Medical Care: Is it a Right?

by Alice A. Chenault, M.D.

Originally posted on PNHP Friday October 22, 2010 re-posted here with permission.

When I was handed the microphone at a recent town hall meeting, I asked Sen. Jeff Sessions if medical treatment should be the right of every U.S. citizen. The crowd roared “No!” The senator agreed.

This got me thinking about what we mean by “rights.”

One lady called out, “We only have the three rights guaranteed in the Constitution: life, liberty and the pursuit of happiness. The Constitution doesn’t say anything about health care!”

Never mind the fact that life, liberty, etc., are mentioned in the Declaration of Independence, not the Constitution. She had launched me on a quest.

A cascade of “rights” flooded my mind. The right to vote, speak freely, choose your own religion, express grievances against the government, decline to testify against yourself, or the right to due process before giving up your property or liberty — all these are granted by the Constitution and its amendments.

But many of our rights are not declared in the Constitution. Supreme Court decisions, like the 1954 ruling that banned racial segregation in schools, bind the entire country with the same force as constitutional provisions. Laws enacted by Congress and signed by the president similarly confer rights with nationwide effect. Other rights are granted by actions of state, county or city governments and affect smaller groups of people.

American children’s right to a free public education is an interesting example. The Constitution makes no mention of any such right. Congress has passed no law mandating it. The Supreme Court has never ruled that our government has to pay for all American kids to attend grades K-12 tuition-free.

This vital matter is left entirely up to the individual states. Laws on schooling differ from state to state. Rules about teacher qualifications, classroom hours and curriculum can change whenever you cross a state line. Shockingly, for example, Alabama’s constitution still mandates separate schools “for white and colored children,” though the law is not enforced and would certainly be unconstitutional if tested.

We usually think of a right as something we can choose to do or not, as we please. “You have the right to remain silent” when arrested, yet you’re free to discuss your case with police if you choose. But consider the difference between the right to education and, say, the right to vote. Voting is considered a sacred right, with elections paid for by government, not the voter. Still the choice is yours: nobody is forced to vote or punished for staying home on Election Day. Sending your children to school, on the other hand, is not only your right but your legal obligation. If your kids don’t go to school, you the parent can go to jail.

This loops me back into whether medical care is, or should be, a right. How weird would it be if parents had to see to it that their children were in school, but no such thing as free, public, universal education existed? Parents unable to afford private school tuition could face criminal charges. I argue that the lack of universal, affordable medical care puts American citizens in a similar bind.

Medical neglect — failure to provide necessary medical treatment for one’s injured or ill child — is legally defined as a form of child abuse, with penalties ranging from loss of custody of the child to imprisonment of the parent. This puts families without health insurance or money to buy medications at greater risk of these punishments than the wealthy. Doesn’t that violate our Fourteenth Amendment guarantee of “equal protection of the law”?

If you can’t go that far with me, consider at least this from veteran journalist Christopher Dickey: “[G]overnments spend money to acquire assets. That includes bridges and nuclear reactors, but also hard-to-price, intangible assets like a well-educated and healthy population.” (My emphasis.)

I hold that to be a self-evident truth.

Alice A. Chenault, M.D., is a psychiatrist in Huntsville, Ala., and a member of Physicians for a National Health Program (www.pnhp.org).

National healthcare advocate to speak in Huntsville — Three events

               North Alabama Healthcare for All presents …

                         Oliver Fein, MD

President, Physicians for a National Health Program

Robert Wood Johnson Health Policy Fellow

Past Vice President of the American Public Health Association

 

All three events are FREE and open to the public

For more information:  (256) 489-3884  Lahaynes@knology.net

 

1) Friday, Feb. 26,  6:00 p.m.
“Healthcare Reform 2010: Where Do We Go From Here?”

Physicians understand the urgent need for healthcare reform — for the good of patients, the profession and the U.S. economy. However, according to Dr. Fein, the present legislation in Congress is not going far enough AND is headed in the wrong direction. This talk, by a leading advocate of an expanded and improved Medicare for All (single payer) program, will describe what’s really happening with our healthcare system and where we need to go from here to reach universal, high quality coverage at an affordable cost for all. Audience Q&A will follow.

