What is Healthcare?
I’ve been thinking a lot about this healthcare question. And if I am honest with myself, I’d say that there is no easy fix. People on both sides of the debate, the right and the left, oversimplify the problem by debating whether or not healthcare is a “right.” Healthcare has been defined as the diagnosis, treatment, preservation and prevention of disease, illness, injury, and other physical and mental impairments in humans through services offered by the health profession (www.thefreedictionary.com). Good health is a desired physical and mental state; every person wants good health. But, through the passing time, lifestyle choices, accidents, heredity, and other factors, good health throughout life is not guaranteed. Even in receiving healthcare services, good health is not guaranteed.
In America, our liberty to make bad choices concerning our health has been costly. Obesity, diabetes, high blood pressure, and other ailments are symptomatic of a free nation that is enslaved to its deadly habits (smoking, drinking, promiscuity, overeating, etc.). Yet, we Americans demand comprehensive AND low-cost healthcare services to aid us in regaining and maintaining good health when our lifestyles or other factors cause our health to fail us.
Identifying the Problem
Talks of rights are somewhat unproductive. When it comes down to it, everyone has a right to almost everything except to infringe upon the rights of others. So naturally, some will tout their right to healthcare services because “Everyone has a right to life and human dignity!” Others will say, “You absolutely have the freedom and the right to obtain healthcare services if you so choose, but not with MY money! You do not have the right to force me to pay for your healthcare services.” We must look beyond this talk of rights and look at the real issue: everyone wants good health and a quality of life. When a person’s health fails, no one, regardless of class or ability to pay, deserves opportunities for improved health over and above another. So here lies the problem: How do we in America help the most citizens obtain access to quality healthcare services regardless of class or ability to pay?
Looking at what we have already done, we have used free market, government control, and charity/volunteer based solutions within our current healthcare system. All have benefited some group of Americans in some way because each has some attractive quality about it. That is why all three have found their way into the current system. Yet, the system is broken and is in need of reform.
Finding a Solution
Among those who identify themselves as liberals, moderates, and conservatives, reforms have generally been sought using one of two solutions— greater government control or increased free market solutions. Besides these two, I suggest allowing volunteer agencies, such as charities and faith based initiatives, to play a greater role in the reform debates. They have not been excluded from the talks, but by and large, the other two have dominated the talks. Volunteer and faith based agencies were the leading healthcare services providers in this nation in times past, before talks of Medicaid and Medicare. They have advocated on behalf of the poor and those with no ability to pay from the beginning. They have ensured that the “least” in society have had access to quality care during a time when the government’s job was to govern. With greater support from local communities and government at all levels, we can encourage volunteer activity and contributions through a variety of means, including educational and tax incentives for volunteers, medical professionals, medical supply companies, etc. Faith-based and volunteer agencies can once again take a leading role in healthcare services in America.
Brief History of Public Health
The emergence and ideas of public health and health services are not new; they were birthed out of necessity. Without going into the whole history of public health, I will mention that epidemics such as the bubonic plague, influenza, smallpox, malaria, yellow fever and syphilis, were catastrophic events that helped move communities all around the world towards public health solutions. Governments, communities, and health boards struggled to find remedies for treatment, containment, and prevention. As well, great industrialization and an overall increase in urban living (largely due to the industrial revolution) have caused problems with the spread of germs and disease, and have caused great unsanitary conditions for people living in overcrowded areas. Again, communities and health boards responded by developing hygiene and environmental regulatory systems and public health laws. Because health maintenance is so wide-ranging, the health profession has become one of the largest and fasted growing professions in modern times.
Blessed are those who live in nations where healthcare professionals are abundant, because the people in these nations have greater access to treatment and medication that is often lifesaving. Poor nations struggle to give their citizens the safety net of services that are provided by wealthier nations. Because good health is so important, and the risk of accident, illness, or disease is high for all, healthcare insurance has become a viable solution for citizens in many nations to supplement the costs of receiving treatment and medication, should it be needed.
Market-Based Health Insurance: The Good, the Bad, the Ugly
In capitalist societies, citizens have a variety of health insurance companies to choose from among those in the marketplace and these insurance companies offer a range of services. Because in the free market, competition drives down costs, citizens can often find low-cost coverage plans that are tailored to their individual or family needs.
Some argue that the capitalist model leaves too many people uninsured and unfairly reduces access to quality healthcare for the poor. They maintain that access to quality healthcare should not depend upon class or income status. For the uninsured, a trip to the hospital may push some into bankruptcy. For these individuals, trips to the emergency rooms ultimately drive up healthcare premiums after hospitals redistribute the costs of providing services to them (in America, federal law prohibits hospitals that participate in the Medicaid program from denying urgent care to the uninsured).
Additionally, greedy insurance companies take advantage of some citizens by denying coverage to some elderly and those with pre-existing conditions. Opponents argue that Insurance companies should not be allowed to decide who lives and who dies.
Government-Run Health Insurance: The Good, the Bad, the Ugly
In some socialist and communist societies, the government either provides a government run-option or is sole provider for healthcare services. Some argue that the socialist model ultimately leads to less access and poorer health services than in the capitalist model. Wayne Grudem has stated that “Government is never an efficient provider of economic goods because it does not have to face the competitive incentives of the free market . . . Federal government control of health care will inevitably mean a steep increase in costs, a decline in quality, a decline in freedom of choice, and a decline in the availability of certain kinds of medical care.” Additionally, “If a nation’s government controls health care, then some rationing system will be necessary to decide who gets treatments and who does not; and there will be widespread instances of denial of care; for a government simply cannot provide an infinite supply of care for everyone who asks for it.”
