About Anja Rudiger

Anja Rudiger, Ph.D., is director of the Human Right to Health Program at the National Economic and Social Rights Initiative (NESRI), which has collaborated with Amnesty International in work on the human right to health care. Anja works with national coalitions and community organizations in the United States to develop human rights tools and analysis for U.S. health care reform.She has many years of experience in promoting a rights-based approach to policymaking at local, national and international levels. Her previous roles include directing the research department at the British Refugee Council and managing the UK Secretariat of the European Monitoring Centre on Racism and Xenophobia, both based in London. Anja has a range of academic and policy publications, and she received her Ph.D. in Political Science from the University of Kiel in Germany.
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With All Eyes on the "Market," Health Reform Overlooked Human Rights

This guest blog post is by Anja Rudiger, director of the Human Right to Health Program at the National Economic and Social Rights Initiative

Six months ago the United States almost got universal health insurance. Advocates celebrating the passage of the federal health reform law argued that this was as good as it gets. While it was understood that the optimistically named Patient Protection and Affordable Care Act (PPACA) emerged as the result of political compromises, many applauded it as a step toward finally realizing the human right to health care in the United States. After all, the bar had been set quite low: because the United States produces poor health outcomes and shocking health disparities despite the highest health care spending in the world – driven by a for-profit health industry – the only way the country could go was forward. Or so it was hoped.

Yet six months later we awake to news of children’s coverage dropped, sick kids being charged more, skyrocketing insurance premiums, employers’ shifting costs to workers, and insurers defending paper-shuffling as essential medical expenses.

Everyone knew from the start that the reform would not be fully universal, with the Congressional Budget Office predicting 23 million people to remain uninsured, nor equitable, with access to care dependent on the payment of premiums, co-pays, and deductibles, nor accountable, with for-profit insurers setting prices and limiting access to doctors and services. Yet many had hoped that a little bit of universality would go a long way toward getting improvements for some. By the same token, the principle of “equity” was deemed just slightly too ambitious when insurance companies could simply be subsidized for selling their products to those working low-wage jobs.

As far as accountability goes, it was considered safer to keep the enemy – our beloved insurance companies – as close as possible, rather than unnecessarily antagonizing it. If the reform stuck to a market-based insurance system – so went the reasoning – access could be within reach of more people without causing disruptions to those benefiting from the status quo.

Except that some rather painful market disruptions are upon us now, with insurers dropping policies and raising rates in droves. But once again, advocates cling to their optimism; after all, the bulk of the reforms won’t come into effect until 2014, and once we plow through this disruptive period, all the pieces will fall into place. Or will they?


Posted in USA

Why the Health Reform Law Fails to Meet Human Rights Standards

Originally posted to Huffington Post

Amidst the celebrations of a ‘historical moment,’ a healthy dose of realism seems in order as we assess the new Patient Protection and Affordable Care Act and the related reconciliation measures. What is seen as a crucial victory for the Obama Administration has been won on the backs of many grassroots activists struggling for health care as a human right and a public good, including women’s and immigrants’ rights groups. The lengthy health reform process has mobilized many millions of people, some new to political activism and many others veterans of the long struggle for universal health care in the United States. This political moment presented a prime opportunity for finally ending the commercialization of one of our most fundamental needs, health care. The failure to seize this opportunity will haunt us for years to come.

What is now touted as the most far-reaching social legislation in almost half a century in fact bears no resemblance to the landmark Medicare Act of 1965, which instituted a fully public insurance system with contributions shared equitably by everyone, in solidarity with older people. Instead of expanding Medicare to everyone, this new law formally affirms and solidifies the private, market-based system in which health care is the domain of a for-profit industry propped up by substantial public subsidies.

Human rights standards do not tolerate the inequities inevitably linked to a reliance on market competition to meet human needs. Yet this legislation also contains some important improvements to health care access for poor people. The Medicaid expansion and the additional funding for community health centers are very welcome and long overdue, but could have been adopted as stand-alone measures. As such, they are indeed cause for celebration, yet most pundits seem to care precious little about these provisions of the new law, despite the fact that the Medicaid expansion will account for at least half of the newly insured population. Instead, all favorable attention is showered on the subsidized expansion of the private, for-profit health insurance industry.

