I gave an impromptu lecture to a class full of medical students about the American health care system a couple of weeks ago. The biggest reaction seemed to be their disbelief that there is no legal right to health care in the American constitution. Government obligation to health care is part of Argentina’s constitution and the country has also committed to a number of human right declarations and treaties.

Argentina spends the most per capita on health care in South America and the United States has the highest per capita spending on health care in the world. Despite the high level of spending in both, neither country has a health system that protects the people it is meant to serve. Disruptions in medical supplies and medication and lack of transparency in bureaucracy interfere with health care for Argentines. Until two months ago, a program of the national Ministerio de Salud provided a box of food each month to indigent families who had an least one family member with a chronic illness. This included many of the patients that come to the clinic that I work at. However, without warning the program has stopped, leaving many families without food in a time of high consumer prices and cold weather.

The United States health care system is no stranger to leaving people out in the cold when programs suddenly end. I can use my home state of Texas as an example. One of the most immediate problems in 2003 was a budget shortfall of almost $10 billion dollars. The legislature cut funding across the board to reduce costs but one of the most severe cuts was to the CHIP program, which provided insurance coverage to children of working families who can not afford insurance. This budget cut was proposed in spite of a offer for over $200 million in matching funds from the federal government. To make matters worse, the legislature also passed stricter guidelines for eligibility. For the 200,000 children that lost coverage under CHIP, there was no safety net save for emergency room visits.

Both examples are similar in that the government committed to providing a service that promoted the wellbeing of the people who benefited from the services. I do not think that are doubts about the harm suffered by the people affected by the sudden abandonment. Are government health programs an entitlement or a privilege? Does the government have a moral obligation to continue providing a service that contributes to health even without a legally defined right to health care? And if not a moral obligation, is there another standard that determines the strength of the obligation?