Sunday, November 16, 2014

Health Care: A Matter of Soul

“We have 900 billing clerks at Duke. I’m not sure we have a nurse per bed, but we have a billing clerk per bed… it’s obscene.”
Health economist Dr. Uwe E. Reinhardt, describing the Duke Medical System
Yesterday was the start of open enrollment for health care insurance under the Affordable Care Act.

This weekend, Physicians for a National Health Program is holding its annual meeting in New Orleans to consider this year’s theme: “Seeking Health Equity: Politics, Racism, and the Fight for Single Payer.”

In Congress, majority leaders are planning major investment of time and money in investigations into every aspect of creation and implementation of the ACA, and looking for ways to vote, once again, on repeal of all or portions of the act.

And last week  the Supreme Court agreed to hear the case of  King v. Burwell, a case challenging the decision of  the Fourth Circuit court to uphold an IRS rule regarding health insurance subsidies.

I confess, I’ve found the animosity toward Obamacare hard to follow, especially as expressed by Christians. Christians have historically been the ones most insistant on helping the sick, often at great cost to themselves. I posted about this several years ago
When plague devastated the 3rd century world, Christians cared for the sick, gathered and took into their homes people thrown into the street by family members fearful of becoming infected.
When Romans and others threw their deformed, surplus, unwanted babies on trash piles or into rivers, Christians gathered them up, fed them, cared for them as their own.
John Chrysostom taught, "If you see anyone in affliction, do not be curious to enquire further... [the needy person] is God's, whether he is a heathen or a Jew; since even if he is an unbeliever, still he needs help."
Even now, with the frightening scourge of Ebola, Christians are essential participants in care of the sick. A Sixty Minutes report on the Ebola outbreak in Liberia made no mention of the Christian faith, but showed the local health workers gathering strength and courage during their breaks by singing hymns together. Two doctors flown back to the US for Ebola treatment last summer were missionaries: Dr. Kent Brantley and Nancy Writebol, both serving with Samaritan’s Purse.
The Good Samaritan, William Henry Margetson,
London, ca 1900

Faithful Christians have always taken to heart the challenging parable of sheep and goats in Matthew 25. The sheep and goats aren’t divided by theological position, experiential worship, whether they’ve prayed or said the correct thing, followed the right leader. In Jesus' parable, they’re judged by their care of those in need: the poor, the hungry, those in prison. The sick. 
‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink?  When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?’
“The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’ 
Care of the sick is not a political issue, although both parties try to  make it one.

It’s a moral issue, with practical consequences in the lives of those without access to care, and heavy financial implications in a system where the only option for the uninsured sick is to show up in emergency rooms.

Before the Affordable Care Act was passed, there were nearly 50 million uninsured Americans. According to Health and Human Services Secretary Kathleen Sebelius: 
More than eight million Americans signed up through the Marketplace, exceeding expectations and demonstrating brisk demand for quality, affordable coverage. . . In addition, over 4.8 million more people have been covered by states through Medicaid and CHIP programs, around 3 million more Americans under 26 are covered under their parents’ plans, and recent estimates show that an additional 5 million people have purchased coverage outside of the Marketplace in Affordable Care Act-compliant plans. 
That’s more than 20 million people who now have access to health care. To me, that looks like a win.

Unfortunately, some of the people most in need of care are still unable to receive it. An important 
provision of the ACA is expansion of Medicaid eligibility to individuals with incomes at or below 138 percent of poverty ($27,310 for a family of three). The expansion was intended to be national, but the June 2012 Supreme Court ruling opened the door for states to opt out. As a result, 23 states have refused to expand their programs, leaving the  median income limit for parents in 2014 at 50% of the poverty rate, an annual income of $9,893 a year for a family of three, with childless adults completely ineligible. As a result, four million adults fall into a “coverage gap”,  with incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits. The majority of those are the working poor, working minimum wage jobs or trying to get by with part-time employment.

The ACA, Obamacare, was a compromise cobbled together in an attempt to care for the uninsured while keeping the insurance industry happy.

From every indicator I can see, it’s improved things for many: young adults struggling to find a permanent job with benefits, peoplewith pre-existing conditions who before would have faced bankruptcy, families of the working poor in states that have followed the Medicaid expansion plan.

But I’m still puzzled at the strong opposition to single-payer health care. To me, it’s a no-brainer. 

Why should my health care dollars pay the salary of the insurance gatekeeper who decides whether my doctor’s prescription is eligible? 

Why should my doctor spend hours every week answering to non-medical personnel eager to boost profits by denying care?

Why should a financial executive behind a desk in Hartford have more say over who needs a hospital than the doctor in the room with the patient?

A 2006 survey examined the amount of time physicians spend on billing and insurance-related paperwork in the United States and Canada (a single-payer system): 
20.6 hours of nurse time per physician in the United States versus 2.5 hours in Canada; 53.1 hours per week of clerical time in the United States versus 15.9 hours in Canada; and 3.1 hours per week of senior administrators’ time in the United States versus 0.5 hours in Canada. 
Economic analysis has repeatedly shown that a single-payer plan would slash administrative costs, allow greater focus on preventive care, free workers and employers from insurance-related staffing decisions, and save billions in health care dollars. 

I’m thankful for doctors. And for nurses, optometrists, dentists, therapists of every kind.

I’m thankful for those who spend their lives training, serving, looking for ways to bring health to bones, brains, eyes, ears, teeth.

I’m thankful for the Affordable Care Act, and the difference it’s made in lives of people I know, and don’t know.

I'm thankful for those willing to face political heat and accusations of “socialist!” to advocate for more and better care for those who are still without.

I’ll be praying this weekend for the doctors gathering to look for ways to advance the idea of a single-payer system. Their website is a revelation of simple good sense and compassion.
“The issue of universal coverage is not a matter of economics. Little more than 1% of GDP assigned to health could cover all. It is a matter of soul.”  Uwe Reinhardt

As always, your thoughts and comments are welcome. Click on the   __ comments link below to post.