Yes, We Have a Right to Healthcare

Hendrik van den Berg
UNL Professor of Economics

Since the beginning of the 2008 presidential race, healthcare has been the focus of election campaigns, lobbying efforts and political debate across the country. All this attention to what is perhaps our most pressing economic and social problem, though, has not brought us much closer to a solution.  

For a hundred years, political leaders have tried to provide healthcare for all Americans. Teddy Roosevelt tried at the start of the twentieth century, but failed to convince Congress and the voters to support healthcare legislation. Franklin Roosevelt was able to get Social Security, unemployment benefits, a minimum wage, deposit insurance, extensive bank regulation and other social legislation through Congress with his large Democratic majority, but he could not pass universal healthcare. President Truman tried again after World War II, but failed. Lyndon Johnson was able get Medicare through Congress—which provided universal healthcare coverage for everyone over 65—but he did not push for true universal coverage for everyone. Bill Clinton pushed for universal healthcare at the start of his first term in 1993, but quickly retreated in defeat. The Obama Administration has tackled the issue yet again, but (despite Democratic majorities in both houses) has only produced a weak bill that, while expanding healthcare to more people, falls far short of universal quality healthcare for all. 

So, the United States will remain the only developed country without universal healthcare. Now that even China, a much poorer country than ours, is moving towards a system of universal healthcare, we should ask what it is about the U.S. that makes it politically impossible to establish a national system that provides healthcare to everyone.

Why We Do Not Demand Public Healthcare 

It is certainly not the success of our current expensive system that blunts political support for healthcare reform. The facts clearly show that the American healthcare system delivers poor results. In an earlier article in Nebraska Report, I referenced studies that show we could save over 40,000 lives annually if we insured everyone, and that we could save over 100,000 lives annually if the U.S. healthcare system achieved the lower French mortality rates for all diseases. And yet, Americans are paying more for this shoddy system of ours than what any other country pays for its healthcare. 

It doesn’t take much investigation to discover that our 37th place ranking among the world’s national health systems is the result of a healthcare system that does not seek to provide coverage to all Americans. The private insurance companies, drug companies, hospitals and clinics that comprise our healthcare system benefit from the high per capita payments they collect from those who can afford to pay (and they prefer to not provide health services to those who cannot afford their prices).  

Let’s face it: it is our private for-profit healthcare industry that’s effectively running the ‘death panels’ Sarah Palin was ranting about—but they are run stealthily in the form of rationing, through high prices, high insurance costs, arbitrary insurance company procedures, employer-provided plans with huge deductions and co-payments, and a confusing mixture of politically motivated government subsidies. The healthcare bill that has been taking shape in Congress does not change this situation at all. It only adds some more subsidies for some more people to purchase high-priced insurance, and simply forces some others to buy expensive private health insurance. 

How can the private healthcare and health insurance industries get away with forcing Americans to pay so much for healthcare while continuing to let many people suffer and die outside the system? In part, it’s because many Americans probably do not understand that they are grossly over-paying for healthcare (at least compared to other developed countries). Nor do Americans understand that the rationing of healthcare services by our for-profit system is infinitely more oppressive than the inevitable choices that are made in public healthcare systems in other developed countries. Our system forces us to argue, beg, and plead with employers, insurance companies and hospital billing offices, while elsewhere the rules are much clearer and medical decisions are made by the doctors and clinics we personally deal with. 

This lack of understanding is driven to large degree by our implicit acceptance of healthcare as a commodity, like a toaster or an automobile. Not a few American economists, pundits and politicians have noted that government-provided healthcare would be equivalent taxing everyone so that the government can give everyone a free car. Americans have also been conditioned over the past 50 years to believe, as Ronald Reagan said, that “Government isn’t the solution to our problems, it is the problem.” And recall that it was a Democrat, Bill Clinton, who later proclaimed that “the era of big government is over,” effectively banishing government intervention from the political toolkit. 

Healthcare as a Basic Right 

But Americans did not always view healthcare as a commodity or deny government’s responsibility for providing healthcare. In 1941, at the urging of his wife Eleanor, President Roosevelt outlined his famous “four freedoms”: namely the freedom of expression, the freedom of religion, the freedom from want, and the freedom from fear. But, in his 1944 ‘State of the Union’ address to Congress, he provided more detail:...

