DAN W. BROCK
Right to Health Care
There is now a broad public awareness in the United States that we are the only industrialized country besides South Africa that fails to ensure access to health care to all its citizens. Some thirty seven million Americans are without health insurance, and many millions more are underinsured. Moreover,this failure is not the result of parsimonious health care spending. Quite to the contrary, we spend a substantially larger percentage of GDP—over fourteen percent in 1992—on health care than does any other country. This failure to ensure universal access to health care is increasingly widely regarded as morally unacceptable, an injustice to those denied access to care. Health care reform to ensure universal access now appears more likely than it has in two decades. As the public and political debate over health care reform intensifies, how we conceptualize the moral claim of individuals to health care can influence the direction and pace that reform will take.
Perhaps the most influential public study and report on access to health care that focused on the ethical issues was Securing Access to Health Care issued in 1983 by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. 1 An important feature of that report for the present project exploring a human rights approach to health care is that the Commission explicitly chose to frame its analysis not in terms of moral or human rights of individuals to health care, but instead in terms of a societal obligation to insure adequate health care for all. 2 In this essay, I shall first briefly summarize the Commission's ethical argument and position regarding access to health care, offer some reasons that I believe led to the choice of a social obligation, not rights, framework, and then evaluate the Commission's own arguments for preferring the language of social obligation. My conclusion will be that it was both a philosophical and political mistake to use the language of obligation instead of rights—the Commission's own arguments strongly support a moral or human right to health care, and rights language