On rights
Wednesday, October 22 2008
The conversation between Maggie Mahar (of Health Beat) and Shadowfax (of Movin’ Meat) about health care being a right has spread through the medical blogosphere – even devout hypocrite Kevin, MD cites Shadowfax’s views approvingly. Of course, Senator Obama called health care a right in the most recent debate, but that doesn’t seem to have convinced anyone. Still, there’s something missing from this discussion.
I agree health care is not a primary right, the way freedom of conscience is – but not all rights are fundamental (bearing arms, anyone?). Instead, health care is a problem of civil rights, at least for the chronically ill people in the U.S. What do I mean by civil rights? From the SEP:
[Civil rights] are the rights that constitute free and equal citizenship and include personal, political, and economic rights. No contemporary thinker of significance holds that such rights can be legitimately denied to a person on the basis of race, color, sex, religion, national origin, or disability.
This last category, “disability”, includes chronic illness – at least according to the law. Most chronically ill people don’t like to think of themselves as disabled, but for now that’s the only accurate way to describe the challenges they (we) face in our society. I don’t like it either, but there it is.
Health care isn’t the only thing diminishing the civil rights of sick people. Discrimination has long been a problem for us – and in that respect, the ADA Amendments Act was a major step forward. But access to health care is an important and growing part of the problem.
The most obvious rights being denied the chronically ill are economic rights. It’s unquestionably true that the terms of my access to health care impinge on my economic rights: I simply cannot work in certain professions or positions – not because I can’t do the work, but because those jobs don’t offer health insurance. So I can’t start my own business, or work in most small businesses, or try my hand as a free-lance writer (as opposed to half-assed blogger).
That has nothing to do with my illness, but everything to do with how we structure health insurance in this country. Granted this is not deliberate oppression, the way Jim Crow was – but just because it’s accidental, doesn’t mean it’s fair.
This is also true, although less obviously, of political and personal rights. For example, I have avoided helping organize a union in my workplace – even though I think it’s necessary – because I worry about being fired and losing my health benefits. Lately, despite a supposed right to privacy, I have been forced to explain to at least a dozen anonymous strangers the nature of my illness and medical needs, simply because they are empowered by our system of health delivery to deny my care if my answers are insufficient. If you don’t already know, trust me: this is invasive, obnoxious, and humiliating.
To the extent that the full exercise of my (primary) right to civic participation is significantly limited by our system of health care, I can claim a secondary right (or an entitlement, per Shadowfax) to health care access. The mistake Maggie and Shadofax make is in not acknowledging the extent to which access to health care affects other rights. Granted this is not obvious from their perspective – but just because it’s subtle, doesn’t mean it’s not pernicious.
Most people arguing “health care is not a right” are arguing against what they see as a claim that sick people have a right to expect other people to pay for their care. As for me, I won’t claim that I have a right to health care at someone else’s expense.
I do have a right to a system of health care access that does not diminish my civil rights. The fact is that some form of universal healthcare is probably the best way to do that, which will ultimately mean that other people pay for my care. (Other people already pay for my care, through private insurance.) I know – that’s a little tricky – but just because it’s complicated, doesn’t mean it’s false.
Look at it this way: do children have a right to be healthy? Maybe not – but we know that childhood illness affects educational and socio-economic attainment, so a health care system that does not provide for sick children ultimately limits their rights as citizens. Most people recognize health care as important to every child’s right to grow into a capable and mature citizen – which is why programs like SCHIP are vital and necessary. We do that even though it means other people – besides their parents and parents’ coworkers – end up paying for their care.
In all honesty, I’m done feeling like I’m less of a person or American, just because I happen to be sick. I’m tired of wonks and docs and insurers treating me like I’m what’s wrong with this country. I refuse to retreat to the margins of society, simply because I’m different. So when I say “health care is a right”, what I mean isn’t that other people should be paying for my care; it’s shorthand for the fact that health care is organized so as to interfere with my civil liberties – my rights as citizen and human being. I understand and appreciate the views of folks like Maggie and Shadowfax, but they’re ignoring an enormous slice of this debate. They’re ignoring me.
Duncan–
Ironically, I agree with virtually everything you say– except that
“right” is the best way to describe why every human being should have access to high quality health care.
Usually, when people talk about healthcare as a “right” they are debating whether it is a “right” or a “privilege.” As I said in my original post, when you put it that way, I will circle “right” every time.
But Shadowfax introduced a third choice to the discussion: healthcare is a “moral obligation” in this sense: a civilized society has a moral obligation to ensure that all of its citizens have healthcare.
To me a society’s moral obligation exists on a higher plane than an individual’s right. under the law. When we move from man-made laws to morality and ethics, we are on firmer ground.
MOreover, the idea that society has a “moral obligation” to ensure healthcare for all asks us to think about health care collectively, not individually. We all deserve health care because we are all in the same boat. Whether we are sick or heatlhy today, we are all human being, and insofar as we recognize each other as equal, and human at we recognize our moral obligation to each other.
In this way healthcare is, as you say, close to what you call a civil right. But I would argue that people like Martin Luther King got as far as they did in campaigning for civil rights by awakening the conscience of the nation. King didn’t say “I” have a legal right–and you have to respect it.
He said “we”– and dreamed of a society in which we would treat each other equally.
