The intense debate about the Affordable Care Act and the “repeal-and-replace” effort currently underway in Congress by the Republican Party majority harbors an elemental question at its foundation: Is health care a human right?
Generally speaking, I think it safe to say Democrats would answer yes to that question, Republicans no. It’s a stark dividing line across which scores of different philosophical arguments and assumptions have been proffered by equally passionate advocates on either side.
But I think it is fundamentally the wrong question, and I will try to wrestle down the reasons why in the rest of this post.
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Neither the Declaration of Independence nor the United States Constitution say anything specifically about a “right” to health care. Republicans are fond of pointing to this in defense of their argument that health care is a commodity, a service provided by others rather than an inherent, individually claimed and experienced right, as is, say, freedom of thought or speech.
The question of anyone’s ‘right’ to be provided health care in an emergency becomes moot, irrelevant; it withers in the presence of a suffering human being, a brother or sister with a certain immediate claim on our conscience and compassion.
No one has to “give” you anything, save for tolerance, for you to exercise your right to speak your mind, goes this line of thought. That makes speech a “negative right,” in that it is absent a requirement for anyone else’s participation.
But health care is different because it is a service and a commodity. That places it in a different category. It is a “positive right,” in that some other person has to provide it for you, and that person has to be paid.
And to that imperative, the purely libertarian position toward which much Republican thought has been trending in recent years asks, “Why should that paying person be me?” (In the form of taxes to help fund the universal access to health care that is the ultimate outcome of a rights-based argument.)
Now, there’s a fallacious aspect to this libertarian argument that isn’t even the most important one against it, but let’s dispense with it here before getting to the more critical point. And it is this:
Even our constitutionally-elaborated negative rights—to speech, thought, assembly, and more broadly, to the Declaration of Independence’s “pursuit of happiness”—have to be protected by authorities such as police, the courts, and legislators. These rights are not sustained without the necessity of supporting them via the efforts of professionals who are paid by all of us with our taxes.
Somewhere and sometime—and it would be soon if law enforcement did not exist—others will infringe and even trample on our rights. Maybe mine more than yours, or vice versa. But we all pay our criminal justice personnel to prevent it. It’s what we do for each other, for the collective, in the social compact that is the basis of civilized society.
Indeed, virtually every aspect of living in community—access to speech, assembly, water, land, roads, energy, security—is dependent on everyone footing some portion of the bill for it and its infrastructure. In most societies, the wealthier classes pay substantially more for those via higher taxes.
So even negative rights require everyone to foot the bill, regardless of how many and how much any of us will ever have a direct need for what is required to ensure them.
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Democrats counter the Republican/libertarian view by citing phrases in the preamble to the Constitution and the aforementioned Declaration of Independence, respectively:
”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…”
“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”
For the more communitarian- rather than libertarian-minded Democrats, “promoting the general welfare” and the “pursuit of happiness” practically beg for the provision of health care as an “unalienable Right.” They would argue that the welfare of society and the happiness of any individual is negatively impacted when significant portions of the population do not have access to, because they cannot afford, health care services.
Republicans fear a culture of dependence, freeloading and over-utilization if health care is guaranteed to everyone as a fundamental right. Democrats fear an unfeeling Darwinian jungle that sees people dying in the streets while doctors and hospitals bar their doors until patients knock with their insurance papers or cash in hand.
Neither argument is without merit nor without its problematic aspects.
My own argument is that while the issue of health care as a right is not unimportant, it also masks a more fundamental and challenging question, which is not about the right of any individual to obtain health care. Rather, it is about the responsibility of a just and compassionate society to provide it to him or her.
In this view, the onus is not on individuals to claim a fundamental right and the authorities to enforce it on their behalf, but on our society to accept the fundamental responsibility to do so.
Do we want our fellow human beings suffering the profound negative effects of going without health care because they can’t afford it? Are we prepared to accept people living in ill health from preventable illness and disease, needlessly dying young, their children brought up without ready access to care while we preach to them about health care not being a philosophical “right?”
