Is Health Care a Right and Should It Be?

In the second presidential debate in October in Nashville, President-Elect Obama was asked whether health care was a right, a privilege or a responsibility. Without hesitation, he said it was a right. He never said why he felt that way, but he has been clear that his administration is making health care reform a top priority -- that is, if there is any money left over in the government after filling the tin cups of Wall Street, the big three automakers, schools, municipalities, etc. But, regardless, should health care be a right? And shouldn't it (health care being a right) be clearly articulated by the electorate and those on both sides of the aisle before our elected officials cogitate over all the bills to reform the health care system once the inauguration is over? The answer to both these questions is clearly, yes.

First, why should health care be a right? After all, it is not written in our Constitution that it is an inalienable right; it is not contained in the Bill of Rights either. Parenthetically, neither is procreation, how many kids to have, being forced to stop smoking after being diagnosed with lung cancer, the right to be free from second hand smoke in public, or crime, or terrorism; and rejecting the imposition of curfews to protect our safety and welfare. The list here goes on and on. Yes, we do have a recognized right to life, liberty and the pursuit of happiness, so maybe receiving affordable and accessible health care falls under this umbrella?

Is health care a right founded in American history? Sources are few and far between on this one, though in an article I wrote last August ("Universal Coverage: How to Get There", in Clininal Endrocrinology News,Vol. 3, No.8 (Elsevier, Inc.-publ. (August 2008)), I suggested that reviewing the background and development for Medicare that was signed into law in July,1965, would be useful for the current debate on how to achieve real reform in our health care system. A writer on the history of Medicare at the time, Peter Corning, described Medicare as the product of considerable effort -- in many ways the product of plain-old political "wheeling and dealing". But Medicare represented the first social legislation to provide medical care to a segment of our population at the time. This perspective was recently amplified in a piece by Blumenthal and Morone, "The Lessons of Success -- Revisiting the Medicare Story", (359 NEJM 2384-2389 (November 27, 2008). In audio tapes and archival materials recently released by the Johnson library, President Johnson told Hubert Humphrey, "Don't ever argue with me. I'll go a hundred million or a billion on health or education...You got to have health...I'll spend the goddamn money. I may cut back some tanks. But not on health." (recording of tel. conv. between Johnson and Humphrey, March 6, 1965, 11:25 a.m., Citation no. C.7024-7025).

The following year, the preamble to a federal health planning act bill stated, "The fulfillment of our natural purpose depends on promoting and assuring the highest level of health attainable for every person."

But, still nothing about health care being a right.

In 1993-94, then President Clinton tried to champion the Health Security Act; it died a million deaths. Now comes along various proposals and commentary to revise our present system: Sen. Ron Wyden's "Healthy Americans Act"; Sen. Baucus' white paper on the subject; Sen. Kennedy is working on his draft; and even HHS Secretary-Elect Daschle has spoken during a recent conference call. Of course, we can't forget what Obama has proposed; what McCain offered and even what Sen. Clinton put forth on health care during the campaign. And, we have yet to hear what Members of the House will offer. True, among these efforts is defining who should be provided with health care protections, but still a whole lot of chest-beating without knowing why are we doing this?

But where has it been officially said that health care is, or should be, a right?

Webster's dictionary defines a "right" in general terms as what is sound and in accord with justice, fact or reason -- what is suitable and appropriate. There is even a definition inclusive of having sound health! So, is health care what is suitable and appropriate?; is it reasonable that all Americans must be healthy by being provided with a doctor and a place to be treated every time we are sick, injured or require surgery? Or, is health care a right because, as we have read and heard, 45+ million Americans have no health care coverage, or have been forced into bankruptcy because they could not pay their doctor and hospital bills? Not exactly, though this (latter) data and events are reasons enough to certainly suggest a system in crisis and in need of immediate repair.

We have seen other countries provide their citizens with health care. Did the leaders there consider health care to be a right. Maybe; maybe not.

How about trying on for size this reason: without being healthy, we cannot be productive, i.e., we cannot work, earn income, spend on goods and services and promote the economy and welfare of the nation. Likewise, if we are sick, dollars have to be spent to make us better; this places a drain on the economy. Of course, if we are healthy, we can do more things for our family, relatives, our churches and synagogues, and our communities. Putting all this slightly differently, without our health, we have nothing, and we then have nothing to offer! Do these premises just stated make health care a right for all Americans? Absolutely!

