The United Nations’ Universal Declaration of Human Rights, signed in 1948, set up the framework that healthcare is a human right. Article 25 of the document stated that, “everyone has a right to standard of living adequate for the health and well-being of himself and his family including…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.”
President Franklin D. Roosevelt previewed these sentiments in his State of the Union Address where he described the four freedoms. The first two, freedom of speech and freedom of religion, are codified in our First Amendment. But the third and fourth, freedom from fear and freedom from want, remain nebulous in our view. And nowhere in our nation’s founding documents does it explicitly state that Americans are entitled to have access to a physician or any form of medical treatment.
Some people might interpret the values espoused in the Declaration of Independence, with its notion of inalienable rights to “Life, Liberty, and the pursuit of happiness,” as denoting that “life” equals an explicit right to healthcare. This is simply not a reality in America.
The preamble to the Constitution mentions providing for the “general welfare.” Could this be recognition enough that healthcare is a right for the individual? No, for one’s individual welfare does not necessarily equate to the general welfare. Although there have been Constitutional Amendments proposed in the past — most recently by Rep. Betty McCollum (D.-Minn.) — as yet, there is no enumerated U.S. right to healthcare.
But, you may ask, doesn’t a pregnant woman have the right to choose whether or not to have an abortion? Isn’t that a right to healthcare? Yes, the Roe v. Wade decision determined that this form of healthcare is legal. However, the Supreme Court based their decision on an individual’s right to privacy in their medical decision making. It did not stem from a right to healthcare.
But, others may say, the emergency department is open to all — doesn’t that mean Americans have a right to healthcare? Unfortunately, the 1986 Emergency Medical Treatment and Labor Act (EMTALA), which made access to emergency care a right for all Americans, is exceedingly limited in scope. It only guarantees treatment for life and limb threatening conditions and treatment of women in labor. It does not guarantee treatment for chronic conditions such as high blood pressure or heart disease. It does not cover cancer care. Moreover, one must ask if a single, limited law could be construed as a right.
Senior citizens have a right to healthcare once they age into the Medicare program. More recently, Americans with specific diseases, such as end stage renal disease and Lou Gehrig’s disease have this right to healthcare extended to them. But as simple laws, the right to emergency care, to care for seniors, and for those with certain deadly conditions could easily be ripped away. A future Congress could repeal these laws if it chose to do so.
It wouldn’t be the first time. We have seen that health laws, such as the Medicare Catastrophic Coverage Act of the late 1980s, can easily be repealed. Other laws, like the Affordable Care Act, show that a single law can be sabotaged whenever a political party has control of both Congress and the White House. And the will of the people can be ignored by dithering politicians who intransigently refuse to implement lawful extensions of healthcare. As just one example, this occurred in Maine in 2018, when the former Governor failed to execute a Medicaid expansion ballot initiative approved by the state’s citizens.
All our patients desire is a chance to be healthy and to keep their families healthy. Should they not be allowed to do this without squandering their life’s savings or risking bankruptcy? Since the 1940s, following the defeat of Nazi Germany, our country has made bold steps towards securing this human right to healthcare and making Americans free from want.
If nothing else, this last year showed us that moving toward the right to healthcare for all is possible. With the federal government ensuring access to COVID-19 testing and vaccinations, everyone in this country had a right to the most aggressively developed medical care the world has ever seen. The pandemic has shown us what we can do when we recognize that an individual’s welfare actually is dependent upon the general welfare. So, although an explicit right to healthcare does not formally exist in the U.S. for all people regardless of age or medical condition, the past 2 years have revealed why every American should be assured of that right.
America must make the healthcare of its citizens a protected right. As difficult as it may be in these polarized times, the U.S. needs a Constitutional Amendment to guarantee healthcare as a right. Anything less would fall short of the needs of everyday Americans. Until then, in America, healthcare is not a right. But its high time we change that.
Cedric Dark, MD, MPH, is an assistant professor in the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine. Kyle Fischer, MD, MPH, is a clinical assistant professor of emergency medicine and fellowship director in health policy at the University of Maryland School of Medicine.