Ascension Healthcare is a non-profit, Catholic health insurer. Its definition of "Healthcare Ethics" succinctly states an answer to the question, "Is there a right to health care?"

From the perspective of Catholic moral teaching, the "right to health care" for all is not an optional stance. Rather, the right to health care is a human right founded on human dignity and the common good. Considered as such, health care is more than a commodity in so far as it is an essential safeguard of human life and dignity that ought to be provided for and to everyone. This absolute right to health care, however, should not be understood as an unlimited entitlement, but as a right that carries with it corresponding duties regarding justice, stewardship and the common good.

According to this stance, there is a right to health care that aims to preserve human life and dignity. I understand this statement as saying that there is also a duty of patients to cooperate with their health care, which answers Mile Hi Mama's concerns about noncompliance.

Years ago, I read a newspaper story about the undue feeling of entitlement shared by many Americans. The author wrote about a woman she had met who was being treated for infertility. She felt the health care establishment should do whatever it took for her to get pregnant, because that is what she needed to be happy, and the Declaration of Independence gives Americans the right to happiness.

Of course, there is no right to happiness in this world. The Declaration of Independence asserts a right to pursuit of happiness. And theologically, complete happiness is a privilege bought with Christ's blood and available only after death.

Similarly, a right to health care should not be confused with a right to health at all costs, as the Vatican's Pontifical Academy for Life pointed out three years ago. There cannot be a right to health at all costs because such a right would be at times contrary to the rights of others and to the common good. For example, a person needing a kidney transplant does not have a right to the kidney of a healthy person; it must be freely donated.

I am adopting Ascension Health's statement as my position on the right to health care. It is balanced by considerations of stewardship over available resources and the common good, and it makes good use of Catholic moral reasoning.

Do you agree with Ascension Health's statement? If not, what do you think is wrong with it?

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Comments in the Right to Health Care series have repeatedly gravitated toward the question of what constitutes "basic" health care. I have not addressed that topic yet because it has not been established that there is any right to "basic" health care at all. But a lot of people think it is important to talk about it, so here are my thoughts.

I would consider a minimum standard of health care, in our affluent and technologically advanced society, to include the following:

• All vaccinations recommended by the various professional organizations, such as the American Medical Association.
• All screening tests recommended by professional organizations, such as cancer screenings as recommended by the American Cancer Society.
• An annual physical, or perhaps biannual for young, healthy adults.
  
• Full prenatal care as well as labor and delivery services.
• Well-baby and well-child exams.
• Treatment of chronic diseases such as diabetes and cancer.
• Surgery to save life, limb, or quality of life.
  

I also consider doctor visits for illness or injury as well as emergency services to be "basic" health care, but would support some way to keep these services from being abused, such as a reasonable copay. Likewise with mental health services.

"Basic" health care, in my opinion, does not include:

• Purely cosmetic procedures, such as removal of moles that are not pre-cancerous.
• Experimental treatments.
  

I would love to know what readers think. What is should be included with "basic" health care and what should be excluded?




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In the post on health care in prisons, MileHiMama asked, "[D]oes ... the government [have] to provide healthcare, or simply ensure unencumbered access to it?"

What constitutes an encumbrance to health care? EMTALA removes the encumbrance of pre-qualification based on ability to pay, but only in emergencies. Most doctors' practices are not affected by EMTALA because they do not provide emergency care.

Medicaid covers people below a certain income bracket. Medicaid recipients have access to routine and preventative care, but people above this income bracket have no guarantee of receiving such care, unless they have health insurance.

Some of these uninsured cannot afford to pay cash for routine care. I see three options for those people: borrow the money, poach from another part of the budget (such as food or transportation), or go without routine care. Do these people have unencumbered access to non-emergency care?




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The U.S. Congress passed the Emergency Medical Treatment and Active Labor Act, section 1867(a) of the Social Security Act, in 1986. It requires three things of hospitals:

• imposes an affirmative obligation on the part of the hospital to provide a medical screening examination to determine whether an "emergency medical condition" exists;
  
• imposes restrictions on transfers of persons who exhibit an "emergency medical condition" or are in active labor, which restrictions may or may not be limited to transfers made for economic reasons;
  
• imposes an affirmative duty to institute treatment if an "emergency medical condition" does exist.

--EMTALA.com FAQ

Particularly notable is the lack of a provision for reimbursement of the hospital. If the patient is not covered by private insurance or Medicaid/Medicare, and cannot pay the bill, the hospital must eat the loss. One way hospitals may offset the loss is by increasing charges for paying patients. Since Medicaid/Medicare has fixed reimbursement rates, and most private insurance also has fixed rates set by contract, that means the uninsured who are able to pay out-of-pocket often subsidize the uninsured who aren't.

Outside the emergency room and EMTALA, medical emergencies are handled by public safety agencies. When a person calls for an ambulance for a medical emergency, states generally require emergency medical personnel to respond, regardless of whether there is an ability to pay.

The principle underlying both EMTALA and the state-imposed duty for EMS to respond is that everyone has a right to be treated in case of emergency. It seems that American society is comfortable with this principle. Do you agree that there is a right to receive emergency medical treatment regardless of ability to pay? If so, who should pay?






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American society already recognizes certain privileges to health care. Considering these would make a good start to a discussion of whether there is a right to universal health care (UHC).

Health care in prisons and jails

Jail inmates who suffer medical emergencies are entitled to receive care, and prisoners also receive basic medical care for chronic conditions while in custody. In some cases, the health care offered by prisons is considered to be quite good. When prisons fail to provide adequate care, the federal government may step in to make sure it is available, as it did in California in 2005; there may also be lawsuits, such as those beleaguering the contractor Prison Health.

There has been some discussion of charging inmates for care they receive while in custody, but no serious programs that do so (to the best of my knowledge). Since inmates are by and large indigent (being unable to work for an income outside the prison), charging them for services seems rather nonsensical.

Arguments for providing care to inmates include the obvious, that their incarceration makes it impossible for them to seek care themselves, as well as the practical, that providing care helps prevent outbreaks of disease. But do they have a right to it?




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The question of a "right" to health care has obsessed my mind for the last several months. Unlike most ideas, which tend to pop in and out, this one has stuck with me, which means I should address it here.

First consideration: Why has this particular question stuck with me? Because, I think, it is the crux of the matter of whether and how universal health care (UHC) should be made available. If there is no "right" to health care, then it is much more difficult for supporters to argue that UHC is in the best interests of the U.S.

Thus I am starting a series on health care rights. If you have an opinion, yea or nay, on UHC, share it in a comment or e-mail me (address in my profile, linked to in the sidebar) if you are interested in a guest post.

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