Is access to healthcare a right? Should it be?

It would be hard to deny that our country faces myriad and unfathomably complex issues--grand strategy, the role of government in our lives, environmental policy, gay rights, abortion, the stratification of social classes and a whole host of others. But among these one rises up as the defining question of our generation--how do we, as the United States of America, want to approach health care?

In this column I attempt to lay out my opinions about the United States’ current treatment of health care as an ideal (as opposed to a right), and the evolution we ought to undergo to treat health care as a right. In other words, what is and what ought to be.

Before jumping into the discussion, it is important to elaborate on a few distinctions. First, there is a difference between health and health care. As defined by the World Health Organization, “[h]ealth is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In contrast, I define health care as the services used--and perhaps needed--to maintain a state of health. Next, there is a difference between a right and an ideal. I see a right as an entitlement. A right is something society values so fundamentally that we commit to guaranteeing it to our citizens. Regardless of cost or imposition, we decide a right won’t be compromised. For example, the right to privacy protects US citizens from invasion of property or person without due process. Regardless of who you are or where you come from, you are supposed to be treated equally in accordance with this right. An ideal, on the other hand, differs from a right. An ideal is a good, service or permission we see as so important that we will do everything in our power to provide it to our members. An ideal diverges from a right insofar as we are not committed to providing an ideal if it is not feasible. Third, and most simple, the difference between what is and what ought to be. The former is the status quo--what we do now--and the latter is what we should do in the future, if it differs from the status quo. With those definitions to serve as a framework, I will now place access to health care into this context.

I think it is fair to say that access to health care is not considered a right in the United States. To illustrate, think of healthcare provision as lying on a spectrum--on one end you have unlimited resources and unlimited care, on the other end you have zero resources and zero care, and in the middle you have some resources and some care. I believe that if the government had infinite resources we would likely provide infinite care. Similarly, if we had zero resources we would provide zero care. That the government uses a positive, but finite, amount of resources to provide some amount of care shows that we do believe some is better than none, but that we are unwilling to forsake other programs and services--that we believe fall more cleanly under the domain of the government, like public education and defense--to guarantee the provision of health care without exception.

So that’s what is. What ought to be?

Most people (myself included) who make use of the healthcare system believe that access to it generally improves quality of life. However, I don’t think the burden should fall on the government to provide this access. According to Aetna, US healthcare spending is projected to reach $4.8 trillion (that’s trillion with a “t”) by 2021 and account for 20 percent of US GDP. It’s hard to even conceptualize 4.8 trillion--that’s the point. For context, the military spending we think is out of control only weighs in at around $620 billion. In the midst of multi-year, contentious cost-cutting efforts, imposing a further pressure on the government to provide universal healthcare would not only be irresponsible but unfeasible. Like access to food, healthcare is something we strive to provide, but only do so insofar as it is possible. Clearly, other countries have found ways to guarantee health care to all of their citizens. I believe, however, that healthcare systems develop within the social context of the country in which they are located. To say that the United States can implement universal healthcare because other countries have too is, in my opinion, invalid. The Affordable Care Act is a good example of this differentiation. Rather than ensure universal healthcare, the ACA employs regulations and subsidy programs to help people access health care.

By that thinking, health care is clearly an ideal. But I’m not comfortable leaving it there. I think about some of our other rights--the right to privacy, the right to bear arms and the right not to have to quarter soldiers in your home during a time of war. These are fundamental benefits of being an American citizen. And I truly believe these rights add to our collective quality of life. But I’m struck by the realization that not one of these directly impacts well-being as much as a person’s state of health.

I want to pause here and preempt any ideas that this column is advocating for universal health care provided by the government. It’s not. But it seems that we have identified a factor--health--that impacts the individual lives of our citizens more than many other rights we fully acknowledge and accept. We have identified a key predictor of that factor--health care. Shouldn’t the government include it in the list of guarantees that make up our social contract? So that there’s no ambiguity, the answer is “yes.”