"Health Care Reform"
Christian Issues Class November 8, 2009 How did we get here? 1776 – 1920s … Out-of-pocket payments 1930s – 1940s … Private insurance is created 1950s – mid-1960s… Public insurance emerges Medicare & Medicaid 1970s – 1980s… Enrollment & costs grow 1990s… Proposal to reform fails Early 2000s… Access & cost crisis Late 2000s… Another attempt to reform Where are we now? US health care expenditures exceed $2 trillion per year 1/7 of our nation’s economy 1/6 of population is uninsured… 1 in 3 under- insured Health care is a contributing factor in over ½ of our nation’s bankruptcies Geography, gender, race, income & age impact both access to and quality of health care Currently, US is only industrialized democracy that does NOT guarantee health care to everyone who lives in the country Perspective of our Christian Faith Luke 6:31, Matthew 7:12, Matthew 22:39 Do unto others as you would have them do unto you James 2:1-17 My brothers and sisters, do you with your acts of favoritism really believe in our glorious Lord Jesus Christ? For if a person with gold rings and in fine clothes comes into your assembly, and if a poor person in dirty clothes also comes in, and if you take notice of the one wearing the fine clothes and say, “Have a seat here, please,” while to the one who is poor you say, “Stand there,” or, “Sit at my feet,” have you not made distinctions among yourselves, and become judges with evil thoughts? Listen, my beloved brothers and sisters. Has not God chosen the poor in the world to be rich in faith and to be heirs of the kingdom that he has promised to those who love him? But you have dishonored the poor. Is it not the rich who oppress you? Is it not they who drag you into court? Is it not they who blaspheme the excellent name that was invoked over you? You do well if you really fulfill the royal law according to the scripture, “You shall love your neighbor as yourself.” But if you show partiality, you commit sin and are convicted by the law as transgressors. For whoever keeps the whole law but fails in one point has become accountable for all of it. For the one who said, “You shall not commit adultery,” also said, “You shall not murder.” Now if you do not commit adultery but if you murder, you have become a transgressor of the law. So speak and so act as those who are to be judged by the law of liberty. For judgment will be without mercy to anyone who has shown no mercy; mercy triumphs over judgment. What good is it, my brothers and sisters, if you say you have faith but do not have works? Can faith save you? If a brother or sister is naked and lacks daily food, and one of you says to them, “Go in peace; keep warm and eat your fill,” and yet you do not supply their bodily needs, what is the good of that? So faith by itself, if it has no works, is dead. Luke 5:17-19 & numerous other healing texts indicate Jesus’ healing ministry One day, while [Jesus]was teaching, Pharisees and teachers of the law were sitting near by (they had come from every village of Galilee and Judea and from Jerusalem); and the power of the Lord was with him to heal. Just then some men came, carrying a paralyzed man on a bed. They were trying to bring him in and lay him before Jesus; but finding no way to bring him in because of the crowd, they went up on the roof and let him down with his bed through the tiles into the middle of the crowd in front of Jesus. When he saw their faith, he said, “Friend, your sins are forgiven you.” Then the scribes and the Pharisees began to question, “Who is this who is speaking blasphemies? Who can forgive sins but God alone?” When Jesus perceived their questionings, he answered them, “Why do you raise such questions in your hearts? Which is easier, to say, ‘Your sins are forgiven you,’ or to say, ‘Stand up and walk’? But so that you may know that the Son of Man has authority on earth to forgive sins”--he said to the one who was paralyzed--“I say to you, stand up and take your bed and go to your home.” Immediately he stood up before them, took what he had been lying on, and went to his home, glorifying God. 2 Corinthians 8:13-14 I am testing the genuineness of your love against the earnestness of others. For you know the generous act of our Lord Jesus Christ, that though he was rich, yet for your sakes he became poor, so that by his poverty you might become rich. And in this matter I am giving my advice: it is appropriate for you who began last year not only to do something but even to desire to do something-- now finish doing it, so that your eagerness may be matched by completing it according to your means. For if the eagerness is there, the gift is acceptable according to what one has--not according to what one does not have. I do not mean that there should be relief for others and pressure on you, but it is a question of a fair balance between your present abundance and their need, so that their abundance may be for your need, in order that there may be a fair balance. Jeremiah 8:18-19, 21-22 My joy is gone, grief is upon me, my heart is sick. Hark, the cry of my poor people from far and wide in the land: “Is the LORD not in Zion? Is her King not in her?” …. For the hurt of my poor people I am hurt, I mourn, and dismay has taken hold of me. Is there no balm in Gilead? Is there no physician there? Why then has the health of my poor people not been