Is Healthcare a Right or a Privilege

Over the past year, the Affordable Care Act has continued to preoccupy our civic discourse. Implicit in this debate is a fundamental philosophical question: Is health a right or a privilege? This question has consequences, both for guiding the direction of healthcare reform, and for building a consensus that will lead to an equitable distribution of finite medical goods and services. We need to settle this debate before we can move forward.

There is no denying that the Affordable Care Act is based on the premise that all Americans have a right to health. It was conceived as a mechanism for providing health insurance to those who fell into the gaping holes that remain in our social safety net—those too wealthy to qualify for Medicaid, those too young to receive Medicare, and those left out of the tax-subsidized employer-based health insurance system. If you don’t believe health is a right, it is very easy to dismiss Obamacare as just another meddlesome government program.

Sometimes, opponents of the ACA are honest enough to acknowledge their disdain for the concept of health as a human right. Back in October, during the height of the Obamacare repeal effort, Wisconsin Senator Ron Johnson was asked by a high school student whether health was a right. Senator Johnson replied:
“Do you consider food a right? Do you consider clothing a right? Do you consider shelter a right? What we have as rights are life, liberty, and the pursuit of happiness. We have the right to freedom. Past that point, everything else is a limited resource that we have to use our opportunities given to us so that we can afford those things.”
As much as I find this attitude callous and cruel, I must admit that from a purely philosophical perspective, he has a point. Health does not seem to be a natural right, and certainly not a right like those enumerated in the Bill of Rights. Constitutional rights are either negative rights or positive rights—negative rights that prevent the government from restricting the liberty of individuals (such as those protecting the freedom of speech, religion, press, assembly, and petition), and positive rights that place obligations on the government (such as requiring search warrants and prohibiting self-incrimination).

Getting medical care is certainly not a natural right. To receive healthcare, someone else must provide it. It’s not like the freedom of speech which everyone is free to enjoy as long as government stays out of the way. Nor is health a due process right imposed on the state, like the right to a fair and speedy trial.

Then again, those who view health as a privilege seem to have a fixed and very narrow view of human rights. This attitude is not in keeping with our national character. Boldly declaring and securing our rights is a quintessentially American endeavor. It is the central theme of our founding document, the Declaration of Independence, which chiseled out a framework of human rights from a regime that for centuries had given primacy to the rights of kings and clerics.

To the founders, “Life, Liberty and the pursuit of Happiness” were three principal rights among other rights yet to be declared. The key word here is “among.” These three rights may be self-evident, but they are not exhaustive. This expansive attitude toward rights found its way into the Ninth Amendment, which proclaims that the enumerated rights contained in the Constitution “shall not be construed to deny or disparage others retained by the people.” Since that time our history has been an ongoing struggle to claim and secure these “unenumerated” rights and apply them more equitably.

To understand how health can be viewed as a human right, we need to broaden our concept of rights. This broader view sees rights as instruments for expressing and protecting the dignity and equality of all persons. This is the concept of rights embodied in the United Nations’ Universal Declaration of Human Rights. Article 25 of that declaration states in part:
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
The idea that society should be ordered in such a way that every citizen has an equal right to security in the event of sickness, disability, and old age may seem like a radical liberal ideal, but it is a concept that has had support—at least in the past—from even conservative and libertarian thinkers. Philosopher and economist Friedrich Hayek, who was honored by both President Reagan and Prime Minister Margaret Thatcher for his defense of free markets and opposition to central planning, had this to say about the role of society in organizing a comprehensive healthcare system:
“There is no reason why in a society which has reached the general level of wealth which ours has attained ... the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance—where, in short, we deal with genuinely insurable risks—the case for the state’s helping to organize a comprehensive system of social insurance is very strong.” (The Road to Serfdom, 1944)
The case for a comprehensive healthcare system is still very strong. You can call it a right, an entitlement, or a social contract. The term doesn’t really matter. Regardless of the terms we use, a nation that spends nearly 18% of its GDP on healthcare can surely afford to reorganize its priorities to ensure that each and every citizen has access to affordable medical care.

A society that views health as a commodity available only to the privileged is failing in its duty to honor the equality and dignity of all of its citizens. As Mr. Jefferson wrote, when a government fails in this central duty, the people have the right to alter it, “laying its foundation on the principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.” The time has come to declare that health is a basic human right.

This past September, the AAFP Congress of Delegates adopted the following resolution:
"The American Academy of Family Physicians recognizes that health is a basic human right for every person and that the right to health includes universal access to timely, acceptable and affordable health care of appropriate quality."

This article was published in South Carolina Family Physician.