Is the US health care system a right or a privilege? Which should it be?
In the United States, people have drastically different opinions as to whether health care should be a right or a privilege, particularly around and since the passing of the Affordable Care Act (Obamacare). While no one can make someone agree with them, it is important to know about the two different major beliefs, and why people hold them.
1) Health care is a right: Those who believe health care is a right believe it is morally unjust that a person's ability to live a healthy and full life should be restricted by their income. Those who believe health care is a right argue that, while it is normal for rich people to have more than poor people, this should not be the case when it comes to basic necessities for existence. It is unethical and unjust for poor people to suffer just because they cannot afford health insurance. They argue providing health care for all is a part of the social contract all Americans participate in, just as much as providing roads or schools. We do not prevent the poor from driving on our roads or using fire and police services; it is not right that we have historically kept them from health care using the "free market" as an excuse.
Proponents of this position also point out that the vast majority of developed, first-world nations provide universal health care. The US is one of the very few developed nations that does not. In fact, countries that are otherwise known for having very poor human rights, such as Cuba and Saudi Arabia, still offer universal health care.
2) Health care is a privilege: Proponents of this position feel that because health care is not included in the Bill of Rights or any part of the Constitution, it cannot be counted as an American right. In the US, health care is typically linked to employment, and this group feels health care is something you should get if you either contribute to society through work or if you are so disabled or young that you absolutely cannot work (even then, some feel children/ the elderly/ people with disabilities should be covered by means other than taxpayer-funded health care). This group argues that we do not fund many things through taxes, and that health care should remain one of them; it is a personal expenditure. In other words, it is part of the individual's contract with the free market, rather than a broader societal contract.
People who hold this position often contend that the American free market has driven us to have better health care than countries with universal insurance. They cite long wait times in countries with socialized medicine and claim that better doctors are available in the US because our approach allows us to pay doctors more. It is, however, important to note that the US can also be very uneven in service delivery, and there are areas or specialties in the US that also offer long wait times or poorer care.
The question of whether health care is a right for all or a privilege conferred to some is the core issue that defines the organizing principle of a nation's healthcare system. If health care is a right for all, then the health care system should provide universal access to care regardless of individuals' ability to pay. Moreover, if health care is a right for all, disparities and inequities in the distribution of health care benefits should be minimized. On the other hand, if health care is a privilege, then access to health care should be restricted to those who have earned it or paid for it, either directly or indirectly. The view that health care is a privilege can accommodate the idea that some people who are unable to pay for health care might still be able to access care if they are deemed to deserve access. For example, children, the disabled, and some 'deserving' poor people may be granted some level of access and health care benefits. However, these individuals do not receive health care because they have a right to it, but rather because those in power have decided that they deserve some level of benefit.
In most of the developed world, national health care systems reflect the view that health care is a right for all. These systems provide universal access to care. Although the Affordable Care Act of 2010 expanded access to health care and increased the number of Americans with health care coverage, the US healthcare system still remains firmly in the camp of those who view health care as a privilege. Not everyone has access to health care. Health inequities and health disparities often divide and distinguish those who do have access to care. As the recent delays in authorizing the Children's Health Insurance Program (CHIP) funding have demonstrated, not even individuals who have traditionally been viewed as deserving of care have a right to care in the US system.