How should health-care reform be carried out? That question elicits a variety of responses, depending on whether it is posed to a Democrat; Republican; doctor; official at a hospital, pharmaceutical company or health-maintenance organization; large or small employer; or someone who is fully insured, underinsured or not insured at all.
Yet most Americans seem to agree that the current system isn’t working.
"It’s not any one thing. It’s a conglomerate effect of an inefficient total system. I don’t think anybody’s very happy with it," said Sister Patricia Schoelles, SSJ, president and associate professor of ethics at St. Bernard’s School of Theology and Ministry in Pittsford.
Jann Armantrout, diocesan coordinator of life issues, said many Americans fear reform could lead to increased governmental control and higher taxes. "But if you ask them, ‘Can we go on this way,’ they’ll say no," she said.
President Barack Obama is adamant about change as he makes the strongest presidential push for health-care reform since an unsuccessful attempt by the Clinton administration in the early 1990s. As the summer of 2009 began, legislation was being furiously debated on Capitol Hill, with Congress members scrambling to meet Obama ‘s deadlines of drafting a health-care reform bill by August and passing it by October.
Amid this flurry of activity, the Catholic Church is sounding a call less directed at specific policies and more toward reinforcing moral priorities. The U.S. Conference of Catholic Bishops, along with the Catholic Health Association, has emphasized the the importance of making health care available for everyone, especially the poor and vulnerable.
"The moral measure of any health-care reform proposal is whether it offers affordable and accessible health care to all, beginning with those most in need," Rockville Centre Bishop William Murphy said in a May 20 statement to the U.S. Senate Committee on Finance.
"All people need and should have access to comprehensive, quality health care that they can afford, and this should not depend on their stage of life, where or whether they or their parents work, how much they earn, or where they live or where they come from," added Bishop Murphy, head of the USCCB’s Committee on Domestic Social Justice and Human Development.
Michael F. Rodgers, CHA’s senior vice president for advocacy and public policy, added that health care should be "tantamount to education" with respect to universal availability.
"We have a right to a basic education in this country. And we believe we have a right to health care as well," Rodgers told the Catholic Courier.
Meanwhile, access to health care is the 2009 advocacy issue for the Diocese of Rochester’s Public Policy Committee. The committee noted that an estimated 47 million Americans lack health insurance and that many more are underinsured as they struggle to avoid financial ruin from increases in private and employer-based premiums, copayments, deductibles and prescription costs.
Pros and cons
In calling for massive reform, Obama has noted that insurance premiums have doubled in the last nine years, rising three times faster than the rate of wage growth. Adding that growing costs for Medicare and Medicaid are the biggest threat to the nation’s federal deficit, Obama said that without reform, one out of every five dollars that Americans earn will go toward health care within the decade. Over the next 30 years, that figure that will rise to one out of every three dollars, he said.
"What I will not accept is endless delay, or denial that reform needs to happen," Obama said June 11 during a town-hall-style meeting on health care in Green Bay, Wis.
According to a June 15 report by the Congressional Budget Office, Obama’s reform plan would cost $1 trillion over 10 years. Much of this spending would be earmarked for reducing the number of Americans who lack insurance, an initiative Obama plans to finance through spending cuts — particularly to the government-sponsored Medicare and Medicaid health programs in such areas as overpayments to private insurers and reducing waste, fraud and abuse — and such new tax revenues as limiting deductions for upper-income families.
Obama also is emphasizing a move toward quality of care over quantity, noting that the U.S. spends more on health care than any other country, but remains consistently low in overall health-care rankings. In a June 29 story in Time magazine, author Michael Grunwald observed that as much as 30 percent of U.S. health-care spending — some $700 billion per year — "may be wasted on unneeded care, mostly routine CT scans and MRIs, office visits, hospital stays, minor procedures and brand-name prescriptions that are requested by patients and ordered by doctors every day."
Perhaps the most controversial aspect of the Democratic president’s plan is creation of a government-sponsored "public option" that would operate alongside private insurance plans. Obama said such a public plan would offer a better range of choices and make the health-care market more competitive.
Opponents of this idea, mostly Republicans, charge that a government-sponsored system would unfairly compete against existing private insurance companies, potentially driving them out of the market and leading to a complete government takeover of health care. Opponents of a public plan also claim it would increase the likelihood of rationed health care, making it much less likely for patients to get the care they seek in a timely fashion.
Other questions in the reform movement are whether people should be taxed for health-care benefits provided by their employers; whether individuals or employers should be required to buy or offer coverage; how to get an accurate handle on the cost and financing of reform while sticking to Obama’s tight timetable; and how universal coverage can actually be achieved in light of the Congressional Budget Office’s projection that current draft legislation would only reduce the number of uninsured Americans by one-third.
In addition, Armantrout questions how well reform will line up with the teachings of the Catholic Church, given Obama’s support for embryonic stem-cell research and abortion rights.
"I am not real confident that the dignity of all human beings is a priority," she said. She said she also wonders whether another practice the church opposes — euthanasia — might become a way to trim costs, considering that end-of-life medical expenses run so high.
Nonetheless, Armantrout — a Catholic Charities staff representative on the diocesan Public Policy Committee — added that Obama’s basic premises of driving reform toward universal coverage "are laudable goals. I’m happy that somebody is trying to take the bull by the horns."
"Comprehensive health care is seen by the Catholics as a goal," Sister Schoelles added. "On that score, Catholic teaching on health care would be in alignment with (Obama’s objectives)."
Will reform become reality?
As elected officials continue shaping the possibilities for health-care reform, Armantrout advised Americans "to keep their ear to the ground" for buzz words like "single-payer" and "socialized medicine," contending that those who stand to be most affected politically and financially "are going to manipulate these terms." Because the battle for reform is so rife with politics and financial interests, she added, not everyone is going to come away fully satisfied.
"There’s too many entities involved," she said. "Doing nothing could be the result of all these forces."
That wouldn’t surprise Jack Balinsky, diocesan health-care coordinator and director of diocesan Catholic Charities. He cited his involvement 15 years ago with the nation’s bishops on a push for universal health care that seemingly had plenty of momentum.
"Nothing happened," he remarked.
But Obama said he’s confident of a different outcome this time around, citing "an unprecedented coalition of health-care insurers, doctors and both (political) parties." Rodgers said June 22 that he’s not sure Obama’s timetable for a reform bill will be met, but that he does sense that organizations responsible for dragging down health-care reform in the past — insurance and pharmaceutical industries, unions, doctors’ organizations and nurses’ groups — are willing to carve out a consensus.
"There’s no question that this is going to be a heavy lift to get this done," Rodgers said. "But nobody’s picked up their stuff and said, ‘I’m leaving, we’re going back on our own.’ I don’t think you had that during the mid-’90s."