VIRGINIA A. LEARY
Two contradictory and seemingly irreconcilable approaches to the concept of a "right to health care" presently co-exist in the United States. In the debate over health care reform, we hear, on the one hand, demands for a "right to health care" and, on the other hand, statements that demands for a "right to health care" are simply rhetorical, lacking in substantive content, are diversionary and fail to address the practical problems in the delivery of health care. Some commentators reject the concept of a "right to health care" on the grounds that it implies a "socialistic" approach which is incompatible with the prevailing American free market economy.
I argue in this paper that a rights based approach to health care should be adopted as the fundamental premise of a reformed health care system in the United States, rather than a market-based approach or a cost-benefit approach or an "ethical obligations" approach. The adoption of the premise of a right to health care would not resolve all the problems concerning health care in the United States, but such a premise would set the parameters within which practical decisions are made by providing goals, orientation and permissible limitations.
In his discussion of Medicare, Theodore Marmor has pointed out that "the United States legislated substantial extensions of the government's role in financing health care during the mid 1960s, but did so with only the vaguest clarity about its underlying rationale... Without understanding what right Medicare was to insure, the American public has been uncertain throughout over whether the program was a success or failure." 1 Canada focused on basic principles before deciding on the details of its present health care system. The report of the Canadian Royal Commission on Health Services, which led to the adoption of the present health care system in Canada, opened with a Section on " Basic Concepts." These basic concepts have provided guidance in the practical working out of that system which, despite