Unitarian Universalist Church of Palo Alto

Health Care for All — A Matter of Faith?

Suzanne M. Marsh
April 6, 2008
Palo Alto, CA

Good morning. I’m grateful to have been invited to be here with all of you this morning. I am Suzanne Marsh, this year I am serving as the Intern Minister at the Unitarian Universalist Legislative Ministry. One of the issues that the UULM is working on is Healthcare for All, an issue that is close to many people’s hearts, and pocketbooks, these days. Over the last year I held much hope that California would emerge as a leader in the arena of real healthcare reform, that we would take a meaningful step in providing affordable, quality health care to all Californians. Alas, it was not to be.

Whether or not we will see real reform in this year, or in any other, will entirely depend on how well we are able to rally those who believe in reform, in how effectively we can raise our voices so that those in Sacramento will know that there are millions of us who know that reform is necessary and who vote. We need to send the message that we have not been defeated by the failures of the last legislative session and that we will not just go quietly into the good night. We will not back down or go away until everyone has access to affordable healthcare. Period. It will not be fast or easy, because there are very powerful forces who are working against it. Forces with more power and influence than most of us who support reform will ever have.

Why is the healthcare issue so difficult for us in this country? We are the only industrialized nation who does not provide health care coverage for all its citizens. Why is this such a struggle for us? When the UULM did its issues survey to decide what its focus issues should be, UU’s listed health care reform as their number one concern and yet we have struggled to get people really engaged with it. What is it about this problem that leads us to know it is important but to shy away from engagement with it?

Healthcare is a deeply personal issue which affects all of use. We can’t distance ourselves from it and work on behalf of others, it requires us to engage with our own vulnerability, with something difficult that we face or that we know we are likely to face someday. Health problems bring with them so much fear and pain and often they bring shame. Am I ill because I did something wrong? It’s very hard to face this and talk about it, to acknowledge that we are vulnerable, even thought we may currently have good insurance or we may be healthy. It is also an issue on which we do not have agreement, many well meaning people have strong feelings for or against some of the proposals and that makes it very difficult to discuss.

Healthcare reform is also a very complex issue and we feel overwhelmed about ever understanding it in the face of all of the conflicting messages. We don’t know who to believe or what we can do. Certainly, tackling this issue will take more energy and time that we have, with all the other things we are trying to do!!!

Perhaps we can somehow work through our discomfort and figure out how we can stand for change, with whatever time and gifts we have, because that is how reform will be accomplished, with each of us doing what we can. In his book The Prophetic Imperative, Richard Gilbert reminds us: “Most of the world’s useful work is done by people who are pressed for time or are tired or who don’t feel well.”

While I know many of us can identify with those conditions, we as a compassionate people faced with other’s suffering, can each find something to do. And, if we stick together, we will accomplish something. We can because we must, because our principles call us to affirm and promote the inherent worth and dignity of each and every person and when millions of Californians lack adequate access to health care, I do not believe we are meeting that standard.

My sister and her husband own a bed and breakfast in rural Maine. Because it is a very small business and is very seasonal, it does not completely support them and their daughter, so they both have had a variety of other jobs, including, part time real estate sales, substitute teacher, urchin diver and call center operator, among many others. They both work hard, but they like it there and are willing to make sacrifices to have the kind of life they want in a rural setting. Over the 22 years they have been self employed, nothing has been as difficult for them as the health insurance question. They did not have insurance for a while and when they set out to purchase it, my brother-in-law’s childhood asthma caused them to be rejected. Eventually they got insurance, at a ridiculous price with a 5 thousand dollar deductible. When their daughter had appendicitis, they discovered just how bad that exorbitantly priced insurance was. When my brother-in-law got a job teaching 3 days a week at the local alternative high school, they were thrilled because that job had insurance. Even in this group plan, the cost was high, but they were happy because the coverage was so good.

Bill teaches 3 days a week and gets insurance coverage for his family. After the premium, his net paycheck is $7 every two weeks. Perhaps, we will soon see people with signs that say “Will work for insurance”; my brother-in-law basically does.

