The United States is unique because of the complex, sometimes hidden, and frequently unintended ways it rations care. The United States is also unique among affluent nations because it does not officially recognize a right to health care. Apart from the right to assistance in an emergency room (which has existed only since 1986, and even then only requires that patients be stabilized), Americans have no legal or constitutional right to medical care. Many other nations include a right to health care in their legal or constitutional documents, and virtually all affluent democracies other than the United States provide universal health coverage as a matter of right to their citizens. The scope and definitions of these rights to health care differ, and countries have created many different kinds of health care systems to help enforce them, but what they all have in common is that rights to access and / or coverage are universal, applying to all citizens of the country. The few rights in the US health care system—such as the right to emergency treatment and the rights of senior citizens and veterans to health coverage—apply only to particular groups of the population or to particular types of care. These selective, limited health care rights are another way that coverage and services are rationed in the United States, although we seldom talk about it this way.
Despite the lack of universal health care rights in the United States, the argument that health care should be a right is a powerful one in a country where "inalienable rights" are central to citizenship and national identity. Presidents from Franklin D. Roosevelt to Barack Obama have declared health care to be a right, not just a privilege. Opinion polls for several decades have shown broad public agreement with the statement that access to health care is or should be a right.
This book tells the story of rights and rationing in the development of the American health care system since 1930. Since the United States recognizes few rights in the health care system, while refusing to recognize that rationing takes place at all, this is a challenging task. To uncover the history of rationing, the following chapters focus on the parallel themes of access to health care and the denial of health care. They tell the story of how Americans have sought access to medical services since the 1930s and how the system grew dramatically with the goal of bringing the benefits of modern medicine within reach of everyone. At the same time, the denial of access, and the refusal to make the benefits of health care available equally, have also defined the system. The history of access and denial is the history of the American way of rationing, and of a health care system whose impressive benefits are available to some, but not all.
The clash between the ideal of access for all and the reality of the denial of health care also helps uncover the history of health care rights in the United States. "The reason why there is a fuss over rights to health care is because so many are left out," writes the medical ethicist Larry Churchill.
Excerpted from Excerpted from Health Care for Some: Rights and Rationing in the United States since 1930, by Beatrix Hoffman, with permission from the University of Chicago Press. Copyright © Beatrix Hoffman, 2012.