Healing The Health-Care System

How should Christ’s mandate that we care for “the least of these” guide our national debate on health-care reform?

If the ambitious Clinton health-care plan becomes law, credit should probably go to the massive failure of our current haphazard patchwork of private and public “insurance.” Actually, the Clinton plan joins several Republican proposals, all conceived under the same lament: the system is indeed broken.

Consider this case for health-care reform:

Mr. Swanson (not his real name) is a 55-year-old man who recently lost his job at a small, engine-building company. He has severe high blood pressure and diabetes requiring four different medications. He makes an appointment to see me because he lost his insurance with his job and cannot afford to see his doctor or fill his prescriptions. I am a primary-care physician at a county hospital. My examination shows us what happens when a patient cannot afford medication. Mr. Swanson’s blood sugar level is twice normal, his blood pressure is dangerously elevated, and he has had exertional chest pain for several weeks. He tells me his medications were costing him $120 a month.

I put him back on his medicines, add aspirin and nitroglycerin to keep his arteries open, and send him to our cardiologist to begin evaluation for heart disease. The cardiac catheterization reveals life-threatening blockages in both the left and right coronary arteries, so Mr. Swanson has an angioplasty, a procedure that uses a balloon to widen the arteries from the inside. Mr. Swanson’s blood pressure and diabetes come under control. He begins occupational therapy and looks for another job. His hospital bill is over $10,000, which he cannot pay.

Could it happen to you?

If you think your health status is much more secure than Mr. Swanson’s, consider our current situation:

• 35 million people in this country do not have health insurance at all, even if they work full-time.

• 20 million people, including some reading this editorial, are underinsured and have poor coverage.

• Even those of us who think we have good insurance sometimes find it fails us when we need it most (loss or changes of job, disabling illness, pre-existing condition, or an employer switching to a less comprehensive plan).

Everyone is vulnerable. Many of us are one serious illness away from our own personal health-care crisis.

So reform is needed, and President and Mrs. Clinton deserve credit for pushing the debate forward. But what should reform accomplish? As Christian citizens, we ought to insist on at least these five goals:

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1. Care for those in need. The primary focus of reform should be to provide health care to anyone in medical need, regardless of ability to pay. Providing care for those who need it is one of the strongest ethical principles found in the Bible. Our Lord clearly articulates the requirements to care for and comfort the sick and to treat “the least of these” decently (Matt. 25:40).

2. Improve doctor-patient relationships. The Great Physician healed persons, not cases. He looked at the sick and the lame, listened to them, talked to them, and touched them. Good health care requires personal relationships. The doctor must know the patient’s case, and that does not always happen from only reading charts. Being physically and emotionally available and then staying with the person over the long haul is the hardest thing about being a doctor. But it is crucial for both patient and doctor. The high current rate of physician and patient “turnover” due to changes in health plans should be decreased.

3. Promote prevention. We often prefer high-tech care to more fundamental preventive and primary care. We opt for dramatic surgery over quitting smoking or having yearly mammograms. But as Dr. David Larson of the National Institute for Healthcare Research has shown, “those who follow biblical values live longer, enjoy life more, and are less diseased.” The new health-care plan must encourage and promote healthy living or health-care costs will double in six years to more than $1.5 trillion yearly.

4. Change economic incentives. This is really a matter of stewardship and priorities. I am paid more for putting in three stitches or looking at a hemorrhoid through a plastic scope than I am for spending a half-hour counseling a patient who is trying to stop using cocaine. The current system tempts physicians in training to think more in terms of procedures than persons. Spending time with patients is not presently a cost-effective way to pay back those $100,000 medical school debts.

5. Be honest about the cost. True reform will be costly and inconvenient. When we increase access to health care, costs will initially increase despite spending caps and other cost-containment strategies. Under President Clinton’s plan, the cost will be an estimated $350 billion annually between 1995 and 2000. We cannot expect smokers to pay for much more than one-third of the cost. (You can’t really tax sins, you have to tax the sinner!) Jesus did not give the responsibility to care for the health of others just to sinners who are smokers. All of us sinners will have to pay up.

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Evaluating the plans

How far do the current plans go in meeting these goals for reform?

The Clinton plan includes an overall structure to control costs and ensure access, a very generous core benefit package, with universal health benefits coverage through a Regional Health Alliance. Business would pay 80 percent of the cost of insurance with some provisions for smaller employers. Also included are insurance reform, medical-malpractice reform, and slowed price increases on prescription drugs.

Each consumer alliance group of 500,000 consumers would have powerful bargaining potential in negotiations with health-care providers and insurance companies. Increased competition among specialists for patients within the alliance and a focus on training more generalists would probably lower physician salaries. Claim forms would be standardized, saving money on paperwork. The plan contains features of cost containment that have already been implemented in HMOs and other forms of managed care.

The Chafee and Hastert plan on the Republican side encourages purchasing cooperatives like Clinton’s “alliances,” but would give the cooperatives less power. These plans avoid saddling businesses with most of the bill for reform, but coverage for the uninsured would be phased in or left to the states rather than assured up front. The Hastert plan and the plan of Gramm and McCain offer the interesting option of allowing us to set up individual tax-free Medical Savings Accounts to pay for the first part of expenses each year. Others support a single-payer plan in which the government is the nation’s health insurance company.

Most desirable would be something less ambitious and costly than the Clinton plan but more aggressive than the Chafee and Hastert plan. An appealing asset of the Clinton plan is its assurance of medical care for the poor and uninsured. The Republican emphasis on controlling costs and encouraging individuals to pay for their own medical care so far as possible is also attractive. Single-payer plans should be dismissed: They do too much violence to the present system, running rough-shod over the positive aspects of our many-faceted and innovative medical infrastructure.

If we are to end up with a system that is significantly better than what we now have, legislators will have to set politics aside. Neither side has come up with the perfect plan, but both parties have introduced innovative concepts that deserve debate. What is most encouraging (and ought to compel Christians to enter the debate) is that politicians and everyday Americans have mutually focused their attention on the health-care system. We are finally thinking about what it might be like to be Mr. Swanson.

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By consulting editor David Schiedermayer, associate professor of internal medicine at the Medical College of Wisconsin and a primary care, physician.

A Holy Disturbance

The 1993 Parliament of the World’s Religions has come and gone, fulfilling its advance billing as “the greatest gathering of religious leaders ever in terms of diversity.” The d-word did not disappoint. The spectrum stretched from Buddhist to Bahai, from Muslim to Mormon, from Unitarian to Zoroastrian. Though convened to promote world peace and religious harmony, the meeting was marked by raucous debate and name-calling, as representatives of the various religious groups excoriated one another for bigotry, intolerance, and crimes against humanity.

From the perspective of historic Christianity, the week’s most significant event was the walkout of Orthodox Christians. In good conscience, they said, they could not participate in a religious assembly with groups that professed no belief in God! Who provoked this Orthodox protest? Was it the Zen Buddhists, the Fellowship of Isis, or the Covenant of the Goddess, whose devotees held a ceremonial Full Moon dance along the shores of Lake Michigan, chanting, “We are one with the soul of the earth”?

When Saint Paul encountered the rather less bizarre religious syncretism of ancient Athens, his “spirit was provoked within him” (Acts 17:16). Rather than adding still another altar to their already crowded pantheon, he preached a sermon on God as Creator and Judge and Jesus as Redeemer and Lord.

Thank God for the Orthodox who still sense a holy disturbance in the face of modern neopagan idolatry and refuse to connive at it. Paul would be proud.

By senior editor Timothy George, dean of Beeson Divinity School, Samford University.

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