We see our President-Elect tout change in health care accessibility and affordability, and we see pundits and elected officials debate the pros and cons for reforming health care; yet, without a clearly articulated statement from the electorate through our elected officials on both sides of the aisle that health care is a right of all Americans, aren't we all just really "dancing on the head of a pin"?

Comments

[caterpol]

Great article that created a lot of interesting dialogue.

I don't know that selling health care as a "right" is the way to go; I see it as simply morally superior given the alternatives. And we Americans, if nothing else, are convinced that we're morally superior.

I also see it as fiscally conservative, given the economic and national security consequences.
Also, I doubt that there's one American who would choose to buy retail what they could otherwise buy wholesale, yet the RW fiscal conservatives in this case argue that paying the corporate middle man to decide on the health choices of Americans is the last defense against socialism.

It's just weird that this same RW bloc insists that they're the party of family values. The party of pro-life.

[j92882]

Healthcare is a right. The Declaration of Independence would support that view: "... endowed by their Creator with certain unalienable Rights, that among these are Life ¦"

It is also implied in the Constitution: "...promote the general welfare ¦"

Assume you have heart disease. Do you need a triple bypass, or do you just want it? Healthcare is a basic need, rather than just a desired benefit. Therefore, it should be construed as a right, rather than a privilege.

Whether healthcare is a right or a privilege is actually only a façade masking a deeper issue concerning the universal healthcare conflict between a one payor (socialized medicine) system versus a privatized system controlled by insurance companies.

The problem is that we treat healthcare as a business. In reality, it is only a business to medical providers and insurance companies. Insurance company profits come from reducing claims, and paying less on claims. This means denying coverage, denying treatment, increasing deductibles, increasing co-pays, etc., and hence, our current healthcare crisis.

Socialized medicine is only the paranoid"s road to communism. Are the Canadians, English, French, and many others, communists and socialists?

The U.S. already has socialized medicine - Medicare, (and, the healthcare program provided to military personnel and their families). Insurance companies operate within the Medicare system, and make a profit (even with the regulations and cost control fee schedules). The shortest path to universal healthcare is to simply open Medicare to everyone.

[VikingQuest]

"It is also implied in the Constitution: "...promote the general welfare"

If you get that from that little statement . . . any gun laws should be repealed today and people should be able to carry RPGs.

"The U.S. already has socialized medicine - Medicare"

Indeed, little do most people know it has about $40 Trillion with a "T" in unfunded liabilities and needs to changed and spending cut ASAP.

[caterpol]

I'd sincerely like to hear your alternative.

You seem to suggest that the physically and mentally illl, from the very young to the very old----an alarming percent of the middle and underclass----should be classified as lazy losers, and be left to die in the streets.

I understand your frustration with those who would rather collect welfare than work, but I do wonder, every time one of your ilk complain about them, why you aren't following suit. If the welfare life is so wonderful, why aren't you living such a free and easy life style?

Why would you be jealous of folks you so obviiously disdain?

[j92882]

Hey ¦ great idea! Let"s cut Medicare. Who needs those sponging non-taxpaying old people anyway ¦ and, we could use the money to buy the things we really need ¦ like RPGs. We could cut Social Security too! After all, those old bums didn"t really put anything in it. How many Trillions with a "T" could we save then? Yea ¦ you"re right ¦ that "¦ promote the general welfare" thing is completely bogus. Any idiot can see that Constitutional "little statements" don"t apply unless they are express and specific.

[brklynivn]

YES, in the 21st Century, Healthcare IS a right.

[devadasi]

Exactly brklynivn! Times have changed.....universal health care has evolved into a 'right'.....otherwise the only people that will benefit from good health care would be the rich. With rising medical costs, businesses won't be able to cover their employees much longer either.

I'm paying for my own health insurance and the stress of that monthly payment is killing me, stressing me out to the max.....that is an oxymoron!

[ReasonIsMyReligion]

Why do we take it for granted that the Fire Department should be a government function, but not the Health Department?

Either way, it's about pooling risk.

