The midterm elections are over, and health care was a major issue. “Medicare for all” was an oft-heard slogan. And why not? In this wealthy society millions of citizens live without health insurance, even with the gains made by the Affordable Care Act (“Obamacare”).
There exists in America a long standing argument regarding universalizing health care. Arguments about health care begin as a rights argument. Do I as an American have a fundamental right to a baseline of health care just as I have a right to freedom of speech? Does the state have an obligation to provide health care for me?
To a great extent, America has provided a partial answer in favor of the rights argument.
Since 1965, Medicare has provided universal health care for Americans over 65. The Veterans Administration provides health care for our veterans. Medicaid covers the indigent, though the rules under which this service is delivered varies by state and thus is complicated. Nevertheless, it is the case that America has declared that the elderly, veterans, and the poor have a right to health care.
Yet significant forces in America oppose universal health care. The primary argument begins with the assumption that health care is not a right, which translates into the claim that I bear no obligation to the person whose circumstances prevent him health care insurance. I ought not be forced to pay taxes for my neighbor’s health care.
That’s the nub of the problem. Either citizens possess this right, or they do not. Everything else, of which there is an enormously great deal, is commentary.
Israel has had a universal health care system since its birth; every Israeli is covered by this system and membership in it is compulsory. Called kupat holim (fund for the sick), it was revised and vastly improved in 1995 when Yitzhak Rabin was prime minister. Israel’s national insurance health law is remarkably comprehensive, including such items as mental health care, elective surgery and highly subsidized medication. (https://en.wikipedia.org/wiki/Healthcare_in_Israel). Over the years there have been many complaints and jokes about kupat holim, but no calls for its abolition, as Israel considers health care to be a fundamental right. Since the revision in 1995, the system has become the source of great satisfaction; kupat holim is rated highly among the world’s health care systems.
America is the only Western country without a universal health care system. Anyone who has lived in a country in which every citizen is covered by has observed what it’s like to live where everyone is guaranteed a minimum baseline of coverage without paying a huge bill upon leaving the emergency room, the hospital, the doctor’s office. America is the only Western country in which a powerful group does not believe health care to be a fundamental right.
There is a wonderfully provocative and oft-cited story found in two places in rabbinic literature that sheds light on this issue.
The story goes that two men find themselves in the middle of a desert with one canteen of water between them. One of the two men owns the canteen of water. The other man has no water. There is insufficient water to share and ensure the survival of both. If they share the water, both will die.
What should these individuals do? If the man who possesses the canteen arrogates to himself the right to the water, he’ll survive, but he’ll witness the death of the other man. If they share the water, both will die.
Two philosophical questions arise.
- On what basis do we share our resources? What do we owe the other in our society, the ones without the water? If both share the water, the problem stipulates, neither will But the corollary to this is that, if the owner of the canteen retains possession, he creates the tragedy of watching his companion die.
- This leads to the second question: Can one human life be valued above another? If I own the canteen, does that mean I have the right to arrogate the water to myself, or, am I obligated to take a risk because the person who stands before me is my societal equal? Am I obligated to pay the “tax” of sharing the water and risking my death as well as my companion’s? The problem leads to political questions of human equality, risk and sharing. What does society as a whole owe its citizens, all of its citizens?
The position of those who oppose universal health care is analogous to the canteen owner who does not share the water. Resources are not distributed equally in society, and I ought not be compelled to re-distribute them to the benefit of those who do not have them. Do we have the obligation to re-distribute resources for the sake of those who lack basic resources?
A society that’s made a commitment to universalizing health care is a society that believes the resources of that society must be re-distributed for the benefit of every citizen of that nation—at least to provide a baseline of coverage for all its citizens. This is so even if in the re-distribution some members of society have to surrender a portion of their resources. This is a society that has decided, above all, that health care is a right.
America has been struggling with that very principle for decades now. Irrespective of complexity and all the complications that accompany universalizing health care, do we join the community of nations and acknowledge health care as a right; or, do we continue to assert one set of problems or another as reasons why we cannot assure every citizen what most of us, in one way or another, take for granted?
So what’s different about America? This is because considerable resistance to the idea from Republicans has interfered with two attempts to convert our current system to a universal one. Under President Bill Clinton, Hillary Clinton drew up a single payer plan which was defeated. The ACA under President Obama might have created a system covering everyone, but was limited by a thousand Republican cuts.
Republicans object to a universal health care system in America for two reasons. The first reason has to do with traditional conservative objections to centralized governmental
But this midterm election health care was front and center, and will be of concern when Congress reconvenes in January. Whether we move toward a more universal system is anybody’s guess. The discussions that informed the midterm elections will likely dominate our public discourse moving forward. Perhaps this is the time when we make a commitment to affirm health care as a basic right of Americans.