BY ANDY ORAM
Medicare, the Affordable Care Act, and other advances in health coverage have traditionally been driven by political forces on the left. Currently, activists who have done so much to improve access to health care are trying to popularize the slogan that “health care is a right.” The phrase was first popularized by Senator Bernie Sanders in his 2016 presidential campaign and returned for the current election season, picked up by Senators Kirsten Gillibrand, Kamala Harris, and other politicians. The right to health care also shows up in the Green New Deal. These politicians are reviving the ideals in the United Nations’ historic 1948 Universal Declaration of Human Rights, whose Article 25 cites a right to medical care and social services.
As a writer who has covered the health IT space for a decades, and a believer in better health for everyone, I’m more concerned with improving health and making a system that works right than in complicated and problematic terminology. Before we talk about rights, we have to be honest about the difficulties of addressing our dual crisis of worsening health and increasing costs.
And health is definitely a crisis. An aging population across many countries has created large bodies of patients suffering from chronic conditions. In the United States, increasing health care costs have suppressed wage increases, fueling a well-known resentment among working-class and middle-class voters. Miraculous advances in treatments have saved lives but saddled the public with unsustainable costs.
Reformers point to other affluent countries, which offer some form of universal coverage. However, even those health care systems now struggle with same demographics of aging populations as the United States, and find their health care system strained: France, Germany, Japan, and (exalted particularly in leftist circles) Cuba. The right to health care in these places is often undermined by long waits and arbitrary denials.
The causes for disease are multifaceted and longitudinal. Every health care advocate knows that, at best, the health care system can only clean up after failures in public health, poverty reduction, and injustice. We now know that physical and mental stresses encountered as a child (and even in the womb) emerge later as health issues. A culture of overeating, alcohol and tobacco use, sedentariness, and mental attitude lead over
decades to health problems and are hard to reverse.
What this means is that good health is, for much of the population, an uphill battle against an inheritance of stress and hard living. The medical field now knows that individuals are affected by the environment.
The role of the health care professionals is to promote an ongoing dialog about overcoming the flawed inheritance with day-to-day choices about exercise, stress, and so on. If people have a right, it should be a right to make changes in their living conditions to avoid the drastic health consequences. We have to think of health care not as something to deliver, as a retail store delivers a washing machine, but as an extended collaboration that involves many disciplines, institutions, and family members.
Technology must be applied creatively. For instance, if a person can be persuaded to press a button on her phone whenever she feels the desire for a cigarette, an automated agent could propose some distracting activity appropriate for her mood, the time of day, the location, and the weather.
Public health will merge with individual health. Health care reformers agree that drastic changes in payment models and treatment have to occur in order to treat everyone cost-effectively; I laid out the consensus among reformers and the requirements of health IT in other articles. We need seamless data exchange and communications among providers, real teamwork among all caregivers, continuous remote monitoring for signs of medical risk, and a long-term view of care that includes environmental factors. It’s up to the medical industry to make these changes.
Instituting single-payer may prompt these good things to happen, as argued by T.R. Reid in his book The Healing of America, but the country could face bankruptcy during the transition and end up pulling back on its idealistic commitments. Proponents of single-payer claim it will enjoy immediate savings by eliminating the overhead of insurance claims. The anticipated savings vary widely in different estimates, but are generally agreed to be significant.
Unfortunately, the estimated costs of adding this new population dwarf even those impressive efficiencies. In my own state, Massachusetts, which led the country on expanding access to health care, an entire legislative committee is dedicated to health care financing. I fear they are trying to adjust the problems of the health care system without addressing the causes.
Atul Gawande, in his usual meandering style, comes out in the progressive New Yorker magazine for universal coverage as a public good rather than a right, but does not specify the prerequisites. An opinion piece from the conservative Fox News lists a few general reforms but fails to delve into the changes they would require to health.
Even the countries offering universal health care need major initiatives to carry out the transformation I suggest in this article–and some promising reforms are being carried out in France and the UK. There are plenty of good reasons to promote health care for as much of the population as possible without invoking the notion of “rights.”
For instance, the importance of universal vaccinations is well-established, and is underlined by the recent alarming choices by misinformed people to refuse vaccinations. Giving treatment to everybody – including undocumented immigrants, for instance, who are discouraged from seeking treatment in a variety of ways – will reduce the spread of communicable
A relatively unexplored area of health benefits involves the effect of treatment on economic advances. What is the differing impact on the economy of a person who must go on disability for forty or fifty years, versus someone who can get a job and pay taxes for those years? Both physical and mental illnesses are currently presenting these opportunities.
What can we do to promote better, affordable health for all?
- We can investigate and publicize the economic benefits of health, and advocate for early intervention on practical grounds.
- We can claim a right for everyone to have affordable and convenient access to food, exercise, and services that reduce loneliness and other psychological ills.
- We can promote holistic, longitudinal interventions that help people make better choices when faced with chronic conditions.
- We can educate health care providers and others to eliminate the dubious barrier between physical and mental health.
All these initiatives are necessary whether or not we think of health care as a right. Let’s focus on measures that work instead of rhetoric.