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It usually takes a constitutional amendment or activist court ruling to establish a new right.

Barack Obama hasn't said how he hopes to create a right to health care for all Americans. Maybe we'll hear more during tonight's debate. It would take the full 90 minutes to address all the questions.

I don't expect meaningful discussion from John McCain, who seems to be sinking into a Bob Dole 1996 sort of aimlessness. If he had the energy, he could force Obama into a lively exchange about the nature of rights vs. benefits.

Lacking an intellectual challenge, Obama can stick to the emotional appeal of his new proclamation. People, like his late mother, get sick and die without possibly life-saving treatment. This country shouldn't let that happen.

Let's all agree on that in principle. At some point, however, you've got to spell out the details. That's where the going gets tougher.

Look at how North Carolina has dealt with the right to a basic education. That right was formally established in the state Supreme Court's 1997 Leandro decision, but it's taken further court actions over the years to define exactly what that means and how it should be implemented. It's still a work in progress.

A right to health care for every American will be even harder to pin down.

Traditionally, going back to "life, liberty and the pursuit of happiness," we think of rights as fundamental freedoms we hold naturally that government can't take away.

These include the right to say what we want, worship as we please, defend ourselves, secure our property and exercise the same privileges of citizenship as any other person.

That's not the same as a right to get something from the government.

I'm reminded of the expression, "Your rights end where my nose begins." Meaning: Don't exercise your freedom at my expense.

If Obama succeeds in creating a right to health care, he'll have to cross that line. After all, health care isn't free. Someone has to pay for it. So the right to receive it will have to be supported by the obligation to provide it. Maybe taxpayers, maybe businesses, more likely both, will be required to foot the bill.

In a radical way, that would distinguish the right to health care from most other rights, like free speech and religion, which can be granted at no expense except to the one who exercises them. You can publish a newspaper or build a church on your own dime. You don't have the right to demand that someone else kick in.

The government already provides health care to some people and taxes other people to pay for it. The Medicaid program is one example. But Medicaid is a benefit, not a right. Recipients must meet eligibility standards. Not everyone qualifies; therefore, it's not a universal right. Rights don't come with eligibility standards. If the government guarantees health care as a matter of right to any American, it has to do the same for every American, from the poorest to the richest.

But how much health care would be granted by right? Would it be unlimited, covering the most expensive cutting-edge medical procedures available anywhere in the country? Or would there be limits set by, well, who knows?

Many rights, in fact, are limited. Look at the right to keep and bear arms. The courts are still grappling with that one, but clearly stockpiling an arsenal worthy of a modern army isn't allowed for a private citizen. In North Carolina, the right to an education doesn't extend to college, and it's obvious that K-12 schools can meet the basic requirements without producing Harvard material. There's really no assurance that kids will learn much of anything.

Obama has laid out a health-care plan that builds on the present system of employer-paid medical insurance. If larger businesses decline to cover their employees, they'd have to pay into a public program. People left out of those options would be able to purchase insurance through a national pool. Many analysts like Obama's plan but warn it still won't cover everyone.

That, to me, doesn't sound like the way to guarantee a right to health care. It has too many elements, too many potential inequities and too many ways for some people to fall between the cracks. Maybe to really get there, the government would have to set up a network of medical centers offering basic care. Compare it to the public school system. The doors are open to all. If you're not satisfied with the minimum and can afford better, you can go the private route. But expect lawsuits from people insisting their newfound rights entitle them to more.

When the right-to-health-care details are settled, we can get to work on the right to a job, the right to a home and whatever other rights will appeal to the voters.