Does Everyone Deserve Health Care

Does Everyone Deserve Health Care?

February 13, 2005

First Universalist Unitarian Church of Wausau

Julie Stoneberg

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…

-Article 25

United Nations Universal Declaration of Human Rights

Therefore be it resolved that the Unitarian Universalist Association affirm that comprehensive health care is a basic human right, and call for the development

of a more just and compassionate system of health care delivery in the United States.

-Universal Health Care Resolution

UUA General Assembly, June 1994

Every person has the right to adequate health care. This right flows from the sanctity of human life and the dignity that belongs to all persons, who are made in the image of God…

-Resolution on Health Care Reform

U.S. Catholic Bishops, 1993

We believe that health is a fundamental human right which has as its prerequisites social justice and equality and that it should be equally available and accessible to all.

- Imam Sa'dullah Khan

The Islamic Center of Southern California

Chalice Lighting

Measure your health by your sympathy with the morning and spring. If there is no response in you to the awakening of nature - if the prospect of an early morning walk does not banish sleep, if the warble of the first bluebird does not thrill you - know that the morning and spring of your life are past. Thus may you feel your pulse.

Singing Together We'll Build a Land #121

Children's Focus It Takes A Village Jane Cowen-Fletcher

Yemi feels very grown-up. Today she will take care of her little brother, Kokou, at the market while Mama sells mangoes. “I will watch yhou,” Yemi tells Kokou proudly, “all by myself.” But Mama and the villagers just smile, because they know better.

Oh, how wonderful Yemi feels as she leads Kokou through the marketplace. But the moment she turns her back to buy some peanuts, Kokou wanders off. Through the maze of stalls Yemi searches, but Kokou is nowhere to be found. Little does she know that her brother is being well-cared for by the friendly villagers. And it’s not until Yemi finds Kokou just waking up from his nap in the mat vendor’s stall, that she discovers what Mama and her friends knew all along. It takes a village to raise a child.

Reading Litany of First UU Health Care Providers

A recent informal (very informal) poll of health care professionals in this congregation found overwhelming, but not unanimous, support for some kind of universal health care, frustration with the current system, and mixed feelings about what role faith might play in this issue. Here are some of the collected comments:

· Almost daily I see the working poor caught in the gap between earning too much to qualify for medical assistance and earning too little to be able to afford insurance. Honestly, I realize that this could very easily happen to any one of us with a slight change in circumstance.

· When we talk about health care, we can't avoid talking about health…how do we define health? Who is responsible for that health?

· In a civilized and rich country like the US, it is reasonable for society to accept an obligation to ensure that all residents have affordable access to at least basic health care.

· The disconnect between society's expectations and its responsibilities is all too obvious to health care workers.

· There should be universal health care, but it should not be free. The patient MUST contribute in even a small way.

· In the US, the typical patient expects the best available treatment, wants it now and expects his insurance or the government to pay for it. I think our attitude of entitlement has to change.

· People must assume responsibility for their own health. When something is free, it has no value to most people.

· I'm inclined to think of medical care as a public interest, one that is best separated from issues of "faith".

· I think access to health care is a part of my core Unitarian spirituality. However, I think we have to look at workable ways to finance it. For starters, we could recall the troops from Iraq!

· As far as my faith as a Universalist Unitarian, I have often found it more challenging than helpful. I never lack for compassion and empathy and know I do my job well…[yet] I have often found myself unsure of my ability to offer spiritual comfort. I continue to search to answer these questions for myself.

· I don't think [my faith] is a factor and I would rather not make health care a religious cause.

· As to how my faith plays a role in my work, I turn to the UU principle that states…justice, equity and compassion in human relations. These are the driving principles behind my support for universal health care and my focus on trying to provide the best health care possible to my patients.

· My take on our first principle is that UUs care about the inherent worth and dignity of all individuals…and the government does not.

· Is it fair for richer people to have access to more than poorer people, or is it fair to limit anyone's access to what society as a whole can afford for everyone?

· I no longer know where I stand on the divinity of Jesus. However, I feel that Jesus' message of caring for the unfortunate among us is an important one no matter what you believe. I think that's part of the reason I went into health care.

· In a perfect world, I would love to see universal health care. Isn't it everyone's right to be treated the same, instead of depending on their coverage? I just wish I could treat all my patients equally.

· Does everyone deserve health care? Deserve in the dictionary says, "to be worthy, fit or suitable for some kind of reward". Kind of like universal salvation?

Sermon

I'm the kind of person who reads signs, billboards, vanity plates and bumper stickers. I'm not sure that this is a particularly healthy thing to do; it can be distracting and perhaps even contributes to a sense of over stimulation with media and cultural messages. But sometimes these readings amuse me, and certainly give me lessons in social anthropology. For example, while at seminary in Berkeley, I regularly walked by a old Volvo station wagon, dusty, permanently parked a kilter…it might have been mistaken for a piece of pop art. One of the many bumper stickers it displayed has stuck with me…It said: "Insatiable is not sustainable". Insatiable is not sustainable. Good one.

