We live in a world that can feel very divided. There are things that all humans have in common, though. We all get sick. Sometimes, the cure is bed rest, other times it might be antibiotics.
Most, if not all of us, have gotten injured badly enough to require medical care. Some people require surgery – to remove impacted wisdom teeth, set a broken leg, remove a rupturing appendix, or to give birth via caesarian section.
Health care is a human right. Every human has the right to have all of their physical and mental health care needs taken care of. This isn’t just my opinion. It is a concept that has been around for a very long time.
Merriam-Webster defines human right as: a basic right (such as the right to be treated well or the right to vote) that many societies believe every person should have.
Neanderthals are our closest extinct human relative. A study titled: “Calculated or Caring? Neanderthal healthcare in social context” was published in The Archaeology of Medicine and Healthcare Journal in 2018.
In short, there was evidence that some Neanderthals suffered from serious injuries and illnesses, but survived because they received help from others in their group.
…Where pathology affects the the essential activities of daily living… such as when individuals are incapacitated for several days or more (as in the case of major breaks to lower limbs, severe systemic infections, inflammation with fever, and so on) survival more clearly implicates extended healthcare from others, however. This help may have taken various forms, such as extended food and water provisioning, or in more severe cases the facilitation of an extended period or rest and immobilization, or perhaps even active nursing…
The study mentions an individual whom archeologists called “Shanidar 1”, a Neanderthal who was found in Shanidar Cave in Iraq. He was between age 35 and 50 when he died, but had suffered a range of debilitating impairments.
Those impairments included: “a violent blow to the face, possibly as a young adult, leaving him with blindness or only partial sight in the left eye, a withered right arm which had been fractured and healed resulting in the loss of his lower arm and hand and possible paralysis, deformities in his leg and foot leading to a painful limp and a hearing impairment.” Those injuries occurred “long before his death and showed signs of healing, with curvature of his right leg compensating for injuries to the left.” “Shanidar 1” also suffered from advanced degenerative joint disease.
“Shanidar 1” would had limited mobility, and would not have been much (if any) help with manual tasks or perceptual abilities. He had partial sight, a hearing impairment, and certainly would not have been able to hunt. Someone so badly injured would not have survived without a daily provision of food and assistance.
Interestingly, “Shandiar 1” wasn’t the only example of Neanderthals who had become disabled and who had lived to an old age, thanks to the help from others in their group. The study points out “…Neanderthals had achieved a level of societal development in which disabled individuals were well cared for by other members of the social groups.”
The Neanderthals knew that health care was a human right.
The Biblical Archeology website states that it was mostly likely that Jesus was born in 4. B.C. That probably sounds a bit strange, because B.C. stands for “Before Christ”. (The Biblical Archaeology blog has more explanation about that.)
Dr. Simon Gathercole, a Reader in New Testament Studies at the University of Cambridge, posted an article on The Guardian in 2017 titled: “What is the historical evidence that Jesus Christ lived and died?” According to Dr. Simon Gathercole, the first Christian writings to talk about Jesus are the epistles of St. Paul, “and scholars agree that the earliest of these letters were written within 25 years of Jesus’s death at the very latest.”
He also mentions writings by Flavius Josephus, who was a Jewish priest, scholar, and historian. Encyclopedia Britannica says that Flavius Josephus wrote history books. One was called Antiquitates Judaicae, which was completed in 20 books in A.D. 93. It contains two references to Jesus Christ.
In Book XX, Flavius Josephus calls Jesus “the so-called Christ”. Dr. Simon Gathercole notes that later in the book, there is a reference to James, the brother of “Jesus, the so-called Christ”.
About 20 years after Flavius Josephus’s writings, there are some written mentions of Jesus by two Roman politicians: Pliny and Tacitus. They held some of the highest offices in the state at the beginning of the second century A.D.
Tacitus wrote Jesus was executed while Pontius Pilate was the Roman prefect in charge of Judea (A.D. 26-36) and while Tiberius was emperor (A.D. 14-37). Pliny was a governor in northern Turkey, and he wrote that Christians worshiped Christ as a god. Neither Pliny, nor Tiberius, were Christians.
St. Paul, Flavius Josephus, Pliny, and Tacitus all wrote about Jesus. Some were fans, others were not. It sure sounds like they were all writing about the same person.
One of the things Jesus was known for was healing the sick. He didn’t ask for money first. He didn’t deny healing to those who couldn’t pay for it. He didn’t turn people away who were poor, or outcasts, or of low-status. He didn’t demand that they follow him. He just healed them.
Here are a few examples:
- Matthew 14:14: When he went ashore, He saw a large crowd, and he felt compassion for them and healed their sick.
- Mathew 15:30: And large crowds came to Him, bringing with them those who were lame, crippled, blind, mute and many others, and they laid him down at His feet; and he healed them.
- Matthew 21:14: And the blind and the lame came to Him in the temple, and He healed them.
- Luke 4:40: While the sun was setting, all those who had any who were sick with various diseases brought them to Him; and laying His hands on each one of them, He was healing them.
- Mark 6:56: Whenever He entered villages, or cities, or countryside, they were laying the sick in market places, and imploring Him that they might just touch the fringe of His cloak; and as many as touched it were being cured.
- Mark 7:37: They were utterly astonished, saying, “He has done all things well; He makes even the deaf to hear and the mute to speak.”
- Luke 7:21: At that very time He cured many people of diseases and afflictions and evil spirits; and He gave sight to many who were blind.
There is no evidence that Jesus ever said “health care is a human right”. But, his actions show that is what he believed. If you call yourself a Christian, and think that health care is NOT a human right – you’re not really a Christian.
The University of Virginia website has information about Theodore Roosevelt’s campaigns and elections. It includes the election of 1912. In this one, Theodore Roosevelt decided to throw “his hat into the ring” against incumbent President William Howard Taft.
