Oregon is set to become the first state in November to enshrine the concept of health care as a human right in its constitution, a step that, at first glance, is fundamentally at odds with the American approach to medical care.
The turning point? Nobody is paying attention. Last year’s fierce battle to insert the proposal into the Oregon ballot of 2022 has given way to a controversial three-governor race, battles fought in Congress, and a lively debate over voting measures on gun permits and slavery ( yes, slavery). While the health proposal is explicitly covered to limit costs, its passage would mark one of the most radical health policies in the United States, at least symbolically, since the arrival of the Affordable Care Act.
Called Measure 111, the proposal “would ensure that every Oregon resident has access to affordable, clinically appropriate and affordable health care as a fundamental right.” While just over a dozen states have constitutions or laws that vaguely mention general welfare, care for the destitute, or public health as duties, the Oregon measure would be the first to put health care itself into a state constitution. as a right. It’s an idea that dates back to the Truman administration.
“The World Health Organization proclaims health care as a human right and many countries have the right to health enshrined in their constitutions, but the United States is an outlier,” said Lawrence Gostin, director of the O ‘Neill Institute for National and Global Health Law at Georgetown University School of Law, which called the measure “truly historic” as it would provide a legal basis for suing the state for poor health care, setting a new precedent. for health rights in the United States
“The Oregon election initiative has a real chance in the current political climate, especially after the Supreme Court overturned Roe v. Wade,” he added.
Yet while both abortion and the pandemic keep health care a top voter concern, the attempt to make it a constitutional right has attracted little attention outside of Oregon. Or even inside.
“There is really no organized opposition to measure 111,” said Jim Moore, a professor of politics at Pacific University outside Portland, Oregon, and polls have shown strong support for the measure. While only Democratic candidate for governor, Tina Kotek, supports the measure in that race, the other two candidates, independent Betsy Johnson and Republican Christine Drazan, did not campaign against their opposition. “In fact, it’s a sleepy year for measurements in Oregon,” Moore said. “A few years we have 25 in the ballot”.
Given the governor’s run and congressional runs, he added, “you couldn’t buy time for publicity on the measure, even if you wanted to.”
Oregon may seem like an unlikely state to defend a fundamental right to health care: The state implemented the Affordable Care Act in 2014 and also expanded public access to Medicaid, a step that a dozen states (for mostly reds) resisted. Only 6.1% of Oregonians do not have health insurance, according to the Kaiser Family Foundation.
Measure 111 was added to the Oregon ballot last year by the state Senate in a largely party line vote. (The Democratic Party’s only “no” vote came from Johnson, who later quit the party in his run for governor.) The vote was seen as a tribute to Oregon Democratic State Representative Mitch Greenlick, a health care champion died in 2020. Greenlick had been trying for many years to turn measure 111 into a state constitutional right, and has succeeded after at least eight previous attempts, according to Oregon Public Radio.
Basically, Measure 111 compromises with past proposals by requiring that it cannot force spending cuts on public schools and essential services to increase access to health care, even if the state loses a lawsuit for it. While this warning likely led to him moving on to the ballot, Moore said, it also left supporters and opponents widely divided over the impact the proposal would actually have.
Supporters of the measure, such as Democratic Oregon State Senator Elizabeth Steiner Hayward, who led efforts to get it on the ballot, told Oregon Public Broadcasting that passing the measure would give the state more legal authority to limit increase the cost of insurance plans and prevent undocumented workers from losing insurance in the future. Rather than requiring state payment for health insurance, the goal is to ensure that everyone has access to it. With health plan costs expected to rise in 2023, about 6.5% for companies according to a recent company survey and a recession that seems more likely to cut tax revenues, controlling health spending could become a major priority for Oregon lawmakers.
Opponents of the measure, such as Johnson and Drazen, see its passage as the Oregon setting for costly lawsuits by the uninsured, Moore said. Critical analysis has suggested that the measure would put the state in trouble for an additional $ 2.5 billion in annual costs to cover the remaining uninsured in the state.
While few people in Oregon do not have health insurance, about a third are “underinsured,” a reality that became painfully evident during the pandemic, said Paige Spence of the Oregon Nurses Association, who supports the measure. “Many people in Oregon want to bridge this gap. So, I think this is a big deal, “she said.” Our nurses are really seeing the effects on people’s health of not having good insurance. “(A June study found that underinsured people who delay treatment and covid diagnosis contributed to 212,000 deaths nationwide during the pandemic.)
In practice, Spence said, approval of the measure should give more weight to the blueprint for a universal statewide health plan that a legislative task force unveiled in September. $ 980 million by 2026). “With covid, there has been a frightening amount of disability and I think there has been a lot of concern for the people on that front,” she said.
In 1945, shortly after the end of World War II, then President Harry Truman proposed a US national health system, paid for with payroll taxes such as Social Security. “Health insurance will mean that adequate medical care will be affordable to everyone who is covered, in the country as well as in the city, as a right,” Truman said.
Like today, when America’s lifespan is shrinking and the country has just emerged from a crisis, the United States in 1945 faced a time when its health problems were evident: Truman noted that 34% of young people in The United States was not eligible for military service at the time, in a letter to a critic of the plan, and wrote: “There is something wrong with the health of the country and I am trying to find a remedy for it.”
Truman’s US plan failed, however, on charges of “socialized medicine” led by the American Medical Association (the AMA accused Truman of following the “Moscow party line”), which opposed the fixation. of reimbursement rates for doctors and the expansion of medical schools to produce more of them. Over the ensuing decades, the struggle led to Medicare and Medicaid in the 1960s and the Affordable Care Act of 2010 (“Obamacare”), all steps towards a national health system, but far from the “right” envisioned by Truman.
“The vote in Oregon is a good step, but it is a long way from overcoming the ‘original sin’ of medicine moving away from the Truman NHS,” said medical historian Mike McGee, author of “Code Blue, Inside America’s Medical Industrial Complex ”and former head of global medical affairs for Pfizer.
The United States pays nearly twice as much for health care, driven by higher prices for drugs, doctors and overheads, than other wealthy nations, McGee noted, with worse results. According to a study by JAMA Internal Medicine, even the richest people in the United States have lower-than-average health scores in those other countries. The life expectancy of the United States, of about 77 years, now lies between that of Cuba and that of Albania. “I think there is a good constitutional argument as to why health care should be a right in the United States,” McGee said. “You cannot have ‘life, freedom and happiness’ without your health.”
The closest case to Oregon is Vermont, said Gostin, who in 2011 passed a bill that makes health care a “public good” and establishes a nationwide first single-pay state health care system. That initiative has failed, with supporters still fighting for the creation of a publicly funded universal health system. The passage of Oregon measure 111 could rejuvenate efforts like Vermont’s elsewhere, he suggested.
“Its significance and budget impact are not yet clear,” Moore said of the measure. “It’s really part of an extraordinary year in politics here that hasn’t gotten more attention.”
But even if measure 111 succeeds on election day, McGee fears that the next passage of similar state constitutional rights would still leave the country with a Balkanized and patchwork healthcare system. (A national system could instead start with expanding Medicare eligibility, he suggested.) and asking a lot of questions about our health care ”.
Thanks to Alicia Benjamin for the copy editing of this article.