Health Care is a Human Rights Issue

By Ronald W. Pies, MD | November 15, 2010

Some see health care as a political or economic issue. They are correct, of course, on one level. But I believe that health care is fundamentally a moral issue; indeed, a matter of basic human rights. I do not believe that a nation as rich as ours (albeit with most wealth concentrated among the upper income levels) can shirk its moral responsibilities in the matter of providing basic health care for all its citizens. This doesn't mean that everybody who wants a face-lift should get one on the taxpayer's dime: I am talking about providing all citizens with the most basic health care, required to sustain life and limb. And, yes: I believe this is a right that any citizen may claim, particularly in a country purporting to be “civilized.”

I am hardly alone in this view, nor is my position new. In 1948, the General Assembly of the United Nations adopted The Universal Declaration of Human Rights, article 25 of which states:

“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 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.”

I don't pretend to be an expert on health care economics, and I am aware of significant logistical problems in some countries that provide health care to all their citizens; e.g., very long waiting lists for elective procedures. I am not advocating the infamous “government takeover” of health care that has been so much a part of recent political diatribes from some quarters. Rather, I favor a single-payer national health insurance system. One ambitious proposal describes this as

“...a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would [retain] free choice of doctor and hospital, and doctors would [retain] autonomy over patient care.” —Source: Physicians for a National Health Program

I would urge all psychiatrists to read over the FAQ section of this website. The PNHP site also notes the following:

“A number of studies (notably a General Accounting Office report in 1991 and a Congressional Budget Office report in 1993) show that there is more than enough money in our health care system to serve everyone if it were spent wisely. Administrative costs are at 31% of U.S. health spending, far higher than in other countries' systems. These inflated costs are due to our failure to have a publicly financed, universal health care system. We spend about twice as much per person as Canada or most European nations, and still deny health care to many in need. A national health program could save enough on administration to assure access to care for all Americans, without rationing.” —Source: Physicians for a National Health Program

On the specific issue of mental health care, we have a long way to go as a nation. For example, many patients with depression—particularly some minority groups—are not being provided adequate care. Contrary to the much-ballyhooed claim that “depression is over-treated” in this country, a recent study¹ suggests that many Americans with clinical depression are not getting any kind of care at all. As the lead author, Hector Gonzalez, MD, put it in an interview with the Wall Street Journal, ““Few Americans with depression actually get any kind of care, and even fewer get care consistent with the [best practice] standards of care.”² Gonzalez and colleagues found, in particular, that Mexican American and African American individuals meeting 12-month major depression criteria “…consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies.”¹

In this country, according to a 2002 study by the Institute of Medicine, 18,000 Americans die every year because they don't have health insurance.³ Almost certainly, some of these individuals die by their own hand, owing to untreated major depression. This is simply unconscionable, particularly in the nation with the highest GDP in the world. Recent changes in health care coverage will improve things for many thousands of Americans,⁴, but much more must be done. A publicly financed, universal health care system, while not without its own costs and problems, is worth trying—and is surely preferable to our current health care debacle. It is also the right thing to do.

For the Couch in Crisis blog that prompted Dr. Pies' commentary, please see Diagnostic Criteria for PIISD – Private Insurance Induced Stress Disorder.

References
1. González HM, Vega WA, Williams DR, et al. Depression care in the United States: too little for too few. Arch Gen Psychiatry. 2010;67:37-46.
2. Wang SS. Studies: Mental Ills Are Often Overtreated, Undertreated. Wall Street Journal. Jan. 5, 2010. http://online.wsj.com/article/SB10001424052748703580904574638750777038042.html. Accessed November 15, 2019.
3. Care Without Coverage: Too Little, Too Late. http://www.iom.edu/Reports/2002/Care-Without-Coverage-Too-Little-Too-Late.aspx. Accessed November 15, 2019.
4. U.S. Department of Health and Human Services. Understanding the Affordable Care Act: Introduction. http://www.healthcare.gov/law/introduction/index.html. Accessed November 15, 2019.

