Article by Senior Editor Liam Sweeney
INTRODUCTION
Healthcare in the United States stands at the intersection of moral principle, constitutional design, and economic necessity. Despite being the wealthiest nation in the world and devoting nearly 18% of its gross domestic product to healthcare[i], the United States remains the only high-income democracy that fails to guarantee universal access to care. ill Tens of millions of Americans remain uninsured, millions more are underinsured, and even those with coverage face high out-of-pocket costs and systemic inequities. ill The result is a healthcare system that delivers worse outcomes at higher costs than its global peers.
At its philosophical foundation, healthcare is a positive human right grounded in human dignity and equal citizenship. [iv] Historically, the American patients’ rights movement linked healthcare to civil rights and economic justice, asserting universal access as a baseline entitlement.[v] Yet the United States legal system has oscillated between recognizing healthcare as a “basic necessity of life”[vi] and disclaiming general affirmative duties. [vil] This tension reveals the instability of healthcare rights in the absence of universal guarantees.
The United States must adopt a universal healthcare system to fulfill its constitutional commitment to “promote the general Welfare,” align with global norms, and ensure justice and equality for all.
A. PHILOSOPHICAL AND HuMAN RIGHTS FOUNDATIONS
At its core, the case for universal healthcare in the United States rests on the recognition that healthcare is a positive human right grounded in human dignity rather than a commodified privilege reducible to individual autonomy or market status. [viii| The dignity-centered view treats social rights as equal in force to liberty rights and imposes correlative state obligations to respect, protect, and fulfill equitable access to care for all persons, including those at the margins of social power. ix| In this framing, universal access to healthcare is not charity or discretionary policy but a baseline entitlement of membership in a political community. [×]
The modern United States “patients’ rights” discourse drifted into a narrow consumer-protection rubric for the already insured, but its historical origins in the late 1960s and early 1970s asserted a broader human-rights agenda that explicitly included guaranteed, universal access to healthcare. [xi] Led by organizations like the National Welfare Rights Organization (NWRO), the early movement linked healthcare to civil rights and economic equality, insisting that poor and minority communities be treated with equal dignity in hospitals and clinics and that health insurance be universal as a matter of right, not privilege. [xii] Although establishment actors resisted, direct action and rights-claims forced recognition of patients’ equal moral worth, making clear that dignity is not satisfied by entry alone when treatment remains second-class. [xiii]
Crucially, rights are realized both top-down and bottom-up: formal guarantees matter, but clinic-level norms, professional ethics, and programmatic infrastructures generate de facto entitlements that make rights tangible in everyday practice. [xiv] The global HIV/AIDS movement exemplified this dynamic. Rights language permeated policy and activism, even where providers avoided legalistic frames, with localized practices nonetheless creating real, group-based expectations of care.[xv| For the United States, this means that a universal right to healthcare requires both a legal entitlement and the institutionalization of norms and delivery systems that operationalize access without stigma or arbitrariness.[xvi]
Recasting healthcare as a non-negotiable element of the American social contract aligns with the dignity-based theory of rights and with the lived reality that modern medicine is indispensable to opportunity and equal citizenship. xvi Because the United States spends more than peer nations while tolerating gaps in access, the barrier is not capacity but a failure to treat health as a right coequal with other foundational commitments.[xviii]
B. CONSTITUTIONAL AND LEGAL FOUNDATIONS
The constitutional foundations of universal healthcare in the United States are complex, reflecting both judicial reluctance to recognize positive rights and statutory precedents that establish healthcare as a necessity of life. The Supreme Court has consistently refused to interpret the Constitution as imposing affirmative obligations on government to provide care, but the jurisprudence and statutory entitlements that do exist create a strong framework for legislative recognition of healthcare as a right.
The Court’s decision in DeShaney v. Winnebago County Department of Social Services epitomizes the rejection of positive rights, holding that the Due Process Clause does not impose an affirmative duty on the state to protect individuals from private harm. [xix] The Court emphasized that the Fourteenth Amendment restrains state action but does not require states to provide members of the general public with protective services, absent “special relationships” such as incarceration.[xx] The ruling underscores that any affirmative right to healthcare must be explicitly recognized by statute or constitutional amendment rather than left to judicial implication. [xxi]
Similarly, in Dobbs v. Jackson Women’s Health Organization, the Court rejected reproductive healthcare protections under substantive due process, insisting that rights must be “deeply rooted in this Nation’s history and tradition.”[xxii] By overruling Roe v. Wade [xxiii] and Planned Parenthood v. Casey [xxiv], the Court not only curtailed abortion rights but also exposed the fragility of all health-related rights absent explicit legal recognition.[xxv] The decision illustrates the risks of relying on judicially implied liberties to guarantee healthcare access. [xxvi]
Yet, within the Court’s jurisprudence lie important affirmative recognitions of healthcare as a necessity. In Goldberg v. Kelly, the Court held that welfare benefits are statutory entitlements requiring due process before termination, affirming that subsistence benefits, including “food, clothing, housing, and medical care,” constitute fundamental interests protected by the Constitution. [xxvii| Likewise, in Memorial Hospital v. Maricopa County, the Court struck down Arizona’s one-year residency requirement for indigent medical care, declaring that medical care is a “basic necessity of life” and that states cannot deny such access in violation of the Equal Protection Clause. [xxviii] These cases show that while the Constitution may not guarantee healthcare universally, it affirms government’s obligation to protect access to care when life and dignity are at stake.
