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Discretionary Programs: Reinforcing Health Care as a Good Rather Than a Right

In this blog series, students in the Health Law and Policy Seminar at Harvard Law School share their thoughts on current issues facing society at large. All topics are relevant to health law and policy and are discussed during class.

This blog post was written by Megan Ma, a Student in 2017 Fall Semester of Harvard Law School’s Public Health Law and Policy Seminar.


 A noticeable similarity across three discretionary programs – The Ryan White HIV/AIDS Program, Title X, and Veterans Affairs is the sentiment that such programs, while helping to serve the health care needs of vulnerable populations, continue to project federal control, rather than federal support, over the decisions of such groups. The federal restraints limit the populations that rely on these programs from truly attaining access to health care they need. These three discretionary programs illustrate that vulnerable groups are either threatened with sizable budget cuts, program and coverage constraints, or altogether elimination.

screen-shot-2016-10-20-at-10-19-18-amIt is puzzling that the health care system, despite having made good faith efforts to serve the underserved, continues to disproportionately benefit those who are wealthy. When health care options available are not the same for everyone, regardless of income, health care becomes a good, not a right. This communicates the stark message that not everyone deserves the same access to quality health care.

Image via flickr user MBK (Marjie); https://www.flickr.com/photos/mbk/

Image via flickr user MBK (Marjie); https://www.flickr.com/photos/mbk/

I consider that health care and more importantly, access to health care, is continually perceived in Congress as a privilege rather than a right. These programs historically offered (and intended) to care for the specific and sensitive needs of low-income and young women, HIV/AIDS patients, or veterans. Such groups have benefited greatly from these programs: young women have been educated and empowered to take control of their bodies, HIV/AIDS patients have attained medically necessary treatment, and veterans have accessed critical support to transition from their time on duty. Unfortunately, with the expansion of the Affordable Care Act, policymakers are finding reason to slash budgets as if provision of health care through these programs is a simple matter of dollars and cents.

I was perhaps most appalled to read that allegedly the severe backlog of patients led to treatment delays that caused the deaths of nearly 40 veterans in 2014. More importantly, the incentive structure (in the form of a cash bonus) for VA hospitals was failing. If hospitals place patients on a “secret list” to evade scrutiny, rather than actively innovating policies to reduce patient wait times, there is an evident systemic issue.

Veterans Affairs also has a budget comparable to a Fortune 6 company, illustrating that the issue is not shortage of funds, but that a systemic reform is past due. This again reiterates that classic market forces do not work well in the provision of health care.

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