Health care: right or privilege?

Our society is pretty thick with buffers in providing food, housing and disaster relief. Most of us think human beings should be treated like we would want to be treated, and that it is inhumane not to do the best we can to help alleviate suffering. There are a lot of ways the delivery of heath care could be seen as a public utility, and legislation could focus on the way we use health care, the regulation of profits, the payment for health care coverage (not really insurance, because it is needed as a maintenance of health also) in either tax incentives or benefits for individuals and families, and so on.
So the whole thing becomes the big ball of wax and tangled gordion knot that we know it to be. Some system-makers, and people who want to have everything be "fair and the same for all" remind me of naive parents who think they will be able to treat their children EXACTLY the same. In reality, the more we stick protocols to each disease, and force the "providers" to follow them, the stiffer and meaner the Bureaucracy with a big B will become. And what will happen is the same thing that occurs in any system --- there will be some outliers, some non-responders, some bewildering failures, and more nit-picking to cover these scenarios.
We weren't able to take the profits out of the insurance industry by capping what their profits should be, like a true public utility. We have also not been able to curb the profits of the pharmaceutical corporations, and the patent laws and US protectionism are being used against us and our patients. Physicians are not a strong-enough lobby to be able to get ourselves paid better, and ultimately, the "extenders" will be how they stretch the dollars.
We are probably on a long trajectory of shifting pollicies, as we go forward. And some people will keep arguing about rights and needs and obligations, in order to try to get more patients better care in a systemically coherent way.
One of my favorite stories is in the book "Mountains beyond Mountains" about Dr. Paul Farmer and his work with Partners in Health. Dr. Jim Kim has that brilliant kind of mind of a systems-oriented thinker. And he looked at the TB-DOTS program, and tinkered with what it would take to really fix it-- and he was able, by a few international miracles, to get some new pharmaceutical companies to come forward and make the drugs cheaper, so more poor patients with multi-drug-resistant TB could be effectively treated.
That is the kind of paradigm shift we need now. We need IUDs to not cost $800 apiece. We need oral contraceptives to be "affordable" to poor women on Medicaid. We need seniors to get preventive care so they won't come in with super-advanced problems which are harder to effectively treat. But we also know that keeping people healthy costs more than letting them suffer and die. And so we face these intrinsic limits all the time about what is actually "reasonable" or "the standard of care"-- or something EVERYONE should have ( which is how I think a lot of unreflective people would define a "right"). There are practical details which can easily be helped, and others which are extremely difficult to change. But change is inexorable, and we really can't stay the same. We already see it in the push for palliative care, and more Hospice care. There is a struggle, and people fall on different parts of the spectrum, but more are starting to be adamant about not wasting precious medical resources at end-of-life. The shift is in the whole society, not just the medical "providers". Business people are weighing in, as well as the ethicists. Things are getting curioser and curioser!