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.

Should Health Care Be a Right?

In the Spring of 2019, President Trump promised that a Republican alternative to "Obamacare" would soon be unveiled; the majority leader of the U.S. Senate, Mitch McConnell, quickly informed the president that the prospects of such legislation passing the Democratic-controlled U.S. House were zilch. This virtually guaranteed that health care would be play a salient role in the upcoming 2020 presidential race. The underlying question, I submit, has been whether health care ought to be a right, which the government would be obligated to ensure. Such a right would obviously not be one of those that hold government back (e.g., the right to liberty). Whether a right ensured by government or holding government back, the nature of a right is such that it is to be respected by others, whether individuals, organizations, or the state. Such respect, being an obligation, constrains those others. Hence, health care as a right has been controversial in the U.S. 
The Senior US Senator from Illinois, Dick Durbin, said the following just before one of the votes in December, 2009 on the Affordable Care Act, the health-care insurance reform legislation initiated by President Obama: “Thirty million Americans who currently don’t have health insurance  have the peace of mind of knowing that they have health insurance,” Mr. Durbin said. He added, “This is a real debate over whether or not health care is going to be a right or a privilege in America.”[1] By using the word, privilege, Sen. Durbin was implying that having access to health care on the sole basis of whether a person has money is unfair. 
If being wealthy is a good indication of being worthy of survival, then it may be assumed that health care for all, whether through private, non-profit, or government insurance, would undermine survival of the fittest. This in turn takes fit to mean strong or good. Were the humans in the financial sector before the financial crisis of 2008 strong or good? Does not fraud point to an underlying weakness? When Dick Fuld was CEO of Lehman Brothers before it collapsed, was he a strong leader or a pitiful man whose ambition got the best of him? 
In "survival of the fittest," fit has to do with fitting in with a changed environment. Such fitness, or fit, is on nature's terms rather than necessarily according to our notions of strong and good. For instance, a young drug dealer in a large city may have twelve "baby mamas." This means that the man had impregnated twelve women, who had been attracted to him on some basis that they valued. The sheer number of offspring suggests that the man was successful in reproducing himself; he thus fit well in his environment on this nauralistic basis. If survival of the fittest lies the availability of health care, should that man be covered while a poor religious man who has contributed to society without earning much money or having children should not? 

See also "Congressional Cuts to Foodstamps: Violating a Human Right?"

1. David Herszenhorn and Robert Pear, "Parties Stay United as Health Bill Clears Steps in Senate," The New York Times, December 22, 2009.

A Bit of Federalism in ObamaCare

Senator Ron Wyden has written to government officials of Oregon to encourage them to “come up with innovative solutions that the Federal government has never had the flexibility or will to implement.” This is significant because he is a democrat. As long as a state covers the same number of uninsured and keeps coverage as comprehensive, the following can be waived:

1. the individual mandate to purchase insurance (i.e., what Virginia and Florida are suing over)

2. regulations about business taxes

3. federal standards for minimum benefits

4. allocation of subsidies in the insurance “exchanges.”

These are called section 1332 waivors. There is also some flexibility on medicaid--but how much flexibility do these waivors proffer? The states might be able to determine how the uninsured are to be insured. For instance, they could go single-payer. Or could they?The federal allocation of subsidies in the insurance “exchanges” can be waived, but can the “exchanges”?

There is a trade-off involved in federal standards and state waivors. If the federal standard is too high (e.g., the number of uninsured covered and the amount of minimum coverage), then not much freedom is involved in the waivors because the standards must be met regardless. Given the diversity within the Union and our system of federalism, the US Government should have been oriented to coming up with minimum standards for health-care rather than trying to make it a federal responsibility. By minimum, I mean that below which is unacceptable for a state in this union. For instance, it could be that universal health-care is a minimum if health care is to be considered an American right. The states, rather than the general government, would then be required to pass laws to implement the minimum standard in any way they preferred. They could determine the means, whether single-payer or exchanges. I’m not sure that the existing waivors, which do not begin until 2017, allow for such flexibility as would accommodate the various political ideologies of our states. Once power is grasped, it is very difficult indeed to let go of some of it.

Source: Wyden Defects on ObamaCare, WSJ, September 3, 2010, p. A16.

Contradictory Comments on Health Insurance as Unethical: The Case of Newt Gingrich

Newt Gingrich said on May 15, 2011 that people should be required to buy health-insurance. He added that he would like to see the mandate implemented at the state rather than the federal level. These comments unleashed a torrent of criticism from Republicans, so the former Speaker of the U.S. House of Representatives spent the following week “walking” his comments back by denying that he had said that he was for a mandate.  The media was in a feeding frenzy, astounded that the former Speaker could simply deny that he might get away with the contradiction. However, in such cases, is it the person or logical contradiction itself that gets us so steamed?