[VikingQuest]

Fire departments are localized aren't they . . .

What do you think your property taxes would be if you slapped health care on that? Your city wouldn't last 6 months before everyone moved.

[FogBelter]

Property tax? Come on. A national consumption tax. Everyone pays into the system every time they buy something. If people want to move out the country because of it, I say leave.

[ReasonIsMyReligion]

I'm arguing the principle of what should be considered a "public good" -- not the method nor quantity of payment for it.

Re localized. Fine. Pick anything we take for granted as a federal function already. Then ask why it should not be localized. e.g. Why a federal Dept of Education, when such is funded by... your local property tax.

[LeftRight]

Yes, they are localized, but there's two problems here:

1) they may receive their DIRECT funding locally, but they also receive a large portion of their funding from FEDERAL sources. That's why Clinton was able to add 100,000 additional police to the streets!

2) it's a total red herring, because we ALL agree that a govt funded Police and Fire Protection department are a good idea, never mind the funding source, so why wouldn't we consider HEALTH CARE as a good idea??

[NordicSci]

If the comments on this blog are any indication, the problem with arguing that health care is a right is that it doesn"t win over many conservatives. If we get universal care in this country it won"t be because a majority came around to see healthcare as some kind of "natural right." As much as it resonates with my liberal instincts, it won"t get us very far in advancing healthcare policy. While I believe Obama when he says health care is a right, I expect him to work the issue by focusing primarily on the practical (economic) advantages of a more universal access to health care system. This is the core of Obama"s approach to politics. In "Audacity of Hope" he often lays out his philosophical views by contrasting them with the other side, and then explaining how you bridge the divide. Liberal ideologues need to relax a bit and recognize that Obama"s approach to governing will focus on getting results, not picking ideological fights. I don"t think this is the same as caving-in or "governing from the center" but reflects his instincts for how to get the results he believes in.

[Apov]

ABSOLUTELY! YES INDEED!

[breakfast]

Is healthcare a right? No but the people of the United States, acting through their Representatives, certainly have the right to make it so, if they wish.

This isn't the US of 1808, or 1908, but now, today. Given the way the economic and social dynamic of the US has been evolved and structured, we really have no choice but to take the profit motive out of healthcare and make it a public utility for the benefit of all. The numbers are too large, the need is too great, and the cost is too overwhelming to do it any other way.

[SEQUOIABISON]

Health care is not necessarily a right but it is an obligation if we recognize that we are our brother and sister's keeper.

It is also mandated in the preamble of the constitution, a guideline if you will, that we from many should meld into one, "in order to form a more perfect union, .....provide for the common defense (and) Promote The General Welfare. Of course our founders did not put any specifics into law but gave us this guideline as a compass.

Preamble to the Constitution;
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."

[VikingQuest]

When your brother or sister is a bum sometimes you need to cut them off and tell them to do it themselves.

[SEQUOIABISON]

Glad I am not one of your siblings, Leaf Erickson.

[mlaiuppa]

Even Cubans have better health care.

The underlying problem with healthcare in the U.S. is that it is considered a FOR PROFIT industry with insurance companies running the show. Take the bean counters out and let the doctors do their jobs. If we had as many doctors as we have lawyers in this country, providing affordable healthcare wouldn't be a problem. Free college education would take care of that. Add public universities to K-12 and you'll have no shortage of doctors.

[Donkslayer]

They don't have better healthcare, at all. They just all have access to crappy healthcare. There's a difference.

[JinChicago]

some would debate that our ER rooms are crappy as well...and thats what the majority of uninsured people end up w/ not having insurance.

[JePenseDoncJeSuis]

If health care is a "right", then let's take a look at all of our hierarchy of needs. Is food & shelter a "right"? Is clothing a right? I guess one could argue that on some level they are. The question then becomes how much? I don't think a lot of people would complain too much about some amount of housing assitance for the poor. On the other hand, they might complain if that meant a large apartment, with cable TV, Nintendo, Filet Mignon, etc. included. It's interesting how these limits are somewhat obvious when talking about fundamental things like housing and food, but not so when discussing health care. Are there any limits? Remember Ted Kennedy and his ability to go to Duke doctors for his cancer treatment? Well, shouldn't we all have that "right"? The hard part, like a lot of rights, will be to determine the limits.

