BOSTON — HEALTH-CARE reform is not just a matter of dollars and cents. It raises troubling issues of civil and constitutional rights; those issues are just beginning to arise in the national debate.
The American Civil Liberties Union (ACLU) recently issued a ``Health Care Reform Bill of Rights.'' It identifies four constitutional areas - equal protection, personal privacy, due process of law, and freedom of religion and speech - in which reforms could run afoul of basic rights.
While Washington policymakers are preoccupied with budgetary complexities of hammering together a compromise reform plan, these issues will likely surface with increasing urgency in months ahead:
* Access, or ``redlining,'' issues usually relating to the ability of the poor and minorities to get care equal to the affluent.
* Privacy, including confidentiality of medical information about people and the possibility that health-care reform could demand a kind of national identity card.
* Whether some people, particularly illegal immigrants, should be excluded from ``universal'' coverage.
* How to accommodate people, who for religious or other reasons, choose healing methods other than traditional medicine.
``When the civil rights and civil liberties communities get into health care, driven by a specific concern like abortion, they'll see that the whole area really raises all the same questions about employment discrimination, privacy, and due process as any other huge federal program,'' says Lesley Harris, public-policy director at People for the American Way.
Access questions deserve more attention than they're getting, says Ken Wing, a University of Puget Sound law professor and a physician. He sees ``a rush to control costs and placate providers and insurers but no bill of rights to guarantee access.''
Minorities at the periphery
Health-insurance practices now force many minorities to the system's periphery. ``In the new plan, there has to be something to deal with ... racial discrimination.''
``Redlining,'' excluding people due to race, economic status, or medical condition, is highlighted in an analysis of health-care reform by a committee of the American Bar Association's Section on Individual Rights and Responsibilities. Committee vice chairman Robyn Shapiro says some levels of insurance coverage possible under a new system raise questions of who gets what level of care. ``Will it reenforce a two-tiered system?''
Mike Frank, a Heritage Foundation health-care analyst, predicts cost controls in the Clinton plan will lead to rationing, ``and any time you get into rationing, people at the lower end of the economic spectrum end up being on the wrong end of the rationing system.''
Privacy could generate the hottest discussions of health-care reform and rights. The ACLU puts abortion in this arena, stating in its ``bill or rights'' that ``the health-care system shall respect a person's right to autonomy in decisions concerning medical treatment, including matters of reproductive choice.'' Another privacy concern is confidentiality of medical records. Centralized health information in a reformed system may be ``wonderful to facilitate communication,'' says Ms. Shapiro, ``but it's very important to ensure privacy.''
Observers, from civil libertarians to conservative Christians, are worried about implications of a new health-security ID card. ``The creation of any type of national card raises serious civil liberties problems because it could result in widespread discrimination against foreign-appearing citizens and residents,'' the ACLU says. Many conservatives see the card as a step toward Big Brother government.
On the ``universality'' issue, Shapiro's committee concluded that the proposed exclusion of illegal aliens from health coverage is a civil rights concern and practical matter. If they're not covered, she argues, they'll end up in emergency rooms where medical care is at its costliest.
Being able to `opt out' of a plan
With regard to those whose beliefs are at odds with conventional medicine, they should be able to ``opt out'' of a national health-care plan. ``Certain faiths, notably Christian Science, reject traditional medicine,'' the ACLU's summary of its report on civil liberties issues in health-care reform states. ``The Health Security Act must, therefore, recognize the equivalence of `conscientious objector' status.''
Shapiro favors ``accommodation of particular approaches to illness or treatment based on individual beliefs'' within the plan, as distinct from opting out. But the more cost concerns push a system toward rationing health care, ``the more danger there is we won't accommodate this.''
In the final plan, says Wing, ``the first paragraph ought to be akin to a bill of rights ... and everything else would address those rights and objectives.''