Health Care: Rx for America

Will evangelical Christians exercise a role in determining the outcome of this country’s health-care-reform debate?

Nearly everybody agrees that America’s health-care system needs fixing. But discord over the solution explains why nothing has been done so far—and why there are half a dozen competing plans floating around Congress designed to fix the system.

Liberals argue a radical overhaul is needed, while conservatives say some minor tinkering is in order. Each bill has certain special-interest groups beaming and others frightened, from senior citizens to pro-lifers, from tobacco workers to homosexuals.

Alliances have formed, and warchests are financing lobbying efforts. Already there has been considerable political jockeying by groups trying to protect their own turf or gain access to someone else’s. The health-care industry has spent $10 million on television commercials trying to plant doubts about President Clinton’s plan.

Christian groups are deeply involved in the debate, in part because of philosophical concerns about life itself. Christians are divided about how much—or even whether—the government should be involved in health-care reform. Evangelicals who stay on the sidelines may be in for a shock at how radically medical care will change.

In today’s health-care debate, political questions almost always have deeply moral and biblical elements:

• Will an operation to save the life of an elderly person be vetoed by a bureaucratic health alliance trying to save limited funds?

• Does the scriptural precept of caring for others require Christians to subsidize the health insurance of the estimated 37 million Americans who do not have access otherwise?

• Will abortion become as accepted a procedure as an emergency appendectomy?

Millions of dollars are flowing to influence Congress and popular opinion, funding everything from TV commercials to post-card campaigns. Virtually everyone, including Clinton, is prepared to compromise in order to guarantee passage of a plan that contains elements of his own package.

Clinton’s concept

The lobbying began in earnest when Clinton waved a pen during his State of the Union address and promised a presidential veto of any plan that did not contain universal coverage.

Under the 1,342-page Health Security Act (HSA) devised by First Lady Hillary Rodham Clinton, a seven-member national health board appointed by the President would set caps on how much can be spent on health care and regulate powerful regional health alliances. These large government-run purchasing pools would determine everything from which treatments are medically “necessary or appropriate” to how many medical students can pursue a certain specialty.

Under a “comprehensive benefit package” determined by the government, everyone in the same geographic region would receive a similar “community rating,” meaning the cost of insurance would be the same for the fitness fanatic as for the AIDS patient. The alliances would collect premiums from employers, who would pay 80 percent of the insurance coverage.

Organized labor is spending $10 million to promote HSA (its largest expenditure ever for a single cause), and Planned Parenthood has allocated $10 million to try to make sure abortion is included. But the U.S. Chamber of Commerce, Business Roundtable, the American Association of Retired Persons, and the National Association of Manufacturers all declined to endorse HSA despite White House lobbying. The Congressional Budget Office did little to boost its chances by saying HSAwould add $74 billion to the federal deficit by the end of the decade, not save $59 billion, as Clinton promises.

Pick a plan, any plan

Clinton’s act has inspired several legitimate contenders, including separate bills sponsored by Rep. Jim McDermott (D-Wash.), Rep. Jim Cooper (D-Tenn.), Sen. John Chafee (R-R.I.), Sen. Don Nickles (R-Okla.), and Sen. Phil Gramm (R-Texas). As if not enough plans exist, the House Ways and Means Health Subcommittee devised its own blueprint in February. Last month, 30 lawmakers—15 Democrats and 15 Republicans—wrote an eclectic plan.

On the Left, the McDermott single-payer plan would enroll everyone at birth and contain a hefty benefit package that includes vision, dental, and long-term care. The McDermott American Health Security Act would incorporate Medicaid and Medicare into a single system and, in effect, eliminate insurance companies. The system would be financed through an 8.4 percent payroll tax on firms with more than 75 employees, 4 percent on smaller firms, and a 2.1 percent payroll tax on taxable income of workers. McDermott told CHRISTIANITY TODAY, “Actually, 75 percent of Americans would spend less, when you consider all that you spend out of pocket, if you think about what you spend in deductible, and co-pays, and things that aren’t covered at all, like pharmaceuticals.”

