Universal Health Care: A Moral Obligation?

By Ronald Pies, MD

As a psychiatric physician for nearly thirty years, I am always surprised when I hear politicians claim that the U.S. health care system is “the best in the world.” To be sure, we are among the most advanced nations when it comes to medical technology, and we are second to none when it comes to the dedication of our doctors, nurses, and allied professionals. But if we examine indices of public health such as infant mortality and preventable deaths, we are far from having the best health care “system.” For example, according to a 2002 study by the Institute of Medicine, 18,000 Americans die every year because they don’t have health insurance. And in a 2008 Commonwealth Fund-supported study comparing “preventable deaths” in nineteen industrialized countries, the United States placed last.

There are social, political, and economic factors that enter into the American health care debate, but the issue is rarely discussed from the standpoint of religious and moral obligations. Perhaps our political leaders are hesitant to bring religious viewpoints to bear on this topic, fearing that they will further polarize the already contentious interest groups involved in the debate. And arguably, religious obligations by themselves cannot be used as the basis for formulating an economically feasible system of health care. Nevertheless, we should be under no illusions: Health care is fundamentally a moral issue — and religion has a good deal to contribute to the discussion.

I wonder if our political leaders are aware, for example, that the three Abrahamic faiths — so often invoked to support “conservative” values — are largely in favor of making health care universally available. Indeed, most Christian, Jewish, and Muslim authorities endorse the proposition that basic health care is a fundamental human right — a principle also endorsed in the 1948 Universal Declaration of Human Rights, adopted by the General Assembly of the United Nations, and signed by 48 countries. I also wonder how many of our political leaders are aware that the United States is a signatory to this declaration.

What do the three Abrahamic faiths have to say on the matter of health care as a basic right? As you would expect, there is a spectrum of opinion, and not all congregations or churches within a given faith explicitly endorse a “right to health care.” Nevertheless, there is a developing consensus that government must play a key role in ensuring that basic health care is both accessible and affordable to all — and particularly, to the elderly, disabled, and minority communities.

For example, Bishop William Murphy of the U. S. Bishops’ Committee on Domestic Justice and Human Development was quoted in a 2009 National Catholic Reporter article as saying that health care reform efforts “must begin with the principle that decent health care is not a privilege, but a right and a requirement to protect the life and dignity of every person.” Indeed, the Catholic Church has been consistent in viewing the provision of health care as a human right. Similarly, while some conservative Christian congregations oppose the role of government in the provision of health care — considering it “not part of God’s plan” — most Protestant denominations support the concept of health care as a human right.

Many Jewish scholars have also endorsed this principle. For example, Rabbi Elliot Dorff, a pre-eminent authority on Jewish medical ethics, wrote in a 2009 Jewish Journal article, “The fact that more than 40 million Americans have no health insurance is, from a Jewish point of view, an intolerable dereliction of society’s moral duty… we are duty-bound to find a way for all American citizens to be able to afford health care.”  And in 1993, the United Synagogue of Conservative Judaism concluded, “Jewish values demand that we work to create a society where no one is denied proper medical care.”

Islam was perhaps the first of the Abrahamic faiths to put these ideals into practice, as far back as Muhammad’s time. Some sources note that the first public hospitals arose in Islamic cultures, and that there was generally a moral imperative to treat all patients regardless of their financial status. Dr. M. H. Al-Khayat pointed out in 2004,  “All human beings, whatever their status or affiliation, were, in the Islamic state, entitled to equal health care, preventive or curative. This is indeed the essence of the goal advocated fourteen centuries later by the World Health Organization.”

In the final analysis, I can’t prove that health care is a basic human right. But the three Abrahamic faiths – which often agree on very little — are largely in accord on this point.  As Dr. Paul Farmer has put it, “I can’t show you how, exactly, health care is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable.”

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Ronald Pies, MD, is Professor of Psychiatry and Lecturer on Bioethics at SUNY Upstate Medical University, Syracuse, New York, and Clinical Professor of Psychiatry at Tufts University School of Medicine in Boston, Massachusetts.

Photo: Detail of Giuseppe Moretti’s 1922 Bronze Hygeia Memorial to World War Medical Personnel, Pittsburgh. By Jim Kuhn [CC-BY-2.0 (www.creativecommons.org/licenses/by/2.0)], via Wikimedia Commons