Introduction
Healthcare is a human right.[1] Multiple covenants, declarations, and countries have recognized this right and taken action to ensure it is protected.[2] However, the United States fails to recognize healthcare as a human right.[3] While a majority of other industrialized countries have a version of universal healthcare, the United States continues to use a system that many Americans find unaffordable.[4] There are several factors influencing the divide between the United States and other countries when it comes to recognizing universal healthcare.[5] While the United States has increased coverage for Americans, there has not been any action towards universal healthcare.[6] However, as healthcare prices continue to increase, consideration of next steps toward a universal healthcare system should occur.
This article will first discuss how healthcare is a human right, looking toward treaties and international law. Next, the article will analyze how internationally, countries have developed a system to ensure the right to healthcare. Following that discussion, the article will discuss the United States’ view of healthcare, looking at historical influences on this stance, past acts regarding healthcare such as Medicare, Medicaid, and the Affordable Care Act, and future steps towards establishing healthcare as a human right in the United States.
I. Health Care is a Human Right
Article 25 of the Universal Declaration of Human Rights provides a right to “a standard of living adequate for the health and wellbeing” of oneself which also includes the right to medical care.[7] The right to health has different factors included, such as water, food, education, and equality.[8] Additionally, healthcare must be provided to everyone without discrimination.[9] Healthcare services must be available, with numerous facilities across the country, accessible (in terms of being available to everyone), acceptable facilities, and there must be quality services that are “scientifically and medically appropriate.”[10] It is important to note that this right does not mean all individuals must be in good health or that everyone’s health should be the same, but rather the factors and conditions necessary to ensure health should be equally available.[11] Additionally, this right is not something that states should hope to achieve as a long term goal, but a right that requires immediate efforts to “guarantee the right to health.”[12] While some states may argue that they are unable to financially afford a right to health, this justification fails to relieve a state from their obligations to secure the right to health.[13]
Additionally, the International Covenant on Economic, Social and Cultural Rights, adopted in December of 1966, found that there was a right to the “highest attainable standard of physical and mental health.”[14] The Covenant lists steps that states who are party to the covenant must take to ensure the right to healthcare.[15] These steps are:
“(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene;
(c) The prevention, treatment and control of epidemic, endemic, occupational and other disease
(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.”[16]
The United States signed this covenant on October 5, 1977.[17] While many other industrialized countries such as China, France, United Kingdom, Germany, Italy, and others signed the covenant as well, they later ratified it.[18] The United States has still failed to ratify this covenant despite previously signing it, separating the country from other prominent powers.[19]
II. International Stance on Healthcare as a Right
The majority of industrialized countries in Europe provide some version of universal healthcare to their citizens. [20] The World Health Organization defines universal healthcare as ensuring “that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.”[21] By taking away the financial burden of healthcare costs, universal healthcare minimizes the risk that people will face extreme debt or poverty for receiving the medical services they need.[22] Universal healthcare does not require uniform implementation and many European countries have their own system.[23] In general, most health systems around the world follow one of four models.[24]
The first model is referred to as the Beveridge Model.[25] In this type of system, the government funds health insurance through taxes.[26] Additionally, the government owns most of the hospitals.[27] Health care is “free at point of service,” and generally financed through taxes.[28] Great Britain implements a version of this model.[29] Great Britain’s health insurance is called “National Health Service” and was established in 1946.[30] This primarily tax-funded system provides coverage for nearly all of the population.[31]
Another type of health insurance system is the Bismarck Model.[32] This system is similar to the United States in the way that payroll deductions fund healthcare coverage.[33] However a significant difference between this model and the United States is that this system provides coverage for everyone.[34] In this system, most hospitals are privately owned.[35] Germany follows this type of system.[36] Germany requires all citizens to have health insurance but offers public health coverage through wage contributions from both employers and employees.[37] However, there is an option to opt out and enroll in private insurance if an individual earns more than $68,000.[38]
The National Health Insurance Model, also referred to as the single payer system, is another type of system that many countries tend to follow.[39] In this system, the government usually has a program that citizens pay into which funds the coverage provided.[40] Canada has adopted a version of this model.[41] While Canada provides free costs for necessary medical services, there are services that are not covered through the government, such as dental care and certain medications.[42] Despite the coverage provided by the government, nearly two-thirds of the population also has private coverage.[43] Private insurance generally covers the services that do not fall within the country’s provided coverage.[44] However, employers and other organizations cover the majority of premiums for private insurance.[45] Some common problems with single payer systems are the limitations when it comes to some services, usually elective procedures, as well as the long wait times to be seen by a physician.[46]
Developing countries generally do not have a health care system in place and rely on an out-of-pocket model instead.[47] In these countries, there is little insurance coverage, if any.[48] This means that only the individuals with the ability to afford medical services have access to health care.[49]
III. United Stats’s Failure to Recognize Healthcare as a Right
Quality of Care: How Does the U.S. Healthcare System Compare Internationally?
