A Christian Theological Statement on Health Care

Transcription

1 A Christian Theological Statement on Health Care Dr. Kevin Mabry Fort Collins, Colorado

2 And what does the LORD require of you but to do justice, and to love kindness, and to walk humbly with your God? Micah 6:8 Our God calls us to witness to injustices in the world. We have the responsibility to seek social redemption when God s children are unable to live with dignity and respect. We are directed in Ezekiel 24:16 to seek the lost bind up the injured, and strengthen the weak. Our loving God requires us to seek justice and equity for all, as revealed throughout Scripture. As the faithful body of Christ, we are called to seek wholeness and healing for all people. It is our mission to seek the redemptive, healing ministry of Christ in our spiritual lives and for the world. The Health Care Crisis: The health care system in the United States has reached a state of crisis. We have experienced extravagant increases in health care costs over the past decade that have limited access to essential health care for millions of Americans. No other industrialized nation spends more on health care per capita than the United States. In 2010, we spent close to 18% of our GDP on health care, while still having 49.1 million people uninsured, with more than 30 million people underinsured. In comparison, every other industrialized nation in the world covers every citizen while spending 11% or less of their GDP on health care. i In 2007, sixty-two percent of American

3 bankruptcies were from medical debt, and of those, 78% had medical insurance (60.3% had private coverage not Medicare or Medicaid) ii. No other industrialized country in the world allows people to go bankrupt from medical debt. Although the United States is among the wealthiest nations in the world, we remain far below other industrialized nations in life expectancy and other health outcomes. iii According to the World Health Organization, the United States ranks 37 out of 191 nations in the world in life expectancy, preventable deaths, and infant mortality. iv We spend more to obtain health care than any other nation, but we get far less for our money. In 2010, President Barack Obama endorsed and Congress passed the Patient Protection and Affordable Care Act (referred to as PPACA, ACA, or Obamacare). This legislation has been widely hailed as the most significant piece of health care reform legislation in the United States since Medicare was passed in There are some good components to this legislation that help Americans obtain health insurance and attempt to prohibit health insurance companies from denying access to health insurance and limiting care. Yet, the point that is often misunderstood is that having health insurance is not the same as having access to health care. The missing ingredient in this reform effort is that it does not control health care costs, nor allow everybody equal access to and continuity of health care. Costs will continue to skyrocket, and cost-shifting to consumers will continue to increase, as insurance companies continue to seek to maximize their windfall profits from gaining millions of new customers required to buy their product. In the creation of state health insurance exchanges by the federal government, an estimated 3.5% fee will be added to the insurance premiums by the states to support running of the exchanges. State run exchanges are also supporting additional costs of marketing and administration to develop and promote their exchanges, thereby consuming resources that could be better spent on providing actual health care. v As a country, we face a dismal future with a multi-layered, unsustainable system of health care bureaucracy and

4 inefficiencies. Even with PPACA, the profit motive remains the dominant force in the U.S. health care system and care will continue to be rationed according to ability to pay: Over 36 million Americans will remain without health insurance, lacking continuity of care, and vulnerable to exorbitant financial burdens, especially in states which elect not to expand Medicaid coverage. vi Millions more people will be underinsured, choosing cheaper health insurance products with fewer benefits and larger deductibles and co-pays. In state health insurance exchanges, the lowest cost and benefit level of insurance coverage (the bronze plan) has a cap of $12,000 dollars for a family of four to pay out-of-pocket for health care needs every year. vii Insurers will still use 15-20% or more of the health care dollar for administrative costs. Providers and hospitals add an additional layer of administrative costs of 10-20% to process, sort, and submit claims in a vast web of negotiated prices and agreements for insurance products, rather than using this money for actual health care. viii (For comparison, Medicare s administrative costs are 2-3%.) Health expenses will continue to climb without cost controls, due to overuse of inappropriate procedures, hospital surcharges, burdensome administrative costs, lack of bulk purchasing of pharmaceuticals and health care products, and lack of global budgets for hospitals and clinics. Employers will continue to decrease their health care costs to stay sustainable in the economic market, shifting more of the burden of costs to employees by providing cheaper insurance products, lower benefit packages, and higher deductibles. Americans will still face bankruptcies due to financial burdens.