Every industrialized country in the world has answered those questions in the negative.
Except the United States of America.
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The question of whether health care is a right or a privilege, an essential human need or elective market commodity, is worthy of interest and helps inform our thinking, but it is ultimately an abstraction. It has little to do with the question we face when a needy, perhaps sick, destitute, or even dying human being is in front of us. What do we say to them?
“Show me your credit card?”
Of course not. We have, indeed, been prohibited from doing so in hospitals across the country since 1986, when the Emergency Medical Treatment and Labor Act (EMTALA) required that hospitals accepting payments from Medicare (which is to say, most all hospitals) offer appropriate screening and stabilization efforts to all patients, regardless of citizenship, legal status, or ability to pay.
Why did we do this? Because quite literally, the cost to our very conscience and self-identity as a nation, as a communitarian populace embracing shared norms of compassion and basic mercy, mandated a response to sick or dying people showing up in our emergency rooms—abstract arguments over rights and commodities be damned.
The question of anyone’s “right” to be provided health care in an emergency becomes moot, irrelevant; it withers in the presence of a suffering human being, a brother or sister with a certain immediate claim on our conscience and compassion. But if this is so, then by what mental gymnastics do we wriggle out of providing all people, the poor most pointedly, with basic care that we know has a materially beneficial effect on their lives, their longevity, and their pursuit of happiness?
It’s not their right so much as it is our responsibility that should concern us. How dare we, by what unfeeling, cruel commodification of human beings, deny such a fundamental human need in the richest nation in history?
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In the Old Testament story, Cain kills his brother Abel and God asks him, “Where is Abel your brother?”
“I do not know; am I my brother’s keeper?” Cain replies. His retort bespeaks irritation, almost a sneer in suggesting, “Am I supposed to keep track of all my brother’s movements?”
But both God’s question and Cain’s response beget a more critical point for our argument here.
“Where is your brother and sister?,” God, perhaps the paramount symbol of mercy in the human psyche, asks of us. “When they are sick, injured, beaten, starving, decrepit and desperate, with no means to assist themselves, what are you to do?”
The answer reveals itself in countless other biblical injunctions, as it does in virtually every other religious text in the world. And it has little to do, in the end, with rights, and even less to do with omnibus budget resolutions, or tax relief for wealthy donors, or allergies to “socialism,” or lectures about how one has lived, or scoldings about spending too much money on smartphones, or on how many healthy angels can dance on the head of a pin.
We will not be judged on any of those questions by those who come after us or by any God who awaits, but rather, “Verily, inasmuch as ye have done it unto one of the least of these…”
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Another question to ask is WHY does healthcare cost so much? It seems that all of the bills, all of the discussions and all of the solutions avoid discussing the real problem, pharmaceutical, medical equipment, and hospitals overcharge for their services. To truly reform health care we have to set limits on these mega-industries industries, ban television commercials for drugs as we did cigarettes and provide alternative health options that are covered by insurance and treat the whole patient and promote health. Especially for children, why not start there?
I wholeheartedly agree Francine.
The reform of Healthcare to something like Single Payer, where healthcare providers are not profit motivated, is a Big Thing…much like the programs of the 30’s under FDR, or the Moon Shot program. It requires most of us being on the same page, wanting the same result. I do not believe we are capable of such “Big Things” in this political environment. We hardly seem capable of passing an annual budget, and most legislation is always tempered by the concrete requirement that the program is “paid for”, usually by cutting essential services for the weakest among us. It is inhumane, absolutely Un-Christian (although most congressional D-Bags profess to be Christian), and runs counter to mores we were taught while growing up in the 50’s and 60’s. What the Hell happened, and how did we become so mean and unfeeling? I have no answers, and still continue to be stunned and dazed by the election of Trump and his ilk…We are becoming a country I don’t much like.
I think this may be my favorite of all your blogs. I love it. Awesome discussion.
