Much of the world has settled the matter of whether health care ought to be a human right. The United Nations said so in 1948. The American founders might as well have said it in 1776 when they listed life, liberty, and the pursuit of happiness among citizens’ unalienable rights, but this vision has not yet been realized, as evidenced by rampant disparities in access to care.
Separating health care from these unalienable rights requires Olympic-level mental gymnastics. Yet every day we find more creative and profitable ways to vault, somersault, and twirl our way out of our mutual (and, according to our founders, creator-endowed) responsibility to ensure that every American is guaranteed health care.
Denying millions of Americans ready and affordable access to health care is often touted as the best option the U.S. has for controlling health care costs. But in times of crisis, policymakers concede that this is a lie — if not explicitly, then with their actions.
For example, when Covid-19 vaccines became available late last year, the general agreement was that free health care was the best, least expensive way to end the pandemic. Vaccines were offered to all Americans. Government and private insurers charged no fees to individuals for these potentially lifesaving shots, and in some cases even picked up the tab for appointment scheduling services and rides to the clinic.
This mass mobilization of subsidized health care spoke volumes. It amounted to the tacit acknowledgement of three truths:
- First, as an overall strategy, preventive care is better and less expensive. Vaccines — which prevent infection and curb the pandemic — are preventive care. And though they cost taxpayers billions, vaccines are less expensive, financially and morally, than the uncontrolled spread of disease.
- Second, health care ought to be a human right. Most Americans don’t believe that people who can afford care are the only ones who deserve it. But our society’s beliefs aren’t congruent with the country’s policies.
- Third, some people need more help getting care than others. Giving everyone the right to vaccines and health care doesn’t mean everyone will have equitable access to them, as we’ve seen during the Covid-19 vaccine rollout. Equitably subsidizing transportation and language services, for example, helps more people exercise their right to health.
Tacit acknowledgment of these three truths is a step in the right direction. But it’s not enough. We must weave them into our health care system.
How can we accomplish this? By guaranteeing high-quality care to all Americans and extending it to them equitably.
People without health insurance are less likely to receive outpatient care and more likely to be hospitalized for preventable health problems. In the hospital, they receive fewer therapeutic and diagnostic services and are more likely to die than those with insurance.
Health care and policy leaders are fully aware how a lack of insurance harms people, yet they fail to guarantee it to everyone. So they find themselves at the source of a widespread, preventable health problem.
The best and latest data illustrates that 80% to 90% of health outcomes are a function of our social determinants of health — factors including where people live, what they eat, their education, income, access to care, and more. But health insurance typically only covers the 10% to 20% of outcomes attributable to medical care, which is not guaranteed to millions of Americans.
A more useful and equitable insurance model would cover social determinants of health, helping better control the 80% to 90% of health outcomes to which they’re tied. In traditional insurance plans, healthy, younger people offset the high medical costs of sicker, older folks. New insurance plans should also empower socioeconomically advantaged individuals to lift up low-income and underinsured people, who bear the brunt of poor outcomes associated with social determinants of health.
Such plans would improve public health and economic mobility by mitigating scourges like poverty, homelessness, and food deserts. During a blistering summer heat wave, a lower-income family in Brownsville, Texas, could receive a supplemental benefit for window unit air conditioners. A struggling student’s parents could make an insurance claim for a tutor to help their child graduate high school on time. A resident of rural Appalachia could obtain assistance with grocery deliveries.
To some, these scenarios sound like nice-to-haves. But make no mistake: They are preventive health measures that represent a better, less expensive, more equitable way to deliver care.
The pandemic has proven that the U.S. can mobilize its resources and give everyone the fully subsidized care they need and deserve, even during a crisis. That means it can be done anytime.
We just need to believe that our collective health is worth it.
Vikram Bakhru is a general practitioner, senior health care executive, and founder of the health equity nonprofit Foundation for International Medical Relief of Children, more commonly known as FIMRC.
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