The next question that comes up, if we accept that healthcare is a right, is how MUCH healthcare is a right? The answer is always "Well, basic healthcare..." So, I guess we can exclude cosmetic surgery. But what else? Does that mean you can get prednisone for your crohn's but not Remicade? We really quickly get into the issue of rationing and cost-effectiveness panels, which is a non-starter in our culture.

Partly this is true, of course, because whenever it is suggested that a service is maybe not cost effective, some medical specialist's income is threatened. Look what happens when it is suggested that mammograms maybe don't have to be done that often, or PSA screening does not improve life expectancy. This is because to a large extent, medicine IS viewed as a commodity. Everyone wants to think that he/she can drive a Lamborghini, and those that sell the product have every incentive to sell more.

I think that if healthcare is to be a right, we have to be willing to have it done all the way; personal provider's income must be disassociated from treatment recommendations. Just having Blue Cross foot the bills is not going to do a thing.

David Grauman MD
Department of Medicine
Commonwealth Health Center
Saipan, Northern Mariana Islands