On the Right, Gramm favors adjustment, not revamping. He says 75 percent of Americans without insurance could buy it under his Comprehensive Family Health and Savings Act, which keeps insurance in force between jobs and makes it uncancelable after illness. Gramm told CT, “I’m not going to support any plan that forces people against their will to buy health care through a government-run agency.”

The Consumer Choice Health Security Act sponsored by Nickles would allow individuals to choose from different plans and benefits. People must purchase at least catastrophic insurance to qualify for tax credits, which are not linked to employment. “People will be a lot more frugal with their own money than they would with employers’ money,” Nickles told CT, “and certainly more frugal than they would be if it’s the government’s plan.”

Division in the ranks

For Christians, health-care solutions are not necessarily evaluated in a spiritual light.

“The church has abrogated its responsibility because of the cost,” says Don Wood, president-elect of the Christian Medical and Dental Society, a group of 8,400 evangelicals. The debate often is played out along familiar conservative-liberal lines, although the demarcation may be wider than usual.

Christian Coalition is spending $1.4 million to campaign against the Clinton plan, the most expensive lobbying effort ever by Pat Robertson’s group. The money is for radio commercials, newspaper ads, a direct-mail and phone campaign, and distribution of 30 million post cards to 60,000 churches.

“It replaces the doctor-patient relationship with faceless bureaucrats, mindless red tape, and mind-numbing regulation,” Christian Coalition executive director Ralph Reed says of HSA. Christian Coalition claims the “draconian premium price controls” would lead to “long lines, extended waits, and rationing of vital medical services.” The organization also criticized the proposal for containing “a massive, job-killing payroll tax increase.”

Soon after, the National Council of Churches (NCC) backed some principles in the Clinton plan, including universal coverage and benefits covering mental-health treatment. “To measure national health-care decisions more by economic than moral or compassionate standards is appalling,” NCC general secretary Joan Brown Campbell said in criticizing Christian Coalition.

Evangelicals for Social Action president Ron Sider found fault with Christian Coalition for opposing coverage for substance-abuse treatment and mental-health care. Reed said churchgoing families are less prone to use such services, a remark Sider called “wrongheaded, callous, and lacking in compassion.”

Sider also reproved Christian Coalition for not making the “needs of the poorest” central to its agenda. Meanwhile, more than 50 predominantly liberal religious leaders have issued a pastoral letter that rejects “any effort to label a single position on health reform as ‘Christian.’ ”

The abortion debate

Numerous conservative groups have allied themselves on the abortion issue, including the two largest religious bodies in the country, the Southern Baptist Convention (SBC) and the Roman Catholic Church. C. Ben Mitchell, the SBC’s biomedical and life-issue director, and Helen Alvaré, director of planning and information for the National Conference of Catholic Bishops, testified before a House subcommittee in January.

While both Catholic and Southern Baptist leaders believe health-care reform is needed, they say they will fight to keep abortion from becoming a federal entitlement. In an unprecedented campaign, the Catholic church has printed nearly 19 million post cards for parishioners to voice their disapproval of Clinton’s inclusion of abortion in his plan.

“Reform should be judged primarily by how it treats the most marginalized and helpless members of society: the poor, the uninsured, the undocumented, and the unborn,” Alvaré says. “Genuine reform must begin from the conviction that healing, not killing, is a service owed to all human beings.” To include abortion as a mandated benefit would “assault the consciences of millions of Americans.” Under HSA, she says, regional alliances would ensure that all women had ready access to abortion, even though 83 percent of all counties now have no provider.

Alvaré and Mitchell see the Clinton proposal as a threat to religious liberty because it would require all employers to buy abortion coverage for themselves and support abortion through taxes and insurance premiums.

