Health Care Justice

By Rev. Thomas Lambrecht


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?

10 thoughts on “Health Care Justice

  1. This is a difficult question to answer through the lens of the biblical witness. By in large, the quality of healthcare has declined in every western country that has socialized medicine. More government bureaucracy is not the solution to this problem. Additionally, the great advances in medicine have not come through government labs but through for profit organizations. Certainly, Obama misrepresented his Obamacare proposal. It is not working. The working class are being badly hurt by it. America needs a healthcare overhaul with bipartisan support.

    A good solution would minimize insurance companies without socializing healthcare. Insurance companies exist to make a profit. They are the foxes that guard the hen house. Insurance companies do not provide heath care to anyone. All the money that they siphon from money given for healthcare takes resources away from the healthcare providers (doctors, NPs, nurses, pharmacists, support staff, hospitals and the like) and makes care more expensive for those who have to pay for it.

    I do have one possible solution. Give every America a $3,000 heath credit card every year. With that card, the person can pick his own providers. The vast majority do not spend over $3,000 a year on healthcare. After that, everyone can purchase a catastrophic care policy on the open market or through a federal exchange. Those premiums are cheaper than normal ones. Since few people will actually spend the $3,000, the plan can be funded by charging each person $1,000 a year. In essence, it is government funded care but it is not government run care. Everyone will get minimum care and the working class will not have to pay extraordinary fees to cover those who do not work. Ultimately, it will be much cheaper than the current program because it minimizes the middleman. We do not need insurance companies. We do need access to quality healthcare that we can afford.

    In terms of the last question; the Wisdom tradition makes a distinction between the poor (widows, orphans, immigrants, the aged, and the sick) who require special care and for whom society has an obligation, and those who lack material resources because they are immoral, make unwise decisions, or will not work hard. How should that teaching factor into this conversation? Jesus did not reward the foolish. Do we even acknowledge the biblical distinction between the wise and the foolish today?

    If we decide that healthcare is a human right that God mandates, then the church cannot limit its concern to America and Americans. Love of neighbor and the Parable of the Good Samaritan requires that we consider the needs of the entire world. What are the global implications of making healthcare a universal right? How does this right relate to the evangelistic mandate?

    1. Thank you, Bill, for your extensive comments. This is truly an issue that needs a lot of discussion.

      You say, “By in large, the quality of healthcare has declined in every western country that has socialized medicine.” I question that. Do you have data that backs up that assertion? My understanding is that the U.S. ranks near the bottom in terms of healthcare outcomes compared to the other western countries that have socialized medicine.

      I resonate with your solution of minimizing insurance companies. However, there needs to be some kind of administrative structure to handle enrollment and vet payments. Under Obamacare, non-profit companies that have tried to run healthcare insurance programs have not been able to make it financially. I’m not sure that the profit taken by insurance companies accounts for very much of the total pie, as they are required to spend a certain percentage of premiums on care, with the rest allocated to administration and profit.

      I like the idea of giving every American a $3,000 health card. How could that solution avoid the problem of all that “free” money just jacking up the costs of healthcare via raised prices?

      There is much to think about here, and I think our Christian commitment to justice and fairness requires us to be involved in this discussion. Thanks for your contribution!

  2. Three comments…First, Utopian fantasies like Obamacare never work. Those fantasies crammed down the throats of the intended “beneficiaries” based on lies and backroom political chicanery are especially bound to fail. The predictable results of any such program are the concentration of power and control in the hands of fewer and worse situations for those on the receiving end of all this munificence. More government (i.e., socialized medicine) will never improve our health care system, it will only make it worse. You can easily find numerous stories of months-long waits to simply see a doctor and rationing of health care services in places like Britain. Same with our VA, as numerous stories have documented in the last several years. If you think these are the systems we should look to as good examples, I say no, thanks.

    Second, in response to the numerous mentions of a “solution” in the article and comments, Thomas Sowell’s brilliant words apply, as they so often do: “There are no solutions, only trade-offs.”

    Third, this essay, one I refer to often, has application here. Yes, “our Christian commitment to justice and fairness requires” our involvement. But does it automatically translate into more and bigger and more intrusive government programs? I certainly hope not.

  3. Guys we have to remember that those who are seemingly “Well Insured” can be paupered by the cost of insurance, co-payments, and out of pocket with a chronic or disastrous condition.

    We make 80K a year and after we spend 10K + a year and the lost work, commuter expenses, and who knows what else….. we just survive. We live pay-check to pay-check and have depleted our savings. We are in our fifties and retirement scares me spitless.

