Steve May: Basic and adequate health care is constitutionally fundamental

Editor’s note: This commentary is by Steve May, who is a member of the Selectboard in Richmond and works as a Licensed Independent Clinical Social Worker specializing in chemical dependency and addiction issues with offices in Shelburne. He was previously the national director of state affairs for the Hemophilia Federation of America, and founded an organization addressing privacy and civil rights issues relative to genetic information called the Forum on Genetic Equity.

Dwight Eisenhower once famously answered a reporter’s question about partisanship by saying that he “had never laid eyes on a Republican Ditch or a Democratic Pothole.” That is to say that there are certain functions of government that are so basic that they simply are. They exist outside of politics because they are essential.

Much has been written and said about health care over the last decade. There have been fights over delivery system, and who should be responsible for what — fights born in spite or a want for control and fostered across the crucible of time.

Time has provided us all precious little clarity. In the beginning, it was a market-driven approach with health insurers at its core, then it became an unfunded mandate, intruding into the lives of ordinary citizens. First it was RomneyCare, then it became ObamaCare. First it came from the Heritage Foundation, and then it came from Hillary and her ilk.

Much has been written and much has been said about health care, health insurance and health coverage. Words like co-pay and co-insurance have become parts of our everyday existence whether we all like it or not. To focus simply on the trappings of the political fight coming in Washington and Montpelier does a disservice to the people whose lives are impacted for good or for ill as a result of extending health coverage to its citizens.

Much has been made of exchanges here in Vermont, and the issues surrounding delivery systems will continue to be grist for the mill. Certainly the public option versus a benefit that is market-driven will form lively dinner table debate. Always there is a question of cost: Who pays and how much? And while interesting, all of these issues are beside the point. There is a single question and it is the only thing that matters. This one singular question upon which all of this fighting over health care turns is:

Do you believe that there is a right to basic and adequate health coverage? And if you believe it is a fundamental right, then doesn’t it deserve to be treated similarly to all of our other most fundamental rights?

Our most fundamental rights are enshrined in our state and federal constitutions. These documents are extraordinary and they detail the rights and interests that make us who we are. They are integral to our identity and sense of self as individual citizens in a free society, as they detail the relationship that we have to one another, and the obligations we have to the state and the state to us.

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A basic health care benefit is not going to be all things to all people, nor should it be, but it does set the floor and establishes a basis for future consensus in governing, without regard to party or politics.


Constitutions are about procuring rights and not about providing remedies. When we have written with an eye toward broad grants of authority, granting powers, we have done well as a society. Think of the First Amendment with its broad grants of authority to individual citizens as opposed to the temperance and prohibition experience we had a century ago with the 19th and 21st amendments.

A guaranteed right to basic and adequate health would ensure that basic coverage is available to everyone. This goes beyond the ethical convention of assuring care and passing the buck to other wealthier payers, as doctors and hospitals seek to be paid (or reimbursed), as the case may be. Stating that there is a legal right to basic and adequate health care as a matter of law synthesizes a political consensus and places it into our social compact.

With all due respect, the questions of plan design and deployment of a statewide system pale in comparison to the issues which arise from providing care to those among us who would most benefit from government setting the floor. That, after all, has always been the proper role of government: to help sustain the least amongst us. In health care that means looking to people with chronic health issues. Often these people present with multiple long-term health concerns. Our conversations to date have discussed these people as cases and patients or consumers. The problem is that when you see these issues through the prism of cost, we all lose track of the reality that these are our neighbors, they are citizens. And as citizens, we all come together and have a social compact.

For more than two centuries, we Vermonters have been marked by our belief that we form a unique people born of common interest and united through a shared experience. Everything we have said and done as a people affirms this belief, that we all are in this together. That is why it is essential that we adopt a state constitutional amendment guaranteeing that all Vermonters have a right to basic and adequate health care.

A basic health care benefit is not going to be all things to all people, nor should it be, but it does set the floor and establishes a basis for future consensus in governing, without regard to party or politics. Matters attached to health and welfare should be beyond the normal din of ordinary politics. Frankly, when you start to address questions of wellbeing, the matters presented aren’t ordinary. And with that said, there is room for legitimate differences of opinion about philosophy and how to serve the public when it comes to health care, but it has never been more important to unite as one people around a fundamental consensus moving forward.


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