Fall 1998 Human Rights Magazine

By Edward M. Kennedy

This year marks the fiftieth anniversary of the Universal Declaration of Human Rights, and it is fitting to reflect on the nation’s progress toward ensuring that healthcare is treated as a basic human right. According to Article 25 of the Declaration, every person has a right to medical care and security. This ideal was reaffirmed and expanded in Article 12 of the International Covenant on Economic, Social, and Cultural Rights. Unfortunately, despite the clear statements contained in each of these basic human rights documents, the goal of guaranteeing healthcare as a basic right for all our citizens remains elusive.

In this time of unprecedented prosperity for the United States, it is clear that the rising tide is not lifting all boats. Millions of citizens work at minimum wage jobs and are unable to meet the needs of their families. They worry about food, clothes, and child care. Saving to buy a house or to help a child go to college is out of reach for large numbers of families. Tragically, for many of these struggling families, health insurance and adequate healthcare are luxuries they cannot afford.

Most Americans agree that good health is an essential part of the American dream. The pursuit of other goals depends on good health and access to good healthcare. Children suffer because their parents cannot afford decent care. Families face financial disaster because of the high cost of serious illness. Every such case in our affluent society mocks the right to life, liberty, and the pursuit of happiness that is the nation’s founding ideal.

Disease and injury deprive too many Americans of the opportunity to enjoy these basic rights. Many of these individuals and families who go without coverage are the same persons who are disadvantaged in other areas. Good healthcare should be a basic right for all Americans. It is unconscionable that in our wealthy nation, a child from a well-to-do family has a better chance for a full and healthy life than a child whose family must delay or do without healthcare because they fear the expense.

The number of Americans lacking health insurance continues to rise. During our most recent national debate on comprehensive health reform in 1993-1994, nearly 40 million Americans were uninsured. That number has now risen to approximately 42 million, and is projected to grow by an additional one million a year for the foreseeable future, unless adequate reforms are enacted. Too many people work for employers that do not offer health insurance. Too many people delay medical care because they fear the cost. Too many people face bankruptcy as a result of medical costs. As the world’s richest country, we should be ashamed to admit these shortcomings.

The United States spends more per capita for healthcare than any other industrial nation; however, we get far less value for the dollars we spend. Nearly every other developed nation ensures good healthcare to all its people at an affordable price, yet spends a smaller portion of its gross national product on healthcare than the United States. Leading public health indicators in these countries, such as infant mortality and life expectancy, reflect their investment.

Too often, individual providers take the Hippocratic oath to do no harm, but they are no longer the decision makers in today’s healthcare system. Instead, HMOs and managed care plans are in the driver’s seat, and the system is focused more on profits than on healing the sick or maintaining health.

Even though we are a nation that places a high value on healthcare, we have done very little to ensure that quality care is available to everyone at an affordable price. Inner-city and rural areas have difficulty in retaining doctors and hospitals. Complicated insurance policies confuse and trap patients in gaps, limitations, and exclusions in coverage. Some of these policies offer benefits so inadequate that serious injury or illness can mean financial ruin for many families.

Beginning with prenatal care, timely access to good health services is essential to proper development during the critically important first three years of life. As children grow, they need to be assured access to well-child care—including immunizations and developmental assessments —to ensure they can perform to the best of their abilities. If a child’s vision or hearing problems go undetected or untreated, the child is doomed to struggle unnecessarily, and, perhaps, face failure at school.

Investments in basic and medical research reap rewards in the form of scientific discoveries that can cure, treat, or prevent diseases and conditions that used to kill or permanently disable men, women, and children. But these discoveries are often not available to those in need.

Slowly, we are shifting our focus to preventive care. Managed care organizations, for all their operational flaws, were designed to provide incentives to keep patients healthy. But doing so for the benefit of all Americans requires commitments that we have so far been unwilling to make.

I believe that all Americans should contribute, according to their ability to pay, to a common fund that pays the cost to prevent and treat injury and illness. All should be eligible for the same comprehensive benefits. No one should fall between the cracks in coverage, and all should be continually covered, regardless of the status of their employment. Above all, no one should be excluded from coverage because the cost is prohibitive.

We also need an insurance program that persuades physicians, hospitals, and other providers to simultaneously control costs, monitor and improve quality, and prevent disability. Competition has failed in the current system because it is not a true free market, nor is it likely to become one in the near future. Purchasing healthcare is not like purchasing a car or other goods. Very few consumers are able to accurately evaluate their options and make informed choices. The answer does not lie in a two-tiered system that treats patients who can pay one way and those who cannot another. Two systems of care inevitably lead to two levels of care. If we decide that it is important to provide healthcare for all, then we must do so without the indignities, hardship, and inefficiency of a two-class system. In recent years, we have had modest successes in making incremental progress toward this goal.

In 1996, Congress passed the Health Insurance Portability and Accountability Act (the Kassebaum-Kennedy Act), which helps people keep their insurance when they change jobs or lose a job, and to avoid the burden of excessive exclusions for preexisting conditions in their insurance coverage.

In 1997, as part of the Balanced Budget Act, Congress created a new children’s health insurance program (based on the Hatch-Kennedy Act), which will invest $24 billion to extend health insurance to children of low-income families during the next five years.

This year, I have introduced legislation that would expand coverage for early retirees and other uninsured Americans between the ages of fifty-five and sixty-four, until they qualify for Medicare. I have also introduced a bill that would require firms with more than fifty employees to offer health insurance and contribute toward its purchase.

Unfortunately, some in Congress are pursuing regressive alternatives that would encourage individual coverage at the expense of employer-based coverage. It makes no sense to address the inequities in our healthcare system in a way that would further undermine the employer-based system.

In the current patchwork system, too many families are forced to gamble with their financial future and their health because health insurance is out of reach. They cannot obtain good care because their incomes are too low to buy insurance, but too high to qualify for current government programs. Their age, employment status, or health status prevent them from being eligible for health insurance. Often, they live in an area where there is little or no care available. They suffer unnecessarily because the current system is unwilling or unable to respond to patients with special needs, such as those disadvantaged by disability, income, location, or age.

We have the knowledge, wealth, and ability to assure that all Americans get the healthcare they need, and at an affordable cost. What we lack is the will. I continue to be convinced that if the American public insists on reform, Congress will provide it, and I am optimistic that such a time will come sooner, not later.

Edward M. Kennedy has served in the United States Senate since 1962, and is currently the senior Democrat on the Senate Committee on Labor and Human Resources.