The strongest precedent for a constitutional duty to provide healthcare arises from Estelle v. Gamble, in which the Court held that deliberate indifference to prisoners’ medical needs violates the Eighth Amendment’s prohibition on cruel and unusual punishment.[xxix] By recognizing that denial of care constitutes unconstitutional punishment, the Court implicitly acknowledged that healthcare is an essential component of the government’s obligation to preserve the basic conditions of human dignity in lawful confinement, rather than a discretionary benefit subject to political choice. [xxx] Although limited to incarcerated populations, Estelle provides doctrinal support for extending healthcare guarantees to all persons under government responsibility.
The Court has also repeatedly affirmed Congress’s authority to establish social insurance and healthcare programs under the Taxing and Spending Clause. In Helvering v. Davis, the Court upheld the Social Security Act, emphasizing that “the concept of the general welfare” evolves to meet modern needs and that Congress has broad discretion to spend for national welfare.|xxxi| Similarly, in Steward Machine Co. v. Davis, the Court upheld unemployment insurance, noting that cooperative federalism in social insurance does not coerce states but addresses national problems. xxxii| Most recently, in National Federation of Independent Business v. Sebelius, the Court upheld the Affordable Care Act’s individual mandate as a constitutional exercise of the taxing power, reaffirming that Congress may impose fiscal measures to expand healthcare access nationwide. [xxxiii] While the Court limited mandatory Medicaid expansion as coercive, it nonetheless affirmed healthcare as a legitimate national concern under Congress’s constitutional authority. [xxxIv]
Modern constitutional theory offers additional avenues for grounding healthcare rights, and one of the most significant is the Court’s recognition of unenumerated rights in Griswold v. Connecticut.|xxxv| In Griswold, the Court invalidated a state ban on contraceptives, reasoning that specific guarantees in the First, Third, Fourth, and Fifth Amendments create “penumbras, formed by emanations from those guarantees that help give them life and substance.”[xxxvi] The Griswold Court held that these overlapping protections collectively established a constitutional right to privacy in matters of marriage and procreation.[xxxvii] This interpretive framework suggests that rights essential to human dignity and autonomy, even if not textually enumerated, may nonetheless be constitutionally protected when derived from the interstices of multiple amendments. [xxxvili] By identifying privacy as implicit in the Bill of Rights, Griswold provides a doctrinal template for recognizing other fundamental rights that safeguard personal autonomy and bodily integrity, including access to healthcare.
Charles Pablico-Fernandez has extended this logic by arguing that the Bill of Rights, read through the Griswold “penumbra” and the Court’s modern “history and tradition” approach, implies a constitutional right to healthcare within the First, Third, Fourth, Fifth, and Eighth Amendments.[xxxix] The recognition that multiple amendments embed protections for health and bodily integrity strengthens the argument that healthcare is already latent in constitutional doctrine. [xl]
Finally, the instability of current statutory rights demonstrates the urgency of codifying universal guarantees. American healthcare rights are inherently unstable because they are partial, stigmatized, and dependent on federal-state partnerships rather than universal entitlements. [xli] Only universal programs like Medicare-for-all or voucher-for-all can provide stable, enduring rights immune from partisan sabotage.[xlii] Taken together, these cases and theories illustrate a paradox: the Court denies general affirmative rights but repeatedly affirms that healthcare is a necessity integral to life, liberty, and dignity. Constitutional authority exists under the Spending Clause and in substantive due process doctrines, but the judiciary has left universal recognition to Congress’ discretion. This underscores the imperative for Congress to legislate universal healthcare explicitly, embedding it as both a statutory and constitutional norm.
CONCLUSION
The recognition of universal healthcare as a fundamental right is both a moral imperative and a constitutional fulfillment of the nation’s founding promise to “promote the general Welfare.” It arises not from charity or expedience but from the intrinsic dignity of every human being and the principle that equality before the law is meaningless without equality in the conditions that sustain life itself. As the patients’ rights and civil rights movements have long affirmed, the right to health is inseparable from the right to participate fully and equally in society.
The United States possesses every necessary resource—economic, institutional, and constitutional—to guarantee healthcare for all. Its failure to do so is not a question of capacity but of political will and moral clarity. The Constitution, through its structure and interpretive evolution, already contains the means to realize this right: the Spending Clause authorizes Congress to legislate for the public good, while substantive due process and equal protection jurisprudence affirm that life and dignity demand more than mere survival. To deny healthcare is therefore to deny the very essence of equal citizenship.
Enacting universal healthcare would not only align the United States with international norms but also reaffirm its own constitutional values of justice, equality, and the collective responsibility of a democratic society. It would transform healthcare from a privilege contingent on employment or wealth into a shared public good, stabilizing access, reducing inefficiency, and restoring public faith in the legitimacy of government itself. In the final analysis, a nation that recognizes life as a right must also recognize the means by which life is sustained. Universal healthcare is thus not an aspiration to be deferred, but a constitutional and moral obligation to be realized.