by Carol Paris | December 19, 2010 10:13 PM EST

My sentiments align with Dr. Pies and Frances Spikerman - Health Care is a human right. But I suppose we also have the "right"to think whatever we want to think...free will. I choose to think thoughts, and be motivated by thoughts, that resonate with my true self...the person I truly want and mean to be...kind, compassionate, grateful. Yes, I have my fair share of judgmental, critical, angry, reactive thoughts, but they don't feel good and they certainly don't resonate with my true self. So I don't take them seriously, I don't act on them, and I'm grateful when they pass. What does this have to do with health care reform? I wonder what kind of legislation would have been enacted if all the "stakeholders" were motivated by their true self, their innate wisdom, their compassionate goodwill?

by Mark Walter | December 18, 2010 12:38 PM EST

Foundational charity??? I haven't seen a case yet where a liberal didn't step away from personal charity when exhorted to it. Again, it's only fun to spend if it's someone else's money and if the spending occurs in a way that is dictated by the liberal self-imagined elite. And psychiatrists shouldn't begin talking about unalienable rights, much less "foundational ones"when their own professional organization, the APA, prints an anti-life position statement on the issue of elective abortion. You cast a vote toward killing unborn children and then you want to tire the nation with talk about how you believe their tax dollars should be spent on the foundational right of healthcare??? In this case, we shouldn't be talking about foundational rights at all, but foundational principles. The field of Psychiatry is in sore need of repair before it completely steps off into liberal oblivion. That sentiment does not apply to all psychiatrists, as I'm encouraged by the occasional sensible psychiatrist that I meet and the majority of non-psychiatrist physicians who continue to oppose Obamacare. But there's a point for the rest of the world to see. AMA's own liberal estimate about the percentage of American doctors that hold membership in their organization is at 29%; a more factual estimate is about 17%. There's a good reason for this. You only belong to a professional organization if that organization represents the professional interests of that profession. Simple. That's what a professional society is supposed to do. It's not intended to me the mouthpiece for a particular political party or political action group; it's not even meant to be a human rights organization. The majority of America's doctors vote on a professional society by use (or not) of their checkbooks.

by Ronald Pies | December 17, 2010 5:40 PM EST

I thank Mark Walter and Frances Spickerman for their comments, and I appreciate that this is a
very contentious issue. The Walter-Spickerman exchange brings with it a strong sense of déjà vu,
as I have seen similar arguments on both sides of the question, having done several blogs for THCB
[thehealthcareblog; see
www.thehealthcareblog.com/the_health_care_blog/ronald-pies and
http://www.thehealthcareblog.com/the_health_care_blog/2010/12/american-healthcare-x-.html).

 My sympathies lie entirely with Frances Spickerman's position. I have no interest in rehashing my arguments against the Libertarian Party position, which I criticize in both my THCB blogs. I also
want to clarify that I am not an apologist for so-called "Obamacare", though I think it contains
some small, positive elements that represent a tiny step forward. Rather, I have advocated a
publicly-funded, single-payer plan, as described by on the PHNP website [http://www.pnhp.org/].
I believe that if Mark Walter reads the FAQ section of this website in detail, he will see that the PNHP plan is quite different than the health care law recently enacted, whatever its constitutional merits or demerits (which ultimately will be decided by the US Supreme Court).

I approach the issue of health care from the framework of bioethics and "natural rights", which
converge on the question, "Is the provision of basic health care a fundamental responsibility of
government?"My answer is an unequivocal yes-the general libertarian position is equally forceful
in its opposition to this claim. Let's be clear: there is no "experiment", study, investigation, or scientific discovery that can answer the question as I have phrased it-the same goes for the broader question, "Is a basic level of health care a human right?" Ultimately, the answer we give to this question depends on the kind of world and nation we want to live in, and on what powers and responsibilities we impute to government (federal, state, or local) as distinct from those of
the individual.

