Thursday, August 20, 2009

Yes, We Can, but Will We? Health Care Reform....

This is a talk I gave this morning at Interfaith Communities United for Justice and Peace (icujp.org):

As many of you know, I have a personal stake in health care because of my wife’s bout with cancer. But I’m sure all of us know of people who have suffered because of our sick health care system, so we all have a personal stake in health care reform.

Let me share a little bit of my own story. Although I have been concerned about health care reform for years, my active involvement began last year when my wife was diagnosed with cancer. That’s when health care became a life-and-death issue.

The first question that anyone asks when you are told you or your loved one has a life-threatening illness is: Is it curable? Is there hope?

The second question we ask is: Can we afford the treatment? Will we go bankrupt?

Only in America are we forced to ask the second question. In every other nation as comparatively wealthy as ours, health care is considered a right and is available to all through affordable, state-run or state-regulated insurance. Here in America health care is a commodity available to those who can afford, and reluctantly doled out to those who can't. As a result, 600,00 or more people will go bankrupt this year because of medical bills. 80% of them have medical insurance.

For a couple of weeks, my wife and I wondered if we would end up like many Americans who think they’re insured but find out that they have been excluded because of a technicality. My sister-in-law ended up with a $40,000 bill when her insurance decided not to cover the second of three treatments for her lime disease. Why the first and third treatments were covered, but not the second is one of those bizarre mysteries of our current health care insurance system that’s too long to tell here. Francisco, my Mexican-American gardener, told me that his insurance covered only half of the bills for his wife’s cancer treatment. He ended up in debt for $70,000. That’s a lot of lawns to mow!

As Michael Moore made clear in his documentary Sicko, having medical insurance is no guarantee of getting medical treatment in America.

Most Americans have health insurance, but over 52 million do not. According to census data, 84% of Americans have some form of health insurance coverage. 60% of Americans receive insurance through their employer. 30% receive insurance through the government—either through medicare, Medicaid, or the military. Only one in ten Americans has individual insurance. (So much for free choice!) 16% have no insurance.

Those with no insurance, or inadequate insurance, are the ones most at risk. According to the Institute of Medicine, around 20,000 adults die each year because of lack of adequate health insurance. More Americans die from lack of insurance coverage than die from homicide.

Indeed, it could be argued that denying someone needed medical care they are entitled to is a form of manslaughter, if not outright murder.

Many are denied coverage because of an insurance loophole known as “rescission.” This is a fancy word for denying medical care that patients are entitled to, and it’s perfectly legal under current laws—a situation Obama hopes to change. According to the LA Times, June 17, 2009,Executives of three of the nation's largest health insurers told federal lawmakers in Washington that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.




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The hearing on the controversial action known as rescission, which has left thousands of Americans burdened with costly medical bills despite paying insurance premiums, began a day after President Obama outlined his proposals for revamping the nation's healthcare system.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

"No one can defend, and I certainly cannot defend, the practice of canceling coverage after the fact," said Rep. Michael C. Burgess (R-Tex.), a member of the committee. "There is no acceptable minimum to denying coverage after the fact."

The executives -- Richard A. Collins, chief executive of UnitedHealth's Golden Rule Insurance Co.; Don Hamm, chief executive of Assurant Health and Brian Sassi, president of consumer business for WellPoint Inc., parent of Blue Cross of California -- were courteous and matter-of-fact in their testimony.
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It seems ironic that these courteous corporate killers do not realize what they are doing is tantamount to murder. It is almost unbearably ironic that an insurance company named after Jesus’ Golden Rule would engage in this murderous practice called rescission.

Despite stories such as these, people have a hard time believing that our country’s health care system is as bad as experts say. Many Americans see our bright, shiny hospitals and read about US medical breakthroughs and think we have the best medical system in the world.

It’s true that America has some of the world’s best hospitals and best physicians (many of whom are immigrants, but that’s another story). Unfortunately, this world-class medical care is not available to all. The wealthy receive more care than they need, and the poor far less than the need. Most doctors agree that the way medicine is practiced in America does not lead to the best possible outcomes. Many doctors practice defensive medicine and overprescribe tests and procedures to avoid lawsuits. Some doctors overprescribe treatment because they are paid extra for doing so. There is also little incentive for doctors to promote preventive medicine. As a result, Americans pay over twice as much as their European counterparts, and we are ranked 37th in medical outcomes.

