Morality and the Health Care Crisis in America

I’ve been meaning to do a post about health care ever since the health care reform bill was debated and passed last year. I’ll approach health care in two posts, first by discussing American health care (pre-reform) and the immorality of the status quo. In my next post, I’ll compare the varying types of universal health care systems and examine the recent health care reform bill.

Health care reform is not just a political issue for me- it’s also a moral issue. There is nothing more fundamental to one’s well-being than their health. One’s ability to obtain an education, to acquire and hold a job, and to sustain a family is entirely dependent on their physical and mental health. If we, as the world’s most wealthy country, were happy with the pre-reform status quo, with leaving millions of lower and middle working class Americans either under-insured or uninsured, and were content with a system that bankrupts people when they become sick and lose their jobs as a result, then we’ve had a significant moral lapse. As I pointed out in a previous post about a “culture of life,” can one truly claim to be “pro-life” when they are content to let people become sick and die for lack of treatment in the wealthiest, most powerful country the world has ever known? I’ve actually had some conservative friends argue as a counterpoint that anyone can be seen in an E.R. (at taxpayer expense), thus there is no need for reform. E.R. access as the sole point of access to health care is woefully inadequate. So, say someone has cancer, do you think they can go to the E.R. for chemotherapy? It doesn’t take a health care professional to explain that the E.R. can handle only emergencies, not medium and long-term care for the seriously and chronically ill, not to mention cost-saving and life-enhancing preventative medicine.

Let’s briefly examine health care in America, pre-reform. (It’s worth noting the central features of the new health care reform bill will not be fully enacted until 2014.) In 2000, the World Health Organization (WHO) ranked the world’s health care systems based on multiple criteria, including the overall level of population health (i.e. infant mortality rates, rates of preventable disease), health care inequalities within the population, and responsiveness of the health care system. The U.S. was ranked at number 37, just behind Costa Rica and barely ahead of Slovenia and Cuba. It was a dismal, albeit unsurprising showing for the U.S. health care system. Before examining some of the major problems with pre-reform U.S. health care, it is important to point out that the WHO rankings were not a condemnation of U.S. health care professionals, who are among the most highly skilled in the world. When opponents of health care reform claim that the U.S. has the best health care in the world, perhaps what they are referring to is American medical professionals, who are truly among the best. However, the debate about America’s health care system is not about the skill set of America’s health care professionals- it is primarily a question of access. And when it comes to access, our system performs exceptionally poorly.

The approximately 45 million uninsured Americans predominantly come from households with at least one full-time worker. Most poor already have access to adequate health care through Medicaid, so health care reform was not about creating a new entitlement program for the poor, as some detractors claimed, but was about ensuring access to adequate health care for America’s working class. The pre-reform health care system is one in which the working poor and lower middle class disproportionally suffer from lack of access to adequate health care. Those affected by the health care reform bill are people whose employers do not provide health insurance, which is about 40% of America’s work force. Factcheck.org offers a great statistical synopsis of the uninsured, setting the record straight for those who falsely assert that most uninsured are illegal aliens. According to a study cited by Factcheck.org, 79% of the uninsured are U.S. citizens. The other 21% are comprised of both legal and illegal immigrants. Twenty percent of the uninsured are children, meaning that millions of American children do not receive the routine pediatric care that is required to ensure that children have a good start a life, including vaccinations and key screenings for illnesses and birth defects. (Again- how can someone say they are “pro-life” when they don’t have a problem with this situation?)

Here are a few more facts to consider:

  • Prior to the recent recession, the number one cause of personal bankruptcy in the U.S. was health care expenses. This is not an efficient way for a modern economy and society to operate; it contributed to the real estate crisis when many people had to sell their homes to pay off major medical bills because they were either uninsured or under-insured.
  • The U.S. is the only industrialized country that does not have universal health care access for its citizens.
  • The U.S. spends far more money on health care as a percentage of GDP (about 17%) than any other country, yet the overall level of our public health as measured by infant mortality, life expectancy, levels of preventable disease, etc, is significantly less than that of most other industrialized countries. In other words, we get much less bang for our health care bucks than do other modern countries.
  • The often criticized National Health Service of the United Kingdom costs British taxpayers only about 7% of GDP compared to the 17% of GDP health care cost burden in the U.S.
  • For decades, many health insurance companies in the U.S. have had morally reprehensible practices such as canceling insurance policies of individuals after they became seriously ill, denying coverage to people (including children) with pre-existing conditions, and placing annual and lifetime caps on benefits- an assault to the seriously and chronically ill. There are many documented cases of people actually dying after their insurance canceled their coverage and they had to stop receiving treatment because they couldn’t afford to pay the bills (especially since most serious illnesses prevent people from being able to work).

