The nations of the world agreed in 1948 that healthcare was an innate right for all human beings. The Universal Declaration of Human Rights passed by the United Nations—and signed by the United States—reads as follows: “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” (Article 25, adopted by the United Nations on December 10, 1948).
Healthcare as a human right has also been affirmed at the U.N. by the Convention of the Rights of the Child and the U.N. Committee on Economic, Social and Cultural Rights, as well as by numerous scholars and human rights experts.
Yet, while most people around the world see healthcare as a basic human right, the United States government has failed to adopt the same philosophy in our homeland. It has instead developed a system of healthcare wherein private insurance companies offer prepaid insurance for medical services.
Health insurance in this country is an extremely large industry, with $93 billion in profits among the top nine companies in 2006 (see table). In 2002, the World Health Organization (WHO) put the cost of healthcare at 15.2 percent of U.S. GDP. WHO reports, “The healthcare industry, including biopharmaceutical and medical device companies, now represents the third-largest sector among the 1,000 largest US firms, behind only energy and retailing.”
Michael Moore’s top-grossing movie Sicko is one example of the growing concern surrounding healthcare in the United States. Sixteen percent of the population is without health insurance. The cost of health insurance is rising two to three times faster than inflation, and unpaid medical bills are the number one cause of personal bankruptcy in the country, writes Walter Trattner in From Poor Law to Welfare State.
The Institute of Medicine estimates that as many as eighteen thousand Americans die prematurely each year because they do not have health insurance. For millions of people unemployed or in jobs without health benefits, health-insurance policies can only be purchased as a personal/family plan directly from private companies. Health-insurance companies exclude people with poor health or preexisting conditions from enrollment or require them to pay exorbitant premiums.
While the wealthy and upper-middle classes have generally been able to afford necessary healthcare in the United States, the bottom one-third of American society (one hundred million people) faces limited access to necessary healthcare. This bottom third, forty-seven million of whom have no health insurance whatsoever, are disproportionately people of color and single women with children. These inequalities of race and gender have led some researchers to conclude that racism and sexism have historically played a major role in U.S. healthcare policy, according to Jill Quadagno in The Color of Welfare.
Consequently, the provision of private healthcare goods and services in the United States is markedly different from other industrialized countries, where single-payer or nationalized healthcare systems provide medical care for all people. Here, private insurance companies sell health insurance to individuals and employers. Insurance companies generally do not provide any healthcare. They are the brokers between the consumers and the providers of healthcare. Most people obtain health and disability insurance through employment-related group plans. However, if one is not a member of a group plan, he or she must purchase an expensive individual policy or accept a plan with huge deductibles or extensive limits on coverage.
The U.S. insurance industry remains severely under-regulated at the federal level. Instead, each state adopts laws and regulations that govern insurance companies headquartered there. A national insurance company may adopt a business practice that one state deems legal while that same practice may be illegal in another state. The fifty states are essential partners in protecting capital and profits in the health-insurance industry. The states, in cooperation with private insurance companies, promote attitudes that encourage doubt, self-blame, and moral responsibility by increasingly linking illnesses and disease to personal lifestyle choices.
The functional result of these healthcare laws and “educational” efforts is to create a cultural climate of individual responsibility for accidents, illness, sickness, and disease, instead of viewing healthcare as a natural human right. This allows for the emergence of social-psychological assumptions in the health-insurance system whereby providers, insurance companies, claims adjusters, healthcare providers, employers, and even patients’ friends and families think in terms of what the sick or injured individual may have done that contributed to or caused the health problem. Therefore, we have a system that diminishes responsibility for services by the providers and refocuses the blame on the persons in need of care. As a result, health-insurance companies tend to approach claims with the general suspicion of possible fraud instead of just paying for the healthcare needed (Insurance as Governance by Richard V. Ericson, Aaron Doyle, and Dean Barry).
The debate over public, single-payer healthcare versus private insurance is very limited in the United States. The private insurance companies and health-maintenance organizations have a desire to remain part of the system and to continue to make huge profits. They have donated funds to presidential candidates to ensure that proposals for universal healthcare will continue to include private insurance in the system. And their massive advertising budgets tend to skew what the American public learns about the issue.
However, most of the industrialized countries in the world provide all their citizens, and in most cases new immigrants, with relatively efficient, state-of-the-art healthcare that is paid for with taxes. Private health-insurance companies are not part of the mix in countries that support healthcare as a human right. In the United States, proponents of private insurance argue that the citizens in these countries pay higher taxes. However, the individual cost to taxpayers in single-payer countries is actually substantially less than the amount individuals and employers in the United States pay in premiums and related expenses. The total per capita healthcare costs in the United States far exceed healthcare costs of all other industrial countries, according to the World Health Report 2006.
People in the United States have a choice. We can continue with a $93 billion, profit-driven, private-insurance healthcare system that leaves many millions to languish without care and many millions more to face the frustrations of systemic delays in care delivery, service diminishment, and denials of promised benefits. Alternatively, we can build a healthcare system that provides necessary healthcare to everyone.
The belief in healthcare for all is deeply embedded in American culture. Across America, local communities regularly hold fund-raising events for children and adults without health insurance who are faced with expensive medical needs. This belief in healthcare as a human right requires us to remove the private health-insurance companies from the system and institute single-payer, universal healthcare for all Americans.
In times of crisis, the American people have joined social movements to demand justice and government action. The progressive movement in the early twentieth century resulted in stronger regulations on medicines, medical education, and healthcare delivery systems. During the Depression, the labor movement won the Social Security Act with the expansion of disability and healthcare benefits for employees. The Civil Rights movement and the War on Poverty led to Medicare and Medicaid. When the American people collectively stand on our belief that healthcare is a basic human right, the healthcare system can be changed to provide necessary benefits for all.