In June of 1912, the Republican Party met in Chicago to determine who their official nominee would be. Roosevelt had won a series of preferential primaries, but Taft controlled the convention floor. Taft’s backers excluded most of Roosevelt’s delegates by not recognizing their credentials.
Theodore Roosevelt was enraged by that, and refused himself to be nominated. Taft won the first ballot and became the official Republican Party candidate.
Roosevelt and his supporters formed the Progressive Party, and gathered in Chicago two weeks later. They nominated Theodore Roosevelt as their presidential candidate and Governor Hiram Johnson of California as his running mate. Roosevelt made a speech calling their party “as strong as a Bull Moose”, and “The Bull Moose Party” became the popular name.
Its tenants included political justice and economic opportunity, and it sought a minimum wage for women; an eight-hour workday; a social security system; a national health service; a federal securities commission; and direct election of US. Senators…
Theodore Roosevelt, and the supporters of The Bull Moose Party, recognized that health care is a human right.
The Democratic Party nominated governor of New Jersey, Woodrow Wilson for President and Thomas R. Marshall, the governor of Indiana, as Vice President.
Wilson captured 41.9 percent of the vote to Roosevelt’s 27.4 percent and Taft’s 23.1 percent. Socialist Party candidate Eugene Debs won 6 percent of the vote. Wilson got 435 electoral college votes, Roosevelt got 88, and Taft got 8.
If Theodore Roosevelt had won the 1912 election, it is possible that the result would have been a national health care system for America. Clearly, Theodore Roosevelt and his supporters believed that health care is a human right.
The Franklin D. Roosevelt Presidential Library and Museum website has a transcript of FDR’s State of the Union Message to Congress. It was delivered on January 11, 1944. Part of it said:
…We have come to the clear realization of the fact that true individual freedom cannot exist without economic security and independence. “Necessitous men are not free men.” People who are hungry and out of a job are the stuff of which dictatorships are made.
In our day these economic truths have become accepted as self-evident. We have accepted, so to speak, a second Bill of Rights under which a new basis of security and prosperity can be established for all regardless of station, race, or creed.
Among these are:
The right to a useful and remunerative job in shops or farms or mines of the Nation;
The right to earn enough to provide adequate food and clothing and recreation;
The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
The right of every businessman, large and small, to trade in an autonomous atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
The right of every family to a decent home;
The right to adequate medical care and the opportunity to achieve and enjoy good health;
The right to adequate protection from the economic fears of old age, sickness, accident and unemployment;
The right to a good education.
All these rights spell security. And after this war is won we must be prepared to move forward, in the implementation of these rights, to new goals of human happiness and well-being…
President Franklin Delano Roosevelt recognized that “the right to adequate medical care and the opportunity to achieve and enjoy good health” is a human right.
Mary Gerich wrote an article titled: “Health Care As a Human Right” on the American Bar Association website. It includes the following paragraph:
…The right to health care has long been recognized internationally. Ironically, the origins of this right are here in the United States. Health care was listed in the Second Bill of Rights drafted by Franklin Delano Roosevelt (FDR). Sadly, FDR’s death kept this Second Bill of Rights from being implemented. Eleanor Roosevelt, however, took his work to the United Nations (UN), where it was expanded and clarified. She became the drafting chairperson for the UN’s Universal Declaration of Human Rights (UDHR). That committee codified our human rights, including, at Article 25, the essential right to health. The United States, together with all other nations of the UN, adopted these international standards…
The United Nations (UN) is an international organization that was founded in 1945. At the time I’m writing this blog, it has 193 Member States. The UN signed The Universal Declaration of Human Rights in 1945.
It is a milestone document of the history of human rights. It was drafted by representatives with different legal and cultural backgrounds from all regions of the world. It sets out, for the first time, fundamental human rights to be universally protected.
Article 25 of The Universal Declaration of Human Rights says:
(1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, 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.
(2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
Article 28 says: Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized.
To be clear, The Universal Declaration of Human Rights includes “medical care and necessary social service” as a human right. The United States is among the nations that adopted The Universal Declaration of Human Rights.
The Harry S. Truman Presidential Library & Museum has information about Truman’s proposed health program. The program was proposed on November 19, 1945, about seven months after Truman’s presidency began.
…Harry S. Truman sent a Presidential message to the United States Congress, proposing a new national health care program. In his message, Truman argued that the federal government should play a role in health care, saying “The health of American children, like their education, should be recognized as a definite public responsibility”. One of the chief aims of President Truman’s plan was to insure that all communities, regardless of their size or income level, had access to doctors and hospitals. President Truman emphasized the urgent need for such measures, asserting that “About 1,200 counties, 40 percent of the total in the country, with some 15,000,000 people, either have no local hospital, or none that meets even the minimum standards of national professional associations…
President Truman’s plan was to improve the health care of the United States by addressing five separate issues:
- Construction of Hospitals and Related Facilities
The Federal Government should provide financial and other assistance for the construction of needed hospitals, health centers, and other medical, health, and rehabilitation facilities. With the help of Federal funds, it should be possible to meet the deficiencies in hospital and health facilities so that modern services – for both prevention and cure – can be accessible to all the people. Federal financial aid should be available to build facilities where needed, but also to enlarge or modernize those we now have.
Truman called for the federal government to create minimum standards for the hospitals and health facilities, and to allocate federal funding to the areas that needed it the most. The concept was likened to the State-Federal partnership in the construction of highways.
- Expansion of Public Health, Maternal and Child Health Services
Previous to the war, the United States embarked upon Federal-State cooperative health programs to deal with general public health, tuberculosis venereal disease control, maternal and child health, and services for crippled children. The project was not completed before the war began.
