Is Health Care a Right or a Privilege in the United States? Spoiler Alert: It’s both.

1. Is Health Care a Right or a Privilege in the United States? Spoiler Alert: It’s both. Carol Apt, Ph.D., Professor of Medical Sociology South Carolina State University, capt@scsu.edu

2. Three Objectives: • At the conclusion of this presentation attendees will have an understanding of: • 1. The issue of access to health care as a basic human right • 2. international perspectives on access to health care as a basic human • right • 3. Whether access to health care in the United States is a right or a privilege

3. Financial Obligations and Connections • As the writer of this presentation, I have no financial connections or relationships related to this work. • Carol Apt, Ph.D.

4. Definitions of a Right and a Privilege • A right is something guaranteed, supplied, and protected by a higher authority. • A privilege is a special advantage or benefit granted to an individual, a class, or a group of people. It can be based on status (social class), rank, or other criteria and is exercised to the exclusion or the detriment of others.

5. The Right to Health Care Is a Fundamental Human Right in International Law • WHO Constitution in 1946 • Universal Declaration of Human Rights in 1948 • World Conference on Human Rights in 1993

6. Is It a Basic Human Right? Some Say Yes, Some Say No • O’Malley (2012) compared the views of Dr. Robert Sade of MUSC and Dr. Edmund Pellegrino of Georgetown University Medical Center. • Dr. Sade said it’s not a right. • Dr. Pellegrino said it is a right.

7. Views of Justice and Human Rights • Dr. Sade interprets justice to mean commutative justice, which is what one individual owes to another. • Dr. Pellegrino interprets the right to health care within the definition of distributive justice, or that form of justice which governs what the state and society owe to each individual citizen.

8. Views of Health Care • Dr. Sade says health care is a commodity to be bought and sold like any other good or service; it’s a service that physicians provide to those who wish to purchase it. • Dr. Pellegrino says that health care of one of those ‘goods’ that falls under the umbrella of distributive justice, or the form of justice that governs what the state owes to its citizens. It’s a precondition of a fully human life.

9. Views of the Physician and Of The Medical Profession • Dr. Sade views physicians as entrepreneurs who own their knowledge and skills and can sell them to whomever wishes to purchase them. The practice of medicine has shifted from a profession and a vocation into a career. • Dr. Pellegrino rejects the notion of medicine as a career and has called for a return to the practice of medicine as a profession and a vocation.

10. International Perspectives • Most developed countries have parallel public and private health care systems. • Norway, and most Nordic countries have dual systems. • In Norway, the right to health is defined as the right to ‘the highest attainable standard of health.’ • Norway’s Patient Rights Act of 1999 – the patient has a right to necessary specialized health care under certain circumstances • The European Union and the United Nations recognize health care as a basic human right

11. What Do Americans Think of the Possibility of Universal Health Care? • 80% say having health insurance is absolutely essential or very important. • 70% say it’s important that the nation has universal health care coverage for some, such as Medicare that covers people age 65 and older.

12. Some of the Arguments About Whether We Should Have Universal Health Care • Is there a fundamental right to health care? • Who should have access to health care and under what circumstances? • How can we achieve quality in the health care system given the huge amounts of money spent? • How can we guarantee the sustainability of both the expenditures and of the health care system itself?

13. Why Don’t We Have Universal Health Care? • American exceptionalism • It smells like socialism • Anti-welfare sentiment • The high cost of universal health care • Social Darwinism

14. Kara McCullough, Miss South Carolina State University, 2017 • She’s a chemist working for the U.S. Nuclear Regulatory Commission in Washington, DC. • Is affordable health care for all US citizens a right or a privilege? • She responded, “As a government employee, I’m granted health care and I see firsthand that for one to have health care you need to have jobs. Therefore, we need to continue to cultivate this environment that we’re given the opportunity to have health care as well as jobs for all American citizens worldwide.” • Her answer was probably based on how she believes things should be, not how they are.

15. The Connection Between Employment and Access to Health Care • Baker (2011) says that connecting health care to employment is largely due to what he calls an ‘historical accident.’ • 1943: IRS ruled that employer-based health care should be tax-free • 1954: Such tax advantages became even more attractive • 1960s: 70% of Americans were covered by some kind of private, voluntary health insurance plan. • Mid-1960s: people with ‘good’ jobs got access to health care through work;

16. Employees in Many Job Categories Don’t Have Access to Health Care • Low-wage workers • Children • Small business owners • The self-employed • Temporary and seasonal employees • Free-lance workers • Independent contractors

17. It All Starts With Education • Public education in many parts of the country fails to produce individuals who are ready for employment or graduate or professional schools. • This disproportionately affects people in the lower social classes and members of racial and ethnic minorities.

18. The Correlation Between Health and Employment • Employment increases health status. • Employment has social, psychological, and financial benefits that can improve health. • Employment is considered to be a key component of mental health. • Healthy people are more likely to work; health has an impact on an individual’s desire to work and their likelihood of being hired or retained. • Health care is a right for some and a privilege for others.

19. What Kinds of Jobs Are Likely To Provide Access To Health Care For Employees? • Averages of civilian, private industry and state & local government jobs • All workers: 76% • Management, Professional, Teachers: 89% • Service Occupations, sales & related jobs: 67% • Construction, production: 78% • All full-time jobs: 91% • All part-time jobs: 23% • All Union Jobs: 95% • All Non-Union Jobs: 72%

20. Job Categories, Continued • Lowest 25% of wage-earners: 48% • Lowest 10% of wage-earners: 36% • What kinds of jobs offer health insurance/access to health care: • Full-time jobs in: • The ‘professions’ • State and local governments • Full-time union jobs