The really vexing point, as you no doubt know, Francine, is that the U.S. spends far more per capita on health care than every other industrialized nation but has far worse health outcomes. Lots of specific data here by the Commonwealth Fund (and many other similar studies): http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017
I’ve included their synopsis below, which gives the lie to the oft-repeated canard that the U.S. has the “best health care system in the world.” We don’t, and we haven’t for a long time, by whatever criteria one applies. We spend far too much on administration, marketing, and paying the huge salaries of insurance and health care company CEOs, along with dividends for shareholders, all of whom need their generous compensation in a market-driven health care system.
The obvious answer is Medicare single payor for all, cutting out all the middle men, just as all these countries ahead of us on these spending and health measures did long ago. But it’s not about data, logic or other countries’ examples anymore, it seems: Instead it’s about a single-minded mania to undo Obama’s signature achievement. It’s personal and political, but it has zero to do with improving access, price or outcomes for everyday Americans.
Here’s the study synopsis:
“The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries.”
James: yes, it’s outrageous, through & through. Maybe we will eventually snap out of this fog we are in, in which actual evidence and outcomes don’t seem to merit much regard. Onwards…
Ryan, thank you. I hope you and your age cohorts will keep on this issue like a dog on a bone. These “two Americas” with respect to health care access and income distribution will be the death knell for us if we don’t fix it.
Wow! What a thoughtful insight into the healthcare problem. Your argument that the question of caring for the sick is not a question of human rights, but of national responsibility to be powerful, even prophetic. It is this salient point that leaves many shaking their heads about what they’re hearing from the Christian right, who are strongly supporting a half-baked healthcare bill being pushed by the Trump administration. I doubt that anyone would argue that Trump isn’t a man focused on “mammon,” rather than God. Yet, the Christian right, especially Fundamentalists, seem to advocate serving the same priorities as Trump, which clearly sets aside every Scriptural statement that we “love our neighbor.”
During the Trump presidential campaign and presidency, I have found myself increasingly uncomfortable with conservative Christianity. Frankly, most evangelicals and Fundamentalists bring to mind a new religion, one that no longer believes in the Gospel. This new religion looks and sounds more like a theological Frankenstein, than a religion built on the teachings of the humble Jesus. I don’t care how important they think politics and national power is, there is no precedent for serving Caesar as a means for creating the “Kingdom of God.”
I understand that the more mainstream Christian Churches are reluctant to speak strongly against the conservative branch of Christian faith. But there are some, like John Pavlovitz, pastor of a Christian Church in North Carolina, who has begun speaking out loudly against Christians who align themselves with Trump. Frankly, I no longer am willing to see myself in a Christian community that includes those who support the draconian faith many, if not most, Evangelicals and Fundamentalists do. If so called “Christians,” like Jerry Falwell, Jr., Dr. James Dobson, Pat Robertson, Jim Bakker, etc., were to act consistently with teachings of Jesus, Trump would lose much of his political base. If the struggle to create a healthcare bill to care for the most needy is lost, it will be on the shoulders of right wing Christian extremists who are trying to replace our democracy with a theocracy.
Robert, I’m intrigued by your positing of a “new religion” in the form of a muscular nationalism and alignment with now long-running proposals (which didn’t start with Trump) to cut taxes for the wealthy, cut services for the poor, eviscerate environmental regulations, and support health care “reform” that will have a predictable negative effect on access for the very people who can least afford it. Can you think of any precedent for this form of Christianity in the U.S. or elsewhere, or have we been witnessing something new since the Christian right came to power by aligning itself with the modern Republican Party?
I will say this about my childhood faith of Catholicism: for all the horrors that have been perpetrated there, the tradition is at least consistent, with its anti-abortion “pro-life” stance, whatever one thinks of it, at least complemented by genuine, theologically elaborated concern and service to the poor. The social gospel is very much alive in Catholicism, Judaism, and progressive Protestant Christianity, but the strange mish-mash of power hunger, money and triumphalism in a good part (not all) of evangelical Christianity continues to baffle me.
The real question is do we want to live in a civilized society or not. I do so want. We have examples here on earth of societies who live in basic survival-of-the-fittest societies. Those are not pretty to contemplate.