Marcia Frellick

September 12, 2017

SAN ANTONIO, Texas — Universal healthcare and healthcare as a human right were among the first big topics delegates took on September 11 as the American Academy of Family Physician (AAFP) 2017 Congress of Delegates opened here.

Several delegations proposed resolutions on the issues and included language urging the AAFP to "recognize that healthcare is a human right for every person, not a privilege."

Most of the speakers spoke in favor of considering healthcare a human right and urged AAFP to set policy around that.

However, James Taylor, Jr, MD, with the Louisiana delegation, said although "at 30,000 feet," that idea is galvanizing, the problems come in downstream implications. If everybody has a right to it, then someone has to decide who will get it and how. Some will not get it at all, and depriving of them of that right could lead to civil action and possibly criminal action, he said.

"Secondly, if this is a right, that creates an open-ended demand for labor and you want to be really sure you're ready to accept that if you're going to put this out as a policy," he continued.

Gary Plant, MD, an alternate delegate from Oregon, agreed there could be unintended consequences. He pointed out that healthcare can extend beyond visiting a physician to getting housing and recommending construction projects for accommodations. What kind of healthcare and how much needs to be considered before making policy, he said.

He told Medscape Medical News that health is a basic human right, and the mission of the AAFP is to improve the health of its patients, and although universal access to healthcare is a vital part of achieving that goal, it is not the goal itself.

"If healthcare is a right, who decides how much and which healthcare is a basic human right? If I want a hip replacement, a tummy tuck, or a lung transplant, do I have a right to all the healthcare I want?"

The idea invites an additional question, he says: "If health care is a right, do we have the right to charge money for it?"

He continued, "It seems a little self-serving for an organization of physicians to declare that everyone has the right to purchase their services. Our mission is to improve health, not to sell more healthcare services to our patients."

Kristi VanDerKolk, MD, an assistant professor at Western Michigan University in Kalamazoo, Michigan, told Medscape Medical News that, "as a family physician in the US, I believe that healthcare should be seen as a basic human right."

She says access to healthcare has improved with the Affordable Care Act, but notes that there is still a significant portion of the population who remain disproportionately affected by lack of coverage, specifically racial and ethnic minorities and LGBT persons.

"All people have a right to health and healthcare, regardless of how they identify themselves," Dr VanDerKolk said.

The resolution includes in its supporting summary that the United States is one of the only industrialized nations that does not provide universal access to healthcare, and that nearly 30 million Americans are still uninsured after full implementation of the Affordable Care Act.

Thomas Hines, MD, with the Massachusetts delegation, which sponsored one of the proposals, said that, given the uncertainty of healthcare policies nationally, "we thought it was a very appropriate time for the academy to take a stand recognizing in no uncertain terms that discussions of the future of healthcare need to be framed in the context that it is a basic human right."

Another speaker added that the World Health Organization considers healthcare a right for everyone on the planet because it is only with access to healthcare that people can reach their full potential.

"Achieving the right to health is closely related to that of other human rights, including the right to food, housing, work, education, non-discrimination, access to information, and participation," the World Health Organization says on its website.

A separate resolution also proposing universal healthcare urged AAFP to "support a single payer health care system that financially incentivizes appropriate use of primary and specialty care services by differential cost-sharing, such as co-pay waivers, tiered co-pays, or similar mechanisms, and...support a single payer healthcare system in which collective negotiations between providers and the single payer entity are completely transparent."

There was wide support for a single-payer system among delegates who came to the microphone, but Dr Taylor spoke strongly against it.

"My state and many states along with us are not convinced. The problem is we don't need more federal involvement, we need less federal involvement. We need less insurance company involvement."

"We should not do this," Dr Taylor said. It would damage the medical profession, especially primary care. "If California can't do it because it costs too much and Vermont and Colorado can't do it because it costs too much, there's a message from those very liberal states telling you that this is a bad idea."

No speakers declared relevant financial relationships.

American Academy of Family Physician (AAFP) 2017 Congress of Delegates. Presented September 11.

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