5 States have the option of declining federal assistance for expansion of their Medicaid programs, and several states have chosen to decline. This means that people of low income will be hurt the most by not qualifying for Medicaid and being unable to afford health care in the state exchanges. PPACA still relies on an extremely flawed health insurance system that provides exorbitant CEO salaries and profits for shareholders instead of quality, cost-effective health care for everyone. Reform Efforts in Colorado: The State of Colorado has made some good attempts at implementing reform efforts to provide health care for its citizens. The 208 Commission in 2006 was initiated to solicit public feedback on reform ideas and make a recommendation to the Colorado Legislature and Governor. Its recommendation supported a plan similar to the Massachusetts plan, requiring people to purchase health insurance with the help of subsidies for low income people. However, an assessment of the 208 Commission proposals by the Lewan Group, an independent financial analysis company, showed that a single-payer plan was more cost-effective and efficient than any of the other proposed solutions. ix The Colorado Health Care Affordability Act, House Bill 1293, was enacted on April 21, 2009, to collect a hospital provider fee that is matched by federal funds. This bill increased funding for hospitals which serve patients on public health insurance programs like Medicaid and the Colorado Indigent Care Program (CICP), and those uninsured. The bill s intent is to decrease cost-shifting to patients with private insurance for low reimbursements, and to provide better care for those in such programs. On April 3, 2011, the Colorado state legislature voted to support Senate Bill to help the state form a health care

6 insurance exchange to synchronize with the Affordable Care Act, as part of national health care reform efforts. Even with these efforts, along with PPACA and Medicaid expansion, Colorado is projected to see a reduction of only 41-50% of the population uninsured by x In 2010, it is estimated that there were 640,000 uninsured in the state of Colorado; xi therefore, without other reform actions, it is estimated that 350,000 Coloradoans will still be uninsured by the end of the next decade. Religious Ethics and Health Care Access: Of all the forms of inequality, injustice in health care is the most shocking and inhumane. xii Unfortunately, these words by the Rev. Dr. Martin Luther King, Jr., about the lack of universal health care in the United States still ring true almost five decades after he spoke them. We still allow health care to be treated as a commodity, and people who live below the poverty line receive lower quality of care and treatment. xiii As people of faith, this inequity should ignite our passion for social justice and compel us to keep working for health care as an equal right for all of God s children. Does every individual have worth? Lack of health insurance is associated with approximately 48,000 deaths per year in the United States. xiv Every one of those people who die needlessly is a child of God, created in God s image. Each person s life is precious, worthy of respect, and entitled to the right of being without distinction of race, gender, religion, political belief, or economic or social condition. In John 10:10, Jesus describes health as a state of being that encourages wellness in physical, social, and spiritual dimensions: I came that they may have life, and have it abundantly. Imparted by God, abundant life assigns dignity and respect to each person. As people of faith, we reciprocate

7 this dignity by advocating for quality, affordable health care for all people. Are we called to seek health, wholeness, and restoration? As followers of Christ, we are called to be restored and made anew, as reflected throughout Holy Scripture. In Luke 9:2, Jesus declares restoration and health as fundamental aspects of his ministry and charges us to proclaim the kingdom of God and to heal. Essential to expressing God s love for one another, providing health and wholeness is a key element in spreading the Good News. There are numerous healing narratives in the Gospel that support this theme. How do we define health in our society? The way health is defined by a society measures its morality, and the way we care for each other measures our compassion. Indeed, each one of us has a responsibility to care for ourselves and follow a healthy lifestyle, pursuing education and practice for preventative health, safety, good nutrition, safe working environments, and safe living conditions. Yet, there is infrastructure that we can t provide for ourselves and is better implemented by society as a whole. We affirm the need for legislatures and courts, public schools and colleges, fire and police protection, public libraries, roads and highways, and public transportation. Health care is another infrastructure that government can provide more efficiently than the private sector; this right should be guaranteed for all people as a public service and responsibility. Ezekiel 34:4 demonstrates how the leaders in government failed to care for the weak and less fortunate: You have not strengthened the weak, you have not healed the sick, you have not bound up the injured. We need health care infrastructure that meets the purpose of providing universal health care, rather than profit-driven private health insurance. PPACA has made some inroads in preventing insurance companies from denying care and access. However, we are still faced with uncontrolled costs of increased premiums and out- of-pocket expenses. There will

