The ACA and the Medicaid Ruling: Let’s Remember that Health Care is a Human Right

On June 28, the United States Supreme Court announced its ruling on the constitutionality of the Patient Protection and Affordable Care Act (ACA). Now widely known as “Obamacare,” the act was signed into law two years ago, expanding health care coverage for millions of previously uninsured people. The Court has ruled that the central provision under examination – the individual mandate, or the requirement that individuals purchase health insurance – is, in fact, constitutional.

While the court has upheld the right of millions of young people in the US to be covered under their parents’ insurance, and the right of millions more with pre-existing conditions to be covered in the event of illness, it has weakened the Medicaid provision which would have expanded coverage to millions of people living at or below the poverty line.

In the hurry by news organizations to cover the decision yesterday, this may all seem like political theater. But the US has a clear and crucial responsibility under international law to guarantee its peoples’ right to health and health care.

Article 25 of the Universal Declaration of Human Rights states that everyone has the right to a healthy life, including access to food, clothing, housing and medical care and necessary social services; the United Nations adopted these principles in 1948.

The US has also signed international laws and treaties guaranteeing more specific rights to our most vulnerable citizens. The US signed the Convention on the Elimination of All Forms of Discrimination against Women, in 1980, which includes Articles 12 and 14 upholding women’s right to health care services. At a time when health care services specifically for women are under unprecedented assault at the state level and women’s health care providers are being threatened and harassed, it seems impossible that we could ever have been even that committed to ensuring women’s access to comprehensive health and reproductive care.

In 1995, the US signed the Convention on the Rights of the Child, which asserts in Article 24 that every child have access to the highest attainable standard of health and for “States Parties [to] strive to ensure that no child is deprived of his or her right of access to such health care services.” Our government’s ongoing fights over funding health care for economically disadvantaged children through the State Children’s Health Insurance Program (SCHIP) are just another example of the many ways in which our human right to a healthy life continues to be used as a political volleyball.

These treaties reveal a longstanding global recognition of the human right to health. We must evaluate the Supreme Court’s ruling in light of this significant body of international law: an important step forward, but only one step on a long journey towards full human rights for all.

For information about MADRE’s international work for health as a human right, click here.

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  • cmarie

    Here’s my comment on the subject of the Health Care Legislation.  It was quickly censored on the last article on this subject I commented on even though who ever did it had no response.  Anyway maybe someone who wishes to respond will get to read it here.   I am just going to add two questions re all the starry eyed references to the great U.N.  Can we just keep in mind that the “Human Rights Council” includes not only China and Cameroon but Saudi Arabia as well?  And how long before we finally have the privilege of valuable insight from North Korea regarding Human Rights and Healthcare?   

    Regarding Obamacare:  everyone will be vulnerable when the last of the M.D.’s take early retirement, switch to doing pure research rather than treating patients directly or leave the country altogether.   Sure, there are people who will take on the tuition costs, the phenomenal responsibility, the cost of malpractice insurance and now lower pay to work as Doctors because of intellectual curiosity and some will even do it for altruistic reasons.  But no where near enough people become M.D’s for those reasons and the vast, vast majority will stop seeing patients in this counrty if Obamacare truly does become the law of the land long term.  What happens when we simply do not have enough Doctors to treat us, when the last of them want to leave, retire, teach, do research or go to work for lawyers?   RN’s, Nurse practitioners and physician assistants do tremendous work but we expect to see MD’s when we seek treatment or at least know that one is overseeing our treatment.  East Germany built the Berlin Wall to keep their best and brightest from taking their brains, their education, their skills and leaving.  But “something there is doesn’t love a wall” and you can be damn sure most Americans are not going to be satistied with anything less than an M.D. when they need medical treatment.  Alot of people like Obamacare in theory but I doubt many would want to volunteer to be operated on by someone lacking an M.D after his or her name.                               If “Healthcare is a Human Right” what rights will overwhelmed Doctors have to stop seeing patients, retire or leave?

  • oak-cliff-townie

    Doctors like nice things !

    They will contine to do and be paid for it .

