Healthcare professionals periodically need to gain perspective on their field. It often helps to listen to the thoughts of people outside the industry who bring fresh ideas. Better yet is gaining the views of distinguished scholars from other fields who analyze basic questions about our healthcare system. Timothy Snyder is one such scholar who wrote a book this year entitled “Our Malady.”
His writing was prompted by nearly dying due to poor medical treatment. This historian from Yale University has been honored with several prestigious awards during his career, and his 15 books have been translated into over 40 languages. The medical care prompting his latest book started in 2019 with an appendectomy, followed by a life-threatening liver infection and sepsis due to missed diagnoses.
His book examines several basic issues, but he caught my attention on the question of whether healthcare is a right. This is a conceptual problem rarely addressed by healthcare providers. Clinicians tend to provide care without much thought to rights. Yet some of our citizens oppose healthcare as a right. Our country has long denied millions the right to insurance, which is generally essential to care.
Socioeconomic analyses of our healthcare system are plentiful. Yet the historical and legal basis for how and why we provide healthcare is less discussed. Snyder’s book is for a lay audience, not an academic one. He cites historical sources only to establish key points. His discussion of what the founding fathers might say today about healthcare is striking.
Now that we have better knowledge of the natural world, we can consider health care as a human right. The Constitution does not prevent us from doing so. On the contrary, its authors had the wisdom to specify that: “the enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.” This leaves room for a right to health care. If we accept Jefferson’s famous trio of rights to “life, liberty, and the pursuit of happiness,” the case for a right to health care is made. If we have a right to life, we have a right to the means of living. If we have a right to pursue happiness, then we have a right to the care that allows us to do so. Without health, said Jefferson very sensibly, there is no happiness. The right to liberty implies a right to health care. We are not free when we are sick.
Let us leave it to another author to present an opposing argument. The focus here will be on the ramifications of Snyder’s position. If we accept that our founding principles implicitly endorse the right to healthcare, we are left to argue only about how to fund healthcare. The debate about providing universal healthcare originates then in principle. The economics become secondary to the basic right.
It is easy to get stuck on the economics of an issue when guiding principles are obscured. The behavioral healthcare field encountered this in the long battle for parity in insurance benefits. The objections of businesses to paying more money for equitable coverage were overcome on legal and moral grounds, not economic. Discrimination against people with certain diagnoses is wrong.
It is worth clarifying that universal healthcare need not be tied to rights. We could decide to pay for healthcare for all Americans even if it is not supported in the Constitution. For example, we might decide that our country would be more competitive economically if everyone had healthcare. We could implement universal healthcare to boost our economic productivity rather than as a human right.
Debates uncover new questions. For example, how broad is the concept of healthcare? Does it include what we call behavioral healthcare today? Improving one’s mental health may have had little meaning at the time of the constitutional convention. Is there a statement of rights to include our field? Perhaps the best and earliest foundational statement is from the World Health Organization (WHO).
WHO defined health in 1948 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This was an important step along the path to parity in 2008. It is worth remembering the philosophical origins of that crusade, not just the social roots. It is also noteworthy that the concept endorsed here, mental well-being, is still relevant today.
Rights have a contagious quality. Denying them by sorting people into categories has not withstood successive civil rights movements. Rights seem to be inextricably linked. Is the discussion here about a right to health, healthcare, or both? How is a right recognized? Hillary Clinton recently reflected on her 1995 speech on women’s rights that “rights are nothing without the power to claim them.”
Let us continue debating a right to healthcare since this question is still not resolved in America. Policy debates today put the cart before the horse. Politicians ask if we should we expand the Affordable Care Act or the Medicare program. These are worthy debates. Yet we should settle more basic questions first. Is healthcare a right and is behavioral health or wellbeing an essential part? Argument is healthy.
Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.