restored? Why would the church be involved? The 1988 General Assembly summarized John Calvin’s explanation: Civil government is ordained by God to order and serve the human community and therefore to be held in respect and honor. Service in the public order is the highest vocation for Christians. The civil state by its own definition and tradition is to serve the causes of justice, the common well being. We believe that the church must not only call upon the political order to serve the causes of justice but actively participate in efforts to shape public policies and institutions so that they serve human needs effectively and equitably. [Minutes, 1988, p. 47] Issues Am I my brother’s keeper? Improve access or control costs? The marketplace or the government? Political partisanship Special interests Vocabulary Market-based health care plan -- commodity to be purchased Universal health care -- everyone guaranteed care Single Payer health system – contributions to a single fund source reimburses providers National health service – universal access to care through government facilities, by government professionals, according to government standards/policies that are publicly financed Socialized medicine National health insurance -- covers entire population through public or private providers that is publicly financed Medicare AARP 8 Myths About Health Care Reform And why we can't afford to believe them anymore By Karen Cheney, July & August 2009 Myth 1: "Health reform won't benefit people like me, who have insurance." Just because you have health insurance today doesn't mean you'll have it tomorrow. According to the National Coalition on Healthcare, nearly 266,000 companies dropped their employees' health care coverage from 2000 to 2005. "People with insurance have a tremendous stake, because their insurance is at risk," says Judy Feder, a professor of public policy at Georgetown University and a senior fellow at the Center for American Progress, a Washington, D.C.-based think tank. What's more, in recent years the average employee health insurance premium rose nearly eight times faster than income. "Everyone is paying for health increases in some way, and it's unsustainable for everyone," says Stephanie Cathcart, spokesperson for the National Federation of Independent Business (NFIB). "Reform will benefit everyone as long as it addresses costs." Myth 2: "The boomers will bankrupt Medicare." If you're looking to blame the rise in health care costs on an aging population, you'll have to look elsewhere. The growing ranks of the elderly are projected to account for just 0.4 percent of the future growth in health care costs, says Paul Ginsburg, president of the Center for Studying Health System Change. So why are health care costs skyrocketing? Ginsburg and others point to all those fancy medical technologies we now rely on (think MRIs and CT scans), as well as our fee-for-service payment system, in which doctors are paid by how many patients they see and how many treatments they prescribe, rather than by the quality of care they provide. Some experts say this fee-for-service payment system encourages overtreatment (see "Why Does Health Care Cost So Much?" from the July-August 2008 issue of AARP The Magazine). Myth 3: "Reforming our health care system will cost us more." Think of health care reform as if it's an Energy Star appliance. Yes, it costs more to replace your old energy-guzzling refrigerator with a new one, but over time the savings can be substantial. The Commonwealth Fund, a New York City-based foundation that supports research on health care practice and policy, estimates that health care reform will cost roughly $600 billion to implement but by 2020 could save us approximately $3 trillion. Myth 4: "My access to quality health care will decline." Just because you have access to lots of doctors who prescribe lots of treatments doesn't mean you're getting good care. In fact, researchers at Dartmouth College have found that patients who receive more care actually fare worse than those who receive less care. In one particularly egregious example, heart attack patients in Los Angeles spent more days in the hospital and underwent more tests and procedures than heart attack patients in Salt Lake City, yet the patients in L.A. died at a higher rate than those in Salt Lake City. (Medicare also paid $30,000 for the L.A. patients' care, versus $23,000 for the care of the patients with better outcomes in Salt Lake City.) Myth 5: "I won't be able to visit my favorite doctor." Mention health reform and immediately people worry that they will have fewer options—in doctors, treatments, and diagnostic testing. The concern comes largely during discussions of comparative effectiveness research (CER): research on which treatments work and which don't. But 18 organizations in a broad coalition, including AARP, NFIB, Consumers Union, and Families USA, support CER—and believe that far from limiting choices, it will instead prevent errors and give physicians the information they need to practice better medicine. A good example: Doctors routinely prescribe newer and more expensive medications for high blood pressure when studies show that older medications work just as well, if not better. "There is a tremendous value in new technology, but in our health care system we don't weigh whether these treatments work," says Feder. "Expensive treatments replace less expensive ones for no reason." 