Ideas Behind Health Care Policy Ignite Passions

May 7, 2017

Debates about health care are complicated, and it's easy to get overwhelmed when complicated things like premiums, block grants, state waivers, Medicaid and Medicare are the main topics.

But what are the ideas driving this debate? And why do debates get so heated when we're talking about something so technical?

To get some clarity about this topic, Michael Cannon, director of health policy studies at the libertarian Cato Institute, and Dr. Kavita Patel of the centrist Brookings Institution and a practicing primary care internist at Johns Hopkins Medicine spoke to Michel Martin on Weekend All Things Considered.

Interview highlights have been edited for clarity and length.


Interview Highlights

On health care as a human right vs. free market arguments

Cannon: It's not like we have one side that wants people to have health care and one side that doesn't want people to have health care. But the free market approach to this problem says, "Actually, a lot of the things that the government is doing to provide health care to people are preventing people from accessing health care." Because what markets do is they identify and they disseminate innovations that fill in the cracks in our health care sector so fewer people fall through — innovations that make health care better and more affordable — and when the government gets involved it causes those cracks to widen.

Patel: I think one of the ideas that's really at tension here is actually whether we believe health care is a human right. So you have people — I put myself in that category, a lot of physicians do as well — we think everyone should have access to health care. Now, there's a lot of details to that. What does that mean? Who pays for it? But we feel very strongly, and many do in this country, that there are basic rights that people are entitled to, and access to health care is a right that all people in this country deserve.

On the American Health Care Act that just passed the House

Cannon: I don't take positions on legislation, but Republicans have traditionally neglected health care as an issue. It's just not a Republican issue, and as a result they haven't been able to articulate why it is that their own principles would deliver better health care. What they've done here is, they've just tried to pass something that they can say is repeal, even if it doesn't repeal the Affordable Care Act. And in the process, they may actually be making the Affordable Care Act worse and setting themselves up for a lot of electoral defeats in 2018, which would then, I think, cause the pendulum to swing back in the direction of the Affordable Care Act or maybe even a single-payer system.

Patel: I'm definitely opposed to the legislation. We will not see premiums come down for everyone. In fact, we know that premiums will go up for people who are older or have chronic conditions. This isn't even repealing the Affordable Care Act. This is actually worse than what care was before.

On why politicians argue about health care so much

Patel: I think health care just touches on something that's so personal to everyone, and then this sense of, "You're taking away my hard-earned money and giving it to someone who doesn't care about their health, and that's wrong." That's tapping into something that's really basal.

Cannon: Health care is a very emotional issue because we rely on health care at the most vulnerable points in our life — and that's not just when we're sick, it's when a loved one is sick or a child is sick. If it appears that someone is trying to take health care away from you or from someone you love, you get a really strong fight-or-flight response from people. And usually it's a fight response.

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MICHEL MARTIN, HOST:

Now we want to talk about health care. On Thursday, the House passed the American Health Care Act by a strikingly narrow vote of 217 to 213. It's the GOP latest effort to repeal and replace the Obama administration's signature health care initiative. There's always a lot to talk about with a major bill like this, but we wanted to try to take a step back to try to understand the competing ideas and principles that may not always be articulated in the push and pull of passing legislation, but which nevertheless inform people's opinions about it.

So we called two people with deep expertise but different perspectives. Michael Cannon is director of health policy studies at the libertarian think tank the Cato Institute, and Dr. Kavita Patel is a fellow at the Brookings Institution. She's also a practicing physician and internist at Johns Hopkins Medicine. Michael Cannon, Dr. Patel, thanks so much for joining us.

MICHAEL CANNON: Thank you.

KAVITA PATEL: Thank you.

MARTIN: First, let's set up these two competing ideas. Michael, what are the beliefs at the core of the idea that health care should be approached with free market or libertarian principles?

CANNON: Well, I would put it this way. It's not like we have one side that wants people to have health care on one side that doesn't want people to have health care. But the free market approach to this problem says - actually a lot of the things that the government is doing to provide health care to people are preventing people from accessing health care because what markets do is they identify and they disseminate innovations that fill in the cracks in our health care sector so fewer people fall through, innovations that make health care better and more affordable. And when the government gets involved, it causes those cracks to widen.

MARTIN: And could you respond to that, Dr. Patel? I mean, what's - what idea do you think should prevail here of health care and how it should be delivered?