Right now it is estimated that there are 7 million Californians who lack health insurance — a number equivalent to the combined populations of Los Angeles, San Diego and San Jose, the three largest cities in California. As soon as the UULM began working on this issue, stories of health care struggles began to flood into our office — the congregation who did not provide coverage for the janitors family, and what they and she faced when she came down with cancer, the woman who, only a week after being diagnosed with a life threatening illness, lost her medical team because her husband’s employer changed insurers. And the stories are not just from those who have no insurance, we also heard from a woman who was refused treatment at a hospital because she had the “wrong” insurance. Another woman, a survivor of breast and cervical cancer, lost her insurance because her employer stopped providing it. As you can imagine, premiums for her to get individual private insurance are sky-high. Although she is at risk for a recurrence of her cancers, she has been unable to afford even a basic check-up with the doctors that she saw for her original treatment. Instead, she lives in fear for her health. And I recently read a story that chilled me to the bone. A man, whose wife had a daunting set of medical problems and was in chronic, debilitating pain, was faced with not being able to afford her medications anymore. She begged him to kill her, to end her suffering, day after day. According to the police reports, he gave her the last of her pain meds, kissed her goodbye and threw her off their 3rd floor balcony. He then called the police and when they arrived he surrendered, simply asking them “What was I to do?”

How did we, one of the richest countries in the world, get here?

Jonathan Cohn has written a book called Sick: The Untold Story of America’s Health Care Crisis — And the People Who Paid the Price. According to his research, our current health care system is product of 80-years of repeated market failure, with each successive reform serving at best as temporary respite from the previous problem. His conclusion is that capitalism can’t deliver decent health care.

What we recognize as modern medicine, Cohn writes, began in the 1920s. That’s when doctors and hospitals began charging more than most individuals could easily pay. To close this gap, which worsened with the advent of the Great Depression, the administrator of Baylor Hospital in Dallas created a system that caught on elsewhere and eventually evolved into the Blue Cross system. The Blue Cross system was essentially nonprofit health insurers who served local community organizations like the Elks. In exchange for a tax break, Blue Cross organizations kept premiums reasonably low.

The success of the Blue Cross system persuaded commercial insurers, who initially considered medicine an unpromising market, to enter the field. Private insurers accelerated these efforts during the labor shortages in the 40s when businesses, seeking ways to get around wartime wage controls, tried to attract labor by offering health insurance. The government encouraged this practice by exempting company expenses associated with health care from the income tax.

The Blue Cross system, in their early days, charged everyone the same premium, regardless of age, sex, or pre-existing conditions. This was largely due to the nature of the companies, they were quasi-philanthropic organizations, and partly because they were created by hospitals and therefore interested mainly in signing up potential hospital patients. They were sufficiently benevolent that when Harry Truman proposed a national health-care scheme, opponents were able to defeat it by arguing that the nonprofit sector had the problem well in hand.

As private insurers entered the market, however, they began to determine premiums by calculating relative risk, and avoided the riskiest potential customers altogether. The combined result was that people who really needed health care had an increasingly difficult time affording, or even getting, health-care insurance.

As health-insurance costs rose during the 1970s and 1980s — health maintenance organizations, which had been around quite a while, began to proliferate, along with other managed-care plans. Like the Blue Cross systems, HMOs became victims of their own success. Initially they were mainly nonprofit, but once again businesses spotted an opportunity and for-profit HMOs displaced nonprofit HMOs. (According to Cohn, 12 percent of the market was served by for-profits in 1981; by 1997, the number was closer to 65 percent.) With their bottom-line approach to care, the for-profit HMOs were much more aggressive about denying treatments. Managed care kept cost increases in check during the early 90s, but eventually costs started rising again, leading to the current crisis. Today employers are reducing or eliminating health-care benefits for employees; hospitals are consolidating and becoming less accommodating to low-income patients as they are engaged in somewhat of a battle with insurers; and the portion of the population that has any health insurance is continually shrinking.

