Three Moral Issues of Health Care

by Jim Wallis 07-02-2009

Good health is the will of God for each and every one of his children. Death, disease, and pain did not exist in the Garden, and Revelation tells of a “new heaven and new earth,” where once again they will not exist. We live in a fallen world where injury and sickness are a fact of life. In fact International Classification of Disease now identifies 68,000 distinct diagnoses. Every year in our country there are about 119 million ER visits, up to 902 million doctor’s office visits, and about 3.5 billion prescriptions filled.

Perfect health will never be achieved and physical death on this earth will never be overcome, but the scriptures paint a clear picture that this was God’s intent from the beginning and will be the goal once again in the end. This means that on a personal, national, and global level the physical well-being of all God’s children is close to God’s heart and should be close to ours as well.

There is not a religious mandate or God-ordained system of health care or insurance. No amount of biblical exegesis or study will lead you to a policy conclusion on health care savings accounts, personal versus employer provided insurance, single payer public systems, or private insurance plans. Luke might have been a physician, but he still never commented on whether or not computerizing medical records should be a national priority.

These policy questions are still of vital importance and will be debated and discussed in the coming months at the White House, in Congress, in the press, and I hope in our churches. With an issue like health, deeply personal but of great public concern, I believe that the faith community has a unique and important role to play. That is, to define and raise the moral issues that lay just beneath the policy debate. There will be a lot of heat, maybe even a few fires, over the weeds of the policy, and the faith community has the opportunity to remind our political and national leaders about why these issues are so important — why they speak to our values.

There are, I believe, three fundamental moral issues that the faith community can focus on and call our political leaders back to, lest they forget. They are: the truth, full access, and cost.

The Truth

For decades now, the physical health and well-being of our country has been a proxy battle for partisan politics. When Truman tried to pass a national health insurance plan, the American Medical Association spent $200 million (in today’s dollars) and was accused of violating ethics rules by having doctors lobby their patients to oppose the legislation. In the 1970’s when Nixon tried to pass a national health insurance plan, strikingly similar to what many democrats are proposing today, the plan was defeated by liberal democrats and unions who thought that they would be able to pass something themselves after the mid-term elections and claim political credit for the plan. In the 1990’s the “Harry and Louise” ads misrepresented the Clinton health care plan but was successful enough PR to shut down that movement for reform.

Already, industry interests and partisan fighting are threatening the opportunity for a public dialogue about what is best for our health care system. As a resource for congregations, small groups, and individuals, Sojourners has worked with its partners to publish a Health Care tool kit [click here to download] to help frame and guide this necessary debate. This guide gives an overview of the biblical foundations of this issue and frequently asked questions about it. What we need is an honest and fair debate with good information, not sabotage of reform with half-truths and misinformation.

Full Access

The second fundamental value question is that of quality and affordable full access to health care. About 46 million people in our country today are uninsured and many more find themselves without adequate coverage for their medical needs. Many of them are working families who live in fear of getting sick or injured. Some delay seeking medical attention at the risk of their own health and increasing cost later on, or use emergency room services instead of primary care physicians. An estimated 18,000 people a year die unnecessarily, many from low-income families, because they lack basic health insurance. As a father, I know how important the health, wholeness, and well-being of my family is to me and is to every parent. Seeing your child sick is a horrible feeling; seeing your child sick and not having the resources to do something about it is a societal sin.

Cost

The third issue is cost. An estimated 60 percent of bankruptcies this year will be due to medical bills. Seventy-five percentof those declaring bankruptcy as a result of medical bills have health insurance. The costs of medical care stem from varied sources. Some of these costs come from malpractice lawsuits, some from insurance companies with high overhead and entire divisions of employees hired to find ways to deny benefits. Someone who thought they were insured could find out that their benefits were terminated retroactively because the insurer decided that there was a pre-existing condition. In the end, some are paying too much for care and others are making too much from these present arrangements.

There is a lot of money, to say the least, wrapped up in health care. The faith community needs lift up the concerns of those who have no lobbyists on Capitol Hill or PR firms with slick advertising campaigns.

These are pressing issues for our country, lives are at stake, and it is a debate we must have and take seriously. For the month of July, we will be taking this discussion to our blog and having some of our regular writers and guests give their opinions and perspectives.

There are a myriad of special interests groups who will be promoting their own self-interests during this process. The faith community has the opportunity to step in and speak for the interests of the common good and those who would not otherwise have a voice. I am sure that every one of the 18,000 preventable deaths that will happen this year from a lack of basic health insurance breaks the heart of God. And, it should break ours too, because healing is at the very heart of the Christian vocation.

