By Dennis Wesley
HEALTHCARE in the US is unanimously regarded as a fundamental human right. Yet, we’ve not been able to guarantee healthcare to everyone.
The coronavirus pandemic has further rattled a healthcare system that many rightly believe was already in the throes of crisis.
Despite sustained debates and legislation, we’re still far from any consensus regarding the means to ensuring timely access to healthcare for all. The ongoing pandemic has shed light on the inequalities and precarities that constitute healthcare experience for large sections of Americans.
In fact, the pandemic has shown us the shortcomings of the conceptual vocabulary underpinning the “human rights” narrative, at least as far as healthcare is concerned.
Rights versus Entitlements
For a while now, philosopher Martha Nussbaum and economist Amartya Sen have argued that we need to reconfigure how we think about essential services such as healthcare, education, and sanitation.
They propose we think of these services in terms of “fundamental entitlements.”
In other words, their proposed term not only reinforces the inalienability of our right to healthcare, education, dignity, among others, but also puts the onus squarely on the state to ensure the delivery of fundamental entitlements.
That is, the state does not grant us our rights; it exists instead to protect our rights and liberties, which we are entitled to.
At this juncture, it is important to note that placing the onus on the state is not to absolve the private sector of its duties to the general public. Indeed, in today’s neoliberal world, regulating the private sector to ensure the pursuit of social justice is one of the main roles of the state.
Yet, “regulation” remains that all-divisive word: for those who want the private sector to think and act more in terms of the public good, it is a means to ensure accountability; simultaneously, sections of the private sector do cry foul at the very mention of the word and claim that they’re victims of excessive, unnecessary, and unimaginative regulation.
In effect, regulation either means holding the private sector accountable or undue interference. This irreconcilability has adversely affected actual healthcare as well as the public discourse surrounding healthcare. We will revisit this in detail shortly.
Returning to Nussbaum and Sen’s fundamental entitlements framework, it’s worth noting that it addresses more than healthcare.
It focuses on the various aspects of political economy and their interplay with private freedoms. Central to their argument is the notion that individuals should be free to decide what constitutes a dignified life, and to do so they must be entitled to fundamental necessities. Without access to fundamental necessities, the pursuit of dignity is difficult for individuals.
What are these fundamental entitlements?
A full list of these entitlements as identified by Nussbaum can be found here (she calls them “The Central Human Capabilities”).
Additionally, Nussbaum and Sen argue that we cannot avoid taking measures to ensure the materialization of these entitlements by saying that people seem satisfied without them. In fact, they use the term “adaptive preferences” to connote how people tend to settle for the status quo, even though it might not be in their best interest to do so.
Nonetheless, experts and the public alike have been urging the American government to rethink and reform healthcare.
Nussbaum in particular argues that we should think of social justice as a normative category.
That is, her list attempts the bold task of identifying and describing essential aspects constitutive of social justice, which is tricky because justice is not a black-and-white category. Nonetheless, this approach is novel because it serves as a guideline for the pursuit of social justice in its various forms.
It has the potential to guide the public and private sectors, and it also enables the general public to demand better from the public-private partnership.
This also means that the absence or endangerment of these entitlements (or even the absence of active measures to ensure the materialization of these entitlements) would represent a severe threat to our pursuit of social justice.
In a free market economy, however, what a state can do to ensure people receive their fundamental entitlements depends significantly on its relationship with the private sector.
In the particular context of healthcare, the free market logic incentivizes private healthcare providers to chase profit. Which makes private healthcare inaccessible to a large number of people in the US. In fact, private healthcare is so expensive that it drives many into debt.
This is not just true of the US but also of many other countries with segmented healthcare, especially developing countries.
Expensive private healthcare has resulted in the emergence of medical tourism, a rather dubious phenomenon. This phenomenon, more than any other, represents the failure of the neoliberal healthcare model.
Even the ability to pay may not be enough to ensure access to healthcare in America.
American healthcare was already in crisis. Even prior to the pandemic, Americans delayed medical treatment on account of high healthcare costs. Unsurprisingly, delayed medical treatment is a significant cause of avoidable deaths. The pandemic has only magnified the effects of this unmitigated humanitarian and public health crisis.
Dennis Wesley is an independent educational researcher. His interests include interdisciplinary practices and methods. He mainly writes about mental health, academia, and sustainability. You can follow his personal blog and Twitter here and here respectively.
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