The American Right to Health

The human right to health has strong American roots. In his 1944 State of the Union address, not long before D-Day, Franklin Roosevelt told Congress, "We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence." He called on Congress to adopt a "second Bill of Rights," a bill of economic security, which included "The right to adequate medical care and the opportunity to achieve and enjoy good health."

President Truman continued FDR's fight for the right to health, telling Congress in his 1948 State of the Union address—the same year the Universal Declaration of Human Rights was adopted by the United Nations—that "Our first goal is to secure fully the essential human rights of our citizens." Regarding health, "Our ultimate aim must be a comprehensive insurance system to protect all our people equally against insecurity and ill health." In 1965 President Johnson traveled to the Truman Library in Independence, Missouri, to sign Medicare into law in Truman's presence as a tribute to his dedication to this cause.

In their thoughtful essay, "Bioethics and Human Rights: Access to Health-Related Goods," John Arras and Elizabeth Fenton persuasively argue that only a political process can adopt and implement the right to health. FDR, Truman, and Johnson would certainly agree. Although American-born, the right to health has had much more support internationally than domestically. A 1947 report of UNESCO's philosophers' committee, for example, listed fifteen "norms" that it found were widely shared by cultural and religious traditions (including Confucian, Islamic, and Hindu traditions) around the world, including "the right to protection of health."

Since the UDHR was adopted, we have become accustomed to having human rights declared internationally by treaty and thereafter promulgated nationally by legislation that enacts specific entitlements. In this framework, a national health care plan of the kind proposed by Roosevelt and Truman (and now by President Obama) would be a statutory enactment of America's vision of the right to health. No specific insurance scheme, delivery system, or benefit package is required by the international right to health, but a national health plan must be universally accessible.

Senator Ted Kennedy predicted to thunderous applause at the Democratic National Convention that Barack Obama would "break the old gridlock and guarantee that every American will have decent, quality health care as a fundamental right and not just as a privilege." The Obama administration has championed a national health plan, but not as a human right. The political debate has focused (so far) not on rights and dignity, but on narrower, institutional strategies to contain costs through "health insurance reform." The only winners of such a debate will be those with the most effective lobbyists—the insurance companies, drug companies, hospitals, and (perhaps) physician groups. Opposition forces also have an easier time creating unfounded fear that national health care would actually undermine human rights by, for example, arbitrarily "pulling the plug on grandma."

Senator Kennedy is, I think, correct in seeing the language of human rights as the only language powerful enough to break the stalemate. Although the internationally recognized right to health (including equal access to basic care) has not been seen as enforceable in the United States, we have come to rely on emergency access to medical care as a legal right. The political question is how to expand this into the more encompassing right to nonemergency health care.

Arras and Fenton properly note that the right to health does not define a minimum medical benefit package; rather, the legislative adoption of this right is a necessary step toward making the definition of a minimum benefit package politically relevant. American bioethicists will continue to play a critical role in helping to define rights in the doctor-patient relationship. Bioethicists should also, I think, take a leadership role by defining the right to a doctor-patient relationship in the first place. That the world's richest country has yet to establish a right to health is both paradoxical and unconscionable. To paraphrase Eleanor Roosevelt, who said that universal human rights begin "in small places...