I am going to start this by stating my own personal opinion on something. One of the great ministries of Jesus was the ministry of healing. The Gospels are full of healing narratives with Jesus healing people of various ailments. As result, the concept of healing is something Christians, at least from my perspective, ought to think of as important to our faith. As a result of this, from a faith and justice perspective, I believe that health care is a right of all people. As we live in a nation filled with people of faith, and as we are an incredibly prosperous nation, I believe that we have a moral obligation to provide health care to everyone. But, in saying this, I do not have the answers on how to accomplish this. I do know, however, that we are not doing a very good job.
In the latest research, the United States ranks 45th in the world in life expectancy. In a world where we possess the largest amount of wealth, 44 nations, many of which we impugn as having health care systems far worse than our’s, out live us.
There are some major factors in this, the first of which I am totally guilty. Our life styles are life styles that tend to be less active and we have poor diets. Our culture of fast food in huge portions has made us the most obese population in human history. Much of what we consume has low notational value, is highly processed, and our bodies do not really have a clue as to how to cope with the garbage we consume. As I write this, I write as one who has consumed a large amount of this stuff as well-----ask my knees how that has gone.
Our health care system tend to be really good at treating illness, but not as good at preventive medicine. Many high quality insurance programs are great at providing care to treat illness, but are not good at paying for tests and services given while we are healthy to prevent those illnesses. Some companies are beginning to change, but the change has been slow in coming and it is still inadequate.
But, as we criticize Canada, a nation with a comparable life style and a country with a nationalized health care system, we criticize a nation that is filled with people with a higher life expectancy. France, a nation of smokers who eat high fat foods, and a nation with a nationalized health care system, is a nation where people live longer than we do. Plus they have great bread and wonderful wine, but I do digress.
I write this, however, unsure that their health care system is the one we truly want.
The American health care system is broken down into several components.
The first is that we have a nationalized health care system for people over the age of 65 called Medicare. It is not an option. When we pay our employment insurance we are paying for Social Security benefits and Medicare benefits. Politicians like to refer to this as a ‘trust fund’ but it is not and never has been a trust fund. It is a tax and that tax is used to pay benefits for people over the age of 65. Lots of people like to clamor that it is a bad investment but it is what it is. It provides a support system for the aged. Many elderly people have additional health insurance, pensions, and savings that enable them to be self-supporting in their retirement years.
Needless to say, Medicare is hit hard because people over the age of 65 tend to use these benefits at a higher rate and in the last month of life most people spend the highest proportion of their benefits during an entire life time. This is a logical outcome of our system as people need more medical attention at the end of their lives.
Much of our system is based on health insurance. For many/most people, that health insurance comes as a benefit if employment. Some people have all of their health insurance paid for, and some people pay a portion of it. Health insurance rates have sky-rocketed in the last decade and so this is becoming a more and more critical issue.
People make a presumption about their health insurance providers that is not very true. The average person, if asked what their health insurance’s job is, they would say to provide payment for health services. That is the wrong answer. The primary job of health insurance companies is to make a profit and reward those who have invested in their company.
Now, before you take my head off, this is not stated in a negative fashion. This is an elementary aspect of the market.
The primary job of Dell Computers is not to make computers, it is to make a profit for investors. Dell, however, needs the ability to raise capital and make a profit, so they have to provide something of worth to consumers. As a result, they build computers in a way that enables them to have the highest possible profit margin. And, because they want recurring business, it is in their best interest to make the best possible equipment and provide follow up assistance so that they have happy customers who will keep spending money at Dell.
The primary job of McDonald’s is not to make burgers, it is to make a profit for investors. If people were willing to go to the drive-thru window and just deposit money, it would be great. However, as the average person will not do this, they must provide a product that will keep people coming back. As a result, burgers and fries, etc., become a part of the equation.
Health insurance companies are like this as well. They must provide a product for people to hand over money. It is, however, in the best interest of a health insurance to not pay for benefits. The more they spend out, the lower their profits tend to be. As a result, the health insurance industry often dictates what procedures are covered and under what the circumstances are. In recent years hospital stays have decreased in time. Some of this is indicative of better medicine and better medical procedures. Some. Much of it is dictated on the health insurance stating what they will and will not pay for and the hospital having to abide by this. If the profit is a non-profit organization, they need to avoid losing money or they will collapse and if it is a for profit hospital, like everyone else, they exist to make money for those who have invested in it.
Service providers, physicians, clinics, hospitals, labs, etc., all are looking to survive, thrive, make a living, etc. They provide services for rates and are compensated, usually for part of what they will charge, by insurance companies that state what is ‘usual and customary.’ As it is in the best interest of the insurance companies to thrive, they will squeeze down on service providers and the service providers will often tend to raise what they need to charge to get what they need.
When uninsured people are treated they get to pay the entire fee which was inflated for insurance or they pay nothing and ultimately the government has to step in. Many hospitals receive subsidies and grants from the Federal Government for a variety of things with the stipulation that they treat the poor. Many impoverished people used hospital emergencies rooms as their primary care providers making this the most expensive health care provided. All of this comes at tax payer expense, thus nationalizing another aspect of health care.
BUT, and this is a big BUT:
There is another huge factor in all of this. One of the staggering fees that service providers pay is for malpractice insurance. When we read of class action lawsuits against some drug or some treatment, we will find that not only pharmaceutical companies are involved, but physicians, hospitals, etc., are all a part of those being sued.
There are instances of real malpractice. The medical community, like every other community, has great people and not so great people practicing medicine. I have been fortunate in my life to have had highly skilled, caring physicians who do and have done a wonderful job. Unfortunately, there are others I have seen who are not nearly as good. Some people get very bad healthcare treatment and some so bad to the point that a lawsuit is the only good answer.
Many lawsuits, however, are not. As a result many doctors practice defensive medicine; they will order tests that might not really be needed, but they do so to protect themselves from litigation. They might even write prescriptions that they do not believe are even remotely necessary, but will give in to the pressure from their patients to protect themselves from a future lawsuit. In a day and age when prescription drugs are hawked on television many doctors find themselves being ‘forced’ to write prescriptions for people who are enchanted by the marketing they watched.
Who wouldn’t want a drug that gives them the strength to carry two bath tubs into the back yard for mutual bathing?
Many lawsuits are frivolous. Many service providers have chosen out of court settlements to avoid long, costly trials. They do so at the urging of their own insurance companies which protect them and find it in their best interest to pay out small sums instead of large sums because they too are looking to make a profit. As a result, a non-compliant patient may have gotten good medical care, the proper diagnosis, but their failure to approve of a test or a treatment led to a graver illness----and so they sue the doctor.
As a result, malpractice insurance, for most doctors and service providers is a staggering expense that is passed on to consumers, health insurances companies, and the government.
What has to happen?
We need better preventative care. We need to have an continue to have great service providers. We need to have be able to have legal services to protect patients, but abuse the system. We need a very different system than we have now. Alas, I don’t know what exactly that will look like.
But this I know. My faith teaches me that health care and healing is a God given right to all people. We have to find a way to accomplish this.