Guaranteeing health care for children in the United States
FernandoStein, M.D., FAAP, President, American Academy of Pediatrics
Letter from the President
As a nation, we continue to debate how to pay for health care in a hyperpartisan environment,
while avoiding the central question that some countries have asked and answered: Is
health care a citizen right? The United States has a de facto
answer: It is not a right.
We hear politicians proclaim “we have the best medical care in world,” while a careful
analysis of the different groups that are providing and receiving health care tells
a different story. It seems the only groups that are happy with the financing of health
care are the ones profiting from it. For the user of health care and the direct providers,
the story is one of “doing better and feeling worse.” Everyone in the system is aware
of the amazing new treatments, the interventional options and the “miracle cures,”
while access to care is filled with obstacles and variability related to individual
plans, geographical region, and social and economic status.
We have some other social de facto agreements: Law enforcement is something society
agrees is part of the social contract and we pay for it. We want to feel safe and
agree to empower our local or federal government with the activity of enforcing the
law. The military institutions of our country is another concept with which society
agrees and pays for (with some debate over a few billion). In general, we have agreed
we have a right to live in an orderly society, and, therefore, we are willing to pay
for police and for the common defense. Let me take the argument one step further.
We need healthy men and women in both law enforcement and the military once enlisted.
How come we don’t want to guarantee their health care when they are growing up? When
they are children or in the womb?
The health status of Americans during the life cycle is deteriorating on several fronts
as illustrated by the increase in incidence in morbidity and mortality from noncommunicable
diseases, decrease in life expectancy and the most concerning of all indicators: the
decrease in years of useful life. The promise of miracle cures, new therapies and
technological advances are really the story of doing better and feeling worse.
Children’s insurance coverage rose to an all-time high of over 95% as a result of
a variety of initiatives and legislative decisions. Given the lack of a societal commitment
to the notion that health care is a right, health care for women and children is at
the mercy of the prevailing political winds. The current debate and attempts to reduce
the levels of coverage carry an ominous potential consequence.
The legal aphorism “justice delayed is justice denied” can be used in the current
discussion by saying “health care delayed is health care denied.” I am concerned about
a potential body count because of the projected changes in health care administration
and implementation. It is not just an ideological argument. Real lives of real people
are in play. If the result is that health care is delayed for many because of the
changes, health care will be denied and will have serious and potentially irrevocable
consequences for many.
When the debate over health care in the United States is centered on price and who
pays, we now have a problem of principle. The real debate we need to have is: as
a society do we think health care should be a right. The right to health care is an
internationally recognized human right. In 1948, the United States and 47 other nations
signed the United Nations Universal Declaration of Human Rights. The document stated
that “everyone has the right to a standard of living adequate for the health and well-being
of oneself and one's family, including ... medical care.” Most of the opposition to
the principle of health care as a right is based on financial, operational and ideological
concerns (a step toward socialism).
At a minimum, the notion of protecting children and women in the reproductive age
with guaranteed health insurance as our biological insurance for the preservation
of our healthy future as a nation is one to be strongly considered. I do not think
social agreement of health care as a right is any more a step toward socialism than
agreement of law enforcement as part of civil society is a step toward totalitarianism.