Healthcare As a Right: Why the Midterms Really Matter
Among issues facing the electorate in a couple of weeks, healthcare is one of the most discussed. As there is smoke among Republicans on it as an election issue -- and there is a lot of it -- there will certainly be fire when it comes to preserving healthcare as a right for all Americans. Two recent examples stand out. On October 10, there was a Democratic effort in the Senate to eliminate short-term health plans that won’t cover essential health benefits, including pre-existing conditions, but it failed in a tied vote of 50-50. Only Susan Collins (R-Me.) bolted from her party and voted for the Democrats’ measure. These plans, pushed by the Trump Administration, are intended to sway those that do not wish to pay the premiums for coverage provided through the marketplaces set up by the Affordable Care Act (ACA) aka Obamacare. What Republicans don’t say is that these policies come cheap because they do not cover essential health benefits like prescription drugs, emergency room visits, or maternity care. Short-term health plans also don’t need to adhere to the ACA’s regulations that protect individuals with pre-existing conditions and comprehensive coverage; these new plans can deny coverage or charge higher premiums based on policyholders’ medical histories.
On the same day, Trump penned an op-ed that appeared in USA Today, “Democrats “Medicare for All’ Plan will demolish promises to seniors.” Among his incorrect statements, he opined,
“As a candidate, I promised that we would protect coverage for patients with pre-existing conditions, and create new health insurance options that would lower premiums. I have kept that promise, and we are now seeing health insurance premiums coming down.”
Yes, it’s true that these Republican-backed policies will cost less, but this is because they don’t provide health insurance coverage for what most Americans need and require to maintain their health. How can we be productive to ourselves, our families, our communities, even to our employers, without maintaining or regaining our health? We can’t.
Another fallacy that voters hear is that Republicans still want to provide coverage for pre-existing conditions. What isn’t said is that the Trump administration is backing a lawsuit brought by multiple states and state Attorneys General pending in federal court in Texas. The lawsuit states that the ACA is unconstitutional, including its pre-existing condition provisions, since the core of the Act -- the individual mandate that requires everyone to purchase insurance less a penalty/fine be imposed upon them -- was stripped out of the ACA in the new tax law passed late last year.
Then there is the idea of having a Medicare-type system for all, e.g. universal coverage, most prominently first advocated by Sen. Bernie Sanders (I-Vt.) but in recent months put forward by many others as an idea worthy of consideration. Those that oppose it say it will destroy the present Medicare system for seniors, but ask any senior what they think about Medicare and the coverage it provides. To state this differently, those that oppose government interference in their healthcare balk at any political interest taking away their Medicare. Go figure. Regardless, fear mongering like in the Trump op-ed is merely a political tuning fork by those opposing any mention of expanding what is working well for the nation’s senior population. If Medicare provides needed and essential government-run coverage for seniors, why shouldn’t others younger than 65 benefit by such a system? If for nothing else, it is certainly worthy of further discussion and analysis.
Just days ago, the Trump administration announced a new policy, making it easier for states to circumvent coverage requirements and consumer protections afforded by the Affordable Care Act. On the same day, the administration -- through the administrator of the Centers for Medicare and Medicaid Services -- indicated adopting a regulation that would allow employers to provide money for their employees to purchase individual health insurance coverage, aside and apart from enrolling in an employer-sponsored health plan. Once again, allowing employees to purchase these plans would deviate from ACA's mandate that any waiver from ACA's requirements must "at least be as comprehensive" as coverages available under the ACA, and must cover "at least comparable number" of people. The new policy would allow states to count those with short-term plans as being covered even though this isn’t providing the coverage required by ACA. These bare-bones plans can leave out prescription drugs, treatment for mental illness and drug abuse, maternity care, and, to reiterate, pre-existing conditions.
Despite all the back and forth, let’s put the brakes on for a moment, even with the midterm elections fast approaching.