The current government-run healthcare systems in America, (Medicare and Medicaid) are expensive and highly problematic. According to a 2009 study done by National Center for Policy Analysis:
The 2009 Social Security and Medicare Trustees Reports show the combined unfunded liability of these two programs (Social Security and Medicare) has reached nearly $107 trillion in today’s dollars! That is about seven times the size of the U.S. economy and 10 times the size of the outstanding national debt. The unfunded liability is the difference between the benefits that have been promised to current and future retirees and what will be collected in dedicated taxes and Medicare premiums. Last year alone, this debt rose by $5 trillion. If no other reform is enacted, this funding gap can only be closed in future years by substantial tax increases, large benefit cuts or both . . . Medicare’s total unfunded liability is more than five times larger than that of Social Security. In fact, the new Medicare prescription drug benefit enacted in 2006 (Part D) alone adds some $17 trillion to the projected Medicare shortfall – an amount greater than all of Social Security’s unfunded obligations . . . More than one-third of the wages workers earn in 2054 will need to be committed to pay benefits promised under current law. That is before any bridges or highways are built and before any teachers’ or police officers’ salaries are paid.
Those figures are catastrophic! America simply cannot afford another government-run health care program; the costs to run the current programs are unsustainable. Doctors and healthcare professionals have already felt the pinch every time the government has reduced their reimbursement payments for services. Expanding government control of the healthcare industry is sure to make doctors, healthcare practitioners, individuals with chronic illnesses, high risk employment, and the elderly among the biggest losers. Opponents argue that the government should not be allowed to decide who lives and who dies.
Furthermore, the American government has not yet figured out how to provide a means for each citizen to receive basic needs such as adequate food, shelter, and clothing, so they lack credibility in promising the poor yet another entitlement that they cannot deliver on. With the billions of dollars spent each year fighting the War on Poverty, and with “free” money, housing allowances, and medical insurance provided for the poor, why has poverty worsened? Kenneth Blackwell has noted that “The Democrats War on Poverty has failed.” He then quoted a 1998 State of the Union address from Ronald Reagan:
My friends, some years ago, the Federal Government declared war on poverty, and poverty won . . . Today the Federal Government has 59 major welfare programs and spends more than $100 billion a year on them. What has all this money done? Well, too often it has only made poverty harder to escape. Federal welfare programs have created a massive social problem. With the best of intentions, government created a poverty trap that wreaks havoc on the very support system the poor need most to lift themselves out of poverty: the family. Dependency has become the one enduring heirloom, passed from one generation to the next, of too many fragmented families.
Again, government is never an efficient provider for goods and services as evidenced with government-run healthcare and other government-run programs.
Volunteer-Based Solutions: The Good, the Bad, the Ugly
Many nations have felt the moral obligation to care for its poor and sick. America is no different. American citizens by and large have agreed to have their earnings taxed for the purpose of providing some state and federally funded insurance for its poor and elderly (Medicare and Medicaid), but many warn that the government has overreached its constitutional authority in forcing some citizens to pay for the healthcare premiums of others.
Throughout most of America’s history, citizens of good conscience volunteered their time, money, and skills to build and work in hospitals and care centers for the purpose of caring for its sick, poor and elderly. They were the founding and leading providers of healthcare services in America! Christians in this nation built schools and hospitals and cared for men, women, and children of all races, classes, and cultural backgrounds. This was in response to the Christian call to “heal the sick” and “care for the poor.” The role of Christians in responding to a variety of human needs, especially those of the poor, has been marginalized in recent times by the broadening role of the American government. As noted in a recent article by Evangelical and Catholic Christians, “It is increasingly the case that wherever government goes religion must retreat, and government increasingly goes almost everywhere.”
Like government welfare, charity (another means of welfare) too has had some adverse effects. For those with no ethics of responsibility to self and community, charity alone may have the unintended consequences of removing the incentive for these individuals or families to save for instances of illness and make healthier lifestyle choices. It has had the effect of creating an entitlement mentality that cannot soon be reversed. Benjamin Franklin, on The Price of Corn and Management of the Poor, November 1766, noted:
I am for doing good to the poor, but I differ in opinion of the means. I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it. In my youth I travelled much, and I observed in different countries, that the more public provisions were made for the poor, the less they provided for themselves, and of course became poorer. And, on the contrary, the less was done for them, the more they did for themselves, and became richer.
There is no country in the world where so many provisions are established for them; so many hospitals to receive them when they are sick or lame, founded and maintained by voluntary charities; so many alms-houses for the aged of both sexes, together with a solemn general law made by the rich to subject their estates to a heavy tax for the support of the poor. Under all these obligations, are our poor modest, humble, and thankful; and do they use their best endeavors to maintain themselves, and lighten our shoulders of this burden? On the contrary, I affirm that there is no country in the world in which the poor are more idle, dissolute, drunken, and insolent.
The day you passed that act, you took away from before their eyes the greatest of all inducements to industry, frugality, and sobriety, by giving them a dependence on somewhat else than a careful accumulation during youth and health, for support in age or sickness. In short, you offered a premium for the encouragement of idleness, and you should not now wonder that it has had its effect in the increase of poverty. Repeal that law, and you will soon see a change in their manners.
President Franklin observed that too many provisions for the poor has had the adverse effect of creating dependent and irresponsible citizens.
Americans Will Decide
The wisdom of America is that the American people decide how they want to be governed. The healthcare safety net in America provided through the free market insurance companies, the abundance of hospitals and healthcare professionals, the volunteer agencies and free clinics, and the government subsidies for the poor and elderly make the United States healthcare system a mixed bag. Everyone agrees that reforms to the current system are needed. Ultimately, the American people will decide whether those reforms lead America towards more government control or towards a freer market; added with that choice, Americans would be wise to re-visit the reasoning and power behind volunteer and faith based initiatives to alleviate the debacle caused by the healthcare dilemma.