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

[burndtdan]

It would be incredibly easy to argue that health care falls under our right to life. Medical care is how we preserve that life, which we are explicitly entitled to.

[Miles J. Zaremski - Huffpost Blogger]

You are correct on how health care can equate and be viewed as the passageway to life (and liberty and the pursuit of happiness).

[Peter007]

Thats not a good logical argument. ie. I have a right to life. Free Health care gives me life. Therefore I have a right to free health care. It Follows not that..

....I have a right to life. The governor of Texas can grant me a stay of execution. Therefore I have a right to a stay.

[LeftRight]

But in the example that you present for why burndtdan's argument fails, you neglect one VITAL piece of information. Your right to life is absolute, UNLESS your living can be shown to cause more harm to society than your life ending will harm you! No right is absolute, since society has the overarching right to protect ITself! Since a person on death row committed a horrible crime (assuming that they weren't placed there wrongly, btu they wouldn't use that as an argument anyway!) they are shown to be a major risk to society as a whole, and thus society has the superright to END that person's right to life!

[randyjet]

In case of war, NO person in this country has health insurance. I looked at my health insurance policy when I had it, and it specifically denied coverage from any act of war or participation in a crime. So if I got shot by a cop, it would not cover me.
The reason all of Europe has national health care is because of WWII, when nobody had health insurance for war related injuries. It was INDEED a right since all of those seriously injured citizens got their wounds for simply being in existence and citizens. There is NO private insurance company on Earth that could possibly cover such a thing.

[Miles J. Zaremski - Huffpost Blogger]

take a look at a piece journalist T.R. Reid did earlier this year for PBS on various national health care plans enacted for citizens in countries like France, Switzerland, Taiwan, England, and so forth.

[Pleneras]

You feed off the impossible rather than the reality that it IS possible and has been proven. Government has wasted our tax dollars for centuries on frivolous practices, think universal healthcare is going to bankrupt us? This will lead to workers having more money in their pockets to stimulate the economy resulting in revenue. And where does universal healthcare get their money? Revenue!

[NordicSci]

Instead of getting tangled in arcane philosophical-historical arguments about what counts among our fundamental human rights, one can also make a case for universal health care simply as a public good like defense, education, etc. There are very practical and economic reasons for moving toward universal coverage. Among them are reducing the economic chaos of unmanaged risk (a lesson we are painfully re-learning from the banking industry), recognizing that we all stand to gain when our neighbors are also healthy, and affirming our undeniable moral inclination to offer critical care to the sick and injured regardless of their ability to pay.

The issue is not whether to socialize medicine (most of it already is) but how to do it better, more fairly and more efficiently. Collectively provided goods and services (whether through private insurance or public taxes) are always vulnerable to abuse and perverse incentives such as cherry-picking the risk pool to exclude certain groups who might be at higher risk, shifting costs to those outside the risk pool, and free-riders who enjoy the benefits of pooling risk without participating financially. It also helps if those insured exercise prudence to reduce unnecessary risk (the moral hazard of insurance systems). Government thus has a vital role to play in overseeing any socialized (insurance) system including those offered by the private sector.

[Miles J. Zaremski - Huffpost Blogger]

But what about the millions who do not have health insurance; who must rely upon the ER of hospitals for care? What about the millions who go bankrupt because they can't pay their doctor and hospital bills? What we need is a public-private universal program to provide health coverage for ALL while at the same time promoting public awareness that staying healthy reduces costs (like the problem we can with overweight folks in the country, for example).

[LeftRight]

"The issue is not whether to socialize medicine (most of it already is)"

I would challenge this assumption. Most doctors are either working in their own PRIVATE practice, or through an HMO. Many of them have contracts with a local hospital, which is now MUCH more likely to be privately owned by a health CARE organization.

In Chicagoland, there are only a couple of public hospitals left around, and the county is now trying to either shut them down or sell them off! Once that happens, there will be NO public health care beyond a county run health clinic which barely provides basic health services to the community!

[NordicSci]

By socialized I meant the payment of health care not the providers of health care. This often gets confused. What needs to be universal (socialized) is access to at least some minimal level of health care (particularly preventative, pediatric, and catastrophic care). This is what insurance schemes do, they socialize certain risks (usually the most capricious, catastrophic kind) and this is often a good thing in a market economy (it is why we socialized the risk of bank failure in the 1930s). But insurance systems are also subject to perverse incentives (cost shifting, cherry-picking, moral hazards) so they need to be well-managed (regulated) by the government. Because health is a public good like education, defense, public safety, and confidence in the banking system it needs to be paid for collectively.

