President Joseph Biden declared on March 23 that health care is a right.
“We have a duty not just to protect it, but to make it better and keep becoming a nation where health care is a right for all, not a privilege for a few,” he said in remarks at the James Cancer Hospital in Columbus, Ohio.
This reiterates his statement last month in which he declared that “health care is a right, not a privilege.”
“I will do everything in my power to ensure that all Americans have access to the quality, affordable health care they deserve,” he said in mid-February.
In doing so, the president raises a heated debate that goes back decades, centered around the question, “Is health care a right?”
To declare that health care is a right might seem like stating the obvious, but the idea has historically had two philosophical problems that are shrouded in ambiguity.
The first is that few who espouse the idea take the time to define what they mean by the term “right,” and the other is the meaning of the term “health care.”
Let’s take of moment to reflect on what we mean by “rights.”
We live in an era where we frequently discuss the freedom of assembly, the right to bear arms, the right to education, freedom of information, intellectual property rights or the right to welfare.
But are all of these the same class? And what is our societal obligation to each of them?
In order to have an adequate discussion about different kinds of rights, we must first make a distinction between inalienable or natural rights versus legal or bestowed rights on the one hand, and positive versus negative rights on the other.
Inalienable or natural rights are not based upon governmental rules or statutes. They are based upon an individual’s membership in a class.
This is what is referred to in the U.S. Declaration of Independence, which argues that, as human being, God built into each of us a right to life, liberty and the pursuit of happiness.
Natural rights are extended to all human beings, and theologians base these rights in the fact that human beings possess God’s divine image from creation.
So, is health care an inalienable right?
It has been argued that a right to health care is an extension of the pursuit of happiness.
In 2005, the United States affirmed the World Health Assembly resolution 58.33, which affirms that it is a natural right and that everyone should have access to health care.
Pope Francis took a similar position in 2016.
Arguing that health care is an inalienable right means this principle applies to all people on the planet.
If we take this position, then the nations adopting this position have a moral obligation to promote health care throughout the world. This is a bigger proposition that involves a tremendous obligation seldom pointed out by theorists.
On the other hand, health care could be seen as a contractual right or bestowed right, with defined boundaries regarding the scope of people granted such rights.
It is important to remember that rights by contract or statute can be changed by new statutes or contracts. They are not universal or eternal. They are based upon agreement.
For example, I have a freedom from financial hardship related to health care because of my contractual agreement with my insurance company. As long as we stay in business together, I have a right to specific services.
With regard to a right to health care, it has been argued that health care sponsored by the state would function this way. A right to health care would be what Thomas Hobbes and John Locke would consider part of a social contract.
So, for example, health care would fall under the U.S. government’s obligation to “promote the general welfare.”
In this case, health care would only apply to citizens and residents covered under the U.S. Constitution or individual state constitutions.
The other issue we must address is the nature of the obligations that inalienable rights or contractual rights place upon us.
Rights can function in either positive or negative senses.
Negative rights are not about empowerment, but about ensuring that an individual is not subject to something or to an action. They are protections against something.
For example, freedom of religious expression is a guarantee that the state will neither infringe upon nor promote someone’s free expression of religion.
The right to bear arms functions in a similar way, with the state not being able to deprive citizens of armaments without due cause, but also not being obligated to provide people with guns and ammunition.
It is simply guaranteeing individuals the ability to participate in some kind of action.
So, if health care is a negative right, then it is simply guaranteeing that an individual will not be restricted from seeking medical treatment.
Positive rights, on the other hand, are designed to obligate an entity or a governing body to empower individuals with some guaranteed service.
The easiest example of this is the right to education where the state is obligated to provide free and equitable educational services for the betterment of its citizens for the purpose of promoting the general welfare.
In like manner, it can be argued that health care promotes the general (and economic) welfare of the country and, therefore, the state has an interest in providing these services.
It is well known that healthy workers are more productive and take fewer sick days, which is one reason many employers are providing high quality health care services.
The right to health care would be a positive contractual right in this case.
Without having a clear picture of what kind of right health care is, it is difficult to form an adequate argument for national or universal health care, and it is impossible to gauge the scope of governmental obligation.
It is also difficult to differentiate the individual positions of policy makers who are all using the same word.
It is time for us as a nation to have a serious discussion about health care, but that starts with defining our terms.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.