The Patient Protection and Affordable Care Act and Minimalist Approach to Health Care Expansion: What Has Human Rights Got to Do with it?

Abstract:     
The Patient Protection and Affordable Care Act, 2010, and the Health Care and Education Reconciliation Act, 2010, (together known as “Obamacare”) have as their objective the provision of comprehensive health care coverage for most residents of the United States. But rather than follow the piecemeal incremental approach adopted by previous administrations (that yielded Medicare and Medicaid, for instance), the Obama administration went for the jugular, radically altering the landscape of health care financing and delivery in the country. The administration's big bang approach sharply contrasts with minimalist incrementalism to which ordinary Americans are accustomed. And that, in a nutshell, is the problem. This paper argues that escalating opposition to Obamacare is rooted in two principal factors, to wit: widespread disapproval of the process that led to the enactment of the legislation and deep-seated fear of actualizing a result that is not only completely at variance with American value system and way of life but also potentially catastrophic for the economy. Polls convincingly show that most Americans actively support reforming the health system. Nevertheless – and this is the key – the role they envisage for the government is quite narrow and limited. This perceived limited role, an original American credo and a pillar of American exceptionalism, is powerfully consistent with a minimalist approach to health care expansion – which, as the paper demonstrates, provides a more acceptable path (gauged by public support) to health system reform. And in contrast to prevailing orthodoxy, which equates the right to health care to provision of comprehensive health care coverage, this paper contends that basic coverage packages (particularly in situations where the former is not politically feasible) is consistent with international obligations of nations to secure and protect the human right to health care in their respective jurisdictions.

Keywords: Health care, health reform, health system, United States

JEL Classification: D63, H51, H53, K32

working papers series