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Healthcare–Right or Privilege?

August 25, 2008

A central, yet often ignored, question in the political debate over healthcare reform is whether or not we define healthcare as a right or a privilege.  As a nation, do we believe healthcare is a given right or an earned privilege?

Given our current healthcare system, the de facto answer to this question seems to be “privilege.”  Most healthcare in our country is provided under health insurance plans.  These plans are overwhelmingly employer-sponsored plans–i.e. you have to be employed (read: “working”) to enjoy healthcare.  Thus, we “earn” the privilege of healthcare through our hard work.  It is not just something handed to us simply for being citizens of this country.

However, the exception to this rule is Medicare and Medicaid.  Both of these programs were created to ensure those who are unable to “earn” their healthcare are given some basic form of medical care.  If our healthcare system is predicated on earning health insurance through employer-sponsored programs, why do we have Medicare and Medicaid?  These two programs seem to be antithetical to our current healthcare system.

Despite these programs and a growing trend throughout the United States to make healthcare accessible to all, healthcare is not defined as a right in the Constitution, the Bill of Rights, or any other amendment.  Nor has their even been a serious movement to define healthcare as a basic right for Americans.

The debate over whether or not healthcare is a right or a privilege is largely an ideological one.  Although an underlying ideology should guide public policy, engaging the public in an ideological debate is not politically expedient.  It is much easier (and sometimes more productive) to engage in discussions over how best to shape public policy rather than argue over ideological distinctions between rights and privileges.

So, if it’s easier to discuss how best to make medical care accessible, why even consider whether or not healthcare is a right?  Without defining basic healthcare as a right, there is no legally binding doctrine forcing policymakers to ensure healthcare for all.  Given the current political climate and prevailing sentiment, it seems almost inevitable that we will soon have a plan for providing some form of healthcare for all.  However, that plan, and any ensuing funding, may be tossed aside as soon as the political winds change.  Massachusetts is an excellent case.  The state recently passed laws mandating all citizens must have health insurance.  The state has also passed laws providing subsidies for those who cannot afford health insurance.  As policymakers are finding out, this is a very expensive proposition.  One answer to the budget deficit created by this new program is to simply repeal the laws and eliminate the funding.  Without defining healthcare as a basic right, there is nothing stopping this from happening.

Regardless of where you stand on “universal healthcare,” it may be more important to define where you stand on healthcare as a right or privilege.  Answering this ideological question first will guide your subsequent views on access to medical care and how such access should be funded.

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