The United States of America is a nation known and heralded worldwide for its democracy, freedom, and wealth. Through our commerce, we have become a prosperous nation. Through our commonalities we stand united. Through our shared citizenship, we establish our community. Through our voices, we are heard. So why is it, our nation has been divided against the idea of health care being funded as a basic human right?
U.S. Senator, Ted Kennedy, once said,
Health care is not just another commodity. It is not a gift to be rationed based on the ability to pay. It is time to make universal health insurance a national priority, so that the basic right to health care can finally become a reality for every American. (2003)
Society has a moral obligation to provide basic health care to all people, yet in the U.S., health care is not a human right despite the fact that many leading documents and institutions of international law closely associated with the United States have publicly declared this important right. Instead, it is viewed as a product, something to be bought and sold, and remains unobtainable for anyone who lacks access or the means to purchase the services.
During the last century, U.S. policies have come closer to funding health care for all through new programs. Medicare and Medicaid brought access to health care to some of the most vulnerable population: the elderly, disabled, and low-income people. Still many Americans are prevented adequate access to health care, largely because they do not have health insurance and it is too costly.
The Patient Protection and Affordable Care Act(PPACA) of 2010 is being phased in over the next few years and through its policies, it will provide health care access to millions of Americans who had previously been left out of the system. The PPACA moves the U.S. towards social justice and funding health care as a basic human right, but it does not fully address the issue of funding health care as a basic human right
Funding health care as a basic human right assumes that medical services are viewed as a natural right of all people and not a privilege of some fortunate individuals. It also assumes certain responsibilities of a nation. Foremost, the government must recognize the human right to health care and apply principles of social justice in legislation at the state and national level to support this right. Secondly, a national strategy on health care, including principles of accessibility, equality, and universality must be adopted. Finally, an awareness that being uninsured and lacking access to care leads to poor health outcomes for a society must drive a nation to develop a plan of action. These factors should serve as guiding components of any health care system modeled under the premise of a human right to health care for all.
Background
The history of health care as a right is important to our position on funding these services as a basic human right. It provides the definition of a right and the timeline for establishing current policy on health care as a right by several credible global organizations. The following historical timeline details how the world has quickly moved to this stance during the last century.
Human rights are rights that are inherent to all human beings. They are commonly understood to be universal and equalitarian, meaning they apply to everyone, regardless of their race, gender, cultural or ethnic background, religious views, or place of residence. It is by virtue of being human, alone, that every person is entitled to human rights equally and without discrimination. Additionally, these rights are inalienable, interdependent, and indivisible. They are inalienable because a person's rights can never be taken away. They are indivisible and interdependent because all rights are equal in importance and none can be fully enjoyed without the others.
A human right is based on the dignity and worth of human beings and is derived from the ideology of natural law which seeks to uphold universally accepted moral principles. Determination of the present global definition of human rights and affirmation of health care as a basic human right has been supported by distinguished institutions and declared in several renowned documents.
After the atrocities of World War II, the United Nations (UN) and its associated institutions, one being the World Health Organization (WHO), were established. An especially noteworthy development for human rights and health policy was the UN's adoption in 1948 of the Universal Declaration of Human Rights (UDHR), which listed a total of 30 internationally agreed upon human rights. It formed a comprehensive common vision of inalienable rights. Though not law, this document laid the framework for human rights policy throughout the world and is referred to today when human rights are called into question.
Article 25 of the UDHR states, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control." (UDHR, 2009)
In 1966, almost 20 years after the UDHR, the UN legislatively embodied the economic and social parameters of the document's adopted rights in the International Covenant on Economic, Social, and Cultural Rights (ICESCR) (Meier, 2007), which elaborates the right to health in Article 12, "The States parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" (ICESCR, 2000). This core treaty emerged to convert the UDHR into binding treaties. It sets forth the responsibility of the States to protect and further its citizens' economic, social, and cultural rights, all of which have been determined to be equally essential to human dignity.
