Is Health Care a Human Right?

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Mr. Moss is a professor of history at Eastern Michigan University. For a list of his recent books and online publications, see http://people.emich.edu/wmoss/pub.htm.

In a presidential debate in October 2008, moderator Tom Brokaw asked, “Is health care in America a privilege, a right, or a responsibility?” When Barack Obama answered, “I think it should be a right for every American,” he was following in the footsteps of three Roosevelts.

When Theodore Roosevelt, the former Republican president, ran as the Progressive Party candidate in 1912, he ran on a platform that stated: "We pledge ourselves to work unceasingly in State and Nation for . . . the protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance adapted to American use.” But it was Franklin Roosevelt who more explicitly stated that health care was a human right. In his January 1944 message to Congress, he said that “freedom cannot exist without economic security and independence,” and called for “a second Bill of Rights under which a new basis of security and prosperity can be established for all.” These rights were to include “the right to adequate medical care and the opportunity to achieve and enjoy good health” and “the right to adequate protection from the economic fears of old age, sickness, accident, and unemployment.” Although he died the following year and his “second Bill of Rights” never became a reality, his widow, Eleanor Roosevelt, was a major contributor to the UN’s Universal Declaration of Human Rights (1948). 

Article 25 (1) of this declaration states: “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.”

This document became the basis for numerous international, regional, and national declarations, conventions, and other agreements. One was the International Covenant on Civil and Political Rights, which the U. S. Senate ratified in 1972. Another was the International Covenant on Economic, Social and Cultural Rights (ICESCR). Its Article 12 declares that states that agree to the covenant should create “conditions which would assure to all medical service and medical attention in the event of sickness.”

ICESCR entered into force for those who had agreed to it in 1976. Although President Jimmy Carter signed the covenant in 1977, more than three decades later the U. S. Senate has still not ratified it. By early 2009, however, about 160 other countries had agreed to it, including the great majority of other democracies. So why has our Senate refused to do so?  

The basic answer goes back to a fundamental difference regarding human rights, and to some extent freedom, that has long divided our nation. The term “human rights” was uncommon before the end of World War II, but the French Declaration of the Rights of Man in 1789 and the U. S. Bill of Rights, ratified in 1791, indicate that concern with them had long existed. 

In the late 1970s the Czech-French jurist Karel Vasak distinguished between three generations of human rights. First-generation rights (like our Bill of Rights) were basically civil and political rights, which often were proclaimed to prevent government oppressions, and were therefore sometimes referred to as “negative rights.” These were the type of rights which U. S. liberals and conservatives could often agree on, which is one reason the U. S. Senate ratified the UN’s Covenant on Civil and Political Rights. Second-generation rights dealt more with the type of social, economic, and cultural rights proclaimed in ICESCR that our Senate has not yet approved. Third-generation rights reflected still newer aspirations like those expressed in international environmental declarations. Second and third generation rights, sometimes called “positive rights,” were usually defended by liberals, but considered bogus by conservatives, who saw them not as essential rights, but as attempts to push forward liberal agendas that might curtail others’ (first-generation) rights and increase taxes. 

Conservative opposition to government attempts to broaden rights by enacting anything close to FDR’s “second Bill of Rights” or ratifying ICESCR sometimes resulted in extreme rhetoric. Fearful that President Clinton was pushing for ICESCR ratification in 1993, one conservative in a Heritage Foundation publication declared:

As a practical matter, signing a treaty laden with economic rights is foolish. It accepts as a premise that government can create wealth. If the 75-year communist experiment proved anything, it is that government gets in the way of producing goods and services. Abundant health care, housing, and food are byproducts of wealth created by private individuals pursuing a profit. Even the most hard-core former communists in Russia and China have come to understand this. . . .

Clinton's proposal to ratify this treaty ignores centuries of Western intellectual and economic history, while at the same time embracing the theories of Karl Marx and Vladimir Lenin. . . .

Ratification of this treaty could be a costly disaster. It would violate the intellectual spirit of freedom and individual liberties that has characterized America since its founding.

