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September 04, 2005
The Health of a Nation
I appreciate the simple message of our Story for all Ages this morning. As church leaders, parents and mentors, we know it is important to teach our children to be kind and helpful, to be a friend to all people and help those in need. We know it is important to pass our values on to our children.
A few years ago, the annual meeting of the Unitarian Universalist Association took place at the Convention Center in downtown Cleveland. At that General Assembly, we saw how well we had taught our children. As they were walking to the convention center, a group of youth saw a homeless man on the street who was terribly in need, needing medical attention and care right away. They stopped to help him when they saw him. They got him some water and food, and brought him to the convention center where they could call for more help and get him medical attention. Later, at the conference, they initiated a campaign to raise money for the homeless shelters in Cleveland.
As adults, though, and as citizens of our country, we too are called to live by this kindness and compassion. And today, the way in which I want to look at how well we are living this is in the area of healthcare.
As a minister, I have a lot of experience dealing with the health insurance industry. Technically, I am self-employed, and since many churches do not offer group plans, arriving at a new job at a new church in a new state usually means shopping for new insurance.
I remember my first experience shopping for individual coverage. It came when I took a job as intern minister in Nashville, TN. The church had a group insurance plan, but the premiums, which would come directly out of my pay equaled almost half of what I was being paid. Instead, I tried to shop for something cheaper.
I looked into a few different agencies. With the first, the friendly salesman came to my office at the church. He asked me questions about my health, age, smoking, etc. But, I was shocked when he pulled out a small plastic bag, opened it, pulled out a large cotton swab and asked me to open my mouth. It was an HIV test, he explained. The last piece of information they would need to process my request for insurance. I did not know what to do. Reluctantly, I opened my mouth.
The next few hours I was in a state of disbelief, fear and anger. I was afraid, because even though I didn’t think I was at risk, I thought, what if that test comes back positive, what if gives a false positive. After all, it wasn’t a technician in a lab performing the test, it was a salesman, and who knows how long the test might sit in his car before it gets taken to the lab, who knows whether it will be handled right. If something goes wrong, I might never get insurance again. By the end of the day, I called the salesman back, and told him to throw away my application including the test. Sure enough, he said, it was sitting right there on his desk, and he would throw it away. The second place I shopped did agree to insure me, at a really affordable price, but they put significant restrictions on the insurance barring any coverage for anything I had seen a doctor about in the past. Unfortunately, I had seen a doctor for back pain, so they excluded “any accident or injury to my neck, spine, back, muscles or related problems.” I offered to pay more to have better coverage, but they refused. This insurance policy is what is called being underinsured.
In the end, I was lucky to have with the church’s group plan—paying nearly 50% of my salary for it, but at least I had good insurance. The situation made me angry—it made me feel powerless and desperate, and if it was this difficult (and costly) for me, a 26 year old, single, healthy female to get health insurance—how hard it would be for most of the population. It was clear to me at that time, that healthcare in this country is in a crisis. And that access to healthcare is a moral issue.
Given my experience, it is no surprise that there are 45 million uninsured Americans in the U.S. This is almost one in every six people. In a group this size, it translates into about 10 people here without health insurance. Children make up 8.4 million of the uninsured, that’s the population of New York city. Imagine the population of New York City, all those people as children, uninsured children. In the state of Texas, a shocking one-fourth of the population has no health care insurance.” This is a moral issue. Even for folks who have insurance, they are feeling the pressure of rising costs and the risk of losing their coverage. Current trends show insurance premiums increasing on average 16-17% a year—that translates to premiums more than doubling every 5 years. As it is now, family coverage averages almost $10,000 a year. Over 14 million Americans (that’s more than the population of Ohio) spend more than a quarter, of their income on healthcare. And one million American middle class families go bankrupt because of medical bills.
As a result of the escalating costs, businesses are dropping health coverage as a benefit for their workers. A fall in the percentage of Americans with employer-sponsored insurance (from 65 percent in 2001 to 60.4 percent this year) accounted for most of the increase in the uninsured. This means working Americans are falling through the cracks of our healthcare system.
Businesses are hurting as well. General Motors found that their employee insurance costs added $1300 to the price of each of their cars. Even locally, Youngstown State University, feeling the pressure of rising healthcare costs looked to transfer some of that cost on to teachers and employees. And so, until this crisis in healthcare is resolved, we will continue to see frequent strikes as employers try to defer the costs onto workers, who will fight to protect their wages. And, who can blame the worker. Even if the costs start low, with the price more than doubling every five years, and with wages not rising anywhere near that rate—it will be a dramatic loss in wages for workers.
American business is hurting because of the cost of the U.S. healthcare. And the saddest part is that until we see corporations, labor, and the citizens of the U.S. demand a better system, we will continue to see the groups hurting the most under the present system, fighting one another—a losing battle.
Why are the cost so high? Well, for one the United States spends more on healthcare than any other country in the world. As a percentage of Gross Domestic Product, we spend twice what Britain spends, and a third more than the next highest countries, Switzerland and Germany.
This significant difference in spending might be acceptable, even worth it, if it translated into better healthcare. In fact, the United States overall is less healthy than the 15 wealthiest industrialized countries. Among these 15 countries, we have the highest infant mortality rate, and shortest life expectancy, each strong indicators that we trail behind in overall health. We also have tremendous disparity in healthcare. The infant mortality rate for black children is twice that of white children. Even across regions, there is great difference. For instance, in Alabama, 16 children out of 1,000 live births die within their first year of life, that’s more than twice the national average. How’s that for the wealthiest nation in the world? In 2000, the World Health Organization released a groundbreaking report with data on the health systems of 191 member countries.