We have the highest infant mortality rate, and the lowest longevity, of all the industrial nations.
Tragically, in some parts of the USA, our infant mortality rate is comparable to that of the poorest African countries.

For those of us in the religious community, this is a moral outrage. Martin Luther King said, “Of all injustices, inequity in health care is the most shocking and inhumane.”

Sad to say, this moral argument does not carry much weight with most Americans, even some of those in the religious community. That’s why advocates of health care reform now say we need to stress the economic, not the moral argument.

When Kathleen and I gave our talks at churches, we found that many in the religious community are open to moral suasion, but some are not. We were mostly well received at liberal churches and meetings when we talked about the need for universal health care from a religious viewpoint. But at one church, government-run health insurance was a hard sell. When I waxed enthusiastic and showed a video about a single payer option, the crowd of mostly gray-haired, retired Methodists grew restless. They raised questions about cost, and were skeptical about whether the government could run a medical insurance program effectively.

Only later did Kathleen remind me that everyone in the room was the beneficiary of government largess, namely, medicare. Many other seniors seemed to be oblivious to this fact. As one angry person said recently in a Town Meeting, “I don’t want the government to meddle with my medicare benefits!”

Medicare has been around for several decades and is so successful that many people seem to have forgotten (conveniently) that it’s run by the government. There are dire predictions medicare will run out of money, but it can be easily fixed simply by charging the rich the same percentage of their income—both earned and unearned—as the rest of us.

I am confident that medicare is here to stay because however much Americans might grouse about government-run plans, the seniors in this country would all turn into raging grannies and grandpas if it were taken away from them. They know that if they had to shop for medical insurance in the free market, most would not be able to afford it. Many would die prematurely as a result.

Why then are American reluctant to accept a government health insurance plan when 30% of Americans are currently covered by such a plan and it provides good service and is less costly than private plans?

Yes, let us proclaim this fact boldly and often: government-run plans are more efficient and more cost-effective than private plans, despite the ideological arguments of conservatives. The administrative costs for medicare are around 2% as opposed to 20-25% for private health insurance. Those administering this government program don’t receive multi-million dollar salaries for excluding people from coverage. They are often referred to as “bureaucrats,” but given their modest salaries, they should be called by the honorable old-fashioned name: public servants.

There are many reasons that Americans distrust government, some of them valid, others the result of prejudice or propaganda. A good reason to mistrust government is because it is largely controlled by corporate interests and the military-industrial complex, and does not serve the people.

Americans become outraged when they see their tax dollars line the pockets of bankers, who receive hundreds of billions in subsidies while people are kicked out of their homes and become bankrupt because of foreclosures.

I think some of this outrage is behind the blind fury that has surfaced at town hall meetings. People mistrust the government because they sense it is not working for their benefit, but rather for the benefit of some shadowy powers beyond their control. We on the left know that this “shadowy power” consists of big business and corporate elites, but many Americans do not see this clearly.

Conservatives have done a good job in channeling this populist rage against government. Instead of attacking the source of the problem—the greed of big corporations like the insurance industry and big pharma—the anti-government, anti-tax crowd lash out against Congressional leaders, seeing them as elitist and out of touch with the people, which many of them are.

One of the deep failings of America is its parochialism and its unquestioning belief that we are number one in everything because we have more weapons and bigger armies than anyone else. Most middle class Americans, especially those of European heritage, have little knowledge of other countries and are easily duped by those claiming that the public health care systems in other countries are the pits. When I told my brother-in-law, a conservative Christian, that France was ranked the best health care system in the world, he sneered: “Do you want America to be like France?” “Why yes,” I replied. “If the French make great wine, and if I wanted to start a vineyard, wouldn’t I want to learn from them? Why shouldn’t we learn from other countries that do things better than we do?”

As an antidote to parochialism, I recommend that people watch an excellent series called “Sick Around the World.” Produced last year by FrontLine, this documentary shows how five capitalist democracies have created universal health care systems that are cheaper and more efficient than ours. None is perfect—and the documentary is scrupulous about showing the weaknesses as well as strengths of each system—but all are better than ours and have something to teach us. I recommend this documentary to church groups because the journalist who put it together, T.R. Reid, is much more balanced and fair than Michael Moore, and is therefore more convincing to those who are middle-of-the-road in their political views.

