Government and Universal Health Care: Obligation or Discretionary?
Health care is a hotly-contested issue domestically. When President Barack Obama promoted and signed into law the Affordable Care Act in 2010, which sought to overhaul the country’s health care system to make it more affordable, voices of dissent could be heard from all corners of the country. Yet, the Obamacare is not even a true universal health care (UHC) system because it does not provide or ensure that every person in the country gets health care coverage. What it does is that it broadens the choices for people allowing people to get more affordable health care coverage. Universal health care as being implemented in such countries as the UK, Canada and Germany ensures that every person gets coverage. Although the US is a signatory to several international and regional treaties that mandate the provision of basic health care for every person, to date the country has failed to abide by that obligation. Although in most instances international law has merely persuasive effect domestically, the US is still bound to abide by its international obligations. The chief argument against the establishment of UHC in the country is economics – that is, imposing such a system can cripple the economy of the country. Several countries, particularly Switzerland and Singapore, which have both UHC but spend only a fraction of what the US does for its health care, belie this contention.
Several provisions under international law point to an obligation, at least moral, on the part of the government to provide health care to its citizens. According to Article 25 of the Universal Declaration of Human Rights, every person has the right to a “standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services” The implication of this provision is that the signatories to this Treaty agree that basic health care is a fundamental right of human beings. The United States is a signatory to this Treaty as well as 47 other countries. The International Covenant on Economic, Social and Cultural Rights (ICESCR) is, however, more detailed in its treatment of healthcare as an obligation of the government. This Treaty, for example, directs signatories to provide the maximum available resources to achieve the highest standard of health for all its citizens. More specifically, it directs signatories to create appropriate conditions to ensure that any and all persons can be given medical treatment in times of illness (cited in Yamin 2005). The US is likewise a signatory to this treaty (UNTC 2016). In addition to these international treaties, there are other treaties, both international and regional, which obligate signatory-governments to take responsibility in ensuring that all citizens enjoy security to healthcare services and provisions.
The legal effect of these international treaties on healthcare, however, is subject to certain conditions. In the case of Medellin v Texas, 552 US 491 (2008), the US Supreme Court held that decisions rendered by the International Court of Justice or ICJ is not enforceable in the US because the treaty that created the ICJ is not a self-executing treaty. The implication of this decision is that international treaties to which the US is a signatory may not have any legal effect domestically at all. A self-executing treaty is one that immediately creates rights without a signatory country having to do any act, such as further legislative action, to make it applicable domestically (Schaffer et al 2014). None of these treaties on healthcare that the US is a signatory to is self-executing, which means that the domestically, the US is not bound to enforce them in the domestic front.
Nonetheless, the US has an obligation to fulfill its treaty obligations, such as providing healthcare to its citizens. A signatory party, such as the US, has to fulfill its healthcare obligations in three ways: to respect them by avoiding direct acts that harm the health of its citizens; to protect those rights by preventing third parties from violating them and this could be done through regulatory measures, and to meet the right by adopting measures that would lead to the provision of universal health care for everyone (Yamin 2005).
Domestic policy on health care, however, is hardly based on international obligations. This is probably the reason why the United States is the only developed country in the world that lacked a universal health care system (Fisher 2012). Norway implemented its universal health care as early as 1912 and Hong Kong its own UHC just in 1993. Other developed countries implemented their respective UHC in the following years: Australia in 1975, Austria in 1967, Belgium in 1945, Canada in 1966, Denmark in 1973, Finland in 1972, France in 1974, Greece in 1983, Iceland in 1990, Ireland in 1977, Italy in 1978, Japan in 1938, Luxembourg in 1973, Netherlands in 1966, New Zealand in 1938, Portugal in 1979, Singapore in 1993, South Korea in 1988, Spain in 1986, Sweden in 1955, Switzerland in 1994 and the United Kingdom in 1948 (NYDOH 2012) .
The reason for the absence of a UHC in the US is often blamed on the hotly contested issue of whether health care should be borne by the government or individually. These debates are underpinned chiefly by the argument that the US cannot afford coverage for those who cannot afford health insurance (Light 2003). Yet, developing countries, such as Bahrain, Brunei, Cyprus, Israel, Kuwait, Slovenia, and the United Arab Emirates were able to implement their own system of UHC (NYDOH 2011). Moreover, the argument against the UHC as an expensive system that can cause the suffering of the American is belied by such countries as Switzerland and Singapore – two countries that are economically inferior to the US, but have UHC systems that entailed only spending a fraction of what the US, a non-UHC country, spends in health care. In 2012, for example, Switzerland spent only $1,879 per person and Singapore spent only $851 per person, while the US spent $4,160 per person (Roy 2012). According to Forbes, Switzerland, which established its UHC in 1994, has the world’s best UHC system. Called Santésuisse, the Swiss UHC is only 2.7% of its GDP as opposed to the US’ 7.4%. The US would save about $700 billion a year if it can achieve the level of spending that Switzerland has in its UHC system. Despite the comparatively low expenditure of the Swiss on its UHC, the life expectancy of its people is the second highest in the world, next to Japan. Its UHC is as efficient as that of the US with about the same waiting time for appointments and procedures (Roy 2011). Singapore, on the other hand, spends only 3% of its GDP for its own UHC. In Singapore, the underpinning philosophy in health care is that no person, even a foreigner, should go about without health care coverage. Despite the differences between the US and Singapore in area, political structure and population, the Singapore example should provide a lesson to the US, according to an expert. The Singapore UHC is characterized by respect for the free market system and strong government role in health care (Feldscher 2016).
The US may not have strictly a legal obligation to provide UHC to its people, but it has moral obligation to abide by the treaties to which it has affixed its signature to. Other developed countries have illustrated their faithfulness to their international obligations. There is no reason why the US cannot do this considering that various countries with economies more inferior to it have successfully achieved universal health care overcoming the chief argument against it – that it can heavily take a toll on the US economy. The case of Switzerland and Singapore illustrated the emptiness of this argument against the adoption of a UHC in the country.
References
Feldscher, K 2016, Singapore’s health care system holds valuable lessons for U.S., Harvard School of Public Health, viewed 9 March 2016, http://www.hsph.harvard.edu/news/features/singapores-health-care-system-holds-lessons-for-u-s/
Fisher, M 2012, Here's a map of the countries that provide universal health care (America's Still Not on It), The Atlantic, viewed 8 March 2016, http://www.theatlantic.com/international/archive/2012/06/heres-a-map-of-the-countries-that-provide-universal-health-care-americas-still-not-on-it/259153/
Light, D 2003, ‘Universal health care: Lessons from the British experience’, American Journal of Public Health, vol. 93, pp25-30
Schaffer, R, Agusti, F and Dhooge, L 2014, International business law and its environment, Cengage Learning.
Universal Declaration of Human Rights 1948, viewed 8 March 2016, http://www.un.org/en/universal-declaration-human-rights/
UNTC, 2016, International covenant on economic, social and cultural rights, viewed 8 March 2016, https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-3&chapter=4&lang=en
Yamin, AE 2005, ‘The right to health under international law and its relevance to the United States’, American Journal of Public Health, vol. 95, no. 7, pp18-23.