The presentation will include updates and responses to President Obama’s healthcare summit to be held in Washington, DC, on the day prior to this event.

Speaker: Oliver Fein, MD, president, Physicians for a National Health Program, (www.pnhp.org)

Location: Shelby Center for Science and Technology, UA Huntsville Campus. Room 107 Auditorium. (near intersection of Sparkman Drive and Lakeside  http://www.uah.edu/map/color_map.pdf )

Co-sponsors: UA Huntsville Political Science Department and Alabama A&M University Political Science Department
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2) Saturday, Feb. 27, 10 – 11:30 a.m.
“Healthcare Justice: The Moral Imperative for Universal Healthcare from a Christian Perspective”

This event offers an overview of problems with the healthcare system, the status of reform legislation, and an affordable solution aimed at just and equitable healthcare for all. We begin by laying out an ethical framework for the discussion. Speakers then address various aspects of healthcare justice and the moral imperative they see as central to the Christian perspective. Audience Q&A will follow.

Location: Faith Presbyterian Church, 5003 Whitesburg Drive, Huntsville. Fellowship Hall. (near intersection of Airport and Whitesburg)
Speakers:
+  Oliver Fein, MD, president, Physicians for a National Health Program (New York, NY)

+  Arthur Sutherland, MD, board member, Tennessee Health Care Campaign, and national board member of PNHP  (Memphis, TN)

+  Abi Carlisle-Wilke, M.Div., Senior Associate Pastor, Trinity United Methodist Church (Huntsville, AL)

+  An additional local minister is being added to the panel.

Moderator: Rev. Frank Broyles, Interfaith Mission Service
Supported by: Interfaith Mission Service;  Indian Creek Primitive Baptist Association;  Greater Huntsville Interdenominational Fellowship.

Coffee, fruit and pastries will be available.
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3)  Saturday, Feb. 27, 1 – 3 p.m.
“Point / Counterpoint: Fixing the American Health System”

Physicians from opposite ends of the policy spectrum will present their solutions to our health care crisis. Dr. Oliver Fein, president of PNHP, will present the case for expanding and improving Medicare to all. Dr. Allan Goldstein, Alabama delegate to the American Medical Association, will focus on quality of healthcare as a way to reduce costs, and the reforms necessary to reach that goal. Audience Q&A will follow. 

Location: Crestwood Medical Center, One Hospital Drive, Huntsville. First floor auditorium.  (near intersection of Airport and Whitesburg)
Speakers:
+  Oliver Fein, MD, president, Physicians for a National Health Program  (New York, NY)
+  Allan Goldstein, MD, past president, Medical Society of the State of Alabama; current delegate to the American Medical Association representing Alabama.  (Birmingham, AL)

———————————————-
Speaker Biographies:
 

Oliver T. Fein, MD   (New York, NY)

Dr. Fein is president of Physician for a National Health Program, a nonprofit organization of over 17,000 physicians who support single-payer national health insurance. He is a general internist who is active in clinical practice, he is also professor of clinical medicine and clinical public health at Weill Medical College of Cornell University, where he serves as associate dean responsible for the Office of Affiliations and the Office of Global Health Education.  Dr. Fein has advocated for an expanded role for primary care, for academic health centers in urban health care delivery systems, and for national health system reform. He was Robert Wood Johnson Health Policy Fellow during 1993-1994, when he worked in the office of Senate Democratic Majority Leader George Mitchell. He spent 17 years at the Columbia Presbyterian Medical Center developing community-based ambulatory care practices and the Division of General Medicine.  He is chair of the New York State Chapter of PNHP and immediate past vice president of the American Public Health Association. Dr. Fein received the Elnora M. Rhodes Service award from the Society of General Internal Medicine in 1999; the Haven Emerson Award from the Public Health Association of New York City in 2001; and the Lifetime Achievement Award from the Robert Wood Johnson Health Policy Fellowships Program in 2008.

