“We hold these truths
to be self-evident, that all men are created equal, that they are endowed by
their Creator with certain unalienable Rights, that among these are Life,
Liberty and the pursuit of Happiness.”
If there is a single sentence defining what the United
States was founded upon and still aspires to become, this from the Declaration
of Independence would be it.
While written in a very different context—a justification
for U.S. independence from British tyranny—Thomas Jefferson’s words might be
applied to contemporary discussions of U.S. health care policy:
Does U.S. health care treat all men--and
women--equally? Does it deliver on each
person’s unalienable right to life, liberty, and the pursuit of Happiness?
The answer, sadly, is that it often does not.
Consider:
Equality: While U.S.
health care excels in some areas, it consistently ranks last or near-last in
access, administrative efficiency, equity and health care outcomes. Many U.S. residents face systematic barriers
to care and discrimination because of personal characteristics, including sex
and sexual orientation, gender and gender identity, race, ethnicity, religion,
language and country of origin.
Life: While helping people live longer and healthier is the
very purpose of health care, the U.S. fares poorly on this as well. Life expectancy is lower and chronic disease
rates are higher than
those of similar countries. The U.S. has a higher mortality
rate for amenable deaths (medical conditions for which there are recognized
health care interventions) than countries like Germany, the Netherlands, Japan,
France, and Australia. The U.S. also has much higher rates of injuries and
deaths from gun violence than other wealthy countries.
Liberty: U.S. health care policy infringes on personal liberty
in many respects: many state governments have passed draconian laws to limit
women’s reproductive
rights and dictate
to physicians what they can or must say to patients, even when it goes against
science and the physician’s clinical judgment and ethical obligations. The U.S. micromanages nearly every aspect of
clinical care, requiring that patients and doctors alike jump through hoops to
get needed care authorized and covered, a characteristic that launched ACP’s Patients
Before Paperwork initiative. Physicians
face a barrage of administrative tasks, including activities related to
billing, electronic health records, and performance measures. Administrative
tasks can contribute to physician burnout. By comparison, physicians in many
other countries with universal coverage have far fewer administrative tasks to
comply with: U.S. physician practices spend $61,000 more per physician per year
on costs related to dealing with health insurers than their counterparts
in the single-payer Canadian system.
Pursuit of Happiness: it
is hard to be happy if one is sick, uninsured, and unable to afford medications
and hospital bills. Yet that is the
reality for tens of millions of Americans. The U.S. is the lone wealthy
industrialized country without universal coverage. More than two-thirds of bankruptcies
in the U.S. are because of health care costs.
And, thousands of children seeking to immigrate to the United States are
being held in horrifying
conditions in U.S. border control facilities, denied access to basic health
care services and personal hygiene, a direct consequence of government policy.
Many of us will be with family members on Thursday
celebrating Independence Day, and the politics of U.S. health care, Medicare
for All, limits on reproductive rights, guns, and immigration may very well
come up. It might be a good time to
reflect that when it comes to living up to the Declaration of Independence’
founding principle, “We hold these truths
to be self-evident, that all men [and women] are created equal, that they are
endowed by their Creator with certain unalienable Rights, that among these are
Life, Liberty and the pursuit of Happiness.” U.S. health care and U.S.
government policy fails to measure up in so many ways.