These UN documents defined and supported human rights for the international community and laid the framework for the idea that health care is a basic human right. Additional backing from the 1978 International Conference on Primary Health Care (PHC), came in the form of the Declaration of Alma-Ata (DAA), which in Article 1, upheld the WHO's affirmation of health as "a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity" (DAA, 1984). However, the DAA expanded on that definition to include the impact of social and economic factors within the capacity of attaining health.
Article 1 continues by declaring health "... a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector" (DAA, 1984). Virtually all member nations of the WHO and the United Nations Children's Fund (UNICEF) attended the International Conference on Primary Health Care and supported its right to health initiative. During this conference, the WHO Director-General, Halfdan Mahler, launched a social and political goal, called Health for All, which provided a policy framework for globally linking primary care to all humans by the year 2000 (Tervonen-Goncalves, 2004). This was thirty years after UDHR defined human rights, including the right to health care.
In 2000, the UN Economic and Social Council's Committee on Economic, Social, and Cultural Rights published a General Comment in regards to the earlier approved ICESCR Article 12. In this comment, the Committee further explained their position on the right to the highest attainable standard of health by reaffirming that, "Health is a fundamental human right indispensable for the exercise of other human rights. Every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity. The realization of the right to health may be pursued through numerous, complementary approaches, such as the formulation of health policies, or the implementation of health programs developed by the World Health Organization (WHO), or the adoption of specific legal instruments. Moreover, the right to health includes certain components which are legally enforceable." (United Nations, 2000)
This General Comment again reinforces health care as a basic human right, one that must be applied to all people around the world simply because they are human.
Through global institutions, such as the United Nations, the World Health Organization, UNICEF, and the International Conference on Primary Health Care, the international society has endorsed the concept of human rights, and more specifically, the right of all individuals to health care. Documents, such as the 1948 Universal Declaration of Human Rights, the 1966 International Covenant on Economic, Social, and Cultural Rights, the 1978 Declaration of Alma-Ata, and the 2000 UN Economic and Social Council's Committee on Economic, Social, and Cultural Rights General Comment, all uphold the global position of health care as a basic human right. Though at various times in history, individual States have followed practices or policies that have not supported the view of the international community, the policy of the world on human rights and health care has been clearly stated and continuously maintained. Our position that health care should be funded as a basic human right emanates from these global policies.
Counter Arguments
Some opponents to funding health care as a basic human right argue that people only have a negative right to health care, which "imposes a negative duty on the states institutions not to harm people's health by its actions" (Ram-Tiktin, 2012). They claim that negative rights do not place an obligation on society or individuals to provide goods to other people. In addition, keeping the rewards of one's labor is an individual's right and should be respected. They assert that health care is a negative right or duty, similar to the negative rights of life, liberty, and the pursuit of happiness listed in the U.S. Constitution (Ram-Tiktin, 2012). However, proponents of funding health care as a basic human right, refute their claims stating health care falls into the category of positive rights since its delivery by the government requires taxation and redistribution (Rubin, 2012). They support "natural law theory grounds a duty to promote the flourishing of others, and because others also have a right to our promoting their flourishing this subsumes a right to health" (MacDougal &Trotter, 2011). Although, negative rights are easy to satisfy and are essentially unbreakable, a positive right cannot be understood as an unbreakable right, rather only an apparent right; therefore, an apparent right to health results "from the duty of others to contribute to our flourishing" (MacDougal & Trotter, 2011). Their assumption is "a right to health care follows, subsequently, from the right to health" (MacDougal &Trotter, 2011). Following this reasoning, policies enacted through Medicare, Medicaid, and the Affordable Care Act all promote health care as a positive human right.
