Right to Health Care FAQ

QUESTION: What is the historical precedent for even considering making health care a right in the United States?

At the present time it is recognized (and accordingly legislated) that every family in our country (all residents) have the right to have their children attend primary and secondary school. This right like that of a “right to health care” did not originate with the founding of our republic, nor during the first decades of constitutional development. A right to education is not in the “Bill of Rights”. Universal education was won state by state with the first attempts at state enactment in the 1770′s and the first limited achievement of “common education” in Massachusetts in the late 1830′s. Eventually, there came a time in our history (after most states had already enacted such legislation) when it was federally mandated that every state should provide for universal education.

Like the right to vote, for laborers to bargain collectively, the 40 hour work week, universal education was slow to be recognized and legislated throughout the states. Generally, civil rights slowly evolve in the public consciousness and eventually get put into law when the populace overwhelmingly supports them. At first, they seem like radical ideas to many and are met with vigorous resistance. However, even some of our nation’s founders (Thomas Paine and Thomas Jefferson) argued vigorously in support of the right to health care and the necessity of this right being recognized in a functioning democracy.

QUESTION: Is there an existing legal precedent for health care being considered a right ?

Yes. The U.S. is a signed supporter of the United Nations Declaration of Human Rights. Article 25 of that document states that:

“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.”

Also the US signed the International Covenant on Economic, Social and Cultural Rights in October 1977. This covenant recognizes “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. Implementation of this covenat includes the creation of conditions which would assure to all medical service and medical attention in the event of sickness.

QUESTION: Isn’t the idea of a “Right to Health Care” un-American in that it undermines the whole basis of our society, namely individual responsibility and self-reliance?

We do not believe that the “Right to Education” (K-12) has undermined the value of personal responsibility. Indeed, it is difficult to imagine how we could claim in modern America (had we not established the right to education) that we believed in providing basic opportunities so that our citizens would have any chance of prosperity in their lives and the lives of their children. We believe that in exactly this way virtually all Americans will look back on the establishment of the “Right to Health Care” and wonder how opponents could have conceived that their society was open to all individuals having opportunity for a measure of success and security of their families without assuring this basic right.

Low-income Americans simply do not have much chance of attaining any type of “American Dream” ever, no matter how hard they work and how highly they value their children without the foundation that these rights provide. Having sick siblings, parents and grandparents who suffer because they do not have access to care, or because they must bankrupt their entire extended families to afford care is NOT the provision of a decent shot at success to all Americans.

QUESTION: If there is such a strong basis for a “Right to Health Care” why haven’t we even been able to convince the professionals directly involved in providing care of its necessity?

Many if not most health care professionals agree that everyone in the United States should have access to regular and appropriate health care. This is borne out by the lists of endorsing professional organizations listed at each of the state websites linked from our homepage. Note that by numbers nursing associations typically have the largest memberships and represent the health care workers most directly and constantly involved with patients.

Furthermore, even the most conservative of health professional organizations – namely the AMA has recently passed the resolution recognizing that ” A physician shall support access to medical care for all” This was adopted by the AMA House of Delegates June 17, 2001. Admittedly, the AMA have continually backtracked on their commitment.

The main objection of the more conservative health professional organizations has been to the word “right”. These organizations like to claim that they are “the advocates for patients” and for the idea that “all people should have access”. At the same time the AMA and many of the state Medical Societies adamantly resist the idea that health care is a “right”. How is this to be understood?

The Neither the AMA or such state medical societies have thus far given any explanation, except to state that they don’t want health care access to be a “right” something any patient can demand when they show up at a clinic. However, any right of refusal physicians may may have at present is extremely limited by individual state law. Furthermore, acknowledging the “right” to primary and secondary education did not result in private schools having to accept every applicant, regardless of ability to pay or preparation.

Apparently the question boils down to fear of loss of privelege on the part of many physicians. At EINO we believe that the “Right to Health Care” must be recognized so that patients can make the demand of their state governments that an avenue of access to high quality health care be allotted to them. Patients need the right so they can defend it when it is denied or abridged.

QUESTION: Isn’t a “Right to Health Care” completely different though than a right to vote or to education. Those latter are essential to the idea of an effective democracy with nearly equal opportunities for all citizens.

Historically, it’s correct that universal education and voting rights were argued largely on the basis of being necessary to effective democracy. Its hard to see though how access to appropriate medical attention, mental and other health services are any less necessary to having a responsible citizenry that pays attention to and understands the crucial arguments of the day. And how else could one hope that the people will be able to cast responsible meaningful votes.

If certain sectors of the U.S. population are allowed to suffer with an illness that is treatable or curable (for lack of appropriate insurance), how could they be considered to have the same opportunities to participate actively in the society (voting, attending public meetings, speaking to their neighbors, handing out leaflets)? Indeed they will have a difficult time thinking about anything other than how to get their needed medical treatments and provide the basic essentials to their families.

