Health Care – Right or Responsibility?

Eesha Pandit

In Tuesday's presidential debate, John McCain said health care is a matter of personal responsibility, while Barack Obama said it was a right. What does that mean for patients and health consumers?

"Quick discussion: Is health
care in America
a privilege, a right, or a responsibility?"

Posing that question during the second
Presidential debate, NBC’s Tom Brokaw asked the two candidates to reveal their
basic views about health care reform in America.

"I think it’s a
responsibility," responded John McCain. An unsurprising answer from the Senator from Arizona, given that his
approach places the burden on individuals to purchase their own health
insurance coverage in the open market, albeit with the assistance of a proposed
$5,000 tax credit.

He continued, claiming,

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"I think it’s a responsibility, in this respect,
in that we should have available and affordable health care to every American
citizen, to every family member. And with the plan that — that I have, that
will do that. But government mandates I — I’m always a little nervous about.
But it is certainly my responsibility. It is certainly small-business people
and others, and they understand that responsibility. American citizens
understand that. Employers understand that."

Brokaw then turned to Barack Obama, who replied,

"Well, I think it should be
a right for every American. In a country as wealthy as ours, for us to have
people who are going bankrupt because they can’t pay their medical bills — for
my mother to die of cancer at the age of 53 and have to spend the last months
of her life in the hospital room arguing with insurance companies because
they’re saying that this may be a pre-existing condition and they don’t have to
pay her treatment, there’s something fundamentally wrong about that."

Viewers who were participating in
a live CNN debate poll responded with an overwhelmingly positive
response to Obama’s declaration of health as a right. Why?

Today, about 46 million people
are without health care, and tens of millions are woefully under-insured.
Today, people stay in dead-end jobs just so they and their families can retain
health coverage. Today, women are still being denied health care if they’ve got
breast cancer and many others must fight to control their own pregnancies and
births.

In this environment, the
difference between a candidate who says that health care is "a right"
versus one who says that it is "a responsibility" is extremely
significant. McCain’s attempt to tie the Obama health plan to socialism,
in the vein of the "Harry and Louise" attack ads that helped sink health care reform in 1992, isn’t garnering the
support that he hopes. Instead, the Obama campaign is apparently succeeding in communicating that their plan does not turn health care into a government
program, but instead strives to insure that all children are covered and that
all adults get quality, affordable coverage.

Both senators noted the
"fundamental difference" between them on health care. Undecided voters in Ohio, women in
particular, noticed the difference as well and turned their dials toward Obama.

But what does it really mean for
Americans, for patients and health care consumers, if health care is a right?
If it’s a responsibility?

If a responsibility, it could be
a personal responsibility or a political one.

A look back at McCain’s earlier comments suggests that for him, health
care is a matter of personal responsibility. In fact, his campaign has said as
much. Back in April, CNN reported:

McCain’s
policy director, Douglas Holtz-Eakin, told reporters Monday night that as
president, McCain would fund public education programs and use "the bully
pulpit" to encourage health attitudes among children and adults.

He said a major plank of McCain’s health
care plan is simply "a focus on personal responsibility, and the kinds of
things that can help you get better outcomes just by taking care of
yourself.

Apparently, for McCain, health
care as a "responsibility" means taking care of yourself. And if health care is instead a right? Let’s
look at some examples of well-established rights.

Because we determine that
everyone deserves the right to a fair trial, we ensure that everyone
accused of a crime has access to a lawyer, regardless of whether or not they can
afford one. We hold a national system of public defenders and judges responsible for this.

Because we determine that
everyone has the right to speak their mind, we ensure that there are public places
and spaces for them to do so without threat of harm. We enlist public safety
officials and open spaces like our houses of Congress to foster civic
participation.

If health care is also a right,
then our government has a responsibility to ensure that we can
exercise that right — just the same as the right to a fair trial or free speech. In
this way, the right to health care implies a political responsibility, not
simply a personal one.