In it’s analysis, the WHO developed 3 goals for what it thought a good health system should do:
1) good healh: ‘making the health status of the entire population as good as possible’;
2) responsiveness: responding to clients expectations of respectful treatment and explanation of information; and
3) fairness in financing: ensuring financial protection for everyone with costs being associated with one’s ability to pay.
According to the WHO goal, the best health system would be one that is both good and fair. According to the WHO rankings comparing just the 15 wealthiest nations, the US scored the highest for responsiveness, but last for fairness, and last for overall health system performance. In addition, the US ranked second to last in percentage of people satisfied with the system, with only 40% being satisfied with the system.
So if we do not have the best healthcare, why does it cost so much? One explanation is that we have more expensive technology available, and we use it more often. But when compared to other nations, this doesn’t bear out. With some expensive procedures like bypass surgery and angioplasty, we perform more than double the next highest countries, but the ratio of expensive high-technology machines per capita, while above the median, are significantly less than many countries. Another reason for our high costs is ironically, the number of uninsured Americans. People without health insurance are unable to receive preventative care, and often only seek medical attention when illness has progressed to an emergency situation. Then, they are forced to seek treatment in the emergency room. Emergency room care is the most expensive form of care, yet in a system where so many have no health coverage, this most expensive way is the first and only front line treatment for the poor, or working uninsured.
But over and above these reasons, undoubtedly most of the high costs of healthcare in this country can be attributed to administrative costs. Physicians for a National Health Program estimate that nearly 30% of what is spent on healthcare goes to administrative costs. By comparison, in Canada, only 8-11% of healthcare costs go to administration.” Meaning we spend three times as much on administration.
Our current healthcare system is called a multi-payer system, which means when you go visit the doctor, or the hospital, bills are paid by a multitude of groups. The patient bears some of the expense, a private insurance carrier bears some, Medicare or Medicaid may pay some, private supplemental insurance plans may pay some, the employer may pay some. The logistics of processing, sorting, figuring out what is covered and what is not, and by who, according to which plan is a bureaucratic feat—and an expensive one at that. It is how we pay for healthcare that accounts for most of the difference between what we spend on healthcare in this country and what similar nations spend.
With a single-payer National health system, one agency would handle paying for all the medical bills, cutting back significantly on these costs. In fact, this is how Medicare works and currently the administrative costs for Medicare are less than 2%. In addition, with universal health coverage, more Americans, the 45 million who currently do not have coverage, would have access to basic preventative care, and would not need to rely on emergency rooms for standard care, saving money for the overall system. People without health insurance tend to have more health problems because of the lack of adequate and regular preventative care. Providing universal coverage for all American, while seeming expensive, would actually cost far less than providing emergency room care for 45 million Americans, and shouldering the financial costs of a confusing and inefficient multi-payer system.
Some people worry, or try to induce fear by arguing our taxes will be raised to provide this healthcare. But in fact, overall individuals and business will experience a lightened financial and stress burden with single-payer universal coverage. The taxes required to pay for universal, single payer health insurance would not be felt by most Americans as it would now cover prescription drugs, doctor co-pays, insurance premiums and other out of pocket expenses.
Another fear tactic used is the fear of waiting to see doctors or waiting for medical procedures. In Canada, there is a waiting period only for elective, non-emergency surgeries and procedures. Emergency cases are taken right away, without a wait. And as for doctors, even in this country, if you are signing up as a new patient or scheduling an appointment for something that doesn’t need immediate attention, it is not uncommon to wait 6-8 weeks for an appointment. Even in this country, we wait for elective, non-emergency treatment. One of the benefits of universal coverage of course, a trade off, you might say, would be not denying folks without coverage access to emergency, necessary life saving treatments.
Dr. Martin Luther King reminded us that we are caught in an inescapable network of mutuality, sharing one destiny. Jesus teaches us clearly, as we do to the least of us, we do to God. The Prophet Micah reminds us that what is required of us is to do justice and to love kindness. Compassion, justice, responsibility and care for others pours out in the words of these great prophets reminding us how we are called to live and what we are called to do.
Healthcare is a moral issue. And the moral response that we need from our government is to find a better system. So far, despite escalating costs and research which shows other nations carrying for their people better and for less, Congress has done nothing to actually seriously investigate these systems to bring a new plan before our people. In response to their lack of will, the people are moving. In states all across the country, including Ohio, people are beginning petitions to start single-payer health care systems in their states. I ask you to sign the petition for single payer health care in Ohio sponsored by the Single-Payer Action Network Ohio. It will be available here at the church in a few Sundays.
I ask you in the meantime to consider the moral demands of justice and the fiscally responsible demands of business and labor—and join the thousands in signing this petition. With 140,000 signatures, we will be able to get this issue on the statewide ballot, so all the voters of Ohio can be heard. This has already happened in Vermont, and there are movements afoot through out the country. If Congress will not act, if the federal government will not act to fix this moral and social crisis, than it is up to the people to force the situation—to remind them what there job is—to protect the health and well-being of this country and its people.
And if you do not live in Ohio, as I know many of you don’t, look on the internet for similar groups in Pennsylvania. If Ohio makes progress, it will bolster organizing in PA.
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