By Ronald Pies, M.D.
OpEdNews, March 13, 2011
In a recent piece in the Boston Globe, David Abel described a 52-year-old woman named Ona Stewart. Despite being deaf and blind, she is able to live independently, and earn a living by making pottery. Ona Stewart has no family in the area, and relies on a state-funded program that provides aides who help her communicate, shop, and run errands.
But now, the proposed Massachusetts budget for 2012 eliminates funding for this program — threatening to leave the DeafBlind Community Access Network high and dry. For people like Ona Stewart, this could mean “dangerous risks to safety,” possible hospitalizations due to failing health, “and institutionalizations,” according to Sharon Applegate, executive director of Deaf, Inc., which oversees the aid program.
Ona Stewart’s plight is just one forlorn strand in the unraveling fabric of the American health care system — if “system” is not too generous a term. Despite our tremendous progress in medical research and technological innovation, our health care system is not taking care of those who need it most: the very poor and sick, whose friends, family, or community cannot or will not help them.
Far from having “the best health care system in the world” — as some politicians persistently claim — our system is failing in the most basic measures of medical care. For example, according to a 2002 study by the Institute of Medicine, 18,000 Americans die every year because they don’t have health insurance. And, in a recent Commonwealth Fund-supported study comparing “preventable deaths” in 19 industrialized countries, researchers found that the United States placed last.
Our failures in health care are not for lack of spending. As Victor Fuchs, Ph.D., of Stanford University recently noted in the New England Journal of Medicine (Dec. 2, 2010), the U.S. government currently spends more per capita for health care than eight European countries spend from all sources on health care. And yet, life expectancy at birth in every one of these eight countries is higher than that in the U.S. The huge amount of money spent on administrative costs in the U.S. — rather than on direct care — is a major factor in these cross-national disparities.
Furthermore, as the Center for Economic and Social Rights notes, “Although the United States offers coverage for the very poorest Americans through Medicaid, this fails to reach millions of Americans who do not qualify as the ‘poorest’ but still have far too little money to afford purchasing their own health insurance and do not have access to it through employment.”
Yes, emergency rooms are obligated to provide critical care to all — but poor patients with cancer or chronic renal failure cannot be safely and effectively treated in emergency rooms. And the “free” care provided to indigent patients in the ER simply means that costs are shifted to some other part of the system. The organization Physicians for a National Health Program — consisting of 18,000 physicians, medical students and health professionals — have put the economic issues in a harsh but realistic light:
“Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all. Only a single-payer plan can assure truly universal, comprehensive and affordable care to all. By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs. That’s enough to cover all the uninsured and to upgrade everyone else’s coverage without having to increase overall U.S. health spending by one penny.”
That said, the core issue underlying the plight of American health care is not economic, but moral: rather than regarding health care as a basic right, the U.S. sees it as a privilege — one available only to those who can afford it, or who are fortunate enough to have adequate insurance coverage. This view flies in the face of many religious teachings and traditions. Thus, Rabbi Elliot Dorff, a pre-eminent authority on Jewish medical ethics has written:
“The fact that more than 40 million Americans have no health insurance is, from a Jewish point of view, an intolerable dereliction of society’s moral duty. The Torah, the Prophets, and the Rabbis of our tradition all loudly proclaim that God commands us to take care of the poor, the starving and the sick. We are duty-bound to find a way for all American citizens to be able to afford health care, for all American citizens.”
To be sure, some right-wing Christian groups have castigated health care reform as a betrayal of “God’s plan,” and as an impious embrace of an over-expansive government. Yet the Catholic Church has been unequivocally on the side of health care as a basic human right. Cited in the National Catholic Reporter (9/18/09), Bishop William Murphy, chair of the U.S. Bishops’ Committee on Domestic Justice and Human Development, writes:
“Reform efforts must begin with the principle that decent health care is not a privilege, but a right and a requirement to protect the life and dignity of every person. … The bishops’ conference believes health care reform should be truly universal and it should be genuinely affordable” (italics in original).
Indeed, the teaching that health care is a right rather than a privilege was articulated by Pope John XXIII in his encyclical, Pacem in Terris (Peace on Earth), published in June 1963. And just three years later, at a Convention of the Medical Committee for Human Rights held in Chicago, the Rev. Martin Luther King Jr. declared: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”
Whatever the religious controversies, it is beyond dispute that the U.S. stands virtually alone among wealthy and industrialized nations, in failing to consider health care as a basic right. Ironically — and some might say, hypocritically — the United States is a signatory to the Universal Declaration of Human Rights, adopted by the General Assembly of the United Nations, and signed by 48 countries. Article 25 of the UDHR stated that “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.”
Indeed, in October 2008, President Obama affirmed that health care should be a right, not a privilege, consistent with the principles of the UDHR, as well as with those of Amnesty International and numerous international covenants.
Of course, even basic, human rights are not absolute, and health care must be provided in accordance with sound medical judgment and fiscal realities. A right to basic health care means that the government is morally obligated to do all within its means to ensure that medically necessary care is accessible and affordable to all. It does not obligate the government, or physicians, to provide free face-lifts and tummy tucks on demand.
Indeed, there is really no such thing as “free” health care; rather, universal health care is made feasible through shared societal responsibility, in the form of a publically financed, single-payer insurance system.
It is impossible to “prove” that health care is a basic human right. There is no empirical investigation or experiment that can demonstrate the truth of this claim. Rather, it comes down to the kind of nation and world we wish to live in.
As physician and anthropologist Dr. Paul Farmer has said: “I can’t show you how, exactly, health care is a basic human right. But what I can argue is that no one should have to die of a disease that is treatable.” It is time for the U.S. to embrace Dr. Farmer’s view, and
to enact a health care policy worthy of this country’s highest moral principles.
Ronald Pies, M.D., is professor of psychiatry and lecturer on bioethics at SUNY Upstate Medical University, Syracuse, N.Y., and clinical professor of psychiatry at Tufts University School of Medicine in Boston. He is the author of several textbooks, a short story collection, a collection of poems and books on philosophy and ethics.
By Ronald Pies, M.D.