The Federal Government should cooperate by more generous grants to the States than are provided under present laws for public health services and for maternal and child health care. The program should continue to be partly financed by the States themselves, and should be administered by the States. Federal grants should be in proportion to State and local expenditures, and should also vary in accordance with the financial ability of the respective States.
The health of American children, like their education, should be recognized as a definite public responsibility.
- Medical Education and Research
Truman called for the Federal Government to undertake a broad program to strengthen professional education in medical and related fields, and to encourage and support medical research.
Professional education should be strengthened where necessary through Federal grants-in-aid to public and non-public institutions. Medical research, also should be encouraged and supported in the Federal agencies and by grants-in-aid to public and non-profit private agencies.
Truman stated that federal aid for medical research and education is an essential part of any national health program, if it is to meet its responsibilities for high grade medical services and for continuing progress. Coordinating the research program and the funding program was necessary to assure efficient use of Federal funds. Truman called for legislation to to make that happen.
- Prepayment of Medical Costs
Everyone should have ready access to all necessary medical, hospital and related services. I recommend solving the basic problem by distributing the costs through expansion of our existing compulsory social insurance system. This is not socialized medicine.
Truman compared this to fire insurance.
Everyone who carries fire insurance knows how the law of averages is made to work so as to spread the risk, and to benefit the insured who actually suffers the loss. If instead of the costs of sickness being paid only by those who get sick, all the people – sick and well – were required to pay premiums to an insurance fund, the pool of funds thus created would enable all who do fall sick to be adequately served without overburdening anyone. That is the principle on which all forms of insurance are based..
…A system of prepayment should cover medical, hospital, nursing and laboratory services. It should also cover dental care – as fully and for as many of the population as the available professional personnel and the financial resources of the system permit…
Truman called for the creation of advisory committees in which the public and the medical professionals are represented. It required that methods and rates of paying doctors and hospitals should be adjusted locally. All such rates for doctors should be adequate, and appropriately adjusted upward for those who are qualified specialists.
People would remain free to choose their own physicians and hospitals. People would remain free to obtain and pay for medical service outside the health insurance system if they desire, even though they are members of the system.
Truman said physicians would remain free to accept or reject patients, and to decided for themselves whether they wish to participate in the health insurance system full time, part time, or not at all. Physicians must be permitted to be represented through organizations of their own choosing, and to decide whether to carry on in individual practice or to join with other doctors in group practice in hospitals or clinics.
Truman emphasized that this is not socialized medicine.
Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.
Under the plan I suggest, our people would continue to get medical and hospital services just as they do now – on the basis of their own voluntary decisions and choices. Our doctors and hospitals would continue to deal with disease with the same professional freedom as now. There would, however, be this all-important difference: whether or not patients get the services they need would not depend on how much they can afford to pay at the time.
Truman’s plan would be for people who work for a living (and their dependents) – no matter where these people worked. It was also for “needy persons and other groups”. Truman called for increased Federal funds to be made available by the Congress under the public assistance programs to reimburse the States for part of such premiums, as well as for direct expenditures made by the States in paying for medical services provided by doctors, hospitals, and other agencies to needy persons.
- Protection against loss of wages from sickness and disability
Truman wrote that a comprehensive health program must include the payment of benefits to replace at least part of the earnings that are lost during the period of sickness and long-term disability. He said this can be readily and conveniently provided through expansion of our present insurance system, with appropriate adjustment of premiums.
Truman strongly urged Congress to give careful consideration to this program of health legislation now. Read the details of Truman’s plan, and it is clear that President Truman knew that health care is a human right.
Truman’s plan went to Congress in the form of a Social Security expansion bill co-sponsored by Senators Robert Wagner (D-NY) and James Murray (D-MT), with Representative John Dingell (D-MI).
The bill was opposed by the American Medical Association (AMA) that capitalized on fears of Communism in the public mind. The main public advocate of the bill was organized labor, which had lost its goodwill from the American people due to a series of unpopular strikes.
President Truman was forced to abandon the bill. If the AMA had backed the bill, instead of trying to scare Americans into thinking that Truman’s plan to improve American health care was “Communism” it probably would have been signed into law. It would have given Americans a nationalized health care system.
On February 6, 1974, President Richard Nixon delivered a Special Message to Congress Proposing a Comprehensive Health Insurance Plan. Here are some key points from that plan:
Comprehensive Health Insurance Plan (CHIP)
This plan was organized around seven principles:
First, if offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;
Second, it will cost no American more than he can afford to pay;
Third, it builds on the strength and diversity of our existing public and private systems of health funding and harmonizes them into an overall system;
Fourth, it uses public funds only where needed and requires no new Federal taxes;
Fifth, it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.
Sixth, it encourages more effective use of our health care resources;
And finally, it is organized so that all parties would have a direct stake in making the system work-consumer, provider, insurer, State governments and the Federal Government.
Nixon’s Comprehensive Health Insurance Plan would offer every American the same broad and balanced health protection through one of three major programs:
Employee Health Insurance, covering most Americans and offered at their place of employment, with the cost to be shared by the employer and employee on a basis which would prevent excessive burdens on either;
Assisted Health Insurance, covering low-income persons, and persons who would be ineligible for the other two programs, with Federal and State government paying those costs beyond the means of the individual who is insured; and,
An improved Medicare Plan, covering those 65 and over and offered through a Medicare system that is modified to include additional, needed benefits. One of these three plans would be available to every American, but for everyone, participation in the program would be voluntary.
The benefits offered by the three plans would be identical for all Americans, regardless of age or income. Benefits would be provided for: hospital care; physicians’ care in and out of the hospital; prescription and life-saving drugs; laboratory tests and X-rays; medical devices; ambulance services; and other ancillary health care.
More details include:
- No exclusions of coverage based on the nature of the illness. Nixon explains “a person with heart disease would qualify for benefits as would a person with kidney disease”.
