Home » OPINION » Columns » BILL CRAWFORD — Rights, entitlements, public interest and health care

BILL CRAWFORD — Rights, entitlements, public interest and health care


The U.S. Citizenship and Immigration Service lists the following as the rights of American citizenship: freedom of expression; freedom to worship as you wish; right to a prompt, fair trial by jury; right to vote in elections for public officials; right to apply for federal employment requiring U.S. citizenship; right to run for elected office; and freedom to pursue “life, liberty, and the pursuit of happiness.”

Actually, the Bill of Rights and other amendments to U.S. Constitution provide many more individual rights, including: freedom of assembly and petition; freedom from unreasonable search and seizure; right to own property and freedom from government seizure without cause; right to keep and bear arms; right to “no-quartering” of troops in peacetime; rights to due process and equal protection under the law and freedom from self-incrimination and double jeopardy; freedom from excessive bail and fines and from cruel and unusual punishment; right to citizenship; freedom from slavery, poll taxes, and involuntary servitude; and voting rights for women and 18-year-olds. 
U.S. Supreme Court rulings and Congress have established rights to privacy; freedom from racial segregation, discrimination, and sexual harassment; rights to same-sex conduct and marriage and inter-racial marriage; contract, property, and abortion rights; and freedom from discrimination based on disabilities.
Not included are any rights to government benefits like those provided by Social Security, Medicaid, Medicare, Unemployment and various welfare programs. Since Congress can change or end these programs at any time, they are impermanent entitlements, not vested rights.  
What, then, of the popular concept that U.S. citizens should have a right to health care? 
Because of Medicaid, Medicare, and Obamacare, health care is well on its way to becoming an entitlement, but not a right. 
Given the growing financial burden of existing entitlements, should health care for all become a national entitlement?
The fiscal answer is “no,” entitlements should be trimmed to reduce budget deficits. The emotional answer is often “yes” due to mounting and extravagant costs for drugs and extraordinary care.
These days there seems to be only frenzy in discussions about health care. However, some dispassionate discourse yields interesting ideas like this one. Why not treat and regulate access to health care as an essential public service like utilities and other industries “deemed to be affected with a public interest?”
“Medicine as a Public Calling,” a scholarly article by University of Michigan assistant law professor Nicholas Bagley, informs this idea: 
“The debate over how to tame private medical spending tends to pit advocates of government-provided insurance—a single-payer scheme—against those who would prefer to harness market forces to hold down costs. When it is mentioned at all, the possibility of regulating the medical industry as a public utility is brusquely dismissed as anathema to the American regulatory tradition.”
“Closer economic regulation of the medical industry may or may not be prudent, but it is by no means incompatible with our governing institutions and political culture.”
As Bagley points out, this may not be the way to go. But this concept and other out-of-the box ideas should be dispassionately considered, away from raging political ideology, if controlling health care entitlement costs while retaining essential services is our goal.
» Bill Crawford is syndicated columnist from Meridian (crawfolk@gmail.com)


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  1. Excellent concept. Of course, “regulation” would make Sarah Palin start screaming “death panels!” But there are estimates that end-of-life care equals almost one-third of all medical costs. Would be nice to have some regulations (don’t tie them to people!) to keep costs under control.

    And whenever the poor are denied health care, I always think of Bombay (former name) when Mark Twain visited. Just walking down the street you could get cholera. It’s in everybody’s interest for everybody to have health care.

  2. Bill, as you know, health care is already highly regulsted, including the prices paid by government programs. The government programs tend to cover a broad scope of benefits while paying less than full cost and even denying payment for care already pre-authorized and performed. Managed care companies tend to copy government program processes, so the regulation is already pretty complete and very complex. Maryland is the only state where the federal government has approved state regulators to regulate all hospital prices for both government and private insurers. Maybe Maryland’s model deserves a closer look.

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