Many lawmakers currently involved in the health care reform debate in Washington are operating under the premise that health care is a basic right of a U.S. citizen.

A long-time friend and a follower of this blog recently posed the question: Is health care a right?

It’s worth pursuing because it’s vitally important that we as a nation come to some conclusion on this as a basic premise in order to finally determine what kind of health care system we ultimately adopt.

Health care is not guaranteed specifically in the U.S. Constitution. But health care has been granted legislatively to those people eligible for Medicare and Medicaid. So that raises the “equal protection” argument that the rest of the population should at least have the same opportunities as those receiving Medicare and Medicaid.

The equal protection clause of the 14^th Amendment to the constitution has been cited in many Supreme Court decisions over the years to ensure to civil rights protection and to mandate public education opportunities to citizens.

However, we don’t think that argument holds up in the health care debate.

The point is worth repeating, we need to determine where health care lies in the legal landscape. Only after we have defined it legally can we have a foundation from which to build a philosophy regarding health care as a right or not.

Furthermore, there is a lot of talk about reforming the U.S. health care “system.” In fact, there really isn’t a system to reform. What we have is a patchwork of ever-changing arrangements between patients, providers, insurers and the government that work well for most, not well for others and not at all for a few.

We need to be talking about building a system, rather than reforming one that doesn’t really exist. Only when we can develop a sound philosophy as to where health care ranks legally based on our constitution, will we be able to determine who should receive care and by whom.

We hear a lot today about the estimated 46 million people in the United States who don’t have health insurance. It’s important to realize that not all of America’s uninsured can be considered victims of a system that excludes them financially.  Many go without insurance voluntarily.

Admittedly the majority of the uninsured, either can’t afford insurance or can’t get it because of pre-existing conditions, but about 2 percent of the uninsured say they just don’t want it and some scholars think that the number who cannot afford it is overestimated.

• Of the reported 46 million uninsured people, 43 percent earn more than $55,000 annually, which is 2.5 times the federal poverty level for a family of four.
• 7.5 million of the uninsured have incomes exceeding $75,000 a year.
• 44 percent of the uninsured are between the ages of 18 and 34, many of whom believe that because of their good health the don’t need insurance. Of this group of “young invincibles,” 10 percent are between the ages of 18 and 24.

Obviously, costs vary in different parts of the country and some do have other priorities that come before health insurance. But, safe to say, there is a sizeable minority that go without insurance because of the low probability that they will use it.

So should we be subsidizing healthy young people who choose to forego health insurance?

Experience tells us there are a lot of young healthy people out there who do without insurance by choice.

Here are four examples we are aware of:

• A young couple both under age 32 with three children. Their household income is $70,000, they live in an upscale house and own two late-model vehicles. Two of the children attend private schools. They don’t have health insurance.
• Another couple is under age 34 and both work. Their household income is between $70,000 and $90,000 a year. They own a modest $110,000 house and are financing two vehicles. Yet they carry no health insurance.
• A young couple with no children earn approximately $60,000 annually and live in a rented apartment. They own one vehicle and are financing another. They have two dogs and no health insurance.
• A young 26-year-old male is self-employed as a construction handyman. He makes $40,000 a year, has a late model vehicle, rents an apartment and owns a boat, but has no health insurance.

All of these people could afford health insurance if they simply put a priority on it. But they have chosen to spend their money in different ways.

Some of the health care reform bills under consideration would offer public subsidies to families up to four times the poverty level. That is your tax dollars going to assist people who can afford insurance, but would rather spend their own money elsewhere.

The Senate Finance Committee on Friday completed its mark-up of a “health care reform” bill.  The process went extremely quickly over the course of two weeks and the committee considered more than 500 amendments during that time frame. That’s indicative of how out of control the process has become. It leads us to some overwhelming questions: Do any legislators actually know what’s in the bill and what the effects will be?

The bottom line for President Obama has always been expanded coverage, yet he continues to insist on a “budget-neutral” bill, one that won’t increase taxes. Our next question is, “Can anyone really believe that is possible?”

And furthermore, how can we expand coverage, keep the funding neutral and still retain quality care for the people who already have access? It seems the variable in the equation is the quality of care. How will it not suffer?

Despite assertions to the contrary, we believe it’s still very much an uphill battle for this bill to eventually pass both houses of Congress. The margin will boil down to whether moderate and conservative Democrats will come on board. Many have been elected to office on the promise of lower taxes and less government. From the looks of this bill, those principles have been sacrificed. Obtaining 60 Democratic votes in the Senate seems like a long-shot.

We’ve had the preliminary debate. Now it’s time to start over on health care reform.