There’s only one problem: the Patients’ Bill of Rights would affect only a minority of Americans–even of those who are insured. And it will do very little to improve the nation’s health.
The real issue is not how to make group health plans pay more, but how to keep Americans from getting critically ill in the first place. Of the 2 million deaths that occur in the United States each year, half are preventable. While the top killers appear to be heart disease (one third of all deaths), cancer (one fourth), stroke (7 percent) and injuries (14 percent), the real culprits are the underlying causes of these conditions–tobacco use (leading to 19 percent of all deaths), unhealthy diet and inactivity (14 percent), alcohol (5 percent), infectious disease (5 percent), firearms (about 2 percent) and accidents (1 percent). These figures represent a million lives that could be saved by an investment of only a few cents of each health dollar into what we call public health.
Public health differs from clinical medicine in two respects: it focuses on prevention rather than cure, and it works on broad measures to protect large populations and communities, not just individual patients. In this century, life expectancy has risen by more than 30 years, due largely to public health, not medical interventions.
But Americans are not getting the modern public-health care they deserve. They need a national defense against the risks of illness and accidents, not just payment for high-tech procedures and emergency care after the fact. We need, in short, a Public Health Bill of Rights. It would include:
The right to information. Citizens deserve the most accurate information medical science can provide on how to promote health and prevent illness. Although we have perhaps the world’s best doctors and hospitals, Americans in some regions live 25 years less than those in others. We should use our new information technologies to analyze the disparities in health status and disease risk in various areas of the country, and then erase them.
A right to information also means being vigilant about emerging resistant infections and local threats to the environment. We need federal support for state and local public-health authorities and population experts who first notice trends and sound the alarms.
The right to mother and infant care. We must enable every woman to plan for her family and, when pregnant, to protect her unborn baby’s health as well as her own. Despite this century’s 90 percent drop in infant and maternal mortality, America ranks only 25th worldwide in preventing infant mortality. We need a national strategy to reduce the disparities among ethnic and low-income groups. It can be done. Over the past 14 years, for example, the state of Massachusetts lowered its infant-mortality rate from 10.1 per 1,000 births to 6.2 deaths per 1,000 births, the best in the country. The state guaranteed all pregnant women payment for prenatal care and created community programs to reach vulnerable “at-risk” women. That is public health.
The right to childhood immunization. American children are free from diseases like polio and diphtheria because of immunization. We must ensure that all newborns receive their vaccines. For every dollar spent on immunization against measles, mumps and rubella, for example, we save more than $13 in medical expenses, amounting to about $4 billion a year.
The right to teenage counseling. There are no vaccines against sexually transmitted diseases and access to addictive substances. Teenagers should have the right to counseling about AIDS–which has killed 14 million people worldwide and 410,000 in this country–and how to protect themselves from other STDs. In addition, we should sharply reduce portrayals of tobacco and alcohol use in entertainment media: think of the impact on teens of Leonardo DiCaprio’s smoking cigarettes in scene after scene of “Titanic.”
The right to health screening. Simple and inexpensive tests can detect cancers of the breast, cervix, colon and prostate in early stages when further spread can be prevented. Routine screening reduces the risk of dying from colon cancer, for example, by at least 33 percent. We also need screening tests for high blood pressure–the major risk factor for heart attacks and strokes.
The right to a healthy environment. The dramatic gains in longevity over this century resulted largely from improvements in environmental health. Malnutrition and specific dietary deficiencies were reduced, housing was improved, and air and water quality became a concern of government and the public. We need more investment in infrastructure such as municipal water systems and tighter controls on air pollution. We must also make indoor environments healthier, especially schools and workplaces, thereby reducing the incidence of illnesses like asthma.
Individual rights imply collective responsibilities. Investing just a minuscule percentage of the trillion dollars we now spend on medical care could result in a dramatic improvement in the well-being of our entire citizenry. It would also save billions of dollars in medical costs for everyone involved. The Patients’ Bill of Rights now before the House is one answer to our health-care problems. But it’s an incomplete one.
