On this occasion honoring the anniversary of the birthday of Martin Luther King 86-years-ago, coinciding with the release of the movie Selma, it is fitting to recall his leadership on moral principles toward equity of health care in this country. Among his many classic quotes about health care, he had this to say in 1966 in a speech to the Medical Committee for Human Rights:
Of all the forms of inequality, injustice in health care is the most
shocking and inhumane.
Were he here today, Martin Luther King, Jr. would be appalled to see what Americans are facing, even five years after the passage of the Affordable Care Act.
Here's one patient vignette that puts a human face on the outcomes facing patients unfortunate enough to live in states that opted out of Medicaid expansion, as more than twenty states have done.
Charlene Dill was a 32-year-old mother of three who earned $11,000 a year cleaning houses and babysitting in Florida. That was too much to qualify for Medicaid, and too little to afford health insurance. The ACA would have provided subsidies for health insurance if her income was more than $23,550. When she developed a heart condition, and later, abscess on her legs, she did go to emergency rooms, but couldn't afford those bills or any other care.
This is not an isolated anecdote, but more the rule for many millions of Americans. Access to care has improved for some, especially in states that expanded Medicaid, but there are still more than 30 million uninsured and tens of millions underinsured. Lacking any mechanisms to rein in markets and contain costs or prices, the ACA has unleashed increasing consolidation and control by hospital systems and insurers.
Wall Street is happy, and health care stocks are soaring. Yet one-third of insured Americans cannot afford to pay their medical bills, often leading to bankruptcy. Meanwhile, our safety net continues to deteriorate. We can expect that to worsen in the months and years ahead if Republican governors impose more restrictions on Medicaid, and if the Republican-controlled Congress cuts spending for critical programs.
As Martin Luther King knew full well, health care is a moral issue. Virtually all advanced countries around the world recognized long ago that health care is a human right, not a privilege based on ability to pay. Dr. Edmund Pellegrino, leading medical ethicist for many years at Georgetown University's Center for Clinical Bioethics, summed up the issue this way at the Annual Meeting of Academic Health Centers in 2000:
Access to health care is a moral obligation of a good society.
Yet, as a society, we still seem to have a moral blind spot when it comes to health care. As the income gap widens between rich and poor in America, and as the middle class falls into increasingly dire straits in affording health care, our sense of social solidarity continues to erode. The political process toward reform has been corrupted by money, especially in the wake of Citizens United and the McCutcheon rulings of the U.S. Supreme Court.
We can expect that Martin Luther King would see our present health care "system," despite limited progress from the Affordable Care Act, as a political failure and a moral crisis unnecessarily harming a large and growing part of our population. He would be a leader toward the concept of health care as a human right, not just a commodity for sale on a largely for-profit market. He would speak truth to power and be a beacon of hope if he were on the scene today. He was never one to give up in a fight, and has left us with this perspective:
We must accept finite disappointment, but never lose infinite hope.
We need to carry on his spirit to best honor his legacy. This would address his strong belief that injustice in health care is a major expression of inequality and inhumanity. An answer to health care reform is in plain sight if we just take off our blinders -- single payer national health insurance along the lines of H.R. 676 Improved Medicare for All, the Conyers bill in the House of Representatives. That will assure all Americans full access to necessary care, with full choice of physician and hospital care anywhere in the country. It includes public financing, coupled with a private delivery system, at a cost far less than we are paying today.
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John Geyman, M.D. is professor emeritus of family medicine at the University of Washington School of Medicine in Seattle and past president of Physicians for a National Health Program 2005-2007. Adapted in part from John Geyman, M.D.'s just released book How Obamacare Is Unsustainable: Why We Need a Single Payer Solution for All Americans, Copernicus Healthcare, 2015.