way.

• On creating a U.S. health care system that increases access — for example, with universal coverage through competitive markets:

RICHARD EPSTEIN: The simple and securest way to increase access today is to reduce the cost so that people could re-enter the market. We have driven people out of the market in droves, in millions.

And then having regulated them out of the voluntary market, we assume that the same people who busted that up beyond all recognition can figure out how to make it coherent when they call the shots.

And remember this point: If you're paying the money, you'll attach conditions to the way the money is spent, and the idea that you could have subsidies without government restraints is one of the great political pipe dreams of all time.

... There's a funny causal relationship. If you put in mandatory programs, what happens is nobody sees the need for voluntary assistance. And the secret for success in this state of creating a huge voluntary health care system in the 19th century was to give every institution the right to turn away anybody for good reason, bad reason or no reason at all, because that's the only legal regime that will get people to come into the charitable business.

And so I think, in effect, if you work this thing correctly, you will have gaps in coverage to be sure, but don't think that you don't have gaps in coverage under the current system which are far broader and far more comprehensive than anything that we've seen before.

• On the United States not observing the 1948 United Nations Universal Declaration of Human Rights calling for a right to a standard of living that includes medical care:

DICK ARMEY: America gives a better promise. You know, the U.N. resolution says we all agree we're going to deliver the goods. America says, no, we're going to set you free. We're going to protect your liberty.

I don't know why that's so hard for people to grasp. Your personal liberty is such a precious thing. In little ways the government trespasses against it.

You know, government exists for the purpose of compelling people to do what they will not do voluntarily. Sometimes that's necessary. Sometimes it's even good. But most times, it's excessive and abusive to your liberty.

Now, I just don't put a great deal of store in the U.N. in general, but their agreements, but why would we reduce ourselves to the rest of the world, when we are so special?

... The government can't do much with any enterprise, except, what should I say — stalemate it. You're going to have to — Armey's axiom number one, study on this, the market's rational, the government's dumb.

Government is a fundamentally stupid enterprise. And I don't mean to be unkind about that. They are dumb for a clearly obvious reason. They don't know what they're doing.

JUDYANN BIGBY: [W]hether or not we are the best at health care or medical care, if you measure it by how much we spend, we might be. If you measure it by the wonderful universities and medical schools where this wonderful research goes on that you're talking about, we might be.

However, we don't provide access to it for everyone who needs it, and it makes us suffer as a result. We have people who are not ready to learn, they're not good workers because they're in poor health, we have kids who are dying unnecessarily, and that is what the health system in the United States has created.

Now, you talk about the government being in a position to protect people's freedoms. I have never, ever, ever heard somebody say that they do not think that having access to health care and the same access as their neighbor has is somehow imposing on their freedom.

We talk about cost, we talk about the role of government and how government is not an effective manager of the health care system; all of that may be true. So let's fix it. But let's not deny the fact the everybody needs access to health care.

• On funding Medicare and increasing government spending on health care:

RICHARD EPSTEIN: The problem that we have with respect to Medicare is not so much that it reduces the liberty of a few of us. It's that it's an enormous subsidy to many people, so the reason you find people marching there with such eagerness is they spend one dollar of their own in order to get eight from everybody else. That's a program you can't resist signing up.

But it's also extremely important to understand that there is a vast difference in this thing - this goes to what the secretary says - between health care and health outcome.

There's been a lot of research on this issue done lately. And, in fact the Robert Wood Johnson Foundation, no paragon of the right, has finally concluded that most of the stuff having to do with health outcomes relatively little to do with health care. It has to do with levels of alcoholism, level of, you know, levels of various kinds of abuses, obesity, smoking, all sorts of other things that take place long before you get into the health care system.

Why would you want to increase the level of government spending if, in fact, you have no promise whatsoever that you're going to be able to reverse these things?

What you do when you tax is you take money that people could spend not on health care as such, but on a new set of tires, on an evening out on the town or whatever it is, much of which will improve their health care.

The optimization problem we're trying to solve is to keep people out of the health care system as long as we can and then care of them in it. If we put all the money once they're in the system, we become experts in intensive care, and what we do is we lengthen their life in the emergency for a week and we shorten it for a year by making them having less resources to do other things.