My family’s health insurance premium in 2010 was over $11,000. Fortunately, much of that was covered by my employer; however, I’ve subscribed to one of the least expensive health care plans that my employer offers. This doesn’t include any dental coverage beyond the annual cleanings and has relatively high co-pays. Now, imagine a lower-working class employee with a family making $30,000 per year, who works for a small business that does not provide health benefits. There is really no way that employee can afford the full premium of my relatively inexpensive plan. If that employee wanted to purchase a plan comparable to mine, they would have to pay significantly more than the $11,000 that my plan cost because they would purchase insurance at the individual rate rather than the discounted group rates available to larger employers. So, in most cases, such a low income family would forgo health insurance.

I think it is frankly immoral for our country, the wealthiest on earth, to allow these types of situations to occur. The working-class breadwinner in this scenario, who is as hard-working as Americans who have health insurance, is forced to live in a situation where his/her family is one serious illness away from personal financial disaster. Because Medicaid will only cover those who have little or no assets (including home equity, retirement accounts, etc.) and practically no income, such a family would have to sell their house and stop working before they qualified for Medicaid. This scenario, which is all too typical in America today, has precisely the wrong incentive structure. The working poor shouldn’t need to quit their jobs and sell their homes and other meager assets to qualify for Medicaid when they become ill. This situation is not only bad for those families, it is bad for our economy as a whole because it contributes bankruptcies, home foreclosures, and leads to reliance on government welfare programs.

We need to ask ourselves, why do we spend far more on health care per capita and as a percentage of GDP than the rest of the world, but have far poorer public health than other industrialized countries? Why do we accept a status quo where such a large portion of working Americans and their families cannot afford to purchase health insurance? I believe that the criteria for receiving adequate medial care should be based on the clinical need of the patient, not one’s ability to pay for it.

Although the Law of Consecration was abandoned because of the early Saints’ inability to adhere to it, the Lord’s declarations are still relevant: “But it is not given that one man should possess that which is above another, wherefore the world lieth in sin,” (D&C; 49:20). Third Nephi chapter six, which discusses how the Nephites descended into wickedness in the run up to Christ’s visit to the Americas, proclaims, “there became a great inequality in all the land,” after the people became distinguished in ranks or classes by their riches and chances for learning. In contemporary America, a great inequality exists in the land with respect to the most basic of human needs- good health. And this is primarily due to a lack of access to adequate health care. Although the health care reform bill is imperfect, I’m very grateful that our lawmakers, after nearly a century of efforts to create universal health care in America, have finally acted to redress this great inequality.

6 Replies to “Morality and the Health Care Crisis in America”

  1. I'll be honest with you Aaron, I've been waiting on two root canels for almost a year because my "discount" program's deductable will cost me over 1K. When there are so many other bills to pay, it's so easy just to overlook or ignore one's health when it is so costly.

  2. James- Good point. I can definitely sympathize with that. With the amount of money the average citizen who actually has health insurance ends up paying in premiums, its really sad how much more they have to pay out of pocket for major procedures (like root canals). I'm just astounded by how much more our country spends on average for health care than other wealthy countries and how much less we usually get for that money.

  3. The immorality of the status quo is the same as the immorality of the ACA. It is immoral for the government to do anything for a person that he should be doing for himself. It is immoral for the government to take from the productive to give to the capable unproductive. LDS doctrine also states that it’s immoral to expect the government to take care of the poor/needy in our families & neighborhoods when we should be doing that ourselves. If I don’t care for those who I’m able to help, I face condemnation. Petitioning the government to do what I should be doing does not absolve me of my personal responsibility.

