Is Health Care a Privilege?
BY DR. RAHMAT NA’ALLAH, M.D.
The author has a master’s degree in public health and is a fellow of the American Academy of Family Physicians. She practices at Unity Point Clinic-Family Medicine in Peoria and is on the board of the Peoria City/County Health Department.
Is health care a privilege? I’ll bet most people will answer no. After all, every human being has a right to a decent home, community, safety and happiness. Why would health care be singled out?
This expectation that health care is a fundamental human right doesn’t seem to be the reality in the United States which, according to the 2014 Commonwealth Fund survey, has been ranked the worst in health care for the fifth time among 11 industrialized nations of the world. The United Kingdom ranked the best among the other 10 nations including Switzerland, France, Canada, Norway, Sweden, Netherlands, New Zealand, Germany and Australia.
One would wonder what these countries have in common that we don’t. I’ll tell you, they provide health care for all their citizens. Their citizens also have better quality of care, better access to doctors, and there is equity in health care procurement. No one is discriminated against based on socio-economic status, ethnicity, religion or race.
The report also shares some staggering statistics. Even though the United States has the worst health care system among these other nations, we have the most expensive health care system in the world. One would then expect that since we’re spending so much money on health care, we should have something to show for it. Unfortunately, we don’t. We have worse outcomes especially in chronic disease management, quality of life and life expectancy, widening health disparity and most of all less patient satisfaction.
Twenty-five percent of the physician work force in the United States is comprised of international medical graduates (IMG) according to the Educational Commission for Foreign Medical Graduates (ECFMG). This commission is responsible for certifying physicians who want to obtain graduate medical education in the United States but who did not graduate from a U.S. or Canadian school. ECFMG certification is hence a prerequisite for temporary and later unrestricted license to practice medicine in the United States. Many of these physicians, receive a special waiver to remain in the United States to provide care to medically underserved communities. A recent study published online Feb. 2, 2017, by the British Medical Journal showed that Medicare patients admitted and treated by internists who are IMGs had lower 30-day mortality rates when compared to those managed by U.S. medical graduates. This debunks the perception that IMGs are less competent. Discrimination in any shape or form is a violation of the medical profession. If IMGs were barred entrance to the United States as the current administration has been urged to do through an immigration executive order, this may exacerbate physician shortages, hence limiting access for millions of Americans.
We know from recent reports by the 2016 Commonwealth Fund survey that the Affordable Care Act has: decreased the uninsured rate; improved Americans ability to buy health insurance on their own; reduced the number of people postponing care and purchasing medications because of cost; provided better access to reproductive health care for more women; and made it easier for people to access preventive health services. The report also showed improved health care access and better coverage between 2013 – 2015, with over 70 million Americans benefiting from Medicaid expansion in 2016.
The United States has the ability to go up the ladder among the other 10 industrialized nations to fulfill the dream of all her citizens that health care is not a privilege, but it is a fundamental human right for all.
(mortality rate comparison between international medical graduates and U.S. grads)
5. American Academy of Family Physicians letter to President Trump
7. Education commission for foreign medical graduates (ECFMG)