- It would cover treatment for mental illness, alcoholism and drug addiction, whether that treatment were provided in hospitals and physicians’ offices or in community based settings.
- Certain nursing homes services and other convalescent services would be covered. Home health services would be covered so that long and costly stays in nursing homes could be averted where possible.
- Children would receive preventative care up to age six; eye examinations; hearing examinations; and regular dental care up to age 13.
- A doctor’s decisions could be based on the health care needs of his patients, not on health insurance coverage.
- There was a cap on how much a family would have to pay out-of-pocket for covered health services. Low-income people would face substantially smaller expenses.
- Every American in the program would get a Health-card when the plan goes into effect in their state. It would be honored by hospitals, nursing homes, emergency rooms, doctors, and clinics across the country. The card could be used to identify blood type and sensitivity to particular drugs.
- Bills for services paid for with the Health-card would be sent to the insurance carrier who would reimburse the provider of the care for covered services, and then bill the patient for his share, if any.
Nixon intended the program to become effective in 1976, assuming that the plan was promptly enacted by Congress. The plan provided an explanation of how employee health insurance would work and ideas to improve Medicare.
The plan also provided an explanation of how assisted health insurance would work:
The program of Assisted Health Insurance is designed to cover everyone not offered coverage under Employee Health Insurance or Medicare, including the unemployed, the disabled, the self-employed, and those with low incomes. In addition, persons with higher incomes could also obtain Assisted Health Insurance if they cannot otherwise get coverage at reasonable rates. Included in this latter group might be persons whose health status or type of work puts them at high-risk insurance categories.
Assisted Health Insurance would thus fill many of the gaps in our present health insurance system and would ensure that for the first time in our Nation’s history, all Americans would have financial access to health protection regardless of income or circumstances…
…Assisted Health Insurance would replace State-run Medicaid for most services. Unlike Medicaid, where benefits vary in each State, this plan would establish uniform benefit and eligibility standards for all low-income persons. It would also eliminate artificial barriers to enrollment or access to health care…
Richard Nixon had a mild case of tuberculosis when he was a child. His brothers died of tuberculosis. That awful experience could be why Nixon created a health plan that could only be created by someone who believed health care was a human right.
What happened to Nixon’s Comprehensive Health Insurance Plan? Commonwealth Fund provides the answer to that question:
…Nixon’s proposal eventually failed, in large part because Watergate destroyed his presidency. But elements of the plan’s innovative design have continued to emerge in many subsequent proposals by Democrats and Republicans, including in the ACA…
The United Nations (UN) adopted the International Covenant on Economic, Social and Cultural Rights on January 3, 1976.
Article 12 stated:
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.
The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for
(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene;
(c) The prevention, treatment and control of epidemic, endemic, occupational, and other diseases;
(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.
This is basically a reiteration that the United Nations recognized that health care is a human right.
On November 20, 1993, the Health Security Act was introduced to the U.S. Senate. It was a health reform bill that was created while President Bill Clinton was in office. Mistakes were made.
The bill is described as: A bill to ensure individual and family security through health care coverage for all Americans in a manner that contains the rate of growth in health care costs and promotes responsible health insurance practices, to promote choice in health care, and to ensure and protect the health care of all Americans.
The University of Virginia Miller Center has information about President Bill Clinton’s effort to enact what was intended to become an a national health care package. It has also been referred to as a single-payer proposal.
…Along with the political scandals that plagued his presidency, Clinton failed to realize a major goal of his administration: affordable health care insurance for every American. The United States is the only industrialized nation in the world without a universal health care system, and Clinton felt passionately about the fact that 60 million Americans did not have adequate health insurance. In addition, health-care costs had skyrocketed since the 1970s, consuming, according to some estimates, one seventh of the nation’s goods and services – a greater proportion than that of any other industrialized country in the world. Winning a national health package would have provided Clinton with a lasting historical legacy, much as Franklin D. Roosevelt had achieved with Social Security. In the minds of some, Clinton’s health care program – if realized – would have constituted the most important piece of social legislation in American history…
There were benefits to passing health care reform. According to the Miller Center, controlling health care costs could remove a major drag on the economy. From a political standpoint, universal health care would link the middle-class and the working-class to the Democratic Party for at least another generation.
There were also obstacles. The Republican party (with a few exceptions) united in their determination to prevent President Clinton’s health care bill from passing. In addition, some Americans were worried that national health insurance was “socialistic”. They worried it would deny Americans the right to see a doctor of their choice, while placing physicians in the service of a government bureaucracy.
Are you seeing the pattern here? Those opposed to a health care bill, once again, tried to terrify Americans by calling it “socialism”. This prevented Americans from having universal health care.
It is the same old story that was pushed when President Harry Truman tried to enact a national health care plan. It is the same story that was pushed when President Barack Obama was working on “Obamacare”. (More on that in a bit.)
President Clinton created a task force to develop the health care program. He selected his wife, First Lady Hillary Clinton, to head the task force, and Ira Magaziner as its director.
…The appointment of Hillary was a serious mistake. It immediately placed the First Lady in a position of being a major policy and political power – an appointment that deviated significantly form precedent, allowing critics to attack her as well as the program. Moreover, her unique relationship with the President meant that other advisers reacted to her differently than they would to any other task-force head, not wanting to alienate the President’s wife with difficult but well-intentioned criticism. Hillary also blundered in several important ways. Her decision to recruit a task-force network of experts to work in secret on complex issues – such as health-care premiums, managed competition, and health-care alliances – looked too much like policy by cabal and fiat. A federal court forced her to make records publicly available of some of the proceedings, after some in the health-care industry sued for open access. Most importantly, the process largely left Congress out of the picture as the task force drafted the particulars of the plan, thus reducing the plan’s chance for legislative success; Clinton had wanted to present to Congress a finished package, which meant that key participants in the congressional lawmaking were not involved in its drafting. Moreover, there was significant internal disagreement within the administration about the costs of the plan, its scope, and its political marketability…
The New England Journal of Medicine posted a article titled “The American Health Security Act — A Single Payer Proposal”. It was written by Senator Paul D. Wellstone (D-Minn) and Ellen R. Shaffrer. The report was published on May 20, 1993.
