What Happened to Social Justice in Health Care Reform?

In the wake of Republican House Speaker Paul Ryan’s proposals last week to systematically dismantle Medicare and gut the Medicaid program, steps that would inexorably lead to greater suffering and penury and many thousands of preventable deaths, one is prompted to ask, “Have you no sense of decency, sir?”

Posing as champions of fiscal responsibility, Ryan and his GOP cohorts are unleashing a cruel assault on the health and well-being of our most vulnerable populations: the elderly, the disabled, and the poor. They do this even as they hand out ever more favorable tax breaks to the largest corporations and the wealthiest 1 percent of U.S. taxpayers.

While Ryan’s latest assault is particularly flagrant, it betokens a wider retreat from the goal of a more just and egalitarian society that has been under way for the past three decades. Its effects can be seen in the policies of both major parties.

The mythology of “free market economics” and the pursuit of individual gain have undermined the conception that society has a moral obligation to care for its members. We have been told, in many and various ways, to let the devil take the hindmost.

The casualties of this ideology go far beyond the poor. The victims represent the vast majority of the population, even those considered relatively well-off. Nowhere is this more evident than in health care.

The First Anniversary of Obama’s Healthcare Law

Take the Obama administration’s health care law, for example, whose first anniversary was observed just last month. In view of sharply rising health insurance premiums, co-pays, and deductibles, not to mention special government waivers giving big corporations such as McDonalds the go-ahead to evade standard health policy provisions, the promise of universal, quality coverage looks as remote as ever.

It begs the question: What happened to social justice in health reform?

The short answer is that social justice was not served by the passage of this law. Despite the early rhetoric from President Obama that health reform must cover everyone, control long-term costs, and improve the quality of health care delivery, none of these goals will be met by the Patient Protection and Affordable Care Act (PPACA).

I say this with considerable sadness as a physician and as a man of faith. But there is no avoiding coming to terms with the mountain of accumulated evidence and experience, both domestic and worldwide, that achieving social justice in health care is impossible as long as investor-owned health insurance companies dominate the system. And the new law is based on precisely that parasitic and immoral industry.

At the beginning of the reform debate, the president said that all ideas would be put on the table for consideration. But this did not happen. The most rational, proven method of financing comprehensive and affordable health care — single-payer national health insurance, or an improved Medicare for all — was deliberately excluded from the debate.

It took the dramatic civil disobedience and arrest of Dr. Margaret Flowers and other courageous single-payer advocates in Senator Max Baucus’ Senate Finance Committee chambers for single payer to register a tiny blip on the congressional radar. Even then, the Medicare-for-all proposal — which enjoys the support of two-thirds of the American people, according to a panoply of polls — was relegated to the sidelines by Baucus and his colleagues, most of them beneficiaries of private health industry largess.

A Modest Reform that Left the Investor-Owned System in Place

As a result, the bill that Congress fashioned and the president signed is not fundamental reform. It leaves our immoral arrangements essentially in place.

What we have in PPACA is a set of modest restraints on the for-profit health industry that were largely shaped by its medical-industrial lobby. Notwithstanding some beneficial features in the law, such as more funding for community health centers, the ability of young adults to stay on their parents’ plan till age twenty-six, the expansion of Medicaid, or regulations curtailing some of the most outrageous practices of the private insurers, PPACA basically maintains our present system.

The new law does nothing to effectively control rising health care costs, including skyrocketing premiums for individuals and businesses alike.

In short, the new law puts corporate interests over patients’ rights.

Accommodating the wishes of the private health industry may have been the “politically smart” way to get the bill passed, but it left in place our fragmented, chaotic, and costly health care “non-system” — a non-system that is inherently unjust.

I am disappointed that our nation’s religious institutions failed in their prophetic mission to reframe the health reform debate from one of partisan politics to the real moral issue involved here, namely, that “Health care is a human right.”

Nowhere is the immorality of our situation more dramatically illustrated than in the number of the uninsured.

The 2009 census figures show that we had 50.7 million people uninsured — an increase of 4.3 million, or nearly 10 percent, over the previous year. The Congressional Budget Office estimates we’ll have about 50 million uninsured for the next three years. In 2014, when the new insurance mandates and Medicaid expansion go into effect, the number will drop to about 30 million. But even if PPACA works as planned, we will still have 23 million people without insurance in 2019.

45,000 Unnecessary Deaths Each Year

Lack of health insurance is deadly, as numerous research studies have pointed out. An estimated 45,000 annual deaths can be linked to not having insurance and therefore not having access to care, according to a 2009 article in the American Journal of Public Health.

Under the new law we can also see a trend in the type of insurance coverage that will be offered to the public. That trend will be toward offering high-deductible and co-pay policies like the “medical savings account” products. These types of “under-insurance” policies will put more financial burden on the public, and will leave people with less financial security if they contract any major illnesses.

As a consequence, medical bills will continue to be a major contributing factor to personal bankruptcy. Writing in the American Journal of Medicine, researchers in 2009 found that illness and medical bills can be linked to 62 percent of personal bankruptcies in our nation. Significantly, three-quarters of all medically bankrupt persons were insured at the onset of their illnesses. This statistic could become worse.

What we need in America is a national health program that covers everyone — especially the most vulnerable such as immigrants and all those made poor and marginalized in our society.

Even with PPACA, we will still be rationing health care by wealth and position in society. This is not social justice and our faith communities need to speak and demand that the system be changed.

As a member of a church and as a member of Physicians for a National Health Program, I work to share the solid research that shows a single-payer national health insurance program, like an expanded and improved Medicare for all, is a just way to improve our nation’s health and wellness.

With its efficiency, transparency, and enormous clout in the marketplace, an improved and expanded Medicare program could control long-term costs, implement national standards, and provide for regional planning to improve the quality of care we receive. Improved Medicare for all would cover everyone in America — all of our neighbors. This would result in health care justice grounded in the equality of all human persons before God, which is exactly what God demands of us in our scriptures and in our professed religious traditions.

Why can’t we do this?