Is Healthcare a Human Right?

Humanity still has not come to a consensus on what are entailed specifically within the rubric of human rights. Even in terms of those specifics that have come to be generally held to be human rights, such as in designated war crimes and crimes against humanity by international agreement, the lack of de jure and de facto enforcement render such agreement nugatory in practice. As a result, calls for human rights are in effect calls for warring to stop. The enforcement that goes along with laws legislated by governments render any consensus on what constitutes human rights more substantive in practice. This is undercut, however, in empire-scale polities of polities, such as the E.U. and U.S., to the extent that human rights are carved out at the federal level to applied across differing cultures. Such ideological diversity between the American member-states has triggered drastically-different notions of just what are included as human rights to be played out in Congress. The debate over the government-financed health-insurance program for the poor in 2025 illustrates such a lack of consensus, which in turn suggests that the member-states should play more of a role in how or even whether to provide free insurance to the poor. Sometimes, one size doesn’t fit all. In short, the matter of federalism is very relevant up front, before matters of the proper role of government itself and of human rights are decided. In other words, the qualitative and quantitative differences between a union of states and a state are very relevant up front, lest states eventually peel off in utter frustration with a one-size-fits-all approach to policy-making to fit an empire composed of member-states.

As the U.S. Senate considered changes to the Medicaid program, Republican Sen. Josh Hawley acknowledged “that the main cost-saving provision in the bill—new work requirements on able-bodied adults who receive health care through the Medicaid program—would cause millions of people to lose their coverage. All told, estimates are 10.9 million fewer people would have health coverage under the bill’s proposed changes to Medicaid and the Affordable Care Act.”[1] Millions would be relegated to not getting medical attention or going to the emergency rooms of hospitals mandated to treat the uninsured, who would be strapped with unaffordable medical bills and thus bad credit-reports.

That a significant number of poor people in the United States would lose health-insurance was known and anticipated by the legislators. Speaking on the bill as it was taking shape in the U.S. Senate, Sen. Hawley said, “I know that will reduce the number of people on Medicaid.”[2] What, then, justifies the loss of health coverage? The senator answered this question by adding, “But I’m for that because I want people who are able bodied but not working to work.”[3] In other words, being able to have access to medical services should be conditional on having a job. The conditionality itself means that health care is not a human right because such rights are inherently unconditional.

Some or even many of Sen. Hawley’s constituents doubtless favored excluding medical services from being included among other human rights, perhaps in the belief that people who are able to work but refuse to work do not deserve to be kept alive if they fall sick, which in turn can be based on a belief that only the strong of any species should survive. Sen. Hawley represents Missouri, when is generally conservative. Sen. Warren of Massachusetts, on the other hand, would find that the conditionality and thus the exclusion of medical care from human rights much less popular in her member-state. Such a wide divide by state on this question would be unlikely in the E.U., even between the states of Hungary or Poland and Sweden or the Netherlands. The European notion of subsidiarity would thus be more applicable in this case to the U.S. than the E.U., given the greater diversity of ideology on the question in the United States. In other words, federalizing universal healthcare would come with less ideological tensions between E.U. citizens in different states than between U.S. citizens in different states; there was more consensus within the empire-scale European Union than within the American bloc.

The imposition of work requirements as a condition for the poor having access to medical treatments may be just fine with most people in Texas and Utah, for example, and yet be very objectionable to most people in Vermont and Connecticut. To conflate these various member-states as being ideologically and culturally homogenous is suboptimal and comes with political costs as opposition pressure is likely to result where the federal policy is unpopular; more optimal politically would be transferring the program of Medicaid to the member-states so their respective peoples could tailor the program—or even cancel it—according to their respective political ideologies. The notion that policy in another state should reflect one’s own views is anathema to federalism, and even to there being empire-scale unions of states. Toleration within a union is thus necessary lest one size be applied throughout and eventually republics break off in frustration, as Britain did from the European Union due primarily to anti-federalist sentiment.

In short, finding a large gap from consensus in Congress (or in the E.U.’s legislature) can be an indication that a policy question would be better resolved by the member-states than at the empire-level, given the heterogeneity between states on the question. Congress and the federal president applying work requirements on what most people in some states regard as an unconditional human right may be intolerable emotionally to those people, but so too, Obamacare had been viewed as an intolerable overreach of government to most people in some other states. Behind this chasm, ideological and thus as emotional as cognitive, lies a basic disagreement on just what should constitute human rights, and thus be an obligation of government. In other words, besides different political philosophies of the proper role of government, different moral principles are involved on the question of whether government should pay for healthcare for the poor. In a federal system, the matter of where such a divisive policy question should be decided should be decided before both the proper-role-of-government and the human-rights questions are decided, or else the federal system itself would be compromised and thus put at risk.

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1. Leah Askarinam, “The GOP’s Big Bill Would Bring Changes to Medicaid for Millions,” Apnews.com, June 15, 2025.
2. Ibid.
3. Ibid.