Here’s how the basic operation of the system was described:
…A single public entity, the federal government, would be responsible for collecting and distributing to all the states all funds needed to pay for covered health care services in the United States. The annual health care budget could increase only as much as the gross domestic product. Each state would receive allocations based on the size and geographic distribution of its population, and on any special health needs. To allow for flexibility, states would administer the program. The state budgets would be divided into operating and capital expenses, with the share consumed by administration capped at 3 percent. Measures to improve the quality of care, as described below, would reduce unneeded services and encourage the provision of more cost-efficient primary and preventative services. The General Accounting Office has estimated that by eliminating administrative waste and shifting the system’s priorities, such a program would be well able to extend care to uninsured and underserved groups without additional expense…
The American Health Security Act was intended as a universal health care program. The report explained: “
…everyone would be covered under the same health insurance system with the same benefits, and there would be no duplicative insurance outside the system for covered benefits. Additional insurance would be permitted only for services that were not covered, such as elective cosmetic surgery. Reciprocity among states would be ensured. The link between employment and coverage would be broken. This is a critical feature of any reform — to ensure security of coverage as our mobile population moves form job to job, to ensure that everyone received the same quality of care, and to hold down administrative costs….
H.R. 3600 – Health Security Act was introduced in the U.S. House of Representatives on November 20, 1993. It was considered by a wide variety of Committees and Subcommittees between then and October 7, 1994. As far as I can tell, the bill was never voted on in the House.
S. 1757 Health Security Act was introduced in the U.S. Senate on November 20, 1993. It was read for the second time in the Senate on November 22, 1993. The Senate Committee on Finance held hearings on provisions of the bill on April 26, 1994. As far as I can tell, the bill was never voted on in the Senate.
On March 23, 2019, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA). It has also been called the Affordable Care Act (ACA) and “Obamacare”.
President Barack Obama said: “Today, I’m signing this reform bill into law on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days.”
Here are some key points of the ACA:
Improved Access to Care
- Prohibited coverage denials and reduced benefits due to pre-existing conditions
- Eliminated lifetime and annual limits on insurance coverage and established annual limits on out-of-pocket spending on essential health benefits
- Required health plans to cover dependent children up to age 26
- Prohibited retroactive cancellation of policies, except in the case of fraud, eliminating the practice of people developing costly illnesses and then losing their coverage.
- Expanded Medicaid to all previously ineligible adults with incomes under 133 percent of the federal poverty level with unprecedented federal support (the Supreme Court directed that this expansion be at the discretion of states.)
- Established a system of state and federal health insurance exchanges or marketplaces to make it easier for individuals and small-businesses’ employees to purchase health care plans at affordable prices
- Simplified health choices by requiring individual and small business plans to offer four standard categories at various costs, plus a catastrophic option for people under age 30 and people who cannot otherwise afford coverage
- Established individual responsibility by requiring all Americans who can afford insurance coverage to purchase it or pay a fee
- Established employer responsibility under which mid-size and large companies provide health coverage to their workers or contribute to their coverage through a fee
- Ensured individual and small business health plans include essential health benefits, covering emergency services, hospitalization, maternity and newborn care, preventative care such as annual physicals, and more
- Simplified eligibility and enrollment requirements in Medicaid and the Children’s Heath Insurance Program (CHIP)
- Expanded Community Health Centers and incentives for primary care providers to practice in the communities that need them most
- Create a new FDA approval pathway to advance biosimilars, which offer the potential to lower treatment costs for patients on high-cost biologics
- Provided new home- and community-based options for elderly and disabled Americans who require long-term care services
- Introduced new coverage options and other improvements for Native Americans through an improved Indian Health Service
- Created a temporary reinsurance program to sustain group coverage for early retirees prior to 2014 reforms
- Created a temporary high-risk pool program to cover uninsured people with preexisting conditions prior to 2014 reforms
- Created health plan disclosure requirements and simple, standardized summaries so consumers can evaluate coverage information and compare benefits
- Provided funding for a voluntary home-visiting program to support mothers and young children in underserved communities
- Covered HIV screening for millions without additional cost and prohibited discrimination due to pre-existing conditions like HIV
- Created a new funding pool for Community Health Centers to build, expand, and operate health-care facilities in underserved communities
- Expanded health provider training opportunities, with an emphasis on primary care, including a significant expansion of the National Health Service Corps
- Improved policy and extended funding for the Children’s Health Insurance Program, which provides coverage for millions of low-income children, in 2009, and extended those policies in 2015
Made Health Care and Coverage More Affordable
- Established financial assistance to help individuals and families who otherwise cannot afford coverage purchase it through state and federal marketplaces
- Created a tax credit for small businesses that provide health coverage to their employees
- Prohibited charging more for women to receive coverage
- Required health insurers to provide consumers with rebates if the amount they spend on health benefits and quality of care, as opposed to advertising and marketing, is too low
- Allow employer health plans to provide incentives for workers related to wellness programs
- Phases out the “donut hole” coverage gap for Medicare prescription drug coverage to save Medicare beneficiaries money
- Expanded competitive bidding in Medicare to lower costs for durable medical equipment such as wheelchairs and hospital beds
- Created new Medicare payment and delivery models to pay for the value rather than the volume of service provided, as well as the new Centers for Medicare & Medicaid Innovation to promote improvement in health care quality and costs through the development and testing of innovative health care payment and service models
- Ensured Medicare Advantage plans are paid accurately and required plans to spend at least 85 percent of Medicare revenue on patient care, while enrollment has grown by over 60 percent and average premiums have dropped by 13 percent since the passage of the Affordable Care Act
- Reduced drug costs through increased Medicaid rebates, expanded discount programs, and established a new system for approval of more affordable versions of biologic drugs
Increased Access to Mental Health Services
- Eliminated out-of-pocket costs for recommended preventative services, including depression screenings for adults and adolescents, through the Affordable Care Act
- Formed the Mental Health and Substance Use Disorder Parity Task Force to work together to ensure that Americans are benefiting from the mental health and substance use disorder parity protections under the Affordable Care Act
- Signed the Clay Hunt Suicide Prevention for American Veterans (SAV) Act, to improve mental health care and suicide prevention programs for veterans
- Issued an Executive Order to improve mental health services for veterans, service members, and military families
- Invested $100 million to improve access to mental health services
At the time I am writing this blog post, it appears that much of the information about the Affordable Care Act has been removed from the official government websites by the Trump Administration.
