Edward M. Welch
As one of the world’s last industrialized nations to be without a national health care system, the United States is beleagured by a host of public health problems and contrasting proposals to solve them. Yet all the discourse appears to have generated no great public outcry for universal coverage or other badly needed reforms. Perhaps it is time for the proponents of basic change in the health system to forgo all the grandiloquent talk and come out swinging with some simple facts aimed at grabbing the attention and support of the public.

To begin with, Catholics usually approach the problem by talking about Catholic teachings on social justice, a highly worthy concept but one that has come to suggest a very formal, theologicalperhaps even legalisticapproach to the issue. Contrast that with the faith-based moral values approach used with such deadly effectiveness by the religious right in the recent election campaign. Yet those moral values are just what we are talking about when we urge on the country the necessity of caring for the millions of Americans who await a truly effective health care system, and we should not hesitate to identify them as such.

Here are some suggestions for framing the health care debate in a way that may better engage the attention of the average citizen. Several of the suggestions have to do with how we name things, others with how we might go about making sensible changes. All of them aim at making a more effective case for doing something, almost anything, that will help to break the health care impasse.

What did Jesus do? Although they are supportive, we need not look to papal encyclicals or statements by bishops’ conferences to find backing for this issue. It is enough to ask how Jesus Christ spent his time on earth. According to the Gospels, he spent a very large portion of it healing the sick. He must have thought it important to do so. He did not exact a fee or ask about backgrounds or worthiness. As followers of Christ we have a moral obligation to provide healing to our brothers and sisters who are illall of them. We should talk about it in these terms.

Not the least common denominator. Universal health care need not mean that everyone gets the same kind of health care. Of course, it would be a big step in the right direction if everyone had some guaranteed health coverage. But one of the reasons there is so little enthusiasm for providing health care to everyone is a belief that it will mean that those who now enjoy health care conveniences may have to give up some of them. Opponents of health care have tried to scare us with tales (which may or may not be true) about long lines and inferior care in places that have socialized medicine. It should be our initial goal to provide some guaranteed stable system of health care to all of the 40 million Americans who do not have it. But, at least at first, we should make it clear that we are not demanding that those people receive the same level of care as everyone else. People who currently have good coverage could continue under the system now in use. Such a multitiered system might not be morally ideal, but improving coverage in the lowest tier would be a good start.

Who is uninsured? The public tends to assume that when we talk about the uninsured, we are referring to derelicts and the homeless. When I speak to groups of middle-aged Americans, I like to ask, How many of you have uninsured adult children? The number is surprising. Many of the uninsured are healthy young people who are working full time. For this reason there is in fact some support for universal coverage among insurance companies. Since these individuals have relatively low health care costs, it could be quite profitable for insurance companies to bring them into the insured pool, provided, of course, that someone pays the premiums. From a moral point of view, it should not matter whether those who would benefit from this are socially or economically similar to us. Practically speaking, however, it helps if the public recognizes that a good portion of those who would benefit from universal coverage are very much like us. In fact, they are our children.

We are not the best. The insurance industry and health care providers have propagated a myth that the United States has the best health care system in the world. That is simply not true. Our life expectancy at birth and our life expectancy at age 65 are lower than those of most other industrialized countries. Our infant mortality rates are worse than Cuba’s. We must disabuse people of this myth before we can move on. Moreover, even if we have the best doctors in the world, or the best hospitals, that does not mean we have the best health care system in the world. Judged by faith-based moral values, a system that leaves 40 million people without organized guaranteed care is not doing very well. In building support for reform, we should distinguish between failings of the system and the quality of individual doctors, hospitals and other providers.

It depends on what you need. How good our system is depends on what you want from it. If you want to improve your sexual performance, you are better off in the United States than anywhere else in the world. If what you need is a flu shot, you are better off almost anywhere else. That is not a system to boast about.

Stop drug advertising. For many years we banned television advertising of prescription drugs. We should go back to doing so. The evening television news often carries stories about seniors who have to choose between buying food and buying the drugs they need. Sometimes these stories are followed by an advertisement designed to increase the demand for, and therefore the price of, prescription drugs. If we want to make drugs more affordable, we should stop the advertising for them. That would lessen an inappropriate demand for such medications and save the pharmaceutical companies the money they spend on advertising. Similarly, we might also reduce the amount of money these companies spend to get doctors to prescribe their drugs.

