This fall, a dispute between Mission Health and Blue Cross Blue Shield of North Carolina exposed the underbelly of the health care system in Western North Carolina. In October, Mission terminated the contract between the two, citing rising health care costs and hoping, by renegotiating the terms of its deal with the insurer, to keep care affordable for its patients. The conflict dragged into December, when the two sides finally struck a deal.
But the question of affordable health care, here as everywhere, lingers. With that in mind, the Asheville High School/SILSA (School of Inquiry and Life Sciences) speech and debate team and the Western Carolina Medical Society hosted a debate on the question of “Health Care: Right or Commodity?” on Dec. 15.
Nine panelists took the stage to discuss the question. Leslie Boyd, a freelance writer for Mountain Xpress, highlighted the stakes of the conversation with the story of her son. Unable to get the care he needed, he died of colon cancer at age 33. Boyd sat glowering behind his photo and came down on the side of “right.” Noting that treating health care as a commodity limits access for the poor, she asked, “When did unemployment become punishable by death?”
Katherine Restrepo, health care policy expert for the conservative Raleigh-based John Locke Foundation, worried about the social implications of health care as a right. “If someone claims to have a right, then they’re forcing someone else to provide that right for them,” she said, “which infringes upon our freedoms as Americans.” She suggested that voluntary markets can provide more access to care for more people.
Already, though, health care is treated as a de facto right, said Dr. Steve Buie, psychiatrist at the Pisgah Institute in Asheville. He cited the 1986 federal law that emergency rooms must stabilize and treat anyone who comes in — regardless of ability to pay — as evidence that everyone has a right to health care.
“If you aren’t willing to let people die because they can’t afford health care, you don’t really believe that health care should be a commodity,” Buie said.
Mary Caldwell, a medical ethicist at Mission Hospital, couched the larger question in terms of the country’s character. “A democracy seeks to be a just society,” she said, “where we value all human beings as worthy of respect.” She later echoed the conservative pundit David Brooks’ idea that “democracy starts with the individual dignity of men and women,” and that dignity, in turn, depends on their health.
After a round of opening salvos, the debaters were allowed to ask one another questions. Longtime conservative political figure Carl Mumpower, an Asheville-based psychologist, chairman of the Buncombe County GOP and no great fan of the government’s involvement in health care, asked whether anyone knew of “anywhere with socialized medicine where health care isn’t rationed?”
Dr. Rob Fields, a family medicine practitioner at Mission, found Mumpower’s question wrongheaded. “If you think that health care isn’t rationed here, then you have a fundamental misunderstanding of what happens on the front lines,” he said.
“Look at prescription drugs,” he later added. “People have to make decisions about whether they will pursue, in some cases, life-saving treatment based on economics.” The smiling face of Boyd’s son sat feet away.
Fields heads a regional accountable care organization, in which doctors, hospitals and other providers coordinate care for Medicare patients to provide timely treatment and avoid duplication of services. When Mumpower claimed that all health care systems with government involvement were failing, Fields countered that his group — which includes eight hospitals, 1,100 doctors, and 90,000 patients — had saved Medicare $11 million in treatment costs in the past year.
As the speakers locked horns, Mumpower became the loudest pro-commodity voice and a lightning rod. He compared health care to air, food, clothes and heat, all of which he described as commodities. Market forces, he said, are what keep air clean, a claim met with wide derision.
“Health care is the meat and potatoes, regulation the salt and pepper,” Mumpower continued. “Socialized medicine makes the salt and pepper the meal.”
Here, Dr. Scott Donaldson, a urologist in Hendersonville, chimed in: “You lost me with that salt and pepper stuff.”
Dr. Marsha Fretwell, a retired doctor and member of Physicians for a National Health Program, piled it on. The United States started treating health care as a commodity in the ’70s, she said, “and that has been a failure.”
Restrepo agreed with Mumpower that the logic of the market can encourage successful health care outcomes. She cited the direct primary care model, in which a flat monthly or yearly fee grants access to a range of primary care services, as a promising innovation.
But the doctors as a whole came down on the side of health care as a right, although exactly what that meant was a question that was never answered entirely. What level of health care did that stipulate? If we say “adequate” health care, asked Dustin McIntee, a lawyer and an assistant football coach at Asheville High, then what does adequate mean? How do we define what is guaranteed when the answer cannot realistically be unlimited?
Fields came closest to addressing this point in his closing argument. Any underlying hesitation, he said, was based on the idea that “we can’t provide it as a right because it’s difficult.”
“And I reject that idea entirely,” he continued. “Just because it’s difficult doesn’t mean it shouldn’t be done.”
After the debate, the candidates debriefed with the 40 or so attendees. Donaldson entertained a small crowd — he is running next year as a Democrat for the U.S. House of Representatives in District 11, which Republican Mark Meadows currently represents.
As his primary approaches, Donaldson is focusing specifically on health care. “I think it’s the only issue right now,” he said. “You talk about health care, you’re talking about jobs, education, wage stagnation — hot-button topics.”
He gave an example of someone working 40 hours a week with benefits who comes up with an idea to strike out and start a business venture of her own. “You’re not gonna leave a job with health insurance if you wouldn’t have health insurance after,” he said, adding: “It’s a question of freedom.”
Ilze Greever, captain of Asheville High/SILSA’s speech and debate team, kept an eye on the candidates’ rhetorical performances. “I think it came off really well,” she said. “Lots of different perspectives on a really important issue.”
The speech and debate team hosts these community forums semiannually on a topic of local political interest. Past renditions have taken on disenfranchisement of African-Americans and fracking in North Carolina.
In the end, Greever considered Restrepo and Fields to be the night’s winners, “just because I liked how they brought evidence and thorough analysis, which is something we really focus on as debaters.”