Opponents also claim that funding health care for all U.S. residents is too costly and unsustainable and while it may be an ideal position to support every person having the right to receive health care, it is simply not feasible. They argue that providing health care to all Americans would greatly decrease the quality of health care for those who currently work hard and pay for medical coverage. Opponents also believe the availability of health care services would be severely and negatively impacted by adding millions of additional Americans to our current fragmented system, resulting in long delays for care and rationing of services. They argue that using tax revenue to provide all residents with health care and installing a universal health system amounts to socialism which goes against the founding principles of the United States (Paton, 1997). They refer to establishing such a system equal to the development of a welfare state chalk full of entitlements. Finally, opponents question the efficiency of a government run health care system by comparing it to other nationally managed establishments stating, "Do the people of this country really want a health care service with the regulatory simplicity of the tax law, the frugality of the Pentagon, the efficiency of the Post Office, and the compassion of the IRS" (Burton, 1994). While it is true that many government run organizations are overrun by regulations and red tape, the private sector is not adequately regulated to ensure that profiteering does not interfere with the ability of all Americans to equally access quality care. In the final analysis, it may well be that considerations of efficiency and fairness "may ultimately pull the society toward a single-payer arrangement for providing universal access" (Menzel, 2011).
Government Recognition of Right to Health Care with Legislated Social Justice
On a national level, our health care system is economically draining. The United States is already the world's biggest health care spender, surpassing countries that provide universal health care access. It spends the highest percentage of its gross domestic product (GDP) on health care, more than any other developed country. This amounted to 17.9% of GDP in 2011 and means we now spend nearly $1 out of every $5 on health care (Santerre & Neunn, 2013). Spending on this sector of the U.S. economy is expected to grow 5.5% in 2013 and 8.3% in 2014 (Shi & Singh, 2013). Yet last year, 48.6 million Americans did not have access to health services (DeNavas-Walt et al., 2012). This is unacceptable. It is society's ethical obligation to provide health care to everyone; however, the U.S. has failed to recognize a human right to health care or apply principles of social justice through legislation. One of the reasons for inaction is that Americans have a strong sense "of reliance on individual responsibility and a commitment to limiting the power of the national government" (Shi & Singh, 2013). Historically, instead of the U.S. government leading the charge of health care delivery, it has been the private sector that has fulfilled this role and the principles of market justice largely have been the status quo. A market justice approach is based on individualism, personal effort, and voluntary behavior.
According to Budetti, "In the United States, health care competes for consumers with other items in the marketplace. Individual resources and choices determine the distribution of health care, with little sense of collective obligation or a role for government" (2008).
Social justice is the contrasting ideology. Under this approach, goods and services are allocated based on need. It stems from principles of shared responsibility and the valuing of collectivism over individualism, with government acting as the agent for safeguarding equity (Budetti, 2008; Drevdahl, 2002). The idea of a right to health care is deeply rooted in social justice, but since the U.S. was established on a capitalistic foundation, Americans have typically supported a market approach to health care and government has stayed out of the way. However, in the late twentieth century, social justice has been entering the picture through government enacted legislation. In 1965, adoption of the Medicare and Medicaid legislation expanded the health sector by providing publicly subsidized health insurance to the elderly and indigent Americans (Shi & Singh, 2013). Implementation of these two wide sweeping programs was an early step toward enacting health care as a basic human right, but it still did not provide access to all Americans. However, the government did initiate principles of social justice through redistribution allocation tools, where resources are taken from one group and given to another (Shi & Singh, 2013, p. 314). This action was an effort toward funding health care for all. The PPACA of 2010 also includes legislated social justice policies that are moving the U.S. closer to funding health care as a basic human right.
Supporting Human Right to Health Care by Providing Accessibility
In health care, access to care is a commonly used term, but it is a complex concept with numerous aspects to consider. Health care delivery is dependent on people being able to enter the system and in the current U.S. structure, health insurance is the golden ticket to ensuring an individual timely access to medical care.
Gulliford et al. (2002) explained accessibility as,
If services are available and there is an adequate supply of services, then the opportunity to obtain health care exists, and a population may 'have access' to services. The extent to which a population 'gains access' also depends on financial, organizational and social or cultural barriers that limit the utilization of services. Thus access measured in terms of utilization is dependent on the affordability, physical accessibility and acceptability of services and not merely adequacy of supply. Services available must be relevant and effective if the population is to 'gain access to satisfactory health outcomes'. The availability of services, and barriers to access, have to be considered in the context of the differing perspectives, health needs, and material and cultural settings of diverse groups in society. To realize funding health care as a basic human right, individuals must have accessibility to services, yet in the U.S., this has been a significant reason for lack of health care. Substantial barriers exist at both the individual and system levels with three factors, race, income, and occupation, predicting who has health care access (Shi & Singh, 2013, p. 299). However, the method of funding health care plays a major role in who has access to care and it is directly related to race, income, and occupation.
