“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.”
World Health Organization Constitution, 1946
Yes 1946, that is when this idea of health as a human right was declared by the international community, a more expansive expression of this right emergent concurrent with the Universal Declaration of Human Rights in the same year by the United Nations. In Article 25 the United Nations asserted that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”
I was three years old.
I have been involved in health care in the United States, in one role or another, for over fifty years. This involvement is a persistent confrontation with the face of human suffering. It is a clear, stark pathway to consciousness about poverty and its price tag. It is a study in moral dilemmas and the moral distress that shape the work of health care providers. During the fifty plus years I worked in health care, I have had the opportunity to observe health care from a wide range of perspectives.
It is my conviction that we have moved irrevocably toward an insistence that health care is not a human right but a “product” purchased by a consumer, subject to the “laws” of the free market. You can have some if you can buy it somehow. If you can’t pay, you go without or get “charity” care if you’re lucky. There is an unstated assumption, often, that it is your fault if you can’t buy the product.
Some of the shifts are easily demonstrated. During the 90s we were advised that we would no longer call our patients by the descriptor “patients”; they were now “customers” or more often “consumers”. We started calling health care, once a practice of compassion, now a “health care industry”. The breaking point for me, a source of extreme astonishment, was the introduction of “for profit” health care. I kept trying to wrap my mind around going to work to make a profit from another’s illness. It seemed creepy.
Now I know all the counter arguments. I recognize the dynamics of “selling a product” for profit. I can support many products that are sold for profit. I buy them all the time. I think health care is not a product. I know all the euphemisms and rationalizations. I lived through them, and still do.
Adaptation has its costs. Playing a support role in the human challenge of serious illness, injury or death does not feel like an interaction about a product.
It is my belief that the vast majority of Americans have no idea that this amazing shift evolved or what it might mean for their well-being. They just want to know that they can get help when they are scared, sick, suffering, or hopeless. They are looking for humane, compassionate care. They anxiously hope they luck out. They are terrified by the costs, the caprice of insurance coverage. Most may wish it were, but do not think that health care is their right.
I have a list of people. I want everyone on the list to spend a week of nights in an inner city public hospital emergency room, every night for at least a week. Then we can talk.
Health care is a human right.