 

Allan R. Goldstein, MD   (Birmingham, AL)

Dr. Goldstein is a native of Cleveland, Ohio, and a graduate of “The” Ohio State University School of Medicine. He has been in practice since 1972 and is Board Certified in Internal Medicine and Pulmonary Diseases. He continues to have an active practice and serves as both a Primary Care Physician and a Consultant. He has been involved in organized medicine for over 30 years.  He has served on the Board of the Jefferson County Medical Society and has been its President. He has served on the Board of Censors of The Medical Association of the State of Alabama, been a member of both the Board of Medical Examiners and the State Committee of Public Health and has been the President of The Medical Association of the State of Alabama. Presently, he is a Delegate to the AMA , representing Alabama.  He is a patient advocate and supports quality and efficient care initiatives that will lead to reduced cost by decreasing the need for unscheduled visits, Emergency Department visits and hospitalization. He is a strong advocate for the patient-doctor relationship and for patient focused care.

  

Arthur J. Sutherland III, MD, FACC   (Memphis, TN)

 Dr. Sutherland is a retired physician and founder of the Sutherland Cardiology Clinic. He currently works with The Healthy Memphis Common Table which is addressing the obesity and diabetes epidemics in Memphis and the Mid-South. Improving health literacy and elimination of social and health related disparities are high priority agenda issues. Dr. Sutherland is also a member of the Memphis School of Servant Leadership and works with the Memphis Theological Seminary in its urban ministry program. He is currently serving as chairman of the Tennessee chapter of Physicians for a National Health Program and is on the national PNHP Board of Directors.  In addition, he is on the state Board of Directors for the Tennessee Health Care Campaign. Both PNHP and THCC have been working for health care justice for over 20 years.

North Alabama Healthcare for All is a nonprofit, all-volunteer organization promoting a healthcare system which provides quality healthcare at an affordable cost to all Americans. We believe healthcare is a human right.

The most effective and cost efficient way to accomplish healthcare for all is through an expanded and improved Medicare-for-all type system. (This is also called universal single payer healthcare, government-funded healthcare, or national health insurance.)

We are a chapter of the national organization Physicians for a National Health Program. Like our parent group, we are not just physicians — membership is open to anyone.

For more information or to sign up for our email list, go to www.NorthAlabamaHealthcareForAll.org

Talking Points — HR 3962 (Nov. 2009)

Here are talking points on the House healthcare reform bill. These are from Physicians for a National Health Program www.pnhp.org — Linda

Talking points on HR 3962

Overall -

The bill is completely inadequate in expanding coverage and controlling costs. It is essentially an insurance industry bailout. Most provisions to expand coverage don’t even go into effect until 2013, after which it still leaves at least 17 million Americans uninsured.

The insurance industry hijacked the process: Private insurers get millions of mandatory new customers and about $600 billion in taxpayer subsidies. This will have the effect of making the health insurance lobby even more powerful, and more able to hijack political processes in the future.

It forgoes over $400 billion annually in potential savings on overhead and bureaucracy in the health system – enough to cover all 47 million uninsured – by retaining profit-driven private health insurers instead of replacing them with a streamlined, more efficient, Medicare for All system.

It makes private health insurance mandatory for middle-income working people, forcing them to buy a defective product. It will become a federal crime to be uninsured, with a penalty of 2.5 percent of income, starting in 2013. Families of very modest means, at 200-400 percent of poverty, will be required to spend an unaffordable 8-12 percent of their incomes on insurance premiums if they don’t have employer-sponsored coverage. Since the bill institutionalizes different levels of benefits and allows for skimpy plans (e.g. “bronze”), the mandated insurance may not even cover their health needs.

We will have a nation of underinsured families and businesses who will be paying money they can hardly afford for health plans that will never meet their needs. Globally, the U.S. economy will continue to be at a competitive disadvantage.

A Medicaid expansion will cover more low-income Americans, but coverage gains – both in Medicaid and for people receiving tax assistance to buy coverage – will be short-lived because the cost is unsustainable as we’ve seen in several states that have attempted reform in recent years.

