The Cultural Moral Right to a Basic Minimum of Accessible Health Care

Paul T. Menzel

ABSTRACT. (1) The conception of a cultural moral right is useful in capturing the
social-moral realities that underlie debate about universal health care. In asserting
such rights, individuals make claims above and beyond their legal rights, but
those claims are based on the society’s existing commitments and moral culture.
In the United States such a right to accessible basic health care is generated by
various empirical social facts, primarily the conjunction of the legal requirement
of access to emergency care with widely held principles about unfair free riding
and just sharing of costs between well and ill. The right can get expressed in social policy through either single-payer or mandated insurance. (2) The same elements that generate this right provide modest assistance in determining its content, the structure and scope of a basic minimum of care. They justify limits on patient cost sharing, require comparative effectiveness, and make cost considerations relevant. They shed light on the status of expensive, marginally life extending, last-chance therapies, as well as life support for PVS patients. They are of less assistance in settling contentious debates about screening for breast and prostate cancer and treatments for infertility and erectile dysfunction, but even there they establish a useful framework for discussion. Scarcity of resources need not be a leading conceptual consideration in discerning a basic minimum. More important are the societal elements that generate the cultural moral right to a basic minimum.
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In the United States, amid the fractious politics of attempting to achieve
something close to universal access to basic health care, two impressions
are likely to feed skepticism about the status of a right to universal
access: the moral principles that underlie any right to universal access may
seem incredibly “ideal,” not well rooted in the society’s actual fabric, and
the necessary practical and political attempts to limit the scope of universally
accessible care to make its achievement realistic may seem marked less
by moral rhyme and reason than by the pull of conflicting interests. I try
to directly dispel the first of these impressions and to obliquely question the second. The immense political barriers to achieving universal access
to basic care should not be underestimated, but the moral landscape in
which reform can work is not unpromising. The essential elements that
imply a moral right to basic care already exist in U.S. culture, and those
same elements give considerable shape to limits on the basic minimum of
care that such a right covers.
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Kennedy Institute of Ethics Journal Vol. 21, No. 1, 79–119 © 2011 by The Johns Hopkins University Press Journal Vol. 21, No. 1, 79–119 © 2011 by The Johns Hopkins University Press



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