It has been almost one year since the specter of health care descended upon America and demanded at last to be recognized.  This is no ordinary ghost, however, and while its presence is felt by every U.S. citizen, there is as yet no consensus as to whether it stands as friend or foe.

Known as the Patient Protection and Affordable Care Act (PPACA), or Health Care Reform, its shape is only just beginning to emerge, and medical practitioners and patients alike are waiting to see how they will be affected.  But before America attempts to confront, classify and coexist with our new system, we as a society must first understand the machinery that lies within.

As the structure of our health care system changes, so too must our definition of an individual’s right to coverage. Make no mistake, health care is a business as well as a service, and to function at its best it must strive for efficiency. Today’s hospitals are constantly criticized for their waste of both resources and finances as they work to stem the never-ending tide of sick patients, but what of the patients themselves?  At what point does a nation’s responsibility to assist those who have become sick intersect with a citizen’s obligation to take care of his or her own body?

As the number of elderly and critical patients continues to rise as our population ages, and federal laws tax our nation’s emergency rooms to the breaking point, it is important to search for ways to reduce the burden on America’s hospitals and, ultimately, the system that funds them.  Provision of health care is a two-way street, and for the new reform to function to the best of its abilities, it must be met halfway.

This begs the question: Is health care a right or a privilege?

The first ten amendments to the United States Constitution protect certain freedoms for all citizens including those of religion, speech, and the right to bear arms, while at the same time defending against unreasonable searches and seizures, self-incrimination, and the quartering of troops. These rights exist as a contract between a nation and its inhabitants, granted at birth.

A privilege, on the other hand, must be earned.  For example, to receive a license to operate a motor vehicle one must exhibit a certain level of competence.  Just as easily, this privilege can be lost by a show of negligence or through disregard for the nature of the privilege itself.

Under the Reform Bill, health care – and emergency medical health care in particular – becomes a right, not a privilege.  There is no prerequisite granting entitlement to its benefits save that of U.S. citizenship, and even the highest level of neglect will not bar any claim to services.  Additionally, the right of health care under PPACA transcends sex, race and class.  Notwithstanding any perceived inequities in this nation’s health care system, it declares that no single individual shall have greater entitlement to the right of health care than another.  For this reason alone, health care defies the basic domestic economic principles of capitalism.

But if health care remains a right that one cannot forfeit through abuse, who is responsible for picking up the tab?  In the past, the business of health care in America has often operated outside the parameters of fiscal consideration, and this lack of financial control has threatened its very existence.  At its core, this new system seeks to address these inequities, recognizing that its survival relies on its sustainability.  Early estimates calculate that health care reform can save $1 trillion between 2020 and 2030 by changing the way the system works, as it forces providers to improve quality, eliminate waste, and place greater focus on the prevention of disease rather than simply addressing treatment.  Optimistically, the health care reform bill promises to create the necessary infrastructure to accommodate these changes, relying upon technology and innovation to forge a new system rather than trying to fix one which is beyond repair. Its goals are lofty and laudable, but at what cost?

As a nation, we do not take fitness seriously.  We eat, drink, and smoke too much, and eschew exercise.  And yet, we have clamored for universal health care as though our bodies were temples in need of constant devotion. For health care reform to succeed it needs active cooperation from the very individuals who enjoy its protection, and the truth is that a long term solution may only be possible after the abolition of unrestrained entitlement to care.  Sadly, today’s health care reform relies upon a level of individual engagement its government has no authority to require or enforce.

Establishing parameters that may one day lead to individual loss of this basic right is not presently up for consideration, and certainly was not included in our current reform package.  But it needs to be.  Otherwise, the foundation of health care will erode to such a degree that any chance to preserve it for the people will be Pyrrhic at best.  Inevitably, the success or failure of health care reform will hinge on how well we as a nation come to appreciate this right and respect the obligations that come with it.  America should enjoy its long-awaited coverage, but treat it with the reverence such a monumental step deserves.