I want to clear up a misunderstanding often voiced in the healthcare blog universe: namely, whether health care is a right or a service. Our answer to this question will affect how we approach healthcare reform in the next Congress, so let me say plainly: health care is a civil right.

Civil rights are what we call those claims necessary to secure free and equal citizenship, secondary to basic rights. For example, we don’t have a right to vote for any natural reason; we have the right to vote because society is ordered in a way that makes voting both possible and essential to our free and full participation in society. Voting is a civil right.

Health care is a civil right because society is ordered in such a way as to make it both possible and essential to the free and full participation of the sick, injured and disabled — i.e. ‘patients’ — in society. I’m a patient, and I can tell you: lack of health care makes it impossible for me to participate freely and fully in society. Among the reasons …

• I can’t choose my work. Because health care is tied to employment, and not all jobs have benefits, I can’t do things that might be socially useful or personally satisfying but lack benefits. I can never start a business, for example, because I wouldn’t have health insurance.
• I can’t buy the things I need. Patients are denied the free purchase of goods and services by restrictions on the healthcare market: FDA regulations, prescription requirements, doctor licensing, insurance rules. These restrictions help make health care safer and more effective, but they also sharply curb supply of medical goods and increase their price, which is paid disproportionately by patients.
• I can’t participate fully in the political process. I rarely volunteer in my community — dealing with my healthcare takes up most of my free time. I can’t give money to causes or candidates I support, because I don’t have any to spare. Moreover, a sick person is less likely to risk losing employer-provided insurance by organizing a union, whistle-blowing against fraud, or reporting discrimination in the workplace.

None of these exclusions is intrinsic to illness, but due instead to the structure of our society. And each reason is more compelling to the extent illness and injury are produced by pollution, toxic products, and other societal causes. A patient’s basic right to justice requires us to respond to the likelihood that we — as a society — had something to do with their illness.

One of the counter-claims made against this line of reasoning is that nobody is entitled to claim a health provider’s labor as a right. But there are many other professions which are subject to civil rights claims: teachers, firefighters, lawyers, to name a few. Moreover, physicians and other providers are able to do their job effectively in large part due to public investment in research and technology.

Unfortunately, the Affordable Care Act did not go far enough to guarantee patients right to health care. Access to insurance is not the same as access to care, as any patient will tell you. The ACA was a small step in the right direction, but we still need legislation recognizing patients’ right to health care. Whatever the outcome of the election, health care must be acknowledged as a civil right.

Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.