  • jennifer-starr

    Comparing the affordable care act to East Germany or to Communism is misleading, not to say hyperbolic–but considering the overhyped hysteria coming from the right regarding this decision (some proclaiming it to be the ‘death of America’ and Jill Stanek is apparently ‘distraught’??) , I’m not all surprised. Do you have any proof at all that Doctors are just going to up and leave?  Has this happened in other countries with similar health care plans?  


  • colleen

    Do you have any proof at all that Doctors are just going to up and leave?

    Where would they go? The US has the most expensive healthcare in the world. Apparently being ‘pro-life’ means that one does ones best to make certain that 40% of the population cannot afford to access decent  healthcare because the poor don’t deserve life.



  • cmarie

    Jen .. I’m not comparing the Affordable Health Care Act to East Germany or Communism.    I’m comparing forcing people to remain in and practice their very needed skill in a particular country to East Germany or Communism.  Obviously we’re not going to build a wall.  Those who want to leave will leave.  If this does in fact become the law of the land long term I imagine they’ll head anywhere they can be paid for their skills and the responsibilities any Doctor takes on.  Many  of those M.D’s  who remain and don’t retire will  transfer their skills to either teaching, working for lawyers or conducting pure research.  Regarding your question about other countries with similar health care laws, here’s a link on the waits for surgery in British Columbia.   Colleen please see above link also I never said I was “pro life”, I’m just acknowledging that for quality medical care it helps to actually have access to a M.D.

  • coralsea

    Cmarie raises some important issues and questions, and I think she should be thanked for doing so.  However, I would like to offer a few ideas on some of the challenges she discusses might be addressed or differently interpreted.  I thank her for raising them, because it is important to explore some of these concepts.  I will provide some of my ideas on what she has said, and hopefully, others will also build on this very important topic.


    First, in regard to disclosure, I don’t have insurance.  I have several serious pre-existing conditions, and even if the pre-existing condition part of ACA stands, if some mechanism to control the cost of premiums doesn’t survive, I won’t be able to afford the premiums.  Considering the incredibly wonky way services are billed, I will be on my own to pay three times as much as an insurance company would pay for tests, treatments, and medications.  That’s just crummy, and tens of millions of other Americans are/will be in the same boat.


    Second, it always amazes me that one of the excuses given for high health care costs is malpractice insurance and awards to injured patients.  If we had universal health care or something reasonably like it, I am quite sure that you would see a huge drop in lawsuits.  In most cases, people sue in order to get money for additional health care or take care of a loved one (or themselves) who has been injured so they won’t either go bankrupt or–perish the thought–allow the loved one to have a lessor quality of life or simply die.  The malpractice issue needs to be framed so that it includes what the stakes are for the people who sue.


    Third, we have a major problem at this point with the insane cost of education, both professional education (doctors, PhD scientists, lawyers [although we could arguably do fine with less of them]).  The costs, even at state colleges and universities have gone through the roof, and if something isn’t done, not only will a generation that includes many of our best and brightest end up spending some of the potentially most productive years of their lives floundering under debt and living in what is basically a holding pattern, but prospects for the upcoming generations are even more bleak.  We have the likely Republican presidential candidate stating that people deserve “the best education they can afford.”  He’s an idiot — but I don’t see other Republicans rushing to rebut his comment.  This is NOT the America most of us were taught to cherish and believe in. 


    For more than a century, the public school system in this country in most cases was sufficiently good to allow talented individuals, no matter what social or economic strata they came from, to rise to the surface.  It will, in fact, be a major hit to our economy if the best are no longer able to afford in a reasonable way the education that will allow them to reach their potential.  Money NEEDS to be made available for education — and it could be if the utterly insane Bush tax cuts were repealed.  This country cannot continue as a first-world nation without good, basic public education and opportunities for talented individuals, no matter what economic strata they come from.


    Fourth, in regard to insufficient healthcare staff — as I’ve already recounted, our system has been so warped by the participation and the demands of the insurance companies, that who knows what the costs even are or how many additional patients could be treated?  Case in point: medical practices devote both personnel and large amounts of doctors’ time to complying with the requirements of insurers, which vary among companies, plans, and individuals.  A single payer system would have solved this mess, but ACA at least makes a step toward freeing medical personnel from having to spend hours every week wrangling with insurers.