Is education primarily a consumer good or common good? This book provides a context for answering that question. If Thomas Jefferson, Horace Mann and John Dewey were now to enter policy discussions on public education, they might well ask if Americans have lost their way. Democracy is about making wise collective choices, not individual consumer choices. They have never been more essential to wise self-rule than they are today.

QUESTION: How did the right to education take root in the public consciousness of working Americans as something that they deserved and should force their representatives to grant it?

Actually, this change in consciousness was both due to insightful and persuasive leadership organizing among the workers and a convergence of circumstance. In the late 1840′s many rural Americans were flocking to the new industries in the cities. The industries in the cities came to realize that they would benefit much more from workers who they could train more easily and who could organize their affairs more efficiently in the city environment. And this meant, at least, basic reading and arithmetic abilities for the common worker.

At the same time Horace Mann (notably him, but obviously many insightful leaders in various states like W.Penn and H. Barnard) were arguing that a democracy needed educated citizens, who were capable of learning about issues and electing their own representatives effectively. Mann was one of the first to argue for mandatory education for all children, which was the only way that working children from working families could be shepherded into classrooms.

QUESTION: At what point did the whole country adopt the right to primary and secondary education and why did the idea win out finally at that point?

This is a matter of definition and perspective. In 1905 the San Francisco school board decreed that school attendance of “japanese or mongolian with white children was baneful and demoralizing in the extreme”. Disabled children were still being sent to schools like the Massachusetts School for the Idiotic and Feeble-minded. By 1918 every U.S. state had compulsory primary education (some sort for all races, even though segregated). At that time 3/4 of schoolage children were actually attending school and averaging 90 days in school per year.

Even this step forward can be considered largely an outcome of economic conditions, resulting from U.S. involvement in and world leadership at the conclusion of World War I. This modern war had demonstrated the need for basic education among soldiers and had also accelerated the pace of industrialization and pressure for an educated workforce at home. In 1954 segregated education was struck down.

QUESTION: The history which EINO recounts shows that the right to education took almost 200 years to be completed! Is this what EINO is proposing as the best route for recognizing the right to health care?

That’s a legitimate interpretation of the history, that it took some 200 years for the right to education to be fully recognized. With a more educated citizenry though, there is no reason to believe that achieving other basic rights will take equally long and there is every reason to hope based on current citizen mobilization that we will see great progress during the first decade of the 21st century.

The history of the right to education also teaches us that economic and social conditions play a huge role in bringing about such change. It is easy to see that every day even the mainstream newspapers of the country carry articles about the threatened closure of our public hospitals, seniors unable to purchase needed medications, ER’s diverting patients, so-called “nursing shortages” and other situations which threaten the health care of every resident in this country whether they have insurance or not. We judge that things are already pretty bad for even the middle-class, but (excepting those unfortunately ill) they haven’t realized the danger in which they and their families currently are.

QUESTION: The UN Declaration on Human Rights was signed in 1998. But no one cares, there is no impact – it has no relevance. If it did wouldn’t things be changing?

It’s easy to understand frustration with how slowly things are changing, and most people in the country would like to see human rights better respected. Although it is not judged the most exciting news, there has been a great deal of interest in expanding human rights and even specifically in the concept that the worth of a human being and the right to health care are inextricably bound to the fight against abject poverty and against social inequity. Take for example these words from Gro Harlem Brundtland*, Director-General of the World Health Organization in 2002:

The last decade has given us a more sophisticated understanding of the nature and dynamics of poverty. Poverty, we’ve come to understand, is not just a function of income, but a function of multiple forms of deprivation. We must now focus more on the factors that drive people into poverty and recognize, for example, the power of better health as an effective poverty-reduction strategy. Diseases perpetuate poverty, for whole countries as well as for individuals. Conversely, leading economists argue forcefully that investments in basic health care will boost economic growth.”

The time has come–nay, it’s overdue–for each of us to recognize that our diverse interests are, in fact, related. If we want economic inequity to cease, we must recognize the connection between basic health and economic development. We can no longer afford either the luxury of mere self-interest nor of hyperfocus on one aspect of the aggregate problems that affect people everywhere.

QUESTION: Even the countries which have universal health care have not found it necessary to explicitly grant their citizens a “Right to Health Care” have they?

Actually the Canada Health Act of 1984 states that “all patients are entitled to receive medically necessary services delivered by doctors and hospitals” and it further stipulates that all health coverage must be “universally available, comprehensive, portable, accessible and publicly administered.”

According to Roy Romanow, Chair on the Commission on the Future of Canadian Health Care, the very foundation of Canada’s publicly funded, universally accessible health care system is a broad consensus among Canadians that medical care is not a commodity but a “moral enterprise”.