The rights enjoyed by Americans have undergone a major transformation from rights that constrain government power -- for example, the Bill of Rights – to rights guaranteeing tangible benefits. This shift is especially notable for healthcare as millions have come to view “free” government-supplied healthcare as an inalienable right akin to the First Amendment’s protection of free speech.

This is a disaster waiting to happen. Slowly extending First Amendment rights is one thing; it’s quite another to expand a right whose implementation will cost tens of billions. Unfortunately, this potential calamity grows more likely by the days as liberal pundits denounce President Trump’s cost-cutting replacement of ObamaCare as mean-spirited and cruel while almost on cue TV crews discovers a father in a “red” congressional district who implores the president to keep ObamaCare to save his gravely ill son unable to afford expensive medical treatment.

Preventing the onward march of a budget-eating healthcare “right” must be accomplished prior to its arrival, since once in place, it will be irreversible. Let me suggest a proactive approach that challenges the intellectual foundation of this putative right.

First, what should government-supplied healthcare target? This is hardly hair-splitting if government must pay for curing “an illness.” What makes this question so timely is that “illness” has been expanding so that what was once a non-medical, purely personal infirmity is now a “sickness” that deserves medical attention. Indeed, countless “sins” now warrant government-paid doctor treatments.  

Examples of this expansive “medicalization” include obesity, sexual dysfunction, multiple addictions -- gambling, alcohol and drug abuse, sexual behavior such as exhibitionism and child molestation -- and crimes such as shoplifting (kleptomania). Millions of youngsters once chastised for being fidgety are now diagnosed with Attention Deficit Disorder and medicated with Ritalin or Adderall. How about people who experience episodic but not debilitating depression?  Surely occasional “being blue” is common but does everyone now have an unalienable right to Prozac?  Even violent criminal behavior can be a genetic disorder and thus possibly reversed by brain surgery, not incarceration.     

Innumerable mental conditions may be troublesome, but are they “illnesses” demanding treatment? Phobias are a perfect illustration and a compendium in alphabetic order runs for pages. Just under the letter A” are 21 distinct phobias, for example, Autophobia (fear of being alone). No doubt, sufferers might demand medical attention but should government be responsible for curing every phobia?

Taking a page from how the Soviet Union addressed political deviancy, are we to classify racism, xenophobia, homophobia, and Islamophobia as pathologies in need of medical intervention? Don’t laugh-- such “dangerous” conditions are already been probed with medical devices while mandatory anti-bias “sensitivity training” is all the rage at many universities (even at Fox News) for those exhibiting “insensitivity.” At least for now, however, the cost of waging war on hate is beyond government-subsidized intervention.   

Then there’s cosmetic surgery. While many procedures are medical necessities, e.g., birth defects, millions are, as the term signifies, “cosmetic.” Should Uncle Sam pay for breast augmentations, breast lifts, buttock augmentation, facelifts, hair transplants and penile enlargements? (See here for countless other examples.) What makes this plastic surgery troublesome is that many procedures, for example, liposuction, can be both legitimate medical procedure while simultaneously bringing social benefits.

Finally, what about ER patients who just refuse to pay their medical bills? In 1986 Congress passed the Emergency Treatment and Labor Act (EMTALA) that  mandates “free” treatment for ER patients unable or unwilling to pay if the hospital accepts Medicare (most do). This guarantee is not unlimited (an emergency must exist) but in principle, millions of Americans currently enjoy this “free” care regardless of what President Trump or Congress decides. A little statutory tinkering could open a floodgate for millions of Americans to avail themselves of “free” medical care via the ER.    

The second issue in this medical-treatment-as-a-government-guaranteed-right concerns the appropriate level of professional intervention. As with defining “illness,” a vast gray area exists regarding Uncle Sam’s financial obligations. Suppose you have a headache. How about visiting a pharmacy and asking the druggist for free advice and then buy some extra-strength Tylenol? But this option requires an out-of-pocket expense, so it is cheaper to visit the “free” emergency room and get the painkiller gratis. Even better, take a government-paid ambulance and avoid a cab or bus fare. Though it is complicated to determine the costs of ER visits, at a minimum the cost will far exceed the $10.34 plus shipping for 50 extra-strength Tylenol tablets on Amazon.

Or, at the other extreme, since everything is “free,” make an appointment with a Mayo Clinic neurologist. Does “free medical care” somehow imply equal medical treatment for rich and poor, black and white citizen and non-citizen? Conceivably, the Supreme Court may answer “yes” (the parallel are cases involving equal school expenditures).

Finally, “free” brings what economists call demand elasticity -- absent price constraint, the appetite for medical solutions becomes rapacious (hypochondria). Every pain, no matter how small, now justifies a visit to the doctor. To be sure, insurance usually caps some services, but the total menu of what can be gotten for “free’ may be huge. A cheapskate parent might use the family doctor for junior’s illnesses -- rashes, sniffles, head lice, athlete’s foot -- once treated with over-the-counter remedies or, occasionally, not treated at all.

This is only a brief sampling of the tribulations awaiting expansive “free” government-subsidized medical care. Clearly, Uncle Sam may be super-rich but nobody is sufficiently wealthy to pay for every health “problem” for every person, and this nightmare would be even worse if, as is now policy in Great Britain, “free” healthcare even extends to everybody physically in the country, even new arrivals. Absent unlimited funding, choices are inescapable, so some will be denied vital health care and will “needlessly” die despite a “free” healthcare right written in stone.

Particularly troublesome is the fact that few of the alternatives will be discussed or settled publicly. Congress cannot legislate everything, so nitty-gritty choices will be resolved by faceless bureaucrats, insurance providers, hospital administrators, and lobbyists agitating on behalf of those with serious skin in the game.

But, in all likelihood, when tough decisions arise in some obscure agency, the pressure will be to say “yes” to demands for yet more “free” government-provided help. When it comes to extracting government benefits, the impassioned few nearly always defeat the indifferent many. Few Americans will take to the streets to protest hyperexpensive government-provided fertility treatments for women unable to conceive the old-fashioned way. Meanwhile, who wants to deny an ER visit by a homeless drunk who needs a safe space to sleep it off? Result: national bankruptcy by a thousand cuts.  

A General Motors executive once quipped that GM is a health insurance company that occasionally builds cars. Unless we are willing to tackle the types of painful quandaries raised here, the federal government may well become a healthcare provider that on the side provides national defense, prints money, builds highways and otherwise offers some underfunded services.