8 still be many situations where employers will not fund adequate insurance coverage and many people will remain uninsured or underinsured. Businesses may choose to pay a fine or reduce their workers to part time in order to avoid paying for adequate health insurance policies. As a society, we must protect each other from the burdens of ill health, medical debt, and bankruptcy due to the inequalities and inefficiencies in the fragmented and dysfunctional health care and insurance systems currently in place. How are we commissioned? Just as Jesus commissioned his disciples to make healing a central part of their ministry (Matthew 10:1), we too have the privilege and obligation to cast out unclean spirits and incorporate healing in our community and nation, as witnesses to the Good News. We have a calling to have compassion for the least of these in need of health care (Matthew 25). We have been gifted as the people of God coming together as the church to participate in healing spiritual, mental, and physical to restore wholeness to people as the first disciples did (Acts 3:2-8). The works of God might be made manifest (John 9:3) in our efforts for healing and honoring all people equally in the name of Christ Jesus. How are we good stewards? Our faith calls us to be better stewards of our health care resources. Health care must be accessible, affordable, accountable, universal, equitable, and sustainable. We thank God for the gifts of medical resources, technology, and knowledge that enable the sick to be healed. We must ask the hard questions of faith in how we are stewards of the finances spent for health care. In the United States, 48.6 million people are uninsured, xv and millions more underinsured, while we pay twice as much per capita as any other industrialized nation. xvi

9 Health care expenses continue to increase at twice the rate of inflation, xvii with administrative costs and the profit motive of health insurance, rather than actual health care, consuming much of the health care dollar. We are called to be better stewards of God s gifts, and overcome ideological and political divisiveness, to seek social justice together in community. Given these faithful principles, what shall we do next? Jesus is the movement for social justice, and the movement for social justice is Jesus in the present. Karl Barth xviii To act with social justice is at the heart of the Gospel. God loves the world and invites us to show that love in practical and material ways. The message of Jesus is the Good News that the Kingdom of God is at hand for all creation and that healing and wholeness are attainable. Let us act in God s love to seek a system of caring that will sustain physical, mental, and spiritual health for all. To participate in this Social Gospel, we join our faith partners to advocate for a system of health care that is equitable, accessible, affordable, accountable, sustainable, and universal. We advocate for this moral vision by talking to our neighbors, our congregations, and our legislators at the state and national levels. We join others who share this calling faithfully, and we support the hard work of social change through the efforts of grassroots movements, social justice advocacy groups, and alliances that seek the common good.

10 We ask for God s guidance and discernment to lead us to a better place in health care that supports all humans in their health and well-being. Let it be so! Amen! Dr. Kevin Mabry, 2013 Signatures of Support

11 Citations: i Hartman, Micah, et al, National Health Spending In 2011: Overall Growth Remains Low, But Some Payers and Services Show Signs of Acceleration, Health Affairs, January ii Himmelstein, D.U., et al, Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, August iii U.S. Health in International Perspective: Shorter Lives, Poor Health, Institute of Medicine, January iv Murray, Christopher J.L., Ranking 37 th Measuring the Performance of the U.S. Health Care System, New England Journal of Medicine, January 14, 2010.

12 v McCanne, Don, Quote of the Day, Physicians for a National Health Program (PNHP), January 18, vi Elmendorf, Douglas W., Congressional Budget Office Report to John Boehner, U.S. House of Representatives, July 24, vii Lore, Ryan, et al, Choosing the Best Plan in a Health Insurance Exchange: Actuarial Value Tells Only Part of the Story, The Commonwealth Fund Issue Brief, August viii Foster RS. Estimated Financial Effects of the "Patient Protection and Affordable Care Act," as Amended. Centers for Medicare & Medicaid Services, Office of the Actuary. April 22, ix Final Report to the Colorado General Assembly, Blue Ribbon Commission for Health Care Reform, January 31, x Holahan, John, et al, The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis, Kaiser Commission on Medicaid and the Uninsured, November xi Health Insurance Status of Colorado Adults: 2012 Update, Colorado Health Institute, June 16, xii The Rev. Dr. Martin Luther King, Jr., 2nd National Convention of the Medical Committee for Human Rights, Chicago, IL, March 25, xiii National Healthcare Disparities Report, 2011, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. xiv Wilper, Andrew P., et al, Health Insurance and Mortality in US Adults, American Journal of Public Health, December 2009; and Woolhandler, Steffie, et al, Despite Slight Drop in Uninsured, Last Year s Figure Points to 48,000 Preventable Deaths: Health Expert, Physicians for National Health Insurance Press Release, September 12, 2012.

13 xv DeNavas-Walt, Carmen, et al, Income, Poverty, and Health Insurance Coverage in the United States: 2011, Current Population Reports, U.S. Census Bureau, Issued September xvi Organisation for Economic Co-operation and Development (OECD), Health Data xvii Friedman, Gerald, Universal Health Care: Can We Afford Anything Less? Dollars and Sense, July xvii Booth, Michael, Key Medicaid Reform Effort in Colorado Shows Promising Savings, Denver Post, September 12, xviii Green, Clifford, Karl Barth: Theologian of Freedom, The Making of Modern Theology series, Fortress Press, Minneapolis, 1991, p. 99. All Biblical references are from the New Revised Standard Version (NRSV) 1989 translation.