To understand health care access for Americans, it is important to look at how it is currently funded through third party payers and insurance since this largely dictates who has accessibility. Presently, health care insurance coverage is categorized as private or public. Private insurance is provided through employer-sponsored and direct purchase plans, while public insurance is provided by the government through Medicaid, Medicare, and the Department of Defense health care program, Tri-Care. According to the U.S. Department of Commerce (USDC) 2011 Current Population Report, of those with insurance, 63.9% are covered with private plans and 32.2% have government or public health insurance (DeNavas-Walt, Proctor, & Smith, 2012). The majority of insured Americans are covered by employer-sponsored insurance, which is insurance available to employees through their work place. In 2011, this amounted to 55.1% or 170.1 million of those included in private insurance (DeNavas-Walt et al., 2012). Those accounted for in direct purchase plans include 9.8% of the privately insured or 30.2 million (DeNavas-Walt et al., 2012). One significant change in the recent USDC census report was that the number of people covered by government health insurance, increased from 95.5 million in 2010 to 99.5 million in 2011; this accounted for the percentage of the U.S. population in public plans, with 16.5% denoted as Medicaid recipients, 15.2% receiving Medicare, and 4.4% on military health care benefits (DeNavas-Walt et al., 2012). It is important to note that the census report estimates for type of coverage are not mutually exclusive since people may be covered by more than one type of health insurance in the year surveyed.
The remaining group represents the share of the U.S. population who face greater barriers to accessing health care, the uninsured. On September 12, 2012, the U.S. Census Bureau released the 2011 data on health care coverage which reported the percentage of uninsured at 15.7% of the total population. While this may not seem like a huge number, currently it represents nearly 48.6 million Americans without insurance (Todd & Sommers, 2012).
So who are the uninsured and why are they without health insurance? The answers to these questions might be surprising. A common misconception is that the uninsured are lazy and unemployed, which is frequently inaccurate. In 2011, one in seven full-time employees was uninsured, representing 15.3% of U.S. full-time workers (Todd & Sommers, 2012). Often, the reason these Americans find themselves uninsured is because they fall between qualifying for Medicaid and being able to afford their employer-sponsored insurance, if they even have access to workplace health insurance at all. Other common reasons for being uninsured include, being employed be a small business, having less education than the insured population, and working part-time (Shi & Singh, 2013). And this is not a dilemma of only those in the lowest socioeconomic class. Many middle-class families find themselves uninsured; a staggering 32% of the 48.6 million U.S. uninsured population had a household income of $25,000-$49,000 in 2011 (Todd & Sommers, 2012). That number is roughly similar to the 31% of uninsured households making under $25,000 (DeNavas-Walt et al., 2012; Todd & Sommers, 2012). Additionally, an astounding 18% of households with incomes over $75,000 per year were left uninsured in 2011 (Todd & Sommers, 2012). This increase in uninsured among the middle-class is frequently due to the cost of health insurance escalating faster than salaries. According to a study released by the Henry J. Kaiser Family Foundation and the Chicago-based Health Research and Educational Trust, "the average annual premiums for employer-sponsored health insurance in 2012 are $5,615 for single coverage and $15,745 for family coverage" (Kaiser & HRET, 2012). The cost of employer-based health insurance has almost doubled in the last decade severely out pricing attainment for many households with middle and lower incomes.
While people of all ages and ethnic groups are represented by the uninsured, certain groups have a higher incidence. For example, in 2011, 27% of the 19-34 year old age group lacked health care access (DeNavas-Walt et al., 2012). In the same year, 30% of Hispanics, 19% of Blacks, 16% of Asians, and 11% of Caucasians were uninsured (Todd & Sommers, 2012).