More recently on the conservative blog RedState there has been some difference of opinion on whether health care is a right or not, but the rhetoric against the government ensuring anything like universal coverage has been consistently negative and often strident.  For example, an opinion in August 2009 declared:

Like other socialists, Barack Obama believes rights to include things the government must provide. . . . Indeed, positive rights are the essence of socialism, and cause an insidious mission creep for an ever-expanding government. Positive rights also lead inevitably to forcing one citizen, whether driver or physician, to serve another. . . . Health care is a right, like the right to leave and go elsewhere. But as no one need pick up a hitchhiker, no one need provide anyone else with medical care. The right to health care implies only that the government must not interfere with our attempts to care for ourselves and others.

An October posting insisted that “there is no ‘right’ to health care and those who argue for it are doing so out of a desire to have everything provided to them without effort.”

Another October contributor wrote:

“Health Care should be a right” is now a manta of the Left. Correct they may well be! However, as is often the case with the Left, they are not saying what they mean. What they mean is, “My health care at someone else’s expense should be a right.” Clearly, this whole concept is self-contradictory. It cannot be a “right” if the exercise of the right requires a duty or obligation by another. Your “right” cannot be a right if it imposes a duty on me. You don’t have a right to it if I have to pay for it.

Basically conservatives believe what President Reagan proclaimed in his farewell speech to the nation, “As government expands, liberty contracts.” Perhaps the U. S. conservatives’ favorite economist of the twentieth century was Milton Friedman, author of Capitalism and Freedom (1962). In a 1999 interview, he stated that he would be in favor of eliminating most U. S. cabinet departments, including Commerce, Education, Energy, Labor, and about half of the Department of Health and Human Services. 

Most conservatives also believe that the United States has more to teach than to learn from the rest of the world, especially in regard to freedom and human rights. But perhaps a little humility is in order. Perhaps the fact that most other advanced democracies have evolved to the point of  recognizing their citizens’ rights to adequate and affordable health care, as proclaimed in ICESCR,  should lead us to ask why we have not. There is also the example of leading human rights advocates like Andrei Sakharov and Nelson Mandela, both of whom often praised UN statements on human rights and maintained that governments had a responsibility to ensure people’s right to adequate health care.

In 1971 Sakharov wrote that “the basic aim of the state is the protection and safeguarding of the basic rights of its citizens. The defense of human rights is the loftiest of all aims." While he was later being held in exile in the Soviet city of Gorky in order to curtail his activities in behalf of oppressed Soviet citizens, Ronald Reagan designated May 21, 1983 as “National Andrei Sakharov Day” and called upon Soviet leaders to free him from exile, adding that “the world needs his learning, his wisdom, his nobility.” But Reagan’s admiration of Sakharov’s wisdom would not have extended to the wording he composed in 1989, shortly before his death, for Article 11 of a new Soviet draft constitution. It began thus:

No one shall live in poverty. . . . Benefits and other forms of social welfare must guarantee a level of life for all members of society that is not below the minimum standard. Medical care for citizens, and the educational system, shall be based on principles of social equity, so that minimally sufficient medical care (free and paid),[schools], and places of rest and recreation, without regard to material wealth, place of residence, or occupation, shall be available to everyone.

Since World War II the United States has gradually broadened its understanding of human rights for minorities, women, gays, and others. Is it not time to continue moving forward by now recognizing a right that most leading democracies and exponents of human rights have come to accept--the right to accessible and affordable health care?

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Janet Ellingson - 12/21/2009

I agree how one defines human rights is essentially a moral issue and, therefore, for many it is a religious issue. Human rights go to the core of what it means to be human, a profoundly moral and religious matter. I wish that everyone (we, the people) shared my view of humanity and shared my beliefs of what our obligations are to each other, but not everyone does. So we the people have some pretty mean arguments. My hope is that at least we all make sure that the people we know and love are fed, clothed, sheltered and cared for in sickness. That is an important step, in my opinion, toward eventually seeing that all people should be as well cared for as those we love. If we can't do that individually we need to do it as "we, the people," in other words through government.

James Goswick - 11/21/2009

Inalienable rights do come from God. The framers said they did, and are part of Natural Law.

Read the Father of the Bill of Rights, George Mason, or Locke. God was a party in the Social Contract.

Liberal secularists want health care as a human right, because to them, man is the measure of all things; an obvious absurdity, but such is their delusion.

