Health Care is a Human Right
If our bodies are just objects, our lives are shorter and less free
Health care is not only a human right, but essential to all the others. If we let ourselves be convinced that our rights do not extend to our bodies, if we accept that our bodies are just objects in a market, we will live shorter and less dignified lives.
Thomas Jefferson spoke of our rights as those of life, liberty, and the pursuit of happiness. Nothing is more fundamental to this famous trio than health, as Jefferson himself fully understood. How else can a right to life be imagined, and realized, than as care for health? Liberty, too, is utterly dependent upon health. If you cannot move your body, or clear your mind, you are less free. And happiness and its pursuit? This is hard when you have tubes in your arms or down your throat. Without health, as Jefferson sensibly remarked, there is no happiness.
In Jefferson's time, when our country was founded, there was no modern medicine. During our Revolutionary War, doctors neither washed their hands nor cleaned their instruments. Infections were thought to be signs of healing, and burns were treated by bleeding.
By the twentieth century, we had learned enough about illness and injury to follow Jefferson's logic, and treat health care as a human right. The constitution of the World Health Organization defines "the highest attainable standard of health" as "one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The Universal Declaration of Human Rights of 1948 includes "medical care" as a basic human right. The chair of the committee that drafted the Declaration was an American.
This was the common sense of the late 1940s, when those documents were written and signed. We have somehow been left behind. Why do we feel led to deny something so important ourselves? I think that this has to do with the body. Americans are taught that freedom is about psychological states. More and more we reduce freedom to expression, and reduce expression to momentary impulses. But freedom, as the founders understood, is about doing, and doing is about bodies. We can see this when we think about chattel slavery, which means treating the body of another as a commercial object.
The most basic of human rights, this reminds us, has to do with bodies. Habeas corpus, which goes back eight centuries, is all about the presumption that we should control the displacement of our bodies unless some good reason can be given to the contrary. The principle, which seems to have originated in medieval England, is the basic notion that one's body cannot be incarcerated without cause. If your body is moved against your will, habeas corpus means anyone has a right to ask that your body be presented and that good cause be given for your confinement. In our tradition, this is seen as the basis for the rule of law.
Habeas corpus is good enough for the middle ages, and a good start for our eighteenth-century constitution, in which it figures. In the nineteenth century, American began a process, not yet complete, of extending basic rights such as habeas corpus to all people, regardless of race or gender. In our age of capitalism and modern medicine, we can and should think about our bodies and our rights in a broader and more sophisticated way.
When we do not have a right to health care, the old inequalities find a new locus, as we saw in 2020 during the pandemic. The opportunities for freedom are different, as are the dangers.
If we say that we do not have a human right to health care, we are placing our bodies beyond the world of rights, which means dropping them into in the world of markets. They then become objects from which others make profits. Our medical system does not incidentally generate profits while providing health care; it incidentally provides health care while generating profits. Whether you come to the hospital in time to give birth, or stay in the hospital long enough after an operation, depends upon financial calculations. When we let the body become an object, we are more likely to die -- and then freedom of thought won't count for much. It might sometimes make sense to die for liberty. It makes no sense to die for oppression.
Once our bodies are seen as beyond the realm of freedom, once it is accepted that health is a commodity, a perverse cycle begins. A lot of money can be made by treating the body as an object. Strong lobbies will emerge which will denounce the very idea that human rights include your body. Freedom, we will be told, includes the freedom of companies to make money from your body, but not your freedom to inhabit your body.
If we concede our right to health, we find it more awkward to talk about illness. The experience of seeing a doctor or going to the hospital will be more mysterious than it has to be. We wonder why this decision or that decision was taken, and worry that it was about money. Health care professionals will be taught that red on a balance sheet is more important than blood on a bedsheet. Physicians will make decisions that they know are wrong, and they will not be able to tell you why. All this will seem normal if our bodies are beyond the realm of freedom, if we do not think of health care as a human right.
If we do not speak of a human right to health care, we get the system that we have. Hospitals are owned by entities concerned with profit. Regional monopolies deny patients any reasonable choice. Family doctors go out of business faced with complex private insurance. Physicians in hospitals spend their time on records that have to do with money rather than health. Tens of millions of us lack insurance and nearly half the population avoids medical care for financial reasons. Life expectancy stagnates in America as it rises elsewhere, and women and children die in huge numbers and entirely pointlessly during childbirth. During a pandemic, we are told not to wear masks while they are being exported to China. The whole system failed us.
That is the way things are in America, but that is not the way things have to be, or should be. When we think about rights without including our bodies, we live lives that are shorter, sadder, and less free. We should claim what is ours. A system of universal access, such as that now being discussed in Congress, would fulfill a basic human right in the United States. It would make us much freer as people and as Americans. Soon I will write about that: how a single-payer system would be a step towards making America a land of the free.
Paul Farmer writes often about the commodification of health care, and how commodifying it also leaves the poor, who most need health care, unable to receive it, of being told it isn’t “cost effective” for them to receive it.
My own experiences with “the health care system” are not very positive. I pay a lot for a “health care package” and get it through work, and it is for the most part, not very helpful for me.
I am looking at Medicare because of the possibility I will retire. There are many decisions you have to make and of course Medicare only covers 80%. There is no dental or Eyecare available unless you take Medicare Advantage, but then you are limited to who you can see and deductibles can be high. Regular Medicare allows you to choose who you want to see, but then you are almost obligated have to pick up Supplemental Insurance because Medicare only covers 80% and with the cost of any intervention, paying a deductible and that 20% could bankrupt you quickly if you are on a fixed income. Plus with regular Medicare, there is no dental or Eyecare at all, so if you want it, you have to get a separate Insurance Policy for that.
I think US Healthcare should also be emphasizing wellness as a key policy, and it doesn’t. Let’s face it, medical costs for “Healthcare” as it is now are prohibitive and no policy can keep up with ever escalating costs. Healthcare needs to be changed from a system of commodification to one where those involved in “Healthcare” strive to keep us well. They “accompany” us in our quest for living well. “Accompaniment” is a term Farmers used in his book “To Repair The World” in a chapter called “Accompaniment As Policy”. Accompaniment is a term he said is used in liberation theology which has its roots in Latin America. So what would “Accompaniment” look like? Maybe a health system fir example, that would have more community health workers to help ensure the health of the elderly where they live, or a system that meets people where they work or go to school.
Loved your book. Beyond being a much valued historian, you an incredibly wise man.