McCain’s argument that health care is a personal responsibility offers a complicated type of moralism. In his view, good employers should not be required to provide health care to their
employees. They should want to. From
a sense of duty and the kindness in their hearts, they will provide health care to their employees. Government’s role in all this, per
McCain, is to encourage their charity by offering tax incentives.

McCain asserted, "[What] is
at stake here in this health care issue is the fundamental difference between
myself and Senator Obama. As you notice, he starts talking about government. He
starts saying, government will do this and government will do that, and then
government will, and he’ll impose mandates."

To McCain’s accusation, Obama replied, "[The]
reason that it’s a problem to go shopping state by state — you know what
insurance companies will do, they will find a state — maybe Arizona, maybe
another state, where there are no requirements for you to get cancer
screenings, where there are no requirements for you to have to get pre-existing
conditions, and they will all set up shop there."

Then Obama pinned McCain’s
approach to health care onto his approach to the economy, his belief in
deregulation and the increasingly evident myth of the trickle down.

"That’s how in banking it
works," said Obama. "Everybody goes to Delaware, because they’ve got… pretty
loose laws when it comes to things like credit cards. And in that situation…the
protections you have, the consumer protections that you need, you’re not going
to have available to you."

"That," he concluded,
"is a fundamental difference that I have with Senator McCain. He believes
in deregulation in every circumstance. That’s what we’ve been going through for
the last eight years. It hasn’t worked, and we need fundamental change."

If Obama’s belief that health care is a right
wins him increased support from Americans
, especially from swing voters, this
could herald a major shift in American politics. A shift from thinking of health care as personal
responsibility to recognizing it as a right is, indeed, a fundamental change.
The fact that viewers responded so positively to Obama’s assertion that health care should be a right suggest that the country might just be ready for
this change. That is perhaps the most remarkable development of this election.

Women all around
the country tell the group I work with, Raising Women’s Voices for the Health Care We Need, that health care is a right. They say that they need help
in securing this right for themselves and their families. They tell us it is
not a mere matter of insurance policies and coverage concerns. Access to health
care affects their children, their partners, their parents, their ability to
work, to thrive, to take care of their families and themselves. Their very
well-being depends on it. If that doesn’t sound like the basis of a human
right, I don’t know what does.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

Roundups Law and Policy

Gavel Drop: The Fight Over Voter ID Laws Heats Up in the Courts

Jessica Mason Pieklo & Imani Gandy

Texas and North Carolina both have cases that could bring the constitutionality of Voter ID laws back before the U.S. Supreme Court as soon as this term.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts

Texas Attorney General Ken Paxton intends to ask the U.S. Supreme Court to reinstate the state’s voter ID law.

Meanwhile, according to Politifact, North Carolina attorney general and gubernatorial challenger Roy Cooper is actually saving taxpayers money by refusing to appeal the Fourth Circuit’s ruling on the state’s voter ID law, so Gov. Pat McCrory (R) should stop complaining about it.

And in other North Carolina news, Ian Millhiser writes that the state has hired high-powered conservative attorney Paul Clement to defend its indefensible voter ID law.

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Alex Thompson writes in Vice that the Zika virus is about to hit states with the most restrictive abortion laws in the United States, including Alabama, Louisiana, Mississippi, and Texas. So if you’re pregnant, stay away. No one has yet offered advice for those pregnant people who can’t leave Zika-prone areas.

Robin Marty writes on Care2 about Americans United for Life’s (AUL) latest Mad Lib-style model bill, the “National Abortion Data Reporting Law.” Attacking abortion rights: It’s what AUL does.

The Washington Post profiled Cecile Richards, president of the Planned Parenthood Federation of America. Given this Congress, that will likely spur another round of hearings. (It did get a response from Richards herself.)

Kimberly Strawbridge Robinson writes in Bloomberg BNA that Stanford Law Professor Pamela Karlan thinks the Supreme Court’s clarification of the undue burden standard in Whole Woman’s Health v. Hellerstedt will have ramifications for voting rights cases.

This must-read New York Times piece reminds us that we still have a long way to go in accommodating breastfeeding parents on the job.

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