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Miles J. Zaremski

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The Ethics and Philosophy of Health Care As a Citizen's Right -- a US Perspective

Posted: 09/21/2012 12:53 pm

I gave the following presentation outside of Tiberias, Israel (NE Sea of Galilee) on September 4, 2012 as part of a United Nations' UNESCO Conference on Bioethics -- days after Paul Ryan said that rights are from nature and God, but not government, and before it was reported that Mitt Romney stated in a private meeting for wealthy donors that 47 percent of the nation believes they are victims who are entitled, among other things, to health care.

In the Fall 2008, while running for his first term as President of the United States, Barack Obama stated of health care:

I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay for her treatment, there's something fundamentally wrong about that.

On August 11, 2012, Paul Ryan was introduced as the vice presidential running mate by Republican nominee for president, Mitt Romney -- who visited Israel earlier in August. Ryan said, "Our rights come from nature and God, not government." When it comes to health care Mr. Ryan, you are sorely mistaken. But as this is my conclusion, so it is useful in my presentation to back up a bit and look at how we in the United States have looked at this notion called health care and how I am led to conclude and have previously written and published that, health care is a right for all Americans.

First, what is a right? Author David Kelley writing for the Atlas Society 18 years ago, said a "right" is a principle which an individual should be free to have or do; a right is an entitlement, something one has free and clear; something you can exercise without asking anyone else's permission. At the same time, such a right -- according to Kelley and those who offer the same prescription, tramples upon liberty and individualism. This is also a tenet of the noted author, Ayn Rand who spearheaded the concept of objectivism in her books -- that man is an island unto and for himself -- as well as her long time associate and protégé, Dr. Leonard Peikoff, who on her death in 1982 became designated her intellectual and legal heir.

Likewise, he said that if health care is a right, then those who provide it become servants of those who need it and would be deprived of "being traders like everyone else in a free society." In 1993, Pelikoff wrote that the health care plan headed up by our current Sec. of State, Hilary Clinton, at the time would finish off the medical profession and "deliver doctors bound hands and feet to the mercies of the bureaucracy." I do not subscribe to these views because certain items in our lives must be a result of shared sacrifice of a society, involving governmental resources.

A right is to recognize a basic need-here, health care, at some pre-defined level; not everyone need have everything that others have in a health plan, but all do deserve a level that enables one to maintain health and be productive... while at the same time, health care providers deserve to be adequately compensated.

Others have said that health care is a responsibility, and not a right, for only with responsibility comes consequences -- and with medical care, it is excess cost for not doing all to ensure health, like maintaining a proper weight, a balanced diet or not drinking too much. Supporting this notion if that if health care were a right, then it must be forcibly obtained from another to the latter's sweat, time and capital investment. But implicit in health care as a right and not anything else is the notion that by doing what is good for the individual in accessing and affording health care, a country should stay clear of doing what it can to preserve, protect and maintain the health of all its citizens. Again, this is a working philosophy incompatible with ensuring a modicum of health care and its resources for a nation's citizens.

Yet others would say that health care is a privilege. But the very foundation of life is health, and if millions have not the means to afford it or access it as others do, is the life of such a person unable to obtain health care any less worthy than someone who can afford and access the best medical science has to offer? The answer should be clear -- NO! To say otherwise is to believe that health care is only for those who can afford to be healthy and maintain health. For those who cannot afford it, one could say a country becomes socialistic. I doubt that every other industrialized country that assists its citizenry with health care considers itself socialistic, our host country included.

As you can see, America's view of health care as a right is not so simple.

The concept of one's health and being able to access and afford a system of health care in order to be and maintain health is a universal concept quite befitting for this UNESCO conference. For example, the Cardinal of Chicago, Francis George spoke last April in Chicago that Catholic bishops have supported universal health care since the original incarnation of the National Catholic Welfare Conference and founded in 1919. That conference still welcomed the goal of the American federal bill on health care -- the Patient Protection and Affordable Care Act --enacted into law in March 2010 and found constitutional by the United States Supreme Court in June.

In 1943, U.S. President Franklin Delano Roosevelt crafted his "Second Bill of Rights." He declared 'freedom of want' to be one of four essential liberties for human security. His definition of freedom included, "the right to adequate medical care and the opportunity to achieve and enjoy good health." [See Jean Carmalt and Sarah Zaidi, "The Right To Health Care in the United States of America-What Does It Mean?" (Ctr. For Economic and Social Rights (2004)].

In a 1948 document, the parent body of UNESCO -- the United Nations -- enshrined a right to health care in its Universal Declaration of Human Rights, when it proclaimed that, "everyone has the right to a standard of living adequate for the health and well-being of oneself and one's family, including food, clothing, housing, and medical care." The largest American health care organization, the American Medical Association, scribed a document on "Patient's Bill of Rights" that includes a statement that patients have a "right to essential health care."