Healthcare as a right, not a responsibility or a privilege, was first mentioned by then-Senator Barack Obama on the campaign trail a decade ago in a Presidential debate with Sen. John McCain in Nashville. Months before, I penned in a publication, Clinical Endocrinology News (July 2008),
…Should all Americans be entitled to healthcare? It is a simple question but one that has produced considerable debate, because we as a nation have never considered healthcare as a right. Should it be? If it should become a fundamental right, should Americans -- such as children -- have health insurance guaranteed to them? ...All Americans…should be provided healthcare as a matter of a new social policy. All Americans should be provided healthcare for many of the same reasons that led to Medicare’s passage in 1965: The crisis is widespread and pervasive today as it was in the years preceding Medicare’s enactment, and some type of relief is warranted on a national level, but for all U.S. citizens -- not just for seniors.
In a follow-up piece about healthcare offered in other nations, I wrote, “But whatever the system, each country’s premise is the same: Everybody has a right to healthcare.” Ted Kennedy espoused this same notion later that year at the 2008 Democratic National Convention.
On March 23, 2010, President Obama signed the Affordable Care Act into law. He stated, “We have now just enshrined, as soon as I sign this bill, the core principle that everybody should have some basic security when it comes to their healthcare.” House Majority Leader, Nancy Pelosi (D-Ca.) was also quoted as saying, “And now we can add affordable care to that short list of fundamental rights for all Americans. Rights, not privileges.” This message has been echoed by numerous individuals running for political office, like Sen. Sanders as part of his presidential campaign, and today by the likes of Democratic candidate for Illinois’ Attorney General, Kwame Raoul.
To repeat, healthcare is a hot-button issue for the Midterms throughout the country. Though the Declaration of Independence speaks in terms of being endowed with certain unalienable rights -- life, liberty, and the pursuit of happiness -- healthcare being accessible and affordable was certainly not on the minds of the Framers back then, and is thus not a right in any constitutional sense; it is, though, in a human rights or moralistic way, like all industrialized countries view it. Even with the ACA and all that led up to its passage and many subsequent legal and legislative challenges to it, healthcare has been a political football, with profits drawn from it in its creation, access and delivery in its keystone, particularly since paying for healthcare has always been through an insurance model in our country.
With what we see in junk healthcare plans now being pushed by interests not supportive of the ACA, or backing the previously mentioned federal lawsuit to do away with coverage for pre-existing conditions, healthcare as that football is not a new concept. It can be traced back to FDR in 1943 when he crafted his proposed “Second Bill of Rights.” As more fully explained by authors Jean Carmalt and Sarah Park, FDR declared “freedom of want” to be one of four essential liberties for human security. His definition of freedom included, “the right to adequate medical care and the opportunity to enjoy good health.” Carmalt and Park wrote, “The right to healthcare was subsequently enshrined in the Universal Declaration of Human Rights,” a 1948 United Nations document that declared. “…everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including food, clothing, housing, and medical care.”
Even the Supreme Court has previously interpreted the 8th Amendment’s prohibition against cruel and unusual punishment clause to include guaranteeing healthcare to prisoners. Lest we not forget the Emergency Medical Treatment and Labor Act, which says hospitals must treat us until we are stable enough to be transferred someplace else or to be discharged.
It is clear that because this notion we call our healthcare is an essential condition of our existence, without acquiring or maintaining it, none of us can be productive to ourselves or to any societal group to which we consider ourselves a part. Its accessibility and affordability as a right requires our vigilance and protection nationwide. Our best effort to date has been the ACA and its preservation; it certainly cannot be supported or be substituted by health plans that do not provide essential health benefits -- as does the ACA -- or by politicians that back plans or a lawsuit that eliminates pre-existing conditions.
Is it more worthy for the country this time around to vote in at least one Congressional chamber with a blue hue to it after November 6? When it comes to preserving healthcare as a right for all Americans, the answer is certainly yes.