    If there are insufficient numbers of doctors to treat the people who have otherwise been dying in the ditches due to a lack of insurance, see point three and the part about making school more affordable to aspiring doctors and other healthcare workers.  As to your comment about people demanding to see doctors rather than nurse practitioners, that is in large part a patient education issue.  Also, when health care workers are freed up from many of their insurance company massaging tasks, this will allow for more time for communication among them on patient care, so doctors are more likely to be free if nurse practitioners or other healthcare professionals need to call them in to talk with a patient.


    Five — Doctors still make a lot of money (more than most of the rest of us).  I know doctors who have dropped out — but it had to do more with wretched working conditions in their practices, some of which had to do with insurance company issues, but often as a result of poor organizational design.  This is also something that can be fixed.  Google it — several excellent studies on the organization behavior within clinical settings have been done and/or are underway (I know — I helped summarize a 15-years study for a major foundation.  I guess I forgot to mention: I have an MBA from a top-tier school (Northwestern University), and so I know rather a lot about economic forces and other drivers affecting how businesses and industries operate).  Foreign-born med students still flock here.  If the Republicans continue to block every effort to help the non-rich population of the U.S. to reclaim its footing, perhaps America will enter such a steep decline that any doctor who can will pick up and flee to more lucrative locales (wherever that would be).  But then a decline in the availability of medical care will be only one of many, many other worries we will have.


    Six — in regard to Saudi Arabia’s record on human rights: how does that apply to us?  I do not wish to lecture you or condemn you on this point, but the fact that other countries whose leaders say that provide “human rights” when instead, they are oppressing their people, should not affect how WE look at how we believe OUR country should be run.  Murder is illegal, but some people who know it’s illegal and say it’s illegal in fact commit murders.  Does this mean that WE should throw in the towel on murder because “they did it,” so, hey, they can’t say we’re bad if we do it, too.  That’s the reasoning of a four-year-old, not the reasoning of an adult who is seeking to live an ethical life.


    Our country is in trouble.  Our public education system is in danger of being dismantled by religious fanatics and corporate education companies who are seeking to sop up the tax money and, thus far, haven’t shown that they are capable of producing a better service than our public schools.  They don’t care about educating our kids; they are in it for the money.  Likewise, I don’t understand how ANY politician can talk about being pro-life or “for the people” and yet continue to hack away at social safety nets and health care.  These people are seeking to steal our country from us.  They are seeking to force all costs onto average citizens while depressing wages and eroding services, while the corporations they have created to provide (in many cases) extremely dodgy educational services, abusive for-profit penitentaries and youth treatment facilities staffed by as many untrained and minimum wage employees as possible to pad the bottom line, and rob citizens of the right to have a say in what happens in their communities (I am talking about the lack of public involvement and permitting processes in the natural gas fracking cases — an appalling departure from the public consultation and decision-making processes that were the norm for six decades). 


    The health care debate is an important issue, as I’ve discussed, but I hope that I have managed to also convey that there are forces, enabled by bought politicians, who are seeking to steal our country out from under us.  The sad part is how many people accept uncritically the statements that get parroted over and over by a lazy and intimidated media.


    Let’s start having a real discussion on these things.


    I apologize for the overly long post, but actually, what I have written only scratches the surface.



  • crowepps

    If this does in fact become the law of the land long term I imagine they’ll head anywhere they can be paid for their skills and the responsibilities any Doctor takes on. 

    Where is that, exactly?  Considering that most other first world countries already have single payer, universal care?


  • cmarie


    thanks for not pretending you think I’m a facist for raising valid points.  Obviously we could go back and forth for years on all the issues you and I have raised and all 300 million plus of us will but I wanted to address #6 re Saudi Arabia.  I’m not saying that it would be a good idea to become like Saudi Arabia.  I think that would be one of the worst ideas imaginable and can’t imagine how I could have conveyed otherwise.  What I’m saying is that if the U.N chooses Saudi Arabia to help head up their commission on Human Rights that might be an indication that we don’t need advice from the U.N. many thanks

  • coralsea

    Hi cmarie — I don’t think I did that great a job explaining my point 6; that’s my bad. (I was writing that overly long post very late at night).  No — I did not think that you were saying that we should pattern ourselves over Saudi Arabia or any other state that has, by any objective standards, a questionable record on human rights.    My point was that I don’t think we want to throw the baby out with the bathwater and say that, because the inclusion of some countries in U.N. committees may be bitterly ironic, that the concept of human rights don’t count.  I’m afraid that I was inferring the concept you were putting forth in your post was one of those “false equivalency” arguments (e.g., “don’t criticize us for killing someone because you shoplifted” sort of thing).