Fortunately, I was writing about the ACA as it was being rolled out. I wrote a blog post on Families.com titled: “Final Rules About What Health Plans Must Cover”.
The 10 Essential Health Benefits Are:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and rehabilitative services and devices
- Laboratory services
- Preventative and wellness services and chronic disease management
- Pediatric services, including oral and vision care
On August 1, 2011, the Department of Health and Human Services added additional guidelines for women’s preventative care to the previous list of preventative care. This includes well-woman visits, contraception and contraceptive counseling, screening for STDs, breastfeeding support, and domestic violence screening and counseling.
All health plans were required to offer all forms of women’s preventative care to consumers without cost sharing. This rule took affect on August 1, 2012.
Of all the attempts at reforming the health care system in the United States – the Affordable Care Act has come the closest to recognizing that health care is a human right.
Kaiser Family Foundation reported, on December 7, 2018, “Key Facts about the Uninsured Population”. It starts with this:
The Affordable Care Act (ACA) led to historic gains in health insurance coverage by extending Medicaid coverage to many low-income individuals and providing Marketplace subsidies for individuals below 400% of poverty. The number of uninsured nonelderly Americans decreased from over 44 million in 2013 (the year before the major coverage provisions went into effect) to just below 27 million in 2016. However, in 2017, the number of uninsured people increased by nearly 700,000 people, the first increase since the implementation of the ACA….
President Barack Obama was started first term on January 20, 2009. He won his second term, which ended on January 20, 2017. President Donald Trump assumed office on January 20, 2017. The number of uninsured people increased by 700,000 people in 2017.
On October 2015, the American Medical Association Journal of Ethics posted a report titled: “Promoting Health as a Human Right in the Post-ACA United States”. It was written by Andrea S. Christopher, MD, and Dominic Caruso. From the report:
…Although the ethical basis of the right to health has received acceptance internationally, it is often avoided in discussions about federal provision of health care in the US. Instead, the economic and political perspectives on health care as a human right predominate, and discussion centers on the tension between the financial burden of providing universal heath care and the primacy of the free market in the US. Mainstream political ideologies agree that the disadvantaged in society require assistance to level the playing field. However, the political parties differ on how much social service to provide. Conservatives generally argue that medical care is a commodity and therefore “able-bodied individuals” should earn the right to afford it. In contrast, liberals frequently view health insurance and access to care as basic entitlements that should be available to all.
We should also consider the powerful influence of health care stakeholders in the national dialogue about a right to health. Health care lobbyists spent an estimated $380 million dollars during the drafting of ACA legislation, with six registered health industry lobbyists for every member of Congress. Despite a lack of transparency with regard to the specific legislation promoted by this health industry spending, we can infer that most lobbyists probably did not advocate for health care as a human right. Additionally, we must acknowledge the role that physician groups have historically played in petitioning against expanding coverage. For example, the American Medical Association sponsored “Operation Coffee Cup,” in which a recording of Ronald Reagan introduced the term “socialized medicine” into our public lexicon during congressional debate about expanding health insurance coverage for the elderly in 1961…
…The focus in the US on health care financing and insurance is reflected in the ACA’s silence on a human right to health and health care. Although the ACA makes strides in reducing the number of uninsured people, it was never designed to guarantee access to health care for everyone in the US – thus neglecting a basic premise of the right to health movement…
…We must acknowledge that the movement promoting the right to health in the United States is actually a movement for universal health care, which is not an unreasonable or even particularly remarkable goal. Nearly all other member nations of the Organization for Economic Cooperation and Development (OECD) provide for the health of all citizens as a fundamental responsibility, not as a condition of employment, income, disability status, or some other criterion. The upcoming UN agreement represents both an opportunity and an imperative for the US to provide health care that is truly universally acceptable to all Americans…
…As current and future US clinicians, we share the professional responsibility to advocate for the health and well-being of our patients. Thus, we find the lack of universal health care in the world’s wealthiest country to be both an embarrassment and a touchstone for action among medical and public health practitioners. While we acknowledge the achievements of the ACA in improving health insurance coverage, we advocate for universal health coverage as a necessary component in the drive toward broad recognition of the right to health…
On December 29, 2017, the World Health Organization (WHO) posted information titled: “Human rights and health”.
- The WHO Constitution (1946) envisages “…the highest attainable standard of health as a fundamental right of every human being.”
- Understanding health as a human right creates a legal obligation on states to ensure access to timely, acceptable, and affordable health care of appropriate quality as well as to providing for the underlying determinants of health, such as safe and potable water, sanitation, food, housing, health-related information and education, and gender equality.
- A rights-based approach to health requires that health policy and programs must prioritize the needs of those furthest behind first towards greater equity, a principal that has been echoed in the recently adopted 2030 Agenda for Sustainable Development and Universal Health Coverage.