Accessibility to health care is a major factor that must be addressed if a nation is to operate under the perspective of social justice and it is critical to any system supporting the human right to health care. Dependence on mostly private employer-sponsored insurance to provide access to care, such is the practice in the U.S., excludes many people from exercising their right to health care. Additionally, while it disproportionally affects minorities, the poor, and uninsured, it is increasingly affecting those in higher socioeconomic classes. To provide health care to all Americans new methods of funding must be developed.
Poor Health Outcomes for Individuals and Society
Studies suggest that providing universal care not only improves health, but also may be cost effective (Wilper et al., 2009). This is because being uninsured or having inadequate insurance has serious consequences for individuals, families, and the United States. Statistics have shown that the uninsured are more likely to die than the insured; approximately 44,789 Americans between the ages of 25-64, die every year due to lack of health insurance (Wilper et al., 2009). However, just having insurance is not always the solution; nearly 16 million Americans, representing 12% of insured adults, are underinsured (Riedel, 2009). These underinsured individuals have such insufficient health insurance that they tend to delay medical care because of costs. This issue affects all income levels; "...median household income of those who were underinsured was $58,950 and 22% lived in households making more than $100,000 per year" (Riedel, 2009).
A study by the National Center for Health Statistics analyzing data from the National Health Interview Survey determined that a substantial percentage of U.S. adults aged 18-64 years have experienced disruptions in access to health care during the last 10 years, including some of the most vulnerable population, those with chronic illnesses (Schiller, Lucas, Ward, & Peregoy, 2010) . This study also found that residents in this same group who were underinsured or uninsured for more than a year were "approximately six times as likely (55.2% versus 9.3%) not to have a usual source of care, compared to those who were continuously insured" (Schiller et al., 2010). Additionally, the uninsured were seven times as likely as those with insurance to skip needed health care, including preventative care, because of the expense (Schiller et al., 2010); therefore, they often receive not enough medical care too late and as a result they are sicker when first seen by a provider. They also tend to use the emergency department as their point of entrance into the medical system causing long waits and excessive burden on the department. In general, delaying care leads to poorer health and increased medical expenditures in the long run, issues that affect everyone through cost shifting.
On an individual level, being uninsured or underinsured can be financially devastating. Unfortunate circumstances like "corporate restructuring, outsourcing, divorce, family crises, chronic illness, and serious accidents" are just a few examples of situations that often lead to lose of health care, frequently with disastrous results, both physically and financially (Sered & Fernandopulle, 2006, p.6-7). Financial burden of illness contributes to bankruptcy. Currently, about half of all personal bankruptcies are related to medical problems and those who declare bankruptcy often cite unaffordable premiums, inability to obtain coverage due to preexisting medical conditions, and employment issues, including job loss or ineligibility for employer-sponsored coverage as reasons for filing (Riedel, 2010). Medical bills have put financial strains on millions of families; 62.1% of all bankruptcies are related to serious health issues that have caused financial hardships that families could not afford (Himmelstein, Thorne, Warren, & Woolhandler, 2009). Most medical debtors were well educated and middle class; three quarters had health insurance.
Himmelstein et al (2009) concluded, 62.1 percent of the bankruptcies were medically related because the individuals had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point. So the cost of health care in this country is not just a problem for the uninsured, it is a problem for every resident. Everyone should have the right to health care and families should not lose everything they own due to someone getting sick and being unable to pay costly medical expenses.
