U.S. Health Reform and the Elusive Target of Human Rights John F. Roatch Global Lecture in Social Policy and Practice, Arizona State University, March 5, 2010 Lance Gable, JD, MPH Assistant Professor of Law Wayne State University Law School Detroit, Michigan, USA

U.S. Health Expenditures, 2007 CountryExpenditures Per Capita % GDPMaternal mortality rank Childhood mortality rank US$ 7, %34 th 40th Canada$ 4, %21 st 28 th UK$ 3, %25 th 28 th Sources: CMS, OECD, WHO

Country Rankings Infant Mortality 1960 and 2004

U.S. Insurance Coverage 2007 Source: US Department of Health and Human Services

U.S. Uninsured Rate Source: US Department of Health and Human Services

U.S. Uninsured Rate Predictions Source: Commonwealth Fund

U.S. Health Expenditures 2007

Major themes Part I. Health as a Human Right: an evolution of substance and process Part I. Health as a Human Right: an evolution of substance and process Part II. Health Reform in the United States: a perennial struggle for common ground Part II. Health Reform in the United States: a perennial struggle for common ground Part III. Health reform proposal and human rights Part III. Health reform proposal and human rights Part IV. Recommendations Part IV. Recommendations

Part I. Health as a Human Right: an evolution of substance and process What is health? What is health? Constitution of the WHO (1948): “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Constitution of the WHO (1948): “health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” What are human rights? What are human rights? What is the right to health? What is the right to health?

Framing Health and Human Rights Human rights are universal and immutable Human rights are universal and immutable Human rights transcend state sovereignty Human rights transcend state sovereignty The human rights movement has had great successes, but human rights violations continue to occur with great frequency around the world The human rights movement has had great successes, but human rights violations continue to occur with great frequency around the world Human rights have proliferated Human rights have proliferated

Sources of the Human Right to Health International and regional legal frameworks International and regional legal frameworks International organizations International organizations National governments and other domestic jurisdictions National governments and other domestic jurisdictions International NGOs, funders, and other political actors International NGOs, funders, and other political actors

Framing Health and Human Rights Three relationships: Three relationships: Health affects Human Rights Health affects Human Rights Human Rights affect Health Human Rights affect Health Health and Human Rights are inextricably linked and mutually reinforcing Health and Human Rights are inextricably linked and mutually reinforcing Mann, Gostin et al. (1994) Health and Human Rights

Source: WHO

The International Human Rights System

Sources of the Human Right to Health Universal Declaration of Human Rights, article 25 (1948): the right to heath is “a standard of living adequate for the health and well-being of [a person and that person’s] family, including food, clothing, housing, and medical care and necessary social services…” Universal Declaration of Human Rights, article 25 (1948): the right to heath is “a standard of living adequate for the health and well-being of [a person and that person’s] family, including food, clothing, housing, and medical care and necessary social services…”

Sources of the Human Right to Health ICESCR, article 12 (1966): “the right of everyone to the…highest attainable standard of physical and mental health.” ICESCR, article 12 (1966): “the right of everyone to the…highest attainable standard of physical and mental health.” Includes: “conditions which would assure to all medical service and medical attention in the event of sickness.” Includes: “conditions which would assure to all medical service and medical attention in the event of sickness.”

Sources of the Human Right to Health General comment 14: focus on the underlying determinants of health General comment 14: focus on the underlying determinants of health Four factors: availability, accessibility, acceptability, and quality Four factors: availability, accessibility, acceptability, and quality Three responsibilities: respect, protect, and fulfill Three responsibilities: respect, protect, and fulfill

Sources of the Human Right to Health Special Rapporteur reports: Special Rapporteur reports: Right to health includes the protection of other human rights Right to health includes the protection of other human rights “a strong health system is an essential element of a health and equitable society.” “a strong health system is an essential element of a health and equitable society.”

Part II. Health Reform in the United States: a perennial struggle for common ground Health Care Reform has always been politically divisive Health Care Reform has always been politically divisive

Part II. Health Reform in the United States: a perennial struggle for common ground

Health Care Reform has been politically divisive Health Care Reform has been politically divisive

Part II. Health Reform in the U.S.: a perennial struggle for common ground

Part II. Health Reform in the United States: a perennial struggle for common ground

Part III. Health reform proposals and human rights 1) Expanding access to health insurance 1) Expanding access to health insurance Limit pre-existing condition exclusions and expenditure caps Limit pre-existing condition exclusions and expenditure caps Individual mandate Individual mandate Subsidies for qualifying individuals and small businesses Subsidies for qualifying individuals and small businesses Health insurance exchanges Health insurance exchanges Essential health benefit packages Essential health benefit packages Abortion Abortion Other access expansions Other access expansions

Part III. Health reform proposals and human rights 2) Cost containment across the health system 2) Cost containment across the health system 3) Quality improvement 3) Quality improvement 4) Other issues 4) Other issues Medical malpractice reform Medical malpractice reform Single payer and human rights Single payer and human rights

Part IV. Recommendations Pass health reform because it advances health and human rights Pass health reform because it advances health and human rights Develop rights-based approaches to health policy Develop rights-based approaches to health policy Recognize the right to health in the United States Recognize the right to health in the United States Support health through other human rights Support health through other human rights

U.S. Health Reform and the Elusive Target of Human Rights Thank You! For more information, please contact: Lance Gable, Wayne State University Law School,