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(Circulation. 2004;109:1460-1462.)
© 2004 American Heart Association, Inc.

Mini-Review: Expert Opinions

US Health Care

Entitlement or Privilege?

Dean J. Kereiakes, MD; James T. Willerson, MD

From The Lindner Center for Research and Education/Ohio Heart Health Center (D.J.K.), Cincinnati, Ohio, and St Luke’s Episcopal Hospital/Texas Heart Institute (J.T.W.), Houston, Tex.

Correspondence to Dean J. Kereiakes, MD, The Lindner Center for Research & Education, 2123 Auburn Ave, Suite 424, Cincinnati, OH 45219 (e-mail lindner@fuse.net); or James T. Willerson, MD, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, Room B524 (MCI-267), Houston, TX 77030-2697 (e-mail suzy.lanier@uth.tmc.edu).

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.

— —The Declaration of Independence of the Thirteen Colonies, July 4, 1776

These words of our founding fathers succinctly congeal the aspirations of all Americans. Although the reference to freedom is unambiguous, the reference to "life" has both figurative and literal interpretations. Was the intent an entitlement to healthcare services? In a country based on free enterprise driven by market forces with an emphasis on consumer choice, was the intent of our forefathers to define health care as unalienable right? Support for this intent may have been provided by the US Congress in 1965 when "first-dollar coverage" was introduced with the inception of Medicare. And yet, in virtually all other sectors of American life (except health care), financial responsibility enables freedom of choice. In buying a house or car, choosing a hotel, or dining at a restaurant, consumers choose what they are willing to pay, and market forces determine the price. This free-market, consumer-driven process implicitly values the quality of goods and personal services provided. Hence, the common adage, "You get what you pay for."

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