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Healthcare: Right or privilege?

by Nancy Hudson

April 15, 2011

I am often asked what kind of work I do when first introduced in a social setting. When I explain that I direct a large free clinic in Mecklenburg County, I often get responses like, “The uninsured just need to get a job.” “Medicaid and Medicare cover everyone who can’t get other healthcare, right?” Or, “if we can solve poverty, we can solve the healthcare crisis.”

There is some truth in all of these perspectives, but, by and large, these statements reflect misconceptions about health insurance and health access in America. Over 60% of those without healthcare coverage work or are in families with at least one person working. Between 1999 and 2007, North Carolina experienced a 12.5% decrease in employer-sponsored health insurance. Industries with high employee turnover, such as restaurants, retail, and hospitality, do not provide healthcare coverage for their workforces. Medicaid has strict financial guidelines and covers those who are disabled for at least twelve months. Medicare primarily covers older adults and the permanently disabled.

The United States has created a complex and disjointed healthcare delivery system. We have numerous gaps in health insurance coverage. Employment status, education, income, and race are just a few factors that influence a person’s ability to acquire healthcare insurance. America’s approximately 46 million uninsured affect the bottom line for large and small employers, all levels of government, and the overall health of our economy. While the rising cost of health care has elevated public discussion about health policy in the U.S., we have not had enough discussion about how other countries spend less on health care, yet achieve better health outcomes in some areas. The US spends almost twice as much per person on health care as any other country, yet our healthcare outcomes rank 37th for health system performance. We lag behind Australia, Canada, Germany, New Zealand, and the United Kingdom in infant mortality, life expectancy, and preventable deaths.  And no one can justify the fact that one-fifth of all Americans do not have access to healthcare or health insurance. Is this situation a violation of our basic rights?

As a nation, we must answer the question: is health care a right or a privilege? I believe that healthcare is a basic human right. Providing healthcare is about granting equal opportunity for everyone to utilize what abilities they have and to live as fully contributing members of society. Norman Daniels of the Harvard School of Public Health states it well: “Specifically, by keeping people close to normal functioning, health care preserves for people the ability to participate in the political, social, and economic life of their society. It sustains them as fully participating citizens – normal collaborators and competitors – in all spheres of social life.”

Each of us has experienced that the world seems to be getting smaller. Viruses emerge in China, speed across the Pacific, and land in the U.S. Children who are not vaccinated against measles, mumps, and whooping cough acquire those diseases and put other children at risk. We are no longer a nation of small rural communities; we’re increasingly urban and connected. I am alarmed when I visit a restaurant and know that the majority of servers and cooks have no healthcare coverage. When I am eating food they prepared, I need them to be healthy so that they do not expose me or others to easily transmitted diseases.

Our leaders have gotten ahead of themselves by asking, How do we deliver coverage for all Americans in the most cost-effective say?  Until we can agree that healthcare is a basic human right, we will not be able to navigate the difficult road of healthcare reform. During the last century, the U.S. has contributed to enormous advances in research and development for all kinds of technologies, in medicine and many other fields. We offer some of the world’s best health care to some people. But for many other Americans, free clinics provide the only health care they can access. We have the ability to offer the world’s best healthcare to more people – yet we do not and cannot with our current system.

I look forward to the day when I attend a party and can get into discussions about how well healthcare reform is working; if not, I might just go get another drink.

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References:
http://www.ncmedicaljournal.com/ (NC Medical Journal)
http://ehbs.kff.org/ (Kaiser Family Foundation)
http://www.iom.edu/ (Institute of Medicene)

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