The Affordable Care Act Running Up Against Federalism

In late 2010, Republicans were quick to declare that "ObamaCare was already on life-support in the wake of federal district court Judge Henry E. Hudson's ruling in Virginia that the Affordable Care Act’s (ACA) requirement to buy health insurance is unconstitutional. But in truth Virginia’s attorney general, Ken Cuccinelli, won only a partial victory. He sought to have the entire law overturned, but instead only the section creating an individual mandate was. This is perplexing to me, as the law contains a clause indicating that if any part is deemed to be unconstitutional, the entire act would fall. Clearly, the health insurance industry didn't want to be forced to pay out without being guaranteed the expanded customer base by the U.S. Government.  

According to Newsweek, "Judge Hudson was very explicit in his ruling that only the mandate that individuals have coverage and 'directly-dependent provisions which make specific reference' to it will be affected. Technically, this means virtually nothing but the mandate is eliminated. But as a practical matter, the requirements placed on insurance companies to make coverage more generous and available to everyone are economically dependent on the mandate. To keep the rest of the bill in place without the mandate would provoke the wrath of the insurance companies’ powerful lobby and set premiums on an upward-spiraling trajectory. On the upside, Medicaid would still be expanded so the millions of poor who are without health insurance will be insured."[1]  In my comparably small and insignificant view, this is the major significance in the entire law.

To Europeans much more so than Americans, generally speaking, healthcare is viewed as a right even for the poor as a matter of human rights. Lest the rich poo poo this right because theirs is secure, I can only shake my head in utter disgust; in a civilized society, even a person incapable of working has the right to survive. Not wanting to pay for this right when one enjoys other advantages of living in a society (e.g., police protecting one's property) is sheer selfishness.  I take the right to survival to be the kernel worth saving in Obamacare even if scrooges poo poo's the plight of their less fortunate fellow citizens while ignoring their own self-centeredness. Hudson also declined to prevent the law’s implementation while the courts sort out the constitutional question. The ACA has been upheld as constitutional by two district courts. According to Newsweek, "Hudson’s decision actually guarantees only one thing: that the constitutionality of the individual mandate will ultimately be decided by the Supreme Court. Legal experts are unclear which way the high court will go

The question of whether the mandate is constitutional hinges on whether it falls within the federal government's enumerated power to regulate commerce. In particular, the question is whether inactivity can be regulated. Failure to buy insurance is inactivity.  Is a decision to buy or not to buy to be counted as an activity?  Or is requiring Americans to carry health insurance a way of regulating how they pay for something that every American will use (i.e., health-care)?  It seems to me that this question has been overly simplied, whereas the past "logic" used by the U.S. Supreme Court to ok expansions in the commerce clause is notoriously invalid even as it has been generally accepted in American society.

Historically, the U.S. Supreme Court has not resisted ever deepening and broadening encroachments by the national legislature and executive on the States by means of the enumerated power of regulating interstate commerce.  In 1942, for example, the court held in Wickard v. Filburn—the most relevant precedent for this case—that a farmer growing wheat for his own chickens, above a maximum of growth allowed per acre at the time, was subject to federal regulation under the commerce clause because the resulting extent to which a farmer does not buy wheat to feed his chickens on the market affects the national market price of wheat. "This goes a step further than Wickard because it’s the omission of action that’s being defined as the interstate act," says Jonathan Turley, a constitutional law instructor at George Washington University. Critics of the mandate say that if you start defining choices not to buy things as actions that affect interstate commerce then there is no limit on what Congress can make you buy. In my view, the action/inaction distinction is not vital to whether the power of the U.S. Government is potentially unlimited under the commerce clause; <em>Wickard </em>itself evinces the potential unlimitedness in the power; even growing wheat for one's own use can be deemed as interstate commerce even though the wheat never even crosses the road.  It is the tenuous multiple links of inference that dwarfs even the action/inaction distinction. The legalese in the inferences has already supported Congress in using the interstate commerce clause to reach a variety of objects (Morrison and Lopez being the two exceptions, but even they allow for indirect effects to the commerce). As another example involving what one grows and consumes on one's property, in 2005 in Gonzales, the court held that the commerce clause entitles the federal government to outlaw California residents from growing marijuana for personal medicinal use. Of course, the government's purpose here was not to regulate commerce; the policy was against illegal drugs being used. This is precisely how the commerce clause can be stretched to cover virtually anything.

If the court throws out the health mandate, it might be just as well as the State governments really should be the ones to address health-care for the uninsured, given our system of federalism. If the mandate is declared to be unconstitutional, I would advise the justices to do it in a way that also exterpates the inferences of legalese that have for more than one hundred years enabled the federal government to encroach on the States--effectively ending the check on government that is afforded by federalism. In other words, the court could use the case as a means of setting definitive limits on the enumerated powers.  Otherwise, Congress will return to the clause for yet another encroachment using linkages--simply sidestepping regulating inaction. The case can occasion a wake-up call concerning the consolidation of governmental power at the center at the expense of the innate diversity that exists in an empire-scale polity. I doubt very much that the court will sound the alarm--seeing the forest through the trees--even if the mandate is declared to be unconstitutional. We simply are not good at looking at things in terms of the big picture; it is no accident that most members of Congress are lawyers.

1. Ben Adler, "Will the Supreme Court Rule on Health-care Reform?" Newsweek, December 15, 2010.