[Originally from 2012, slightly updated]

I think first of all one need ask if the premise is correct: DO MOST Americans think that health care is not a right?

And then I would ask: From where did you come up with this assertion?

Maybe you are correct. Certainly I have seen publications in which this assertion is claimed as fact. But it has seemed to me that the more I look at this, the more it appears that the WAY the query is posed is fairly important. And, I must say, my experience as a surgical intensivist makes me think that this is important.

For example, many years ago I cared for an 18 year old with a severe traumatic brain injury. We pulled him through the acute portion of the process and he was in need of aggressive neuro-rehabilitation; with this kind of physical therapy, he MIGHT be pretty close to normal at the end (related to the plasticity of brain and neurological function – a different topic I will comment upon another time if you wish). The boy’s mom and dad looked at me and asked where this could be done and how much it would cost; they had no money and no insurance even though they both worked. These parents informed me that they thought this kind of thing was “just covered”. When I told them it was not, that this health system was not organized in the way they seemed to believe (I was trying so hard to be gentle with them, this was so horrible, I promise you), they were near tears. Our Social Workers tried to get the kid some rehabilitation and we were more or less successful.

But the point is that these two parents were people who could have been opposed to “socialized medicine” in theory, but were certainly for it when it became clear that their child needed what they could not provide. So, lots of words to say that the way the question is posited probably makes a difference in the assertion that “most Americans think health care is not a right”.

But if it is true that many of our people think this, why might it be ?

I am of the opinion – and this is opinion – that a major reason relates to our system of propaganda (yes, I used the “P” word) and lack of education or even “dys-education”.

Although it is abundantly possible to get real data and countervailing opinions, we are hit over and over with media and political coverage that asserts America is somehow “different” than everyplace else in the world; this, of course, is the concept of “American Exceptionalism”. The logic seems to go, we – unlike the weak British or Canadians, or…. – do not need governmental assistance for health care. And if we do, we can do as former President GW Bush suggested, go to the Emergency Department.

That this is absurd is evident to many when it is considered carefully.

First of all, yes, there are may remarkable things about our Country, but we are not so special or different than anyone else. Many of you reading this will not remember, but you can find the data if you look, that before President Johnson’s Medicare program, our grandmothers and grandfathers had to decide upon food versus health care. This is not apocryphal, it is fact. Medicare – socialized insurance for our elders – worked wonders and continues to do so. It needs some tuning, for sure, but it works.

Messers Romney and Ryan, who were running when this piece was originally written, had promised to turn it into a voucher program; this would have destroyed the program and removed the safety net from our elders.

We as Americans have CLEAR examples that treating health care as a right – Medicare, military medicine, European and Canadian examples – leads to nothing but benefits for the individuals covered. It is not that all will be perfect, it won’t; but we are smart enough to work out the problem areas.

The reason we fight and fight this battle is, again in my opinion, related to our system of propaganda – see Paul Starr’s The Transformation of American Medicine, Basic Books; organized medicine and the acolytes of our system have argued that it would bring about the death of our system, of our country.

And many believe this nonsense; and it is nonsense. You will not remember, likely, but my own American Medical Association – supportive of the Affordable Care Act – argued in the past that socialized medicine would be the first step toward communism.

If we believe that health care is not a “right”, however we define rights, it is because we allow ourselves to be manipulated, because we are too lazy to figure out what in the world this discussion is about, and because we somehow think “it won’t happen to me”; then, when it does happen, we search all over for help.

I don’t know if health care is a “right” in some over-arching philosophical sense. But I do know that if we want to consider ourselves a civilized people – and I think we do – if we want to consider ourselves a humane people – and I think we do – then we cannot allow our fellows to die because they cannot afford health care.

Go to the Emergency Department as Mr. Bush suggested ? Pure silliness, rank stupidity, callous heartlessness.

In one of my previous lives, I ran the Division of Emergency Medicine at the University of Florida, Shands Hospital; I was the Division Chief from 1995 to 1999.

People would come in with diabetes, we would try to get them “tuned up” and we would send them out with very little hope of any followup .

If they came back in diabetic crisis (ketoacidosis or non-ketotic hyperosmolar coma, for example) we would admit them to the hospital, spend lots of money to nurse them back to health, and then send them out again with little hope of ongoing care to prevent recurrence.

What is this called ?

A waste of humanity. A waste of resources. Oh yes, and it is also called callous and inhumane.

That is the system we had before President Obama’s Affordable Care Act, as imperfect as it is. And it is IMPERFECT and expensive; it is also a first step.

I think it is the duty of those of us in health care to try to provide education.

Do most Americans think health care is not a right ? I frankly doubt it. Poll after poll shows that this issue is extremely important for most people. Having watched families – including my own – struggle with obtaining access to health care after the loss of employer-provided health insurance, I know this this well.

And the next step we must – must – take is one of the versions of Medicare for All.