Although we tend to point to the person who has made a contradiction without acknowledging it, ascribing possible sordid motives, it could be that the logical contradiction itself lies at the source of the angst in the beholder. More specifically, the logical contradiction itself may be in its substance an uncomfortable emotion rather than reason. In other words, violating logic may be an emotion that appears in the form of twisted reason.

Otherwise, it would be a case of reason causing an emotion. For example, “You logically contradicted yourself and that makes me mad” is typically taken as something of reason causing a particular emotion. It is difficult to link reason and emotion because we take them to be different things. It is a bit like Descartes’ mind-body problem.  Were logical contradiction itself an emotion, however, then to say that a contradiction caused anger might be easier to explain as one emotion would be giving rise to another—both being of the same type of thing (i.e., emotion).

Going even further, the observation that logical contraction is an emotion distinct from the anger may be an illusion.  Because the anger comes so quickly and naturally, it could be that what we take as the anger is simply part of the complex emotion of experiencing a logical contradiction. Similarly, when a person says that he feels confused, a cognitive condition is really an emotion because it is felt. Like confusion, experiencing logical contradiction does not feel good.

In general terms, talking about logical contradiction as an emotion of disapprobation reconciles Kant’s first formulation of his categorical imperative to Hume’s psychological theory of morality.  To Kant, moral principles are universal because of the role of universality and necessity in reason, so maxims that involve a logical contradiction if they are universalized cannot be moral. To Hume, moral judgment just is the sentiment of disapprobation.

Typically, Kant’s ethical theory is viewed as rationalist, whereas Hume’s is portrayed as psychological. However, if logical contradiction is itself an emotion having the form of reason, then it could be said that the moral sentiment of disapprobation applies to the uncomfortable emotion that the experience of logical contradiction. Reason turned against itself only seems to be cognitive rather than emotion. If what we have in a logical contradiction is essentially an emotion (or even an emotional reaction), then Kant’s rationalism and Hume’s sentimentalism are no longer antipodal. To say that logical contradiction is unethical is to say that it gives a rational and emotional being a sentiment of disapprobation. Logical contradiction itself naturally gives us a bad feeling; indeed, the contradiction may simply be a way of labeling a particular emotion.

So when we say that Newt Gingrich should not have contradicted himself (or he should own up to having contradicted himself), the basis of our moral judgment could be the emotion that we feel when we are confronted with a logical contradiction—the contradiction being that sentiment of disapprobation.

See related essay: "A Health-Insurance Mandate Consistent with Federalism."

Sources:

Kant’s Groundwork of Metaphysics and his Critique of Practical Reason.  See also David Hume’s Treatise of Human Nature.

Naftali Bendavid and Jonathan Weisman, “Medicare Revamp Exposes Divisions Within the GOP,” The Wall Street Journal, May 17, 2011, p. A6.

Happiness: A Matter of Prosperity or Economic Security?

A macro-economist would probably assume that the percentage of people rating their lives positively enough to be considered thriving is positively correlated with real GDP per capita. Yet evidence suggests that this is not the case. The key to happiness, I submit, is having the sense of foundational economic security—that come what may, even in the case of rich people, you won’t fall through the cracks. It is difficult to thrive over a continuous, subterranean (i.e., subtle) anxiety, whereas a sense of security, such as most children feel while still living in their childhood homes, is a sturdy foundation on which a sense of thriving can grow and survive. I think most people, particularly Americans, take this point for granted, and thus are all too willing to make staples like housing, food, and health care conditional on having money.

In Britain during the two years leading up to the referendum to secede from the E.U., Gallup found that the percentage of people who were happy in the sense of having the sense of thriving fell 15 percent.[1] Meanwhile, GDP per capita (PPP) in current international dollars increased from $38,873 to $41,499.[2] Egypt, likewise, went from 29 percent “happiness” in 2005 to 8 percent in 2012, while GDP per capita increased from $8,123 to $11,210. Clearly, something other than the level of prosperity is behind changes in happiness as a sense of thriving.

That Norway (7.537), Denmark (7.522) and Iceland (7.504) led the pack among countries in terms of happiness as thriving in 2017, with the Netherlands coming in sixth and Sweden tenth may suggest that having an economic safety-net may be important. The United States stood at only 6.993, and the safety nets in those states are partial. To be sure, the state of France in the E.U. came in even lower, at 6.442, and Italy at 5.964, so we cannot conclude that the stronger safety nets in the E.U. necessarily translate into more happiness. However, even within the E.U. Denmark and the Netherlands were known for their well-fortified socio-economic infrastructures, whereas in the U.S. only Massachusetts and California were known to have relatively encompassing social policies in comparison with the other American states. Unfortunately, Gallup lumped all of the American states together while distinguishing the European states, so we cannot tease out differences within the U.S. 