Yet it is precisely this aspect of the new law — market-based health insurance reform — that entrenches the treatment of health care as a commodity by locking us into a market mechanism that sells access to health care based on a person’s ability to pay rather than their health needs. Public subsidies for pricey (and not price controlled) insurance products are intended to mitigate the inequities inherent in a for-profit system, while leaving no illusion that coverage will continue to be stratified and access to care out of reach for many. This volatile combination of at-will pricing by insurance corporations and the promise of subsidies to match prices also renders the system financially unsustainable for individuals and government alike.

In sum, the new health law fails to meet the key human rights standards of universality, equity, and accountability. Rather than guaranteeing universal health care, the law excludes many millions of people from access to coverage and care. Instead of ensuring that care is available for those who need it, the law makes access contingent on the purchase of private insurance. And rather than holding the private sector accountable for protecting the right to health, the law permits the industry’s focus on their bottom line. Health care is treated as commodity, not as a universal right and a public good shared equitably by all.

Many grassroots activists and their academic and advocacy allies, including the National Economic and Social Rights Initiative, have challenged this prevailing policy paradigm and presented solid evidence that health care financing and management through market relationships is unable to meet everyone’s health needs. In all other high-income countries, health systems are highly redistributive in economic terms, funded collectively through cross-subsidization with a common pool that includes all, not limited to residual public programs for certain groups. Yet Democrats in Congress and the White House did their best to silence these voices and insisted on a market-based approach despite their own better knowledge — the President himself admitted as much when he remarked that a single payer public insurance system would be necessary to achieve universal coverage. But this was not the route pursued by our legislators, and so a workable solution was jettisoned in favor of an ideological approach approved by the health care industry.

We can turn this moment into a historical one if we take it as a new beginning, not an end, for a human right to health care movement in the United States. Grassroots campaigns are well underway for universal health care at the state and even local level, for example in California, Vermont, and Montana. By using the human rights framework to guide us, we can build a broad-based movement that inspires solidarity for sharing the public goods required to meet our fundamental needs.

Posted in USA

Health Care Reform: Back to Human Rights Basics

In a turbulent week in U.S. politics that saw the president abandoning his promise of universal health insurance and the Supreme Court elevating corporate spending in elections to a human right – protected as free speech in the same way as human speech – human rights activists should take solace in the fact that giving up pretensions can be the first step to real change.

This is particularly important for human right to health care activists who have long been dismayed with market-based health care proposals that blatantly fail to satisfy basic human rights standards. There was perhaps only one policy measure the U.S. needed even less than the opening of floodgates for vast new corporate political spending, and that was a health “reform” bill funneling millions of new customers to the for-profit insurance industry and billions in subsidies into the coffers of the…wait for it…very same industry. If this bill, in its Senate and House versions, now appears threatened by the Democrats’ loss of one Massachusetts Senate seat, a new opportunity has emerged to call for simple but meaningful health reform measures based on human rights.

Many activists and advocacy organizations, including Amnesty, have consistently pointed to the fundamental flaw underlying the approach adopted by health reformers in DC, and urged them to treat health care as a human right, not a commodity. Yet the reform bills failed to meet the human rights principles of universality, equity, and accountability. Rather than guaranteeing universal health care, they excluded many millions of people from access to coverage and care. Instead of ensuring that care would be available for those who need it, the bills made access for most people contingent on their ability to purchase a private insurance plan. And rather than holding the private sector accountable for protecting the right to health, the bills perpetuated the industry’s focus on their bottom line.

The rapidly faltering popularity of this market-based approach creates a new opening for demanding simple but systemic policy changes that move the U.S. system toward treating health care as a public good shared equitably by all. A Medicare-like public health insurance program for everyone in the U.S. could guarantee progressively financed, publicly accountable, and fiscally sustainable universal coverage. Therefore, building on the success of Medicare and expanding it to more and more people below the age of 65 can be a key component of a rights-based reform strategy. It is equally important to secure and expand the health rights of poor and low-income people through guaranteed public coverage provided by Medicaid and the Children’s Health Insurance Program (CHIP). Without a progressive expansion of publicly financed and administered health care, it will remain virtually impossible to ensure that people’s health needs are prioritized over market incentives to deny access to care.


