In Matthew 25, Jesus paints an image of His return in glory. On the Day of Judgment, Christ will separate His sheep from the goats. The sheep are those that cared for “the least” of Jesus’ brothers: the hungry, the thirsty, the naked, the stranger, those sick, and those in prison. The goats didn’t remember “the least” among them and as Christ foretold, “in all truth,” they have “received their reward,” in this life and will not in the next. Jesus’ teaching is unavoidable.
This message is especially relevant to the injustice of the American healthcare system. To call American healthcare—as a system—immoral makes no judgment on healthcare professionals or hospitals, but rather on the design itself. Many have advocated for universal healthcare in our country and have been rejected for proposing so-called “socialized medicine.” I am personally a proponent of a universal healthcare system. We have the medical care, the financial resources, but we seem to lack the moral will to acknowledge that we are our brother’s keeper.
Does the United States have the best healthcare in the world? It depends. In reality, there are at least five different co-existing healthcare systems in our country. They can be described as follows: first, at the top of the system are the wealthy and well-insured, particularly those with indemnity, fee-for-service health insurance. In this case, the United States has the highest quality, most technically advanced medicine in the world; second from the top is the private, employer-based insurance for the middle class, usually with some features of “managed care” and some restrictions on what the insurance company will cover; the third layer consists of insurance for lower-income workers in the form of tightly managed health maintenance organizations (HMO), substantial out-of-pocket payments and moderate restrictions on the doctors that can be seen and treatments covered; the fourth layer is Medicaid, Medicare, and the State Children’s Health Insurance Program (SCHIP), which are grossly underfunded systems of federal and state insurance for the lowest of middleclass families, the poor, for children, the disabled, and the elderly. This group faces severe restrictions on doctors that can be seen and on treatments covered; the bottom of the ladder is “charity care” and emergency room care, which is available to those who have no medical insurance.
The American healthcare “system” translates into a socio-economically based distribution of medical care, which is fundamentally more of a medical caste system than a healthcare system. This hardly seems compatible with Jesus’ teaching in Matthew 25. The results aren’t either. In virtually every form of basic statistics measuring days of illness, death rates, and life expectancies, the United States ranks behind almost every other industrialized nation. The U.S. ranked last in 2007 of every industrialized nation in terms of citizens dying from preventable disease; France ranked first. In France 64 people died from preventable disease, in the U.S. approximately 101,000 died from preventable disease. The difference couldn’t be starker, particularly given the fact we spend more on healthcare than any other industrialized nation in the world and for us it is only partial, not universal coverage as in other countries.
The “every-man-for-himself,” radical individualist strategy of American healthcare not only is disastrously irresponsible, it seriously violates basic Christian teaching. Make no mistake, this is not an endorsement to eradicate personal responsibility and moral virtue (communism, in other words), but an observation that a private sector dominated healthcare system is bad business without some sort of minimal regulation. The Catholic principle of subsidiarity is an organizing principle that calls us to allow the smallest, most local institution to handle matters if it can be done more efficiently than or just as efficiently as would be done at the national level (or state level in America). But, if the task cannot be done efficiently at this level, then the national (or state) government has an obligation to have some sort of role to ensure the common good.
Any healthcare system—in my view—that is based on private insurance with no government intervention is fatally flawed. The incentive of private insurance is upside down. After premiums are paid, the less care they provide, the higher their profits—this is undoubtedly their goal. Hence, all the horrid stories one hears about insurance companies searching for the smallest technicality to not cover something. Thus, public health and human welfare is not the incentive, but rather profit. Profit over health and dignity is not a Christian value. Fundamentally, health and wellness should not be treated like any other consumer-based industry.
The problem with healthcare costs is hard to deal with in the current system. With thousands of different private health insurance plans, it’s virtually impossible to negotiate consistently lower costs with healthcare providers and drug companies. A universal healthcare system, on the other hand, has the potential to rein in costs. More importantly, private insurance is a colossal waste of money. Administrative costs for Medicare, for example, which is government-financed (not government-run) are 2-3% of the total cost. Approximately 30% of private insurance premiums go to overhead, profits, and executive salaries. Overall the administrative costs of private insurance exceed $400 billion dollars in a year. That is arguably sufficient to cover all the uninsured without raising taxes.