Medical debt is remarkably common, affecting about 1 out of 6 nonelderly adults or about twenty-nine million Americans (Seifert & Rukavina, 2006). Though the risk of medical debt is greater for the uninsured, even those with insurance are vulnerable; "15% of those who had insurance for all the past twelve months reported having medical debt and 70% of all those with debt said that they were insured at the time the debt was incurred" (Seifert & Rukavina, 2006). Just having medical debt tends to create access to care barriers, even for the insured. This is because people who carry medical debt are much less likely than those without unpaid medical bills to obtain health care services. They do not "fill prescriptions, see a specialist when needed, or visit a doctor or clinic for a medical problem, and they are more likely to skip a needed test, treatment, or follow-up" (Seifert & Rukavina, 2006). Interestingly, a recent study found that over one-quarter medical debtors "changed primary care doctors because of the money they owed for care" (Seifert & Rukavina, 2006). Regardless of the level of medical bankruptcy, "it is now documented that medical debt resulting from being uninsured or having inadequate insurance reduces access to care and undermines the financial security of American families" (Seifert & Rukavina, 2006).
It could be argued that on many levels, the lack of properly funded universal health care, affects not only the health of the American people, but also the economic strength of the nation. The high and escalating out-of-pocket costs of medical care are forcing families to delay mortgage payments, sell their homes, and cut back on normal household expenses. Retired families are forced to spend their savings for health care expenses. "Surging health care costs slow the rate of job growth by making it more expensive for companies to add new workers" (Riedel, 2009). By driving up total employee compensation costs, wages are suppressed and companies are becoming unable to fund current pension levels and health benefits.
As healthcare costs rise, corporate operating margins are cut, which reduces the capacity of firms to grow by investing in research, plant and equipment. This puts American firms at a steep disadvantage in world markets, where they have to compete against companies with much lower health care costs in the nations where they operate. Rapidly escalating costs are producing severe long-term budgetary problems in the public sector and are affecting the solvency of federal and state health insurance programs, such as Medicare and Medicaid. (Riedel, 2009) These are major concerns for a nation known and heralded worldwide for its democracy, freedom, and wealth. The unwillingness to acknowledge health care as a basic human right and provide appropriate funding for all Americans will devastate our future prosperity as a nation, however, it is already shattering the lives of many individuals and their families.
Current Health Policy and Modifications
It is obvious that significant changes in U.S. policy are required to support our position of funding health care as a basic human right and the Medicare program is an ideal starting point for delivery system reform. With its roots deeply entrenched in the concept of national health insurance since the Progressive Era, Title XVIII of the Social Security Act, better known as Medicare, has been the forerunner of a publicly funded health insurance plan.
Medicare was initially established to provide health insurance to people aged 65 and older. It later expanded its coverage to include people under the age of 65, who received Social Security Disability Insurance and those with End-Stage Renal disease (Friedland, 2005). According to the Centers for Medicare & Medicaid Services (CMS) (2012), "the program is paid for through two trust fund accounts held by the U.S. Treasury. These funds can only be used by Medicare". The first trust, called Hospital Insurance (HI), or Medicare Part A, is funded through the payroll taxes of employees, employers and the self-employed. Services covered by Hospital Insurance include inpatient hospital care, skilled nursing facility care, home health care, and hospice care (CMS, 2012). The second trust, called Supplementary Medical Insurance [sMI], or Medicare Part B, is funded through premiums deducted from the social security benefits of those beneficiaries who choose to enroll. Services covered by SMI include: physician visits, outpatient hospital care, home health care services not covered by Medicare Part A, and selective preventative services (CMS, 2012).
In the forty seven years since its enactment, the plan has undergone several legislative modifications. These changes have provided Medicare beneficiaries the option of appointing private insurance carriers to manage their health plans and prescription drug coverage.
Schlesinger and Hacker (2007) state,
It's because Medicare has become a public-private hybrid, it is uniquely situated to become the vehicle for serious efforts to universalize health coverage. While the combination of public and private insurance may irritate ideological purists, it bolsters Medicare's public legitimacy. While these dualistic features have been challenging to administer in an even-handed fashion, they give the program sufficient flexibility to effectively address the needs of a diverse population and perform under the heterogeneous circumstances in which health care is delivered in the United States... Indeed, as improbable as it may seem at first, Medicare may be the only practical avenue for achieving health security for all Americans. In addition to the many options available for choice, Medicare beneficiaries are much more satisfied with their overall health care coverage, access to services, and protection from medical bill financial hardship than the non-elderly population is with their private coverage (Davis, 2006).
