Markkula Center of Applied Ethics

With Health Care And Justice For All

By Margaret R. McLean

In the run-up to the November election, the silence from candidates on the topic of health care is deafening. Yet millions of Americans continue to have inconsistent or no access to basic health care services because they are either uninsured or underinsured.

Recognizing this injustice, the Catholic community has steadily insisted on universal access to health care. For years, The Catholic Health Association (CHA) and its member systems have worked tirelessly for legislation to expand access and coverage.

Catholic social teaching is consistent in its concern for justice and the common good and in its call for advocacy on behalf of people who are poor, not only in dollars but also in mind, body, and spirit. Persons who are ill are among the most vulnerable. If health care is a basic human right, then the poor in health levy a claim for a more equitable and just health care system that guarantees health care for all.

Currently, we are far from such a system. Data recently released by the Census Bureau indicate that 46.6 million (15.9%) of us lacked health care coverage in 2005. The number in California is 6 million.

This 2005 figure is an all-time high. Significantly, 5.4 million more people lacked health insurance in 2005 than in the 2001 recession, primarily because of the loss of employer-based insurance. Only 60% of those employed were covered by an employment-associated plan in 2005. Premiums are currently rising at three times the rate of inflation.

Most people who have health insurance receive it as a part of a benefit plan provided by their employer or qualify for a government-sponsored plan such as SCHIP, Medicare, or Medicaid. On average, employers are asking employees to contribute more to the cost of health care through higher premiums, deductibles, and co-payments. Fewer businesses are offering health coverage. More workers are deciding not to enroll.

Not surprisingly, people with annual incomes of less than $25,000 were three times as likely to be uninsured when compared with those whose incomes exceed $75,000. African-Americans and Hispanics were much more prone to be uninsured than non-Hispanic white people.

Uninsured children (8.4 million in 2005) and adults are less likely to receive preventive care. Because people who lack insurance tend to put off going to the doctor, they are four times more likely to require emergency room care and avoidable hospitalizations than are those with insurance. The Institute of Medicine (IOM) estimates that each year 18,000 Americans die prematurely because they are uninsured.

A family with even one uninsured person easily finds itself in financial jeopardy. They may lose the assets they have worked hard to accumulate, but in addition, their problem will eventually become everyone's problem. According to the IOM, uninsured people pay only 35% of their medical costs themselves. The remainder is paid primarily by taxpayers, through subsidies to clinics and hospitals. The presence of a considerable population of uninsured in a community draws funds away from public health programs, such as those for communicable diseases and emergency preparedness-a particular concern as we consider our responses to a potential flu pandemic.

So, how can we do better? The CHA has proposed guidelines for the radical transformation of our health care system. A transformed system would:

  • Make health care available to all, regardless of employment, age, income, or health status;

  • Make a defined set of basic benefits available to all;

  • Share responsibility for health among all-individuals, families, health care providers, employers, and government;

  • Base health care spending on appropriate and efficient use of resources;

  • Share responsibility for financing among government, employers, and individuals;

  • Promote the continuous improvement of health care services;

  • Encourage effective participation in decision making by patients and their families.

It is easy to agree with these guidelines in principle, but providing access for all to health care is a grave and ever-expanding practical problem, without easy or clear answers. Solving the access problems requires recognizing that costs must be contained. Solving the access problem requires recognizing that everyone must have something but everyone cannot have everything.

Let me suggest that we must insist that the question of access be part of the election debates. Then, as we consider solutions, they should be consonant with the following principles:
  • Access must be universal and continuous.

  • Providing access must be affordable to individuals, families, businesses, and communities.

  • The finance plan must include shared expenses among government, employers, and individuals.

  • Resources must be used appropriately and efficiently.

  • The health care access plan should strive for simplicity and enhance individual and community health and well being.

  • The health care access plan must benefit vulnerable populations, especially children and elderly persons.

Health care access is not as intriguing or mind-blowing as regenerative medicine or genetic engineering-but it is more important. Access should be a topic of discussion in the upcoming election and an area of action in the legislative sessions. We must be adamant that our elected officials remain silent no more.

The IOM has called on the federal government to take the action needed to achieve universal health insurance by 2010. What if this call is heeded?

One might be able to paint a picture of health care in 2011-where everyone receives basic preventive and primary care and has an illness or injury treated in a timely manner. In this picture, families rest assured that they will not lose their home because of the illness of the bread-winner. Health care providers and institutions are financially stable and engaged in innovation.

And, if we do not heed the call of the IOM, what then? The picture is too grim to paint.

Margaret R. McLean is director of biotechnology and health care ethics at the Markkula Center for Applied Ethics. This article appeared originally in "The Valley Catholic."

October 2006

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