The 28th Amendment

IN RESPONSE:

Dr. Neubauer's suggestion that all citizens be granted equal access to legal services does seem reasonable. Access to legal services issue is a whole other debate, however, since legal services are not exactly analogous to health care.

Our editorial was not “tongue in cheek,” as Dr. Paola suggests; these are serious, indeed life and death, issues. At the same time, he did pick up on a hint of satirical tone, in the tradition of Jonathan Swift's “A Modest Proposal.” As he suggests, the 13th Amendment did neutralize the recognition of slavery in the original Constitution. In making the point, however, he underscores the Constitution's concern with social and economic issues, not just intrusions of the state. As to his concern that a constitutional amendment would overburden the courts with challenges to this initiative, we already have a seemingly endless stream of legal cases arguing the right to specific treatments for specific diseases, in addition to those dealing with perceived misadventure. At least some of the legal “new” challenges under a Constitutional amendment would be on the broad grounds of general access, some encompassing class actions.

Dr. Romano has somehow concluded that the amendment we propose would automatically convert all physicians into salaried federal employees. What he has read into our proposal is exactly what the amendment is intended not to do. It would establish only the “what”—the fact of access—but leave the “how”—financing, administration, delivery of services—entirely up to the states, the cities, the marketplace, and the professions.

Dr. Anderson equates “access” with financial coverage. We agree that the financing of health care is crucial, but it is certainly not the only element of access that matters. Excellent insurance coverage means nothing if facilities, providers, and knowledge aren't available. As to forcing the redistribution of resources from those who have “earned” it to those who haven't, Dr. Anderson has got his figures wrong: The great majority of the medically uninsured (and underinsured) are employed. We are talking equity here, not charity.

More than 10 states now have laws that guarantee access to complementary and alternative medical practices. Thus, on the one hand, we face an additional irony: a willingness to legislate access to special forms of health care in response to the demands of special interest groups, while we have lacked the will to assure access, at least so far, to even the most basic medical services as a matter of equity. On the other hand, legislative action on universal access is actually beginning to happen: At the state level, for example, an amendment to the Illinois state constitution has now been proposed that would establish health care as a right. Referred to as the “Bernadin Amendment” (in honor of the late Joseph Cardinal Bernadin), the amendment reads:

“Health care is an essential safeguard of human life and dignity, and there is an obligation for the State of Illinois to ensure that every resident is able to realize this fundamental right. On or before May 31, 2002, the General Assembly by law shall enact a plan for universal health care coverage that permits everyone in Illinois to obtain decent health care on a regular basis.”

The chief sponsor of the amendment is Representative Mike Boland, at 605 17th Avenue #2, East Moline IL, 61244; fax, 309-752-7186.

At the national level, Representative Chaka Fattah (D, Pennsylvania) is planning to introduce the Health Care Access Assurance Act of 1999 in the upcoming session of Congress. The act would “require each State to provide a minimum level of access to health care to all citizens of such State as a condition for participation in federal health care funding program.” Mr. Fattah's office can be reached at 1205 Longworth House Office Building, Washington, DC 20616; phone, 202-225-4001.

Straws in the wind? We can hope so.

• Copyright ©2004 by the American College of Physicians