Skip to main content

The health capability paradigm and the right to health care in the United States

Theoretical Medicine and Bioethics volume 37, pages 275–292 (2016)Cite this article

Abstract

Against a backdrop of non-ideal political and legal conditions, this article examines the health capability paradigm and how its principles can help determine what aspects of health care might legitimately constitute positive health care rights—and if indeed human rights are even the best approach to equitable health care provision. This article addresses the long American preoccupation with negative rights rather than positive rights in health care. Positive health care rights are an exception to the overall moral range and general thrust of U.S. legal doctrine. Some positive rights to health care have arisen from U.S. Constitutional Eighth Amendment cases and federal and state laws like Medicare, Medicaid, the State Children’s Health Insurance Program, the Emergency Medical Treatment and Active Labor Act, and the Patient Protection and Affordable Care Act. Finally, this article discusses some of the difficulties inherent in implementing a positive right to health care in the U.S.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Estelle v. Gamble, 429 U.S. 97 (1976).

  2. Griswold v. Connecticut, 381 U.S. 479 (1965).

  3. General Statutes of Connecticut §§ 53–32 (1958 rev.).

  4. Roe v. Wade, 410 U.S. 113 (1973).

  5. Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 851 (1992).

  6. Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261 (1990).

  7. Maher v. Roe, 432 U.S. 464, 469 (1997).

  8. Harris v. McRae, 448 U.S. 297, 317-318 (1980).

  9. Youngberg v. Romeo, 457 U.S. 307, 317 (1982).

  10. Brown v. Plata, 131 S. Ct. 1910, 1928 (2011).

  11. Gregg v. Georgia, 428 U.S. 153 (1976).

  12. Ruger, Theodore W. 2012. Of icebergs and glaciers: the submerged constitution of American health care. Law and Contemporary Problems 75: 233.

    Google Scholar 

  13. Wilmington General Hospital v. Manlove, 174 A. 2d 135, 139 (1961).

  14. Guerrero v. Cooper Queen Hospital, 537 P. 2d 1329 (1975).

  15. U.S. Department of Health and Human Services. 2010. State operations manual: appendix V—interpretive guidelines—responsibilities of Medicare participating hospitals in emergency cases. CMS Manual System, Pub. 100-07 State Operations, Transmittal 60. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R60SOMA.pdf. Accessed September 18, 2014.

  16. Annas, George J. 2003. The right to health and the nevirapine case in South Africa. New England Journal of Medicine 348: 750–754.

    Article  Google Scholar 

  17. Ruger, Jennifer P. 2009. Health and social justice. Oxford, UK: Oxford University Press.

    Book  Google Scholar 

  18. Ruger, Jennifer P. 2006. Toward a theory of a right to health: capability and incompletely theorized agreements. Yale Journal of Law & the Humanities 18: 273–326.

    Google Scholar 

  19. Hunt, Paul, and Joo-Young Lee. 2011. Deepening the human rights connections. Journal of Human Development and Capabilities 12: 577–586.

    Article  Google Scholar 

  20. Ruger, Jennifer P. 2011. Reply. Journal of Human Development and Capabilities 12: 599–605.

    Article  Google Scholar 

  21. Rawls, John. 1971. A theory of justice. Cambridge, MA: Harvard University Press.

    Google Scholar 

  22. Daniels, Norman. 1985. Just health care. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  23. Tilley, Larry P., Francis W.K. Smith, and Dana Allen. 2000. Stedman’s medical dictionary, 27th ed. Baltimore: Lippincott Williams & Wilkins.

    Google Scholar 

  24. Walzer, Michael. 1983. Spheres of justice: A defense of pluralism and equality. Basic Books, Inc.

  25. The Experts in Chronic Myeloid Leukemia. 2013. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood 121: 4439–4442.

    Article  Google Scholar 

  26. Scanlon, Thomas. 1975. Preference and urgency. Journal of Philosophy 72: 668.

    Article  Google Scholar 

  27. Ruger, Theodore W. 2011. Plural constitutionalism and the pathologies of American health care. Yale Law Journal 120: 347–365.

    Google Scholar 

  28. Gottlieb, Daniel J., Weiping Zhou, Yunjie Song, Kathryn Gilman Andrews, Jonathan S. Skinner, and Jason M. Sutherland. 2010. Prices don’t drive regional Medicare spending variations. Health Affairs 29: 537–543.

    Article  Google Scholar 

  29. Fisher, Elliot S., Julie P. Bynum, and Jonathan S. Skinner. 2009. Slowing the growth of health care costs: lessons from regional variation. New England Journal of Medicine 360: 849–852.

    Article  Google Scholar 

  30. Ruger, Jennifer P. 2012. Fair enough? Inviting inequities in state health benefits. New England Journal of Medicine 366: 681–683.

    Article  Google Scholar 

  31. Centers for Medicare and Medicaid Services. n.d. State Medicaid & CHIP profiles. http://www.medicaid.gov/medicaid-chip-program-information/by-state/by-state.html. Accessed May 28, 2015.

  32. Young, Katherine, Robin Rudowitz, Saman Rouhani, and Rachel Garfield. 2015. Medicaid per enrollee spending: variation across states. The Kaiser Commission on Medicaid and the Uninsured. http://files.kff.org/attachment/issue-brief-medicaid-per-enrollee-spending-variation-across-states-2. Accessed May 28, 2015.

  33. Annas, George G., Theodore W. Ruger, and Jennifer Prah Ruger. 2014. Money, sex and religion: the Supreme Court’s ACA sequel. New England Journal of Medicine 371: 862–866.

    Article  Google Scholar 

  34. Burwell v. Hobby Lobby Stores, Inc., 134 S. Ct. 2751 (2014).

  35. Ruger, Jennifer P., Theodore W. Ruger, and George G. Annas. 2015. The elusive right to health care under U.S. Law. New England Journal of Medicine 372: 2558–2563.

    Article  Google Scholar 

Download references

Acknowledgment

I would like to thank Daniel Sulmasy and Daniel Brudney for their extremely insightful and effective suggestions and participants (James Nickel, Gopal Sreenivasan, Matthew Liao, Sarah Conly, David Reidy, John Tasioulas and Varun Gauri) in the University of Chicago’s Neubauer Collegium for Culture and Society and Pozen Family Center for Human Rights symposium, “Is Health Care a Human Right?” for very helpful comments. I also thank Daniel Kim and Betsy Rogers for editing assistance, Michael DiStefano and Joshua Jordan for research assistance, and the Greenwall Foundation for grant funding.

Author information

Affiliations

  1. Perelman School of Medicine and School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, USA

    Jennifer Prah Ruger

Authors
  1. Jennifer Prah Ruger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer Prah Ruger.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ruger, J.P. The health capability paradigm and the right to health care in the United States. Theor Med Bioeth 37, 275–292 (2016). https://doi.org/10.1007/s11017-016-9371-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11017-016-9371-y

Keywords

  • Right to health
  • Health capability
  • Shared health governance
  • Affordable Care Act
  • Health capability paradigm