One doctor's opinion: health care Is a right not a privilege
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Three years after its implementation, the Patient Protection and Affordable Care Act (ACA; Obamacare) continues to provoke  intense debate over its benefits and problems, and whether it should be improved, repealed, or even replaced by a single public health-care option. At the heart of the matter is one fundamental question: Is healthcare a human right, or is it a privilege?

European nations have had different models of health-care coverage for more than a century, driven by the need for protection of wage loss due to sickness, rather than payment of medical expenses. Today, they provide excellent government-sponsored health care at reasonable costs. The European Union and the United Nations (UN) recognize health care as a human right, and it is guaranteed in the constitutions of 38 percent of UN members.


The evolution of health care in the United States took an interesting path. After World War II, President Truman proposed a national insurance system, similar to the Canadian model today. The effort failed for 2 reasons: 1) opposition from the American Medical Association, perhaps fearing loss of income; and 2) the belief of Southern Democrats that a national insurance system would force hospital racial integration (in fact, Medicare, introduced in 1966, resulted in desegregation of U.S. hospitals). Two decades later, healthcare interest groups became a powerful force against government-based universal health care that might jeopardize industry profits.  Other forces have also hindered progress: American exceptionalism; ideological opposition to “socialized medicine” and government safety nets; and anti-welfarism.

The reluctance of Americans to embrace universal health care may have been influenced by ideological movements of the late 19th century, driven by the writings of William Graham Sumner. Darwinian evolution and Malthusian economic theory aligned with capitalism shaped much of that thinking. Simply stated, it posits that the world population is increasing geometrically but resources are increasing arithmetically. Civilization can choose liberty, inequality and survival of the fittest, or no liberty, equality and survival of the unfit. Through Darwinian evolution, the former moves societies forward by selecting its best; the latter moves societies downward by selecting its worst. By inference, government interventions interfere with natural selection and weaken societies.

Social Darwinism prevailed into the beginning of the 20th century, and was used to justify horrors such as the Armenian genocide and the Holocaust. It inevitably led to medical Darwinism (survival of the healthier, or wealthier, fittest) and may have encouraged acceptance of health care as a privilege available only to those with means. However, Americans believe in equal opportunities to achieve the American dream, and therefore in the need for protection during hardship. Eighty-three percent  of Americans believe health insurance is essential or very important, and 70 percent support universal coverage. Some disagree. In 2003, a Texas legislator said, “Where did this idea come from that everybody deserves… Free medical care? It comes from Russia…straight out of the pit of hell.” Still, most Americans believe in equal access to and guaranteed fairness in health care.

If health care is a human right, who will pay for it?  The resources exist, but  are diverted from patient care. European countries spend 6-12 percent of their GDP on health care; the United States spends 18 percent. Americans believe we have the best health care  in the world, but this is not supported by studies that rank ours near the bottom by objective measures. Of close to 4 trillion dollars spent in the U.S., less than one-third goes to direct patient care. The rest is diverted as sometimes exorbitant profits to the health-care industry, and billions are lost in excessive bureaucracy and Medicaid/ Medicare fraud. Addressing these issues can result in a system that delivers quality, affordable care.

The Medicare and Medicaid programs signed into law by President Johnson in 1965 were our first steps to make health care available to vulnerable Americans (children, elderly, poor). The ACA is our first attempt at affordable health care for all. It is already making a difference. The rate of uninsured Americans decreased from 18 percent before the ACA implementation to 8.6 percent in early 2016, the lowest level ever.

Americans have a choice among three possible systems. The first is to revert to the “for-profit” model available before the ACA. This left 50 million Americans uninsured and 15 to 30 million with worthless insurances when facing major illnesses. These Americans suffered from the devastating consequences of poor health, estimated to cause the loss of 20,000 lives annually. This is inconsistent with health care as a human right and favors medical Darwinism. The second is a government-based, not-for-profit system, or “Medicare for all.” The existing ideological-societal conditions do not favor this. The third is to accept the ACA as the basis for health care as a human right and improve it, so that many more millions of Americans have access to affordable health care.

Hagop M. Kantarjian, MD, is chairman of the Leukemia Department at The University of Texas MD Anderson Cancer Center, and a Baker Institute Special Fellow for Health Policies at Rice University.

The views expressed by authors are their own and not the views of The Hill.