- The right to health must be enjoyed without discrimination on the grounds of race, age, ethnicity or any other status. Non-discrimination and equality requires states to take steps to redress any discriminatory law, practice or policy.
…”The right to the highest attainable standard of health” implies a clear set of legal obligations on states to ensure appropriate conditions for the enjoyment of health for all people without discrimination.
The right to health is one of a set of internationally agreed human rights standards, and is inseparable or ‘indivisible’ from these other rights. This means achieving the right to health is both central to, and dependent upon, the realization of other human rights, to food, housing, work, education, information, and participation.
The right to health, as with other rights, includes both freedoms and entitlements:
Freedoms include the right to control one’s health and body (for example, sexual and reproductive rights) and to be free from interference (for example, free from torture and non-consensual medical treatment and experimentation).
Entitlements include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health.
The WHO included details about Core components of the right to health.
Refers to the need for a sufficient quantity of functioning public health and health care facilities, goods and services, as well as programs for all. Availability can be measured through the analysis of disaggregated data to different and multiple stratifiers including by age, sex, location and socio-economic status and qualitative surveys to understand coverage gaps and health workforce coverage.
Requires that health facilities, goods, and services must be accessible to everyone. Accessibility has four overlapping dimensions: non-discrimination, physical accessibility, economical accessibility (affordability), information accessibility.
Accessing accessibility may require analysis of barriers – physical financial or otherwise – that exist, and how they may affect the most vulnerable, and call for the establishment or application of clear norms and standards in both law and policy to address these barriers, as well as robust monitoring systems of health-related information and whether this information is reaching all populations.
Related to respect for medical ethics, culturally appropriate, and sensitivity to gender. Acceptability requires that health facilities, goods, services, and programs are people-centered and cater to the specific needs of diverse population groups and in accordance with international standards of medical ethics for confidentiality and informed consent.
Facilities, goods, and services must be scientifically and medically approved. Quality is a key component of Universal Health Coverage, and includes the experience as well as the perception of health care. Quality health services should be:
- Safe – avoiding injuries to people for whom the care is intended:
- Effective – providing evidence-based healthcare services to those who need them;
- People-centered – providing care that responds to individual preferences, needs and values;
- Timely – reducing waiting times and sometimes harmful delays
- Equitable – providing care that does not vary in quality on account of gender, ethnicity, geographic location, and socio-economic status;
- Integrated – providing care that makes available the full range of health services throughout the life course;
- Efficient – maximizing the benefit of available resources and avoiding waste
On May 4, 2018, the “Report of the Special Rapporteur on extreme poverty and human rights on his mission to the United States of America” was presented to the General Assembly of the United Nations. It was presented in the thirty-eighth session of the Human Rights Council, which took place between June 18, 2018, and July 6, 2018.
It is the report of the Special Rapporteur on extreme poverty and human rights, Philip Alston. It is about his mission to the United States of America from December 1, 2017, through December 15, 2017.
The purpose of the visit was to evaluate, and report to the Human Rights Council on, the extent to which the United States Government’s policies and programs aimed at addressing extreme poverty are consistent with its human rights obligations and to offer constructive recommendations to the Government and other stakeholders.
Philip Alston met with U.S. government officials at the federal, state, county, and city levels, members of Congress, representatives of civil society, academics and people living in poverty. He received more than 40 written submissions in advance of his visit.
He visited California (Los Angles and San Francisco), Alabama (Lowndes County and Montgomery), Georgia (Atlanta), Puerto Rico (San Juan, Gyayama and Salinas), West Virginia (Charleston) and Washington D.C.
The report is well worth reading and is filled with plenty of details. Philip Alston was required to stay under a certain word count. He wrote: “The strict word limit for this report makes it impossible to delve deeply into even the key issues. Fortunately, there is already much excellent scholarship and many civil society analyses of the challenges of poverty in the United States.”
For the purpose of this blog, I’m going to pull out some portions of the report that focus on health care.
…The visit of the Special Rapporteur coincided with the dramatic change of direction in relevant United States policies. The new policies: (a) provide unprecedentedly high tax breaks and financial windfalls to the very wealthy and the largest corporations; (b) pay for these partly by reducing welfare benefits for the poor; (c) undertake a radical program of financial, environmental, health and safety deregulation that eliminates protections mainly benefitting middle classes and the poor; (d) seek to add over 20 million poor and middle class persons to the ranks of those without health insurance; (e) restrict eligibility for many welfare benefits while increasing the obstacles required to be overcome by those eligible; (f) dramatically increase spending on defense, while rejecting requested improvements in key veterans’ benefits; (g) do not provide adequate additional funding to address an opioid crisis that is decimating parts of the county; and (h) make no effort to tackle the structural racism that keeps a large percentage of non-Whites in poverty and near poverty….
…Successive administrations, including the current one, have determinedly rejected the idea that economic and social rights are full-fledged human rights, despite their clear recognition not only in key treaties that the United States has ratified, such as the Convention on the Elimination of All Forms of Racial Discrimination, but also in the Universal Declaration of Human Rights, which the United States has long insisted other countries must respect. But denial does not eliminate responsibility, nor does it negate obligations. International human rights law recognizes a right to education, a right to health care, a right to social protection for those in need and a right to an adequate standard of living. In practice, the United States is alone among developed countries in insisting that, while human rights are of fundamental importance, they do not include rights that guard against dying of hunger, dying from a lack of access to affordable health care or growing up in a context of total deprivation…
…Proposals to slash the meagre welfare arrangements that currently exist are now sought to be justified primarily on the basis that the poor need to leave welfare and go to work. The assumption, especially in a thriving economy, is that there are a great many jobs out there waiting to be filled by individuals with low educational qualifications, often with disabilities of one kind or another, sometimes burdened with a criminal record (often poverty related), without meaningful access to health care, and with no training or effective assistance to obtain employment. It also assumes that the jobs they could get will make them independent of state assistance.