Almost every industrialized country has some version of universal healthcare; however, the United States fails to recognize the right to healthcare.[50] A study has found that the United States healthcare system falls last in comparison to 11 other high-income countries.[51] The report indicates that economic status is determinative of the quality of healthcare in the United States.[52] Numerous reports show a large portion of low income U.S. citizens failing to receive certain care due to the costs of the services.[53] In terms of access to healthcare, regardless of economic status, all U.S. citizens face challenges due to the cost of care, “with 38 percent of adults reporting they did not receive recommended medical care in the past year because of costs.”[54]
When analyzing health outcomes, the United States comes in last place in comparison to the other countries, as the country struggles with “maternal mortality, infant mortality, life expectancy at age 60, and deaths that were potentially preventable with timely access to effective healthcare.”[55] The country also comes in last place for administrative efficiency due to the large amount of paperwork and issues with insurance.[56] However, the country does rank second when it comes to the care process, as there are higher rates of preventative care, but this placement is not enough to save the country’s overall ranking from last place.[57]
U.S. Stance on Healthcare
There are numerous reasons why the United States struggles to stand with other nations when it comes to healthcare. One explanation for the United States’ stance is the attitude of the nation.[58] Generally, Americans have had a more negative perception of the government than other countries.[59] This negative view influences the public’s trust in the government, especially when it comes to something as serious as their healthcare.[60] Further, Americans have had an individualistic view as well.[61] Individuals with these views typically want less government involvement in society and generally does not hold the government responsible when it comes to the healthcare of citizens.[62] While this may have been the belief historically, recent polls have indicated a shift, with studies showing that 63% of adults in the United States believe “the government has the responsibility to provide healthcare for all.”[63] Further, this study found that there was an increase among Democrats when it comes to support for a single payer system.[64]
In addition to the culture of the nation, outside corporations and industries play a role in influencing the United States’ stance on healthcare.[65] Groups that stand to face significant financial losses with the creation of universal healthcare in the United States, such as pharmaceutical and insurance industries, have pushed against any kind of healthcare reform through lobbyists.[66] These hired lobbyists attempt to influence elected officials responsible for healthcare reform to protect their employers’ interests.[67] By spending thousands on lobbyists and campaigns, misinformation was spread, creating fear and uncertainty in citizens, stunting growth in the healthcare reform movement.[68] An example of industries fighting back against universal healthcare is when the insurance industry fought against the Affordable Care Act (ACA).[69] While not universal healthcare, the ACA stood to impact the industry, leading the industry to use lobbyists and campaigns to push back against the Act.[70] A universal healthcare system poses a serious threat to private insurance and the industry is unlikely to back down anytime soon.[71]
U.S. Steps Towards Increasing Coverage for Citizens
While the United States has not recognized healthcare as a human right, there have been some efforts to address the problem that many Americans face: lack of coverage for medical services. Medicare and Medicaid programs increased healthcare coverage for low-income and older citizens.[72] Most recently, the Affordable Care Act (ACA) passed with the intention of helping increase insurance coverage across the nation.[73] However, none of these programs or acts are a sufficient stand in for universal healthcare.[74]
Some states have taken matters into their own hands, attempting to create universal healthcare through a single payer system in their state.[75] One state that has consistently been pushing for universal healthcare is California, whose Governor recently signed a bill that works toward that goal.[76] However, states looking to change their healthcare system struggle with securing funding.[77] Since the program would only be through the state and not the nation, states would have to find a way to fund the new system.[78] Obtaining funding “would require each state to apply for waivers to divert federal funds used for Medicare, Medicaid, and Affordable Care Act exchanges” to fund the state’s “single- payer plans.”[79] While states may request these exchanges, the Department of Health and Human Services is not obligated to grant the request.[80]This means that states would likely have to rely on tax increases to fund the new system.[81]
Another obstacle for states attempting to establish a single payer system comes from existing insurance plans.[82] Many Americans obtain insurance through their employers.[83] Employer-provided insurance could drastically affect a single payer state system because states generally lack the ability to regulate insurance provided by employers.[84] Trying to implement this new system would be difficult without changing the current private insurance plans that most Americans rely on.[85]
Benefits of a Single Payer System in the U.S.
While there are many routes to take when it comes to universal healthcare as other countries have shown, a single payer system could significantly improve multiple aspects of the healthcare system of the United States.[86] First, and arguably most importantly, moving towards a single payer system would prevent deaths, as Harvard Medical School conducted a study in 2009 that found almost “45,000 annual deaths are associated with lack of health insurance.”[87]
Similarly, this system would allow more individuals to receive medical services that were once unaffordable.[88] A study comparing countries’ health care systems found that 50% of low income and 27% of high-income Americans reported they did not receive care due to costs of medical services.[89] No one should have to decline medical care due to unaffordable costs. As an industrialized country, one that often claims to be the best, citizens should not face financial instability as a result of receiving medical services.