Many conservative-leaning thinkers are concerned about the loss of freedom and the efficiency of a national healthcare plan. Ironically, the freedom that many people fear will be loss at the implementation of a universal healthcare system is already gone. Many choices in healthcare are at the discretion of the private sector insurance companies. They choose what doctors you can see, whether you are qualified to be covered (if you have a history of illness, good luck—you cost too much), what they will and will not cover and how long you can receive treatment, and this is all if they don’t find some small technicality on which they can drop coverage all together to preserve their profits. It seems that we fail to realize how much is already controlled by large corporations—at least government officials can be voted out of office.
Even more so, we already pay for people to get medical care. When people go to the emergency room to receive medical treatment without health insurance, the cost is spread amongst everyone else. This is one reason why insurance premiums skyrocket and we’re also taxed, since hospitals can receive government grants to offset some of their losses. Wouldn’t we rather have paid for the preventative care than wait until it is much more expensive?
Additionally, it is nothing unusual for a hospital to have to bill more than 700 different payers and insurers–HMOs, PPOs, MCOs, IPAs, and an alphabet soup of other organizations. Each one has its own set of rules for what services are covered, the level of reimbursement and the kinds of documentation and pre-approval required. It is an administrative nightmare. And for this mess, we Americans shell out $2.2 trillion a year (more than any other nation) and all this inefficiency costs patients tens of billions of dollars each year. Billing, collection, and payment administration represents some 20 percent of that $2.2 trillion we spend on healthcare. There is nothing even remotely “conservative” about this—it’s nothing but “big spending” and for what results?
To consider this again in Christian thinking—we have a call from the Lord to give preferential option to the most vulnerable among us. Poverty and ill health travel often together. Poverty puts one’s health in jeopardy, ill health with its attendant high medical bills, impairment of working ability, and days lost from work, make it difficult to find and hold a good job. This is a terrible and vicious cycle. The current healthcare system is evidently not accommodating.
Now there is a “safety net” of charity healthcare that ought to be commended. The Veterans Administration healthcare system, the Indian Health Service, state and local departments of public health, public hospital emergency rooms, community health centers and clinics, faith-based clinics for the poor and homeless, and the list goes on. Despite their tireless work and efforts, many lack the funding and the resources to address the problem at hand—they adequately cannot overcome the effects of the lack of good, regular access to mainstream healthcare.
Hispanics, African Americans, people with less education, part-time workers, and foreign-born persons have the highest rates of being uninsured. Guess what? They also are the same people who have more abortions. 1 in 2 African American pregnancies end in abortion. African American children are born into this world more often than not with the odds against them—the black community is experiencing a terrible crisis of missing fathers, thus single parent households. Statistically, children that grow up in such environments are inclined to have a weak parent-child relationship, prone toward committing crime, drugs, alcohol, sexual promiscuity, more likely to repeat a grade, less likely to graduate high school, and are often victims of abuse and neglect. And single mothers, particularly young ones, face a long, uphill battle toward economic self-sufficiency and the current healthcare system does little to help those in this sort of situation.
The elderly have limited economic productivity and healthcare is getting exponentially more expensive; we have a moral obligation to see that their needs are met, particularly for a group that often has very dire medical needs. While there is Medicare, it faces problems in providing long term care of chronic conditions, incorporating new technology, and lacks the financial resources needed.
Much of this may be slightly more “liberal” than one’s own political perspective, but Catholic Social Teaching is beyond “left” and “right” politics. If we subjectively identify with one side of the political spectrum more than the other, we must do so as Catholics, which entails crossing party lines. We cannot continue to allow our politicians to cover unborn children in the children’s healthcare program to encourage women not to have abortions only to denounce expanding coverage, or redirect funding from the program. This isn’t all “liberal” either. We need to heed the Bishops advice on the both/and approach. There is another side of this debate that conservatives need to win. That debate is in regard to much of the content of American healthcare and this debate involves religious freedom, Catholic and private hospitals, abortifacents, emergency contraception, patients rights’, and the full range of so-called “reproductive health services,” in vitro fertilization, genetic manipulation, etc.
The Democratic Party is currently the natural home of legislative proposals for healthcare reform. I firmly believe that universal healthcare is going to come sooner or later and if Catholics aren’t sitting at the table, our values will be off the table. I see this fundamentally as a “life issue” in its own respect and from a pro-life perspective, the status quo is not acceptable. We may not agree on the details, but on fundamental principles of human dignity, basic civil rights, and the end goal of, in some way or another, providing universal access to quality and affordable healthcare, there should be agreement. No one should be left out. That’s the ideal goal.
Back to the fundamental question: does America have the greatest healthcare system? Not at all and I don’t even think it’s debatable. And reform is not only necessary, it is required.