Healthcare Debates: Is Healthcare a Right or Privilege?

The debate in the United States over whether or not healthcare is a right or a privilege has been raging for over a century. Do all U.S. citizens have a right to access healthcare, regardless of their position in a free market system? Or, as healthcare services are a limited resource requiring money to operate, is access to healthcare just like every other commodity—a privilege reserved for those who are competitive in the free market?

As there is real-life evidence to support both outlooks, the debate over whether healthcare is a right or a privilege ultimately is a values-based debate. Where someone stands on this debate comes down to how they view rights, the role they believe the government has in enforcing these rights, whether or not they believe healthcare is something every individual deserves, and whether they believe we are connected or separate.

Keep reading to learn more about the fundamental questions we must ask ourselves as individuals and what our nation must answer as a collective to come to a consensus around whether or not healthcare is a right or a privilege.

When the healthcare debate rages, one of the dialectics that fuels the debate is the semantic meaning of the word “rights.” While we all have a generalized sense of what this means—something we are entitled to simply because we exist—the debates over healthcare arise from differing ideas regarding how rights are idealized and from these idealizations: how they should be enforced.

Parties who believe that healthcare is a right often operate from the rhetoric of positive rights, whereas those who believe health care is a privilege often operate from the rhetoric of negative rights.

Those who see healthcare as a privilege will often use the rhetoric of negative rights. In a negative-rights framework, rights are restraints on actions rather than an obligation to act. In the case of the constitutional decree that we have the right to life, liberty, and the pursuit of happiness, a negative rights outlook would mean that you have no obligation to help another person to attain life, liberty, or happiness—but you do have a duty not to get in their way.

In the case of healthcare, those who believe in a negative rights framework believe that you cannot have healthcare as a right because it places a positive obligation on others to provide access through the nonconsensual surrender of income to the state. From a negative rights perspective, the only duty or obligation we have to one another in regard to healthcare is not to threaten choice or bar access, but we should not be forced to contribute to the care of others.

Parties who see rights from this perspective believe that helping with healthcare needs to be voluntary (i.e., free-market decisions or healthcare charities run on voluntary donations). The government’s role in healthcare is to protect this individual’s right to choose. Simply put, in a negative rights framework, healthcare can be available through the mechanisms of a free market system, but it is not a right.

Those who advocate greater governmental responsibility in healthcare are often working from a positive rights perspective—a framework where a positive duty is imposed on us to sustain the welfare of those in need.

There is a major global consensus that health—and all the circumstances that mediate health—is a fundamental human right (see the UN Universal Declaration of Human Rights and the World Health Organization’s Constitution). Healthcare is often a necessary tool for the attainment of access to health and, from a positive rights perspective, it is something that should be provided to everyone, whether or not they can participate meaningfully in a free market system.

From this point of view, marginalized populations who struggle to find adequate work or cannot work (e.g., the young, the poor, the elderly, those with debilitating chronic diseases, the disabled) should have a right to healthcare. In this framework, it is the government’s duty to ensure that the conditions that mediate fundamental human rights are attainable, regardless of the lottery of the birth. Therefore, the government has a right to impose taxes that will help those for whom the free market system imposes an undue burden.

In a positive rights framework, healthcare is a tool to attain the basic human right of health, and it is the duty of the people to ensure access to it.

As a result of an unequal system of healthcare that began during World War II, the idea of healthcare as a basic entitlement that we all contribute to—much like clean water, garbage collection, roads, etc.—has experienced a complete breakdown in American cultural consciousness.

In linking health insurance to employment and thereby intrinsically linking access to care to employment, the U.S. became the land of an inequitable system whereby different people with varying circumstances became subject to different rules for healthcare. This history is integral to the way we speak about whether or not people deserve healthcare.

For parties who believe that healthcare is a privilege, one of the key beliefs is that rights do not distinguish between the deserving and the undeserving. Within this framework, narratives of self-reliance and hard work are key rhetorical cornerstones. Those who do not believe healthcare is a right often assert that work is the key that opens the door to healthcare all throughout the lifecycle. Earning money, saving for health, and choosing employment with health coverage is what hardworking, self-reliant individuals should do in their productive working years to ensure access to the privilege of healthcare for themselves and for their children.

As these individuals work, they pay into Medicare, and this is the system that ensures that hardworking, self-reliant individuals will retain access to health care when they are no longer capable of work.

For those who are working hard and earning wages that do not cover the cost of healthcare, access to government assistance or charity is an earned privilege. However, from this point of view, those who are not productive members of society do not deserve access to care—nor to collective pools of money paid into by those who are productive. Supporting those who cannot contribute is seen as detrimental to the system, opening the door for abuse of the system.

Parties that believe healthcare is a right tend to use rhetorical frameworks that demonstrate all lives have equal value and that access to healthcare for all is necessary for a prosperous society.

Because of these centralized beliefs, those who believe that everyone deserves healthcare argue that it should not be linked to one’s capacities to work. There are many people who—through no fault of their own—are born with physical or mental disorders that bar them from work and many who, despite having some productive years, develop chronic conditions that prohibit them from working.

There are also those who do work—like the estimated 35 percent of the adult workforce in the United States who are in the gig economy—who do not have access to healthcare because of lack of access to employer coverage. Those who believe healthcare is a right state that investing in the health of all these people is essential because, with healthcare, these humans have the capacity to live up to their greatest potentials and may contribute to our communities in a way that cannot always be measured within a framework of contribution to a GDP.

Overall, supporting those who cannot work can lead to abuses in the system, but this is a small price to pay for opening the door to all citizens to live up to their greatest human potential.

Ultimately, all the questions that come before connect to one penultimate question around whether our fates are connected or if they are separate.

Those who believe healthcare is a right utilize the rhetoric of the connected. What impacts one of us impacts all of us—both in the realm of the negative and the in the realm of the positive. Healthcare, therefore, needs to be a right because if the most vulnerable member of our society is not cared for, it means that we—as a collective—are not cared for.

The real-world implications of this are seen in a healthcare system that is the most expensive, least effective, and least accessible in the western world. Those who see healthcare as a right argue that improving access to healthcare saves us money, heals people, and creates a more engaged citizenry.

Those who believe healthcare is a privilege utilize the rhetoric of the separate. It is the belief that we have a duty only to our own freedoms and to reap the benefits of the work we have done. Being forced to use what we have earned against our will to help another is akin to theft.

By putting the responsibility for healthcare on the shoulders of the individuals in need, we will ultimately save money because prices will become more competitive, and the citizenry will become more engaged if they wish for healing. They believe that our healthcare system is the most expensive and least effective in the western world because there is too much assistance on which people are becoming dependent.

The debate over whether healthcare is a right or a privilege has more questions than answers—and the answers to these questions are not straightforward. If they were, this debate wouldn’t have a century-old history. What individuals believe about healthcare comes down to a complex mixture of:

• Life experience – Did they have a work-ending condition?
• Values – Do all human lives have equal value?
• Ideologies – Are rights negative or positive?

When debating in the realm of ideals, it is challenging to come to a conclusion as the values underlying the belief are often antithetical and irreconcilable. This begs one more question: can we come up with a system of healthcare that blends both ideologies so that we can move into a healthcare system that costs less, is more effective, and is a win-win for our ideals and the health of our citizenry?