A Just Nation Must Make Healthcare a Right

Few topics engender as much animus and debate than healthcare, specifically its provision and funding. Some firmly believe the American government must supply some form of healthcare while others passionately disagree.

The fundamental questions before us are:

• Is healthcare a right?
• Is the government responsible for providing healthcare for its citizens?
• Should a just healthcare system provide dental care for its members?

In order to answer these questions we must first decide if healthcare is a right. If so, then the government has a duty to provide at least some kind of basic healthcare and honor that right. Second, we must evaluate the value of dental care in order to decide whether it should be included as a basic benefit.

Many believe that healthcare is a right but do not realize that making this declaration involves designating someone or something with corresponding duties. If someone has a right to something, then someone else has a duty to honor that right. Therefore, it’s important to discern what kind of right healthcare is so we can assign corresponding duties to a formal agent.

Human rights are natural rights, those which we are all entitled to without discrimination. They include the right to life and liberty, freedom from fear and violence, freedom of opinion and expression, and the right to education, among others. Civil rights are conferred legislatively, by virtue of a legal edict, such as those granted by the United States Constitution (eg, freedom of the press and assembly, trial by jury).

Supporters of the idea that healthcare is a human right find support in international decisions, such as the United Nations Declaration of Human Rights (“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care”) and the World Health Organization’s Constitution (“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, or economic or social condition”).

Hessler and Buchanan¹ believe that healthcare is a human right because it is a component of human well-being, which is a moral right. There is an obligation of all to honor these rights because it is in all our best interests. However, as Baumrin² states, if “the United Nations itself does not provide the means, it only creates the right” then “the right is empty.”

Others believe healthcare is, at the least, a civil right and advocate for legislation to secure the duties of others in granting that right. The Constitution established America’s national government and fundamental laws, and guaranteed certain basic rights for its citizens but it grants no rights related to healthcare. Therefore, any discussion regarding healthcare rights is best grounded in a civil rights approach and on Congress’ ability to tax its citizens and spend that money on programs that benefit society.

Attempts to honor this right began more than 100 years ago with President Theodore Roosevelt’s progressive agenda: “…the health and vitality of our people are at least as well worth conserving as their forests, waters, lands, and minerals, and in this great work the national government must bear a most important part.”³

President Franklin D. Roosevelt authorized the Social Security Act, creating Medicaid, which provides medical care to the poor. In 1997, the Children’s Health Insurance Plan began providing health coverage to children in families with income too high to qualify for Medicaid, but who can’t afford private coverage. In 2010, Congress passed the Affordable Care Act, which increased the number of insured in the US by 20 million people. However, 28 million Americans still do not have health insurance.⁴ A 2024 Pew Research Center survey found that 65% of Americans said that the government should be responsible for ensuring healthcare coverage for all.⁵

Silvers and Francis⁶ discuss the role of civil rights as “instruments for expanding pragmatic equality.” Their function is equal to that of basic human rights and “build on what exists in the continuing effort to create social conditions under which we all have the opportunity to flourish.”⁶

Our system of government was founded on democratic principles created to ensure one virtue above all others: justice. What is just is what is fair; a just government is one which is fair. A just government treats all its members equally, considering all their needs equally. If some people’s needs are deemed less important than others’, then that is injustice and contrary to our principles. Additionally, there exists a normative consensus that all Americans have a right to basic healthcare. Therefore, healthcare is a right and a just government has a positive duty to honor that right by providing at least a basic level of healthcare.

The Value of Dental Care

In 2000, the US Surgeon General released the landmark report “Oral Health in America,” which brought much anticipated attention to the nation’s poor oral health and the need for a strengthened commitment on the part of public health officials and oral health providers to improve the nation’s oral health. Here are some of the findings of that report:⁷

• There are profound oral health disparities within the American population. People in families with incomes below the poverty level experience twice as much dental decay as those who are economically better off. Dental caries in poor individuals are more likely to be untreated than caries in those living above the poverty level.
• Oral diseases and disorders in and of themselves affect health and well-being through life.
• Oral diseases and conditions are associated with other health problems. Periodontal bacteria have been found in samples removed from brain abscesses, pulmonary tissue, and cardiovascular tissue. Periodontal diseases are associated with adverse pregnancy outcomes, respiratory disease, cardiovascular disease, coronary heart disease, and diabetes.

