Friday, September 18, 2009

September 18, 2009 - Worse than Drunk Driving and Homicide Combined

It's worse than drunk driving.

It's worse than homicide.

It's worse than drunk driving and homicide combined.

What is it that causes more Americans to die each year than either of these two fearful scourges?

Lack of medical insurance.

So says a new study released by Harvard Medical School. If these numbers are correct - and with a Harvard cachet, most would conclude they probably are - our country's healthcare crisis is worse than nearly all of us imagined.

It's a stark number: 45,000 deaths a year. That's how many American deaths the Harvard experts attribute to lack of medical insurance. One death every 12 minutes.

About a year ago, one of our daughter's high-school classmates was struck and nearly killed by a pickup truck, while crossing the street in a designated crosswalk. She survived, but with brain damage, blindness in one eye and mobility issues that could result in lifelong disability (we continue to be hopeful for recovery). A friend who was walking beside her was knocked off balance but escaped virtually unscathed. The truck's driver - who tried to flee the scene but was later apprehended - was reportedly very, very drunk.

The community was outraged. Their outreach to the family, both in terms of fund-raising for medical expenses and simple human kindness, has been awe-inspiring. (The family does have medical insurance, by the way; it just wasn't enough. What private-insurance policy would be, for such devastatingly high bills?)

Yet, where is the outrage when another family's house goes into foreclosure because of unpaid medical bills due to lack of insurance - or even due to a policy that looked good on paper but came up lacking, once Big Insurance's casuistic cost-cutters had sharpened their knives?

Where is the outrage when a young mother, just told she has Stage IV breast cancer, admits she felt several lumps months before, but delayed going to the doctor while she was between jobs? She waited too long. The cancer had advanced.

She knew, she confided in me later, that if she received a diagnosis while still unemployed and without insurance, her treatment for a pre-existing condition would probably never be funded. Never.

Knowing breast-cancer treatment can drag on intermittently for years, she did a grim mental calculation and concluded it was worth a roll of the dice. She lost. Yet, why should a human being, a child of God, ever have to roll such dice at all?

These aren't mere statistics. These are people I know personally. What's more, such stories could belong to any of us.

Any of us. (Unless we happen to be super-rich.)

I'm not an activist by temperament. I have political convictions, but on most issues I try to keep them to myself, not wanting to limit the reach of my ministry. Yet, I'm a cancer survivor who's looked into many a careworn face on the far side of a doctor's waiting room. I'm also a pastor who's held many whispered consultations with family members at the foot of hospital beds. I'm aware of how huge this problem is, how deep its personal bite can be. The Harvard statistics confirm what I've long known, on a gut level, to be true. Some - maybe even some of my parishioners - may wish I'd remain above the political fray on this issue. But, I can't. Lives are literally at stake.

It's not that those who oppose increased government involvement in healthcare funding are bad people. They have their own convictions, their own ideologies. Some honestly believe, as a matter of principle, that the private sector can do medical insurance better than the government can (despite compelling indications that Medicare beats the average private-insurance policy hands down, on most metrics). Yet, when it comes to the large number of Americans who have reasonably good insurance and who've never faced a major health crisis, they have no idea. They simply have no idea how close they or their loved ones are to the abyss. Each and every day.

As my daughter's friend has discovered, it's as close as one second in time when stepping out into a crosswalk.

This morning I was reading an eye-opening article, "No Country for Sick Men," in the latest issue of Newsweek. The author, T.R. Reid, makes a number of telling comments:

"'You have to understand something basic about Canadians. Canadians don't mind waiting for elective care all that much, so long as the rich Canadian and the poor Canadian have to wait about the same amount of time.'

In that last sentence, [Saskatchewan Medical Society official Marcus] Davies set forth the national ethic of health care in his country: medicine is not a commodity to be sold to the highest bidder, but a right that must be distributed equitably to one and all. In short, the Canadians have built a health-care system that neatly fits the Canadian character: ferociously egalitarian, but thrifty at the same time."

(It's a question of fundamental values, in other words.)

"But the most important influence of national culture can be seen in the most basic question facing any country's health-care system: who is covered?

On this fundamental issue, the United States is the odd man out among the world's advanced, free-market democracies. All the other industrialized democracies guarantee health care for everybody - young or old, sick or well, rich or poor, native or immigrant. The U.S.A., the world's richest and most powerful nation, is the only advanced country that has never made a commitment to provide medical care to everyone who needs it."

(Are we really so narcissistic in this country that we think we can be so right, and so many other nations so wrong?)

"Those Americans who die or go broke because they happened to get sick represent a basic moral decision our country has made. All the other rich countries have made a different decision: they cover everybody. A French physician, Dr. Valerie Newman, explained it this way: 'You Americans say that everybody is equal,' she said. 'But this is not so. Some are beautiful, some aren't. Some are brilliant, some aren't. But when we get sick - then, yes: everybody is equal. That is something we can deal with on an equal basis. This rule seems so basic to the French: we should all have the same access to care when it comes to life and death.'"...

(Isn't that just common sense?)