People in other developed nations all use some form of non-profit national health insurance to get better care for less money. Their average per capita cost of healthcare is about half what it is in the United States, yet people in Canada and western Europe live about two years longer and have lower infant mortality. As with our traditional Medicare program, they have completely free choice of doctor and hospital. We need to start from scratch with a Medicare-for-all, single-payer approach.

On private insurers

Private health insurance is an overpriced, defective product, and this bill won’t change that. The majority of Americans who face medical bankruptcy start their illness with private health insurance, but are bankrupted anyway by gaps in coverage, like co-payments, deductibles and uncovered services.

Individuals and families with incomes up to 400 percent of poverty ($73,240 for a family of 3) are eligible for skimpy subsidies to buy coverage through a new “insurance exchange.” Families of very modest means (200-400 percent of poverty) are still responsible for paying an unaffordable 8-12 percent of their income towards health insurance premiums.

The bill bans denials of coverage based on pre-existing conditions (starting in 2013) and recissions (retro-active cancellation of coverage) immediately. But insurers are still allowed to deny claims, and two industry whistleblowers (Dr. Linda Peeno and Wendell Potter) have testified before Congress that the industry is now so sophisticated in its ability to deny claims, control care, and cherry-pick that these protections are essentially worthless.

Similarly, caps on out-of-pocket expenses (at $5,000 for individuals and $10,000 for families) don’t prevent medical bankruptcy because they don’t include expenses for uncovered services.

Insurers are supposed to spend 85 percent of premiums on care, but experience from Minnesota shows that insurers are able to circumvent this rule easily by categorizing administrative expenses as “clinical” or “quality improvement.”

On Medicaid and community health center expansion

The bill expands Medicaid after 2013 to additional low-income Americans (up to 150 percent of poverty), which is good, but you don’t need this bill to expand Medicaid. Also, rising costs, and a lack of funds for Medicaid at the state level, will quickly erode any gains in coverage.

The bill increases funding for community health centers, which again, is good, but this could be done independently.

The bill eliminates the Children’s Health Insurance Program in 2014, routing the beneficiaries into Medicaid (under 150 percent of poverty) or into the purchase of private coverage), adding hassle and possibly disrupting care arrangements for these children.

On the public option

The public plan option is a sham. According to the Congressional Budget Office, the premiums will actually be higher than premiums in the private sector, and fewer than 2 percent of Americans will enroll. So the public plan option will be an expensive, tax-funded subsidy to private health insurance, because the public plan option will take the sickest patients off their hands. It won’t expand coverage or decrease costs.
On the employer-mandate

Starting in 2013, employers with payrolls over $500,000 are required to provide coverage and pay a share of the premiums (72.5 % for individual, 65% for family coverage) or pay an 8 percent payroll tax.

Employers are not required to meet benefit standards until 2018, but even then are only required to help fund the “lowest cost plan” that meets the “essential benefits package,” and so may offer very skimpy coverage. The “basic plan” on the insurance exchange, for example, is only required to cover 70 percent of benefit costs. As there are no cost controls, coverage will deteriorate further, leading to a rise in underinsurance nationwide.

Millions of working Americans will continue to lack coverage. In Hawaii, which has had an employer mandate since the 1970′s, many employers circumvent the requirement by hiring part-time employees or using consultants. Also, small businesses are not required to provide coverage (but receive a paltry tax credit for two years if they do).

On the insurance exchange and tax subsidies

The bill creates a national insurance exchange, a marketplace where individuals and small business would go (after 2013) to buy insurance. If you have subsidized coverage, you would have to buy your insurance through the exchange. Like the “Connector” in Massachusetts, the exchange will add another layer of bureaucracy to the health system, and an additional 4 percent overhead to every health plan.

Subsidies for low-income people to purchase coverage will be hopelessly complex, requiring verification of income, citizenship, employer size, etc.

Millions will have their subsidies change as they change or lose jobs. Imagine finding a job, losing your insurance subsidy, then being laid off your job and applying for a subsidy all within a year. How would this work?