[tzip]

When the constitution was written health care was dangerous to your health. A house could be built with a saw and a axe or mud and not be condemed as unfit and out of code. If decent health care had been available with the disparity of care there is now it is likely to have been in our constitution. How about life liberity and the pursuit of happiness? Rich and powerful people get better health care everywere. That does not mean we don't have the right to decent affordable care. That does not impoverish anyone who is ill.

[milesz]

You are correct in the extent and nature of a "right". You mention such items as clothing or housing or perhaps material goods as a "right". But, without our health, we can never hope to achieve the other items in your list. Yes, we have citizens who are less fortunate in their circumstances than others in a variety of ways, but I suspect not even approaching the extent to which Americans don't have the ability to keep themselves healthy. When health care is denied over 46 million because they cannot afford it, or when millions more, perhaps, go into bankruptcy because they cannot afford to pay their medical bills, shouldn't as a nationally recognized policy there be an understanding that health care is an item to be provided all Americans because we are, well, Americans?

[Jesster]

Mybe, even if it is not a "right" - it is - nevertheless "the right thing to do."

[JePenseDoncJeSuis]

There's a bit of a chicken & egg problem to your argument. Without food and shelter, your health will suffer. People survive without health care, but not without food & shelter. Clearly, in the hierarchy of needs, food & shelter are more important. So that begs the question as to why those aren't "rights" more so than health care.

I take exception with your claim that 46 million Americans are "denied" health care because they can't afford it. Based on the 2006 Census Bureau statistics, 10 million of these folks are not American citizens. Another interesting statistic is that over 9 million of the uninsured have household incomes over $75,000. Add to that the number of people who simply choose not to get coverage (often young folks who'd rather have the money) and you quickly realize the problem isn't quite one of "denial" for a large chunk of the uninsured.

[Donkslayer]

Another question might be: "What if a person has intentionally hurt their own health?" (smoking, being fat and/or eating poorly, etc)

[WorkingClass]

You left out sports injuries.

[FogBelter]

I seem to recall the phrase "promote the general Welfare" occurring in the US Constitution at some point, but then the Constitution has been so selectively interpreted I'm sure that those words have been all but stripped of their meaning.

[Jesster]

Unfortunately the current Supreme (and lower) Court(s) are stacked with socalled "strict constitutionalists" which in practical terms means they have no peripheral vision. They are so blinded by their fundamentalist, literal mindsets that they are incapable of seeing the forest for the trees.

[barblibrarian]

As the wealthiest nation on earth we have the ability to recognize and provide to each US citizen the basic necessities to maintain human dignity and reach the full potential of the individual. This includes food, clothing, shelter, health care, education, and a reasonably safe environment. To me this is the moral minimum a nation of our wealth, power and greatness should provide. What a cold hearted perspective to only view this from its benefit to society as a whole. By identifying health care as a right, all judgement calls are eliminated and each person is worthy. By calling it a service or looking at it as a benefit to the larger society, an individual situation can still be called into question and health care can be denied. I believe all human beings have a right to receive health care that is covered cooperatively by society as a whole. And, society as a whole has a responsibility to determine the extent of this coverage and what treatments/procedures may need to be limited or not provided at all.

[Miles J. Zaremski - Huffpost Blogger]

Excellent analysis. Health care is neither a benefit nor a service. A benefit is something received by being part of something else; like the benefit of being a member of a church is to have one's cildren attend youth programs. A service is that which is provided by another, such as a a service provided by a local garage mechanic is to get a free car wash with every oil change. A right is based on nothing other than being (here) an American citizen or taking steps to become an American citizen. Thus, health care is more a right than anything else.

[drock973]

"A benefit is something received by being part of something else"

Which is exactly what health insurance is, a benefit of being part of the company that you work for.

[JePenseDoncJeSuis]

By that argument, you also apparently believe that food, clothing, and shelter are "rights" that require the government to bestow them unto the population.

