21 September 2009

A Healthcare Riddle

Now that I'm living in the United States, I can walk into my local pharmacy and get a 'flu shot ('flu jab) for $24.99 (about £15.25).

In the UK, under the NHS, those of us who were not considered at risk for the complications of 'flu were asked not to present ourselves for a jab so that those who needed the jab (the elderly, those with certain medical conditions) could have one.

So, if I go get a 'flu shot at the local pharmacy tomorrow, am I "taking personal responsibility for my own health"?

Why do *I* "deserve" to have a 'flu shot, just because I can pay for it, even if I don't really need one? And why is it OK that someone who is actually at risk but who can't pay shouldn't have one?

I do understand utilitarian arguments from those who do not call themselves Christians. What I don't understand is how a Christian can argue from Christian theology that God is perfectly happy with the idea that those who have money can have an inoculation and that those who don't have money can't.

I know I'm going on about it, but after my move to the US, I find it really difficult to make the adjustment from a Christian theology that thinks healthcare is a community responsibility to a Christian theology that thinks it's blindingly obvious that it isn't.

12 comments:

Doorman-Priest said...

Socialist!

(But that's not a bad thing.)

PamBG said...

The question is "What do we mean by 'being a socialist'?"

I think that the visceral reaction to that word in the US is entirely different than in it is in the UK, even amongst comparable ideologies. I doubt, for example, that Boris Johnson would think that being a socialist is akin to being Evil Incarnate[1] even if he would disagree with socialism.

[1] I acknowledge that the voice of more moderate and sane conservatives isn't being heard in in the US but I feel that, like the many people who want a more "social" solution to our healthcare problems, the moderate conservatives aren't speaking up either.

Fat Prophet said...

Were your ears burning earlier - you were mentioned at District local Preachers Meeting

PamBG said...

Yikes, Ian! I hope it was good. :-) My ears are almost *always* burning; I'm a 52 year old woman, for goodness' sake! But I never put it down to people talkkng about me! :D

Fat Prophet said...

My wife has the same problem and it's not because I talk a lot!
Ken Mothersdale was reporting on changes of tutor in your old circuit and said the on before you had moved somewhere and of course you had moved back to America.

Allan R. Bevere said...

Actually, Pam, almost anyone can get a flu shot if they want one. Many health clinics do offer them for free or for a very nominal fee depending on income, and many businesses, this year such as Walgreens and CVS pharmacies, are giving free shots to the unemployed and to those without insurance.

I know that will not be completely satisfying for you, but it is not the case that the poor just get left out in the cold here.

Are there some that perhaps fall through the cracks. Probably, but it simply isn't the case if you are poor you are out of luck.

And I will pay for my flu shot because I can afford it and those of us who can should because it puts money in the system so that those who can't pay can still get it.

PamBG said...

OK, Allen that's good and I'm relieved to hear it.

But - and I'm not being facetious here - isn't the principle of "personal freedom and responsibility" about the idea that those insurance companies should be able to deny these shots if they choose to do so?

It's this principle that riles me. That somehow if a civic community develops the idea that everyone is responsible for everyone else and they decide to codify this ethic that they are somehow doing something sub-ethical and that God doesn't like.

johnmeunier said...

There is a story out of Oxford, Ohio, today about a 22-year-old woman who died of swine flu. She had no insurance.

The poor can get care, but it is usually sub-standard. Plus, being poor, they are reluctant to get nailed with huge medical bills. So, they delay seeking help until they are terribly sick.

Medical bills for the uninsured and poorly insured can be massive. The threat of those bills keeps people from seeking care that theoretically is available to them

Another unmentioned aspect of the problem is that a market-based system for allocating medical resources means the quality of care in poor areas is markedly worse than in other areas.

Our problems are more than just a few people "falling through the cracks."

toujoursdan said...

Actually, Pam, almost anyone can get a flu shot if they want one. Many health clinics do offer them for free or for a very nominal fee depending on income, and many businesses, this year such as Walgreens and CVS pharmacies, are giving free shots to the unemployed and to those without insurance.

I know that will not be completely satisfying for you, but it is not the case that the poor just get left out in the cold here.

Are there some that perhaps fall through the cracks. Probably, but it simply isn't the case if you are poor you are out of luck.


The problem with this, as I see it, is how disorganized, inefficient and arbitrary this is.

If you know about these programmes and show up at the right time and in the right place, perhaps you'll get a free (or cheap) shot. But these initiatives aren't widely advertised. There aren't consistent places and methods of delivery or standards for eligibility and few organizations go into poor communities in a proactive way to get the word out, and the truth is that in the U.S. most would rightly assume that shots cost lots of money and not seek them out themselves if they think they can't afford it. So many many people do fall through the cracks because they are poor and due to lack of knowledge of the alternatives.

In the two universal healthcare systems I am familiar with - Canada and New Zealand - the eligibility requirements were universal. Everyone knew where to go, what to expect, if there was a cost so the penetration rate was much much higher.

As a Canadian, one of the worst things about the whole U.S. "small government" mentality when it comes to the delivery of basic services is that you really don't know where to turn or what to expect. Everything is extremely inefficient, inconsistent, fragmented and almost secretive. People have to hire advocates to find out how to navigate the system and in the case of healthcare, this can lead to bankruptcy, sickness and even death.

PamBG said...

I meant to answer earlier.

Dan, you said: The problem with this, as I see it, is how disorganized, inefficient and arbitrary this is.

But somehow, I get the impression that the disorganization, inefficiency and arbitrariness is part of the "freedom deal". And therefore it's part of what people value whether they realize it or not.

I'm not saying that people actually value inefficiency but there does seem to be something about the idea that looking out for others is OK as long as it is: voluntarily engaged in, small scale (even sufficiently small scale as to be inefficient and ineffective), and not everyone knows about it.

If you have the nouse to find out about these small-scale programs yourself, then you are somehow being "responsible" rather than selfish and those who don't have the means to find out about them[1] are just being "lazy".

[1] E.g. if my parents needed such programs, there is no way they would be able to find out about them without help; they are getting to the point where paying their bills is an overwhelming physical/mental task.

toujoursdan said...

That makes sense... in its own way. But it reminds me how different I am culturally (at least) than most Americans.

PamBG said...

Hah! You and me both! And I have to live here.

I was never an Anglophile and just "happened' to end up in the UK, but in the British Methodist Church I thought I'd found some sanity.

It's exceedingly weird to hear people react negatively to the concept of socialism. And LOTS of people assume I'm politically conservative when I tell them I was a minister and start ranting about healthcare. I've got my diplomatic patter now: "You know, it's strange. I've moved from the UK system which everyone here says is awful; it was a system that I had confidence in and where I saw many elderly people treated far and above any consideration of the cost. To me, I was confident in the National Health and find the US system more frightening." So far, it's shut everyone up! :-)