Rights under the law, like the right to bear arms, may change with changing times. Moral obligations to treat each other as equals (becuase we are all human) do not change.
Maggie – thanks for your comment. The question of which is the higher plane – “right” or “moral obligation”? – may be simply a matter of training and lexicon. I don’t see much difference, but I can accept that you do.
I agree about King, and I do wish for a similar “awakening” regarding health care. But so long as most people see the problem as simply being sick or not, getting medicine or not, seeing a doctor or not, that awakening will not happen. Most people – and this is my criticism of you and Shadowfax – do not discuss the extent to which health care affects the many other areas of a sick person’s life, including civil rights. Not even most sick people understand this problem. It took me thirteen years of struggle to really get it. (You and Shadowfax may well be aware of this problem, but it’s missing from your exchange.)
So the first step to that awakening is getting people to recognize that their rights as citizens are diminished and denied simply by virtue of their illness. Sick people need to recognize their circumstances as a contingent fact, the same as race, religion, and gender, and thus not legitimate grounds for discrimination. For all King’s challenges, he had this going for him: his people were plainly obvious, as was discrimination against them. The chronically ill spend their lives trying not to look sick, trying not to think sick, trying to be normal as possible; we’ve internalized the norm that says we shouldn’t talk about our illness, and it prevents us from recognizing our circumstances. Imagine if King first had to convince people that it was okay to talk about being black: where would we be?
If we’re discussing societal priorities more broadly, “moral obligation” is fine – but I don’t think it’s adequate to the task of understanding sick people’s place in society. From a sick person’s point of view, it is deeply disempowering to have to argue that the rest of society has a “moral obligation” to provide my care. (In fact, I don’t think I could mean it.)
So, yes: we have a moral obligation to provide health care. But I – as a sick person – also have civil rights that are denied by our current system.
I am a practical thinker. When we speak of rights, like the right to free speech, we are talking about an abstract concept. It doesn’t cost anything or take any resources. We all are supposed to abide by it.
A right to health care has tangible monetary costs and resources. It is fundamentally different than the Bill of Rights. There in lies the problem.
Energy and economic issues are problems we can solve with the appropriate attention. Issues of health care bring up questions of our own mortality which have not and will not be answered ever unanimously. Is the physician’s goal to prevent death or to improve our quality of life? With each additional decade the human race survives on average, there are new frontiers of disease which will take greater resources and more expensive technologies to continue the species. I predict in 150-200 years patient’s will have the option not to die. Once we have the ability to remove God’s own term limits, will that solve the issue? No.It will create even more frightening problems as death will no longer be the ultimate equalizer.
At present, the best thing we can do is to come to some difficult conclusions about our mortality and how much of society’s resources the individual deserves. Neither the government nor the private insurers have bottomless pockets. I would like those decisions to remain between the family and the physician rather than the government and I would rather have Universal Health Care with choices rather than Socialized with none.
I understand your point. I have a disabled son and for him, it is not access to healthcare that is the biggest problem, but the quality of it when he gets it. My fear is that any further “universalization” of our system will result in even poorer quality.
I also shudder every time I read or hear the phrase “high quality health care” because it’s undefined, yet it is assumed everyone knows what it means.
Health care is much too complex an issue to leave to experts and bloggers. Anyone with a decent level of verbal facility can make a decent surface argument for a 100 different positions that have nothing to do with reality and complexity.
You have a right to bear arms, but not a right to ask me to pay for your gun.
You have a right to vote, but I don’t have to drive you to the polls unless I want to.
Interestingly, children’s health, or anyone’s, seems to be inversely correlated with the amount of healthcare available in their locality. Do you have a right to healthcare that shortens your lifespan.
“Healthcare” is not a simple, disambiguated good like money, or sex, or religious perfection perhaps are. The amount of resources that can be spent on your health is unlimited. The amount that can do you any good, or enough good to be worth the effort, might be very limited indeed.
Why should people too stupid, or ignorant, to understand that distinction be given control of one of the largest, most inefficient and dynamic sectors of our economy?
If you want to increase your life expectancy, sight unseen, increase your relative socio-economic status. As long as you reason at so unthoughtful and self-centered a level, that’s not going to happen (I hope.)
Thanks everyone for the comments. Glad to be read – even if you disagree.
Doc – we think the right to a trial by jury (Amendment VI in the Bill of Rights) permits the government to compel citizens to serve on those juries. I earned something like $10 a day for the five days of jury duty I served (since I had exhausted all my vacation days on sick leave). So there’s one right that compels people to incur very tangible costs.
I want decisions to remain the patient’s, with input from the doctor. Right now insurers, employers, pharmaceutical companies, and even the government all have a lot more say than patients do. I’m not advocating for more government involvement – just a system that closes the gap between patient and provider.
Donna – you’ll be relieved to know that nearly every industrialized country that has a universal health care system actually has better health outcomes than our system, at about half the cost. I’ve lived in one of those countries, and I can tell you: it’s not bad. Meanwhile, is your disabled child going to be able to afford care when he’s an adult? Through his job? I hope he’s the right kind of disabled for that – the alternatives are pretty bleak.
Frank – Yes, out with experts and bloggers, in with the comment trolls. Concerning rights, see the discussion of Amendment VI above. As for socio-economic status: re-read my post. As for ad-hominem attacks: I’d be just fine with a system that rewarded reasoning, but who are you kidding?