“By making abortion a requirement of the comprehensive benefits package, health-care reform of the President’s variety would compel every denomination and local congregation to either fund abortion or else break the law and suffer its penalties,” Mitchell says. “Every congregation, as an employer, would be required to take money from the offering plate and offer it up to abortionists.”

Pro-life input

National church offices are not the only groups opposing abortion in health-care reform. Among the harshest HSA critics is the National Right to Life Committee (NRTL) in Washington, D.C.

“Under the Clinton bill, all health plans would be required to pay for any abortion,” says Douglas Johnson, NRTL legislative director. Under HSA, he says, the federal government would buy the mandatory benefits package for low-income Americans, thereby nullifying the 18-year-old Hyde Amendment and the laws of 37 states that restrict tax funding of abortion. Furthermore, creation of a National Health Board would overrule state parental consent or waiting period laws that interfered with the abortion “benefit.”

Judie Brown, president of the American Life League, says HSA “seeks to legitimize abortion in unprecedented ways” by requiring medical schools to provide abortion instruction and spend $1.5 billion to build and operate school-based clinics.

When the Clinton plan fell into disfavor early this year, the incipient rival to gain momentum was Rep. Cooper’s Managed Competition Act. While the Cooper design has gained the most bipartisan support, it has been attacked by both liberals and conservatives for its amorphous “abortion neutral” stance. A group of 29 female lawmakers oppose Cooper’s plan because it “shortchanges women’s health.” Seven profamily groups—Christian Coalition, Family Research Council, Concerned Women for America, American Family Association, Eagle Forum, SBC Christian Life Commission, and the NRTL Committee—informed Cooper they oppose his plan unless it is amended to exclude abortion.

Nickles’s plan alone specifically prohibits abortion. “If Mrs. Clinton is successful,” Nickles told CT, “you’re going to see the number of abortions increase, its acceptability increase, the mechanisms for acceptability increase.”

Fears of rationing

Because the Clinton and Cooper bills strive for cost containment, many Christians foresee government determining when life should end.

“End-of-life decisions should not be predicated strictly upon economic restraints or government protocols,” Mitchell says. “Neither should health care be rationed or restricted upon the age, quality of life, or disability of the patient.”

“The plan Mrs. Clinton has presented really does jeopardize people with disabilities,” says Joni Eareckson Tada, president of Joni and Friends Ministries in Agoura Hills, California. “If our government puts into motion a health-care system that decides certain disabled people don’t merit life-sustaining treatment, then a further step may be taken to terminate their lives.”

“If you use up your money and you’re still on the respirator, that’s it,” says surgeon Wood. “You’re shut off.”

Tada, who was paralyzed by a diving accident at age 17, says that while it is not a federal responsibility to insure every American, the government should see to it that those who cannot afford health insurance—the poor, the elderly, the handicapped newborn and unborn—have a means to secure equitable coverage. She says pre-existing condition clauses prevent many people with disabilities from being able to buy affordable insurance. Tada advocates replacing bureaucratic “discriminatory Medicaid regulations” that “put a heavy burden on the disability population” with tax credits and vouchers.

Merrill “Buddy” Matthews, Jr., director of the National Center for Policy Analysis in Dallas, supports private high-risk pools, which 27 states have started (often via a broad-based tax subsidy) for those who have real needs and no insurance. “They usually pay a little more for the premium, but they get a whole lot more as well.”

In addition, the concept of medical IRAS has been incorporated into several bills. They allow employees to put the money their company would have spent on their insurance premiums into a personal medical savings account. Most people could buy a catastrophic policy that covers major health-care expenditures and still have enough left in the account to cover the deductible for smaller health bills, essentially providing first-dollar coverage. “The first dollars you spend at the doctor or getting a prescription can be drawn directly out of your medical savings account,” Matthews says. “You can cover yourself for a major risk, and then any money you have left over in the account that you haven’t spent you get to keep.”