This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights—among them the right of free speech, free press, free worship, trial by jury, freedom from unreasonable searches and seizures. They were our rights to life and liberty. 

As our nation has grown in size and stature, however—as our industrial economy expanded—these political rights proved inadequate to assure us equality in the pursuit of happiness. We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence. Necessitous men are not free men. People who are hungry and out of a job are the stuff of which dictatorships are made. In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all—regardless of station, race, or creed. 

Among these are:

  • The right to a useful and remunerative job in the industries or shops or farms or mines of the nation; 
  • The right to earn enough to provide adequate food and clothing and recreation; 
  • The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
  • The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
  • The right of every family to a decent home;
  • The right to adequate medical care and the opportunity to achieve and enjoy good health;
  • The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;
  • The right to a good education. All of these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being. America’s own rightful place in the world depends in large part upon how fully these and similar rights have been carried into practice for our citizens.

Conservative politicians immediately attacked Roosevelt for suggesting people had a right to housing, healthcare and employment, but the speech was well received at the time. Roosevelt’s list of rights came to be known as the “Second Bill of Rights” or the “Economic Bill of Rights.” His statement “Necessitous men are not free men” clearly recognized that Constitutional freedoms—such as the freedom speech, religion or the right to vote—have little practical meaning if people are hungry, homeless or in poor health. People must be able to satisfy their basic wants before they can exercise free choices about what they say, where they work and how they live their lives.  

The Universal Declaration of Human Rights

After her husband’s death, Eleanor Roosevelt remained an active supporter of human rights, and she was instrumental in getting the United Nations to approve the “Universal Declaration of Human Rights” in 1948. The Universal Declaration of Human Rights contains 30 articles. The early articles cover standard human rights, such as the right to life, liberty and security of person, and a ban on slavery or servitude, torture and cruel, inhuman or degrading treatment or punishment. Also dealt with are political and legal rights, such as equal stature before the law and prohibitions of discrimination. The latter part of the Declaration, however, explicitly states Roosevelt’s economic rights, including: 

Article 25: 

(1) 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.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

The Universal Declaration was adopted by the General Assembly on December 10,1948 by a vote of 48 in favor, 0 against, with 8 abstentions. Abstaining countries were the Soviet Bloc states of Byelorussia, Czechoslovakia, Poland, Ukraine, U.S.S.R. and Yugoslavia, plus the apartheid state of South Africa and the fundamental Islamic kingdom of Saudi Arabia. The United States voted in favor of the document, and it remains in effect today. 

Americans Have Forgotten the Economic Bill of Rights

The Cold War soon distorted Americans’ worldview, and during the McCarthy era in the early 1950s, the fear of socialism caused the Economic Bill of Rights to be quickly pushed to the background of American politics. Today, few young people have ever heard of Roosevelt’s proposal or the U.N. Declaration our government signed. 

The claim that government healthcare is a form socialism is still able to mute public discussion of economic rights, and there have been surprisingly few protests against the special interest lobbying that has destroyed any chance for real healthcare reform. Nor have many people openly criticized the backroom political deals between the Obama Administration and the health and insurance industries. It is almost as if Americans see such blatant corporate dominance as a natural part of government policymaking. So we will not get real universal healthcare, and people will continue dying needlessly. 

Should we not at least remind those who obstruct efforts to finally bring F.D.R.’s vision to life that no one is free, able to truly enjoy life, or actively pursue happiness when they are in poor health? Nor are people free if they are tied to a lousy job for fear of losing health insurance; their life’s savings are threatened by illness or disability of a family member; stagnant real wages of working families are reduced each year by rapidly rising healthcare costs; families lack the means to acquire routine healthcare; and our for-profit healthcare system has every incentive to limit their services to those who can pay the most. Necessitous men, women and children are not free. 

Sadly, the erasure from our collective national memory of Roosevelt’s Economic Bill of Rights—and our ongoing failure to put in place an equitable universal healthcare system—means that we are not the free society we claim to be. And, if anything, as a nation, we are getting further from the claim with each passing day.  

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