Monday, February 25, 2008

Health Care as a Right in Oregon

Everyone interested in medical ethics and health policy should thank Oregon. In the 1980s-1990s Oregon brought rationing out of the closet as a question calling for open debate. Now it has outed the question of whether we should think of health care as a right.

Representative Mitch Greenlick, chair of the House Health Care Committee, and former director of the Kaiser Permanente Center for Health Research, is champion for House Joint Resolution 100, which proposes adding a section to the Oregon Bill of Rights:

"The people of Oregon find that health care is an essential safeguard to human life and dignity and that access to health care is a fundamental right. In order to implement that right, the Legislative Assembly shall establish by law a plan for a system designed to provide to every legal resident of the state access to effective and affordable health care on a regular basis."

On February 14 the House voted 31-29 – on strict party lines – in favor of the amendment. If the Senate approves, which is expected to happen, the amendment will go onto the state ballot in November. Let’s hope that happens. The debate will be educative, and progress in health system ethics requires societal learning more than anything else.

Oregon Catalyst, a web site for conservative Oregonians, threw down the gauntlet on health care as a right two years ago:

"There is No ‘Right’ to Healthcare – Period!

...the exercise of a right does not require anything from anyone else other than from the person exercising them. This is because a right exists independently, by nature. They are not granted by the Constitution. They are not granted by the government. Your next-door neighbor does not grant them.

Rights are natural, inherent, something you are born with. No one can give them to you, which means that a right cannot require someone else give something to someone.

Healthcare may be a need along with the infinite other needs of humans like food, water, or shelter. But, Health care is not a right because someone else has to provide it...

Even if I am hungry and need food, I can’t just take it from my neighbors. I do not have a right to their food just because I have a need. If I take it, that is called stealing.

If I put a gun to a doctor’s head and force him to treat my ingrown toenail that is also theft. (As well as assault with a deadly weapon.) I may have needed treatment, but I do not have a right to that treatment because it requires someone else's time or treasure.

Government should protect rights. Charity should provide for the needs of those that are unable to provide them for themselves. Requiring charity under threat of force is theft, just like holding that gun to the head of a doctor. We should encourage charity, not force it upon people through laws and taxation.

I expect that this strongly stated libertarian view of rights as inhering solely in the individual against outside powers will resonate strongly with the electorate. But after asserting that there are indeed "Natural rights inherent in people," the Oregon Bill of Rights gives an additional, more communitarian, way of thinking about rights:

"We declare that all men, when they form a social compact are equal in right: that all power is inherent in the people, and all free governments are founded on their authority, and instituted for their peace, safety, and happiness; and they have at all times a right to alter, reform, or abolish the government in such manner as they may think proper."

As I understand the Oregon debate, Greenlick and his allies are arguing that in a society as affluent as the US is, we should commit ourselves, through our government, to protect "peace, safety, and happiness" by ensuring access to decent health care for all, just as we commit ourselves to providing a basic level of education to all. From this perspective, the commitment creates the right, not vice versa.

Even though the Oregon Health Plan has come onto hard times, its creation advanced public understanding of the connection between setting limits and providing access. If HR 100 gets onto the November ballot, we can hope for a comparably educative debate.

Hat's off to Oregon!

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