"That principle seems so obvious to people in Europe, Canada, and the East Asian democracies that health officials asked me over and over to explain why it isn't obvious to Americans as well. 'The formula is so simple: health care for everybody, paid for by everybody,' a deputy health minister in Sweden told me. 'You Americans are so clever. Why haven't you figured that out?'"...

(Oh, to see ourselves as others see us!)

"In the U.S.... some people have access to just about everything doctors and hospitals can provide. But others can't even get in the door (until they are sick enough to need emergency care). That amounts to rationing care by wealth. This seems natural to Americans; to the rest of the developed world, it looks immoral."

Yes, there are legal, economic and political aspects to America's bitter healthcare debate. Yet, I'm becoming increasingly convinced that the line of argument that dwarfs all these others is the moral one.

As a preacher, that's my department. And that's why I refuse to keep silent.


Anonymous said...

Egocentric - narcissistic? We will have to kindly agree to disagree. I respect your opinion but I will say that you are also not looking at the entire picture. Why, as others have mentioned, do we feel the need to hand over the control of our health to a government that can not handle other areas without problems? Where is the 900 billion plus coming from to fund this proposal? If we do not look at how this is being funded, then we can not be upset when it falls apart later and by fall apart I mean that services suddenly are being denied or put off. I also know those who have been affected because of medical bills and I do think that we need a safety net for them - I do not believe that it needs to come in this manner. That does not make me unkind nor does it mean that I am less than you - it just means that I believe we need to find a different manner to reach the common goal. In your quest to share your opinions, I ask that you begin to talk with people with opposing opinions and really listen and not simply shut them down. It is through listening to all sides that we can at least begin on a common ground. I don't think people are saying we don't want to help - we just need to ensure that the help we say we can offer is the help we can deliver and right now with this bill it simply isn't possible. If you think that this is not so - look at the concerns about Social Security....

Craig Gregoire said...

Amen, keep preaching! I read the newsweek article myself and watched the Frontline show by TR Reid as well.

I agree, the basic issue is a moral one. How can we proclaim that the US is a "Christian" nation, when it's so obvious we care so little for our fellow man?

Anonymous said...

Being a Christian does not mean that we jump in the ocean to save a drowning person without first knowing how to swim. Can you please talk about what this bill includes - I know that it's over 1,000 pages long and has a lot of legalese - but really if we are going to start saying that people who don't support this bill are not Christians then we should be able to say just what this bill is asking us to do and at what cost. I am amazed that because people don't agree with this bill that people are suddenly judging them as not being believers in Christ. I don't know anyone who disagrees with this bill that is saying we shouldn't help others. HOWEVER, it must be a plan that will work, with a sustainable budget, that does not take from those that are most vulnerable. It does absolutely no one any good to throw together a plan that in the long run will not help those we seek to help.

Carl said...

Never did I claim that anyone who supports or doesn't support a particular bill before Congress is not a Christian. I'm just trying to make the case that healthcare reform is an issue with a strong moral dimension, and that - from the Christian standpoint - seeing to the needs of the sick and the poor (two terms which, in our dysfunctional healthcare funding system, are often synonymous) ought to be a high priority.

LeighSW said...

Very well said. The issue of health care is most certainly a moral one. If it is not addressed now in one way or another, it will only get that much worse and that much more difficult to address.

Anonymous said...

God Bless You, Carl! I couldn't agree more. Rock on. I can only hope that the people in Washington can get something sensible done. This time. MB

Anonymous said...

You're right - helping those in need - whatever the situation - is morally right. That being said, how do we approach this issue? Because it is morally reprehensible to just simply say go with anything because it's better than nothing. It's not that Americans are saying we don't want to help those in need - what we are saying is show us something that will not only work now but 10, 20 , 30 years down the road. While we are putting our ideas together and submitting them to our representatives, I would hope that the churches and communities are helping those in need. Perhaps you can share a good news story - maybe those you spoke of were helped by your congregation.

Anonymous said...

Carl, the quote, "rationing care by wealth" was a shocking reality check. It's also, unfortunately, a good description of our system.

I don't know the answer to all the issues, but our country does indeed need to face the moral issue of - do we die because we're poor, or do we die because all efforts have been exhausted? (No, we won't be asking - despite the fear-mongers - "do we die because some government death board says so?")

The choice is not between rationed care and our current system - in that system health care is already rationed by wealth. The choice is between coverage for all or coverage for the privileged, myself included.

As for stories, you and I know that the financial magnitude of these health crises often exceeds our church's entire budget. Deacons help put band-aids on, to keep people from sleeping on the street, or to pay for prescriptions. But there isn't enough money in one church or the whole local ministerium to cover what's needed. The only way to cover all of us is for all of us to contribute to a program that limits costs by its very nature.

Those without insurance pay higher fees than the unrealistically low negotiated fees our docs get from our insurance companies. There are too many fingers in the pie - we need a health care system that is not based on paying outrageous dividends and bonuses.

And that, as far as I can see, is the only way to limit costs. It also stands to reason that offering preventive and regular well-care to everyone will avoid our system having to absorb the inappropriate use of ERs for preventable issues or things that could be taken care of if a person had an affordable primary care physician -- not to mention the high financial, social, and labor-force cost of delayed treatment.

Rock on, Carl!

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