By Rev. Thomas Lambrecht

HC

Our country is having difficulty getting it right when it comes to providing health care for all its citizens. This is an area of great controversy and much political disagreement. Despite the enactment of the fairly comprehensive Affordable Care Act, also known as “Obamacare,” both the controversy and the problems with health care access and cost continue.

Recently our home area of Houston suffered a major shift in availability of health care. All the insurance companies that have been offering plans on the open market have shifted from PPO plans, which provide a wider range of available doctors and hospitals, to HMO plans, which provide a much narrower range of available doctors and hospitals. (As a point of comparison, our current PPO lists 15 rheumatologists within ten miles of our home, while our new HMO lists four.) The reason for shifting from PPO’s to HMO’s is that the insurance companies lost $400 million dollars last year on their PPO plans.

Not only is there going to be a much narrower range of doctors and hospitals available, some of the top-rated doctors and hospitals in the country are now excluded from all local insurance plans. It was front-page news in our paper that M.D. Anderson, the nation’s #1 rated cancer treatment facility, is not going to be covered in network by ANY local insurance plans on the open market. People travel from all over the world to get the best treatment at M.D. Anderson, but that treatment will be unavailable to many Houston residents. Not only that, but patients who are in treatment at M.D. Anderson locally will have to switch to a different doctor and hospital in the midst of dealing with a life-threatening disease. Moreover, these patients may no longer have access to cutting-edge treatment trials being run at M.D. Anderson.

The Houston situation is not an isolated event. United Healthcare, one of the largest health insurance companies in the country, has announced its plan to cut back participation in the open market in 2016 and possibly withdraw from it altogether in 2017. This is due to anticipated losses of $200 million on those plans in 2015.

After several years of slower healthcare cost inflation, the pressure to raise insurance premiums will be very strong. There is also the move to shift more of the costs to the individual and family through higher deductibles and co-pays. Out-of-pocket costs for many plans are in the range of $6,000 to $7,000 per year per person, in addition to insurance premiums of $10,000 to $17,000 per year (for those not receiving insurance subsidies from the government).

The effect of these changes is to reestablish the two-tier system in health care that existed prior to Obamacare. Those who are in the top ten percent of earners or who have a good job with robust health insurance benefits will be able to afford good quality health care, and even get the best care in case of a life-threatening illness. Those who don’t have health insurance benefits through their jobs will be unable to afford good health care, and many will be unable to afford any health care at all. Lower middle class folks are putting off getting treatment or filling prescriptions because they have to pay for it out of pocket, and they are unable to pay the bill.

This was exactly the problem that Obamacare was designed to address, namely, that there was a whole segment of society that could not receive health care because they were priced out of the market (or were excluded because of pre-existing conditions). Now, our health care system is evolving right back into that same situation.

I think part of the problem is a fundamental philosophical question: Is health care a right or a commodity? Many on the right view health care as a commodity that should be purchased by users, and that the market system can bring about the most equitable distribution of resources in the most efficient manner. Many on the left view health care as a basic right of people that should be assured by the government, which leads them to propose government-run health care. (The U.S. is the only Western country that does not have government-run health care.)

If health care is a commodity, then how do we make the health care system operate in an open-market way? The prices for doctors and procedures and prescriptions are normally not available for everyone to see prior to making a decision on what health care to receive. It is nearly impossible to compare prices between one provider and another. Even if “list prices” were fully available, the price negotiated by each insurance company is different and normally not available for comparison. So the “shopper” for health care has to buy a product for which he/she does not know the cost.

Furthermore, people often make health care decisions under duress. The patient has a difficult or painful condition that needs to be resolved ASAP. Even if it were possible to compare prices, taking time in midst of the pain often makes it unrealistic to “shop around.” It is one thing to compare prices for routine physicals or planned elective procedures. It is quite a different thing to be lying in a hospital bed being told you need an emergency heart bypass operation and then to look at three different hospitals and three different doctors to get the best price on the operation.

Finally, if health care is a commodity, how do we ensure that everyone can get treatment? How do we prevent a situation where people who can afford health care receive it, and those who cannot afford it either receive substandard care or no care at all—leading to chronic loss of health or even death? It’s not like we’re looking at the difference between a Chevrolet and a Cadillac. Both cars will get you around, one with more comfort and luxury than the other. But cancer treatment is not a luxury—it is an essential. And some cancer treatments are better than others. If I can’t afford the best treatments, does that mean I have to be resigned to an earlier death?

Some people are afraid of the idea of “rationing” health care. This is usually framed as government bureaucrats determining which health treatments will be covered and which will not, and which patients are eligible to receive which treatments. But “rationing” is already going on. It is not the government bureaucrats, but the health insurance bureaucrats who are determining which treatments will be covered and who will receive them. And health care is now being rationed by income, in the sense that the rich or those with good jobs can receive whatever care they want, while the rest of the population are excluded from certain treatments because they cost too much.

I don’t know the answer to solving the health care crisis. I have read some good ideas that could make things better. But until we decide whether health care is a commodity or a right, we will be at loggerheads in trying to fashion a solution. As Christians, I think we need to apply the lens of justice and fairness to proposed solutions. I’m not sure I would want to face the Lord on judgment day after telling a couple, “I’m sorry, we cannot give your seven-year-old daughter treatment for her leukemia because you didn’t come up with the $70,000 it will cost.”

What do you think? How should our Christian values influence our opinion on resolving the health care crisis?