OpenForum - a blog by the Health and Human Rights community » nationalized health care

Why “health insurance reform” fails to meet human rights principles

Anja Rudiger — Thu, 30 Jul 2009 17:58:40 +0000

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.

Reminders of the insurance industry’s power are everywhere: people who lack insurance, people whose claims are denied, whose coverage is rescinded, or who pay exorbitant premiums that may – or may not – preempt catastrophic bills but do not cover actual visits to the doctor. The business model of insurance companies only works if as many healthy people as possible buy policies and pay premiums that are as high as possible, and if those same people then forgo actually using the health care covered by that policy. None of this is news to mainstream health reformers, yet hardly anyone points to the emperor without clothes: because insurance corporations can profit only by restricting access to care, they act as hostile gatekeepers rather than as vendors of a value-adding service. In one of our news media’s rare instances of bluntness, a Paul Krugman blog in the New York Times explains that “private insurance basically spends a lot of money on socially destructive activities.”

Yet both Obama and congressional leaders remain worryingly silent on the role of the insurance industry, despite their rhetorical shift from health care to health insurance reform. Hence they struggle to devise a sustainable cost trajectory for their proposed reforms, which are weighted down by the immense costs of keeping private insurance corporations in business. These costs include profits and corporate salaries, plus the even greater amounts wasted on underwriting and marketing to exclude people who might actually need care, and on claims administration to deny care to those who have already paid for it. To help meet those costs, reformers have proposed a requirement on all individuals to purchase an insurance policy, which amounts to a massive bailout for an industry that has continued to make record profits and is accountable only to its shareholders. Such public subsidies to the industry, via policyholders, constitute the greatest cost factor in any of the bills under discussion, yet they fail to guarantee access to health care for all. Even under the best proposal, people would still have to pay up to 11% of their income in premiums for a skimpy policy, on top of co-pays and deductibles. These provisions illustrate that the economic costs of sustaining the private insurance industry can only be paid through the social costs of restricting access to care to those able to pay.

Always on public relations alert, all key industry players – hospitals, pharmaceuticals and insurers – claim to have made concessions that would curb the excesses of the market and sustain the policy consensus for commodified health care. Yet smoke and mirrors cannot hide that market-based health care is inherently unable to contain costs at the same time as ensuring access to quality care for all. Even the President accepts that universal coverage is not possible without a publicly funded and administered system, such as single payer, that automatically includes everyone. Such a system would treat health care as a public good rather than a market commodity, and enable access on the basis of need, not payment. Guided by the principle that basic human needs give rise to government human rights obligations, such a public health care system would be financed collectively in order to meet people’s health needs with equitably shared resources. Instead of providing profits and benefits to a few, a rights-based system would enrich everyone living in a healthier society.

Anja Rudiger, PhD, is director of the Human Right to Health Program, a joint initiative by the National Economic and Social Rights Initiative (NESRI) and the National Health Law Program (NHeLP) based in New York City.

Healthcare for UK’s Vulnerable Migrants

OpenForum — Fri, 08 May 2009 08:18:10 +0000

Recent changes in U.K. health policy affecting asylum seekers who have been denied refugee status reflect a larger trend of decreased willingness by governments to provide healthcare to migrants. Is this vulnerable group being denied the right to health?

It depends on who you ask. UK’s National Health Service (NHS) states that its mission is “to make good healthcare available to all, regardless of wealth, as long as you are a resident of the UK.” Overturning last year’s decision, appeals judges ruled that rejected asylum seekers are no longer legally entitled to free secondary NHS care, although hospitals can treat them at their discretion if they are penniless. Lord Justice Ward argues in his decision that “failed asylum seekers ought not to be here. They should never have come here in the first place and after their claims have finally been dismissed they are only here until arrangements can be made to secure their return.” Last year, Matthew Elliot of the TaxPayers’ Alliance argued that rejected asylum seekers should not be paid for at the expense of law-abiding taxpayers, and that providing them with free care will only create a burden on the already overstretched system, especially with the flood of health migrants he believes will follow. These concerns are by no means unique to the UK, and are echoed in other countries trying to decide how and whether to provide care to migrants using public funding.

Yet others argue that it not only makes public health sense to provide healthcare to all migrants – it helps control infectious diseases and decreases expensive emergency care through earlier diagnosis – it is a matter of human rights. The UK is a state party (see 5.2) to the treaties that include the right to health (see 10), which obligates the UK to make health services accessible to all, without discrimination, and especially to the most vulnerable and marginalized sections of the population. Asylum seekers are one of the groups least able to pay for their healthcare, while most vulnerable to suffering; most take enormous risks in migrating from their country of origin, where they face war, poverty, or persecution. Complicating matters, many of those who are not accepted as refugees are unable to return to their country of origin due to continued conflict or a refusal by that country to readmit them. They are effectively stuck, and should not be denied care.

Even if a country chooses to restrict immigration, there should be a clear separation between immigration law and the provision of health services. As the number of migrants steadily rises worldwide, with anti-immigrant sentiment following not far behind, governments should carefully reconsider their discriminatory health policies toward migrants, and incorporate the right to health.

Striving to Present Health Care as a Human Right

OpenForum — Thu, 30 Apr 2009 18:49:49 +0000

Health care is a universal right, declare health care reform activists in Montana. If we recognize universal care as a right rather than as a private product, the activists contend, Americans across the country could gain fair and equitable care.

Anja Rudiger of the Human Right to Health Program, said that a set of principles should be used to determine whether a system supports health care as a right or if the “profit motive” overshadows the affordability and accessibility of care. Rudiger has previously written an article for Health and Human Rights demonstrating the use of a “human rights framework, [in which] ethical principles — or “values” — are the premise for action.” This framework, Rudiger asserts, allows activists and policy-makers to re-frame the debate on health care by leveraging, “theoretical and empirical findings to make a case for re-envisioning health care as both a right and a public good.”

Montanans for Health Care, a group involved in this movement, is pushing for congressional hearings. In particular, they address their concerns to U.S. Sen. Max Baucus, D-Montana, who chairs the Senate Finance Committee. Senator Baucus is the committee chairman writing the Senate Health Bill, who, along with Massachusetts Senator Edward Kennedy, “has been criticized by progressive groups for bowing to pressure from the health insurance industry lobbyists,” reports Democracy Now, an independent daily TV/radio news program. Earlier this year at a National Health Policy event, Sen. Baucus said, “at this time, in this country, the single-payer [health care system] is not going to get even to first base in the Congress.” A single-payer health care system is not the only way to achieve the right to health care in the U.S., but is it acceptable that this option is taken off the table from the start?

Amnesty International has echoed the Montana movement and has called on reformers in a petition based on the work of the Health Care is a Human Right Coalition. The Coalition, which includes Amnesty International, National Social and Economic Rights Initiative (NESRI), the National Health Law Program (NHeLP), and the Opportunity Agenda, seeks to promote health care as “a human right, not a commodity.” The Amnesty petition states, “Gap in the health care system should be eliminated so that all communities, rich and poor, have access to comprehensive, quality treatment and services. Publicly financed and administered health care should be expanded as the strongest vehicle for making health care accessible and accountable.” Both this petition and the activism in Montana are critical steps in challenging our current health care systems across the country.

We in the health and human rights community should stand with this reform activism, with the hope that health care can one day soon be seen as right, rather than a privilege.