Health Care Equity and Wealth Discrimination

One of the charms of life is finding old books in used bookstores. Online shopping provides more extensive resources. Nonetheless, I continue to enjoy physically looking around, skimming, and choosing personally.

Some years back, I found a small book entitled The Right to Abortion: A Psychiatric View (1970) by the Group for the Advancement of Psychiatry, Committee on Psychiatry and Law. It recommends no criminal sanction for abortions performed by licensed physicians. 

Roe v. Wade (1973) authorized certain criminal sanctions. Four states had liberal abortion laws when Roe was announced. They all allowed some criminal sanctions. New York had the most liberal law, but still only allowed abortions after a certain point to save a woman's life. 

Canada matches the recommendation to a significant degree:

We can be comforted by the fact that abortion is decriminalized in Canada, with no legal requirements such as parental consent or waiting periods that can prevent access. Karina Gould, minister of families, children and social development, has said Americans could travel to Canada to receive an abortion, which may lead to an influx of U.S. patients to Canada.

Canada provides government funding to support abortion services. Nonetheless, abortion access -- especially later in the pregnancy -- remains hard to come from in various places. Medical regulations remain as do limits on funding for those too poor to pay.  

The ACLU did not support abortion rights as a constitutional right until the mid-1960s (New York and California led the way). The book lists the various constitutional arguments they made:

• Vagueness
• Equal Protection (Wealth)
• Privacy
• Right of Physicians To Practice Medicine
• Liberty (Substantive Due Process) 

I recently talked about vagueness while also touching upon health care overall. Roe v. Wade rested on the right to privacy. Planned Parenthood v. Casey later framed it as a liberty interest. It also talked about how it was a matter of "conscience," which shows religious liberty connotations. 

The rights of physicians specifically were not an independent interest. They were protected as necessary to carry out abortion rights generally.  Wealth discrimination was the least successful argument. Certain state courts recognize the need to provide access equally no matter how much money a person has is required to truly protect abortion rights. 

The Supreme Court rejected the argument even when an abortion was necessary to protect a person's life and health. The Declaration of Independence tells us that governments are in place to "secure" our rights. Affirmative action, including providing financial aid, is necessary here.

Connecticut's law against the use of contraceptives was particularly burdensome for the poor. Justice White (who dissented in Roe) recognized this in his separate opinion in Griswold v. Connecticut:

And the clear effect of these statutes, as enforced, is to deny disadvantaged citizens of Connecticut, those without either adequate knowledge or resources to obtain private counseling, access to medical assistance and up-to-date information in respect to proper methods of birth control.

Well-off people might privately receive birth control advice from physicians or by traveling to New York. The poor were denied the opportunity of public clinics. The class of people who are "without either adequate knowledge or resources" would also cover other people, including well-off Catholics who would not know how to go about getting info.

The 1960s and early 1970s were a high point regarding recognizing the constitutional issues involved when wealth was a barrier to rights. People have a right to a lawyer when charged with a crime. No poll taxes are allowed before you can vote. Before various benefits can be removed, a hearing must take place. 

So, selective denial of health insurance that made carrying out a constitutional right seemed to many a clear problem. The Supreme Court went another way.  

Limits on health care continue with regulations under the Affordable Care Act. People also might discover their employer is a religious institution (including a private college) that does not provide certain health care. The last issue is a bit more complex. 

Overall, however, this two-tiered approach to basic needs is unjust. It is not only unfair, it should be found unconstitutional. Health care is not merely a private benefit. The government funds and regulates it in a variety of ways. The government is bound by the U.S. Constitution.  

It is not just a matter of negative limits. The government and society have obligations if we want a just society. The Constitution provides states and the federal government the authority to equally protect life, liberty, and the pursuit of happiness.