Health Care is a Human Rights Issue
Health Care is a Human Rights Issue
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. Gonzlez 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.
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.
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?
[forwarded from Carol Paris MD]
In the spirit of full disclosure, I am a psychiatrist and an active member of PNHP, Physicians for a National Health Program. Our private, profit-driven (non)system of financing health care for 40% of the American population (60% are already publicly funded,
including Medicare, Medicaid, VA, FEHBP)is the reason we cannot accomplish the goal of lowering the cost of healthcare,much less expanding coverage to everyone living in the U.S. I came to this conclusion slowly, after spending 3 years working through my state medical
society on the legislative committee, pursuing legislation designed to incrementally "level the playing field"for physicians with respect to the advantage the insurance industry has over physicians AND patients. I learned alot about the political process at the state level.
Then came "health care reform" onto the national stage in 2009. From the day of his election, until the day PPACA (Patient Protection and Affordable Care Act) was signed into law, the health insurance and pharmaceutical industry spent 1.4 million dollars per day lobbying Congress to assure that their profits would be protected (Center for Responsive Politics). Wendell Potter, the CIGNA executive turned whistle-blower has dubbed the bill "the Private Insurance Industry Profit Protection and Enhancement Act". Please do not
confuse "Obama-care" with a National Health Program. PPACA is nothing more than a mandate to
purchase a defective product, with premium subsidies paid for with taxes. Premiums, mind you,
that waste 30% on overhead, profits, and, of course, all that lobbying.
Dr. Pies has made the "human rights" case for a National Health Program. I agree. But it can also be argued from a purely financial, socially conservative perspective.
Its the money, stupid. Healthcare has become big business and physicians have become pawns. I get it that there are a lot of doctors reading this blog who are feeling angry and abused. But let's be clear who the abuser is: its the for profit health insurance
industry (and big Pharma).
You can blame it on "big government" if you want to; that's just what corporate America wants you to think. Keep us focused on "big government" so Corporate America can keep raking in their obscene profits. Or you can blame it on all those lazy, poor, old, disabled,
mentally ill Americans who just want to be on the dole. Or you can blame it on all those left-wing liberals who just want to throw YOUR money away on social programs for the lazy, poor, old, disabled, mentally ill Americans who just want to be on the dole.
Follow the money, stupid. (Please note, I am NOT calling anyone reading this blog "stupid"....I don't recall the source but its a commonly used phrase.)
But in order to do that, you'll have to actually read something other than The New York Times or The Washington Post and you'll have to listen to something other than Fox News or the mainstream media outlets. Follow the money. The boards of directors of the mainstream media outlets overlap with....you guessed it...the boards of directors of the health insurance
and pharmaceutical industries. They are only going report what they want you to know.
Whether you agree with a National Health Program or not, how much did you read about it during
the so-called health care debate? Did you know that hundreds of people got arrested, protesting at insurance companies? Did you know that doctors and nurses got arrested protesting at the Senate Finance Committee's Roundtable "discussions" on May 5 and May 12, 2009?
I was one of the doctors arrested on May 5th. It cost me a lot of money in missed time from
work, because of all the court appearances that ensued. I am not complaining. I was arrested again on Jan. 29, 2010, and I will be arrested again, if I think it makes sense strategically. I've learned a lot and will continue to seek the facts and to give witness to the real stories
of real people who are being traumatized by our insane non-system of health care financing in this country. We can do better than this.
Follow the money. It's pointing in the same direction Dr. Pies is pointing from an ethical vantage point. [relayed from Carol Paris MD]
Thanks to Mark Walter and to Dr. Carol Paris. I especially appreciate Dr. Paris's long-time
efforts and personal sacrifices in behalf of a national health care plan, and I will defer to her on the economic advantages of a single-payer plan. I would like to focus again on some of the ethical and human rights issues.
I understand that health care reform--like many hot-button issues--stirs up a good deal of passion and anger. My working assumption is that all who have written in share the basic goal of "doing the right thing"and acting compassionately toward our fellow citizens.
And yet, as some of the readers' responses suggest, one's position on health care can become a sort of Rorschach test for all kinds of real or imagined views, such as those on abortion, American politics, "liberals", "charity", etc. In many ways, the health care
debate reflects tensions and strains present in our society since the American Revolution: tensions over the proper role and reach of the federal government; the weight we give to individual freedom versus the "common good"; the right of the federal government to levy certain kinds of taxes, etc.