In reality, the job market for such people is extraordinarily limited, and even more so for those without basic forms of social protection and support. The case of Walmart, the largest employer in the United States, is instructive. Many of its workers cannot survive on a full-time wage in the absence of food stamps…
There is a section about Adult dental care:
The Affordable Care Act greatly expanded the availability of dental care to children, but not for adults. Some 49 million Americans live in federally designated “dental professional shortage areas” and Medicare (the program for the aged and those with disabilities) does not cover routine dental care. The only access to dental care for the uninsured is through the emergency room, where excruciating pain can lead to an extraction. Even for those with coverage, access is not guaranteed, as only a minority of dentists see Medicaid patients. Poor oral hygiene and disfiguring dental profiles lead to unemployability in many jobs, being shunned in the community and being left unable to function effectively. Yet there is no universal program to address those issues, which fundamentally affect the human dignity and ultimately the civil fights of the persons concerned…
There is a section about Persistent discrimination and poverty. It includes a section on gender:
Women often experience the burdens of poverty in particularly harsh ways. Poor pregnant women who seek Medicaid prenatal care are subjected to interrogations of a highly sensitive and personal nature, effectively surrendering their privacy rights. Low-income women who would like to exercise their constitutional, privacy-derived right to access abortion services face legal and practical obstacles, such as mandatory waiting periods and long driving distances to clinics. This lack of access to abortion services traps many women in cycles of poverty. When a child is born to a woman living in poverty, that woman is more likely to be investigated by the child welfare system and have her child taken away from her. Poverty is frequently treated as a form of “child neglect” and thus case to remove a child from the home, a risk exacerbated by the fact that some states do not provide legal aid in child welfare proceedings.
Racial discrimination makes matters worse for many poor women. Black women with cervical cancer – a disease that can easily be prevented or cured – have lower rates than White women, due to later diagnosis and treatment difference, owing to a lack of health insurance and regular access to health care. The United States has the highest maternal mortality ratio among wealthy countries, and black women are three to four times more likely to die than White women. In one city, the rate for Blacks was 12 times higher than that for Whites…
There is a section on “Confused and counterproductive drug policies”:
The opioid crisis has devastated many communities, and the addiction to pain-control opioids often leads to heroin, methamphetamine and other substance abuse. Instead of responding with increased funding and improved access to vital care and support, the federal Government and many state governments have instead mounted concerted campaigns to reduce and restrict access to health care by the poorer members of the population…
The Special Rapporteur on extreme poverty and human rights, Philip Alston, provided conclusions and recommendations. The one related to health care says:
Recognize a right to health care
Health care is, in fact, a human right. The civil and political rights of the middle class and the poor are fundamentally undermined if they are unable to function effectively, which includes working, because of a lack of the access to health care that every human being needs. The Affordable Care Act was a good start, although it was limited and flawed from the outset. Undermining it by stealth is not just inhumane and a violation of human rights, but an economically and socially destructive policy aimed at the poor and the middle class.
The World Population Review posted information about “Countries With Universal Healthcare 2019”.
The following countries have universal health care policies in place:
Albania, Algeria, Andorra, Antiqua and Barbuda, Argentina, Australia, Austria, Bahamas, Bahrain, Barbados, Belarus, Belgium, Belize, Bhutan, Bosnia and Herzegovina, Botswana, Brasil, Brunei Darussalam, Bulgari, Burkina Faso, Canada, Chile, China, Columbia, Cook Islands, Costa Rica, Croatia, Cuba, Cypres, Czech Republic, Denmark, Ecuador, Eritrea, Estonia, Fiji, Finland, France, Gabon, Georgia, Germany, Ghana, Greece, Gurnsey, Guyana, Hong Kong, Hungary, Iceland, Iran, Isle of Man, Israel, Italy, Jamaica, Japan, Jersey, Kazakhstan, Kiribati, Kuwait, Lativa, Liechtenstein, Lithuania, Luxembourg, Macau, Macedonia, Malaysia, Maldives, Malta, Mauritius, Mexico, Moldova, Monaco, Montenegro, Namibia, Netherlands, New Zealand, Niue, Oman, Pakistan, Palau, Panama, Peru, Poland, Portugal, Qatar, Romania, Russia, Rwanda, Saint Lucia, Saint Vincent and the Grenadines, Somoa, San Marino, Saudi Arabia, Serbia, Seychelles, Singapore, Slovakia, Slovenia, South Korea, Spain, Sri Lanka, Sweden, Switzerland, Taiwan, Thailand, Timor-Leste, Tonga, Trinidad and Tobago, Tunisia, Turkey, Tuvalu, Ukraine, United Arab Emirates, United Kingdom, Uruguay, Uzbekistan, Vanuatu, Venezuela, Zambia
Does this mean that all of these countries are shining examples of protectors of human rights in every way? Not necessarily. Some come much closer to that ideal than others do. The understanding that health care is a human right is one thing they all have in common.
You may have noticed that the United States is not on the list of countries that have universal health care. This is a huge problem, and needs to change as quickly as possible.
Health care is a human right. The Neanderthals knew it. People who follow Christianity should know it (and many do). Every person who has gotten seriously ill or injured, or who has a loved one in that situation, knows intrinsically that health care is a human right.
Many United States presidents knew that health care is a human right and tried their best to enact policies that would make that right a reality.
The human right to health care includes all forms of physical health care (including eye care, dental care, addiction care and reproductive health care). It includes mental health care – everything.
All humans have a right to health care no matter how much money the person makes, their race, their gender, where they live, where they work, their economic background, who they voted for in previous United States elections, or anything else.
The United States is one of the wealthiest countries in the world. There is no valid reason why this country has failed to live up to its responsibility to ensure that everyone gets all of the health care that they need. Health care is a human right. It always has been. It always will be.
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