Additionally, recognizing healthcare as a human right would allow the United States to live up to international law.[90] With numerous covenants and treatises, it is clear that healthcare is an internationally recognized right.[91] All other industrialized countries have recognized it, and it is time the United States does the same.[92]
Finally, funds and resources currently spent on addressing medical problems after they arise could be directed to addressing the root cause of health issues, mitigating the prevalence of the medical issues in the future.[93]
Conclusion
Numerous declarations and international laws recognize the human right to healthcare.[94] These declarations and laws lay out the factors that affect the right to health and healthcare, as well as steps to achieve the right to healthcare.[95] Most industrialized countries agree that healthcare is a right, implementing systems to ensure everyone has this right.[96] Despite this, the United States rejects this right for its citizens, leaving Americans struggling to afford needed healthcare.[97] Studies have shown that that the U.S. healthcare system falls behind other countries in terms of outcome and care, leaving Americans paying high costs for a system with worse quality.[98] The United States has recognized problems presented when millions are left uninsured and has taken steps to try to extend coverage, however more drastic steps need to occur in order to ensure the protection of the right to healthcare.
[1] G.A. Res. 217 (III) A, Universal Declaration of Human Rights, at 25, (Dec. 10, 1948).; The Right to Health, Off. of the U.N. High Comm’ r for Hum. Rts. and WHO 1, 3 (Jun. 2008), https://www.ohchr.org/sites/default/files/Documents/Publications/Factsheet31.pdf.
[2] Id.
[3] Alicia Ely Yamin, The Right to Health Under International Law and Its Relevance to the United States, 95 Am. J. of Pub. Health 1156, 1157 (July 2005), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449334/pdf/0951156.pdf.
[4] Id.; New International Study: U.S. Health System Ranks Last Among 11 Countries; Many Americans Struggle to Afford Care as Income Inequality Widens, The Commonwealth Fund (Aug. 4, 2021), https://www.commonwealthfund.org/press-release/2021/new-international-study-us-health-system-ranks-last-among-11-countries-many.
[5] Yamin, supra note 3, at 1158.
[6] Andrea S. Christopher, & Dominic Caruso, Promoting Health as a Human Right in the Post – ACA United States, Am. Med. Ass’n J. of ETHICS (Oct. 2015), https://journalofethics.ama-assn.org/article/promoting-health-human-right-post-aca-united-states/2015-10.
[7] G.A. Res. 217 (III) A, supra note 1, at 25.
[8] Off. of the U.N. High Comm’ r for Hum. Rts. and WHO, supra note 1, at 3.
[9] Id. at 4.
[10] Id.
[11] Id. at 5.
[12] Id.
[13] Id.
[14] G.A. Res. 2200A (XXI), International Covenant on Economic, Social, and Cultural Rights, at 12 (Dec. 16, 1966).
[15] Id. at 8.
[16] Id.
[17] Chapter IV: Human Rights, United Nations Treaty Collection (last visited Dec. 2, 2023), https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-3&chapter=4&clang=_en.
[18] Id.
[19] Id.
[20] David Rook, How Does Healthcare in Europe Work, JP Griffin Group (Jan. 11, 2018), https://www.griffinbenefits.com/blog/how-does-healthcare-in-europe-work.
[21] Universal Health Coverage (UHC), WHO (Oct. 5, 2023), https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc).
[22] Id.
[23] Rook, supra note 20, at ¶ 3.
[24] T.R. Reid, Health Care Systems – Four Basic Models, PNHP (last visited Dec. 2, 2023), https://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php
[25] Id. at ¶ 4.
[26] Types of Health Systems, Columbia University Irving Medical Center (last visited Dec. 2, 2023), https://www.publichealth.columbia.edu/research/others/comparative-health-policy-library/health-systems.
[27] Reid, supra note 24, at ¶ 5.
[28] Columbia University Irving Medical Center, supra note 26, at ¶ 2.
[29] Reid, supra note 24, at ¶ 6.
[30] National Health Service, Britannica (last updated Nov. 23, 2023), https://www.britannica.com/topic/National-Health-Service.
[31] Id. at ¶ 1.
[32] Reid, supra note 24, at ¶ 7.
[33] Id.
[34] Id. at ¶ 8.
[35] Id.
[36] Id. at ¶ 9.
[37] Roosa Tikkanen, et. al., International Health Care Systems Profiles Germany, The Commonwealth Fund (Jun. 5, 2020), https://www.commonwealthfund.org/international-health-policy-center/countries/germany.
[38] Id. at ¶ 1.
[39] Reid, supra note 24, at ¶ 10.; Columbia University Irving Medical Center, supra note 26, at ¶ 4.
