The Patient as Obligation - The Binary Failure of "Privilege" vs. "Right" Part 2 - My Privilege - From The Great Equation to An American Sickness to Mac and Cheese for All to An American Idea.

S D Med 2020 Jan;73(1):22-31

Sanford Clinic - Infectious Disease, Sioux Falls, South Dakota.

"Privilege" vs. "Right" in healthcare is a failed political binary because it has divided the nation. The "my privilege" end of this false choice has been damaging, shifting the burden to the patient and away from the physician. It is medicine's historic privilege to care for any human but obligation has waned being plagued by opportunism. Also, what we have a right to or are privileged to receive is undefined. Past premises for the privilege are untrue, based on Health = medical care. Present assessments of the privilege are unfair, deeming American medicine a sickness. Future solutions for the privilege are untenable, if "equality" is the goal. The framework for healthcare's obligation-to-give already surrounds us, emerging from the American Revolution with its idea of individual dignity as to priority, checks and balances as to protection and Federalism as to improvement. American medicine has followed this idea albeit misused and unfulfilled. The null hypothesis of this debate must be fairly tested - that American medicine is the worst form of healthcare delivery - except for all the rest. Both Big Business and Big Politics in healthcare have become ends unto themselves and therefore neither can solve the privilege question nor bear the weight of our obligation-to-give. The patient-as-obligation must be our aim.

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January 2020

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