Health Care Reform: A Human Rights Approach

JANET WEINER

There is growing consensus that the U.S. health care system needs major reform to ensure access to health care for all Americans. Most proposals for reform call for a uniform, standard or minimum benefit package that delineates the scope of health care we will have. There is far less consensus on what that benefit package must include. To which services must we all have access? Within the universe of possible human interventions to improve health, which ones can we agree to assure to everyone? For now, we will call this subset "basic health care."

Basic health care can be discussed in three ways. We could articulate the criteria by which services are judged to be "basic." Alternately, we could describe a process for determining which services are basic. Lastly, we could generate a list of categories of services that constitute basic health care. ¹ A list of health care services makes sense only within the context of explicit criteria by which to make decisions and a process that allows social consensus for doing so. Thus, this paper explores the medical and health values that could form justifiable criteria for deciding among health services and suggests a fair process for determining and updating a benefit package. While health care can be discussed in the absence of a determined infrastructure, ultimately the benefit package will involve considerations of the structure and financing of the delivery system. Further definition of basic health care will help elucidate values and decision rules to be followed in the social process of creating a benefit package within a reformed health system.

Before we can define basic health care, we must articulate why health care is so important, and what we want health care to do

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