DCC Opening Event Video

Time Code

OPENING REMARKS

00:00:47  Rogers Smith: T.H. Marshall, social rights, and the Affordable Care Act.

OPENING STATEMENTS

00:05:31  Julie Lynch: H. Jack Geiger Introduction

00:08:08  H. Jack Geiger: Having health insurance does not guarantee access to care, which itself is a relatively small determinant of health.

00:20:52  Julie Lynch: Dorothy Roberts Introduction

00:22:35  Dorothy Roberts: Framing the issue as access to healthcare sometimes obscures more important barriers to equal citizenship that lead to, for instance, a persistant racial gap in health status.

00:35:55  Julie Lynch: Jeffrey Goldhagen Introduction

00:37:06  Jeffrey Goldhagen: Children’s rights are so critical because as soon as a person is born, the determinants of their longterm health are largely set, and would be regardless of the rights conferred for healthcare per se.

ROUNDTABLE QUESTION

00:48:55  What social rights in addition to healthcare would be necessary to ensure equity and health?

00:51:02  Dorothy Roberts: The language of rights is problematic for capturing the social changes necessary to create a society more equitable in health outcomes.

00:52:36  Jeffrey Goldhagen: The framework of rights has in fact been critical and necessary in movements for social justice, though establishing on the order of three rights is not enough; the U.N. charter on the child has 41 articles.

00:55:52  Jack Geiger: We are currently in a political cul de sac and need to radically reenvision health care to include the right to adequate nutrition, as Dr. Geiger demonstrated in a community health center in Mississippi, where doctors “prescribed” food.

AUDIENCE QUESTIONS

01:03:00  Are there any provisions in the ACA that would help diagnose and treat food insecurity as Dr. Geiger did in Mississippi?

01:04:00  Jack Geiger: There are palliative measures that have been successful, but structural change requires a different level of political, social and community activity.

01:09:20  Jeffrey Goldhagen: The ACA has a readmission penalty that might create the incentive for more equitable care, as well as other “little pieces” of the legislation.

01:12:13  Under the ACA, will the insurance industry have a greater stake or role in ensuring health equity?

01:13:12  Dorothy Roberts: Are you talking about access to healthcare or a right to health status?

01:14:19  Jack Geiger: As implemented right now, many healthcare networks game the system by excluding certain hospitals and community health centers as a way to ensure profitability.

01:16:43  Jeffrey Goldhagen: Even “non-profit” Blue Cross providers make billions in “excess revenue over expenses,” demonstrated in the architecture of their headquarters.

01:17:42  What role does individual responsibility play in health equity, for instance in compliance?

01:18:11  Dorothy Roberts: Most “non-compliance” is rooted in structural issues.

01:20:10  Jack Geiger: Communication difficulties between patient and physician also contribute to non-compliance.

01:21:32  Will the ACA help reduce discrepancies in health literacy?

01:21:56  Jeffrey Goldhagen: The ACA is fundamentally an extension of health insurance, rather than a fundamental reform of healthcare delivery – aside from measures such as the push for electronic medical records, the value of which is debatable.

01:24:25  Will we be able to actually confer socioeconomic rights in the U.S. with neither a powerful labor movement nor constitutional guarantees?

01:25:50  Dorothy Roberts: The current concept of rights in the U.S – in which the Supreme Court considers rights to exist even if states set up major obstacles to exercising them – needs to be supplanted by a broader concept of justice.

01:29:12  Jeffrey Goldhagen: Just having the legal document establishing rights, while important, is not enough unless it is used as a tool for achieving outcomes.