I want to briefly discuss the health care system in two countries that are portrayed in this documentary--Taiwan and Switzerland—and have something to teach us about health care reform. Taiwan adopted a single payer system, similar to Canada’s, and got it up and running in less than ten years. So a major transformation is possible in a short period of time. Switzerland has a totally private insurance and health care delivery system, but it’s much more efficient and cheaper than ours. The Swiss example shows that a free market health care system can work, but it must be strictly and intelligently regulated.

As I compare these two systems to ours, keep in mind that we spend over 16% of our gross domestic product on health care—and it’s expected to rise to over 20% in the next five years if we don’t do something to cut costs. As Obama and others point out, these costs aren’t sustainable and could lead to another collapse in our economy.
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Taiwan


Twenty years ago Taiwan was in a health care crisis worse than ours. Forty percent of their people lacked health insurance coverage. Taiwan addressed this problem by adopting a "National Health Insurance" model in 1995 after studying other countries' systems. Like Japan and Germany, all citizens must have insurance, but there is only one, government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada's -- and the U.S. Medicare program.

How does it work? Taiwan's new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen has a smart card, which is used to store his or her medical history and bill the national insurer. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country's single insurer, Taiwan's health care system has the lowest administrative costs in the world.

Percentage GDP spent on health care: 6.3.% (instead of our percentage; 16%).
Co-payments: 20 percent of the cost of drugs, up to $6.50; up to $7 for outpatient care; $1.80 for dental and traditional Chinese medicine. There are exemptions for major diseases, childbirth, preventive services, and for the poor, veterans, and children.

What are the concerns? Like Japan, Taiwan's system is not taking in enough money to cover the medical care it provides. The problem is compounded by politics, because it is up to Taiwan's parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

Switzerland


What is it? The Swiss system is social insurance like in Japan and Germany, voted in by a national referendum in 1994. Switzerland didn't have far to go to achieve universal coverage; 95 percent of the population already had voluntary insurance when the law was passed. All citizens are required to have coverage; those not covered were automatically assigned to a company. The government provides assistance to those who can't afford the premiums.

How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.

Percentage of GDP spent on health care: 11.6

Average monthly family premium: $750, paid entirely by consumers; there are government subsidies for low-income citizens.

Co-payments: 10 percent of the cost of services, up to $420 per year.

What are the concerns? The Swiss system is the second most expensive in the world -- but it's still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.
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If governments in other countries can ensure universal health at an affordable cost, I say, “Yes, we can do it here.” The question is: “Will we?” I think we will, but as Winston Churchill once said, “You can always rely on Americans to do the right thing after they have tried every other alternative.”

Besides parochialism, another stumbling block to universal health care is racism: many of those opposed to health care reform are white folks afraid they are losing control of the country. They see Obama not as a duly elected leader, but as a tyrant. Hence the Vermont man who brought a loaded gun to an Obama rally and carried a sign saying that “The tree of liberty must be watered with the blood of tyrants.” After he was acquitted of all charges, a group of gun fanatics stood outside a convention center in Arizona to protest Obama’s health care program. One carried a loaded AK-47 and proudly pointed out this was his legal right. The cops agreed. I must point out when when AFSC protested during the Democratic rally in LA, they were not allowed to carry large wooden crosses because these were seen as potential weapons. How weird we American must seem to the rest of the world: it is okay to automatic weapons, but not crosses!

It is hard not to see racism behind such violent feelings, especially when this same gun-loving, Obama;hating group violently insists that health care benefits should not be extended to what they call “illegals.” As a result, Obama has had to say repeatedly that undocumented workers will not receive health care under his plan.

This is bad policy, but given the intensity of anti-immigrant feeling, it’s the politically expedient thing to say at this time. In reality, sooner or later, we must give coverage to everyone who works in America, just as they do in Europe and other civilized parts of the world.

By far the biggest challenge to health care reform is not the people, most of whom support medicare for all, but the corporations who funnel vast sums of money to influence our legislators.

What can we do to make a difference?

There are basically two choices that I see: one is to stand up for the health care plan you believe is the best, and the other is to stand up for the best possible plan.
I don’t think both options need to cancel each other out, as long as we agree to be honest and civil as we promote whatever approach we feel is best.

Advocates like Ralph Nader have taken the uncompromising approach. According to Nader, single payer (“medicare for all”) is the best option, and we should fight for it whether or not it has a chance of success right now. Nader believes that ultimately, history will vindicate those who right for single payer, as it did those who fought to end slavery, to give women the vote for women, and to pass the Civil Rights Act, etc.

