The Constitution, Health, and Culture in America – The Health Care Blog


The Right to Health Care and the U.S. Constitution.” On the surface, it sounds like a straightforward topic – a simple presentation. But a gentle scratch at the surface reveals a controversy that literally dates back 250 years and more. Is it a right”, a privilege”, or simply a necessity?”

I’m not a lawyer or Constitutional scholar. But I do know health care, its history, and its many strengths and weaknesses. What does our Constitution have to do with health care? The answer: That depends on how broadly you define “health.”

Before we were ever a nation, there existed a 300 year period of war and conquest, of genocide and superstition masquerading as science, of promises made and promises broken in the Americas. The naive fledgling nation that declared its independence in 1776, knew that what they were attempting was a long shot. As Alexander Hamilton wrote in the first Federalist paper, the pressing question was “… whether societies of men are really capable or not, of establishing good government from reflection and choice, or whether they are forever destined to depend, for their political constitutions, on accident and force.” It was, and is, an open question.

One hundred and seventy years after our Declaration of Independence, General George Marshall raised the same question when charged with rebuilding the destroyed societies of vanquished enemies, Germany and Japan, from ashes. Where should he begin? In 1946, he decided to begin by establishing national health plans in each of those nations. He believed that by creating services that emphasized safety and security; handed out compassion, understanding and partnership in liberal amounts; reinforced bonds between individuals, families and their communities; and processed a population’s collective fears and worries day in and day out, would help establish a level of trust and tranquility necessary to secure the foundations of a thriving and lasting democracy. It was, if you will, a “nation building” plan, The Marshall Plan.

General George Washington’s moment in history  on June 15, 1775 when he assumed the helm of the Continental Army was quite different. He had no such insights. He had his hands full assuring our immediate survival. Governance and representation, rights and privileges, checks and balances – these were issues decidedly on the table in 1776. Health of the population was not. Nowhere in those early years will you find an essay titled “How do we make America healthy?” Arguably, the aristocratic leaders of this fledgling nation spent much of their time doing just the opposite – figuring out how to subjugate women and harm a large portion of their fellow humankind, most notably indigenous natives and enslaved Africans. Had there been a broad goal of creating an equitable healthy population from the beginning, our Founding Fathers would have been forced into a “Truth and Reconciliation” process of our own – an impossibility according to many historians if the goal was to “unite” a group of disparate and independent minded colonies

We went with the “United States” as it was, as it still is. Trump and his Republican admirers are simply residual damage, evidence of the persistence of unhealthy and discriminatory behaviors, and proof positive that “life, liberty and the pursuit of happiness” is quite impossible without good health.

Health is foundational to a functioning democracy. Health is recognized by most throughout the world as a fundamental right, intertwined with our economic, social, and political systems. But health must be shared and be broadly accessible to be an effective enabler of good government.

Our Constitution is aspirational and idealistic – a “living document.”  We have the opportunity to actively pursue a healthy America. It is within our grasp to improve on the Founders vision and demonstrating to Hamilton, in modern times, that we are “capable of establishing good government from reflection and choice.”

The choice of Health Care for All is a basic and foundational component for a thriving democracy. Understanding the Constitution and our nearly 250 years of relevant case law has been an eye opener for me. I thought I really understood the history of health care in America. But viewing it through a legal lens has only reinforced my belief that we together, as Americans, deserve better. We have a right to share a healthy culture, lives of promise and productivity, and secure a bright future in this country we love.

Ignoring health has brought American culture to its knees, allowing weak values, fear, and ignorance to make Trump possible. We shouldn’t require any more proof than this. Surgical extirpation of this malignancy is underway. But that will only bring us back to neutral.

How will we finally make our American culture healthy. General George Marshall would say, “Begin with health. It is a necessity.”

Mike Magee MD is a Medical Historian and author of “CODE BLUE: Inside the Medical-Industrial Complex.”

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