Mandates: the Other Side of the ‘Right to Healthcare’

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By Jane M. Orient, M.D.

A “right to healthcare” 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-healthcare” 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 have already 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 [Un]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 has thankfully been reduced to $0 under Trump’s tax reform, but the benefits mandate remains, so true insurance is still 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 benefit. He generally cannot buy a private catastrophic-only plan plus a health savings account (HSA) or join a Direct Patient Care (DPC) practice, a new, non-insurance 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 certificate-of-need laws, and physician-owned hospitals have been choked and new ones outlawed by ObamaCare. In California, under AB72, insured patients have NO right to pay a market price for an out-of-network and otherwise unavailable service, because insurance plans will dictate allowable fees even for physicians with whom they have no contract.

In more recent news, legislation is being proposed in Congress (H.R. 365) to fix the situation that Americans now have NO right to use funds in their HSA to join a DPC practice and NO right to contribute to an HSA if they are a member of a DPC practice. And HSAs were supposed to be the patient’s own money! (Look for Democrats to oppose this bill.)

It gets worse. It’s not just that patients have NO right to choose how to spend their money, but that they may have NO right to opt out of treatment. In New Jersey, a bill is being railroaded through the legislature to severely limit the religious exemption to the 74 shots children have to receive to be allowed to attend school. (So much for the “right” to a public education.) This was introduced by a Democrat just before Good Friday, Passover, and spring break. Despite the short notice, parents, many with vaccine-injured children, showed up in droves to testify at a hearing. Only 64 were allowed to speak, for exactly 60 seconds each.

Parents have NO right to make health decisions, such as to forgo certain vaccines and self-isolate if there is an outbreak, as of currently rare measles. They have NO right to practice their religion—and the state even defines what constitutes a genuine faith. They have NO right even to be heard.

It makes sense: if you have a “right” to healthcare, and the government is empowered to define it and obligated to provide it, you are part of the herd on the government ranch. It’s the population health that is important, not yours or your child’s.

And don’t believe that these “compassionate” or public-health-conscious politicians aren’t being driven by money. Physicians may be tightly scrutinized lest they charge $5 too much or accept a sandwich or a notepad from a drug company. But how big a bonus do they get from insurance plans for nearly perfect vaccine compliance? How much of Medicare and Medicaid funding and insurance subsidies is enriching managed-care executives and big hospital systems while providing minimal care?

Americans need to look behind the “rights” rhetoric, see the chains, and follow the money.


Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. Since 1988, she has been chairman of the Public Health Committee of the Pima County (Arizona) Medical Society. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fourth editions of Sapira’s Art and Science of Bedside Diagnosis published by Lippincott, Williams & Wilkins. She authored books for schoolchildren, Professor Klugimkopf’s Old-Fashioned English Grammar and Professor Klugimkopf’s Spelling Methodpublished by Robinson Books, and coauthored two novels published as Kindle books, Neomorts and Moonshine.More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.

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