Focus on the Family and the Family Research Council back the Nickles and Gramm bills that have medical savings account and tax-credit features. But, so far, Republicans have been unable to unify their plethora of rival plans. Gramm says, “I’m willing to compromise details, I’m willing to compromise procedures, but I’m not willing to compromise principles. Let’s make sure it’s portable and permanent.”

Health Reform Has Arrived

Health professionals are among the first to admit reform is needed, but not necessarily by government fiat. Some physicians are welcoming changes while others are apprehensive.

There already have been massive layoffs in anticipation of mandated federal reform, which may be years away from full implementation.

“The whisper of health-care reform has caused the whole industry to shift,” says Don Wood, a Chicago surgeon. “By the time Congress gets done with it, everything will already have changed.”

Laurence O’Connell, president of Park Ridge Center for the Study of Health, Faith, and Ethics in Chicago, says the health-delivery system began to reconfigure before Bill Clinton became President, but his election accelerated the process. According to O’Connell, an advocate of universal access, there is much waste and overtreatment in the current system. He cites an acceleration of hospital-high-tech-equipment purchases in a comfortable society wanting every pain eased, even though the infant death rate within inner-city America exceeds that of much less developed countries. He says the price of some surgeries can be done with equal effectiveness for one-tenth the cost under health maintenance organizations (HMOs).

“It was just a matter of time for insurance companies to discover they could hire their own doctors and set up their own rules and market a cheaper product,” says John Testerman, head of a university residency program in Southern California. “So we [physicians] have to call the HMO for permission to do procedures. The HMO will not prescribe certain medicines that are too expensive.”

More economical team-nursing caregivers often see hospital patients rather than physicians. Wood says doctors have been relegated to a secondary role because gatekeepers who know nothing about medicine are determining whether treatment should be allowed at all.

Doctors have experienced a 15 to 30 percent decline in annual income, according to Wood. Now, Testerman says, health-care conglomerates are the beneficiaries of big bucks.

Wood sees one bright spot: some Christian doctors who have quit are going to the mission field—where they will work unfettered.

Results of rhetoric

After months of rhetoric, House health subcommittees began actual work on health-care reform in March. Three House panels—Education and Labor, House Energy and Commerce, and House Ways and Means—have primary jurisdiction over the issue initially. Later, the Senate bills will be processed through the Finance Committee and the Labor and Human Resources Committee. Eventually a bill will emerge for all of Congress to consider.

Because no plan has anywhere near majority approval, the final product could include provisions from a multitude of proposals. Amendments—such as one to insert full abortion coverage—could be added on the floor, sparking a last-minute free-for-all. Minority leader Bob Dole could threaten a filibuster. The whole process very likely will not be finished before October adjournment.

“Rationing and abortion will be live issues through the vote, whatever the vehicle is,” says NRTL’s Johnson.

Many Christians question the wisdom of a federal takeover. “When government puts itself in the arena of moral choice, illness becomes a spiritual problem,” Wood says. Adding layers of bureaucracy to handle paying for managed care, he says, would result in treating people as machines and illnesses merely as something to be fixed.

Mitchell concurs. “Government, often with the best of intentions, sometimes breeds unnecessary bureaucracy, complacency, insensitivity, and woeful ineptitude.”

But the status quo will not suffice. “Our present system of spotty coverage is really unethical and immoral because people are falling through the cracks,” says John Testerman, family practice residency director at Loma Linda University in California. Firms continually switch to the lowest cost health conglomerate. Workers who have cancer suddenly cannot be treated because of a “pre-existing condition.” A pregnant woman may have to change obstetricians three times.

Christians may not be able to reduce health-care costs, but they can have an impact on solving societal problems that spur a need for reform. “What is causing exorbitant health-care costs?” Tada asks. “Violence, diet, drug abuse, teenage illegitimacy, promiscuous sex. This is an appropriate place where Christians can get involved.”

By John W. Kennedy.

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