Perhaps most important is the striking reality that safe and effective measures to prevent dental diseases are currently available. It has been 25 years since that critical report was released and the nation’s oral health status remains unchanged. Dental caries remains a common chronic disease (among adults ages 20 to 64, 91% had dental caries) and 64% of Americans now experience periodontal diseases.⁸ Basic dental diagnostic and preventive services significantly improve an individuals’ oral health and regular dental check-ups are recommended at 3, 4, and 6 month intervals by the American Dental Association.⁹

In a 2018 editorial, the chief economist and vice president of the American Dental Association’s Health Policy Institute, Marko Vujicic, PhD, wrote: “We will not see major expansions in dental care use and sustained improvements in oral health in the coming years, especially among those with the highest needs, under the status quo model. The dental care system needs major reforms.”¹⁰

A need is considered basic if, without it, people cannot reasonably expect to achieve their goals — regardless of what those goals may be. Oral healthcare is a basic need. Individuals do not have the resources necessary to achieve their goals, to live a fruitful life, if they cannot chew food because their teeth are rotted or if they are in pain.

The US is the only developed country in the world that hasn’t fully accepted the notion that healthcare is a right. The right to healthcare, whether it exists as a human right or a civil right, creates an obligation on the part of a just government to provide resources to grant that right. Even Baumrin concedes that the right to healthcare is found at least “within the confines of a few medically enlightened nations.”² Our government is such a nation. It has the resources necessary (knowledge, equipment and a skilled workforce) to provide basic healthcare to promote the health of all its citizens. That is the responsibility of a just government.

References

1. Hessler K, Buchanan A. Equality, democracy, and the human right to health care. In: Rhodes R, Battin M, Silvers A, eds. Medicine and Social Justice: Essays on the Distribution of Health Care. 2nd ed. Oxford, England: Oxford Academic; 2012:97-104.
2. Baumrin, Bernard H. Why there is no right to health care. In: Rhodes R, Battin M, Silvers A, eds. Medicine and Social Justice: Essays on the Distribution of Health Care. 2nd ed. Oxford, England: Oxford Academic; 2012:97-104.
3. Roosevelt T. “New Nationalism” speech. Osawatomie, Kansas: August 31, 1910.
4. KFF. Key Facts About the Uninsured Population. Available at kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population. Accessed October 21, 2025.
5. Pew Research Center. Americans’ Views of Government Aid to Poor, Role in Health Care and Social Security. Available at pewresearch.org/politics/2024/06/24/americans-views-of-government-aid-to-poor-role-in-health-care-and-social-security. Accessed October 21, 2025.
6. Silvers A, Francis L. Reproduction as a civil right. In: Francis L, ed. The Oxford Handbook of Reproductive Ethics. Oxford, England: Oxford University Press; 2016.
7. Oral Health in America: A Report of the Surgeon General. J Calif Dent Assoc. 2000;28:685–695.
8. National Institute of Dental and Craniofacial Research. Dental Caries (Tooth Decay) in Adults (Ages 20 to 64 Years). Available at nidcr.nih.gov/research/data-statistics/dental-caries/adults. Accessed October 28, 2025.
9. American Dental Association. Home Oral Care. Available at ada.org/resources/ada-library/oral-health-topics/home-care. Accessed October 28, 2025.
10. Vujicic M. Our dental care system is stuck: And here is what to do about it. J Am Dent Assoc. 2018;149:167–169.

From Dimensions of Dental Hygiene. November/December 2025; 23(6):9-10.