On evidence that this bill won’t reduce the number of uninsured or control costs

The coverage gains from the bill won’t last. What’s happened in the past when bills like this have passed in the states is that they run out of money very quickly, healthcare is simply unaffordable, and then you start to see the coverage expansions cut back. The subsidies shrink, the Medicaid shrinks, and then you’re back at square one, where you’ve spent a lot of money and not made any progress. And we’ve seen this over and over in the United States-in Massachusetts in 1988, in Oregon in 1992, in Washington 1993-passed bills virtually identical to what’s being passed in the House right now, and there was no durable improvement in the number of uninsured in those states. Healthcare was not affordable ten years after those bills were passed.

The Massachusetts plan is the model for this bill. Massachusetts expanded Medicaid (which again, is good, but you don’t need this bill to expand Medicaid) and passed an individual mandate that makes it illegal to refuse to purchase private health insurance. The fine is up to $1,068. The plan has been very expensive. The state has opted to pay for that by taking money from safety net clinics and hospitals, so that safety net providers that care for immigrants, the mentally ill, people with substance abuse, that provide primary care, they’ve seen their funds shrunken, so that money could be handed over to purchase insurance policies.

On the anti-abortion provisions

The bill applies restrictions to policies sold through the insurance exchange to undermine women’s rights. It creates an insurance exchange, a marketplace where you would go to buy your insurance. If you have subsidized coverage, you would have to buy your insurance through the exchange. And any insurance plan purchased through the exchange would have to exclude coverage of abortion. So, for the first time, Congress has stepped in and said that even with your own money, with private money, it’s illegal for insurance to cover abortion. It’s a tremendous step backwards for women’s rights.

On prescription drug costs

It fails to lower drug costs for the majority of Americans and those unable to afford expense medications. Drugmakers have raised wholesale prices on brand name drugs by 9 percent this year alone in anticipation of reform.

Biotech firms receive a windfall 12 year patent on new drugs.

A very small share of the population, Medicare recipients who are in the doughnut hole, will receive a discount on brand-name medications.

The doughnut hole is reduced in size until it is eliminated in 2019.

Overall, the pharmaceutical industry is thrilled with the bill, and Wall Street has rewarded them by driving up the value of their stocks.

On undocumented immigrants

Requires verification of citizenship to apply for subsidies for the purchase of insurance. Thus, the bill mandates that non-citizens buy insurance, but leaves it unaffordable for them.

Medicare Advantage Plans

The bill phases out overpayments to Medicare Advantage plans. It also requires them to spend at least 85 percent of premiums on care, but as shown in states like Massachusetts, insurers can easily circumvent this rule.

Summary of commendable features – some may not make it into final bill

Medicaid expansion (delayed until 2013) to about 10 million people

Increased funding for community health centers (to double capacity over time) and other community programs like home visiting programs.

Increased funding for primary care health professional education

Phasing out of doughnut hole in Medicare prescription drug plan by 2019 and Medicare Advantage plan overpayments

Eliminating pre-existing conditions (2013) and recissions (2010)

Extending health benefit tax benefits available to married couples to domestic partners

Extending parental coverage to children aged 26-27

Progressive tax on the wealthy for funding instead of taxing health plans that are comprehensive (so-called “Cadillac” plans).

Protesting the TEA party protesters — Nov. 4, 2009

Hi all,
Here is the media coverage of yesterday’s protest. Lots of good shots of our signs and great quotes from Dr. Pippa Abston. Again, we thank everyone who took time out of their busy schedules to be there!

Channel 31
http://www.waaytv.com/ scroll right to the segment titled “Opposing Views Represented At …”

Channel 48
http://www.waff.com/global/story.asp?s=11447634 This has the script of the interview. If you watch the video, you can see they cut out “for all” at the end of my quote. But they did at least cut to one of our signs that said “healthcare for all.”

Channel 19
http://www.whnt.com/ scroll down the page to “top videos” section. The segment is titled “Hundreds Protest Health Care Issue” (that’s misleading… but the anchor says at the end that the event drew about 100.)

Channel 54 — the local Fox affiliate doesn’t have anything up yet. They have a very small newsroom and it usually takes a few days for the website to be updated.