[Skepticat]

In many civilized countries basic affordable universal health care is now considered a right because the citizens forced their leaders to look beyond the way things use to be - and would not take tradition as an excuse. The US constitutionalist were very smart and progressive for the pre industrial 1780's but slavery was still in, and women voters were out. The constitutional writers, smart lads that they were, realized that their perfect union may be imperfect and thus created a mechanism for amendments, new government responsibilities - and re-definition of "rights" which later generations used to create a "more perfect union".

[silveyk]

If we were to compare the U.S. healthcare system to that of the universalist systems (that is, every other developed Western country on the planet), we would see that we spend significantly more per capita and yet have a higher rates of infant mortality and chronic disease. As a doctor working in a regional public hospital, I have first-hand knowledge that this occurs as a result of how healthcare dollars are spent. Unless you are well-off or have great insurance, one is likely only to receive acute catastrophic healthcare. However, emergent angioplasty is not going to fix the long-term problem of heart disease if the patient cannot afford the adjunct medications or follow-up doctor's visits. While I have philosophical/ethical differences with the Walmart franchise, they have had the greatest positive impact on healthcare in the past few years with there $4 per month generic medications. More businesses should follow their lead and demand changes in the healthcare system (especially when it comes to insurance and pharmaceutical companies). Advocating on behalf of their employees' health would not only cut premiums but decrease sick time and boost company morale.

[schatsie]

Tell me, do you really want Walmart bringing in drugs from China????

We need to be able to import drugs from Canada also....

[AntsyAmerican]

"After all, it is not written in our Constitution that it is an inalienable right; it is not contained in the Bill of Rights either."

Sigh. Let me introduce you to the Ninth Amendment, which reads:

"The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people."

[Peter007]

Ok let me explain it. You have a right to buy health care. You have a right to own a house. You have a right to buy an elephant. ( forgetting state regulations. ) You don't have a right to infringe upon other peoples rights or take their property or services. You have a right to get your broken bone fixed but not a right to make a doctor fix it for free,.

[colleen2]

"You have a right to get your broken bone fixed but not a right to make a doctor fix it for free,"

you're confused. No one claimed that they wanted to force Doctors to work for free. What we would like is something back for the tax dollars we all pay besides unnecessary invasions and occupations that kill our children, raving fanatics lying to our children about human sexuality, welfare for the upper .5% of income earners and a crumbling infrastructure.
I know it does not matter to republicans and the religious right if people die due to lack of health care but it does matter a great deal to normal folks.

[Miles J. Zaremski - Huffpost Blogger]

Sigh. Sigh. You still have not pointed out where it is said, or why, outside the Constitution that health care is a right. regardless, it should remain a right - - - not a benefit nor a service!

[Peter007]

A more important conversation would address the unlimited demand for health care verses the limited supply. What system is to be employed to allocate the limited supply? Remember we have a federal health care program now in the form of Medicare. The future obligations or funding of that program have not been assigned. It is estimated that funding for Medicare will expire by the year 2019. If the economy slows thus year, the system will run out of money before then. Any suggestions?

[NordicSci]

A well socialized (well organized universal) system would only cover what society agrees are the basic, essential services that are in our moral and collective interest to cover " services focused on preventative care, catastrophic care, and care for children. Medicare funding doesn't expire in 2019 but at some point the money going into the system from our payroll taxes will exceed what we are paying out -- we may have aready reached that point. But your question really is about how to ration health care. With private goods the rationing is done by price and ability to pay. When health care is treated as a public good like education or public safety we have to find other ways to ration it besides price. Given that much of health care is already socialized (treated as a public good, including private insurance) we have the problem of excessive demand, which is why health insurance has grown increasingly expensive. To control costs a "better organized system" would build incentives for getting preventative care and controlling lifestyle factors that add to health care costs (e.g., smoking cessation, weight control) and would strictly limit socialized coverage of "non-essential" care (people would have to pay for these services on their own). The judicious use of co-pays might be employed to keep people from seeking excessive treatment for minor ailments (again unless they want to pay for this service on their own).

[SeriousBlack]

Sure. I suggest you start with a premise that isn't complete b.s.

I.E., claiming there is "unlimited" demand for health care.

Wow, you automatically win any discussion starting that way huh?

A), there ISN'T "unlimited" demand for health care, B) There may be a limited supply of health care services but that is something that CAN in fact be addressed by CRE-A-TING MORE health care services. Simple enough for you?