The History of Debates Over the Right to Medical Care in the United States

How the debate has affected public policy and medical practice

Dates of Project: 2002 to 2010

Field of Work: History of the debate over the right to medical treatment in the United States

Problem Synopsis: Unlike citizens of other developed nations, Americans do not have a constitutional or legal right to health care. Yet advocates have established various rights to health care for particular conditions. Despite that history, no one had published research specifically devoted to health care rights and rationing in the United States.

“The history of American health care is a history of rationing, mostly based on ability to pay.”—Beatrix Hoffman, PhD

Synopsis of the Work: Hoffman investigated how medical professionals, patients, government officials, advocates, and the public have talked about a right to medical treatment, and how that debate has affected public policy and medical practice. After receiving an RWJF Investigator Award in 2001, she visited 28 historical archives around the nation, seeking to “find evidence of ordinary Americans’ experiences in the health care system.”

Key Findings and Conclusions: Hoffman published her findings in a book, three articles, and five book chapters. Those findings include:

  • “The history of American health care is the history of unequal access. Every time an expansion occurred, it was accompanied by limitations, especially limitations on treating health care as a right.”
  • The history of American health care is also a history of rationing, mostly based on ability to pay but sometimes based on other criteria.
  • Mandatory emergency room care doesn’t really mean treatment. Patients have to be examined and stabilized. It’s not a universal right to health care.
  • U.S. social movements around health care have tended to focus on single issues or constituencies, such as AIDS or breast cancer, rather than universal access.

“Health care for undocumented immigrants has reflected a tension between sympathy for them and a desire to exclude them.”—Beatrix Hoffman, PhD