Friday, October 10, 2008

Health Care: A Right?

In the second Presidential debate of the season, the two Presidential candidates were asked whether they believe that health care is a privilege, a right, or a responsibility. 

Senator McCain responded:

"I think it's a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that...I have, that will do that. But government mandates I -- I'm always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that."

I had trouble figuring out what McCain meant by saying health care is a responsibility since he followed that up with "we should have available and affordable health care to every American citizen." After going through his health care proposal I have come to understand his response as: it would be his responsibility as President to encourage the market (employers and insurance companies) to provide health care for American workers. He does not believe that increases in health care accessibility and affordability should result from increases in government spending on health care. But what about the people who cannot afford to work enough hours to be eligible for employer-based insurance (due to economic turmoil, layoffs, or family responsibilities)? What about the elderly? The disabled? What about the hard-working Americans who are working double-duty shifts and yet still earn less than half the median income-- not enough to pay $5-8,000 out-of-pocket for quality health care coverage for their family? Whose responsibility is it then? If it is the government's responsibility to provide access in these cases, the government is not doing enough.

On the other hand, here is Senator Obama's response:

"Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that."

That health care is a human right is widespread belief. The preamble to the World Health Organization Constitution declares "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." Recently, the Office of the United Nations High Commissioner for Human Rights and the World Health Organization released "The Right to Health," a fact sheet that seeks to outline the basic understanding of what "the right to health" is and "its implications for specific individuals and groups." 

While no country has a perfect health care system, some certainly have achieved more equity and better health outcomes than what we observe in the US. Ours is a system driven by capitalist principles for all but the most impoverished families (who are eligible for Medicaid and SCHIP). While I have heard it argued that no one can be turned away from medical services for immediate life-threatening illness or injury, we all know that chronic health conditions are increasingly placing a burden on our system in terms of human and financial resources. Plenty of studies (including an upcoming publication in Journal of Women's Health -- woohoo!) support the notion that men and women without health insurance are less likely to access and receive preventive health services. This results in later disease complications and even (preventable) death. I will readily acknowledge, however, that providing health insurance to everyone is not a magic bullet solution to the current state of (ill-) health  in our country.

What are your thoughts on health care as a right or a responsibility? Do you think health care rights include social conditions such as safe drinking water, adequate nutrition, proper housing, and gender equality? What about access to essential medications, preventive health services (screening, education, vaccinations), reproductive health services? Why?

Finally, will the country's looming health care crisis factor into your vote on November 4th? 

Comment! I know you want to.

Update: America's Health Insurance Plans investigated the average cost of health insurance. While premiums for families varied widely depending on the State in which you live, the average cost was $5799. In Massachusetts, the average cost was over $13,000. Obviously, there are huge differences as well in what you get for $6000 family insurance in terms of deductibles, preventive care, and copayments. 

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