Huntsville Times
http://blog.al.com/breaking/2009/11/people_protest_against_-_and_f.html — While the article focuses mostly on the tea party folks, we do get our points in there and are given the last word… that’s always a good thing.
http://photos.al.com/huntsville-times/2009/11/tea_party_rally_1.html — This page has a slide show of photos from the event. Look to the right of the page and click on “View as a slideshow.” There’s one poor guy who ended up being photographed with a sign that says “angry mob” and an arrow that, the way he holds it, points to his groin area …

Linda
=================

—– Original Message —–
From: Linda Haynes
Sent: Wednesday, November 04, 2009 9:47 PM
Subject: report on tonight’s event — protesting the protestors

Hi all,

Great response tonight! Big thanks go to all 20 of our NAHA people (and friends!) who made it out to protest the local TEA party folks (anti-healthcare reform people).

Below are photos from the event:
YAHOO http://groups.yahoo.com/group/NorthAlabamaHealthcareForAll/photos/album/679380920/pic/list
FACEBOOK http://www.facebook.com/album.php?aid=158399&id=159504394739

We were interviewed by all four TV stations and the Huntsville Times. We’ll post their items as they become available.

Again, thanks everyone for your quick and enthusiastic response!

Linda

Summary chart of the new healthcare reform bill / two articles

Healthcare Rally September 26, 2009

We had about 20-25 people at today’s “Healthcare Not Warfare” rally in Huntsville …  and I’m sure the steady drizzle kept many others away.

I posted photos on Yahoo here

http://groups.yahoo.com/group/NorthAlabamaHealthcareForAll/photos/album/1958635078/pic/list

And, posted them on Facebook here

http://www.facebook.com/album.php?aid=147383&id=159504394739&saved#/album.php?aid=147383&id=159504394739

The Huntsville Times and WLRH both sent reporters to cover us. Keep an eye/ear out for their reports.

We thank everyone who took time out of their busy schedules to join us this wet morning. That was dedication!

Linda

Health Care Reform: Can We Have Universal Coverage,

Quality Care and Controlled Costs? – Aug. 25, 2009

Below is media coverage on last night’s healthcare forum in Huntsville from Channel 48/WAFF and the Huntsville Times. Channel 19/WHNT hasn’t posted their video to the website … I’ll send that when available.

Special thanks go to Sherry Walker who brought the signs “Respect” and “Healthcare Reform: Discussion not Disruption.”  These signs were featured in both media pieces.

It was fun watching the 10 PM newscast segments on my television last night … I saw friends in those who I didn’t know came … I guess that will happen with almost 300 people in the room! 

I was also pleasantly surprised to see about 20 local doctors stand up when asked to by our accomplished moderator.

If you attended the event, please share your thoughts … what new information you learned, what stood out for you about what our distinguished panelists and/or moderator had to say, or other general comments about the event.

Thank you, everyone!

Linda

‘A ray of hope’ for reform amid the sound and fury

Different kind of healthcare forum held in Huntsville

Healthcare: The next generation – June 27, 2009

I wanted to let everyone know that the healthcare reform event on Saturday drew 51 people!  That’s not bad for a very hot and sunny Saturday afternoon. As you know, we co-sponsored this event with Organizing for America and Health Careers Opportunity Program at AL A&M University.

Big thanks go to these folks from our HCEA e-mail list group for their part in the event:

+  Razi Hassan, PhD — for having his students help sponsor and volunteer at this event; making the room arrangements; and handling event publicity on campus.

+  Anis Salib, PhD — for giving a short talk on the healthcare reform scene in Washington, DC as it is today.

+  Pippa Abston, MD — for giving a short talk on the Alabama numbers … uninsured, underinsured and about the monopoly that Blue Cross/Blue Shield has in our state. (Many of us were surprised they have 83%!)

+  Jennifer Humiston — for helping with handouts, participant sign-ins, and posting flyers before the event.

Channel 48/WAAF -TV came out and taped a segment for their 5 PM news on Saturday. Maybe some of you caught that?

If not, here’s the link http://www.waff.com/global/story.asp?s=10607969

Linda