Tuesday, September 8, 2009

Universal Health Care: So That We Might Live

By Lisa Nilles, M.D., M.A.T.

(Editor’s Note: The following transcript is of a talk presented by Lisa Nilles at St Joan of Arc Catholic Church on August 30, 2009.)

Today’s reading from Deuteronomy describes a scene some 3200 years ago, in which the Israelites, after many years of slavery and wandering in the desert, are finally poised to enter the promised land. Moses, unable to enter with them, uses this last chance to pass on all that God has revealed to him. Moses instructs the people, “Now Israel, give heed to the statutes and ordinances that I am teaching you to observe, so that you may live to enter and occupy the land that the Lord, the God of your ancestors, is giving you. You must neither add anything to what I command you nor take away anything from it, but keep the commandments of the Lord your God . . . for this will show your wisdom and discerning to the peoples.”

Now fast forward some 600 years, for this is when the book of Deuteronomy was actually written. Israel is in crisis. It is divided into two kingdoms, and partially occupied by the Assyrians. In order to survive, the nation needs to unite and pull together. The Moses story reminds people of their history and the principles upon which Israel was founded. Additional laws in the book form the basis for the reforms enacted by Josiah that once again unite Israel. These additional laws address such things as social relationships, and care of the poor and needy. For example, “If there is among you anyone in need . . . do not be hardhearted or tightfisted toward your needy neighbor. You should rather open your hand, willingly lending enough to meet the need, whatever it may be.” Israel’s secular rules are infused with a conscience and guiding set of principles.

Now, fast forward again – this time to the United States in 2007. We are a nation at war, a nation divided by the ideologies of the “right” and the “left,” a nation on the brink of an economic recession. It is at this time that Wendell Potter, the head of corporate communications for CIGNA health insurance company, visits the Wise County Health Fair. He is astounded. He cannot believe that in this land of milk and honey, this land with a huge and successful health industry, thousands of people seek care in makeshift shelters, hundreds of miles from their homes. Indeed, there is a disturbing irony in the fact that the organization that coordinated this fair, Remote Access Medical, was founded in 1985 to airlift medical supplies to remote areas of the world such as the Amazon rain forest. Now, Remote Access Medical devotes 60% of its resources to free care in the United States. We have become the land of remote medical access. That this has happened is tragic. That it has happened in a setting where enormous profit is made from health care is a disgrace. When the health of our economy is measured by the profits of health insurance companies rather than the health of our citizens, we have become a nation that has lost its way.

Which brings us to today. We are now in the midst of a swirling health care debate, much of which has been reduced to a shouting match of staged events rather than a true dialogue. We are besieged with information and misinformation, overwhelmed with sound bites, disheartened by revelations of insider deals, and dismayed at the power of the voices of industry over the voices of the people.

Like Israel so many years before us, we need to return to, and be guided by, our unifying values. In the realm of health care reform, what is our unifying value?

The answer is clear: universal care. No more, no less. Everybody in, nobody out. The word “universal” does not allow exclusions of the sick, the poor, the unemployed, and the visitors to our nation. The word “care” does not allow allow exclusions of essential components of care such as mental health care, dental care, or medications.

Universal care is a value handed down to us over the millennia. Beginning with the admonition in Deuteronomy to care for the needy, to the words of Jesus to love our neighbor as ourself, to the United Nations Declaration of Human Rights which named medical care a basic human right, to the papal encyclical Pacem in Terris which did the same.

In the din of the current debate, who is calling for universal care? How might we get there? Let me highlight worthy efforts at the national and state level in the march toward universal health care.

At the national level, pay attention to efforts to enact a form of national health insurance. National health insurance, as encapsulated in Rep. John Conyer’s “Improved and Expanded Medicare for All” bill, HR676, would open the doors of Medicare to every American. As a model for reform, we know that conversion from our overly complex and woefully inefficient multiple-payer system, consisting of upwards of 1300 private payers in addition to our public payers, to a single payer system, would save enough money in administrative costs that we could pay for universal health care without any increase in total health spending. It is a tragedy that “Medicare for All” was excluded from this year’s initial health care hearings. Nonetheless, due to persistent pressure from citizens, and with courageous congressional leadership from Rep. Weiner of New York, the “Improved and Expanded Medicare for All” bill has been promised a full House floor debate and vote this fall. This is the first time that a national health insurance bill will receive a vote on the floor of the House.

What about the “public option?” A strong public option could be a stepping stone to universal health care. A weak public option won’t add much of anything to our current health care system. This “public option” concept means that Americans would have the choice of buying insurance from a publicly administered plan, along with choices of privately administered plans. This sets up the debate – who can administer health care more efficiently – the government or the private sector? While this is an intriguing concept, for this test to succeed, there must be a guarantee that the public and private plans compete on a level playing field. To date, the bills written that include a public option are inadequate. They include a public option that is a far cry, and deadly weakened, from that imagined at the outset. Minnesota progressives, including ISAIAH and the Minnesota Universal Health Care Coalition, have outlined criteria necessary for a strong public option. We have sent letters to the Minnesota delegation with these details.

If we tragically fail to enact meaningful national health care reform this time around, we must move ahead at the state level. We have a strong universal health care bill in the Minnesota Legislature, called the Minnesota Health Act. This bill, co-authored by Senator John Marty and Rep. David Bly, and supported by over 1/3 of Minnesota legislators, is based on the value of universal care. The bill begins with the following language, “In order to keep Minnesotans healthy and provide the best quality of health care, the Minnesota Health Plan must ensure all Minnesotans receive high quality health care, regardless of their income.”

We must persist until we have universal health care so that, in the words of Deuteronomy, “you may have life.” For indeed we know that those without access to health care are sicker and die younger than those with access. Dr. Michael Belzer, chief medical officer of Hennepin County Medical Center describes uninsurance as “a fatal disease.” Unless we reverse our current trend of steadily worsening access to health care, uninsurance will be the third leading cause of death in the 50-64 year old age group by the year 2015. Dr. Martin Luther King, Jr. insists, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” We must act.

I leave you with two ideas for becoming informed and involved in this historic march toward universal care.

First, watch the episodes of Bill Moyers’ Journal over the past months devoted to health care reform. These are available on the PBS website, and, as well, are catalogued on the Minnesota Universal Health Care Coalition’s website. Moyers offers a compelling look at the institutional forces behind the debate, and a poignant look at the devastating consequences to individuals denied access to care – in America.

Second, join the Minnesota Universal Health Care Coalition in the Campaign for the Minnesota Health Plan. It may be that the march to universal health care begins right here at home, not in Washington. Please join us. We need you.

Thank you.

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