Even so, the high marks of Denmark, Norway, and the Netherlands suggest that having a solid social-welfare safety net for the most vulnerable in matters of food, housing, and medical care is at the very least consistent with a broad sense of happiness in the sense of not merely surviving, but thriving in life. With less of the existential, conditional angst, people rich or poor can feel more stability upon which they can step out onto striving, venturing, into the unknown, with paradoxically a higher chance of sustainable self-sufficiency.

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1. Jon Clifton, “The Happiest and Unhappiest Countries in the World,” The World Post, March 20, 2017.

2. Source: The IMF

Business CEO’s Overstating Political Uncertainty in the United States

The impact on business of political uncertainty in countries that are seized by revolution can be substantial—so much so in fact that CEO’s and board directors are motivated to avoid the uncertainty itself. I submit that business analysts of political risk tend unwittingly to routinely overstate the uncertainty arising from incoming U.S. presidential administrations. If I am correct in this claim, CEO’s and board directors pay too much heed to political uncertainty itself in the making of major strategic decisions involving operations in the American context.

Although American culture welcomes and even encourages leaps in technological development capable of transforming daily life, another sort of change—one more subject to societal control—is tolerated only if made incrementally. Otherwise, the change is dubbed as radical, which is a charge made more out of fear than according to any objective measure. Clutching at the status quo unduly translates politically into the tyranny of the status quo as powers both in business and government that profit as things are hold back all but incremental change that does not threaten the current basis of benefits. The many points of access into the federal legislative and executive machinery enable the stultifying influence a virtual veto over proposals of serious, or “real,” change. Such change tends to be pulled back until only the tolerated incremental change remains.

A few examples reveal the pattern. In 1986, amid large budget deficits caused in part by the tax cuts of the early 80’s, Ronald Reagan pushed for a wholesale change in the federal income tax, ridding it of its myriad of deductions. Yet as the U.S. Senate debated the tax code, individual senators came forward with rationales for all of the major deductions. The “powers that be” were exercising their prerogatives to continue their respective benefits, which Reagan’s vision for change would put at risk. Business practitioners anxiously pointing to the political uncertainty of a revised tax code were in retrospect overreacting, and thus putting too much emphasis on the uncertainty itself.

In 2008, Barak Obama campaigned under the slogan of “real change.” After his election, political risk analysts were doubtlessly impressed with the sheer uncertainty latent in the very notion of real change. Yet when Congress was considering the Affordable Care Act, Obama dropped his proposal for a public option, which would be useful should private insurers leave the planned exchanges. The president gave into pressure from the insurance industry lobby, the members of which stood to lose benefits should Obama’s healthcare plan instantiate real change even just in terms of there being a public health-insurance option. The resulting law was incremental because the private health-insurance companies were still to be relied on. The anticipated uncertainty regarding the American health insurance system turned out to be much less. The analyses of CEO’s making strategic decisions based in part on avoiding the American context due to the uncertainty would have been distorted, and thus not optimal.

In 2016, when Donald Trump was elected president, the uncertainty in terms of political risk must have been palpable in corporate boardrooms. Trump’s proposal of a substantial tax, or tariff, on American companies that take advantage of lower labor-cost countries and import the resulting products back into the large U.S. domestic market undoubtedly stocked the uncertainty without much thinking-through of how political compromise could take its toll on the proposal as it moves through Congress. Similarly, fears of trade wars resulting from the proposed tariff may have been overblown. That American companies would be subject to the penalty means that foreign companies manufacturing outside of the U.S. and importing into the large domestic market would have a competitive advantage. Pressure from Chinese companies could mitigate the likelihood of a Chinese-stoked trade war even though the pulling out of American companies (i.e., the loss of some manufacturing plants) would have a detrimental impact on the Chinese economy. Of course, such a scenario assumes that the actual tariff is enough to motivate American CEO’s to return their manufacturing to America; the political compromise that may be needed to pass such a tariff might reduce it to an insufficient level and thus effectively discredit the very idea of using public policy to alter the financial calculus of American companies such that they have a financial incentive to return voluntarily in line with maximizing profit.

The American preference for incremental over systemic change puts any genuinely new political proposal at risk of being shrunk to fit through the contours of the status quo, which is so dear to the vested interests. The uncertainty typically thought to exist in the advent of a new presidential administration tends to be overblown in retrospect. The American economy suffers from this bloated condition to the extent that CEO’s and corporate board directors move operations away from the geographically delimited hyper-uncertainty.

