Health Care – Right or Responsibility?

Eesha Pandit

In Tuesday's presidential debate, John McCain said health care is a matter of personal responsibility, while Barack Obama said it was a right. What does that mean for patients and health consumers?

"Quick discussion: Is health
care in America
a privilege, a right, or a responsibility?"

Posing that question during the second
Presidential debate, NBC’s Tom Brokaw asked the two candidates to reveal their
basic views about health care reform in America.

"I think it’s a
responsibility," responded John McCain. An unsurprising answer from the Senator from Arizona, given that his
approach places the burden on individuals to purchase their own health
insurance coverage in the open market, albeit with the assistance of a proposed
$5,000 tax credit.

He continued, claiming,

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"I think it’s a responsibility, in this respect,
in that we should have available and affordable health care to every American
citizen, to every family member. And with the plan that — that I have, that
will do that. But government mandates I — I’m always a little nervous about.
But it is certainly my responsibility. It is certainly small-business people
and others, and they understand that responsibility. American citizens
understand that. Employers understand that."

Brokaw then turned to Barack Obama, who replied,

"Well, I think it should be
a right for every American. In a country as wealthy as ours, for us to have
people who are going bankrupt because they can’t pay their medical bills — for
my mother to die of cancer at the age of 53 and have to spend the last months
of her life in the hospital room arguing with insurance companies because
they’re saying that this may be a pre-existing condition and they don’t have to
pay her treatment, there’s something fundamentally wrong about that."

Viewers who were participating in
a live CNN debate poll responded with an overwhelmingly positive
response to Obama’s declaration of health as a right. Why?

Today, about 46 million people
are without health care, and tens of millions are woefully under-insured.
Today, people stay in dead-end jobs just so they and their families can retain
health coverage. Today, women are still being denied health care if they’ve got
breast cancer and many others must fight to control their own pregnancies and

In this environment, the
difference between a candidate who says that health care is "a right"
versus one who says that it is "a responsibility" is extremely
significant. McCain’s attempt to tie the Obama health plan to socialism,
in the vein of the "Harry and Louise" attack ads that helped sink health care reform in 1992, isn’t garnering the
support that he hopes. Instead, the Obama campaign is apparently succeeding in communicating that their plan does not turn health care into a government
program, but instead strives to insure that all children are covered and that
all adults get quality, affordable coverage.

Both senators noted the
"fundamental difference" between them on health care. Undecided voters in Ohio, women in
particular, noticed the difference as well and turned their dials toward Obama.

But what does it really mean for
Americans, for patients and health care consumers, if health care is a right?
If it’s a responsibility?

If a responsibility, it could be
a personal responsibility or a political one.

A look back at McCain’s earlier comments suggests that for him, health
care is a matter of personal responsibility. In fact, his campaign has said as
much. Back in April, CNN reported:

policy director, Douglas Holtz-Eakin, told reporters Monday night that as
president, McCain would fund public education programs and use "the bully
pulpit" to encourage health attitudes among children and adults.

He said a major plank of McCain’s health
care plan is simply "a focus on personal responsibility, and the kinds of
things that can help you get better outcomes just by taking care of

Apparently, for McCain, health
care as a "responsibility" means taking care of yourself. And if health care is instead a right? Let’s
look at some examples of well-established rights.

Because we determine that
everyone deserves the right to a fair trial, we ensure that everyone
accused of a crime has access to a lawyer, regardless of whether or not they can
afford one. We hold a national system of public defenders and judges responsible for this.

Because we determine that
everyone has the right to speak their mind, we ensure that there are public places
and spaces for them to do so without threat of harm. We enlist public safety
officials and open spaces like our houses of Congress to foster civic

If health care is also a right,
then our government has a responsibility to ensure that we can
exercise that right — just the same as the right to a fair trial or free speech. In
this way, the right to health care implies a political responsibility, not
simply a personal one.

McCain’s argument that health care is a personal responsibility offers a complicated type of moralism. In his view, good employers should not be required to provide health care to their
employees. They should want to. From
a sense of duty and the kindness in their hearts, they will provide health care to their employees. Government’s role in all this, per
McCain, is to encourage their charity by offering tax incentives.

McCain asserted, "[What] is
at stake here in this health care issue is the fundamental difference between
myself and Senator Obama. As you notice, he starts talking about government. He
starts saying, government will do this and government will do that, and then
government will, and he’ll impose mandates."

To McCain’s accusation, Obama replied, "[The]
reason that it’s a problem to go shopping state by state — you know what
insurance companies will do, they will find a state — maybe Arizona, maybe
another state, where there are no requirements for you to get cancer
screenings, where there are no requirements for you to have to get pre-existing
conditions, and they will all set up shop there."

Then Obama pinned McCain’s
approach to health care onto his approach to the economy, his belief in
deregulation and the increasingly evident myth of the trickle down.

"That’s how in banking it
works," said Obama. "Everybody goes to Delaware, because they’ve got… pretty
loose laws when it comes to things like credit cards. And in that situation…the
protections you have, the consumer protections that you need, you’re not going
to have available to you."

"That," he concluded,
"is a fundamental difference that I have with Senator McCain. He believes
in deregulation in every circumstance. That’s what we’ve been going through for
the last eight years. It hasn’t worked, and we need fundamental change."

If Obama’s belief that health care is a right
wins him increased support from Americans
, especially from swing voters, this
could herald a major shift in American politics. A shift from thinking of health care as personal
responsibility to recognizing it as a right is, indeed, a fundamental change.
The fact that viewers responded so positively to Obama’s assertion that health care should be a right suggest that the country might just be ready for
this change. That is perhaps the most remarkable development of this election.

Women all around
the country tell the group I work with, Raising Women’s Voices for the Health Care We Need, that health care is a right. They say that they need help
in securing this right for themselves and their families. They tell us it is
not a mere matter of insurance policies and coverage concerns. Access to health
care affects their children, their partners, their parents, their ability to
work, to thrive, to take care of their families and themselves. Their very
well-being depends on it. If that doesn’t sound like the basis of a human
right, I don’t know what does.

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