Tuesday, December 10, 2013


By Ronald Fox

I’ve had countless arguments with conservatives opponents of the Affordable Care Act (i.e., Obamacare). I’ve done so even though I’m not a big fan of the Act. It is extremely complex, key provisions are vague, which will probably lead to inconsistent and arbitrary enforcement, and, worst of all, it contains no public option, making it unlikely escalating healthcare costs can be controlled. These legitimate concerns, however, are rarely topics of discussion among the conservative ACA critics I’ve encountered.

Almost without exception, I’ve found these people to be uninformed, misinformed, and downright duplicitous debaters. It’s the same old ideologically dogmatic, hyper-partisan story: ignore facts and accept as truth only what conforms to one’s ideological beliefs and prejudices. I don’t think, however, that disagreement over facts lies at the heart of the current Obamacare divide; rather, the bitter divide seems to me to follow from differing philosophies about whether health is a basic human right and whether public authorities have an obligation to ensure realization of this right.

Most Americans believe, at least in theory, in the universality of negative political and civil rights (so-called “freedom from” rights), meaning that no public authority can interfere with the private person in civil society, but many draw the line when it comes to positive socioeconomic rights (“freedom to” rights), which obligate public authorities to ensure such things as minimal food, shelter, and healthcare. Most conservatives I’ve talked to or heard pronounce on the subject categorically reject the notion that health is a positive human right obligating states to strive to secure its realization. They tend to see good health as a private privilege earned by healthy living, hard work, and personal financial responsibility, a belief they similarly apply to other socioeconomic issues. Accordingly they pay scant, if any, attention to the rich body of international law that affirms the right to health. If I mention such law, the usual response is to express contempt for international economic, social or cultural law as hopeless, even harmful, idealism. Few want to see our sovereignty or the primacy of American national law subjected to some external mandate, even when the intent seems good.

According to international law, every woman, man, youth and child has the human right to the highest attainable standard of physical and mental health, without discrimination of any kind. Enjoyment of this right is vital to all aspects of a person's life and well-being and is crucial to the realization of many other fundamental human rights and freedoms.  This basic right is guaranteed in: the Universal Declaration of Human Rights (UDHR), Article 25; International Covenant on Economic, Social and Cultural Rights (ICESCR), Articles 7, 12, 14, and it’s 2000 General Comment No. 14 (The U.S. signed, but has not ratified the ICESCR); International Convention on the Elimination of All Forms of Racial Discrimination (CERD), Article 5;  Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Articles 11, 12, 14; Convention on the Rights of the Child (CRC), Articles 3, 17, 23, 24 (U.S. signed but has not ratified); Convention on the Rights of Persons with Disabilities, Article 25; and, the International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families, Articles 28, 43, 70.  All of these declarations, treaties and covenants have received the requisite number of country ratifications to come into force.

In addition to the above, The World Health Organization (WHO) Constitution reaffirms that “the enjoyment of the highest available standard of health is one of the fundamental rights of every human being.” Commitments to the right to health were also made at the Earth Summit in Rio, International Conference on Population and Development in Cairo, World Summit for Social Development in Copenhagen, and the Habitat II Conference in Istanbul.

This extensive body of international law leaves little doubt that there is widespread global recognition of the human right to health, even though there are many differing interpretations about what it means and takes to be healthy. What these laws articulate is a set of freedoms and entitlements about the delivery of healthcare services which take into consideration an individual’s biological and social conditions as well as the available resources of a state. While right-to-health principles are not legally binding, they do carry a moral power based on expectations in the global community. I share the belief that access to appropriate, affordable and quality healthcare, information and services, without discrimination, is a basic human right. This view is not exclusive to “those on the left;”  in fact it is near universally accepted throughout the world, though unfortunately far from universally realized. The principle enjoys wide partisan consensus in Europe and Canada. Even European conservatives embraced it long ago.

Without a doubt, a large number of Americans are out of the global mainstream on the principle of the human right to health. Americans who do believe in health as a human right probably want to see Obamacare succeed in improving wellness and extending healthcare to all Americans, though I’m sure many would have preferred a single-payer system or a version that included a workable public option. Those who don’t believe in the principle of health as a human right likely want the ACA to fail and many will do whatever it takes to help make sure it does. While they may claim to base their opposition on worries about individual cost, violation of freedom of choice, the potential for rationed care, long lines, harm to businesses, online issues, or the latest falsehood emerging from Fox News or right-wing talk radio, the bottom line, it seems to me, is that they simply do not believe the United States, the wealthiest country in the world, has a moral obligation to try to ensure a healthy America. This is a shameful state of affairs.


  1. My wife and I have 4 surgeries between us this year. Thank god (LBJ) for Medicare. Single payer is the only reasonable option. Expand Medicare for everyone. It already has the bureaucracy, the standards and the contracts. Let the insurance corporations insure cars, houses, lives, and whatever else they can think up.

  2. I would like to think that cost alone would be enough to convince the republicans our current system of health care is not cost effective. We spend 17% of our GDP on health care while other "western" countries spend around 6 to 7% on health care and everyone is covered. The ideology, the anti government fever, and the big money in the insurance industry are feeding the conservative agenda. Yes it is shameful!

  3. True, the current health care "system" has resulted in continually soaring costs, but those folks in the medical-pharmaceutical complex (to somewhat borrow a phrase) have become quite rich, thank-you. They are not about to let their golden egg-laying goose to be butchered. And they have the bucks and warped message to succeed in convincing folks to oppose the "socialist,European-style" ACA, even though such opposition is against their own self-interest. This is nothing new: Reagan was a master at selling his voodoo supply-side, trickle-down economics to folks who would never benefit(although he used different bugaboos). If people really acted in terms of their true, enlightened self-interest we would have had national health care long ago.

  4. Dr.Paul Gottlieb MD,FRCS,FACSMarch 3, 2014 at 10:44 AM

    Americans are under the illusion that we we have the finest health care system in the world. Aside from the fact that we are the only western nation without some form of universal health care, nothing could be farther from the truth. Depending upon which system you use ,we rank fron 14th to 35th.
    Lack of physicians in poorer areas and obesity are said to be part of this. How about 45 million uncovered Americans ?
    Our incidence our infant mortality is 14th which is disgraceful .
    Certainly is have the means ,excellent health care is available but that doesn't apply to the greater population who are exposed to and often suffer from crippling medical debt.
    Americans don't understand the difference between universal health care, socialized medicine and national health care.
    The AHCA is a step in the right direction but not the right answer. We need a one payor system of some kind.
    Americans typically talk about any of the above three systems of health care delivery in a perjorative way. They are " socialist", a dirty word.
    Americans have the right to health care . This should not place a crushing burden on so many.
    Medical tourism now accounts for 10% of care! (people going elsewhere for top rate but significantly cheaper care)
    Our emergency rooms should not be used as primary health care centers by those without without coverage ,as the cost is prohibitive.
    We need to wake up and join the rest of the Western world and provide affordable health care to all citizens, it is our right not our priviledge.
    Dr.Paul Gottlieb MD,FRCS,FACS

  5. I wish the right-wing opponents would at least be able to see their own self-interest on this topic, even if they don’t care about universal human rights. To view “good health as a private privilege” in the way they view their other socioeconomic privileges is terribly short-sighted. Many very serious public health crises and disease vectors do not respect gated communities or first-class tickets.


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