The basis of human rights is birthed in the Bible (Romans 2:14-15). LONANG, in the DOI, is from the above passage, brought to the world by Christians, not through the enlightenment, but through the Reformation, and part of Natural Law.

Revelation never goes so far as to say health care is a universal right. Deut. 15 says we should help the poor, and the N.T. says if Christians don't work, they shouldn't eat.

Jesus said there will always be the poor. The socialist agenda of Obama and the liberal order want to eliminate the poor from this planet; The God-Man says it will never happen.

R. Richard Schweitzer - 11/18/2009

We are speaking of humans and human relations and interactions.

In any societal grouping, a "Right" is the name given to the obligations due from one individual or group of individuals to another individual or group of individuals.

An obligation (like a religious commandment) may be negative in character (thou shall not); such as the group's (and members') obligation not to interfere with an individual's mode of worship forms the Right to freedom of worship (but only to the extent the obligation is performed).
If the obligation is fixed that the group and its members shall not use the instrumentalities of government to interfere, that becomes a Constitutional Right.

An individual (or group) may have a Right with respect to another specific individual (or group) such as the distinctions of rights between serfs and masters, and as amongst only serfs. Rights may vary as do obligations by the nature of relationships.

Differing circumstances give rise to variances in obligations - and hence Rights.

In the case of healthcare (or any care) such a Right exists only to the extent that there is an obligation on the part of others to provide it.

An "entitlement" is a specific set of obligations to a specific individual or grouping, generally one imposed upon another undefined grouping; unless it is predicated on a specific relationship such as marriage; where one might claim an entitlement as spouse. There are many others, of course.

Some obligations come into existence through force (See, the Plantagenet Motto of the English Monarchy). Some can take the form of responsibilities as a result of a relationship; or a commitment which is by voluntary act, etc.

The concept is often best grasped by some in terms of accepting that "Animal Rights" do not exist among animals, they are the name given to the obligations of humans in their relationships with animals. Childrens Rights are the obligations of adults in their relations with children, etc., etc.

How obligations come into being (evolve & erode) in various societal contexts is a matter for social anthropology, but the evidence and experience are plain and obvious. Not all individuals within a societal grouping recognize, much less accept, the obligations commonly or widely held by a groups members - and performance, as well as modes of performance, forms the issues of polity.

From a personal essay by:
R. Richard Schweitzer

Arnold Shcherban - 11/11/2009

Well said, Mr. Cahill... to all those who try now (when they cannot outright deny them) to confuse these things through evasive and sophistic rhetoric.

Timothy Shane Cahill - 11/9/2009

Rights can not be taken away, but they can be denied. If you are imprisoned arbitrarily, you still have a Right to your freedom, while you may lack freedom itself. Breaking laws does not invalidate them.

There should be no confusion between the imperatives of Natural Law and the goals and deeds of Humankind. We have very little control over Nature and absolute control over ourselves. This is why we have no human laws of Gravity but we do have speed limits.

While we do have an animal nature, which is expressed far too often, we also have consciousness and free will.

If we depended upon the intervention of Gods to compel us to behave, what would be the point of that free will? Inalienable rights do not require a deity, and are not fiction.

We can chose to declare a Right of Freedom to or from certain acts or status, because to do so is consistent with the most basic human aspirations. Human Rights are elements of the Social Contract. Contracts are not fiction, they are held to be enforceable, but not by Nature, indeed despite Nature at times. (Such as is the case with insurance)

John D. Beatty - 11/9/2009

It is a privilege, a perquisite, that can and often is negated by reality. YOU HAVE NO RIGHTS by that definition. No "right" you "have" cannot be taken away by someone or some thing.

What other definition is there? the concept of "inalienable rights" is a linguistic fiction that requires belief in an all-mighty, all-controlling deity that controls all things. Few would assert that this is the case, since unlimited and unfettered access to health care can and will be denied to some regardless of what the oxygen thieves in Congress do. It will be restricted by simple economics, by supply and demand, by politics.

You have a "right" to seek happiness. That is not a guarantee that you will be happy. Mandating that I pay for YOUR tummy tuck is tyranny, and inevitable if "reform" actually occurs the way the advocates envision it.