The overall trend — the result of an increasingly market-driven health-care system — is to undermine the very idea that the cost of illness should be spread out among the general population, healthy and unhealthy alike. In this sense, the private health-care market is too efficient. Assigning health care costs to sick people is what the free market wants to do. So we arrive where we are today. We have a health care system that is all but closed to those of modest means whose employers do not provide insurance and it is generally inaccessible to those who need it the most.

The moral imperative of affordable health care for all raises questions about how we care for our sick and challenges our image of ourselves as a compassionate people. It highlights the fact that the U.S. is the only economically advanced nation that does not see health care as a basic human or social right. Our current system views patients as health care consumers who purchase whatever services and products they can afford. The harsh truths are that, at least in some circumstances, the U.S. health care distributes services unjustly, rations care inequitably, and too often offers compassion only for a fee.

We appear to be deadlocked in partisan political debate, struggling to imagine a dialogue that embraces the common good and respects human dignity. What should be a dialogue about maintaining or restoring health in the lives of individuals becomes a profoundly political conversation about health care rationing, financial insecurity and often ends with blaming the victims. The very purpose of the system seems to be nearly lost. Very simply, our way of doing health care is in moral crisis.

This political deadlock rises from the difficult questions at the heart of the issue. Do we want to improve access, or control costs, or both? Is health care a right or a privilege? Is it the responsibility of individuals or of our society? Who best provides for the “common good” — the government or the marketplace? Are those who need health care “patients” or “consumers”? Should profits really be made on individuals need for basic healthcare?

And the question that we as UUs inevitably must ask is: Does this growing group of under or uninsured individuals weaken our interdependent web of existence? If so, what, if any, responsibility do we have to do something about it? What do our shared principles call us to do? And how in the world can we effect change in a system that is so massive, so dysfunctional and so mired in money and politics?

I do not have the answers to these questions, but one thing is clear to me, at the root of many of the problems we see is our system that treats buying health care and insurance as simply another market transaction. As a society we have many laws and regulations that put requirements on individuals in order to serve the public good, such as the requirement that all drivers have car insurance and that children are vaccinated. We pool our resources to pay for police and fire protection, not just because we need these services, but because it is good for all of us if they are available, whether we personally need them or not. Having good affordable health care for all Americans seems to me to fall into the same category, yet somehow rather than a basic right; healthcare has become a consumer commodity in an open market system, benefiting a shrinking number of those individuals that it purports to serve.

In his address in Sacramento at the premiere of his new movie “Sicko”, Michael Moore noted with incredulity that our healthcare system, that operates for profit has as its goal, focusing on increasing shareholder value rather than the health of the patients. While we likely do not all agree that his approach is the only or the best one, it is certainly clear that the current system is not working for the 50 million Americans who currently have no insurance.

Given our current political environment, there is growing recognition that successful health reform must follow a process similar to that of other social reform movements … a process in which smaller successful state and federal efforts build on one another until the intended goal is achieved. Progress toward that end is underway. Here in California, many people worked tirelessly last year on this issue and various bills were introduced in the Legislature last year. At the beginning of 2007, the Governor announced that he wanted to be the healthcare governor. There was a bill passed by the Legislature (AB8), which was vetoed by the Governor, and the compromise bill ABX 1 1, which was introduced in what was essentially the 11^th hour, was passed by the House but failed to get out of the Senate Health Committee. The bottom line is this: Millions of Californians are still waiting, and many are dying, for quality affordable health care for all.

If you agree that we must do something about this, now is the time to do whatever you can to ensure that this issue stays at the top of the legislative agenda. While we were deeply disappointed in the results of lasts years efforts, we have reached many people like you all and formed strong coalitions around this issue. In these actions, and in an emerging commitment to health care as a moral value for our society, there is optimism for the future.

For me, if there is such a thing as a sin in UU theology, the healthcare situation in this country qualifies.

