Health Care Reform by HC121103234649

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									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

								
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