What is beyond dispute, however, is that our present health care "non-system" is in deep trouble.
As the 2009 Institute of Medicine report stated, "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not
ensure that all citizens have coverage."
http://www.iom.edu/Reports/2004/Insuring-Americas-Health-Principles-and-...
Reasonable and well-intentioned people will differ regarding the solutions to these problems.
The group Physicians for a National Health Program (PNHP) have proposed an economically feasible,
single-payer plan which I support. By combining current sources of government health spending
into a single fund, modest new taxes will be offset by reductions in premiums and out of pocket
spending [see www.pnhp.org]
One can see such a plan as "spending other peoples' money", or one can see it as a civic responsibility that benefits society as a whole. One can see it as an example of "liberal" politics, or one can see it, as I do, as a deeply conservative principle in action: for by investing in the health of our fellow citizens, we are "conserving" our most precious resource. Better health for all Americans means more people are able to enter the job market
and become productive members of the work force--and that's good for all of us.
Many of us who don't have children, but still pay hefty school taxes each year, do not complain that we are being "coerced" to provide "charity" for others. Rather,we see it as a wise investment in the children of our state and country, and we are proud to contribute our share in taxes. Indeed, the issue of universal health care is not one of "charity" at all, but of justice--justice for the thousands of people who, through no fault of their own, lack the means to pay for life-saving or life-sustaining treatment.
The 1948 UN Declaration of Human Rights (UDHR)--which counted health care among our basic human rights--was approved by 48 countries of every political, social, and religious stripe, including the U.S., the U.K., Canada, Afghanistan, Argentina, Australia, Belgium, Bolivia, and Brazil. One can disagree with the Declaration, but it is folly to write it off as merely a
"liberal" (whatever that means) program. Indeed, in 1995, no less a religious conservative than Pope John Paul II called the UDHR "one of the highest expressions of the human conscience of our time." He added,
"In Asia and Africa, in the Americas, in Oceania and Europe, men and women of conviction and courage have appealed to this Declaration in support of their claims for a fuller share in the life of society."
http://www.vatican.va/holy_father/john_paul_ii/speeches/1995/october/doc...
-ii_spe_05101995_address-to-uno_en.html
Advocating for national health insurance is not a matter of belonging to the APA, nor of calling oneself liberal, libertarian, or conservative. It is not about "socialized medicine", since the PNHP plan preserves professional autonomy for physicians, and free choice of doctors
for patients. Contributing one's fair share for universal health care is about protecting the well-being of the country we live in, and of the people we love.
--Ronald Pies MD
[sorry for any formatting problems!]
I would support increased funding for public primary care and mental health clinics, but would prefer that the care I get comes from the private sector. I would prefer Health Savings Accounts. Once a service becomes a "right" and the whole delivery system is under government control, innovation and initiative are likely to come to a halt. I have worked in state, federal, county, and publicly supported non-profit mental health facilities. Bureaucracy rules, patient care is less important than procedural mandates, funding is based on politics, unions trump patients, and everybody waits in line. Absolute power tends to corrupt absolutely. Bill Gates has the money to pay for better care than I do, and that is good.
As for corporations having big stashes of cash, most Americans own stock in corporations through pension plans or directly. Corporations are solvent. I buy my food, clothing, cars, and household goods from corporations. Medicaid, Medicare, and Social Security are actuarially unsound. Bernie Madoff is a two bit con-man compared to the Ponzi Scheme the government has created with these unfunded promises. Keep the government out of the doctor-patient relationship as much as possible. And, with a Health Savings Account, keep the insurance companies out of anything but catastrophic coverage. Even Medicaid could go to a Health Savings Account format, with patients getting a percentage of, say anything left before $5000 is spent. This would discourage emergency room use for rhinitis, encourage generics use, and have people thinking twice about the money being spent.
I thank Farrel Klein for the interesting comment on health savings accounts. However, PNHP points out many reasons why HSAs will not solve the major problems in our system (see pnhp.org and search under "savings accounts"). For example, "HSAs will do nothing to reduce the number of uninsured. Since the primary difference between an HSA and a regular savings account is that the HSA income isn't taxed, the only attraction of an HSA is its tax-deductibility. More than half of the uninsured have no income tax liability. In addition, skimpy HSA-compatible plans still have high premiums. A recent study estimates that widespread implementation of HSAs will reduce the number of uninsured Americans by less than 100,000...
