THE HEALTH CARE DEBATE

    RAD shared the podium Thursday morning with a Pacific colleague before an Occupational Therapy class on the Hillsboro campus discussing whether or not health care in the USA ought to be considered a "human right."  
    My colleague pointed out the conceptualization of what is a "right" is fraught with many terminological and real world problems.  If such a "right" exists what is its origin?  And if such a "right" can be clearly explained does this mean we should act on such a claim?
    The First Amendment of The Bill of Rights guarantee us freedom of speech, press, religion and peaceful assembly.  The Second Amendment gives us the more problematic right to bear arms.  Are "rights" totally elastic?  Can we afford to act upon all such "rights" claims?  
    The answer seems yes, rights are elastic.  As the nation has matured we have expanded rights not granted early in our history:  the right of women to vote; the right of African-American's to be liberated from slavery; the right of 18 year old to vote and the right of Native Americans to tribal status.    
    In the aftermath of the Great Depression and before Pearl Harbor FDR expanded the concept of rights to include the Four Freedoms including freedom of speech and expression, freedom to worship, freedom from want and freedom from fear.                              
    President Truman was the first president to commit specifically to viewing health care as a right.  But he got nowhere on this agenda.  But two decades later LBJ Great Society program launched Medicaid and Medicare.         
    As time has moved on we have also incorporated the concept of affirmative action to make rights claims actionable for racial minorities, women, those with disabilities and more recently gay and lesbian Americans.
    But there has also been political backlash against the concept of entitlements for such targeted groups.  President Nixon adopted benign neglect on the racial front, while President Reagan worked unsuccessfully to end the entitlement state.
    If we consider K-12 education as part of the social contract underwritten by taxpayer dollars, whether or not one is a parent or your kids attend a public school, it appears to be a defacto "right" even though the Supreme Court in San Antonio v. Rodriguez found in a 5-4 vote that education is not a "fundamental right" nor does it require equal funding. 
    If education is a "right" within the framework of the American social contract should health care be considered such a right too?  The right to health care like education offers the promise that everyone should begin life on an even playing field as they pursue happiness.                    
    Today D.C. insiders are gridlocked over the expansion of SCHIPS and Oregon voters just turned down expanding health care to 60,000 of our children. The division between Red and Blue states and voters seems to be located in the political equivalent of the Deep Muddy.                      
    Nevertheless, a consensus from the current debate on health care is emerging that Americans should have the right to some type of universal health care insuring basic coverage.  However, the line that divides basic from supplemental coverage is open to interpretation.
    We've come to a point where Americans claim many "rights" but few responsibilities.  Along with the claim of the "right" to health care what responsibilities do we incur with such a claim?  As consumers of health care and engaged citizens what can we do to bring health care costs down? 
    In the health care arena three responsibilities stand out:  1) we need to focus on removing health care disparities along class, racial and urban/rural lines; 2) we need to focus on primary care to get at health problems before they get truly serious; and 3) we need to focus on chronic care, preventive care and wellness strategies. 
    So what is the status of the right to health care in the US?  We know that Bill and Hillary Clinton tried to advance the cause in 1993 only to be shot down by the Harry & Louse commercials fronted by the Health Care Industrial Complex of big drug, insurance and hospital corporations aided by the AMA, forever hostile to anything smacking of "socialized medicine.                                 
    But we have programs which give "protected" populations a right to government sponsored health insurance or access to health care accommodations - those over 65 (Medicare); those living in poverty (Medicaid and SCHIPS); those who have served in the military (VA); members of Congress; and those with disabilities (ADA).     
    Despite these efforts we still have 47 million Americans without any health insurance, 1 in 3 Americans who at any time are in between coverage due to a job loss or change and 1 in 4 Americans who are underinsured.                                  
    The cost of this benign neglect is that life expectancy in the USA is lower than in Britain, France and Canada.  While we e spend more for health care we get less bang for our buck.  And the productivity of the American worker is compromised by our gap ladden multi-layered, public-private system.        