Does the Affordable Care Act: Healthcare as a Human Right?

Did the Americans who were in favor of passage of the Affordable Care Act in 2010 believe that access to healthcare is a human right? Did the Americans who opposed “Obamacare” reject that assumption and thus favor treating health insurance as a commodity? We can look at political and economic indications to reach an answer.

According to a report by the U.S. Department of Health and Human Services, based in turn on Gallup survey data from early March 2015, 16.4 million people had gained health-insurance coverage since the Affordable Care Act went into effect. The figure includes people who signed up for Medicaid under the law. “When it comes to the key metrics of affordability, access and quality, the evidence shows that the Affordable Care Act is working, and families, businesses and taxpayers are better off as a result,” said Sylvia Mathews, the Health and Human Services Secretary at the time of the report.[1]  That the uninsured rate had fallen to 13% from 20% at the beginning of open-enrollment in October 2013 supports the secretary’s conclusion. 

The strongest gains were from the states whose governments expanded Medicaid. “Those states had an average baseline uninsured rate of 18% in early March, compared with 23% for those that didn’t.”[2] This suggests that an upturn in the economy did not account for all of the change. The overall increase is large enough that the upswing in the economy is not likely to be the sole cause, according to Rachel Garfield, a researcher at the Kaiser Family Foundation.[3]

Furthermore, the difference between the two zones of states (to borrow a catchy term from Europe) points to an ideological condition wherein Americans as a whole were not convinced that access to medical care is a human right, and thus a responsibility of government. Modern federalism, wherein the member-states and federal institutions both have a share of governmental sovereignty, accommodates “being on the fence” concerning whether a benefit is properly a commodity or human right.  To the extent that the benefit is available regardless of state, that extent of being insured from the federal government can be treated as a human right, whereas the amount of benefit left up to the states indicates the extent to which Americans do not consider health-care to be a human right.

Admittedly, a federal base-level combined with various amounts of contribution from member-states does not necessarily mean that “We the People” are on the fence on whether a benefit is a human right. A person could be in favor of more state authority because of an excess at the federal level, for instance, while firmly believing that the benefit at hand is a human right. Clearly, other measures are needed in the assessment.

Another indication of the extent to which Americans as a whole consider health-care to be a human right is how close the percentage of uninsured is to zero. The uninsured rate of 13% for adult Americans and illegal immigrants in March 2015 tells us that health-care was not viewed as a full or established human right. Were access to medical care definitively regarded by “We the People” as a human right and the elected representatives representative of their constituents as a whole, the Federal Government would see to it that every American or even every resident of the U.S. has access to healthcare. This does not necessarily imply a single-payer system, though reliance on private insurance companies without subsidies for every poor person would be insufficient.

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[1] Stephanie Armour, “Rate of Uninsured Falls Sharply Under Health Law, Report Says,” The Wall Street Journal, March 17, 2015.

[2] Ibid.

[3] Ibid.

An Ebola Vaccine: A Lesson for Obamacare

With the Ebola virus confined to impoverished states in Africa until 2014, drug companies had little financial incentive to develop a vaccine. “A profit-driven industry does not invest in products for markets that cannot pay,” Margaret Chan, the director general of the World Health Organization, said in late 2014.[1] At the time, at least 13,567 people were known to have contracted the virus in the outbreak, with nearly 5,000 people dead. It cannot be said that the profit-motive in a market economy is efficient in this case.

As a few cases made their way to the U.S. and E.U. in the Fall of 2014, elected officials quickly felt the fear among their respective constituents. As a result, the U.S. sent troops to West Africa to help contain the illness. In short, money began entering the equation in significant amounts as soon as the people in developed countries perceived themselves as being at risk. Doubtless public funds went to drug companies for expedited research toward a viable vaccine. The arrow here goes from governments to private companies in the marketplace, rather than coming out of the “efficient market hypothesis.” In other words, relying on private companies and the market mechanism, moreover, may be suboptimal in the field of medicine.

The implication for the Affordable Care Act, or “Obamacare,” is that the president erred in caving into the health-insurers lobbyist on including a public option. Relying on private insurance companies may be suboptimal, though admittedly they are not drug companies. Even so, if the market mechanism itself is deficient in the case of a vaccine, then perhaps the healthcare industry, including health insurance, ought to rely chiefly on government rather than the private sector.

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1.Rick Gladstone, “Ebola Cure Delayed by Drug Industry’s Drive for Profit, W.H.O. Leader Says,” The New York Times, November 3, 2014.