To learn more about health-care reform, click here to visit Sojourners’ Health-Care Resources Web page.

Categories: Health

MarkJay

I think Jim is correct that the faith community needs to step in and have a voice. I don't know what the solution is to better health care, maybe we already have the best system? I would be interested in reading comments.

kjacksonp

As a physician who has always done both insured and indigent care, it hurts me to see the medically indigent population growing with the result that many are burdened beyond their means by health care costs. At the same time, creating a massive additional (medicare and medicaid already are massive) federal bureaucracy to "fix" the problem may create financial burdens on the same people through taxes, limitations on other services, etc. Any system that has no competition and is heavily regulated by a governmental bureaucracy is likely to be expensive and cumbersome. Any system run by private industry is likely to leave some unserved because they are not profitable. Where is the middle ground that provides efficiency without leaving behind the most needy?

Trogdorprof

kjacksonp,

Thanks so much for being a compassionate physician who cares for the insured as well as the indigent! I really agree with your heart to "provide efficiency without leaving behind the most needy." Three of your concerns caught my attention: 1) competition, 2) expensive bureaucracy, 3) financial burden

1) The main thing being proposed right now is adding a public option to the existing private ones. This would add an option for people and stimulate competition as a result. From what I understand, many regions of the country actually lack competition right now, where private insurers have de facto monopolies (in fact there is talk of some anti-trust investigations into this). So the public option would greatly improve competition & choice.

2) I do hear of doctor's woes in repayment from Medicare, but in terms of financial efficiency, it actually runs at about 1/3 or 1/4 the overhead cost of private insurers, who have more administrative costs and are ultimately beholden to Wall Street investors for maximum returns.

3) It's debatable that taxes will go up, at least on those who can least afford it (the only proposals right now are to tax employer benefits and to raise taxes on those with income over $250,000). Aside from this, people's expenses will go up without reform that includes a public plan because their premiums will continue to skyrocket, well outpacing wage increases. This will dump more people into Medicare roles or force people to use the most expensive kind of health care: ER visits. Best I can tell, there seem to be very real costs to doing nothing.

Thanks again for your service to people in need!

prk

1. Why do we need a public option there are more than 1500 insurance companies competing now. Is 1501 a magic number? We both know how big a bat Washington would swing to put all others out of business.

2. Yes Medicare pays doctors a lot less than do private insurance, they would also do the same with the public option. But who in your state administers Medicare, in my state, Tennessee, BCBS has been doing this since the 1960's. That is your administrative savings having the paper work done by a flexible private work force.

3. Let's not forget the taxing of healthcare benefits for some with better benefits than others, as long as you are not in a union. The CBO estimates are over 1.6 trillion over 10 years and they are always light.

Think about it if you have a product that you are selling and the supply is fixed(doctors, nurses, hospitals, ect) and demand increases (free care) will the price go up or down.

jb145

Hi prk,

Insurance varies from state to state. Here in RI, we only had two choices, Blue Cross and United, until recently. Now Tufts has been approved by the DBR to offer insurance.
However, the rates of the three seem to be very similar.

To me, a public option might serve to level the playing field a bit. As it is now, the big guys have all of the advantages.

JB

sonicmoon

That's why one of the components of real reform should be to allow interstate purchasing of insurance. More competition results in better pricing along with the other measures to lower costs and close the gap on coverage.

okiesal

Unfortunately, private insurance companies refuse coverage to millions of people for all sorts of reasons. They don't want to cover everyone. Competition only extends to those with low enough risk the insurers are willing to accept them. That's why the private insurance market isn't sufficient to address the problem. Either insurers need to be mandated to offer coverage to everyone (at group or shared-risk rates) or we must have a public alternative that will guarantee coverage to all.

prk

Who are the uninsured? How many of the uninsured cannot "afford" coverage? How many cannot get coverage? Why is a policy ten times more expense in Mass than SD?

The policy that I bought for my family cost a little over $600 for my family of 4. I can afford that since I drive a Saturn and not a Lexis.

The public option will drive private insurers out of business because of governments heavy hand forcing doctors and hospitals take less, leaving them to make up the difference from the private insurance sector.

You say they should be mandated to cover everyone but should I not be rewarded for my health lifestyle? Should car insurance be the same way with bad drivers paying the same rates as good ones?

Trogdorprof

prk (this is in response to your 1st post):

1. Many are far from convinced that the public option would put the private companies out of business. This is probably because public & private mixtures already exist in many sectors, not least of all health care (state employees & retirees often choose private insurance over their government option). Besides, the private insurers would only go out of business if they failed to adapt to make themselves more competitive. They're not exactly hanging on by their fingernails right now - they are choosing to deliver huge profits to investors by minimizing coverage & upping rates. With the pressure of the public option, they would be forced to provide better/cheaper coverage. This is free market logic at its most basic.