[gaydm]

Roads do not build them selves, bridges do not just grow out of thin air. It takes people too make things, think of things, and to a large extent do the things that keep us all safe and comfortable. Health care for all should be as mandatory as maintenance of any equipment that you use, or rely on, if you want the best performance. I believe it is in the best interest of all of us to have a national health care system. I pay taxes for war, I should pay taxes to keep us healthy as well.

[Miles J. Zaremski - Huffpost Blogger]

Could not agree with you more. What you are suggesting is what we should have: a public-private partnership, where taxes pay for a floor of coverage for all, with higher levels paid for privately through employers or us individually. But let those in Congress know how you feel!

[VikingQuest]

Health care is not a right in this country, if it is please show me where it lies in the constitution/bill of rights. You many "feel" like it is but it is not unless you want to amend the constitution.

[Miles J. Zaremski - Huffpost Blogger]

while your comments are appreciated, by suggesting that you are a strict constructionist (like Justice Scalia of the Supreme Court when he says if it is not written within the Constitution we do not have a right to "it"), then you are indicating that there are many items that you obviously presently enjoy or favor which you would do without, because they are not found within the four corners of a document (US Constitution) scribed by our founding fathers, correct? If I am correct in this assumption, then I hope you can always afford and obtain health care for you and your loved ones. Unfortunately, 45+ million Americans do not have that luxury; even today (12-4-08), it was reported on CNN's morning show by Dr. Sanjay Gupta that nearly 100,000 Americans who are diagnosed with cancer will go bankrupt because of the what it will cost to care and treat them.

[Peter007]

I disagree with Scalia.
Its the 10th amendment. "All rights not set forth in this document are reserved for the citizens or states." ( I paraphrased )

[SeenItBefore]

I am one of them. Just had a cancerous prostate removed. If there is no spread, the cost may stay around $28,000.00, the amount I had to pony up before anyone would do anything. That was my entire HSA and a nice chunk out of an IRA. If there is reoccurrence, and I need chemotherapy and/or radiation, I can kiss another 40-60 thousand good bye.

I will be left with 1/2 of my life savings/investments and the real possibility of spending my golden years in a refrigerator crate under a bridge. Quite a reward for playing by the rules.

[Pleneras]

Maybe this will make a lightbulb click in your heuristic circuit. Sometimes stepping out of ones box helps understand the possiblities. Where is this fear and lack of humane compassion coming from if your not really going to pay thousands of dollars out of your own pocket for people to receive universal healthcare? It is only a matter of re-distribution of our tax dollars. We eliminate programs we spend billions on that do not work, reduced programs that are over staffed, boost the economy, and then we shift that expense over to healthcare. How could that hurt you in anyway?

"The free market only works when the consumer has the option of not making the purchase. This is why we have "socialized" police protection, fire protection, mid-air collision protection, and education. Because, as a society, we have said that receiving these services is a necessity, not an option. How can we not say the same for health care?"

[LeftRight]

Yeah, you know what else isn't a right spelled out in the Constitution? Privacy. And yet the SCOTUS has determined that it is a right IMPLIED by the Constitution. In addition to that, there is a little line in the Constitution which reads:

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

This is also known as the Ninth Amendment (oddly enough, part of the Bill of Rights that you speak of!) which states clearly that just because a right is not spelled out explicitly in the Constitution does NOT mean that it doesn't exist!

[Topsailsman]

Viqueen,
We have numerous rights that have been established through regular legislation. If you want to argue that there is no Constitutional Right, go ahead and argue a point that is likely moot. In fact, anyone over 65 has a right to get Medicare. Not in the Constitution. Just takes regular legislation.

[LeftofTerry]

So, the only "rights" that exist are ones that American business leaders (aka - founding fathers) mentioned in the bill of rights/constitution.

So, in 1750, there were no rights for anyone, for anything.

Yes, health care is a human right.

[Miles J. Zaremski - Huffpost Blogger]

Spread the word on health care as a right!

[saami]

Healthcare is a right because with out health you can not truly have life, liberty and the pursuit of happiness. Health trumps everything. Civilized countries around the world have recognized this and have enacted universal coverage. You shouldn't have to have money or a job to have healthcare; it is difficult to keep a job if you aren't healthy.

[VikingQuest]

How about a house?

You can't be homeless either and have life.

I also want a satellite dish and a LCD TV too.

