January 1, 1999

By Rodrigo Muņoz, M.D.
APA President

More than fifty years ago the president of the United States presented to Congress a second bill of rights. President Franklin Delano Roosevelt's State of the Union address in 1944 stated, "This Republic had its beginning, and grew to its present strength, under the protection of certain inalienable political rights-among them the right of free speech, free press, free worship, trial by jury, freedom from unreasonable searches and seizures. They were our rights to life and liberty."

President Roosevelt found that these rights were not enough in 1944. "We have come to a clear realization of the fact that true individual freedom cannot exist without economic security and independence." New rights became necessary so that "a new basis of security and prosperity can be established for all. . . regardless of station, race, or creed."

President Roosevelt articulated the second bill of rights as follows:

"The right to a useful and remunerative job in the industries or shops or farms or mines of the nation;

"The right to earn enough to provide adequate food and clothing and recreation;

"The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;

"The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;

"The right of every family to a decent home;

"The right to adequate medical care and the opportunity to achieve and enjoy good health;

"The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;

"The right to a good education.

"All of these rights spell security."

President Roosevelt would have been surprised that measures taken just a few months before his State of the Union address would do much to thwart his lofty pursuits. When wage and price controls in 1943 brought employers into the health arena, the seeds were planted for the eventual growth of industries that would challenge the right to adequate medical care. In the struggle between adequate care and reduction of costs, care has typically been the loser.

Those who celebrate President Roosevelt's 1944 declaration can take heart in actions passed by the AMA's House of Delegates and the APA Assembly that reaffirm the right of individuals to make decisions about their health care. According to these bodies, the right to adequate medical care for all individuals includes the right to select, purchase, and own a health coverage plan; the right to obtain all the tax advantages, discounts, and extra benefits available to others; the right to select their physicians, centers of care, and methods of treatment; the right to be informed about all treatment options; the right to emergency treatment; the right to confidentiality and protection against violation of privacy; and the right to appeals processes and legal action when care is denied.

President Roosevelt was in close contact with physicians for most of his life. He would have personally appreciated these extensions of his second bill of rights. He knew what many in the business community are now coming to appreciate: A healthy and profitable enterprise owes its success to the protection of a healthy workforce.