Should healthcare be Considered an American Right?
Freedoms and liberties are the basis of determining laws and services in the United States. Should Americans have a right to use our healthcare system? Does limiting our access to our healthcare system inhibit our freedom to utilize our other guaranteed rights?
There are two types of rights when we discuss healthcare. Rights in healthcare refer to protections from physicians and represent patient liberties. Rights to healthcare refer to positive freedoms and positive rights.
Patient Liberties
The Physician’s Charter, a document that summarizes a physician’s ethical responsibilities to society, states that a physician is responsible for promoting patient welfare, patient autonomy, and social justice (Physician Charter, 2002). These principles manifest into four major medical rights: beneficence, non-harm, autonomy, and justice. These rights can mostly be categorized as negative rights, such as autonomy over medical decisions and protection from harm. Negative rights outline the boundaries of what a healthcare provider can do and aim to limit the power of physicians over their patients. In this way, these rights respect the knowledge of the patient and promote cooperation between patient and physician.
Positive Rights Freedoms
Positive rights, on the other hand, represent a claim of assistance. In the United States, services like education, infrastructure, and public security are all examples of positive rights that the government supports. These services are needed by people to maintain a basic level of livelihood. Positive rights can be considered protections by providers instead of from providers. Positive rights are necessary because they protect our livelihood and ability to live safe, free, and fulfilling lives.
When people discuss healthcare as a right, they ask the question, do people have a positive right to healthcare, and does a barrier to healthcare limit an individual’s ability to exercise their other rights? A positive right to healthcare would guarantee that if someone gets sick, they will be provided a certain level of care regardless of whether they can pay.
Important Questions
Even within groups that agree that there should be a right to healthcare, there is disagreement about what type of healthcare should be guaranteed. Vital questions arise about allocating scarce resources when multiple individuals have a claim to them. If healthcare should be viewed as a right, what services should be considered healthcare? Do some services have priority over others? If healthcare is a public resource, how do you decide what services are essential and required for a basic level of care? In the post-Affordable Care Act United States, healthcare insurers are required to provide ten essential services in their health plans. These include preventative services, emergency care, ambulatory services, hospitalization, maternity and newborn care, pediatric services, prescription drugs, laboratory services, mental health and abuse services, and rehabilitation services (Johnson, 2022). It would be reasonable to assume that these services would be guaranteed should healthcare be designated as a positive right.
“Neither healthy, caring or a system”
The reality of healthcare is that most people in the United States agree that changes need to be made to healthcare. While the changes that need to be made are up for debate, the statistics clearly show that our healthcare system fails, whereas other systems do better. While comparing systems directly is difficult, the data clearly shows a pattern. The United States performs particularly poorly in regards to access to care, affordability, equity, and administrative efficiency. When comparing healthy life expectancy, a metric that looks at the age before people start experiencing major health setbacks, a person in the US has an average of 66.1 years, less than Turkey, Peru, and Thailand (CWF, 2021). These statistics inform the sentiment shared by journalist Walter Cronkite that the US healthcare system is “neither healthy, caring, nor a system” (Kristof, 2023). The failures of American medicine directly impact individuals in personal, tragic, and intimate ways. Under this context, Americans have looked to other countries that consider healthcare a right and asked questions about how they want their healthcare system to function.
These questions have generally, but not unanimously, led to legislation improving people’s access to healthcare. With the passage of the Affordable Care Act in 2010, more Americans have gained access to health insurance (Gwande, 2018). The ACA expanded Medicare eligibility and provided a public option to people who were previously reliant on the private sector. The ACA has become a lightning rod for political discussion and still remains on shaky grounds. Despite the intense political discussion, polls show that 50% of Americans want to expand the law to include more people and more coverage (Kearney, 2024). In 2022, Oregon passed measure 111, stating, “It is the obligation of the state to ensure that every resident of Oregon has access to cost-effective, clinically appropriate, and affordable healthcare as a fundamental right” (Templeton, 2022). The passage of this measure was the first in the country to articulate that healthcare is a state-guaranteed right (Templeton). This measure demonstrates how government language in Oregon is changing to a more inclusive, progressive stance on healthcare.
If you would like to read more about the consideration of healthcare as a right, I highly recommend the Gawande article in the New Yorker, the Kristof article in the New York Times, and The Commonwealth Fund report.
References
Gawande, Atul. (2018, September 25). Is Health Care a Right? The New Yorker. https://www.newyorker.com/magazine/2017/10/02/is-health-care-a-right
Johnson, M. (2022, October 1). What Essential Health Benefits Must All ACA Plans Provide? [Review of What Essential Health Benefits Must All ACA Plans Provide?]. GoodRXHealth; GoodRX.
Kearney, A., Montero, A., Valdes, I., Kirzinger, A., & Published, L. H. (2024, February 21). KFF Health Tracking Poll February 2024: Voters on Two Key Health Care Issues: Affordability and ACA - Findings - 10306. KFF.
Kristof, N. (2023, August 16). Opinion | How Do We Fix the Scandal That Is American Health Care? New York Times. https://www.nytimes.com/2023/08/16/opinion/health-care-life-expectancy-poverty.html
Medical Professionalism in the New Millennium: A Physician Charter. (2002). Annals of Internal Medicine, 136(3), 243. https://doi.org/10.7326/0003-4819-136-3-200202050-00012
Templeton, A. (2022, October 15). Measure 111 passes, giving Oregonians a constitutional right to access affordable health care [Review of Measure 111 passes, giving Oregonians a constitutional right to access affordable health care]. OPB; OPB.
The Commonwealth Fund. (2021, August 4). Mirror, Mirror 2021: Reflecting Poorly. www.commonwealthfund.org; The Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly