Surrendering the Health Care High Ground

For more than thirty years, we at Physicians for Human Rights (PHR) have maintained that the ability to obtain essential curative and preventive medical care is indeed a human right protected by international humanitarian law. That right is most starkly threatened in situations of military or political conflict. But today in the United States, as legislators consider replacing the Affordable Care Act (ACA), the right to health care is threatened by politics. Whether intentionally carried out for military ends, used as a tool of political oppression, or done with crass indifference, restricting health care access is an egregious violation of human rights.

Here are a few instances where PHR has documented the assault on the right to health care:

    • In Syria, PHR has documented 423 attacks on medical facilities and the deaths of 782 medical personnel. These attacks were either intentional or indiscriminate such that they constitute war crimes, and 90 percent of these strikes were carried out by Syria’s government and its Russian allies. Doctors and patients were the indented targets, a profound violation of medical neutrality.
    • In Myanmar’s Rakhine state, PHR showed last year that security forces routinely extort and impede medical carefor members of the Rohingya ethnic group. Those who refuse to pay bribes are barred from passing through checkpoints, and consequently from receiving health care. More than half of the Rohingya people surveyed by PHR said that restrictions on movement affected their ability to travel to a clinic.
    • In southeastern Türkiye, in an effort to crackdown on Kurdish fighters, government forces have destroyed medical facilities, barred emergency vehicles from reaching the wounded, and punished doctors for attempting to treat those harmed in the ongoing conflict. PHR reported that this crackdown caused the deaths of at least 338 civilians between August 2015 and April 2016.

Less recognized, however, is that the United States is in grave danger of joining this assault on the right to receive effective health care, sliding back to a time when millions were left without insurance. This month Congressional Republicans unveiled the American Health Care Act (AHCA), a replacement for the ACA. While the initial proposal maintains some key protections, it also contains provisions that will disproportionately affect poor and elderly patients.

Specifically, after 2020 the bill will significantly reduce the number of people eligible for Medicaid, affecting at least 40 percent of all children in the United States whose care, in one way or another, is tied to government insurance programs. In addition, since subsidies will be replaced by tax credits based on age rather than income, older Americans will see costs skyrocket.

For example, under the initial proposal, a 64-year-old earning $26,500 a year would see current $1,700 premiums increase to $14,600. While the bill continues to undergo revisions, the Congressional Budget Office initially estimated that the new law would increase the number of uninsured by 24 million people by 2026. A full repeal without replacement would drive 32 million Americans into having no health coverage whatsoever. Such a dramatic drop-off would disproportionately impact people of color, the elderly, and people living in poverty.

Regardless, both the proposed bill or a full repeal are deeply flawed because, as the American Medical Association summarizes, “we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.” One of the objections by those who oppose assistance in paying for health insurance is that this would constitute a new “entitlement.” This is, in effect, an announcement that the United States Federal government has no stake in the health of its population. As one commentator has noted this is not America first; it is families last.

From a human rights perspective, the consequences of proceeding with either the AHCA or an ACA repeal would violate the principles of international humanitarian law cited above. Of course, there is no moral equivalence between a deliberate, direct, and intentional destruction of human life in medical facilities and the decision to restrict the ability to receive health care — even if the latter is on a scale that suggests blatant disregard for human life.

But policies that eliminate access to care by making it unaffordable for millions of Americans is a violation that shows callous disregard for citizens’ welfare. It is not as dramatic as bombing a hospital, but that is little comfort to a single mother phased out of Medicaid, or a town where the community health center or rural hospital shuts down leaving people without accessible quality care. While one is barbaric, the other is heartless, and both constrain the right to obtain essential medical care.

Over fifty years ago, as a doctor in the Mississippi Delta, I vividly remember desperately sick black patients being turned away from segregated ambulatory facilities, and black mothers giving birth in parking lots of hospitals that would not admit them. Eradicating Jim Crow laws that permitted such monstrous cruelty is something the United States rightly celebrates. It was the sort of sociopolitical development that gave Americans a moral high ground to denounce illiberal governments or authoritarian dictatorships that intentionally target civilians and doctors.

While the current Congressional proposal is not as harmful as an outright repeal, making health insurance more expensive for poor and elderly patients and reducing quality of care across the board would be a departure from core values and human rights standards — values that have made the United States exceptional. If Americans condemn the actions of Syrian President Bashar al-Assad in one breath and then advocate revoking health care in the next, this country may not be so exceptional after all.

PHR’s ongoing focus at this point is not to specify every detail of the health care decisions that confront us; it is, rather, to draw attention to a parallel process of exclusion and denial of care in the current debate. It is essential that we maintain our focus on the preservation of an essential human right protected by international humanitarian law.

This blog was co-authored by Abe Nelson, Dr. Geiger’s research assistant who made substantial contributions to this effort.

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