Healthcare as a Civil Right – Forgotten
In honor of the 50th anniversary of the March on Washington and Dr. Martin Luther King Jr.’s “I Have a Dream” speech, Dan Munro wrote a timeless column in Forbes reminding us that King saw healthcare as a civil right. Sadly, we have made little progress on healthcare inequality, with roughly 50 million Americans without health insurance and another 40 million under-insured.
The Affordable Care Act (Obamacare) relieved some of that, with the individual mandate to buy healthcare insurance and subsidies for low-income Americans. But individual states are still allowed to choose whether or not to support and fund a key component of the ACA – Medicaid expansion. Many will, but some won’t. And many doctors have walked away from taking Medicaid patients. Some have abandoned Medicare patients too.
Universal Healthcare
Every other industrialized country adopted some form of “universal coverage” as the very foundation of their healthcare system, recognizing it as a civil right. So why haven’t we?
In a single word: FEAR. That excuse seems to be based on three strong beliefs:
- The false assumption that universal coverage is Government run healthcare and thus bureaucratic and wasteful. It’s neither.
- An attitude of American “Exceptionalism” that assumes no other nation can teach us anything.
- The myth that anyone can rise out of poverty to become rich and prosperous through hard work and determination. We praise all who do but scorn those who don’t, labeling them losers who don’t deserve free healthcare provided by others.
The article prompted an online discussion in one of my LinkedIn groups, and I thought my response was worth sharing.
My Response
I think Fear of Helping Losers is a smoke screen – part of an intentional misinformation campaign among those with a lot to lose from a universal healthcare system. The real fear in my view is the loss of revenue if such disruptive ideas are implemented and successful. My response to another LinkedIn group on The Future of Healthcare seems to apply here too. (excuse the length) …
CORPORATIONS measure success in business terms like Profit, ROI, and Payback Period and thus look at relatively short-term investments that show strong shareholder returns. Corporations, by their very nature and even their legal mandate, have a primary objective of serving the interests of shareholders, not the interests of society. That’s why, if viewed as a person and evaluated based on personality profile testing, they generally behave as sociopaths. (See www.mhealthtalk.com/2012/07/corporate-behavior-and-rising-health-care-costs/.)
GOVERNMENTS in place to serve society measure success from investments differently and generally over much longer time periods. That’s why infrastructure investments (highways & bridges, sea and airports, public utilities, public education, basic research, etc.) often make more sense for governments – both to benefit all of society and to promote competition, which again serves all of society. If FedEx built the roads and charged tolls, for example, could they price out their competition: UPS & US Postal? If American Airlines built the airports, would Delta even be allowed to land there?
There obviously are pros & cons of the different incentives of public & private organizations, and an ideal healthcare system would recognize that and work to maximize the strengths of both. (See www.mhealthtalk.com/2012/08/hybrid-model/.) If a hybrid public/private model actually reduced our $4.3 trillion/year of healthcare expenses by half, to match what other industrial nations pay, then over $2 trillion could go into the economy elsewhere. But how likely is that?
Disruptive health reform is unlikely since SOMEBODY will no longer get their part of the $2 trillion, and they’ll scream bloody murder. The incumbents will naturally and fiercely defend their current positions and oppose any public health care initiatives. They’ll fight to keep their profits and argue that much of it will trickle down to others somehow. Yeah, right.
Public Health as an Engine of Economic Growth
A Harvard Business Review article in 2004 found that “employers are beginning to realize that they face a nearly invisible but significant drain on productivity: presenteeism.” It’s a problem of workers’ being on the job but, because of illness or other medical conditions, not fully functioning. Seasonal allergies, headaches, and lack of sleep are all examples that affect one’s ability to concentrate, and thus their performance. Presenteeism can decrease productivity by a third or more. It appears to be a much costlier problem than its counterpart, absenteeism. And, unlike absenteeism, presenteeism isn’t always apparent: You know when someone doesn’t show up for work, but you often can’t tell when—or by how much—illness or a medical condition is hindering their performance. That’s why I look as public health as an engine of economic growth and worth good public policy.
Ideally, government would work to serve all of society by developing a skilled, healthy and productive workforce that adapts easily to tech innovation and skills obsolescence. Ideally, they’d be paid well enough to create market demand for the goods and services they create. Such policies would also promote wellness and healthy lifestyles to minimize the need for medical care, provide equal opportunities, and drive economic benefits across all social and socioeconomic sectors. But instead of that, our government subsidizes agribusiness and processed foods, big oil and the resulting environmental contamination, and Wall Street, all of which contribute to rising healthcare costs and limited productivity.
When was the last time our government undertook a major infrastructure project or actually served society instead of plutocracy? Today’s politics, and the corrupting influence of powerful special interest lobbying, has divided our nation to the point that creating the ideal healthcare system, or the ideal government, seems impossible.
ABOUT THE AUTHOR
Wayne Caswell is a retired IBM technologist, futurist, market strategist, consumer advocate, sleep economist, and founding editor of Modern Health Talk. With international leadership experience developing wireless networks, sensors, and smart home technologies, he’s advocated for Big Broadband and fiber-to-the-home while also enjoying success lobbying for consumers. He considers himself independent, but leans left to support progressive policies. (contact & BIO)
RELATED ARTICLES:
Medicare-for-All is a beginning, but Not Enough — New Koch-funded study finds that Bernie’s Medicare-for-All plan would cost the government $32 trillion over 10 years, but that’s LESS than the >$3.5 trillion/year we pay now.
Watch this TED Talk about Poverty, asking “What if our healthcare system kept us healthy?” https://www.youtube.com/watch?v=BoRUrWcdkQ4
Thanks, Bill, for visiting this site and sharing your views. As we consider our healthcare system and how to reform and improve it, we as a nation must have a respectful conversation and decide on our values and what’s important to us.
I personally love medical ethics debates, including how do we decide who gets an organ transplant. Is it based on their wealth, age, potential contribution to society, how long they’ve been waiting in line, or some other factor? These are all tough questions, and you rightful ask about the issue of healthcare as a right. Deciding that issue may help lead us toward other policy decisions, including whether or not to promote Medicare for All or some other form of universal healthcare. Other nations that have done that pay considerably less as a percent of GDP and deliver better care quality by almost every measure. If we don’t go that direction, what other options might we explore to contain the rising medical costs, which will surely get much worse as boomers enter retirement age?
My reluctance to declare health care to be a right has nothing to do with fear; rather, it has to do with the definition of a “right”. A right is something that is innate to a person. One’s right to free speech belongs to one whether in a crowded city or on a desert island (granted that there is no one to hear it). But one’s right to speak freely, or to exercise freedom of the press, does not require that a government agency, or one’s neighbors, provide the megaphone or the printing press.
I would agree that people have a right to health care in that the government should not interfere with anyone’s right to obtain health care at their own expense, nor to force someone to be “cared for” in a way they do not consent to. But if we say that a person has a right to health care, that creates an obligation on the part of someone else to provide that care. Does the man on the desert island have a right to health care, even though there is no doctor? On the edges of this debate, could the state force medical professionals to provide care for patients who need it for free?
It seems perfectly reasonable to argue over whether or not people might be granted an entitlement of health care, but rights imply something that is inherent in the individual and must not be interfered with, rather than something that must be granted to the individual by someone else.