Wednesday, July 3, 2019

How does U.S. health care measure up to the Declaration of Independence?


“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.

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