In 1943, President Franklin D. Roosevelt proposed a “Second Bill of Rights” for Americans, declaring “freedom from want” to be one of four essential liberties necessary for human security. Roosevelt’s definition of freedom included “the right to adequate medical care and the opportunity to achieve and enjoy good health.” The right to health was subsequently enshrined in the Universal Declaration of Human Rights.
Unfortunately, the United States turned its back on Roosevelt’s vision, and as a result our health care system is in a state of ever-deepening crisis. Despite spending far more per capita on health care than any other country, the U.S. has some of the poorest health indicators in the industrialized world. It is the only industrialized nation to deny its citizens universal access to medical services.
Fully one-third of the population lacks health insurance for at least part of the year. Of the 44 million who are completely uninsured, 78.8 percent work full or part-time and spend $80.1 billion out of their own pockets to cover health costs. The lack of available care is especially acute for those living in rural areas and for minorities. The disparities are so stark that whites in the U.S. are expected to live six years longer on average than African Americans.
This record can be largely attributed to the notion that health care is simply one commodity among others, a privilege for those who can afford it rather than a fundamental human right for all. With a system that values profits over people, it is no surprise that health care costs continue to spiral out of control for ordinary Americans even as HMOs and pharmaceutical companies accumulate record-breaking profits.
Only a new approach recognizing the right of every American to adequate health care can address the magnitude of the current crisis. Using international human rights principles as a framework for health care reform in the U.S., a new report from the Center for Economic and Social Rights gives four basic recommendations:
• Health care policy needs to be about the right to health. The current debate over health care reform tends to bog down in ideological disputes and arguments over economic efficiency. In contrast, a human rights approach would focus on the underlying purpose of the health care system. Framing health care reform as a matter of right establishes a mechanism for government accountability and encourages public participation.
• The health care system needs to be simplified. The current system has become bewilderingly complex, making it more difficult than ever for individuals to access health care. With federal, state, and private funding sources, hundreds of individual insurance plans to choose from, and different referral procedures for different types of delivery systems, obtaining basic care has become a bureaucratic nightmare. Despite the vast array of putative “choices,” the U.S. health care system frequently delivers inadequate and poor quality health care, and entails wasteful expenditures on administrative and litigation costs.
• Health care must be universally available and accessible. Basic human rights principles hold that health care must be accessible and affordable to all, irrespective of race, gender, religion, geography, and income. The increasing costs of providing services combined with the waste and inefficiency apparent in the current system result in fewer and fewer people having access to basic health care. Policymakers must ask at the outset how well a given plan will work to cover all — not most, or more, but all — people in this country.
• Quality and diversity must increase, including cultural sensitivity. Quality enforcement and measurement must be part of any reform plan. Moreover, minorities in the U.S. receive even poorer health care thanks to dramatically lower rates of minority health providers, lack of health services, and systematic discrimination. Under-representation of minorities in the health care workforce must be addressed, and proactive measures must be taken to reverse discriminatory practices and inequalities built into the current health care system.
Today, the human rights movement can provide a universal and populist language for the cause of health care reform. The time has come for the U.S. to fully recognize the universality of all human rights through a health care system that fulfills Franklin D. Roosevelt’s vision of freedom for all.
— Excerpted from “The right to health in the United States of America: What does it mean?”
Center for Economic and Social Rights, www.cesr.org.
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