  4. This article on the Canadian system is dated but it lays out the economic factors very nicely. Easy to read and it brings out the questions.
    If we say that people have a right to goods or services then we are also saying that someone else has an obligation to provide those goods. When the state goes too far in imposing those obligations the government becomes a tyranny. To make things better here I would like to see more visibility on costs, more competition on health insurance (just look at the ads for GEICO, State Farm and so on in the auto industry), more tort reform (how much of our medical care is really defensive medicine?), some buy in by the consumers (when we separate the consumer from the bill payer demand goes up and costs go up leading to limited availability). No matter what we do the rich will always get what they want and the absolute poor always end up in the back of the line. I would be happy to see the middle class do better and Obamacare is not doing that for us as far as I can tell.

    1. Thank you for your thoughts, Kevin. It is a complicated subject! I would point out that your article on the Canadian system is 27 years old (as you say, “dated”). I wonder what the current experience is and how it compares with our current experience in the U.S.? I have not heard very many complaints about the Canadian or British health system in the last few years. Is it possible they are doing better? It is certainly true that health outcomes for the population of the U.S. is worse than either Canada or Britain. By now, they may be getting those higher health outcomes with a lower expenditure of money. If so, we should look at those options (personal opinion).

      1. Try this analysis on Canada vs US in health care.

        The biggest complaint among our Northern neighbors is wait times for specialist services. The biggest complaint here is cost. What is interesting is the overall health outcomes in Canada vs USA. This study concludes that single payer systems do not deliver better health outcomes across all income levels as people like to believe.

      2. Rev. Lambrecht, would you trust your critical health care today to doctors in the U.S. or a country with socialized medicine? A few quickly found examples of why those who can chose to come here do so (links within to sources and more information):

        Do you want our government, now $17 trillion in debt (and growing by $100s of billions each year) in charge of your health care?

        Beyond the nuts and bolts, this article emphasizes a point I think is so important, as raised in Roger Scruton’s piece, to which I linked previously:

        “But the principal damage that the NHS inflicts is intangible. Like any centralized health-care system, it spreads the notion of entitlement, a powerful solvent of human solidarity. Moreover, the entitlement mentality has a tendency to spread over the whole of human life, creating a substantial number of disgruntled ingrates.”

        Rev. Lambrecht, I doubt you see greater and greater dependence on government (or charity) as consistent with God’s will for his people. At least I hope you don’t.

  5. Since most Canadians live within an easy drive of the border they have a way to solve their wait time problems in our free market health care system.. They get the best of both worlds in that respect. The invisible hand is difficult to resist.

  6. The vast majority of people are not in need of intensive critical care. In fact, the need for such services is often the direct result of people not having affordable access to basic routine health care.

    The current U.S. healthcare model is a train wreak. Throwing thousands of dollars each year down a rat’s hole called a health care insurance policy only serves to put lots of money in the pockets of insurance companies and their investors. It does zip in actually meeting the needs of average Americans for healthcare.

    People scream and holler about paying taxes for healthcare. They opine that someone might (God forbid!) tell them “No,” if they want a particular procedure or they might be told they have to wait, that they can’t schedule around their vacation or their children’s camp schedule, etc. Oh the misery they would have to endure with tax paid healthcare.

    What difference is there in pouring out piles of money to a insurance company for healthcare insurance … then them telling you what they will and will not pay, who they will and will not allow you to see, what hospital they will and will not allow you to use, etc.

    Like it or not, the insurance companies are not in business to provide you healthcare. They are in business to make money off of you. The minute you get to be more than a net profit item, they do their best to eliminate you from their roll. So… how is that any different than being told by a govt. clerk that you can/can’t have a procedure, go to a doctor, etc.? Any difference is purely in the mind of the beholder.

    Health care justice? That is a oxymoron. There isn’t any such thing. There never will be. The rich will always be able to buy whatever they want… including healthcare. They will always opine that everyone should just take care of their own needs. It suits them b/c it doesn’t cost them any money. Those who are on the bottom of the economic pile will always have to take whatever they can get… at least as long as politicians are afraid to raise taxes to pay for the actual services that voters in this nation want.

    The current administration has crippled any possible movement to a more equitable healthcare system in this nation. The issue is so politicized that no one can bring themselves to simply deal with it from a dollars and cents perspective. About the best thing anyone can do is just try to keep themselves in good shape and avoid paying any more for insurance than absolutely necessary. Stash the cash saved where you can use it to pay for what you want/need. Otherwise it’ll just end up paying for a doctor’s bmw… or a golden parachute for some insurance exec. when he crashes the company.

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