Health Care Reform: Back to Human Rights Basics

In a turbulent week in U.S. politics that saw the president abandoning his promise of universal health insurance and the Supreme Court elevating corporate spending in elections to a human right – protected as free speech in the same way as human speech – human rights activists should take solace in the fact that giving up pretensions can be the first step to real change.

This is particularly important for human right to health care activists who have long been dismayed with market-based health care proposals that blatantly fail to satisfy basic human rights standards. There was perhaps only one policy measure the U.S. needed even less than the opening of floodgates for vast new corporate political spending, and that was a health “reform” bill funneling millions of new customers to the for-profit insurance industry and billions in subsidies into the coffers of the…wait for it…very same industry. If this bill, in its Senate and House versions, now appears threatened by the Democrats’ loss of one Massachusetts Senate seat, a new opportunity has emerged to call for simple but meaningful health reform measures based on human rights.

Many activists and advocacy organizations, including Amnesty, have consistently pointed to the fundamental flaw underlying the approach adopted by health reformers in DC, and urged them to treat health care as a human right, not a commodity. Yet the reform bills failed to meet the human rights principles of universality, equity, and accountability. Rather than guaranteeing universal health care, they excluded many millions of people from access to coverage and care. Instead of ensuring that care would be available for those who need it, the bills made access for most people contingent on their ability to purchase a private insurance plan. And rather than holding the private sector accountable for protecting the right to health, the bills perpetuated the industry’s focus on their bottom line.

The rapidly faltering popularity of this market-based approach creates a new opening for demanding simple but systemic policy changes that move the U.S. system toward treating health care as a public good shared equitably by all. A Medicare-like public health insurance program for everyone in the U.S. could guarantee progressively financed, publicly accountable, and fiscally sustainable universal coverage. Therefore, building on the success of Medicare and expanding it to more and more people below the age of 65 can be a key component of a rights-based reform strategy. It is equally important to secure and expand the health rights of poor and low-income people through guaranteed public coverage provided by Medicaid and the Children’s Health Insurance Program (CHIP). Without a progressive expansion of publicly financed and administered health care, it will remain virtually impossible to ensure that people’s health needs are prioritized over market incentives to deny access to care.


Happy birthday, Medicare!

July 30, 1965: President Lyndon Baines Johnson signs Medicare into law. Also seated is President Harry Truman, recipient of the first Medicare card.

July 30, 1965: President Lyndon Baines Johnson signs Medicare into law. Also seated is President Harry Truman, recipient of the first Medicare card.

Medicare turns 44 years old today. It’s in good health.

The program remains efficient — Medicare’s administrative costs are about three percent, much less than that of employer-based private insurance (five to ten percent of premiums for large companies, 25 to 27 percent for small ones) or individual private insurance (40 percent of premiums). Medicare, of course, doesn’t devote administrative dollars to denying coverage or claims on a case-by-case basis. Also, unlike the private insurance industry, it doesn’t seek out profits.

And Medicare remains popular, so much so that weakening it is a legislative third rail that health care reformers are finding they have to avoid at any cost. That’s true even if some of its biggest fans are confused about how it works:

At a recent town-hall meeting in suburban Simpsonville, a man stood up and told  Rep. Robert Inglis (R-S.C.) to “keep your government hands off my Medicare.”

“I had to politely explain that, ‘Actually, sir, your health care is being provided by the government,'” Inglis recalled. “But he wasn’t having any of it.”

Actually, Inglis doesn’t have it right either: Medicare is national government financing for health care, not government provision of health care. Medicare-financed health care is provided by private doctors, clinics and hospitals. Medicare is an example of what journalist T. R. Reid calls the National Health Insurance model, like the health care systems of Canada, Taiwan and South Korea. Canada, in fact, calls its system “Medicare” too.

Here in the United States, Medicare is a model for treating health care as a public good rather than a commodity: a system in which benefits and contributions are fairly shared, one that works for everybody, rather than one in which health care is something to be bought and sold — and tough luck for those who can’t afford it. Medicare is like a fire department that protects everyone’s house — like the fire departments we actually have in this country. The private parts of our health care financing system are like fire departments that only protect the houses of people who can afford to pay.

The current health care reform process offers an opportunity to move towards establishing health care in this country as a public good and a human right. A key step is establishing a new Medicare-like public health care plan that guarantees access for all, something we’re calling on Senate leaders to do.

The Senate is the key battleground now. Of all the Congressional committees with health care jurisdiction, the Senate Finance Committee is least hospitable to a public plan, and has yet to pass a bill. The eventual Finance Committee bill faces a bruising reconciliation with the Health, Education, Labor and Pensions Committee bill that’s already passed. And there will be a further fight when the full Senate debates and votes on the merged bill. In honor of Medicare’s birthday, tell Senators Baucus (chair of the Finance Committee), Dodd (HELP vice chair, running the committee with chair Ted Kennedy ill) and Reid (majority leader) to ensure the final Senate bill provides a Medicare-like public health care plan for all.

Over the looming August recess — the Senate is scheduled to adjourn next Friday, August 7 — everyone with a vested interest in keeping health care a commodity will be working as hard as possible to close the window on a new Medicare-like public plan. Which makes the delaying tactics we’re seeing on the Hill that much more galling. Health care legislation doesn’t have to take this long. In 1965, after all, in the first year of Johnson’s second term, Congress passed Medicare in late spring, in time for the president to sign it into law on July 30 — 44 years ago today.

What's So Funny About Universal Healthcare?

Yesterday someone emailed me a link to a mock NYT article, National Health Insurance Act Passes.  I’m embarrassed to confess: I fell for it, hook, line and sinker. I believe that universal health care is one of the most important issues of our time, so, for a minute, as I read the first few paragraphs, I was elated. And then I noticed the date: July 4, 2009.

The United States National Health Insurance Act really does exist. Representative John Conyers first introduced the bill (H.R. 676) in 2003. Today there are 93 cosponsors. The bill would create a publicly financed, privately delivered health care system for all, essentially expanding the U.S. Medicare program.   It would be what is described as a “single payer” system.

Polls show that some sixty-four percent of Americans want the U.S. to adopt universal health insurance. Fifty-four percent support a single payer system, as do 6 in 10 physicians. President-elect Obama has said that he would  consider a single payer health care system if he were designing a system from scratch.

So why does the idea of “Medicare for all” seem so far-fetched?  Is it really on “that’ll never happen” par with Donald Rumsfeld tearfully admitting on “The View” that “the whole torture thing wasn’t such a good idea” (as reported in another mock NYT article)?

Are we intimidated by the prospect of confronting a powerful insurance lobby? Is the stumbling block the “socialized medicine” label that opponents are quick to throw around?

I’ll confess one other thing: the article left me feeling energized in a surprising way.  For a moment, I felt what it would be like to learn that Congress had taken a genuinely groundbreaking step to ensure that no one falls between the cracks. That the right to health care would finally be something people enjoy and not just hear about in debates. That 18,000 people wouldn’t die that year because they couldn’t afford care. That hundreds of billions of dollars wouldn’t be diverted from health care to administration while policymakers talk about having to make hard choices about who can be covered. And that hundreds of thousands of people wouldn’t be forced into bankruptcy or homelessness by crushing medical bills.

So what do you think? Can we make universal healthcare a reality in the United States?

Learn more about what activists in the U.S. are doing to bring about universal healthcare:


Health Care for America Now


Human Right to Health Care