94% of the country's insurance markets are “highly concentrated” right now, as noted by the American Medical Association, so the practical result of ending up with only government insurance could hardly be worse than what we have now, since the sole provider would be a non-profit insurer instead of the for-profit insurers that already ration care and price gauge because they lack competition.

And at a moral level, should we be more concerned about protecting companies who have come between people and the health care they need, or should we be more concerned with making sure all or most people have access to health care?

2. That’s interesting about a private company administering state Medicare. Is that what is being proposed with the federal public option? (I honestly haven’t heard anything to that effect). But doesn’t your example show that public-private cooperation is effective after all? And doesn’t that mean that the private companies wouldn’t go out of business since they’d be administering insurance for as much as 45 million new customers?

3. The president does not want to tax benefits, but many economists do because they feel it encourages wasteful use of health care services, driving prices up. Besides, as you put it, this would only be on those with “better benefits” (i.e., not those who can least afford it, as I put it). To me that is more than acceptable.

As far as price tag is concerned, the HELP Committee came out with a new bill a few days ago that would cover 95% of the uninsured with a public option and only costs $600 billion, topping off at $1 trillion once the Finance Committee adds in their costs. Again, that is over 10 years.

prk

The states are self insured just like all big business, the sub out the administration to BCBS, Unitied Health or another insurer because of the effience they create by not having to deal with a state workforce.

So there is no competion with 1500 insurance companies but 1501 there would be? Giving the pols power over our healthcare is just bad for most Americans. Remember the "better benefits tax" would not effect those under a collective bargaining contract.

The pols have caused the problem getting them out of the way not more into it is how to solve it. Remember they want power, they do not care about you or me.

As far as covering 95% of the uninsured I doudt that when 20% are illegal ailens which none of the proposed plans cover.

Under the Kennedy plan my insurance would not meet the guidelines and would go away. So much for everyone being able to keep what they like now.

Yes, healthcare is rationed, the question is do you want it ratiioned by the markets or the pols? The market is my preferance as a Christian.

Trogdorprof

Prk,

1. “So there is no competion with 1500 insurance companies but 1501 there would be?”

Yes. That 1500 # is misleading for the reason I mentioned above: “94% had commercial markets that were ‘highly concentrated’ by standards set by the Federal Trade Commission and Justice Dept.” Mind you, these are the words of the American Medical Association! (http://www.ama-assn.org/amednews/2009/03/09/bis...)

For example, they found that in “Alabama, the biggest insurer, Blue Cross Blue Shield, controls 83 percent of the statewide market. There, and in nine other states – Hawaii, Rhode Island, Alaska, Vermont, Maine, Montana, Wyoming, Arkansas and Iowa – the two largest health insurers control at least 80 percent of the market.” (http://tpmmuckraker.talkingpointsmemo.com/2009/...)
Much of this is due to the increased consolidation (mergers) of insurance companies (meaning that 1500 number can be reduced to a much smaller number of parent companies), so much so that a former top Federal Trade Commission official is requesting the Justice Department's Antitrust Division investigate the matter!

So, the current market realities are plainly failing to produce competition because consumers don’t have 1500 choices, they often have 1 or 2 (says the AMA). So, introducing what would really be a 2nd or 3rd option that is more affordable, does not deny coverage for pre-existing conditions, is available everywhere, and is not tied to a job, would absolutely provide significant competition! This is exactly why the insurance companies are so afraid.

2. So when you say, “do you want [health care] ratiioned by the markets or the pols? The market is my preferance as a Christian,” I am truly alarmed:

An ideological commitment to “the market” has nothing to do with biblical mores. If something as sacred as the Sabbath was made for man, and not man for the Sabbath, then surely the market does not deserve unswerving loyalty. It must be evaluated for its practical value to produce good results for people in each sphere. As just noted, it is simply not producing good results by itself in the realm of access to health care. Hence the public option: it would directly increase access to those who have zero (the opposite of rationing) while forcing companies to be more competitive (and so give greater access, less rationing). Thus this actually works with the market, making it work more honestly. As I said before, I would trust a non-profit entity over a for-profit entity with my health care insurance (yes, even the government), given how the for-profit entities have behaved. (http://www.insurancecompanyrules.org/blog/entry...)

3. “Under the Kennedy plan my insurance would not meet the guidelines and would go away.”

