Tired of being Undeserving

This was a comment that I made on another blog, but I think it stands alone as a blogpost. And - sorry folks - it's another healthcare rant if you want to skip it.

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Speaking as someone who presently can’t afford healthcare, I’m tired (there is a LOT of emotion behind that word “tired” that I can’t properly communicate) of fellow Christians telling me that I don’t deserve healthcare or that “people like me” don’t really want it.

The church has very clearly called upon us to tithe our income which does not currently pay the bills. We do tithe and would have done so anyway, but truth be told, having been told to tithe I now resent doing it. I have gone from feeling good about giving to God sacrificially to feeling that people might be wondering why we are giving so little – surely they must be making more than THAT?

What would happen to us in the event that we had a big medical crisis/bill? Well, we’d be left to accept the charity of the hospital or possibly of family. The church will maybe come up with a casserole. But, in the face of such opposition we certainly can’t be real enough with anyone at church to admit that not having healthcare is a worry. And no one would actually help us out with our real needs. I wouldn’t really expect that either, but I really MIND it in the context of being told that we would not deserve to have medical care on account of not being able to afford it at the moment.

Now that I’m finally getting a job and we’ll be able to pay our bills – although we’ll still worry about medical care and won’t really be able to afford preventative dentistry or checkups – am I supposed to: a) Say “Whew! Now I’m part of the mainstream in my church. I’ll join in the view that people in the condition I was in a few months ago don’t deserve healthcare? or b) Remember what it was like to worry? I’m pretty sure it’s going to be option (b). And we’ll still be worrying that we’ll get away with good health until we are able to earn an upper-middle class wage with all the perks.

From Deserving to Undeserving

Here is a story about John from Oregon in the New York Times. Hat tip to Steve Manskar via Facebook for this article.

Articles about individuals and families very much like John's have been appearing in our local newspapers here in Northeast Ohio almost daily. In a region that never really recovered from the demise of heavy industry, thousands of skilled laborers and professionals are out of work in this region or they are under-employed at 30-hour/week minimum wage jobs with no benefits. (When I participated in a group interview for such a job, there were a dozen of us: one young man in High School, one other woman with over 25 years experience in retail and the rest were men in their 40s, about half of whom had previously had professional jobs.)

Now, I've read a number of blog posts and comments on blogs about how God thinks that a Federal healthcare safety net is "stealing" if that safety net is funded by taxes. This point of view seems to emphasize the free will of individuals to give charitably as being of first-order ethical importance which trumps any notion of the collective good of society.

The admonition coming from this point of view seems to be: Your health has no intrinsic worth and if you cannot pay for healthcare, you don't deserve to have it. Wanting healthcare that you can't afford is of the same order of selfishness as wanting an iPod or a car that you can't afford. If you are truly a Christian person, you will trust in God for his will vis a vis your health. And maybe some part of the Church Universal will decide to throw a bit of charity your way; because, of course, Christians should be giving to others (but if we can't do it with a cheerful heart then God will understand if we don't give). One blog commentator even claimed that his Christian faith only obliged him to give to people he knew.

So for all of you who believe that giving should be from individual to individual (or from small group to individuals) and that giving should always be at the discretion of the giver, here are my questions:

1) How is the church's small-scale, and sporadic (read "unreliable") giving going to help John and millions of others like him? Pot roasts are not going to help John a lot nor is a $100 or $500 or even a $1000 charitable contribution.

2) Can you really look John in the eye as well as other individuals who have lost their jobs through no fault of their own and tell them "You do not deserve healthcare"? Did John deserve healthcare when he was a healthy, working 21 year old but now he dosn't? Why? What changed his ontology from "deserving" to "undeserving"?

3) For those who are pastors and who are comparing John's need for healthcare to coveting an iPod or a car that he cannot afford, do you really look your parishioners in the eye and tell them that their desire for decent healthcare is morally equivalent in the eyes of God to lusting after a consumer gadget or a toy?

I do appreciate that there are many people who think that healthcare needs reforming and who believe that the Federal government would make a mess of reform and that this is the reason they oppose a Federal option for healthcare. That's a fair enough point of view.

But I really wonder how a Christian can look another human being in the eye and tell him that his health has no intrinsic human worth to himself or to society, that he doesn't deserve healthcare, and that asking for society to take a collective interest in his health is tantamount to stealing. I'll confess that it's incredibly difficult not to wish that such people would find themselves in the shoes of people who have suffered bad luck and bad health through no fault of their own. Not so that they would suffer, but so that they would understand.

Co-Operative Health Insurance?

In my post Capitalism as a Belief System, I mentioned the idea of using capitalism as a way of running an economy without buying in to capitalism as a belief system.

I think I've already explained what I mean by not buying into capitalism as a belief system: a rejection of the idea that any and every enterprise "should" or "must" be run according to the principle of maximum return per unit of risk. In my previous post, I suggested that the health-care area was one area where I'd personally want to use the Golden Rule as the governing value. I accept that there is much debate about the values surrounding healthcare, but I just want to suggest here a mechanism by which the operating systems of capitalism can be used for more altruistic ends. That mechanism is the co-operative enterprise.