[Moreover] HSA plans increase administrative costs. Administrative bloat and bureaucracy already consumes 31 percent of our health spending, hundreds of billions of dollars in waste each year. HSA plans, which require the tracking of all out-of-pocket spending by each patient, their HSA corporate manager, and their insurer will only increase these costs."
Respectfully, Ron Pies MD
I simply could not ignore this story (1), which speaks volumes regarding the state of health care in this country:
James Verone said he walked up to a teller at a Gastonia, N.C. bank and handed her a note.
It said "This is a bank robbery, please only give me one dollar."Verone then told the teller he'd be sitting in a nearby chair, waiting for the police.
The 59-year-old said he did everything he could to get caught so he could receive free health care in jail.
Verone has a growth on his chest, two ruptured disks and a problem with his left foot. With no job, Verone thought his desperate plan was the best way to provide for himself.
Verone was charged with larceny.
Courtney Boyd Myers at The Next Web notes Verone's plot provides clear evidence of a flawed medical system.
"As his fellow American, I have to say, our national health care is in a very sad state," Myers writes.
You think?
Ronald Pies MD
1.http://www.huffingtonpost.com/2011/06/20/james-verone-robs-bank_n_880660...
Amen! And isn't there an irony that the only population in the USA to have healthcare as a right is those in our prisons.?! That's not to say the prisoners don't deserve this and not to deny that the quality is low in certain states, but this is better than what the population outside of prison is entitled to as a whole. Steve Moffic
Thanks, Steve--I believe that most physicians, after reviewing the available studies, would conclude that a
publicly financed, universal health care system makes good sense. Of course, the use of our prisons as a de facto holding unit for many with serious mental health problems is yet another major problem, as you well know--but as you point out, at least prisoners get a modicum of general health care! --Best, Ron
I also encourage readers to go to the www.pnhp.org site to learn about single payer/universal health care. PNHP physicians/researchers have done many of the evidence-based studies that highlight the failure of a market-based approach to social safety net needs like healthcare, police, and fires as well as the toll this failed approach extracts from patients AND physicians. We have an epidemic of tired, burned out doctors. I disagee that the recent legislation will help many people; yes, the funding for community health centers and expansion of SCHIP was an incremental step, but could have been done WITHOUT the blatent gift to the private health insurance industry in the form of mandates to purchase their defective products. All we've accomplished is moving more people from the rolls of UNinsured to the rolls of the UNDERinsured. Join PNHP!
Another Amen! A couple of years ago I had to have emergency surgery. My employer didn't provide health insurance and I couldn't afford to buy insurance. I ended up with over forty-thousand dollars in medical bills, and eventually had to file for bankruptcy. The hospital wouldn't give me a break on the bill, saying that I "made too much money". My salary at the time was in the low-income bracket for this area. I suppose some people are not bothered by filing for bankruptcy, but for me it was extremely humiliating. Maureen L.
Thanks to M
Thanks to Maureen Lide and Dr. Paris! I agree that the current "fix" to the health care system leaves much to be desired, and gives too much away to the insurance companies. I have been having quite a spirited (and sometimes acrimonious) debate on one of the medscape forums, and I hope Dr. Paris will consider supporting the PNHP position on this site--I could use some reinforcements! ---Best, Ron Pies
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?
I couldn't disagree more, and I wouldn't stand by a UN definition of anything. The UN has proven to be the most ineffective (how about another sanction on Iran to limit their access to nuclear weapons?) and corrupt global body in the post-WWII era. Healthcare isn't a basic human right any more than basic necessities like food/water/shelter/clothing are a right. Being helpful, convenient or even essential does not make something a right. That's the equivalent of saying that if mankind doesn't make these things available for all people then Divinity should. The terms of Obamacare are unconstitutional and place direct burden of providing what you've defined as a "right" on the shoulders of taxpayers and healthcare providers. It's no coincidence that I am now witnessing many physicians cut ties with medicaid and medicare in favor of fee-for-service practice. It's also no wonder that many are planning retirement from medicine well ahead of their retirement years. I'd advise any reasonable physician to cut ties with the AMA and APA and to join a professional society that actually supports you, such as the American Association of Physicians and Surgeons.
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.
<p>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-h...).<p>
<p> 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).<p>
<p>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.<p>
<p>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=05uD0006...
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 <p>
<p>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.<p>
<p>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#ixzz18PVpbE...
I say, "Amen!" to that. Let's begin by providing affordable single-payer, health care insurance to all Americans.
-Ron Pies MD