The collapse of the seven-year Republican campaign to repeal the Affordable Care Act (ACA) was caused in large part because a majority of the American public has come to view a government guarantee of universal access to healthcare as an entitlement that cannot be taken away.
The effect is to bolster American support for the principle that healthcare is a human right, a norm accepted by most countries and especially by other advanced democracies, but long ignored in mainstream American political discourse despite its origins in the work of a US President and First Lady.
That healthcare is a human right is in fact a basic principle of international human rights law that emanates from the ideas of Franklin & Eleanor Roosevelt. In his 1944 State of the Union Address, President Roosevelt called for an Economic Bill of Rights, including “the right to adequate medical care and the opportunity to achieve and enjoy good health.”
The 1948 United Nations’ Universal Declaration of Human Rights, drafted under the leadership of Eleanor Roosevelt, drew on FDR’s ideas to include rights to medical care and security in the event of sickness, and codifying these principles into a binding international treaty, the 1966 International Covenant on Economic, Social and Cultural Rights established “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”
164 countries have become state parties to the Covenant. The United States has not ratified the Covenant, but having signed it must at least not act to defeat the Covenant’s purposes.
The US has ratified another important human rights treaty, the International Convention on the Elimination of All Forms of Racial Discrimination, which requires that it guarantee the right of everyone to public health and medical care without discrimination.
The Obama Administration never urged domestic support for the ACA based on these human rights principles, so broadly accepted around the world. However, defending the human rights record of the US in its quadrennial Universal Periodic Review before the UN Human Rights Council in 2010, the US cited the ACA for making “great strides toward the goal that all Americans have access to quality, affordable health care.”
It’s notable that the Obama Administration was willing to make an argument for external consumption it likely thought impolitic to make domestically.
As economic rights are to be progressively realized, retrogressive measures such as repeal of the ACA are presumed to be impermissible. Accordingly, on February 2 the UN Special Rapporteur on the right to health, Lithuanian doctor Dainius Puras, wrote to the State Department warning that repeal of core provisions of the ACA may violate US obligations under international human rights law.
Polling data clearly shows that the American public has moved towards viewing healthcare as a human right. Both Pew Research and Gallup report that a majority of Americans believe the federal government has a responsibility to make sure all Americans have healthcare coverage.
Moreover, the debate over Republican plans to reduce coverage extended by the ACA has only increased those majorities and support for the ACA itself. Retrogressive measures are apparently as disfavored by the public as they are in international law.
The principle that healthcare is a human right should be explicitly reaffirmed, and no longer marginalized in domestic political discourse. A rights-based approach elevates universal coverage from a debatable policy goal to one entitled to permanent and stable support by all political parties.
The universal coverage enjoyed by virtually every other advanced democracy rests not merely on political or policy choices, but on the recognition of healthcare as a human right.
The US introduced this principle into international law through the work of Franklin & Eleanor Roosevelt, and the debate over ACA repeal has taught us to embrace it once again.
Lawrence Moss is Distinguished Lecturer and Rita E. Hauser Director of the Human Rights Program at the Roosevelt House Public Policy Institute at Hunter College.