PATEL: So I think one of the ideas that's really at attention here is actually whether we believe health care is a human right. So you have people - I put myself in that category. A lot of physicians do as well, that we think everyone should have access to health care. Now, there's a lot of details to that. What does that mean? Who pays for it? But we feel very strongly and many do in this country that there are basic rights that people are entitled to. And access to health care is a right that all people in this country deserve.

MARTIN: And where does that idea come from?

PATEL: I think you actually can trace it historically back to even Ellis Island and kind of the notion of what you saw when immigrants were coming to Ellis Island. I'll just tell you that that was actually the initiation of what I would say is a health care infrastructure. We actually had the public health service with their commissioned officers on Ellis Island helping to process and understand what health needs people had and that was really because we knew that as people were coming from all over the world to this great country, that they were also coming in with not only their own health care issues, but potentially public health implications because we had diseases back then that could cause a problem once they were in the United States.

MARTIN: So, Michael, do you think it's fair to say that underlying that libertarian perspective on this is that health care is not a human right?

CANNON: Well, I would say that you do have a right to health care in the sense that you have a right to make your own health care decisions. You have the right to benefit from all of the innovations that people could bring to you that would make health care more accessible for you and more accessible for the poor. So in that sense, I think that we do have a right to health care.

When you say that you have a right to other people's earnings or their labor in order to give you health care, I would object to that on principle grounds. I don't think that you do have a right to rob Peter to provide health care for Paul both because that's not moral, but also because it means you get worse health care for Paul, not better health care for Paul.

MARTIN: But is the underlying principle of the libertarian view that you only have a right to the health care that you can personally afford yourself? Is that the underlying principle?

CANNON: I think that there are two elements of the libertarian view, and one of them is that. But the other part of the libertarian view is that when you try to make health care a legally enforceable right, that actually disables the market processes and the generation of these innovations that bring health care within reach of more and more people all the time. So even if you say that health care is a right, that doesn't mean you're bringing it to the maximum number of people.

MARTIN: You have two different philosophies as we've heard, but you're both opposed to the recent Republican bill, the American Health Care Act. Why is that?

CANNON: So I don't take positions on legislation, but Republicans have traditionally neglected health care as an issue. It's just not a Republican issue. And as a result, they haven't been able to articulate why it is that their own principles would deliver better health care. What they've done here is they've just tried to pass something that they can say is repeal, even if it doesn't repeal the Affordable Care Act.

And in the process, they may actually be making the Affordable Care Act worse and setting themselves up for a lot of electoral defeats in 2018 which would then, I think, cause the pendulum swing back in the direction of the Affordable Care Act or maybe even a single-payer system.

MARTIN: Dr. Patel, what's your take on this? Why do you think that this is bad policy?

PATEL: I'm definitely opposed to the legislation. We will not see premiums come down for everyone. In fact, we know that premiums will go up for people who are older or have chronic conditions. This isn't even repealing the Affordable Care Act. This is actually going worse than what care was before.

MARTIN: One of the things that I have noticed is that these conversations around health care and health policy have become very inflamed, very self-righteous very quickly. Why is that?

PATEL: I think health care just touches on something that's so personal to everyone and then this sense of you're taking away my hard-earned money and giving it to someone who doesn't care about their health. And that's wrong. That's tapping into something that's really basal.

CANNON: Health care is a very emotional issue because we rely on health care at the most vulnerable points in our life, and that's not just when we're sick. It's when a loved one is sick or a child's sick. If it appears that someone is trying to take health care away from you or from someone you love, you get a really strong fight or flight response from people, and usually it's a fight response.

MARTIN: Michael, I gave you the first word, so I really want to give Dr. Patel the last word. Do you envision a time when we would actually come to an agreement on this?

PATEL: I think so. And I'll tell you why it's because the cost imperative is just getting more dramatic, and if some of the toxic elements of the American Health Care Act actually become law and are signed into law, I think that's going to happen a lot quicker. And where Michael and I actually agree - I do think it will actually bring us full circle potentially back to something like a single-payer system or something like Medicare for all.

MARTIN: Dr. Kavita Patel is with the Brookings Institution She's also a practicing internist. Michael Cannon is director of health policy studies at the Cato Institute. That's a libertarian think tank. They were both kind enough to join us here in our Washington, D.C., studios. Thank you both so much for speaking with us.

PATEL: Thank you for having me.

CANNON: Thank you. Transcript provided by NPR, Copyright NPR.