In her report in Health Care Financing Review, Davis (2006) found, 87 % of aged Medicare beneficiaries report being very or somewhat satisfied with the quality of health care received in the past 12 months, compared to 81% of those with employer coverage, 79% of those with individual coverage, 87% of those under age 65 with Medicaid coverage, 80% of the Medicare disabled, and less than one-half of the uninsured (48%).
Furthermore, when compared to non-elderly adults, Medicare beneficiaries believe they have more choice in where to go for medical care, are confident they will receive the best care possible, and therefore, "are much more likely to rate their insurance as excellent or very good, than are those covered by employer plans or individual coverage" (Davis, 2006). Personal satisfaction is an important factor for health care beneficiaries, but so is not stressing over problems due to cost. Care access issues related to expense, "such as not going to a doctor when needing medical attention, not filling a prescription, skipping a medical test, treatment, or follow-up visit recommended by a doctor, or not seeing a specialist when a doctor thought it was needed" (Davis, 2006) occurred less frequently for Medicare beneficiaries than for non-elderly adults covered by employer plan or individual coverage.
What is the cost for all these great benefits? According to the Centers for Medicare & Medicaid Services (2012), most people get premium-free Part A coverage. There is no cost for Part A Inpatient Hospitalization coverage if the individual or their spouse paid Medicare taxes while employed, or receive Social Security or Railroad Retirement benefits. Additionally, those who do not qualify for premium-free coverage can purchase Part A for $441.00 per month in 2013 (CMS, 2012). Medicare's Part A deductible, whether earned through payroll taxes or purchased separately, is $1,156.00 per benefit period (CMS, 2012). The Part B medical premiums are determined by income level, with the lowest 2012 premium set at $99.90 and the highest at $259.70 per month; the 2012 annual deductible for Medicare Part B is currently $140 (Davis, 2006).
According to Shi and Singh (2013), "the most credible argument for policy intervention begins with the identification of situations in which markets fail or do not function efficiently" (p. 315). This accurately represents the U.S. health care system. Furthermore, health policies often come as a by-product of public social policies enacted by the government and a relevant example is the expansion of health insurance coverage. This is an important step to funding health care as a basic human right. Perhaps Medicare is NOT a 'one size fits all' health care option, but it certainly offers a framework for the public funding of health insurance as a basic human right, aimed at providing coverage to all American citizens, regulating health care costs and eliminating personal and financial loss due to medical expenditures. With some modifications, it could offer a feasible solution.
In order to address these issues and move the U.S. to funding Health care as a basic human right, we propose using the Medicare policy as a framework to establishing true single-payer health care for all Americans. Congressman John Conyers introduced this idea of expanding Medicare in the U.S. Congress in 2007 through HR 676. The bill was coauthored by Ohio U.S. Representative Dennis Kucinich and is called the ''Expanded & Improved Medicare for All Act'' (S. 676, 2009).
The bill, establishes the United States National Health Care (USNHC) Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care (S. 676, 2009).
The bill proposed no cost-sharing among participants (S. 676, 2009); there are no premiums, deductibles, co-pays, deductibles, or major medical bills, like those resulting from coinsurance under the current U.S. health care model, that could potentially cause individuals or families financial hardship.
HR. 676 (2009) proposes funding for Medicare for All by depositing existing government health care funding sources into the USNHC Trust Fund. The bill also recommends increasing the personal income tax for the top 5% of income earners, placing a progressive excise tax on payroll and self-employment income and introduces small taxes on stock/bond transactions and unearned income. Only public and nonprofit institutions are allowed to participate in the program, however it does allow "nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate", but "prohibits financial incentives between HMOs and physicians based on utilization" (S. 676, 2009).
The bill in its current form has a lot of positives and sufficiently addresses many of the common problems found in current health care funding and delivery. For example, it proposes funding mental health coverage on the same basis as other medical conditions and eliminates being denied coverage due to pre-existing conditions. It also provides funds for continuing education for medical providers and allows patients to choose their own doctor from participating physicians (S. 676, 2009).
