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Alker's important Opinion piece (1) rightly points out the problem of Medicaid spending cuts, particularly for vulnerable populations and clinicians who care for them. What can be done?
Unsurprisingly, such cuts occur at a time when health inequalities have reached a crisis point (2). In particular, the idea of the right to health is being eroded in the United States and worldwide. This right has a long and complex history in the US, and has never been formally recognised in the Constitution, unlike in most other Western countries (3). It is no coincidence that these cuts follow the United States' withdrawal from the WHO (4), whose core mission statement and Constitution has always been to promote the right to health for everyone.
Alker points out that these cuts also go hand-in-hand with Medicaid eligibility being reliant on "government proscribed preferred behaviours" (1). This attitude is suggestive of "healthism," which frames health as a personal super-goal and individual duty to maintain (5). Health promotion without healthism is sorely needed in our times of gross health inequalities. A collective response to spending cuts that re-affirms the inalienable right to health for all is sorely needed.
References
1 - Alker J. Large cuts to Medicaid and other new policies may create untenable choices for clinicians in the US. BMJ 2025;389:r563
2 - Bambra C. (2024). The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries. International journal of social determinants of health and health services, 54(3), 199–205. https://doi.org/10.1177/27551938241244695
3 - Right to health, a comparative law perspective, United States of America. EPRS | European Parliamentary Research Service Comparative Law Library Unit PE 729.407 – May 2022. Available at: https://www.europarl.europa.eu/RegData/etudes/STUD/2022/729407/EPRS_STU(2022)729407_EN.pdf
4 - McQuillan C. (2025). President Trump orders US withdrawal from WHO. The Lancet. Infectious diseases, 25(3), e138. https://doi.org/10.1016/S1473-3099(25)00104-5
5 - Crawford R. (1980). Healthism and the medicalization of everyday life. International journal of health services : planning, administration, evaluation, 10(3), 365–388. https://doi.org/10.2190/3H2H-3XJN-3KAY-G9NY
Competing interests:
No competing interests
07 April 2025
Timothy P Daly
Postdoctoral researcher in public health
UMR 1219 (Bordeaux Population Health), University of Bordeaux & INSERM
Medicaid spending cuts: a human rights-based response is needed
Dear Editor
Alker's important Opinion piece (1) rightly points out the problem of Medicaid spending cuts, particularly for vulnerable populations and clinicians who care for them. What can be done?
Unsurprisingly, such cuts occur at a time when health inequalities have reached a crisis point (2). In particular, the idea of the right to health is being eroded in the United States and worldwide. This right has a long and complex history in the US, and has never been formally recognised in the Constitution, unlike in most other Western countries (3). It is no coincidence that these cuts follow the United States' withdrawal from the WHO (4), whose core mission statement and Constitution has always been to promote the right to health for everyone.
Alker points out that these cuts also go hand-in-hand with Medicaid eligibility being reliant on "government proscribed preferred behaviours" (1). This attitude is suggestive of "healthism," which frames health as a personal super-goal and individual duty to maintain (5). Health promotion without healthism is sorely needed in our times of gross health inequalities. A collective response to spending cuts that re-affirms the inalienable right to health for all is sorely needed.
References
1 - Alker J. Large cuts to Medicaid and other new policies may create untenable choices for clinicians in the US. BMJ 2025;389:r563
2 - Bambra C. (2024). The U-Shaped Curve of Health Inequalities Over the 20th and 21st Centuries. International journal of social determinants of health and health services, 54(3), 199–205. https://doi.org/10.1177/27551938241244695
3 - Right to health, a comparative law perspective, United States of America. EPRS | European Parliamentary Research Service Comparative Law Library Unit PE 729.407 – May 2022. Available at: https://www.europarl.europa.eu/RegData/etudes/STUD/2022/729407/EPRS_STU(2022)729407_EN.pdf
4 - McQuillan C. (2025). President Trump orders US withdrawal from WHO. The Lancet. Infectious diseases, 25(3), e138. https://doi.org/10.1016/S1473-3099(25)00104-5
5 - Crawford R. (1980). Healthism and the medicalization of everyday life. International journal of health services : planning, administration, evaluation, 10(3), 365–388. https://doi.org/10.2190/3H2H-3XJN-3KAY-G9NY
Competing interests: No competing interests