So, what might our shared principles call us to do? There are a few simple things that we all can do and others that will take more time and resources. It doesn’t matter, if we all do what we can do, then we will make progress.

First — we all can look for opportunities to educate ourselves and others on this topic. One of the tools that is often used against healthcare reform is creating fear and divisiveness in the public arena, people with health care are frightened into believing that healthcare for all will somehow diminish what they have or it will cost them huge amounts in taxes. I encourage you to do your own research but when confronted with such advertising, I ask you to remember 2 things:

1. Having good coverage today does not mean we will have it tomorrow, no one is in the current system is safe from having their access cut off or reduced. The truth is that healthcare is changing and not for the better .
2. In many of the countries with universal coverage the amount spent per capita for coverage is significantly lower than what is spent in the US and these systems uniformly cover everyone. Access to health care for everyone does not have to cost more or reduce benefits.

Educate your self about the various options that folks have set forth to remedy this crisis. Find the option that makes sense to you and support it in any way you can. We do not all need to agree on what is the right answer; we can all work for the change that we believe in. Healthcare made available to any additional people reduces the problem. What is most important is that we do not let them use our differences of opinion to divide and conquer us!!

Another thing we can all do is keep reminding our legislators that we care about this issue. Sending emails or faxes every time a bill related to health care is being voted on only takes a few minutes, and it reminds our state or federal lawmakers that we are paying attention.

Make sure that you are on the UULM mailing list. See me to sign up after the service. When there are bills in play, when there are rallies or lobby days we will let you know via email so you can take part in anything that fits in to your schedule. Think about attending the Interfaith Lobby Day on May 13^th and take the opportunity to speak to your Legislators or their aides about this issue.

Begin a discussion within your congregation about developing a UULM issue action team in your congregation. Screen the movie “Sicko” or the new movie that will be coming out “Critical Condition” with a group of your friends. Host a discussion of the movie and the issues in your home or in your congregation.

If you want to do more you can actively participate in working on making change through various organizations such as the UULM, Health Access for All or OneCareNow.

Even though this sometimes seems like an insurmountable obstacle, it is imperative that we take action. By some estimates, 18 thousand people die every year simply because they did not have access to health care. We Unitarian Universalists have always come to stand beside those who have no one to speak for them, even when it was uncomfortable, unpopular or just plain hard.

In the parable that Rita read earlier, we heard of a small bird who saw his friends in danger. He could not put out that fire himself, but he did what he could to help others. While we know that those small drops could not put out the fire, all of us together can carry enough water to put it out. I know that I cannot ensure affordable, quality healthcare for all Californians, I know that alone I cannot ensure affordable, quality healthcare for all Californians, but I intend to do what I can do and hopefully all of our efforts combined will eventually get quality affordable healthcare for all Californians.

In closing, I bring you the words of Robert Fulghum:

The line between good and evil, hope and despair does not divide the world between us and them. It runs down the middle of every one of us. I do not want to talk about what you understand about this world. I want to know what you will do about it. I do not want to know what you hope. I want to know what you will work for. I do not want your sympathy for the needs of humanity. I want your muscle. As the wagon driver said when they came to a long hard hill. Them that’s going on with us, get out and push. Them that ain’t get out of the way.

Health care affects us all, every day in many ways. We know we must do this because we are all in this wagon together. Leaving some of us behind is not an option.

Here’s hoping that we will all get out and push, that we may all go on together, healthy and whole.

May it be so.
Amen.

 

---

 

Sources and Inspirations

Jonathan Cohn. Sick, The Untold Story of America’s Healthcare Crisis. Harper Collins, New York, 2007.

Richard Gilbert, The Prophetic Imperative. Skinner House Books, Boston, 2000.

Health Care — Private Health Insurance Reform Resources

WHO Core Health Indicators — 2007

The State of Health Insurance in California — 2001 Survey

Michael Moore

 

---

 

Reflection: The Health Care Dilemma by Rita Hays