We support a few additional proposals in the area of staffing. Since the number of primary care physicians is decreasing, utilizing a teamlet model to deliver care, where a doctor, nurse practitioner (NP), or physician assistant (PA) is paired with an allied health professional would be beneficial for patients (Shi & Singh, 2013, p. 345). Offering incentives and loan forgiveness for primary care residents, NPs, and PAs would provide more practitioners to care for the large increase of U.S. residents that would be added to the system. For this same reason, we propose that the current 2015 mandate to increase NP credentialing to a doctorate level be delayed until 2020.
With the increasing cost of health care and the escalating demands of the United States
aging population, a solution to the current inefficient and unfair health care system is needed and the Expanded & Improved Medicare for All Act with a few additional provisions, offers a workable policy by modifying the current Medicare program framework. This bill received wide public support from groups, such as national nursing and teacher organizations, health worker, manufacturing, and automotive unions, and religious organizations (Participatory Politics Foundation, 2012); however, it has stalled in Congress since the enactment of the PPACA in 2010. We feel the Medicare for All Act offers more than the PPACA toward funding health care as a basic human right and should be revisited by Congress.
Conclusion
It is easy to see why the 'healthcare is a right' debate has become so contentious - people mean entirely different things when they use the word 'right'. Some believe it places an obligation on society or individuals to provide goods to other people, while others believe it means do no harm and no duty is required. Among developed nations, the U.S. stands nearly alone in our failure to accept healthcare as a human right largely due to characteristic American ideologies of individualism and self-determination, distrust of government, and reliance on the private sector to address social concerns. While the government does step in to provide a safety net for the gaps in private insurance through programs such as Medicare, Medicaid, CHIPS, the Military Health Services System, Department of Veterans Affairs, and workers' compensation, millions of other Americans are left out of the system. This goes against the human rights policies set forth by global institutions which the United States helped develop and is unacceptable.
Funding health care as a basic human right assumes that medical services are viewed as a natural right of all people and not a privilege of some fortunate individuals. It also assumes certain responsibilities of a nation. Foremost, the government must recognize the human right to health care and apply principles of social justice in legislation at the state and national level to support this right. Secondly, a national strategy on health care, including principles of accessibility, equality, and universality must be adopted. Finally, an awareness that being uninsured and lacking access to care leads to poor health outcomes for a society must drive a nation to develop a plan of action. These factors should serve as guiding components of any health care system modeled under the premise of a human right to health care for all. Health care policies must be developed that will address these points. Historically, U.S. health policies have been incremental and piecemeal. This does not effectively address the problem. Real reform is needed and the Expanded & Improved Medicare for All Act offers a practical framework to start the health care funding transformation.
In May 2009, during his final days of life, Senator Ted Kennedy wrote a letter to President Obama to be delivered posthumously. It was during the time of heated Congressional debate on legislation that would become the Patient Protection and Affordable Care Act.
In the letter, Senator Kennedy (2009) wrote, There will be struggles - there always have been - and they are already underway again. But as we moved forward in these months, I learned that you will not yield to calls to retreat - that you will stay with the cause until it is won. I saw your conviction that the time is now and witnessed your unwavering commitment and understanding that health care is a decisive issue for our future prosperity. But you have also reminded all of us that it concerns more than material things; that what we face is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country. And so because of your vision and resolve, I came to believe that soon, very soon, affordable health coverage will be available to all, in an America where the state of a family's health will never again depend on the amount of a family's wealth. And while I will not see the victory, I was able to look forward and know that we will - yes, we will - fulfill the promise of health care in America as a right and not a privilege. (2009)
Senator Kennedy's words elicit the feelings of many in regards to health care; it is a right, not a privilege for those who can afford it. His words also offer hope that soon, this right will be attainable. As a nation, the United States must make funding health care as a basic human right a priority, a position we strongly support.
Funding Health Care as a Basic Human Right written by Jennifer Bergen, Jay Fultz, Sally Kessie, and Angela Osburn (Miami University).
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