Why the Health Reform Law Fails to Meet Human Rights Standards

By Anja Rudiger for Amnesty International

Amidst the celebrations of a ‘historical moment,’ a healthy dose of realism seems in order as we assess the new Patient Protection and Affordable Care Act and the related reconciliation measures. What is seen as a crucial victory for the Obama Administration has been won on the backs of many grassroots activists struggling for health care as a human right and a public good, including women’s and immigrants’ rights groups. The lengthy health reform process has mobilized many millions of people, some new to political activism and many others veterans of the long struggle for universal health care in the United States. This political moment presented a prime opportunity for finally ending the commercialization of one of our most fundamental needs, health care. The failure to seize this opportunity will haunt us for years to come.

What is now touted as the most far-reaching social legislation in almost half a century in fact bears no resemblance to the landmark Medicare Act of 1965, which instituted a fully public insurance system with contributions shared equitably by everyone, in solidarity with older people. Instead of expanding Medicare to everyone, this new law formally affirms and solidifies the private, market-based system in which health care is the domain of a for-profit industry propped up by substantial public subsidies.

Human rights standards do not tolerate the inequities inevitably linked to a reliance on market competition to meet human needs. Yet this legislation also contains some important improvements to health care access for poor people. The Medicaid expansion and the additional funding for community health centers are very welcome and long overdue, but could have been adopted as stand-alone measures. As such, they are indeed cause for celebration, yet most pundits seem to care precious little about these provisions of the new law, despite the fact that the Medicaid expansion will account for at least half of the newly insured population. Instead, all favorable attention is showered on the subsidized expansion of the private, for-profit health insurance industry.

Yet it is precisely this aspect of the new law — market-based health insurance reform — that entrenches the treatment of health care as a commodity by locking us into a market mechanism that sells access to health care based on a person’s ability to pay rather than their health needs. Public subsidies for pricey (and not price controlled) insurance products are intended to mitigate the inequities inherent in a for-profit system, while leaving no illusion that coverage will continue to be stratified and access to care out of reach for many. This volatile combination of at-will pricing by insurance corporations and the promise of subsidies to match prices also renders the system financially unsustainable for individuals and government alike.

In sum, the new health law fails to meet the key human rights standards of universality, equity, and accountability. Rather than guaranteeing universal health care, the law excludes many millions of people from access to coverage and care. Instead of ensuring that care is available for those who need it, the law makes access contingent on the purchase of private insurance. And rather than holding the private sector accountable for protecting the right to health, the law permits the industry’s focus on their bottom line. Health care is treated as commodity, not as a universal right and a public good shared equitably by all.

Many grassroots activists and their academic and advocacy allies, including the National Economic and Social Rights Initiative, have challenged this prevailing policy paradigm and presented solid evidence that health care financing and management through market relationships is unable to meet everyone’s health needs. In all other high-income countries, health systems are highly redistributive in economic terms, funded collectively through cross-subsidization with a common pool that includes all, not limited to residual public programs for certain groups. Yet Democrats in Congress and the White House did their best to silence these voices and insisted on a market-based approach despite their own better knowledge — the President himself admitted as much when he remarked that a single payer public insurance system would be necessary to achieve universal coverage. But this was not the route pursued by our legislators, and so a workable solution was jettisoned in favor of an ideological approach approved by the health care industry.

We can turn this moment into a historical one if we take it as a new beginning, not an end, for a human right to health care movement in the United States. Grassroots campaigns are well underway for universal health care at the state and even local level, for example in California, Vermont, and Montana. By using the human rights framework to guide us, we can build a broad-based movement that inspires solidarity for sharing the public goods required to meet our fundamental needs.


  1. Chris Hagel on April 20, 2010 at 2:07 pm

    Thanks to everyone who have contributed so much to grow this movement.

    I just have some points to make:

    *Congresswomen Carolyn McCarthy’s and other’s opposition to HR 676 was that (paraphrasing): “People can not be forced to give up their insurance to be in a Medicare for all system”.
    (If these people were actually informed on how much better off they would be from many different standpoints more of them (the middle class) would be cool with it. Also remember, when any law was passed there was never 100 % for it. The civil rights law, labor laws etc. )
    To the main point, conversely however, what this Bill has done is force the uninsured people to buy over-priced, low quality, low quantity health insurance subsidized with taxes; a give-a-way to the health insurance industry. They don’t even have to market and sell their shoddy product, it’s fallen right in their lap. (This is corporate welfare big time.)
    They wouldn’t force the people with good health care policies into HR 676 but this Bill ultimately forces the blue collar and poor to buy their shoddy products; these policies will not be like the ones the others with good policies have. This is all about making it appear that change and justice has been carried forward, when in reality the uninsured and underinsured have been totally taken advantage of; it’s an attempt to appease us.

    *So now our economy and people are burdened even more with a very expensive, fragmented, and bureaucratic health care non-system.

    *Also, generally speaking, this is all about the extremely class conscious mega rich elites (and upper middle class people) in this country who are simply repulsed by the concept of national health insurance for working class/blue collar people. Obama and his cohorts have courted these people during this fake health care reform.
    Playing that class card you say, well it’s all about class, it’s always been; you don’t have to play the class card.
    But when you watch TV, it makes it seem like we’re just one big happy family of Americans.
    American style fascism is on the march.

    *So now, with this Bill, what the 47 million uninsured are stuck with is musical chairs in health care. Who’s going to get the health care? Do we really know when the music stops who’s going to get a seat? And the uninsured have to fill out all kinds of forms and paper work and maneuver through all the channels just to get health care. All of this so Obama and his cohorts can protect their buddies in the health insurance industry and Big Pharma.
    With HR 676 we just show our national health insurance card and get treated. No hoops to jump through or fences to climb over.
    It’s a win-win for our country, economically, morally, and spiritually.

    *We should go on strike for one day and see what would happen. No taxis, no buses, no waitresses or waiters, no construction, no store clerks etc. Let’s see what would happen.
    We deserve the dignity of getting our ailments and injuries checked out without being reduced to health care beggars!!!

    *All those congressmembers screaming and turning red in the face about a big Government take over of health care are such phonies and bullies. Yeah, big government, give us a break, it’s just small enough to work in and get their A-Z health care, most of it paid for with tax payer money.
    This Bill is a corporate consolidation by the health insurance industry of our health care, with our tax payer dollars to subsidize the over priced low quality/quantity policies of those who can’t afford the policies.
    This is not socialized medicine. This is not socialized medicine. This is not socialized medicine. This is not socialized medicine. This is not socialized medicine.
    Is it getting through to them. Do they get it?

    *So now what we have more than ever is a government of, by, and for the health insurance industry and big pharma not of, by, and for the people.

    *Yeah, it’s alright for people to get rich (not how it’s been done in the past scandals and everyone deserves a living wage) but we are the only industrialized country to still have health care in the commodity and privilege column instead of the public necessity/service and human rights column, and that, fellow Americans is barbaric and evil.

  2. amyamylsone on November 18, 2011 at 4:32 pm