[Rimser]

If you have your health, you can then work and thereby pursue whatever makes you happy.

[PATina]

Come to Pittsburgh... there are a lot of "living" homeless people here!!!!

[LeftRight]

Everything that you list is not essential for life. Many of them are things that might make people happy, but we do not have a right to be happy. We have the right to PURSUE happiness, but we cannot do that if we are not healthy!

[Miles J. Zaremski - Huffpost Blogger]

Right on!

[Mnemanth]

Ok. Let's make this simple. We supposedly have a government by the people, for the people, and all that. The People (that's us, by the way) are overwhelmingly in favor of nationalized healthcare. We're all paying taxes- well most of us anyway- and since it's our money, the sweat of our labor, we should and will tell our public servants what will be done with those funds. I feel sorry for the worlds poor, and destitute, and diseased, and heartbroken; however, until my family is cared for and living the same dream as the rich, then the rest of the world's just going to have to wait. It doesn't matter if this is a "right", per se. The People (again, that's us, you and I, the constituency) have called for it, and it will, therefore, happen.

[Miles J. Zaremski - Huffpost Blogger]

Thank you for your thoughts. Yes, a voter would expect that if a majority of us tell our elected officials to do something, they would do it. Unfortunately, our political world does not seem to work that way, i.e., the $700 billion bailout that Congress approved, but no one knows where the money is going, and why, and now Paulsen switches reasons why the money is being doled out the way it has been so far. But, getting back to health care, there is an overwhelming movement to mandate health care for every single American, young and old, rich or poor. But it is only through our collective voices heard over and over again that change which President-Elect Obama speaks about here really come about.

[Mnemanth]

Sir, I no longer just expect anything other than corruption. "Expect that if a majority..."? That's how it's supposed to work, and it's about time it got that way.
I have the sneaking suspicion that with the mounting tension (foreign occupations, financial handouts to the rich, layoffs, political turmoil) our friends in Washington are creating an atmosphere demanding action from the People. Action I don't think they're going to much care for.
It's time to take our country back. Collective voices? Someone, regardless of who, better get to listening before it soon becomes collective...something else.

[debrouillard]

What a question.

I have always wondered about the so call pro-lifers in the right wing.

They are against every one having quality healthcare as in McCains Air Quoting it.

Yet they claim to be pro-life. Its Ok for a newly born to die because their parents cant afford healthcare for them.

[Miles J. Zaremski - Huffpost Blogger]

Thank you for taking the time to respond. Yes, it appears to be oxymoronic to take a "pro-life" stance, yet do not believe that health care should be for all - - - particularly since health care enables all to be as healthy as possible---whatever the their status in life.

[Freesia2]

Interesting article Mr. Zaremski.....I think the problem is when we get stuck on words like "right". When we ponder whether it's "founded" in our history. Many things weren't "founded" there. Like Income Tax.

From the moment last century we were required by the government to pay our first income tax payment, we stepped off our foundation. (Waded into the shallow end of socialism?) It's not in our foundation as a country to hand over a good percentage of our earnings to the government in a required payment. Taxes per se - certainly. But traditionally we paid them on what we bought, from tea on, but we could always choose to switch to coffee or just drink water and save our pennies. To buy what we chose. Such as some health care.

As long as the government takes our money in a blind payment for our "greater good" then as citizens we get to decide what is in our greater good. I think having an equipped military, bridges that don't fall into rivers, roads that do go somewhere, education for children and a hot lunch for them as well, are good for us all. Being able to go the doctor is as well.

They take our money - but decide that it isn't in our greater interest to give us health care. Fine. Give me back my money and I'll pay for my own doctor and look after my own interest.

[Miles J. Zaremski - Huffpost Blogger]

Thank you for your observations. It is about time that we achieve real health care reform, so that every American has it, and those who cannot afford it, obtains it.

[Libbydoe]

Healthcare needs to be a right in a civilized country simply because of the contagion factor. Germs can't tell if you are rich or poor. I certainly don't want to get sick because the person in front of me in the grocery line can't afford to go to the doctor for treatment.

Naturally, I know that not all healthcare issues involve contagious diseases, but as the supposedly most advanced country in the world, shouldn't we make sure our citizens are healthy regardless of socio-economic status?

[Miles J. Zaremski - Huffpost Blogger]

Thank you for your response. You are correct that disease and illness is an "equal opportunity employer" - - - it does not know who it affects or to what degree. But, as you rightly point out, health care is a right belonging to all, regardless of race, creed, color, class or socio-economic standing.