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The Question of Universal Health Care

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In the lingering aftermath of Michael Moore’s film Sicko and the long run-up to the 2008 Presidential election, the subject of universal health care has established itself firmly atop the docket of public debate.  The questionable nature of Moore’s technique and journalistic integrity notwithstanding, his work has certainly called into question the efficiency of the United States health care and health insurance structures.  Couple the $24 million that Sicko has hauled at the box office with a front-running Presidential candidate who has made health care reform her calling card, and the publicity is no surprise.  Ever since her stint managing health care programs as First Lady for her husband Bill, Hillary Clinton has been to health care what Al Gore has been for global warming: an outspoken, relentless spokesperson for a trendy cause that is garnering an ever-increasingly receptive audience.

In response to her strength in the area and the growing prominence of the issue internationally, all the candidates have revised or refined their platforms in preparation for the race to the White House.  The question is how to unpack the politispeak into understandable tenets for the insurance consumer.  So let’s try to do just that.

Background

In the latter decades of the 20th century, Canada, Cuba, much of Europe, indeed most First World countries, adopted systems of universal health care.  The health care systems of Canada, Cuba, France and the United Kingdom were the primary focus of Michael Moore’s film, but other countries as various as Australia, Russia, Saudi Arabia and Argentina have similar socialized medicine systems.  Mexico is working towards a transition to universal health care, as is India.  The United States has never employed a system of socialized medicine or universal health care.

But what do those terms even mean?  This is a good time to disambiguate the two.  In a system of universal health care, every citizen is cared for when he or she is sick.  The term also connotes better preventative care, and more comprehensive treatment of chronic illness.  It does not necessarily specify the source, funding or delivery of medical care—only that everyone gets care whenever he or she needs it.  Thus the systems and plans, and the multitude of political proposals and platforms, are a rich diversity.

Socialized medicine, on the other hand, is the plan for everyone to be ensured of receiving care from one source, a “single payer,” which may or may not be the government.  Political advocates of socialized medicine in this country shy away from that label, preferring the more innocuous “single payer system” or the more vague “universal health care.”  In actuality, the systems in the U.K., Canada, etc. are systems of socialized medicine, and are referred to as such within those countries.  American voters are expected to reject the term because most Americans remember a Socialist Republic that we fought for a long time and we aren’t eager to jump on that economic bandwagon.

Thus, effective socialized medicine is a type of universal health care, and indeed the very type that most politicians intend to denote with the term “universal health care.”  Unfortunately, though not for the first time, the politics of an issue have softened the terminology to the point of imprecision, or even confusion.  But then again, maybe that’s the point.  In a double-edged dig at both the system of socialized medicine and the vacuous language the movement propounds, some free-market economists have decried that as a matter of practice, the inefficiency of a completely socialized system disqualifies it from the classification “universal health care.”

In any case, “universal health care” is the controversial end, and most of the time, “socialized medicine” is the controversial means to that end.

What are patients’ rights?  What is the right to health care?

Another phrase that you will likely hear bandied about a great deal in the upcoming months is “the Patients’ Bill of Rights.”  The first patient’s bill of rights was a series of recommendations published in 1998 by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry.  The eight recommendations cover the following areas:

1. Information disclosure
2. Choice of providers and plans
3. Access to emergency services
4. Participation in treatment decisions
5. Respect and nondiscrimination
6. Confidentiality of health information
7. Complaints and appeals
8. Consumer responsibilities

None of the findings of the commission were passed into law, however, and so although some health plans have adopted the recommendations, many others have not and are not required to.  Three years later, the McCain-Edwards-Kennedy Patient’s Bill of Rights (S. 1052), which advocated similar rights, was batted around in Congress for a few months.  The House and Senate passed different versions of the bill, lacking any executive power of enforcement, and by 2002, the bill was rejected and forgotten.

The United States has never had a real “patient’s bill of rights,” therefore.  Legally, there is no such thing as a right to health care.

Traditionally, of course, the same is true.  Health care has never been guaranteed in any official sense, and has always been delivered by private providers of insurance and doctors who work for themselves and for hospitals.

And perhaps most importantly, there is no mention of the right to health care in the Constitution or the Bill of Rights.  So be wary of anyone, politician or not, who refers to “the right to health care” or “the right to affordable health care,” because as far as law, history and the Constitution can tell, there is no such thing.

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