“Broccoli?” Let’s Get Real.

In 1943 President Roosevelt proposed a Second Bill of Rights declaring “freedom from want” to be an essential human right that included “the right to adequate medical care and the opportunity to achieve and enjoy good health.” The United Nations embraced FDR’s vision in 1948 and  drafted The Universal Declaration of Human Rights which states “everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including food, clothing, housing, and medical care.”

America rejected Roosevelt’s vision, making us the only powerful nation to deny universal access to healthcare until recently when, in March 2010, President Obama signed the Patient Protection and Affordable Care Act (“ACA”). The Obama Administration has been fighting to preserve ACA ever since and it is now before the Supreme Court. I’m not optimistic about the outcome since the current Court is one of the worst in our history, second only to the Taney Court that gave us the Dred Scott decision (which legalized segregation until it was overturned by Brown v. Board of Education 50 years later). Last week Justice Scalia created a bizarre analogy between eating broccoli and the ACA’s mandate to purchase health insurance.

Yep: broccoli. Taney would be proud.

Certainly the ACA is not perfect. I hoped for nationalized healthcare; instead we have a government partnership with insurance companies. However, the ACA is a step in the right direction: before it became law Americans experienced some of the poorest health indicators among all industrialized nations, despite spending more per capita on healthcare than any country in the world. Over fifty million Americans, 19 million of whom were children, lacked access to adequate healthcare and those who had access didn’t always receive the best care.

America has been insanely bogged down in arguments that healthcare is a non-essential discretionary commodity rather than a basic human right necessary for life. As I already mentioned, even Scalia has gotten lost amidst the kale and leeks in the produce aisle. The debate has been further muddied by fear-mongering arguments about efficiency and cost, neither of which holds water.

The debate should turn on one issue and one issue only: whether a minimal level of healthcare is a basic human right. If we agree it is, then everything else is merely process.

Edmund Pellegrino, M.D., insists healthcare is a right: “Americans have made healthcare a commodity when it should be primarily a human service. Healthcare cannot be left to the vagaries of the marketplace. Sickness is a universal human phenomenon that ultimately afflicts all of us. That is why economics, while important, should not drive health care. Caring for the sick, the poor, the elderly and the very young are societal obligations – not opportunities for investment and profit making.” 

Pellegrino has written over 600 articles and books in medicine and ethics. He’s founder of the Journal of Medicine and Philosophy, a Master of the American College of Physicians, Fellow of the American Association for the Advancement of Science, member of the Institute of Medicine of the National Academy of Sciences, Professor Emeritus at Georgetown University, and recipient of 52 honorary doctorates.  

Arthur L. Caplan, Ph.D., also believes healthcare is a human right. Caplan is Professor of Bioethics, Chair of the Department of Medical Ethics and Director of the Center for Bioethics at the University of Pennsylvania. He’s authored 25 books and over 500 papers in medicine, bioethics and health policy.

Caplan states “… health insurance is not a luxury, it is a right...This nation espouses a belief that there will be liberty, justice, and opportunity for all. Are we succeeding when we deny basic healthcare coverage to the vulnerable, the frail, or the working poor? And what kinds of opportunity exist for those who cannot walk, eat, drive, or speak because they have suffered strokes, heart attacks, or loss of limbs that could have been prevented with better access to primary and preventive care? Many object to calls for universal coverage on the grounds of cost, intrusion into freedom of choice, abhorrence of paternalism, and a demand for more individual responsibility, among other reasons... many of those raising these objections…already support another system that has many parallels to universal health insurance coverage: universal education.”

Caplan writes that “It is the right of all Americans to obtain a basic education. It is also their responsibility to obtain it. One cannot simply “opt out” of being educated, because we as a society consider it… too important to have an educated populace. While it is true… many of our public schools are dismal failures, that does not lessen the national commitment to try and ensure a decent education is available to all…”

Pellegrino and Caplan are only two of many ethicists who argue healthcare is a right. These are the leaders who should help us shape the debate, not judges who compare healthcare to vegetables, paid lobbyists for drug companies or politicians playing ideological games. We need to center social welfare policy inside moral philosophy, not toxic ideology.

Thanks for sticking with me. We’ll continue this discussion next week.
Enjoy your holiday.

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This article was first published 3.28.12 in my OpEd column at the Journal Tribune
http://www.journaltribune.com/articles/2012/04/04/columnist/doc4f7c65c647d00754485170.txt