CITATIONS
[i] Cynthia Cox et al., How Does Health Spending in the U.S. Compare to Other Countries?, Peterson-KFF Health Sys. Tracker, (Apr. 9, 2025).
[ii] Michelle M. Doty et al., The Cost of Not Getting Care: Income Disparities in the Affordability of Health Services Across High-Income Countries, Commonwealth Fund, (Nov. 16, 2023).
[iii] Sara R. Collins & Avni Gupta, The State of Health Insurance Coverage in the U.S.: Findings from the Commonwealth Fund 2024 Biennial Health Insurance Survey, Commonwealth Fund, (Nov. 21, 2024).
[iv] Martin Buijsen, Autonomy, Human Dignity, and the Right to Healthcare: A Dutch Perspective, 19 Cambridge Q. Healthcare Ethics 321, 323–25 (2010).
[v] Joseph C. d’Oronzio, A Human Right to Healthcare Access: Returning to the Origins of the Patients’ Rights Movement, 10 Cambridge Q. Healthcare Ethics, 285, 285–86 (2001).
[vi] Mem’l Hosp. v. Maricopa Cnty, 415 U.S. 250, 259–60 (1974).
[vii] DeShaney v. Winnebago Cnty. Dep’t of Soc. Servs., 489 U.S. 189, 194–97 (1989).
[viii] Buijsen, supra note 4; Joseph C. d’Oronzio, A Human Right to Healthcare Access: Returning to the Origins of the Patients’ Rights Movement, 10 Cambridge Q. Healthcare Ethics, 285, 285–86 (2001).
[ix] Buijsen, supra note 4.
[x] Fazal Khan, Towards Achieving Lasting Healthcare Reform: Rethinking the American Social Contract, 19 Annals Health L. 73, 74–78 (2010).
[xi] d’Oronzio, supra note 5 at 285–86, 288.
[xii] d’Oronzio, supra note 5, at 288–92, 296.
[xiii] d’Oronzio, supra note 5, at 293–96.
[xiv] Carol A. Heimer & Arielle W. Tolman, Between the Constitution and the Clinic: Formal and De Facto Rights to Healthcare, 55 L. & Soc’y Rev. 563, 581–83 (2021).
[xv] Heimer & Tolman, supra note 14, at 563–66, 573, 581–82.
[xvi] Id. at 581-83; David Orentlicher, Rights to Healthcare in the United States: Inherently Unstable, 38 Am. J.L. & Med. 326, 345-47 (2012).
[xvii] Khan, supra note 10, at 74–78; Martin Buijsen, Autonomy, Human Dignity, and the Right to Healthcare: A Dutch Perspective, 19 Cambridge Q. Healthcare Ethics 321, 323–25 (2010).
[xviii] Jason Beckfield et al., Healthcare Systems in Comparative Perspective: Classification, Convergence, Institutions, Inequalities, and Five Missed Turns, 39 Ann. Rev. Sociol. 127, 129–34 (2013).
[xix] DeShaney v. Winnebago Cnty. Dep’t of Soc. Servs., 489 U.S. 189, 194–97 (1989).
[xx] Id. at 198–200.
[xxi] Id. at 197–201.
[xxii] Dobbs v. Jackson Women’s Health Org., 597 U.S. 215, 224–25, 302 (2022).
[xxiii] Roe v. Wade, 410 U.S. 113 (1973).
[xxiv] Planned Parenthood v. Casey, 505 U.S. 833 (1992).
[xxv] Id. at 227–28, 327–28 (Breyer, Sotomayor & Kagan, JJ., dissenting).
[xxvi] Id. at 302–03.
[xxvii] Goldberg v. Kelly, 397 U.S. 254, 261–66 (1970).
[xxviii] Mem’l Hosp. v. Maricopa Cnty., 415 U.S. 250, 259–60 (1974).
[xxix] Estelle v. Gamble, 429 U.S. 97, 104–05 (1976).
[xxx] Id. at 103–04.
[xxxi] Helvering v. Davis, 301 U.S. 619, 640–45 (1937).
[xxxii] Steward Mach. Co. v. Davis, 301 U.S. 548, 586–89 (1937).
[xxxiii] Nat’l Fed’n of Indep. Bus. v. Sebelius, 567 U.S. 519, 562–66 (2012).
[xxxiv] Id. at 585–88.
[xxxv] Griswold v. Connecticut, 381 U.S. 479, 484 (1965).
[xxxvi] Id.
[xxxvii] Id. at 485–86.
[xxxviii] Id. at 484–86.
[xxxix] Charles Pablico-Fernandez, Note, Born to Die: Finding the Right to Healthcare in the History and Tradition of the Bill of Rights Amendments, 57 Loy. L.A. L. Rev. 791, 806–17, 829–32 (2024).
[xl] Id. at 831–32.
[xli] David Orentlicher, Rights to Healthcare in the United States: Inherently Unstable, 38 Am. J.L. & Med. 326, 326–27 (2012).
[xlii] Id. at 345–47.
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