OpenForum – a blog by the Health and Human Rights community

[Editor's note: This article is cross-posted from Human Rights Now, the blog of Amnesty International USA.]

A dramatic disconnect between principles and policies has hampered current US health care reform efforts. This became obvious when candidate Obama declared health care to be a right and then proceeded to treat it as a commodity when negotiating with insurance companies a requirement for individuals to buy a commercial health insurance product.

Similarly, early on in the debate the president championed the principle of universality by promising some form of health coverage – if not necessarily health care – for 46 million uninsured people, only to lower the policy goal to 30 million American citizens in his speech before Congress, excluding many immigrants and low-income people. Since then, further policy provisions that restrict access to health coverage for immigrants – documented and undocumented – and reduce affordability for lower-income people have appeared in the health care bill adopted by the Senate Finance Committee.

With people of color already up to three times more likely to be uninsured than white Americans and suffering from unequal health outcomes, it is no surprise that over the past few weeks a new coalition of groups representing people of color has launched an ad campaign for racial equality in health care reform. With this new advocacy push, prominent national organizations such as the NAACP and the National Council of La Raza (NCLR) are now framing their intervention in terms of people’s rights.

The coalition’s principles state that “health care is a basic human right, as essential as food and shelter,” thus echoing ongoing human right to health care campaigns by organizations such as Amnesty International USA and its coalition partners. A number of mainstream media outlets covered the launch of this new campaign – most notably Public Radio International and WNYC’s The Takeaway, which featured a thoughtful piece aimed at “exploring whether or not affordable health care can be considered a fundamental human right.” However, while the Takeaway reporters seemed prepared to answer in the affirmative, representatives from NAACP and NCLR remained oddly silent on this issue.

That’s because as soon as principles are placed into the realm of policy, they become subjected to pressures created by the dominant political consensus. Translated into policy, the new coalition’s main demands include a so-called public option, steps to eliminate racial disparities, and “complete access and coverage for all legal residents.” The imagery used in their TV ad – people of color denied boarding a bus – emphasizes that the current health care debate should be linked to past civil rights struggles, with a focus on desegregation and formal equality.

Aligning health reform with a civil rights perspective clearly sends a powerful message, but it does come with some definitive drawbacks. Civil rights, rooted in Amendment XIV of the Constitution, do not include non-naturalized immigrants – documented or undocumented. Therefore, while a policy push that narrows health care access to “legal” residents may not conflict with a civil rights approach, it does ignore the human rights principle of universality. Presumably, such a policy is pursued on a purely pragmatic basis, reflecting the dominant tone of the debate, according to which, as stated by a prominent mainstream migration policy organization, “most agree that unauthorized immigrants should not benefit from government spending.” Read more

Six months into the administration of the United States’ first black president, the right-wing fringe has reclaimed the center of attention in US domestic politics, propelled by industry money and media interests. Health care reform happens to be the issue at stake, but any other issue would have served the purpose, as long as it guaranteed media coverage for right-wing fear-mongering and promoted the ongoing reframing of popular values (choice, security, people’s control) — mastered in the 1990s by Newt Gingrich — into Republican campaign slogans, spiked with racist undertones for good measure. In this context and to a backdrop of news about the return of militias — which kept a suspiciously low profile during the years of the Bush administration — I found the prospect of carrying out field research in Montana on the human right to health a little daunting. But reassuringly, Montana’s Human Right to Health Care campaign is run by an organization that is also Montana’s first and foremost expert in monitoring and fighting right-wing extremism: the Montana Human Rights Network.

With my counterpart from the Montana Human Rights Network, I set out this August to conduct focus groups in Lewis and Clark County, western Montana, to explore people’s health needs and their experiences with the local health care system. To our relief, we did not attract town hall size groups ready to vent their engineered hate, but we also did not fully escape the ugly reverberations of Fox News and Talk Radio. Some people with low incomes and very limited access to health care looked with disdain to the perceived health needs of others — particularly to those who had already been “othered” by decades of right-wing ideology (immigrants, the poor) — as an explanation for their own unmet needs. The community spirit of a frontier area sat in uneasy tension with the blaming game promoted on the airwaves from far away.

Yet we also heard plenty of other voices, from the poor to the privileged, who reported barriers to insurance coverage, a shortage of doctors, and a lack of respect for human beings in need, and who  openly welcomed the notion of health care as a human right for all, regardless of ability to pay. Read more

Now that the President has officially designated the ongoing health care reform efforts as “health insurance reform,” we can stop the charade that this debate was ever about “care.” Or about health, for that matter. Oddly enough, the obsession with “coverage” – a potential mechanism to facilitate access to care – has not led to a serious consideration of the private insurance industry’s raison d’être, at least not beyond the community of single payer advocates whose voices are drowned in the constant drumbeat about a supposedly American – read: “market” – solution.

How are the current proposals for health insurance reform treating an industry that siphons off roughly $10 billion in annual profits? We now have two health reform bills reported out of congressional committees (”America’s Affordable Health Choices Act” in the House and the “Affordable Health Choices Act” in the Senate – using terminology pushed by Democratic pollsters, no doubt). Neither of them meets key human rights standards, and both cast private insurance corporations in the role of gatekeepers that control people’s access to care. At the same time, opposition is mounting against all and any reform measures.

Yet there continues to be great hope among many long-time health policy advocates that will we see meaningful health reform later this year. Advocates count on this reform to solve or at least alleviate the current health care crisis, which results in an estimated 22,000 preventable deaths due to lack of insurance each year, as well as skyrocketing costs that bankrupt families and public budgets alike. Pundits optimistically point to the many new measures the reform bills introduce: reining in the “free” insurance market through tougher regulation, including through a so-called Exchange mechanism; setting up a public insurance plan; expanding Medicaid; requiring employers to contribute to costs; and mandating everyone to buy insurance. All Americans (though not all immigrants – documented or not) will get health insurance – or so the hopeful want to believe.

Their hope is born out of desperation. Most advocates are painfully aware that health care is treated as a market commodity in the United States, and that market rules are stacked against those with little purchasing power. And these are usually the very people who need health care the most: poor people and people with serious health issues. In a blatant affront to the basic human rights principle of equity, minority groups and poorer communities in rural and inner city areas suffer disproportionally from market barriers to health care. Read more