When most Americans think of the rights and principles that our country was founded on, we refer to the ideals of freedom, prosperity, and the pursuit of happiness written in the Declaration of Independence. However, have our political institutions evolved from this 18th century premise? When we look around the world, especially at European countries post WWII, they built political institutions with a modern social democracy of human rights, such as the 1978 Alma Ata Declaration that declared a right to health. Every country was signatory except the U.S. and Somalia. Or, the UN 1994 Universal Declaration of Rights, which protects health, education, food security, etc.. A FoxNews Contributor recently said this document did not afford health as a human right, which is wrong. In 2020, the debate on healthcare reform has centered on costs and who should have access, but not a fundamental question of why our democracy has not evolved into a modern social contract to protect the health and wellbeing of its people.

Michael Moore’s Sicko compares US healthcare to others across the world.

This May marked the 13th anniversary of Michael Moore’s documentary, Sicko, which depicts the healthcare and pharmaceutical industry in the U.S. and compares its dismal outcomes to Canada, the United Kingdom, and even some low-income countries. In it, Moore says that the U.S. is the only country in the Western World that does not believe that healthcare is a human right. Today, we are not just the only country in the Western world, but many developing nations, such as India and Trinidad and Tobago are implementing universal health coverage (UHC) plans. While the infrastructure of India’s healthcare system currently functions differently from the U.K., with government commitment to this human right, who knows where they will be in 20 years time. 

And this is really the crux of the argument, while politicians and lobbyists debate over costs and logistics, very few have publicly acknowledged that health is a human right and one that has been re-affirmed in various international treaties and declarations, such as Goal 3 of the UN 2030 Sustainable Development Goals, the 2018 Declaration of Astana, 1994 Universal Declaration of Rights, and the 1978 Almá Atá Declaration that identified universal primary healthcare to obtain Health for All. If we cannot acknowledge that health is a right then what does this say about our democracy and institutions to protect the social contract?

Ideals of Democracy

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Many of us have learned in school that as the founding nation for democracy, we pioneered modern political institutions to promote the ideals of freedom, prosperity, and the pursuit of happiness. However, in terms of civic education, our concept of democracy begins and ends in the 18th century, but other countries have evolved their democratic institutions or created new ones. In 1942, in Great Britain, a coalition government issued the Beveridge Report, which aimed to provide a comprehensive social insurance program from “cradle to grave”. This includes the country’s National Health Service (NHS) founded in 1948. This created the concept of a “social citizenship” in Great Britain, where economic and social rights are included.

After the Great Depression in the 1930’s, the U.S. did make some changes, such as the right to a pension with the passage of the social security act and to form labor unions, but this did not go as far as Europe. Therefore, the lack of economic and social protections is revealing itself in this current COVID-19 pandemic where, so far, more than 40 million jobs have been lost. Consequently, because healthcare has been viewed as a privilege for the “deserving” and because most Americans’ access to healthcare is through their employer, for millions of them, that lifeline has been cut. 

In a twist of irony, this means that many will have to enroll into a Medicaid plan for coverage, as the costs of purchasing a private plan will be out of reach. So the pandemic may actually bring us closer to Universal Health Care, as mentioned in Lindorff’s article above, he points out that times of economic crisis could bring reforms to build a stronger safety net. 

“This is one of the ways that the public health crisis threatens to balloon the economic crisis: by pushing more families into poverty via healthcare debt.”

In the middle of pandemic, where herd immunity seems less likely without a safe and effective vaccine, hundreds of thousands of Americans will spend weeks in a hospital. Their families will worry about a five or six figure bill in an economy where many are not working and will not return to work anytime soon. This is one of the ways that the public health crisis threatens to balloon the economic crisis: by pushing more families into poverty via healthcare debt. This is a real failure of the American democratic institutions, as it will reverse any gains in development made since WWII. Thus, many of us realize that the ability to go see a doctor, especially during an emergency, should not be left for the “deserving” – it is a basic social and economic protection to not have to choose between paying a doctor’s bill and putting food on the table. In the 21st century, America should modernize its principles of citizenship and democracy to include health as a fundamental right.


Sabine Franklin

Sabine Franklin earned her Ph.D. from the School of Organisations, Economy and Society at the University of Westminster. Her thesis examines the local governance of the 2014 Ebola Epidemic in a comparative case study of Sierra Leone and Liberia. She has an interest in international development, global health governance, and qualitative fieldwork methods. Her area of expertise is to use evidence-based research to inform policy. Her work is also in Africa SpectrumSAGE Research Methods CasesRevistas Brasileira de Estudos Políticos, and Springer’s upcoming Encyclopedia of the UN Sustainable Development Goals, vol. 16: Peace, Justice and Strong Institutions.