I’m sorry, but can you produce a quote from the text of the bill that says as much? I’m not trying to be picky here, but I am unaware of any stipulation that would force certain insurance plans to “go away” for not meeting certain “guidelines.” If there is, that'd be good to know.

(And which Kennedy plan are you referring to? The one produced a few days ago by the HELP Committee or his original one from a while ago?).

4. “As far as covering 95% of the uninsured I doudt that when 20% are illegal ailens which none of the proposed plans cover.”

The recent HELP Committee bill would ensure 20 million by 2019 and expand Medicare to cover 20 million more people. That’s 40 million out of 45 million uninsured. So, the bill would actually provide coverage to 89% of the uninsured. The 95% number actually refers to the % of the total population that would then be insured (my bad). And if we’re only talking about those who are here legally, then the number actually goes up to 97%. (http://blogs.tnr.com/tnr/blogs/the_treatment/ar...).

prk

Starting with the competion and lack of choices, 47% of healthcare is the goverment when you add up medicare and medicaid, secondly when our local paper the Chattanooga Times FreePress ran there hit job on lack of competion they only talked about the commercial side. Where close to 50% was spilit between BCBSTN, United Health and Cigna. They did not discuss how the individual market is broken down.

If you simply changed the tax structure then you would encourage individuals to buy health insurance on their own, this would add to the competion.

Here is a link on the Kennedy bill, I have a HDHP now, the Pols really hate these, since I see all the bills since I am paying.
http://online.wsj.com/article/SB124536864955329...

The BCBSTN is a non profit. About half of the BCBS are non profits, why are they never mentioned in the public option that the pols want us to have.

WaveTossed

"3. The president does not want to tax benefits, but many economists do because they feel it encourages wasteful use of health care services, driving prices up. Besides, as you put it, this would only be on those with “better benefits” (i.e., not those who can least afford it, as I put it). To me that is more than acceptable."

Imposing a new tax on working people in the form of taxing their health benefits is NOT acceptable. How would the government define "better benefits?" And it's most likely that the tax will keep on expanding until it includes "all employer-paid benefits." One big reason I voted for Obama and not for McCain was McCains' advocacy of this new tax. I'm glad to see that Obama still opposed this new tax. I'm sorry to see many "progressives" starting to embrace this idea of this new tax.

Employer-paid health insurance plans do NOT encourage "wasteful spending." I don't know who came up with that idea or what statistics they twisted (if they even attempted to come up with statistics). I'm in an employer-provided health care plan. Each year, the premiums go up and up and each year, the benefits get cut back with higher co-pays and higher deductibles.

Myself, I'd much rather fund any health care reforms with money saved from not engaging in wasteful military expenses gotten from the U.S. trying to be the Morality Thought Police of the world. Which of course adds tons of health care expenses when soldiers are wounded.

dennis7773

one federal bureaucracy cannot possibly be as expensive and cumbersom as hundreds of insurance companys each having a multitude of plans. Hire a good cost analyst and you will find that your cost of doing business with the insurance companys with their hundreds of forms and plans, plus getting approval from an insurance bureaucrat who know nothing about medicine, is many times greater than dealing with Medicare. The paper pushing staff and expense for a physician in Canada is many times less than here.

The entire industrialized world, except for us , has some type of universal single payer and spends way less money and has better results. What are we waiting for?

MARROY

Every economist seems to say Medicare is most efficient we've got. All other advanced countries do it with varying degrees of efficiency yet you say it can't be done here. What's the matter with us? Sometimes gov't does work. At least let's create a public option-on a level playing field- no subsidies for pvt. insurance cos. and let good old competition lead the way. I heard we're averaging 1400 bankruptcies a week due to peoples inability to pay medical bills. The system in broken . We shouldn't ask people to settle for more of the same.

dennis7773

Govt should not be running everything, but govt works just fine when it is allowed to do its job without interruption from outside greed and corruption and is properly funded to the work that is needed to be done.

xfree9

govt works just fine when it is allowed to do its job without interruption from outside greed and corruption and is properly funded to the work that is needed to be done.
Care to provide some examples? Also, what happens if a corporation gets too greedy and corrupt? Eventually it will go out of business. Government works in the opposite direction; it keeps adding funding because the excuse is, "we didn't spend enough." Not always, but that's usually the way it goes. It may take time for a corrupt enterprise to end, but it takes forever for a corrupt government program to end.

dennis7773

Pope John Paul "Capitalism unchecked by morality will destroy itself"

I havent seen any greedy corrupt corporations go out of business. Im not in

disagreement that there are too many govt programs and unfortunately many

outlive their purpose. However, I do believe that govt should be the morality

check on corporations. If not govt, then who? The faith community is entirely

too busy with fun, food, and fellowship.

