Challenges and Answers for Universal Health Care in the United States
Across the world we all cannot agree on a lot of things because of different beliefs and cultures accustomed to societies, but one thing most nations can agree on is that healthcare is a right. On December 10, 1948, forty-eight countries agreed to the United Nations’ Universal Declaration of Human Rights. Article 25 of that document notes the right to health care: “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.”
Today, almost 200 nations have agreed to this statement for a total of 30 articles universally protecting the rights a person has, because they are human. It sets a common standard for which all societies should pursue in order to maintain humanity’s fundamental needs.
In response to signing this agreement, leaders from developed nations with the finances available have gone back to their respective countries and implemented universal healthcare as a form of social responsibility to this declaration. According to data monitored by the Organization for Economic Co-operation and Development (OECD), 35 of today’s 36 developed nations have universal health coverage with the U.S. being the only exception. Even though Eleanor Roosevelt, the wife of U.S. President Franklin Roosevelt, was Chair of the United Nations Commission that wrote the Universal Declaration of Human Rights in 1948, the U.S. still stands alone within the developed world in efforts to make healthcare available to all of their citizens. This means that healthcare is, instead, treated as a commodity, not a right. It’s something we have to buy, a privilege, and a benefit. It’s not something you get just for being born in the U.S. as you would if born in other countries, such as in Poland, Slovenia, Finland, or France. Instead, access to healthcare in the U.S. is through insurance, which provides an entire slew of limitations including affordability, subpar plans, risk of bankruptcy, and more. Since the U.S. takes a different approach with our healthcare system, we stand out in almost every health metric in comparison to the rest of the developed world, For example, our costs are exuberantly high, yet our quality is poor, health disparities persist, life expectancy is declining, and infant mortality rates increasing.
The World Health Organization had its 1st Global Symposium on Health System Research in 2010 and concluded with this summary: Out of the countries in their analysis, 75 had legislation that provided a mandate for Universal Health Coverage independent of income. The U.S. was still not one of them. It has been over 70 years since the United Nations unanimously declared Universal Health Coverage as a public priority for our world. More recently, all United Nations Member States adopted the Sustainable Development Goals of 2015 stating that all U.N. Member States agree to try and achieve Universal Health Coverage by 2030, urging governments to move toward providing all people with access to affordable, quality healthcare services as a part of sustaining our human race and planet. Although these goals are a beautiful example of a universal call to action to protect the planet and ensure that all people enjoy peace and prosperity by 2030, unfortunately, accountability is lacking. These goals are all aspirational, and no Member State is obligated to anything other than their citizens. There will be no sanctions or the like on the U.S. for not adhering to these goals. We, as American citizens, have to take it up with our government for not doing so. The United Nations will not.
While Member States are formally accountable to their citizens, people often have limited meaningful opportunities to hold their governments accountable. However, I firmly believe in the power of the people and their voting rights to help provide pressure for domestic accountability towards UHC if they are supported by a treaty such as the Framework Convention on Global Health (FCGH). This treaty is aimed at addressing the shortcomings in implementing the right to health including binding standards requiring accountability and enforceability. The FCGH Alliance, a Geneva-based NGO formed under the Swiss civil code, has extensive engagement with the World Health Organization, a champion for global health rights. The FCGH Alliance is in the process of articulating functional remedies for violations of the right to health. These binding remedies would hold U.N Member States accountable for health justice violations and would advance health equity by ensuring that those responsible for the abuses answer for their actions.
However, this all begins with education and being informed. In our U.S. health system, this education gap is wide, as studies show that 90% of the general U.S. population is unaware of the details of our health system. In fact, I argue that Americans have been conditioned to be uninformed because they don’t want us to have the power that comes from knowledge, which often entails action. Information makes us liberated and is the foundation of progress. If Americans become knowledgeable, they have power, and that power can impact our healthcare system, changing the status quo that has comfortably kept incumbents from profiting at the expense of public health, keeping our commodity-based system intact.
For a binding treaty like the FCGH to be successful in the United States, Americans must be informed enough to accept it, putting pressure on their elected representatives to support it. I see the FCGH as a partnership with informed Americans that can help health policy shift as consumers become educated and informed and pressure begins to mount.
In an effort to help move toward health equity in the U.S. by informing the American people, I have recently published a book to help close the gap of our health system illiteracy. This book aims to provide a snapshot of the core dialogue taking place in our healthcare system and provides an ethical argument for health equity. I provide evidence showing how not having health equity is the basis to all of our health system’s problems and the need for accountability as a requirement for any lasting change to happen. My book aims to provide a path for social empowerment for the powerless American health consumer.
The balance of profit and social justice is a true dilemma in the U.S. healthcare system and leads to a level of inequality that is unconscionable. Our commodity-based system forces leaders of health organizations to be motivated by money which deters from the mission of caring for the sick and injured, promoting prevention, and keeping people healthy and happy. For example, healthcare is unaffordable and inaccessible for many, yet executive leaders take home salaries at the amount of millions of dollars, meanwhile many legislators work towards taking away coverage instead of increasing it so that these compensations can continue. Our commodity-based system has put incentives in the wrong places, compromising health justice and the general American population is unknowingly supporting an immoral health system.
Society suffers injustice when not everyone gets to share in the benefits and when distributions of resources are not equal. In healthcare, this creates an environment where health equity is compromised, and health disparities shade society with injustice, which is the unfortunate reality in the United States. Moving to a system where the incentives change and the priorities shift to include everyone, will remove this injustice. This is because what a government prioritizes and spends their money on defines what’s important to them, and extending access to quality healthcare to everyone has never been a priority. One of the biggest issues we have in the U.S. healthcare system is not not having enough money for Universal Health Coverage, but how our limited healthcare dollars are spent.
Award-winning 20th century philosopher John Rawls was interested in what makes a just and moral society. At the core of Rawls theory is that no matter what our circumstance, environment, or influence, we are human, and basic rights for everyone in all positions of society must be observed to truly live in a moral, ethical, and just society. I am encouraged by the mission of the FCGH Alliance, and its vision towards a more just society that ensures the right to health for all people by addressing health inequities.
