Tuesday, January 18, 2011

Is There A Right To Health Care?

As part of an online community, a colleague presented this article to the group in order to further discussion and debate of the issues surrounding health care reform.  The article aims to discount claims that there is any sort of right to health care.

Not surprisingly to anyone who reads this blog, I disagree.  I'm posting my reply below.


This might not surprise anyone, but I find the article less than compelling.  If anything, the author has noted that England's approach to universal health care isn't idea, but he has not shot down the idea of universal health care overall.  In other countries (and in certain communities in our country), universal coverage is provided in ways that make health care available to all: there is England's national system, Canada's provincial systems, Switzerland (where everyone has coverage via an individual mandate and tight regulation of insurance company practices and profits--sound familiar?), Germany's combination of private/public coverage, Medicare (which dramatically changed the lives of elderly Americans), the Veteran Administration system (which some argue is among the best systems in America), etc.  The one question that can be fairly asked is how universal coverage should be paid for, but there are multiple arguments that the coverage can be provided.

From the standpoint of whether there is a right to health care, I don't think the article's author really, honestly addresses the question.  This is a complex question, and one that seems glossed over as the author moves on to attack the means of delivering universal care (as opposed to the perceived right to access care).

A few points:

  1. The rules of medical ethics can be used to argue that access to health care should be available to all: the principles of beneficence, non-maleficence, justice, and autonomy would suggest that a) access to care is good; b) lack of care is bad; c) it is unjust that some have access to care while others do not (often for reasons that are not in their own control); d) one cannot be a fully autonomous individual if one is not healthy.
  2. Religious guidelines can also be used in favor of the right to access: so much as religious faith compels one to help those less fortunate and to provide aid to the ailing, then faith can guide a right to health care.  The argument could be made whether such care should be provided in faith-based institutions, charitable organizations, or through government programs, but any faith that concerns itself with caring for the ill and the poor would have a hard time claiming that access to health care is not a right.
  3. Civil institutions can be used to argue for a right to health care: If we are seeking rights to "life, liberty, and pursuit of happiness", it is easy to argue that one cannot have any of the three if one does not have health as a necessary precondition.  The connection of health to life and the pursuit of happiness is clear, but is also applies to liberty.  How can anyone be an active citizen and take advantage of our cherished liberties if one is not in good health?
  4. Philosophical constructs exist that suggest that as individuals and as societies we should be working for the greatest good for the greatest number.  Kant's categorical imperative states that each of us should act in ways that we would like to see become universal law.  In this context, the argument I could make is that a)if we all agree that health care is a good thing, then b) we should seek to make health care available.  I think the argument could again be made as to the best way to reach that goal, but I think the goal itself can be easily agreed upon.
Regarding the author's question as to why a right to health care didn't exist in 250 BCE or 1750 AD, a quick answer could be this: in those years, medicine had fewer proven benefits and engaged in practices that actively caused harm (bloodletting, laudanum for anxiety, etc), whereas today's medical practice offers a much stronger balance of benefit vs. harm.  The argument could be made that increased access to medicine in the 1500s hurt more than it helped--maybe that is why societies did not seek to establish that harm.  Of course, in those years one could be enslaved and treated as chattel: maybe our society has advanced and moved forward to a more enlightened place?

Regarding other needs that the author addresses--food, shelter, clothing--many of us feel that there should be mechanisms to assure at least basic needs in all three areas.  Even if one does not feel that way, though, I would argue that good health is a necessary precondition for meeting these other three needs.  So in that perspective, health (and, by extension, access to health care) is a primary need for all.

I apologize this has run on for a while, and I thank anyone who has read this far.  I am not a philosopher, and so I am sure that I haven't been 100% on-target with my statements above--please feel free to point out if I am in error.

The author of the article argues that there is no right to health care because he believes that there is no right to health care.  He doesn't back up his claim in any meaningful way, and chooses to attack the *right* to health care by focusing on problems with the *delivery* of health care--two very different arguments.


If anyone who reads this would like to point out flaws in my argument or take a different position, please do.  I really do think that engaged, intelligent, civil discussion is an important part of our democratic process.  Please comment!

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