I was a small business owner for my career. Yes, if corrupt and too greedy I would

have gone out of business. In theory it works. However, today we have allowed

business to get way too big and competition has been limited and they have way

too much power and influesnce. This has happened before. Teddy Roosevelt the

trust buster brought it too an end.

The absolute problem , I believe is how we finance political campaigns. This is the

change that could solve a multitude of problems. Each party gets the same amoung per

race and allow some type of provision for a third party.

xfree9

I haven't seen any greedy corporations go out of business
Really? Keep in mind I'm not talking big businesses only, I'm speaking generally of businesses of any size. What about all the businesses who are going out of business or going bankrupt in our current economy? Are you certain that none of them is a result of excessive greed?

As for government, you must have the belief that government does mostly good, with a few exceptions. I happen to believe the opposite, and there's little proof that government methods are better than open market methods. As for the big business stuff, big businesses are not pro free markets, they are oftentimes protectionist and lobby on their own behalf. If Barack Obama really did kick out all the lobbyists in Washington, our country would be 100% better in a month's time. I'd probably even vote for him next election if he truly accomplished that (your campaign comment would help, too!). But he won't, because he is just like every other politician, and caters to his special interest groups.

We both believe in rule of law. Capitalism is "checked" internally, as well as by rule of law. If government is the morality check on corporations, we've got plenty of problems. Funny thing is, if you really think about it, we should be thanking capitalism for bringing to light our current economic crisis. Just like our body, when toxic things are placed into it, it spews it out. That is what is happening now. It's a testimony that the market clears out greedy investors and people who want to buy more than they can afford (which is another form of greed). Government didn't bring to light our current crisis; those who believed in a free market knew this was coming (read Ron Paul's writings and congressional statements anywhere from 2-10 years ago).

Anyway, that's a bit off topic...

dennis7773

Im enjoying our conversation

We are certainly in agreement on the lobbyist. I believe lobbyist is synonmous with bribe.

The problem today is that big corporations have limited competition and end up too big to fail.

I personally think the big banks with mortgage problems should have been allowed to fail and the

home owner mortgages assigned to local banks via govt insurance at a fair market fixed rate. Bush

of course needed to bail out his buddies and it wasnt stopped in the current environment.

I personally bank at a local bank that has three branches. The VP at my branch knows my

first name and so do most of the tellers without seeing my deposit slip.

I sold my business ten years ago I had thirty employees and 10M in sales.

My health insurance was 120 per month, 750 deductible, 80/20 to 5K and then 100%

Today it is 480 per month, 1500 deductible, 80/20 and then 100%

The number of insurance companies in my state has shrunk by over 50 % in the last 15 years

and four companies dominate the market. There is no competition anymore and someone

with the least bit of medical issues cannot buy insurance on their own. Small business

can no longer afford it either.

United Health Care is located where I live. They paid millions per year to Bill McGuire. He's the

CEO who got caught backdating stock options . They then gave him a 16 billion, yes billion with

a B, golden parachute. The largest severance in American history. All of these people sit on each

others boards and pad each others ______. We the people need to force our elected officials

to step in and clean up the mess. Stock options of course have much more favorable tax treatment

than income. And I am supposed to want to buy stock in these companies? I liquidated half of my

portfolio in Sept of 2007 and the second half in Jan of 2008.

The basic pure simple fact still remains that the rest of the world does a much better job and spends

a whole lot less. In the last year I have had the opportunity to have personal one on one conversations

in the course of my employmentwith five different people from four different countries about health care.

These were above average income people as they were visiting here. They were not students. All five told me that what we

are being told by our media about their health care is somewhere between gross distortion and pure lies.

And now this one really hurts. They also commented that they would not even consider trading their

citizenship for ours and the number one but not the only reason was health care, followed by education.

When it comes to health care the free market needs at a minimum, some public competition. It is

definitely broken. Govt has the responsibility to be the policeman. You and I are the ones who

need to kick the lobbyists out. I agree there are lobbyists for all sides and as long as this situation\

exists I favor the ones who are on the side of the middle class. I am well within the top 10 % of net

worth in the country, probably even 6-7 % The problem is that the distance between me and the bottom

ten percent is a couple mil. Then difference between me and the top two percent is 500 million and into the

billions. This is not what made this country great.

WE as citizens have the ability to hold the govt accountable and we have been extremely negligent in

out duties. As a society we have unhook ourselves from Michael Jackson, big league sports, and computer

games and start growing up and being responsible for both ourselves and our country and our society.

You want to start a movement to kick the lobbyists out?