Markkula Center of Applied Ethics

Expanding Health Care Coverage: A Balm for California?

By Margaret R. McLean

From the balm of Gilead to Jesus’ soothing touch, God is consistently and compassionately concerned with the healing of creation, with the health of humankind.

Since we are called to extend God’s compassionate and healing presence, our concern should be reaching new heights as those who are poor—both here and abroad—die daily of preventable or treatable injuries, infections, and disease. If healing is the yardstick by which our love for one another and creation is measured, absent significant change, we will have a good deal of explaining to do.

The number of uninsured Americans is approaching 50 million. Most of these people are, in the words of health care analyst Uwe Reinhardt, “low-income, hard working stiffs”—taxi drivers, nursing home aides, security guards. The average cost of health care coverage for a family of four has risen 78% since 2001. An increasing number of employers claim that they cannot provide health coverage to their workers if they want to compete in the global marketplace.

It is a sad truth that this nation brutally rations health care, tethering it to job status, income, and cost. Those who have access to the system get adequate—often topnotch—treatment. Those unable to pay—either through insurance or out of pocket— settle for inconsistent and inadequate treatment. Despite spending more of our Gross Domestic Product on health care than any other country, we fall behind most industrialized nations in key areas such as infant mortality and life expectancy.

Nine months after proposing a far-reaching plan to bring health care coverage to 6.8 million uninsured Californians, our governor and legislature are closing in on meaningful reform. There is consensus in Sacramento that

  • government programs must be expanded to cover more of the working poor

  • insurance premiums—which rose by 6.1% in 2006—must be affordable for individuals and businesses

  • employers ought to provide insurance, but workers must share the cost

  • insurance providers should take all-comers regardless of health status

  • insurance industry profits must be capped

Deliberation continues over how to pay for such expanded coverage and whether or not to mandate that all Californians be insured.

How might we think about this—or any other—proposed health care reform ethically? The Catholic faith, with its never-failing concern for social justice, tells us that we are created in the image of God with an inherent dignity and a responsibility to and for each other. Our social structures are measured against their ability to promote the dignity and well-being of all persons. No one reaches his or her human potential without health, and no one can maintain his or her health without dependable access to quality health care including preventive medicine.

The work of ethics is to provide standards that promote human dignity and help us identify what ought to be done. Catholic social teaching highlights:

The inherent dignity of human persons requires that people be treated with dignity and respect, which includes the fulfillment of the basic human need for health care.
The common good recognizes that the good of the individual is woven together with the good of the community. A health care system rooted in the common good nurtures human relationships, promotes human flourishing, and leaves no one behind.
Health is a fundamental good necessary for human flourishing and health care is a fundamental human right. Because health care, at its best, promotes and sustains human health, society is obligated to provide access to basic quality health care for all its members.
Social justice requires that whatever approach reform of the health care system takes be focused on the poor and the sick, and that those most in need—the uninsured and the underinsured—receive what is necessary for their health and well-being.

Catholic health care stresses “service to and advocacy for those people whose social condition puts them at the margins of our society and makes them particularly vulnerable to discrimination” (Ethical and Religious Directive #3). Health care reform must focus on equity, efficiency, and a just use of resources from physician time to gauze bandages. Any limits—and there will be some—must be set in light of the common good and a constant concern for those on the economic and health margins.

Paying attention to human dignity, justice, and the common good suggests that health care reform must:

  • provide universal, consistent, and continuous access for all, regardless of employment, age, or health

  • manage costs so that health care is affordable for individuals, families, and employers

  • be sustainable over the long term

  • offer care that is safe, timely, and centered on the patient

  • share financial obligation among stakeholders, i.e., individuals, employers, insurers, the government

The current concern for health care reform in California and the run up to the Presidential election will provide opportunities for us to consider options for health care delivery—single-payer plans, insurance company regulation, Medicare expansion, caps on cost, mandated coverage—and to take their measure against the yardstick of dignity, justice, and the common good. We have our work cut out for us. The goal of universal health care is the only ethically defensible goal. How we reach that goal is a matter for careful and prayerful consideration.

Perhaps the American Catholic Bishops said it best in their 1981 pastoral letter: “Because we believe in the dignity of the person, we embrace every chance to help and to liberate, to heal the wounded world as Jesus taught us. Our hands must be the strong but gentle hands of Christ, reaching out in mercy and justice, touching the individual persons, but also touching the social conditions that hinder the wholeness which is God’s desire for humanity.”

Margaret R. McLean is director of Biotechnology and Health Care Ethics at the
Markkula Center for Applied Ethics. This article was written for the Valley Catholic (Oct. 16, 2007).

September 28, 2007

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