I posted on facebook recently about a patient I had.  He was 63 year old veteran and had no insurance.  When he came to us, he had a very treatable cancer that no one should die from.  You can keep it at bay through chemotherapy 99% of the time or remove the organ if chemo fails. Any 3rd year medical student could have made the diagnosis.  He'd had classic symptoms for 2 years.  Unfortunately, he couldn't afford to come to us until too late.  When he arrived at our hospital, he'd been transferred from a small hospital a couple of hours away.  A few days before he'd been doing manual labor to try to earn some extra money, but his body collapsed under the strain of it.  He went to the ER.  He'd been in the other hospital a day and a half.  Long enough to get a biopsy, but not long enough to get a diagnosis.  When he arrived at our hospital, the resident got to tell him and his life long partner that he had metastatic cancer that had taken over his body.  He had a few days to live, and his pain was so bad that we would start morphine immediately.  This would relieve the pain, but make him so sleepy that he wouldn't really be able to be "with it."  So his partner had to walk over and say her goodbyes immediately.  I held her as she collapsed in my arms when she heard the news.  The resident cried with the family.  Later, among the team, the attending physician blasted the local hospital for transferring him instead of letting him have the choice to go home, and the crappy system that took a benign cancer and made it fatal.  He died 2 days later.  There was nothing more we could do. 

All of this is the back story for what I really want to talk about.  I am thinking a lot about justice and rights lately.  When I posted it on facebook, one friend made a comment about the compassion deficit demonstrated by the lack of universal health care in this country.  She believes all people should be covered.  While I certainly understand the intention of her statement, I think she got it wrong.  The word "compassion" implies that health care is something we do for people out of the goodness of our hearts.  Because we want to be nice and kind people, we should cover everyone and let no one die this way. 

I strive to be a compassionate health care provider.  I think that the nurses and doctors on his team were excellent in their medical management and bedside manner.  His partner said she was very moved and felt that everyone there gave wonderful care.  Every patient deserves that and I believe that every provider takes pride in delivering it. 

But that isn't what my friend meant by "compassion," and that isn't what was lacking.  "Health care is a human right" has become a slogan.  And I absolutely agree.  Adequate health care should be equally distributed across any given society and across the globe.  Every human being has value that is simply intrinsic to being a person.  I don't know how to argue for that.  I was raised on the Bible and the Declaration of Independence to believe that this is self-evident.  Lack of health care can be a death sentence, so I suppose you could group it in with the right to life.  You could appeal to the argument that we are all God's children, made in His image, and what you do unto the least of us you do unto God.  I don't love appealing to religious arguments.  I prefer good old secular logic.  I don't even believe in God, but I still find a truth in those basic assessments of the value of human beings.  At the end of the day, I just have to admit that, at some point, those are just my values.  I believe that medical care is a human right.  I just do. 

But if health care is a human right, then it follows that a person who is denied it is not suffering from a lack of compassion.  They are suffering a lack of justice.  When I vote, I don't vote because men were nice enough to let me.  I vote because I am an adult with the God-given right to participate in my government.  Men have simply gotten out of the way.  While I do appreciate that, I don't owe anyone a debt for their compassion.  They gave me what was already mine.  Or really, just stopped taking it away from me.  That's what "human rights" are - those things that each person deserves simply for being a human being.  Denying the basic human rights of others is the definition of oppression.  Oppression is a scary word that makes me shiver in my boots a little.  Is that really an appropriate word?  Yet, isn't that what follows from "health care is a human right?"

It is more comfortable to confront this problem by calling it a lack of compassion.  It calls out the problem and makes a case for addressing it.  Similarly, there are many rational and convincing economic arguments for why it is bad for society to run our health care system this way.  But when we call it injustice or oppression, we aren't simply asking people to look within their hearts to be better people.  We are making demands.  We are calling out tyranny.  That feels radical to me.  Those are civil rights words.  Those are words for Martin Luther King, Nelson Mandela, Cesar Chavez, or suffragettes.  Sometimes, it feels like they could not be words for right here, right now, in my little corner of the world.

In this country, 45,000 adults die each year due to lack of insurance.  I knew that before I met this patient, and I still know it now.  I didn't learn any new facts by watching this man die.  It didn't change my mind about anything - I still think single payer health insurance is the most effective national policy.  I still think health care is a human right.  The only difference is that I saw it up close.  I watched a man die.  I held his partner in my arms.  I could not stop it.  All I can do is bear witness.

I am ready to call it oppression.  I may not be comfortable with the term, but that is what logic demands.  I cannot escape logic, and that makes it my responsibility to do something about it.  I am ready to scream until someone hears me, to annoy my friends and family with my incessant 'know-it-all' opinionated comments and facebook posts,  to "rattle the cage" as our professors instructed us.  I am also ready to listen.  I will hear anyone's solution that makes a sincere effort to fix this.  It doesn't have to be all my way, and I know I don't have all the answers.  But I cannot walk back into that hospital and be silent.