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. Myth 7: "We can't afford to tackle this problem now." We may be in the middle of a recession, but as Robert Zirkelbach, spokesperson for America's Health Insurance Plans, says, "the most expensive thing we can do is nothing at all." If we do nothing, the Congressional Budget Office projects that our annual health costs will soar to about $13,000 per person in 2017, while the number of uninsured will climb to 54 million by 2019. Already more than half of Americans say they have cut back on health care in the past year due to cost concerns. Roughly one in four of us say we put off care we needed, and one in five of us didn't fill a prescription. Clearly, the urgency is greater now than ever before. Myth 8: "We'll end up with socialized medicine." Some experts favor a single-payer system similar to Medicare or the health program offered to federal-government employees. Yet all the proposals being discussed today would build on our current system, Feder says—which means that private insurers and the government are both likely to play roles. Says Lumpkin: "There are many ways to solve our health care problem, but we will come up with a uniquely American solution, and that solution will be a mixed public and private solution." FactCheck.org A Project of the Annenberg Public Policy Center Seven Falsehoods About Health Care Big myths about the current debate August 14, 2009 False: Government Will Decide What Care I Get (a.k.a. they won’t give grandma a hip replacement) This untrue claim has its roots in the American Recovery and Reinvestment Act of 2009 (the stimulus bill), which called for the creation of a Federal Coordinating Council for Comparative Effectiveness Research. The council is charged with supporting and coordinating research that the government has been funding for years into which treatments work best, and in some cases, are most cost- effective. American Recovery and Reinvestment Act of 2009: Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer. … None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates or clinical guidelines for payment, coverage, or treatment. False: The Bill Is Paid For At least, it isn’t paid for yet. Big questions remain. Will the president break his promise and sign a bill that piles up hundreds of billions of additional debt? Will the legislation have to be scaled back to cost less, and perhaps cover fewer of the uninsured? Who will pay additional taxes? Can pain-free reductions in other government programs be found? False: Private Insurance Will Be Illegal In July, Investor’s Business Daily published an editorial in which it claimed that H.R. 3200 would make private insurance illegal. But IBD was mistaken. Under the House bill, people who want to buy new individual, nongroup coverage will have to purchase it through a new health insurance exchange. They can still buy private insurance – the exchange, in fact, would offer a range of private plans, in addition to a new federal health insurance option. However, those who were already buying their own insurance before the bill went into effect – about 14 million Americans – will have their plans grandfathered in. The part of the bill IBD cites doesn’t forbid insurers from issuing new plans. It says that new individual plans will not be considered grandfathered, and will have to be purchased through the exchange. False: The House Bill Requires Suicide Counseling This is a misrepresentation. What the bill actually provides for is voluntary Medicare-funded end-of-life counseling. In other words, if seniors choose to make advance decisions about the type of care and treatments they wish to receive at the end of their lives, Medicare will pay for them to sit down with their doctor and discuss their preferences. There is no requirement to attend regular sessions, and there is absolutely no provision encouraging euthanasia. In a 2003, Republicans passed a prescription drug bill that endorsed end- of-life counseling in virtually the same terms that in 2009 was cause for alarm. Time False: Families Will Save $2,500 Proponents speak constantly of holding down rising medical costs. As recently as May 13, the president said legislation plus some voluntary measures by the private sector "could save families $2,500 in the coming years – $2,500 per family," echoing a claim he made countless times on the campaign trail last year. CBO: [E]xperts generally agree that changes in government policy have the potential to significantly reduce health care spending—for the nation as a whole and for the federal government in particular— without harming people’s health. However, achieving large reductions in projected spending would require fundamental changes in the financing and delivery of health care. False: Medicare Benefits Will Be Slashed The claim that Obama and Congress are cutting seniors’ Medicare benefits to pay for the health care overhaul is outright false, though that doesn’t keep it from being repeated ad infinitum. The truth is that the pending House bill extracts $500 billion from projected Medicare spending over 10 years, as scored by the Congressional Budget Office, by doing such things as trimming projected increases in the program’s payments for medical