The Human Right to Health Care in Vermont

Rally at the Vermont State House in Montpelier.

Rally at the Vermont State House in Montpelier.

Communities across the country are demanding the human right to health care, while Congress is tweaking its latest version of health insurance legislation that continues to treat health care as a commodity.

This unacceptable discrepancy between public will and corporate power in Washington, DC, is being challenged by state-based campaigns for the human right to health care. Activists in states such as California and Vermont have their eyes on a prize much grander than anything Congress is willing to consider: single payer health care at state level. So it’s no coincidence that it is Vermont’s U.S. Senator Bernie Sanders (I) who seeks to change the health bill under discussion in the U.S. Senate by introducing an amendment that would make it easier for states to go it alone and implement a Medicare-for-All, publicly financed health care system in their state.

Vermont is ready for it, and activists think they could even manage without such federal assistance. Over the past few months, the Vermont Workers’ Center’s campaign has organized a series of People’s Forums across the state with the involvement of over 70 state legislators and more than 800 Vermonters. Participants affirmed the importance of establishing a universal, equitable and accountable healthcare system in Vermont. Bekah Mandell, a forum facilitator and campaign activist, summarizes their mood: “Ordinary Vermonters will continue to put pressure on their elected representatives until we win this fundamental human right. It is clear to us, now, that we can win, and we will win.”

On January 6, the first working day of the 2010 legislative session, the Vermont Workers’ Center will deliver thousands of signed postcards demanding health care as a human right. The legislative leadership announced at a recent People’s Forum that hearings on a single payer bill will begin on January 12. SEE THE REST OF THIS POST

Dollars and cents of new health care legislation

Patients not profitWhile protesters have been occupying House Speaker Pelosi’s office, demanding a health care system that serves “Patients not Profit”, the House of Representatives is preparing to vote on the market-based health care bill introduced last week by Speaker Pelosi. It is not expected that the House leadership will allow a lengthy floor discussion, but the most recent news reports suggest that the promised vote on Rep. Anthony Weiner’s (D-NY) single payer amendment may be allowed. Meanwhile, Speaker Pelosi has presented the leadership’s additions to the bill in a so-called Manager’s Amendment, stating that this would strengthen provisions for “excluding insurers who put profits over patients from an affordable marketplace that will serve tens of millions of Americans.”

Does that mean the protesters demands have been met? Is this health care bill bringing us closer to realizing our human right to health care? Let’s recall that according to international legal standards, the human right to health requires that “health facilities, goods and services must be affordable for all. Payment for health-care services…has to be based on the principle of equity.”

The House bill aims to achieve affordability by subsidizing the purchase of an insurance policy for those earning between 150% and 400% of the federal poverty level, provided they don’t have employer-based insurance. In practice, this means someone with an income at the upper end of this scale would pay $5300 a year in premiums and up to $2000 a year in cost-sharing, amounting to around 17% of their income. At the bottom end of the scale, health care costs would be around 6-7% of a person’s income – which is still higher than a general income tax increase proposed by single payer health insurance bills.  Many immigrants would get no support at all, and anyone unable to afford such an insurance plan would be subject to a penalty payment, since everyone will be mandated to purchase insurance.   SEE THE REST OF THIS POST

Beyond the Market: Health Care as a Civil or Human Right?

A dramatic disconnect between principles and policies has hampered current U.S. health care reform efforts. This became obvious when candidate Obama declared health care to be a right and then proceeded to treat it as a commodity when negotiating with insurance companies a requirement for individuals to buy a commercial health insurance product.

Similarly, early on in the debate the president championed the principle of universality by promising some form of health coverage – if not necessarily health care – for 46 million uninsured people, only to lower the policy goal to 30 million American citizens in his speech before Congress, excluding many immigrants and low-income people. Since then, further policy provisions that restrict access to health coverage for immigrants – documented and undocumented – and reduce affordability for lower-income people have appeared in the health care bill adopted by the Senate Finance Committee. SEE THE REST OF THIS POST