    Why do we accept a heath care insurance system that results in such disparities?  And would the option of universal health insurance, not "socialized" medicine, be advanced by a "rights" claim for it?                      
    The short answer is the lack of political will has prevented us from doing what every other democracy in the world has done on the health care front.  But along with a failure of nerve, Americans seem tone deaf to the concept that health care is a fundamental "right."                 
    Why is this so?  Some trot out the well tested "socialized" medicine argument.  Others fear inventing another big government, big spending program. Other detractors argue that we will lose our right to chose our doctors and/or hospital.
    The choice argument is very curious since under the current HMO dominated system this "right" to choice is problematic.  If your doc or favorite hospital is not in "network" good luck!  Canadians have choice - so what's the real issue?                         
    Now to be fair, moving to a national health care insurance system like the Canadians have will not be cheap.  There will be upfront costs and deferred care costs that can't be anticipated just like there were when the Oregon Health Plan came online in the '92.                             
    We pay 16% of our GNP for health care while our Canadian friends pay around 11%.  Why is health care more costly in the USA?  Answer, the fancy ads you see on TV for meds and insurance plans are NOT free.  Besides the Health Care Industrial Complex are for profit businesses where stock holders are more important than patients.
    Guess who pays for those fancy ads or the salaries and stock options paid to health care CEOs?  Those of us with insurance!  We also pay for those who go to an ER when they are really sick but have no insurance!   Cost shifting in the USA is a major cause of rising health care costs.                              
    Should access to health care in the USA be considered a "right" or a privilege of those who can afford it?      Historically it's been a negotiated "right" between employers and employees with the gaps covered by the government.  But facing global competition employers want out.                                                                                                            Yes health care should be a "right" whether that "right" is founded on the concept of "natural rights" (i.e. the inalienable right to life, liberty or the pursuit of happiness) or embedded in the penumbra of our "social contract" (our Constitution).                                         
    Such a "right" emanates from the notion that our Constitution as a living breathing document can be adjusted to the challenges of the 21st century rather than be forever stuck in the 18th century.                             
    US history is a saga of expanding "rights" claims that the Founders turned a blind eye towards - the rights of the propertyless, indentured servants, women, slaves and Native Americans.  The genius of the Founders' construction is that our Constitution is not stuck in time.                 
    It's past time we joined the most progressive nations of the world by including health care as a fundamental human right.  To get there takes political will and money.  And the devil is always in the details.  But a nation which rebuilt Europe and Japan after WW II and which spends $12 billion per month in Iraq has no excuses.                        
    As the current presidential campaign moves along we need to do what Nixon admonished voters to do - "watch what we do, not what we say." This was good advice in the '60s and good advise now.                           
    While the "dark" Lutherans of Garrison Keillor's Lake Woebegone felt suffering was inevitable and noble, why should a child be denied medical care simply because of their street address, race or class?  Why should they be a victim of the circumstance of their birth?                            
    As Jesus said - "do unto them, as you would have them do unto you."  Who would of you deny a homeless child in Washington County medical care simply because of his or her lack of a home address?                             
    To paraphrase Martin Luther King, Jr. - we should judge a person by the "content of their character" not the color of their skin or the size of their parent's wallet.  In God's eyes we are ALL human.  We can do better!           
    The city on a hill that Governor 0John Winthrop promised his flock of Puritans upon coming to America is still a work in progress.  It's time the politicians quit haggling about the shape of the health care table and the price tag.  It's time to pay on the next promissory note of the American Dream.             
    So is health care a "right?"  It is if we make it so.  There will be thorny issues to debate along the way.  How long do we prolong life?  What extraordinary care should be included?  How should the health professions be organized to best serve heath care consumer-citizens?
    But these are the pesky details.  Right now we need to develop the "will" to do the right thing before we design the new health care system.  Fortunately, Oregon's legislature in '07 signed on to the concept of universal health care.  Now an interim task force is working on the design features of an Oregon model.             
    If former Governor John Kitzhaber has his way we'll take the Oregon Plan on the road to the nation!