If healthcare is a right, where does it come from? And what should we do about it?

I believe in a right to health care.  I think this is one of a number of birthrights that attach to all children.  And everyone I have ever met is somebody’s child. 

This makes a huge difference in the policy arena.  If healthcare is a commodity, a service that is purchased, a privilege to be earned or afforded, then it is completely possible to decide that some people get none, that some people get a lot, and that everyone else will fall in between, mainly a function of their financial situation, but probably also due to matters of race, class and gender.  Limits are easy to find when it is something you purchase.

What if it is a right?

If it is a right, then it is a “call” upon the larger society:  “You must care for me when I am sick.”  But no society can ever provide 100% of the care desired by 100% of the population.  There simply isn’t enough time, energy and money.  Therefore, each society has to make tough choices about how much care they are willing to give and to whom and under what circumstances. 

I think most wealthy enough societies will meet almost all of the healthcare demands of their children, and then start to make tough choices at the other end of life.  Along the way, there will be some limits, like with cosmetic surgery (not after trauma or disease, but strictly for appearances).  And some communities will decide that certain treatments are so unlikely to help that they won’t pay for them, while other societies might make a different evaluation.

But what is clear is that if healthcare is a right, then it is up to the government to provide it, since the call is upon the community, and the government is the agent of the community.  That is what TR Reid, the author of The Healing of America, found in the countries he visited, that they started with the notion that healthcare is a right, and that led them to universal coverage.

Lots of politicians have said the words – healthcare is a right – but they have not worked towards policies that are consistent with those words.  Obama has said that he thinks healthcare is a right, but the ACA is not based upon such a principal at all.  Sanders is the main person making the connection between the idea and the policy that follows from the idea.

Where do rights come from?

That is an easy question for me to answer, but I have found it so tough for others to answer it that they don’t even want to be asked the question.

As a public health ethicist, I have found that almost all of my colleagues in the field think that health care is a right.  In fact, a famous public health leader (Jonathan Mann) won quite a bit of acclaim for his argument that the basis of public health ethics was “human rights.”  But I have found almost no one amongst my colleagues who wants to discuss where such rights come from.  Either they hem and haw, or they mention something about the Universal Declaration of Human Rights, from 1948.  But were there no rights before that?

In the Declaration of Independence, we say that:

    "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable rights – that among these are life, liberty and the pursuit of happiness.  That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed."

The existence of these rights are “self-evident.”  You don’t need to conduct research on this.  These rights exist and we know that their existence is obvious.  Such rights are often referred to as “natural rights,” those rights that arise from the nature of what it means to be human.  They are inalienable (inseparable) from any human being, by virtue of his or her humanity.

And we get these rights from our Creator.  Some of you, who believe in a personal God, accept this as a direct statement. 

For people like me, who have a strong concept of Transcendent Meaning, but do not believe in a purposive entity named “God,” then this is really a metaphor.  For me, this means that there is a transcendent reality from which we draw meaning, and that the experience of this transcendent reality and the understanding of that meaning is what I label as “the holy.” 

A religious gesture

But whatever we call that which exists within Transcendence, we are making a religious gesture.  It is a spiritual commitment to the existence of Transcendent Meaning.  Our lives have meaning, and one of the things we know about that meaning is that every society owes its members certain rights, and that the government is assigned the duty of providing for those rights.  (That part of the Declaration is usually not included when this section is quoted.  More neoliberalism, I think.)

And among these rights are the right to life, liberty and stuff.  (The Founders really were referring to property rights, but thought that wasn’t gentile enough, so they used the euphemism of “pursuit of happiness.”  It is intended to mean a right to own stuff.)  Among these rights, but not only those rights mentioned. 

So, if there are such rights beyond these three, we as a community have an obligation to figure out what they are; we need to make exactly those choices.  And the basis for those choices ends up having to be our belief in Transcendent Meaning.

My assumption is that my colleagues don’t want to talk about where rights come from because they don’t want to have a conversation about religion, most (but not all) of them being atheists or agnostics, as are so many intellectuals today.

What if rights aren’t transcendent

If rights aren’t transcendent, if they are only material, then they are only the result of our agreements to uphold certain of them.  And agreements made can be unmade.  Non-transcendent rights are, therefore, dangerously ephemeral. 

Plus, if you want to condemn the practices of horrible people around the world, you need something I have referred to as “Transitive Morality.”  (From an earlier blog post.)  We have to be able to say that the third of the world that denies the dignity of women is morally wrong in doing so, and that they must change.  And that “must” must be based upon something other than a handshake.  It has to be based upon the moral ground that comes from the community agreeing to recognize the transcendent source of such moral values. 

Otherwise, who are we to judge these misogynists?  After all, it is only their culture. 

But, of course, the oppression of half the race is not a matter of mere culture.  It is a call to the rest of us to act on behalf of the oppressed.  It is a call to us, because those women have rights that are being denied.  And we may act because those rights have a basis in Transcendent Meaning.

I do think healthcare is a right, and I am comfortable with the religious origins of my views.  And I feel the call to act.  Anyone else feel the same?