One of America's founding principles in our Declaration of Independence declares life, liberty and the pursuit of happiness to be inalienable rights. Is health care included? No, not by name or by reference though much of what Americans enjoy were never embodied in our country's founding documents. In a monograph published in Great Britain in January this year by Phillip Booth of London's Institute of Economic Affairs, titled "...and the pursuit of Happiness" the author focused on Great Britain and 125 other countries, not the United States. However, one of his main points is quite relevant here: "the more citizens are allowed to use economic resources to pursue their own goals the greater one's well being will become." Shouldn't a country provide economic resources to enable a person to access and afford the means to be and maintain health?

Putting this another way, and as stated in an editorial on February 17, 2012 by a legislator from the state of New Mexico in the U.S., "Health care is a fundamental right that is an essential safeguard of human life and dignity." If one does not have health, one has nothing at all. If one does not have health, one cannot be productive to him or herself, to family or to friends, to having employment, and even to the nation in a macro economic sense.

David Kelley to whom I referred earlier wrote, "if health care is a right, then government is responsible for seeing that everyone has access to it, just as a right to property means the government must protect us against theft." Concomitantly, if government has such a role, then there will be greater control over the providers of health care and the health care industry. Again, Kelley's thesis is that any right to health care is anathema to individualism and liberty. His thesis does not comport with reality, either in the United States or certainly even in countries like Israel, which created in 1995 its own national health care system.

In the U.S., there are millions of citizens who have no health insurance or who do but are severely underinsured. According to the 2011 edition of the Commonwealth Fund's National Scorecard on U.S. Health System Performance, the U.S. earned a score of 64 out of 100 on 42 indicators of health care performance, and that access to health care significantly eroded since 2006. As of 2010, more than 81 million working-age adults -- 44 percent of those ages 19 to 64 -- were uninsured during the year or underinsured, up from 61 million (35 percent) in 2003. Further, the United States failed to keep pace with gains in health outcomes achieved by the leading countries.

The U.S. ranks last out of 16 industrialized countries on a measure of mortality amenable to medical care [deaths that might have been prevented with timely and effective care], with premature deaths that are 68 percent higher than in the best-performing countries. As many as 91,000 fewer people would die prematurely if the United States could achieve the leading country rate. Health care costs in the U.S. are roughly 18 percent of GDP (in Israel it is about 8 percent) and the average American spends $7,900.00 per year on health care -- twice as much as any other country. And performance on indicators of health system efficiency remains low in America, with the U.S. scoring 53 out of 100 on measures that gauge the level of inappropriate, wasteful, or fragmented care; avoidable hospitalizations; administrative cost; and use of information technology. The World Health Organization ranked us 37th in terms of health system performance. And millions of us citizens go uninsured or are critically underinsured.

All this is why our Affordable Care Act was created and enacted into law. While it will require tinkering after it is fully up and running in 2014, it is America's way of pursuing the goal of health care as a right for all Americans. Of course, there are strong objections from those who oppose government interference into the lives of individuals, asserting that if government attempts to implement a right to health care, the result will be the abrogation of liberty rights.

This is being untruthful to any who have heard such commentary. Again, I draw your attention to Paul Ryan's comments upon being selected as the running mate for Mitt Romney -- rights do not come from government. With health care, nature and a supreme being alone do not provide millions of humans around the world and in the United States with the financial means to access a health care system. To put it in simpler terms -- with a dose of reality -- we have what is called Medicare, a government-run insurance programs for our citizens 65 and older. When asked of this age group about our new health care law, it was not unusual to hear, "I don't want the government to interfere with my life, but it better not touch my Medicare plan." Get my point?

Private industry with fee for service had its chance in the U.S. -- that did not work; then managed care programs within the private sector had their opportunity to provide better access and lower costs. It failed too. What remains is what the U.S. will be doing with its Affordable Care Act and that industrialized countries worldwide have been doing for its citizens for many years.

Yes, government must have a role in the health care of its citizens. Without it, health care will simply continue to be viewed as just a commodity, to be bought and sold on the open market with profits to be made. A government's role does not diminish individual liberty and individualism; does not create a socialistic state, and does not seek to "rob" providers of health care of their goods and services.

Instead, government can provide for a human rights approach that focuses on the underlying purpose of any health care system, as writers Carmalt and Zaidi have written. A government's role is to foster the basic underpinning we call affording and accessing health care, either on its own, partnering with the private sector, or to provide citizens with multiple avenues to acquire and maintain health. Again, without our health, none of us have anything at all. It is thus a moral imperative that health care is recognized as a right for all of a nation's citizens, including, of course, America's.

Thank you.

 

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