Before anyone feels that they need to enlighten me about the facts, co-operative enterprises are not new nor do I claim to have invented the idea. As businesses, they tend to work very much in the same way as ordinary businesses: investors, a managing board, operations management, employees and customers/clients. The difference between a co-op and a profit-seeking organization is their reason for existing. Almost all for-profits business exist with the ultimate sole goal of maximizing profits. Co-ops exist for the benefit of stakeholders.

Probably one of the most well-known forms of co-operative in the United States are old-fashioned credit unions. You become a member of a credit union, deposit some money in a savings account, and get a return on your money from monies that the credit union lends to other credit union members. In the old days, you couldn't borrow money from a co-op until you had deposited a sum of money for a specified period of time.

What is the point of a credit union? To hopefully provide a service to members whereby: 1) they have access to loans which they would not have otherwise had access to; 2) they have access to a good rate of return on their savings and; 3) they have access to a good borrowing rate on their loans. The primary goal here is not for the credit union to make a profit to reinvest in order to grow and provide shareholders or owners with an ever-increasing earnings stream. The primary goal is to provide a decent, basic savings and loan service to members.

It seems obvious to me that health insurance could be run on similar principles. I know that in California, homeowners who cannot otherwise find home insurance due to a high risk of fire in their area can insure their homes through a type of State insurance which seeks only to cover the costs of claims. On a much more simple level, the Amish operate a system whereby every family puts a sum of money into a "pot" and medical care is paid out of this pot. There are also a couple of medical cost-sharing schemes run by Christians for Christians (which typically require you to sign up to a doctrinal statement!) which aim at members covering the cost of other members.

Will co-operative health insurance solve the current crisis of health-care costs? No, I don't think so. The causes are many and complex but a lot of them can easily be filed under the two basic categories that drive all capital markets: fear and greed. Fear of not having the absolute cutting edge drug or treatment; fear of not having the best possible consumer choice if one has the money to purchase it.

The underlying problem is spiritual, it is a problem of values, as I suggested in my last post. We simply cannot countenance a health-care system that is run for the general good which might limit the ability of the very rich to buy cutting-edge medical care. In money we trust. We are happy to tell the working person that he has no right to a vaccination if he cannot afford it, because what we are absolutely certain of is that the rich person has the right to expensive experimental drugs if she can afford it.

Capitalism as a Belief System

There have been a number of debates going on in the blogosphere about US health-care reform which I have been participating in over the last few weeks and quite a few of these have branched off into discussions about business, economics and social beliefs and values. In conjunction with yesterday's post on the subject of compassion and The Golden Rule, I've had a some thoughts on the subjects of "The Golden Rule, Capitalism and Health Care" which I'm going to attempt to write about in a series of posts.

In many ways, I'm still a "foreigner" here in the US and one of the things that has struck me is how much capitalism appears to be for many people in the US a belief system as well as a way of running an economy. After twenty years working in the equity markets, my own opinion is that capitalism is, historically, the least worst way of running an economy that human history has devised.

It's also my opinion however, that as a belief system, capitalism stinks. And I believe that capitalism is the number one belief system held by US society. Christians may say that they believe in the Lordship of Christ, but in actual fact we believe in the Lordship of Profits. We prove this every day by the way we live our lives.

I think that there are historic reasons for many of our economic beliefs. The rule of King George III in raising taxes in America for his own selfish empire building had much to do with establishing the idea that taxation is stealing. The right to "life, liberty and the pursuit of happiness" which is enshrined in the Declaration of Independence was almost "life, liberty and the pursuit of profit"; so this value has a 200+ year history in US society.

And, of course, the Cold War which was actually a clash of super-powers was characterized in the US as "The good and moral values of capitalism versus the bad and immoral values of socialism/communism". In US culture, "democracy" and "capitalism" are seen as synonymous by many even though they are not. In US culture, "totalitarianism" and "socialism" are seen as synonymous even though they are not. And the worst conflation of all is the idea that Christianity and the pursuit of profits (capitalism's value system as opposed to its operating system) are synonymous.

Let's be really simplistic here. Jesus said that the greatest of all commandments is "love God and love your neighbor as yourself" (basically, The Golden Rule). Capitalism says that all businesses must be run for the highest risk/reward ratio - for the highest profit. Therefore Capitalism's value system cannot be the focus of Christian behavior or of Christian ethical reasoning.

Rather than testing every social venture by the test of "Will this venture make the highest profit for the capital that has been invested?", Jesus' teachings require Christians to use the test of "Will this venture benefit the citizens of this country/State/city/county in aggregate?" I appreciate that determining aggregate social benefit is another complex ethical problem but I don't think that we can abdicate the responsibility of making that moral determination by simply defaulting to the standard of profit. "Oh, it's too difficult to decide what it means for society to 'benefit' from health-care, so let's just run our health-care system on the basis that all providers should make as much as they can from their investment."