    I wasn’t dwelling on the U.N.’s definition of human rights — I was thinking of what I and other progressives would consider to be a sound social compact within a wealthy, advanced, first-world country.  Unfortunately, the U.S. has begun to slip in some very important areas.  As a result, a tremendous gap has grown between the richest and the poorest Americans at the same time that some of the few public safety nets that people could rely on have been shredded.    The last time I checked, the gap between rich and poor in this country is considerably larger than in many third-world countries.   As Americans, this should be a source of shame that so little is done to make things a liiiitttllle more equal — or at least to make it possible for people who work full-time to be able to afford a place to live, reasonably nutritious food to eat, and healthcare if they (or their kids, if you don’t care about the parents) get sick.  And yes — I do believe that, especially in a country that has the resources, food, shelter, education, and healthcare are basic human rights (since I’m not a socialist, people can get their own clothes at Wal-Mart or wherever).  I believe that a reading of John Adams in the Federalist Papers suggests that the Founding Fathers believed this, in general, too.


    I also believe that the opportunity for people to work and earn money (if they aren’t disabled) is,  if not a basic human right, then an important characteristic of a healthy democracy.  That doesn’t seem to be of interest to either many corporate leaders or most legislators on the Republican side of the aisle right now, however.  So not only are people put down if they are unemployed or under-employed, they are decried as leaches for wanting — oh, I don’t know — food, a place to live if they have lost their homes through the mortgage debacle, and health care for their asthmatic kid after the COBRA runs out. 


    As I stated, our system of private insurance grew out of post-war wage controls.  It worked pretty well for several decades, in part because non-management, non-white-collar workers were also well covered because many belonged to unions.   Even blue-collar or production workers who weren’t union enjoyed decent wages and benefits because the unions basically set the bar for all workers.  Now, of course, companies do everything they can to shed benefits and the unions have been significantly diminshed.  As a result, we not only have millions of people who have no health insurance, but they are also socked with two or three times the cost that insurers pay out to to hospitals if we are “self-pay.”  In my case, for example, I can scrape together $1,200 to pay for the CT scans I am supposed to have to monitor the on-going damage that rheumatoid arthritis, an autoimmune disease over which I have NO control, is doing to my lungs, but not $3,600.  The $1,200 was what my insurer–when I had insurance for a brief time a few years ago–paid.  $3,600 was the self-pay rate.


    You get the picture, so I am not going to go on about it. 


    From a purely economic point of view, our misbegotten health care system costs our economy dearly.  Our health care system is ridiculously expensive because of the money that the insurance companies take in and the extra work they require on the part of health care providers.   In addition, lost time on the job because of illness, the number of people who end up on disability because they got too sick to work, often because of a lack of insurance, and then the inflated cost of emergency interventions that happen when uninsured people put off getting medical care because they have no insurance (until they have no choice — which is often going to cost considerably more than if a condition was cured or managed earlier on), all cost our economy dearly.  The cost in terms of individual and family suffering is immeasurable.       


    Oh dear — I’ve written too much again.  Anyway, solving the many problems we have going on right now is a daunting task.  Many of them are intertwined, and many of them, once researched, are not what they seem.  I thank you for even trying to discuss it — I expect that you are right about some things and I am right about others (and wrong in some regards, too).   But if one has to take a stand, I don’t see how one can possibly say, considering what America is supposed to stand for, that healthcare, at some level (one could come up with an economic “point of diminishing returns” if one wishes to go about it in a bloodless, purely empirical manner) really is a human right.  If it isn’t, then I don’t see how one could possibly conclude that any of us has a right to life, either.


  • coralsea

    BTW Cmarie — in my opinion (oh, jeez, I’m saying that a lot tonight — I sound like some pumped-up jerk, sorry) your posts deserve way more than a 1.  Some of us may not agree with some of your comments, but you attempted to explain yourself and you raised many important issues.  For the record, I gave you a 5 for your last post (and something well above 1 for the others).