We are all entitled to our own opinions on these matters, but we are not entitled to our own facts.
And on the medical facts of the matter, there is simply no question: the American "system" of health
care is failing its most vulnerable and needful citizens. I could cite a dozen or more studies supporting
this claim, but I would suggest beginning with the recent Commonwealth Fund Study [G. F. Anderson and
D. A. Squires, Measuring the U.S. Health Care System: A Cross-National Comparison, The Commonwealth
Fund, June 2010]. Another study of our poor showing with regard to "amenable mortality" is found at:
http://content.healthaffairs.org/content/27/1/58.abstract?ijkey=05uD000683MNE&keytype=ref&siteid=healthaff

And, notwithstanding Mark Walters' disdain for the U.N., I do think readers should look at the recent
report from UNICEF on the comparative health of children in various wealthy nations. Once again, we in
the US are not doing a very good job. www.unicef-irc.org/publications/pdf/rc7_eng.pdf 

On the matter of "human rights", "natural rights", etc., I will simply make one comment. It is extraordinary to me that most Americans are more than willing to endorse the ringing statement in the Declaration of Independence-that all persons "…are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness"-but that some strongly deny that basic health care is also a fundamental right.
As a physician, I do not understand how one can maintain "life"-much less pursue happiness!-if one is afflicted with lung cancer and can't afford surgery; or if one has chronic schizophrenia and can't affordmedication. Saying that we are entitled to life and the pursuit of happiness but not basic health care is like telling a drowning man he is entitled to be on
dry land, but refusing to throw him a life preserver! It is like granting individuals the right to live in a house
but denying that they have any right to the land it is built on. In short, a decent level of health care, available
to rich and poor alike, is a foundational right, upon which most other subsidiary rights rest. In my view, health care is not a matter to be left for "charity" or the kindness of strangers-much less to the whims of the market place.

As physician and anthropologist Dr. Paul Farmer has put it:

"…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. .. The human rights community has focused very narrowly on political
and civil rights for many decades, and with reason, but now we have to ask how can we broaden the view."
http://www.brainyquote.com/quotes/authors/p/paul_farmer.html#ixzz18PVpbE31

I say, "Amen!" to that. Let's begin by providing affordable single-payer, health care insurance to all Americans.
-Ron Pies MD

by Mark Walter | December 17, 2010 12:09 PM EST

Christian principles are not coerced at the government level. You can't create genuine Christian charity by having a corrupt body of Congress ramrod socialized medicine down the throats of American taxpayers. Christian charity is personal. Unfortunately, liberals are good at one thing: spending someone else's money. My advice would be to make your charitable acts personal. If you identify any thing as a "right,"then make it right on a local, personal level. If you see a starving individual or family in your community feed them, and if you see a family lacking what you feel is adequate insurance, adopt them and pay their health insurance premiums. But don't expect anything good to come out of the corruption of American politics. We have no right to declare anything a "right." If we did, some would declare that they have a right of representation by their elected representatives. If that were true, they were certainly denied that right in the passage of Obamacare.

by Frances Spickerman | December 17, 2010 10:49 AM EST

Anyone who states that health care is not a human right has never had a child die because he couldn't afford health care at the same time that a rich person's child survived and thrived because he could afford basic--or even quality--care. People are not without health insurance because they are lazy and won't work. They are without health insurance becasuse we are paying insurance company executives and shareholders immoral amounts of money, to the sum of billions a year-- that could be spent on health care. And most people who declare bankruptcy due to medical bills HAVE HEALTH INSURANCE. When Germany instituted a national health care program, it was founded on the Christian principle that we bear each other's burdens, not on the principle that we blame people for their poverty--or their middle class misfortunes, or their "decison" to be fat and sabotage their health--and maintain that every person looks out for his own hide. Simillarly, when England instituted its national health care program after WWII, the rationale was that if the country could and were willing to spend massive funds to finance military defense, they could certainly decide to care adequately for the health of their citizens. Check the World Health Organization's statistics on quality of medical care. Of all industrialized nations, the US ranks at the bottom. Is this a source of pride to a nation composed of rugged individualists who see the good Samaritan as a left-wing tree hugger?

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