[40] Id. at ¶ 10.
[41] Id. at ¶ 11.
[42] Roosa Tikkanen, et al., International Health Care System Profiles Canada, The Commonwealth Fund (Jun. 5, 2020), https://www.commonwealthfund.org/international-health-policy-center/countries/canada.
[43] Id. at ¶ 11.
[44] Id.
[45] Id.
[46] Single Payer Healthcare: Pluses, Minuses and What it Means for You, Harv. Health Blog ¶ 5 (Jun. 27, 2016), https://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835.
[47] Id. at ¶ 12.
[48] Columbia University Irving Medical Center, supra note 26, at ¶ 5.
[49] Reid, supra note 24, at ¶ 12.
[50] Yamin, supra note 3, at 1158.
[51] The Commonwealth Fund, supra note 4, at ¶ 6.
[52] Id. at ¶ 2.
[53] Id. at ¶ 3.
[54] Id. at ¶ 7.
[55] Id. at ¶ 9.
[56] Id. at ¶ 10.
[57] Id. at ¶ 8.
[58] Bruce Vladeck, Universal Health Insurance in the United States: Reflections on the Past, the Present, and the Future, Am. J. Pub. Health Vol. 93, No. 1 1, 17 (Jan. 2003), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447684/.
[59] Id.
[60] Id.
[61] Timothy Callaghan, Three Reasons the US Doesn’t Have Universal Health Coverage, The Conversation ¶ 9 (Oct. 25, 2016), https://theconversation.com/three-reasons-the-us-doesnt-have-universal-health-coverage-67292.
[62] Id. at ¶ 10-11.
[63] Bradley Jones, Increasing Share of Americans Favor a Single Government Program to Provide Health Care Coverage, Pew Research Center (Sept. 29, 2020), https://www.pewresearch.org/short-reads/2020/09/29/increasing-share-of-americans-favor-a-single-government-program-to-provide-health-care-coverage/.
[64]Id. at ¶ 5.
[65] Callaghan, supra note 61, at ¶ 12.
[66] Mariah McGill & Gillian MacNaguhton, The Struggle to Achieve the Human Right to Health Care in the United Sates, S. Cal. Interdis. L.J. 625, 659 (Summer 2016).
[67] Id.
[68] Id. at 660-661.
[69] Callaghan, supra note 61, at ¶ 13-14.
[70] Id. at ¶ 12-14.
[71] Id. at ¶ 14.
[72]McGill, supra note 66, at 626.
[73] Andrea S. Christopher & Dominic Caruso, Promoting Health as a Human Right in the Post-ACA United States, American 17 Medical Association Journal of Ethics 958, 959 (October 2015).
[74] Id. at 960.
[75] Jean Yi, More States are Proposing Single Payer Health Care. Why Aren’t They Succeeding, FiveThirtyEight ¶ 1 (Mar. 9, 2022, 6:00 AM), https://fivethirtyeight.com/features/more-states-are-proposing-single-payer-health-care-why-arent-they-succeeding/.
[76] Angela Sosa, New California Law Takes a Step Toward Single-Payer Healthcare, L. A. Times ¶ 1 (Oct. 8, 2023), https://www.latimes.com/california/story/2023-10-08/california-gavin-newsom-single-payer-healthcare-sb-770-scott-wiener.
[77] Yi, supra note 75, at ¶ 5.
[78] Id.
[79] Id.
[80] Id.
[81] Id. at ¶ 8.
[82] Id. at ¶ 7.
[83] Id.
[84] Id.
[85] Id.
[86] Rook, supra note 20, at ¶ 28-30.
[87] David Cecere, New Study Finds 45,000 Deaths Annually Linked to Lack of Health Coverage, The Harvard Gazette (Sept. 17, 2009), https://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/.
[88] Sandro Galea, Is the U.S. Ready for a Single-Payer Health Care System, Harv. Bus. Rev ¶ 7 (Jul. 18, 2017), https://hbr.org/2017/07/is-the-u-s-ready-for-a-single-payer-health-care-system.
[89] The Commonwealth Fund, supra note 4 at ¶ 3.
[90] G.A. Res. 217 (III) A, supra note 1, at 25.; Off. of the U.N. High Comm’ r for Hum. Rts. and WHO, supra note 1, at 3.
[91] Id.
[92] Yamin, supra note 3, at 1158.
[93] Galea, supra note 88, at ¶ 9.
[94] G.A. Res. 217 (III) A, supra note 1, at 25.; Off. of the U.N. High Comm’ r for Hum. Rts. and WHO, supra note 1, at 1.
[95] Id.
[96] Yamin, supra note 3, at 1158.
[97] Id.; The Commonwealth Fund, supra note 4, at ¶ 7.
[98] The Commonwealth Fund, supra note 4, at ¶ 7-9.
