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PHM-US Editorial featured on cover of The Lancet

December 7, 2009

The latest issue of The Lancet features the editorial below, written by members of the People’s Health Movement-US. Click to view the full December 5, 2009 Lancet, which also includes a letter from PHM activists Wim De Ceukelaire and Pol De Vos from Belgium, “Social movements are key towards universal health coverage.”

The Lancet, Volume 374, Issue 9705, Page 1887, 5 December 2009


Health-care reform and the right to health in the USA
Laura Turianoa, Matthew Andersonb, Todd Jailerc, Maureen McCued, Mohammad Shahbazie, on behalf of People’s Health Movement—USA

The House and Senate of the US Congress have released their health-care reform proposals, revealing the range of possible changes for the US health-care system. Even the best of these proposals have little chance of covering everyone, or controlling health-care costs overall, let alone meeting human rights standards of universality, equity, and accountability.

As a presidential candidate, Barack Obama’s original reform plan only partly met human rights standards.1 As President, he has not promoted a plan that would most benefit the American people. Instead he has courted Republicans and the medical care industries. The result will be a windfall for insurance, hospital, and pharmaceutical corporations through the mandate to obtain health insurance that is a key component of each reform bill.2 In exchange for submitting to a few new regulations, such as guaranteed issue and renewal, insurance companies will get millions of new customers, many subsidised by the government.
Despite subsidies, health-care costs will still burden some families, particularly those just above income cut-offs.3 The proposed public plans are specifically structured to be available only to those not insured by their employer, rather than an option open to all based on Medicare. Specific regulations, and probably small enrolment, will limit these plans’ ability to negotiate lower prices.

Meanwhile, despite the efforts of a few Democrats, legislation consistent with the right to health is mostly ignored. Publicly popular proposals, HR676 and S703, would create a national health insurance system, by expanding and improving Medicare to cover everyone. However, their passage is unlikely given massive campaign donations and lobbying from medical care industries, and the assertion that policies to improve public welfare equal socialism.

The health-care reform process exposes how corporate influence renders the US Government incapable of making policy on the basis of evidence and the public interest. The right to health requires that a health system, available and accessible to all, includes protection and promotion of health, and treatment of illness. There is no excuse for the USA not to adopt a system like any of those in many other countries that cover everyone and control costs—systems that better integrate public health and individual medical care. Without such a system, comprehensive primary health care will not be implemented, nor will the social determinants of health be effectively addressed.

The belief in US exceptionalism must be laid to rest. People living in the USA are as entitled to the right to health as others, and the USA should be accountable to the same standards as any other country.

We declare that we have no conflicts of interest.

1 National Economic and Social Rights Initiative, National Health Law Program. Human right to health care: nominees’ plans lag behind public demands. Issue brief. (accessed Sept 15, 2009).
2 Hamburger T, Geiger K. Healthcare insurers get upper hand. Los Angeles Times Aug 24, 2009. PubMed
3 Center for Policy Analysis. HR 3200 delays public plan, skirts affordability. (accessed Sept 24, 2009).

a People’s Health Movement, Oakland, CA 94602, USA
b Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
c Hesperian Foundation, Berkeley, CA, USA
d Global Health Studies, University of Iowa, Iowa City, IA, USA
e Jackson State University, Jackson, MS, USA