    1. Travis, thanks for commenting, but I’m wondering if you even read the article. ACA isn’t about providing health care to the poorest, who already have Medicaid. It’s about helping the WORKING poor and even many in the lower middle class whose jobs do not provide health insurance and who cannot afford it on their own. You obviously haven’t checked into pricing of individual health care plans. And you are incorrect- LDS doctrine does not state that it is immoral for the government to help the poor and the needy. President Hugh B. Brown of the First Presidency once warned us in matters of politics: “Allow within the bounds of your definition of religious orthodoxy variation of political belief. Do not have the temerity to dogmatize on issues where the Lord has seen fit to be silent.” That’s precisely what you have done. The current Church leadership manuals state that it is sometimes appropriate for members to turn to gov’t assistance in times of need.

  4. I have a few issues with the characterizations you make in this post. At one point you write that you can’t get cancer treatments from the emergency room. As someone who has worked in a cancer treatment hospital I can assure you that patients are treated regardless of their ability to pay. I can also confidently state that Medicare is by far the most difficult and unbending of any insurance carrier to work with, both for provider and patient.

    You use the WHO report to prove US healthcare is poor. That study includes in its rankings things that have nothing to do with the adequacy of health care. Things like how progressive of an income tax we have. When you look at the actual health care related items, the US is first in patient satisfaction and outcomes. We are first in inventing new procedures and technologies. Virtually every medical technology we use today, things like MRI machines etc, were invented in the US health care system. Just about every nobel prize winner in medicine for the last 30 years has been either an American or completed their studies or research in America. What the US healthcare system produces is much better than does any other country in the world.

    The 45 million uninsured number is dubious. Nearly a quarter of them are already covered by Medicaid or SCHIP. 20% are non citizens. A third are either significantly over the poverty level or are young, single, and childless. In other words, there are not 45 million people in this country who are too poor to afford insurance. The number is considerably smaller. As such, it doesn’t make sense to support such a huge overhaul and takeover of the healthcare system when you really ought to be targeting just a few million people.

    The one part of this post that I wholeheartedly agree with is that our system is expensive. Unfortunately, the ACA does very little, if anything, to curb those costs.

    It’s a leap of logic to state that health care and health insurance is expensive and therefore we should support the ACA. There’s a very important step missing from that equation.

    Healthcare solutions in this country need to revolve around answering the question of why it costs so much.

    1. Cameron, thanks for taking the time to read and comment. In my post I said nothing to denigrate the quality of care provided to Americans who are fortunate enough to have insurance. I agree with you, the quality of health care available in the U.S. is world-class- definitely some of the best out there. That’s not the flaw in the system. The problem is our DELIVERY system. We have one of the worst, most inefficient health care delivery systems in the world. Part of that is the problem of the uninsured, which ACA does a lot to overcome. I’d like to see some data backing up what you’ve claimed, that 25% of the “uninsured” are covered by Medicaid or SCHIP. The non-profit, non-partisan Kaiser Foundation, from which the Factcheck.org link I put above obtained its information, indicates to the contrary. One positive trend we’ve seen since the implementation of ACA is a deceleration of the rate of health insurance premium inflation. When the mandate goes into effect in 2014, we’ll almost certainly see a much more significant slowing down in premium increases. It’s a matter of simple insurance pool economics- by inserting many younger, healthy people into the risk pool, we’ll have relatively lower premiums. But I agree with you that ACA does not go nearly far enough to control health care costs. The vast majority of our HC expenditures go towards a very slim portion of the population. But we cannot have an adult conversation in this country about end-of-life care when both parties are accusing each other of trying to throw grandma over the cliff. Thus, I see ACA is a very important first step in reforming the system. As with some of our other entitlement programs, reform came piecemeal, not all at once. We need further reform of the HC system to do more about controlling costs.

      I contend with your comment about those who cannot afford insurance or to pay hospital bills getting free cancer treatment. Perhaps that is true at your hospital (they must have some wealthy philanthropic supporters), but it certainly isn’t true throughout the country. I have immediate family and friends who work in the health care industry who’ve pointed that out. And, expanding the example, hospitals generally don’t give free dialysis treatment, liver or bone marrow transplants, prosthetics, and so forth to those who can’t afford to pay and who have no insurance. Hospitals are businesses that need to at least meet their costs, and if a potential patient isn’t covered by private or public insurance, they generally refuse treatment outside the ER. And if they do give treatment, they send collection agencies after the poor uninsured to recoup their costs. This is widely documented. And prior to the recession, the #1 cause of personal bankruptcy in the U.S. was medical bills. I’m not trying to lambast hospitals. They wouldn’t survive if they gave free care to everyone without coverage or couldn’t afford it. That’s why ACA is so critical.

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