Others are concerned that in our pursuit of what is best or perfect, we may lose what is good. If we can raise the number of insured from 85% to 98%, and if we can institute “consumer protection” for private health insurances through regulation, and if we can cut costs and make insurance more affordable, then we will have done a good thing and moved a step forward along the road to real reform.

Some advocates of single payer disagree. They feel that a compromise won’t work-the system itself is fundamentally flawed—and the sooner we convince our fellow Americans that health care as a right, not a commodity, and get rid of private insurers, the better.

For the long haul, I agree with the Ralph Nader approach and believe the best solution to our health care problem is to extend medicare to all Americans as soon as possible.

For the short term, however, I agree with the Quaker lobbying group, Friends Committee on National Legislation (see fcnl.org).

Here are the FCNL talking points:

1. A strong public insurance option should be made more widely available to people who want to sign up for it.

2. Insurance coverage should be available and affordable for everyone, either through employers or through affordability credits. Caps on out of pocket expenses and the competition provided by the public plan will keep health care premiums low.

3. Real reform of the health insurance market must include guarantees that no one can be denied health insurance because of their current or past health conditions, limits on co-payments and other out of pocket expenses, and requires that health insurance premiums be spent primarily on health care services instead of administration and unreasonable profits.

4. Progressive financing can be made possible by cutting back on wasteful administrative costs, reforming the health insurance market and increasing the tax contributions of wealthy households with incomes over $350,000 a year.

In addition to advocating for the public option and a bill ensuring these points, FNCL,has also suggested that we go to the offices of our elected officials with flowers to show our support for universal health and to change the tone of the debate from rancorous to civil. I find this tactic to be very Quakerly and hope it catches on and gains media attention.

Can religious communities make a difference?

Some of us may feel that it is futile to reach out to the religious community on causes such as health care or dismantling the war machine. But many in the religious community care deeply about this issue. Our voice is being heard and it can make a difference. This week I participated on a conference call with the President sponsored by Faithful Reform for Health Care. Over 150,000 people took part and I’m sure Obama was glad to know he had so many people in the religious community supporting health care reform. I receive daily emails from various liberal religious lobbying groups urging me to contact our elected officials, write letters to the editor, and talk to our friends and neighbors. I do what I can, trusting that my little drop of truth and passion can swell the choir and help drown out the voices of defeatism and fear.

These anti-tax, anti-government voices are loud, but are not necessarily taken seriously by our elected officials. I am sure that many elected officials silently cheered when Barney Frank had the hutzpah to speak truth to a young woman who asked the absurd question: “Why do you support Obama’s Nazi health care plan?” Being Jewish, he resorted to biting humor. He replied, “I will revert to my ethnic heritage and answer a question with a question: what planet do you live on?”
I love this response, but as a Quaker, I would have been obliged to say something a tad friendlier.

As a Quaker, and as a person of faith, I am obliged to counter lies whenever I hear them. We all need to do the same. This week I received a weird email from a friend I thought was sane and intelligent, and who usually is, but he got duped by a viral email claiming that p. 435 of the Obama health plan would require seniors to go for counseling on euthanasia every five years. “This is chilling,” he wrote. “Contact your elected officials and tell them you’re opposed to this plan.”

I sent him back a response from Fact Check.org showing that this allegation was a fabrication by the right to discredit Obama. What p. 435 actually says is that if people want end-of-life counseling from a doctor, the plan will pay for it, but only once every five years. This counseling is purely voluntary.

We need fight these malicious lies as quickly as we can. As Mark Twain once said: “A lie can travel half way around the world while the truth is putting on its shoes.”

The crisis in our current health care system is a sign of a deeper malaise in American political and social life. Our system exalts profits over people, and as a result turns health care into a commodity, and people into mere consumers. As a person of faith, I believe “we the people” are made in the image of God, and that each of us is infinitely precious. When we begin to think of ourselves merely as consumers, and health as merely a commodity, we lose touch with who we really are. We end up becoming addicted to consumerism, and ultimately to war.

We need to transform our core values so we can transform our society. That’s what we in the religious community are called to do. That’s our job. I ‘d like to close with words of the Talmud: "It is not upon us to finish the work, but we are not free to ignore it." (Mishna, Ethics, 2:21). And what is “the work”? Tikkun Olam, which means: “Repairing or healing the world.” Beginning with ourselves of course…

2 comments:

  1. I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


    Susan

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    ReplyDelete
  2. Dear Susan, Thanks for your words of encouragement.

    ReplyDelete