Health care as a right

Reports on President Trump’s first 100 days have dominated the news lately.   Some have argued that he has not been able to deliver on his promises, while others have pointed out that he is slowly but surely keeping them. No matter what your political perspective, you will be able to find a cable news channel or some other media outlet that validates what you have been thinking.

Perhaps you have been keeping track of the ongoing debate over the Affordable Care Act (aka “Obamacare”). Seemingly all of the Republican candidates for president last year spoke of how they would “repeal and replace” Obamacare. And when Trump was elected, many assumed that the days of Obamacare were numbered.   However, an amazing thing happened along the way: it appears that Obamacare is more difficult to repeal and replace than first imagined. Even President Trump expressed this frustration when he said, “Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew health care could be so complicated.”

The reasons for this complexity are too numerous to elaborate here. It is noteworthy that the Republicans had been campaigning against Obamacare since it was signed into law, but when given the opportunity to repeal and replace it after gaining control of the White House and both houses of Congress, there was no popular ready-made replacement to be found.

That said, the recent discussion on health care and the future of Obamacare raises an important question: Is health care a constitutional right? In a pivotal 1991 senatorial election, unknown candidate Harris Wofford defeated a former two-term governor of the state, Richard Thornburgh, by arguing that if the United States Constitution guarantees the right to an attorney, then by extension it guarantees the right to a doctor. Gov. Thornburgh never really rebutted the logic of that argument, and when it resonated with many unemployed Pennsylvanians, his easy path to victory was lost. The momentum of Wofford’s win was part of the rocket fuel that boosted Bill Clinton to victory in 1992 and inspired a national debate on health care insurance during the first years of his presidency.

Fast forward 25 years. Obamacare passed in 2010 and since then the Supreme Court has upheld its basic constitutionality. What Trump is now facing is the reality that it is very difficult, if not impossible, to repeal an entitlement, something that is considered by many to be a right. In an address to the Florida Bioethics Network last month, Rep. Debbie Wasserman Schultz not only defended the positive elements of Obamacare, she also revisited the basic argument of Senator Wofford. The message of her talk was that health care is a right for all Americans. She argued that taking health care away from anyone, as the replacement plan offered by the GOP is said to do, must be resisted.

It’s not clear what the next 100 days will bring, but it might be wise to revisit the “health care as right” discussion. At the very least, it could clarify what the next legislative steps should be.

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Matthew Cote, MD
Matthew Cote, MD
4 years ago

Framing the general nature of the health care discussion in terms of rights seems to be at best counter productive. The suggestion is that a person is entitled to health care, a posit that most hold to be true, including myself. The real question is what does that mean? How much health care? What is the obligation of the individual to be responsible for their own health, and caring for it? What is the responsibility of the individual to face fiscal consequences for bad health decisions? Labeling healthcare as a right or entitlement would seem to imply no obligation on the individual, with the burden solely being the obligation of society by which we mean the government. A more meaningful discussion requires better defining these questions. Labeling healthcare a right is both true and misleading, ultimately not helping us face the reality that individuals, as consumers of healthcare, need to have some accountability, in addition to needing to establish a base level of healthcare access . Unfortunately, the current system in the United States (ACA) is not financially viable, making some type of change to it necessary and inevitable.