Demand Your Human Right to Health Care

Human Rights Principles for Financing Health Care

Dear Representative

The goal of a healthy society is at the core of human rights principles, which places a duty on government to protect everyone's health. In the United States, this requires urgent health care reform to end the needless loss of life, health, and well-being of millions of people. Current reform plans are driven by a sense of economic necessity, based on cost concerns; they do not seek health as a social goal. In addition, these proposals fail to realize that the social and financial goals of health care reform cannot be realized as by-products of fragmented, market-based services.
Whether it is the systematic denial of coverage and care in the private insurance system, the price-inflated private Medicare plans, the poor results of privatized Medicaid administration, or the costly Massachusetts health reform, in no instance has the market succeeded in providing equitable access to quality care at a cost affordable to individuals and society as a whole. Indeed, as a market good, health care is by definition exclusionary, sold only to those who can pay, and readily exhaustible, depleted by private interests that literally "take their cut" from available resources through profit, leaving less for the public at large. 
A society disposed to protect both bodily and financial health requires the collective provision of health care on a guaranteed and sustainable basis. In such a society, health care is treated as a public good, rather than a commodity sold in a marketplace dominated by private interests. The following ten principles, formulated by the Human Right to Health Program, outline a plan for financing health care from a human rights standpoint recognized in the United States and around the world. They are intended to guide the design of a sustainable, cost-effective system that secures comprehensive health care for all.
   The Ten Principles
1. FOCUSED ON HEALTH: Health care financing must be completely aligned with the central purpose of a health system: protecting people's health. The goal of a healthy society must take precedence over factors such as market imperatives, profit motives, and the vagaries of policy and budget cycles. A health care system should be financed in a way that guarantees and secures comprehensive health care for everyone, consisting of all preventative care, screening, information, treatments,  therapies, and drugs needed to protect people's health, including mental health, dental and vision care, and reproductive services.
2. UNIVERSAL AND UNIFIED: Health care financing must secure automatic access to care for everyone and avoid separating  people into different tiers. How health care is financed must not lead to differences in how people receive health care, either with regard to access, quality, or outcomes. Everyone must be included and get automatic access to equal high quality health care, guaranteed throughout their lives and appropriate to their needs. Financing mechanisms should produce a unified health care system and not give rise to different tiers of access or coverage. When everyone is part of the same system, and can access and use it in the same way, the system itself is stronger and more sustainable since everyone benefits from supporting it.
3. PUBLIC: Health care is a public good that belongs to all of us, and burdens and benefits must be shared equitably by all. The government has a duty to guarantee everyone equal and easy access to public goods. It can best meet this obligation through public financing and administration of health care, as this minimizes the disincentives to providing care that characterize the business model of private insurers. Steps toward a public system may include expanding public programs such as Medicaid and Medicare, establishing a strong public insurance option while effectively regulating the private insurance sector.  In this option, the government must fulfill their obligation to protect against insurers and other private actors undermining the right to health care.
4. FREE: At the point of access, health care services must be provided without charges or fees. When visiting a doctor, clinic or hospital, patients should not have to pay. Health care funds should be collected independent of the actual use of care, to avoid creating a barrier to care. Services must be provided based on clinical need, not payment, regardless of the financing mechanism used.
5. EQUITABLE: Finances for health care provision must be raised and spent in an equitable way. General progressive taxation constitutes the most equitable mechanism, followed by a sliding scale social insurance contributions. Whichever model the government adopts, financial contributions from individuals must be according to ability to pay, in order to be affordable for all (e.g. on a sliding scale starting at zero). They must be assessed in a non-discriminatory way, ie, they cannot differ on grounds of health status, gender, age, employment or any other status except income. In a similar fashion, corporations should be required to contribute to the costs of the health care system.
6. CENTERED ON CARE: Care should be financed as directly as possible, without intermediaries. The key function of a health care system is to provide care, not coverage. If insurance coverage is used as a vehicle for financing care, this can only benefit all if those who happen to enjoy better health or higher incomes contribute at a level that helps support the whole system, including those in poorer health or with low incomes. This grounds the system in the principles of risk and income solidarity and means that insurance must include everyone (guaranteed issue), spread costs and risk across society as a whole (community ratings, large pool), guarantee comprehensive benefits to all, and collect contributions based on ability to pay.
7. RESPONSIVE TO NEEDS: Resources must be allocated equitably, guided by health needs. Health care spending must be guided by health needs and rectify existing disparities in resource allocation and infrastructure development. Resources must be used equitably for the benefit of all, while recognizing that some communities and individuals may need more care or different services than others... Communities should be involved in determining how their needs are met, and their participation should be fully funded.
8. REWARDING QUALITY: Health care spending must reward quality, appropriate care, and improved health outcomes, rather than profit-seeking, marketing, unnecessary medical procedures, poor coordination, or other interests or effects not linked to protecting health. If care is financed through private insurance, regulation must ensure (through measures such as medical loss ratios) that resources are not diverted away from quality care. On the provider side, we should reward doctors, clinics, and hospitals who focus on quality and outcomes rather than volume, deliver primary care, provide medical homes, and serve communities and areas in need.
9. COST-EFFECTIVE: Resources must be used effectively and sustainably to protect the health of all. Financial resources in the health system must be used for the benefit of the whole society, leaving no one behind and investing in communities whose health has not kept up with that of the rest of the population. Wasteful or uncontrolled spending in some areas restricts opportunities fro protecting health in others, so the cost-effectivg. through needs assessments, global budgets for hospitals, control of capital expansion and technology projects, etc.)
10. ACCOUNTABILTY: Whether public or private. all financing mechanisms and procedures must be transparent and accountable to the people for whose benefit they exist. The people have a right to participate in the oversight of financing structures, and the government has a duty to ensure that financing decisions are based on the human rights principles of universal, equitable health protection. To ensure that this is the case, monitoring and evaluation systems, as well as appropriate public and private remedies, must be put in place to enable the public to measure and oversee progress toward meeting human rights standards.
Health care reformers who take into account these basic principles should be able to develop a sustainable system that is universal, equitable and fair. THESE are the items that need be "on the table" during this period of health care reform in our country. We the people expect you to consider these principles when designing a system of health care protection in America. 

[Your name]