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Miles J. Zaremski Headshot

The Supreme Court's Health Law Cases -- Is Health Care 'Happiness'?

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The Declaration of Independence declares life, liberty and the pursuit of happiness to be inalienable rights.

In 1943, FDR proposed a 'Second Bill of Rights' that included freedoms inclusive of adequate medical care and the opportunity to achieve and enjoy good health. Five years later, the United Nations' Universal Declaration of Human Rights enshrined a right to health care.

The American Medical Association's "Patient's Bill of Rights" includes a statement that patients have a "right to essential health care."

Many politicians, included Obama, have also announced that health care should be a right, and not a privilege or responsibility. So has this writer many times over.

Conversely, others have said that health care cannot be a right because [any such rights] impose on some other person or group an involuntary, un-chosen obligation to provide them. And, so the argument here goes, "When government attempts to implement a right to health care, the result will be the abrogation of liberty rights."

And, now, as oral arguments over three days late next month before the United States Supreme Court approach, the nagging question behind all the legalese written and to be argued before the nation's highest court is, no doubt, what is it about our health care and ways to access and afford it that make the decisions to be forthcoming by end of the court's term so monumental and significant?

Did the Founding Fathers have in mind, at least in part, being well and healthy when they said that we have an inalienable right to pursue...happiness? Is being healthy "happiness"? Is being healthy a state of wellbeing? Is part of life's satisfaction being healthy enough to enjoy it? Logic would provide an obvious yes to all three queries. Another answer may lie in a monograph just published and that brings together a series of essays on whether government should try to maximize wellbeing. The title is, ...and the pursuit of Happiness, edited by Phillip Booth (Institute of Economic Affairs (1-16-12). Though this collection focuses on Britain and 125 other countries, findings include that happiness is related to income; that no evidence suggests equality in income is related to happiness (only employment, marriage, religious beliefs and avoiding poverty); that wellbeing at work weakly correlates with being happy; that the more government spends on its citizens the less likely a correlation to a growth in life satisfaction; and the more citizens are allowed to use economic resources to pursue their own goals the greater one's wellbeing will become. It is this last point that bears relevance to this post.

Without health, one has nothing. Without health, one cannot be productive using any yardstick. Without health, one cannot achieve wellbeing, physically and mentally. Of course, to be healthy requires a citizen to access and afford the avenues by which one can achieve or maintain a state of wellbeing, i.e., a state of health. This, in turn, requires economic resources as Booth describes in his monograph. Deductive reasoning would then have us believe that when a citizen fails to have adequate financial resources to achieve a state of healthiness, then -- as described by Booth and his colleagues -- wellbeing cannot be achieved and life's satisfaction deteriorates. A book published last month and written by Otis Webb Brawley,M.D., How We Do Harm -- A Doctor Breaks Ranks About Being Sick in America (St. Martin's Press (2012), also bears relevance on this point. Some thus conclude that health care needs to become a right in a kind of human rights or moralistic way.

Our law and those who decide it through written opinions are necessarily constrained by the surfeit of legal precedent and judicial doctrines developed over time. It is not typical that a philosophy or ideology becomes a catalyst for how any one case will be, or is, decided. The health care cases could be different, since the marketplace we call health care goods and services and typically the market that enables most of us to access and afford it---the insurance market---are intertwined together like strands of DNA in a graphic with a philosophical underpinning that relates accessing and affording health care to our state of wellbeing and...happiness. While legal issues can most often by decided in black and white terms constrained by the "four corners" of "the law", the nine members of our nation's highest court know that while deciding the legal issues before them, not a one of them will be immune from the state of wellbeing that is theirs alone through being as healthy as they can be by the health care available to them. Concomitantly, what is theirs is shared equally by the millions of Americans having the real possibility of achieving a similar state of wellbeing by what is offered in the health care law if left intact and not ruled unconstitutional.

Let's hope there will be a majority of our Supreme Court that appreciates health care equates to happiness, wellbeing and life's satisfaction. Let's believe that such an appreciation will be woven into the words that make up a final opinion on the issues to be decided.