We do already recognize that some services to society are too important to leave to individuals to either perform or to raise money for. And, historically, many of these things were once left to individuals: policing, fire-fighting and education. It's a mystery to me how we can argue that education is of benefit to society and should be paid for by taxes but that health-care is not a benefit to society and that those who cannot pay for it do not deserve it. One blogger actually compared health-care to purchasing an iPhone or a car: a luxury consumer good that one shouldn't have if one can't pay for it. That makes sense using the "lens" of capitalistic values to make my ethical judgments. If I use the "lens" of doing unto others as I would have them do to me, I come up with a whole different opinion about the value of health-care to society.

Healthcare: Values versus Administrative Process

It occurs to me that many of the debates currently waging in the US media about healthcare fail to distinguish between three questions:

1) What is the principle upon which we wish healthcare to be based?
2) What are our desired goals for healthcare?
3) How do we best administer a healthcare system?

I have some ideas about my own personal answers to the first two questions. I have less of a concrete idea about my answer to the third question - basically because I'm not expert either in US healthcare administration or in US governemental administration.

Here are my thoughts:

1) Our current system is based on the principle of 'patients are a source of profts for healthcare providers and healthcare insurance companies'. I want our healthcare system to be based on the principle that 'healthcare is a human right.'

I wonder if anyone would actually like to argue the principle that healthcare is not a human right? I wonder if anyone would like to argue the principle that 'those who cannot pay for healthcare deserve to become ill and die'? Possibly a few odd eggs, but I'm going to assume that, actually, most people agree with this idea.

2) Based on this principle, some of my desired outcomes would be goals like providing effective, preventative healthcare to everyone in society as well as providing effective specific care for specific illnesses and injuries. Such healthcare should be accessible, efficient and timely.

Broadly speaking, would anyone want to disagree with any of these things? I suspect not, although if we were going to start compliling a list of specific outcomes, there would probably be some disagreement. But let's say, broadly, we want everyone to have good, effective healthcare.

3) Now the big question. Given that we want healthcare to be a human right and we want everyone to have good, effective healthcare, who is going to pay for this? And how will this healthcare system be administered?

This actually seems to be the area where people with the least knowledge and experience have the strongest opinions.

I won't claim to have a definitive answer to this. What does seem clear to me, however, is that there are many ways to administer such a system and it's not simply a question of 'Nationalized, socialized healthcare based on the values of healthcare as a human right versus entirely privitized healthcare based on the value that patients are profit centers.'

But I think we DO need to be clear about the value that healthcare is human right and we have to fight for this principle to be articulated and to be the foundation of healthcare insurance going forward.

Given that our current system is based on the principle of 'patients are a source of profits', I wonder why people aren't afraid of insurance companies pulling the plug on granny? Or maybe more precisely insurance companies pulling the plug on mom and dad or sister and brother? If you have a long-term health condition that looks like being expensive and something that the insurance company is going to have to pay for over the course of decades, you'd better worry about having your insurance plug pulled or your access to treatment restricted. Either that, or hope your spouse has fantastic group insurance and that s/he isn't at risk of being laid off any time soon.

The NHS through US Eyes

Here is an excellent article on the subject of This American's Experience of Britain's Healthcare System.

The author has been far more articulate than I could be. With the exception that I never shared the author's initial dislike of the NHS, her experience of the echoes mine. Perhaps her post is far more convincing for the fact of her initial dislike of the NHS.

I'll note in passing that Wonderful Husband and I have yet to be able to set up our our health insurance. We seem to have fallen through the cracks of The System in trying to apply for our (potentially very expensive!) private health insurance. Quite a difference from our recent experience of the NHS when WH received emergency eye surgery on the NHS in a matter of hours.

Let Them Go to the Emergency Room

Over on Connexions there is a - what's the euphemism? - 'robust' debate about health care, sparked in part by my husband's experiences getting his torn retina fixed on the NHS

This article by the American Associate of Retired People (AARP) on the subject of 8 Myths about Health Care Reform is worth reading.

One of the arguments that gets put forward frequently is that people without health insurance still get good quality health care in the Emergency Room. The AARP article addresses this issue in 'Myth 6':

Myth 6: "The uninsured actually do have access to good care—in the emergency room."

It's true that the United States has an open-door policy for those who seek emergency care, but "emergency room care doesn't help you get the right information to prevent a condition or give you help managing it," says Maria Ghazal, director of public policy for Business Roundtable, an association of CEOs at major U.S. companies. Forty-one percent of the uninsured have no access to preventive care, so when they do go to the ER, "they are most likely going in at a time when their illness has progressed significantly and costs more to treat," says Lumpkin. Hospitals have no way to recoup the costs of treating the uninsured, so they naturally pass on some of those costs to their insured patients.