23 July 2009

Universal Health Care: Let's Be Honest, Shall We?

Yesterday's mail edition of Newsweek featured this cover article by Sen. Edward Kennedy. If you're not a subscriber, it's worth a look anyway.

Our elected officials are engaged in a very acrimonious debate on health care, health insurance and the future of American medicine at the moment. President Obama wants something on the table prior to the August recess, while some are suggesting we shouldn't rush things.

For me, one troubling aspect of the entire debate is the way terms get thrown around with little care for how they are defined. The words "medical," "care," "health" and "insurance" seem to be interchangeable, while they actually describe very different things depending on how they are paired and how they are used. "Health Care" and "Health Insurance" are two very different things: the first describes an actual interaction with a medical professional, while the second describes a company or government program whereby the professional is guaranteed compensation for services provided, and the patient generally bears a portion of the cost in addition to a base premium surrendered monthly, quarterly or annually. You can see the problem when the two start getting tossed around as if they are the same thing.

In a professional sense, I'm fairly un-qualified to weigh in on this issue. I'm certainly not a businessman, nor am I a health care professional. What little mental health care I'm qualified to provide falls under the umbrella of spiritual care: the nano-second I sense that we might be drifting into illness, I refer to a qualified professional, as I am NOT a mental health counselor. In an ethical sense, however, we are all qualified to weigh in, as we, the American people, are the ones who are and will be affected by the ongoing discussion of medicine in America. And I dare say that those of us who serve in the pastoral office are called to be advocates when we feel ethically driven toward a certain point of view.

So, it seems to me that as a country we have one basic choice in front of us. The time has come for a decision about medicine in America: is it primarily a for-profit business or a social service? We are rapidly approaching the point when we will no longer be allowed to waffle between the two extremes, and for me, at least, the decision is obvious: medical care is a social service that must be guaranteed to all Americans. Period.

I'm not saying this is going to be easy. But when an estimated 47 million people can't get medical care for real illness and medical problems, easy has long since left the barn. To my mind, we have an ethical imperative to guarantee reasonable access to affordable medical services, and I, for one, am willing to do my part to see that it happens.

Taxes will need to be raised. That's a given. Medical profits will be cut. Also a given. Insurance companies may find themselves competing against the government. Some insurance companies might go bankrupt. We'll need to transition out of employer-based insurance, which was a bad idea from the start and has only become worse with time. All of these are real repercussions of shifting the model from profit-bearing to service-providing, and it might be bad before it gets better.

But the alternative is worse, in my opinion. Some estimate that 55 million Americans will be without health insurance in the very near future if we do nothing. That, to me, is an unconscionably high percentage of the American population with no hope of cure when illness strikes. That's 55 million Americans who can't get their infant daughters to the doctor when they have an ear infection, like our Alanna had last month. That's 55 million Americans who can't find respite from back pain, as I have this summer. That's 55 million Americans who can't escape the clutches of depression, as I have over the past three years. Can we really think this is the better solution?

The total cost of the medical care required for the births of our daughters, Ainsley and Alanna, was in the neighborhood of $32,000. That's approximately 90% of my yearly cash salary. Health insurance covered most of the cost for us - what are the options for mothers who don't have insurance?

The time has come for a renovation of American medicine. No renovation comes without sacrifice, struggle, and moments when the damage done seems to outweigh the possible end result. But the present situation is a house of cards teetering on the verge of collapse. We have an ethical and moral imperative to do better for our society - let's speak the truth and get it done.

Grace & peace,


  1. One distinction that should also be made is health "insurance" and health "care", as I understand it, everyone who shows up at a hospital is entitled to health care whether they can afford it or not, if they cannot afford it, that is what medicaid is for, if they can afford it, then they need to pay for those services. Something needs to be done in relationship to health care and health insurance, however I fear if we move to a not for profit model, innovations in health care will be curtailed, as what would be the incentive apart from helping, which is a good incentive, but hey we still live in the sinful world.

  2. There other questions involved in this debate, even if health "care" is a social service, which a hospital would have to provide, regardless of the form of compensation (insurance, medicaid, some other as-yet-to-be-determined government program). That is, what exactly would be the extent of the "entitled" health care? Would pain management drugs be considered necessary and entitled, or would they be a luxury item? How about an epidural, or an ultrasound? Are those entitlements or elective? Medical weight loss interventions? Where is the line drawn as to what medical care is our right, and how much a privilege? Then there's age--will there be an age at which knee replacement surgeries, hip surgeries or biopsies/mastectomies, etc. become a luxury item due to the age of the patient based on the "return on the money"? The question may become, "is this procedure life-saving, or merely life-improving?" Right now each insurance company pre-determines what they will and will not cover, as does Medicaid. The types of things they cover often impacts the premium.

    Right now insurance and Medicaid are available for the people of the US. The problems occurs at the user-level not at the bureaucratic one. First, not all doctors accept Medicaid. That should not be an option, at least not for doctors who work in emergency rooms, or provide services covered by Medicaid's contract of coverage. Second, there is the problem of the "unwise decision maker." Believe it or not, there are people out there who do not pay for insurance and can easily afford it. Instead, they spend large amounts of their resources on vacations, luxury cars, creature comforts instead of calling insurance a necessity. Quite frankly, these people should face the repercussions of their decisions. The largest problem is that of the qualification process for Medicaid. The issue is with the "working poor" and those currently (but not chronically) unemployed due to the loss of a job that had previously carried their insurance who have too much in their assets (which may or may not be accessible) to qualify for Medicaid. However, if they pay for insurance, their disposable budgets will not allow them to be able to pay for things like food, or diapers. This is where the breakdown is occurring and in my humble opinion, where our senators and representatives should be focusing: the Medicaid qualifications. My 2 cents.

  3. T'illa,

    Definitely not an easy issue to fully grasp, the entitlement verses non-entitlement is where it breaks down for me, as more of a civil libertarian I am not in favor of the gov telling me to do anything. If I choose to not purchase insurance and live irresponsibly by taking vacations when I cannot afford it because I think "I deserve" it then if you have problems you must pay, as you are not entitled to health care for free. My concern is that if the gov gets involved even more in health care I fear that I will no longer have the best available care nor will I be able to have options. As someone with an auto-immune disease choice is very important for me. But the costs must be brought into line somehow without damaging our health care system, and choice must always remain, as I believe this is constitutional.

  4. Scott I just now found your blog-- It is great! Mine is pretty much all biking and paddling.

    Great post btw!, and the one about your van, and for the record I read Stephenson's Baroque Cycle books

  5. We have universal health coverage right now, and the best medical system in the world.

    Thousands of Canadians (with a govt. system of their own) come across the border and spend their own money to get the healthcare that they need, that they cannot get in their govt. rationed system.

    When the govt. system needs to cut costs, there is only one end that they can do so and that is the services end.

    If they can postpone your surgery, they will. Sometimes for years. Ask a Brit, or a Canadian.

    I only hope that while we are waiting, many will not die. But many will. And the govt. healthcare administrators will not care because they neith know you, or care about you (you're just a number to them) and you are helping them to cut costs by you're 'going away' (dying).

    That is simplified, of course, but it is the truth.

    You want a picture of govt. healthcare run by bureaucrats...then go to the DMV. The only difference there is that people's lives are not at stake.

  6. Some good arguments against a govt. run system:


  7. Dennis Prager is a terrific (the best in my opinion) talk show host, who thoughtfully argues on these great matters.

    This link can get you to his program.

    Also, towards the bottom of the page a bit, you can hear parts of his past programs and discussions on topics such as healthcare.

    Really good stuff!