Friday, August 7, 2009

Health Care

The need for health care reform is a subject upon which in principle all men of good will in the United States can seem to agree. It is almost universally agreed upon that our health care system is in trouble and that action must be taken to fix the problem. As always the actual problems are masked in flurry of political posturing.
The problems with health care in the United States can be divided into several key areas. First, the number of uninsured continue to grow. Second, the majority of U.S. Citizens above the age of 65 have health care either partially or entirely provided by the government funded Medicare program. Third, a majority of Americans receive their health insurance through their employers, most commonly through a cost splitting arrangement. The increasing cost of this arrangement is causing increased overhead for employers and financial hardship for workers.
Approximately 45 million people in the U.S. are uninsured. Of this number approximately 11 to 12 million of these people are foreign born, the majority of them in the United States illegally. The population of the United States is estimated to be approximately 305 million people. So approximately 15% of the population is uninsured.
About 9 million of those who are uninsured could afford insurance if they so chose. Another eleven and a quarter million is eligible for coverage under existing government health programs, should they apply. The rest are simply unable to afford health coverage. As many as a tenth of those could afford regular group coverage but due to pre-existing conditions cannot afford, or will not be accepted for individual health insurance.
The fact that so many people can not or will not get health insurance coverage is a problem because, quite apart from the Christian principles that call for access to medical care for every individual based upon their inherent dignity as a being created in God's image, most of these people are not unable to get health care in an emergency. The law requires that any hospital receiving public funds care for anyone who shows up at their emergency care facilities, whether they have insurance or not. Of course emergency care is some of the most expensive health care available. Members of this group are also likely to be sicker and live a lower quality of life because they wait to receive medical attention until their problems are acute. This also requires that more expensive treatments be used, because chronic conditions, which can sometimes easily be treated with drugs, not themselves always cheap, must instead be treated with expensive invasive procedures.
The number of people covered by Medicare is approximately 45 million people, the majority of whom are over 65. As of last year Medicare is 14% of the national budget. In the next few decades the number people on Medicare is expected to almost double, while the number of people paying in to support the program is not expected to rise consistent with this increased funding need. Medicare is a unfunded liability which will require a larger and larger percentage of the GDP. It is a program which is basically unsustainable. In 2007 Medicare cost $440 billion of which approximately $60 is thought to have been the result of fraud. In other words over 13% of the cost of Medicare is wasted.
In the last eight years the cost of employer provided health care has increased 78%. There are several reasons for this increase in cost. Advances in medical technology add to the cost of health care. New diagnostic equipment, pharmaceuticals and methods add to the cost of care. Liturgical considerations, that is the cost of malpractice insurance and litigation which results in reimbursements and penitential awards have some effect. The increased care required by a culture which tends to promote both overeating of unhealthy food and lack of physical exercise is arguably the greatest contributor to cost.
Note that in the above discussion problems with the actual quality of care, the ability of medical organizations to carry on research or for researchers to deploy new treatment options are not negatively impacting American health care, which is seen internationally as the best in the world.
The huge health care crisis is a money crisis. It is also no wonder that solutions being proposed by congress and the Obama administration are solutions based on improving the bottom line, not on improving care. Like old style efficiency experts and corporate managers their goal is a hard nosed cost analysis based change, not a change based on Christian social values. The end game is not the highest quality care for all, but something called “equitable” care, a euphemism for health care rationing. Everyone will have health insurance, but that health insurance will be as meaningless as the “universal” care possessed by citizens in Canada, Britain or France. Though I have no doubt members of Congress and the President will continue to enjoy the best health care America can provide.
Such a financially centered modification of our health care system would enjoy dubious support of Christian organizations on its best face. The fact that the present effort in health care reform is actually using the financial justification as a distraction to hide the real agenda of the Administration which is to use reform to push federally financed and mandated abortion support which will be used as a club against Catholic hospitals and medical professionals who oppose abortion. Also being hidden in the plus 1000 pages of the reform bill are attempts to destroy the private insurance industry, the one part of the American health care system which provided freedom from the tyranny of a government run health care system. Efforts to control and collect medical information about patients, who as U.S. Citizens should be protected from government intrusion in their private lives.
The cost of continuing to support the existing Medicare system, while effectively doubling the number of people covered is only the down payment. If Medicare is unsustainable how can doubling the size of the program be sustainable? Of course the 85% of those now covered by private insurance will not remain so. I have seen nothing in the bills rolling through Congress that will in any meaningful way prevent employers, large and small from dumping their employees onto the public health care system. This is the almost sure result and barring other factors the cost of health insurance continues to rise. In the present environment of high job turnover even if employers were prevented from dumping present employees, if they were allowed to simply not cover new employees, in a very short time, measured probably in years not decades a majority of the workforce would almost certainly land in the government program.

So what's the Christian answer to these problems?

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