services, not including physicians. Increases in other areas, such as payments to doctors, bring the net savings down to less than half that amount. But none of the predicted savings – or cuts, depending on one’s perspective – come from reducing current or future benefits for seniors. False: Illegal Immigrants Will Be Covered One Republican congressman issued a press release claiming that "5,600,000 Illegal Aliens May Be Covered Under Obamacare," and we’ve been peppered with queries about similar claims. They’re not true. In fact, the House bill (the only bill to be formally introduced in its entirety) specifically says that no federal money would be spent on giving illegal immigrants health coverage: H.R. 3200: Sec 246 — NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States. Also, under current law, those in the country illegally don’t qualify for federal health programs PCUSA General Assembly Urged Congress to make available accessible, equitable, affordable high-quality health coverage to all people residing in our nation. While the PC(USA)’s preference is for a single-payer delivery system, we urge that health care reform legislation at least adhere to the following principles : http://presbyterian.typepad.com/peacemaking/2009/08/presbyterian-church-usa-calls-for-just-health-care-reform.html Universally Accessible: We believe that all people possess inherent worth as children of God, and that God’s promise extends to all. Health coverage in the United States must be available to all persons, regardless of income, race or ethnicity, geography, age, gender, employment status or health status. Equitable: Because the right to acquire adequate health care springs out of our worth as living human beings, rather than out of any particular merit or achievement belonging to some but not to others, adequate health care should be defined equally for all people. Affordable: Too often in the U.S., health care is available to those who can afford to pay for it, rather than on the basis of illness and need. We believe that it is our responsibility as a society to ensure that all persons, regardless of their financial situation, have access to the care they need to live healthy, productive lives. All health care proposals will be evaluated through this lens. Principles of others Accountable Sustainable Continuous Able to enhance health and well-being 5 Challenges to Health Care Reform #1 Lack of Vision The underlying challenge is the absence of a strongly articulated moral vision Do we want to guarantee that everyone in our country has a truly affordable insurance that provides access to needed health care or not? #2 – Improve Access and Contain Costs Our goal should be to BOTH improve access to health care AND to restrain the growth of costs… while maintaining a high level of care But because we don’t start with the moral imperative of “everybody in,” we wind up debating how many more to cover and at what cost… under written by whom? patients employers governments insurers providers drug manufacturers all share # 3 -- Marketplace or Government? Are health care needs best served by markets, individual ownership, competition, and profits OR by governments and laws that guarantee access & fair distribution of costs? #4 – Political partisanship Political partisanship among elected officials exists in spite of repeated public polling that shows a majority of Americans want health care reform. # 5 – Economic self-interest of key players Some concessions were made by health care entities as reform plans were being formulated: insurers pharmaceutical industry hospitals Faith-inspired values Christians engage in the health care debate with additional values that include shared responsibility human dignity compassion a sense of community a concern for the vulnerable a commitment to faithfully use resources Health Care Reform Will not be fully realized in the current legislation Comprehensive health care reform will take many more years Real reform will ultimately depend upon the transformation of our hearts and minds, guided by the values that call us to live together in full community. NY Times 11-1-09 Why mandate is necessary? Presently, those without health insurance often turn to ERs for free care, driving up health care costs for everyone else Unless the pool of those covered includes a large number of healthy persons, the costs of insurance will be too high Therefore, important that everyone be required to buy health insurance Will premiums go up? Insurance companies contend premiums will go up Other are convinced premiums will go down Congressional Budget Office concluded that one version under consideration in the Senate would provide more coverage for less cost Will there be help? Bills in both houses of Congress would expand eligibility for Medicaid to cover millions more AND would lower contributions for poorest Americans Tax-credit subsidies would help low and middle-income people pay for premiums, for those buying from an exchange What is affordable? No one has a clear answer and various experts use different approaches to calculating affordability. Has it been tried? Massachusetts has some experience near universal coverage is supported broadly by Drs. surge of newly insured folks has increased waiting times to see a Dr. some forced to buy insurance were miffed at the mandate