INTRODUCTION

In 1941, President Franklin D. Roosevelt proclaimed “freedom from want” to be one of the four essential liberties necessary to achieve human security. The polio-stricken president included in his definition of freedom “the right to adequate medical care and the opportunity to achieve and enjoy good health” (Roosevelt 1944, 41). This expansive vision of a right to health, which included both medical care and the preconditions to health, was subsequently incorporated into the Universal Declaration of Human Rights (UDHR) and has since been enshrined in many international and regional human rights treaties.

Roosevelt's vision was never fulfilled because the United States turned its back on economic and social rights. Despite spending far more per capita on health care than any other country, the United States continues to have some of the poorest health indicators in the industrialized world (Commonwealth Fund 2007). It is the only industrialized nation to deny its citizens universal access to medical services. Fully one-third of the population lacks health insurance for at least part of the year, and although this percentage is expected to decrease substantially as a result of the recently passed Patient Protection and Affordable Care Act (PPACA), those reforms still do not guarantee universal access. Add to this the lack of services for many Americans, discrimination in health care provision and inequitable outcomes between different racial groups, and pharmaceutical and insurance costs spiraling out of control, and it is clear U.S. health care is in a profound predicament.