The following is a review of the book, “Why the United States Healthcare System Should be a Limited Human Right for All,” Section One (2009) with Section Two (2010-2017) by Mark Tozzio, M-IHHS and Fellow of the American College of Healthcare Executives.
Since 1946 the United States has signed and ratified, by a two-thirds vote of the United States Senate, two treaties recognizing the right to health care for Americans, in part or in whole. These treaties are considered legally binding. The first treaty was the adoption of the World Health Organization Constitution in 1946 (and ratified June 14, 1948)1 that states, in part:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition . . . Governments have a responsibility for the health of their peoples, which can be fulfilled only by the provision of adequate health and social measures.”2
The second treaty was the adoption of the International Convention on the Elimination of All Forms of Racial Discrimination in 1946, ratified by the U.S. Senate in 19943 and which states, in part:
“In compliance with the fundamental obligations laid down in article 2 of this Convention, States Parties undertake to prohibit and to eliminate racial discrimination in all its forms and to guarantee the right of everyone, without distinction as to race, colour, or national or ethnic origin, to equality before the law, notably in the enjoyment of the following rights . . .The right to public health, medical care, social security and social services.”4
Two other treaties were signed by the United States, but they were never ratified by the U.S. Senate and, thus, not legally binding. One was entitled “International Covenant on Economic, Social and Cultural Rights” and adopted Dec. 16, 1966.5 The treaty was signed by President Jimmy Carter on Oct. 5, 1977. The relevant section is Article 12, which affirms, in part:
“1. The State Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”6
Parts 2-(a) through (d) delineate what steps need to be taken by the signatories to achieve the right to health care.
The second treaty , entitled “Convention on the Rights of the Child,”7 was adopted Nov. 20, 1989, and signed by United Nations Ambassador Madeleine Albright on behalf of President Clinton on Feb. 16, 1995. To date, the U.S. Senate has not ratified the treaty. The relevant section is Article 24, numbers 1 and 2, which state, in part:
“States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.”8
In Section One of Mark Tozzio’s book (published 2009), he focuses on the ethical, philosophical and socio-economic rationale for instituting universal health insurance coverage in America. The book concluded that affordable health insurance mandated for all citizens was the correct thing for the government to do in order to strengthen the state-of-health of the nation. By examining a vast array of data, Tozzio tempered that point by stating there are limitations to any government’s ability and responsibility to ensure everyone has access to basic health services and preventive care. Vermont Senator Bernie Sanders differentiated between “affordable health care” and “access to health care” by stating: “‘Has access to’ does not mean that they are guaranteed health care. I have access to buying a $10 million home. I don’t have the money to do that.”9 Since 2010 annual American health care spending has increased to (in 2016) $10,345 per capita, far higher than any other country in the world and with worse health outcomes than other OECD (Organisation for Economic Co-operation and Development) countries. The current U.S. health care tab is $3.35 trillion for all types of health care services, which constitutes 18.5 percent of the Gross Domestic Product.10 Tozzio makes the point that “throwing money at health care problems does not guarantee better care, quality outcomes or cost effective care.” Hence, he uses the phrase in the book’s title “limited human right.”
On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law, which seemingly ended the debate on “whether or not health care was a right in the United States.” The first title within the ACA law affirmed the “goal of achieving quality, affordable health care for all Americans.” In 2013 Obama reiterated his core belief, “No one should go broke just because they get sick. In the United States, health care is not a privilege for the fortunate few; it is a right.”11 Tozzio does conclude that, although ACA is far from perfect legislation, great strides have been accomplished for “bending the cost curve” in the long term while providing health insurance protection to millions of additional citizens.
With the recent debate in the U.S. Congress regarding the “repeal and replace” of ACA, the “right to health care” is again being debated. For instance, ACA gave all people with prior medical conditions a guaranteed right to purchase insurance at the same price as all other people. The law also required health plans to provide 10 essential benefits, including preventive medicine. Now, this is in danger of being scrapped. As a result, Tozzio decided to update his book and re-examine the paradigm shift to universal and value-based care that ACA is creating. By updating his data from 2010 to 2017, he has discovered that evidence points to a significant shift in utilization patterns with a focus on quality and safety while at the same time experiencing a moderation in the rising cost of health care when compared to the pre-ACA era. The end-point of his data analysis is “regression is not a logical option for the American health care system. The logical approach is to repair and enhance ACA.”
In terms of the American health care consumer, the question is, “Why is this book important to read?” Whereas people tend to focus on the daily tasks of their lives and occasionally utilize health care services, they rarely have time to pause and look at the “big picture.” All Americans need to see where health care is heading in order to pave the way for an orderly transition of their health insurance coverage. The policy changes being contemplated by Congress for the American health care system will have important consequences for health care consumers as they adapt to new directions resulting from changes to ACA. The fact that the Republican Party is focused on repealing and replacing the Affordable Care Act means there is great potential to create confusion and to cause gaps in insurance coverage for the unsuspecting citizen. Whereas legislators and public policy analysts deal in the theory of health care coverage and attendant costs, the individual citizen lives with the reality of the government’s decisions. As a result, everyone needs to understand the basic premises of how and why the health care system is formulated and implemented. Then, these citizens need to participate in the debate regarding the contemplated changes.
I commend Mark Tozzio’s book to the citizens of the United States to read, to discuss and to retain.
References
1 Constitution of the World Health Organization.
2 United Nations, Preamble to the Constitution of the World Health Organization, “Chapter IX Health,” as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (accessed June 24, 2017).
3 International Convention on the Elimination of All Forms of Racial Discrimination
4 The United Nations, “Chapter IV Human Rights: article 2.1. International Convention on the Elimination of All Forms of Racial Discrimination,” Treaty Series 660, 195. (Accessed June 24, 2017).
5 Ann Piccard, “The United States’ Failure to Ratify the International Covenant on Economic, Social and Cultural Rights: Must the Poor Always be with Us?” The Scholar: St. Mary’s Law Review on Minority Issues, Winter 2010.
6 The United Nations, “Chapter IV Human Rights: 3. International Covenant on Economic, Social, and Cultural Rights.” treaties.un.org. (Accessed July 13, 2017).
7 Luisa Blanchfield, “The United States Convention on the Rights of the Child.” April 1, 2013. crs.gov.
8 The United Nations, “Chapter IV Human Rights: 11. Convention on the Rights of the Child” treaties.un.org (accessed July 13, 2017).
9 https://www.bustle.com/p/15-quotes-about-health-care-that-prove-its-a-right-not-a-privilege-56086 (accessed June 24, 2017).
10 R. Alonso-Zaldivar. PBS Newshour (July 13, 2016) “$10,345 per person: U.S. health care spending reaches new peak,” http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/ (accessed June 25, 2017).
11 The White House, Office of the Press Secretary (September 26, 2013) “Remarks by the President on the Affordable Care Act,” https://obamawhitehouse.archives.gov/the-press-office/2013/09/26/remarks-president-affordable-care-act (accessed June 26, 2017).