Reimportation makes no sense. Drugs are cheaper in Canada than in the United States. Many Americans therefore try to buy their pharmaceuticals from Canada, a practice that is against federal regulations. The president and Congress are considering allowing the reimportation of drugs from Canada. This would mean that Canadian wholesalers could buy drugs in the United States and that American consumers could then reimport them from Canada. This is ridiculous. Why don’t we ask, Why are drugs cheaper in Canada? The answer is that the Canadian government regulates the prices drug companies are allowed to charge. The United States, by contrast, gives priority to the sacredness of its market-based system.

We have tried market-based solutions. Today the most popular approach to solving any problem is to have the government back off, deregulate and let the market work things out. That has already been tried in health care, where a market-based approach has predominated for the last 20 years. That is what has gotten us into this mess. It is not the approach that will get us out of it.

Whose bureaucrats? We have seen massive, persuasive ad campaigns that ask Americans, Do you want government bureaucrats deciding what health care you can have? What those ad campaigns do not ask is: Or would you rather have those decisions made by other bureaucrats, who work for insurance companies with a financial interest in providing you with less health care? We need to make it clear that this is the alternative. While government bureaucrats might not be anyone’s first choice, the public would probably prefer them to insurance companies.

One price. We have a health care pricing system that is very much like the one used by the airlines. Some people pay a great deal more for the same services. Supporters of the system argue that everyone is charged the same price; it is just that big discounts are given to the government and large insurance companies. This is a distinction without a difference. The result is that uninsured individuals are often charged the highest fees. Economically, there may be some explanation for that. Morally, it is simply wrong to charge the highest prices to those least able to afford them. Everyone should pay the same price for the same medical service.

These are a few suggestions for how we should take a fresh look at the curent health care situation. Others may perhaps refine them, offer different suggestions or phrase them more effectively. My point is that it is not enough to analyze these problems carefully, or even to base our solutions on moral values, though we must do both. More important, we need to build broad support for the proper solutions and articulate our proposals in a manner persuasive to the American public. In short, we must become skilled salesmen for these ideas. This is part of politics, of democracy, of conversion. It applies not only to health care, but to all aspects of our social agenda. If we expect the Holy Spirit to inspire policy makers to do the right thing, we must also become instruments of the Spirit. Only then can we hope to present our faith-based solutions in ways that will inspire people to open up their hearts and recognize the moral implications of the health care problems facing our country.

Edward M. Welch is a professor in the School of Labor and Industrial Relations at Michigan State University.

Comments

Bernard Survil | 3/5/2005 - 8:21am
Let the author of "Plain Talk About Health Care" (America Feb 21, 2005) know that Pennsylvanians are doing more than "something, almost anything, that will help to break the health care impasse."

Over 45 people just in the Pittsburgh area alone have organized PUSH: Pennsylvanians United for Single-payer Health Care.

And State Wide we now have: PUR Health Care: Pennsylvanians United for Reform in Health Care, the community education and outreach arm. Full-time staff has been contracted and an office, and interactive web site are close to a being a reality.

Pennsylvanian readers of America who want to participate can use me for the moment as a contact, until phone numbers and website are ready.

(Fr) Bernard Survil Tel: 724-850-1616 email:bsurvil@dioceseofgreensburg.org

Bernard Survil | 3/5/2005 - 8:21am
Let the author of "Plain Talk About Health Care" (America Feb 21, 2005) know that Pennsylvanians are doing more than "something, almost anything, that will help to break the health care impasse."

Over 45 people just in the Pittsburgh area alone have organized PUSH: Pennsylvanians United for Single-payer Health Care.

And State Wide we now have: PUR Health Care: Pennsylvanians United for Reform in Health Care, the community education and outreach arm. Full-time staff has been contracted and an office, and interactive web site are close to a being a reality.

Pennsylvanian readers of America who want to participate can use me for the moment as a contact, until phone numbers and website are ready.

(Fr) Bernard Survil Tel: 724-850-1616 email:bsurvil@dioceseofgreensburg.org