Maybe some of you, like me, have been through a phase in your life when new age spirituality crept onto your radar screen and whispered to some place in you that has failed to thrive…a place that feels dried up, underfed, or short-changed. Coming to full flower in the me-generation, this new age spirituality has fanned the flames of our sometimes rampant individuality. It has told us that abundance is there for the taking …that all we have to do is to open ourselves to the limitless possibilities (and resources) of the universe. Everything we want is out there for us, and when we get it, our lives will be happier and more fulfilling.

If this is your life philosophy, however over-simplified, I mean no offense, but I do mean to offer a critique. As with every other philosophy and theology, I would challenge us to look deeper, to consider the effect that such a philosophy has on the way we live our lives. I wonder how a theology of abundance, or maybe of an everlastingly generous God, might tempt us to view everything as a commodity, to objectify everything, including our relationships. And, it might also make it more difficult to be aware of those places where abundance is not evident…those corners of the room that never seem to get enough light…the edges of the cake to where the frosting just won't stretch… Sure, it's fine if you're in the center of the room, but what if you're not? Is there abundance for everyone, or for just a lucky few? And, is what we get necessarily connected to what we deserve?

Abundance is a polemic - an extreme - and naturally exists with its polar opposite. The other side of abundance is scarcity, a fear that there isn't enough…which can lead one to suspect others of horning in on one's rightful deserts. Thomas Merton, 20^th century poet and monk, once wrote for the lenten season… "Now one of the things we must [give up] … is fear. Fear narrows the little entrance of our heart. It shrinks up our capacity to love. It freezes up our power to give of ourselves."[1] What a wonderful world it would be if everyone were willing to give up fear for lent. Because, if Merton was right, less fear equals more generosity. In other words, a lack of fear would lead to more abundance, abundance of a sustainable kind, abundance accompanied by giving, by justice, and by a sense of responsibility for others.

Does Everyone Deserve Health Care?…is a rhetorical question, because I happen to believe that yes, everyone DOES deserve access to affordable care. The question I'm really interested in is 'why don't we have it?' Why is it so difficult to accomplish? Universal Health Care is not an idea that is supported by everyone. One of the resources I picked up at the library when preparing for this sermon was a book entitled The Enemy Within, by Michael Savage. If you know of him, you might guess that we (or at least most of us in this room) are the enemy of whom he speaks…Savage believes that liberals are destroying the fabric of the American way of life. It is we who have allowed our borders, our language, and our culture to be diluted.[2]

In regards to health care, Savage believes we should return to the 'values' of the mid-twentieth century…a era that for him represents the best of America…a time when everyone worked hard and took responsibility for their own health care. But this is pure nostalgia speaking…we can't go back. In 1950, medical spending was about $500 per person per year (adjusted for inflation), an amount that might have been possible for many people to pay. Today, medical spending has reached $5000 per person per year, an amount not readily on hand for most Americans. In addition, the quality of medical care is completely different now…our expectations are much higher. Suppose you were offered that $4500 back (the difference between costs in 1950 and today) but in exchange you could only have medical care at a 1950's level. Would you take that offer?[3] We demand a different, more expensive kind of health care than what was available 50 years ago.

Savage also makes very specific claims about the problems with our health care system. Without apology, without mincing words, he places the blame squarely on those he labels as ingrates, inmates, and illegals. Suffice it to say that Michael Savage does NOT believe that everyone deserves health care.

Now, Savage might be an extreme example, yet scattered throughout almost every exposé on health care are less directly stated suggestions that there are those who might NOT deserve health care…those who would use health care services for cosmetic surgery or other elective treatments… those who make absolutely no financial contribution… those malingers who abuse the system… those who don't take responsibility for their own health …

What's the issue here? Is it one of deservedness? Cost? Greed? Fair distribution of goods and services? Apparently no one believes that there is an abundance of health care…attempts to fix our nation's health care crisis focus on two competing agendas… decreasing costs (an area I am not exploring today) and limiting access to fewer people. Both of these agendas focus on scarcity…and fear. Behind attempts to decrease access by delineating who qualifies and who doesn't is a substantive and complex discussion around rationing, and all of the fear that the word 'rationing' evokes. Will I get what I need? Will there be long waits to get treatment? Who is going to pay for universal care? Do I have to pay more? Fear has led us to ration health care, but not based upon need. Rather, we ration health care based upon one's ability to pay. Is that fair?

Our country is facing a health care crisis. Even if we don't believe, as Savage does, that our otherwise good system has been contaminated by ingrates, inmates, and illegals, we cannot ignore the fact that there is a huge problem. Here are some disturbing factoids:

- Fact: Currently, the US is the only industrialized country in the world that does not guarantee access to medical care for its residents. While we mistakenly boast of the best medical care in the world, the reality is, according to the World Health Organization's 2000 report, that in proportion to dollars spent, the US is ranked 72nd in health gains and only 37th in overall health.[4]

- Fact: The Census Bureau says that the number of uninsured people in 2002 was 43.6 million; that's over 15% of the population without health insurance.[5] Current estimates put the number of uninsured Americans at closer to 45 million. To get a sense of the size of that number, 45 million people equals the combined populations of Oklahoma, Connecticut, Iowa, Mississippi, Kansas, Arkansas, Nebraska, Utah, Nevada, New Mexico, Oregon, West Virginia, Maine, New Hampshire, Hawaii, Rhode Island, Wyoming, Montana, Delaware, North Dakota, South Dakota, Alabama, and Vermont…twenty-four states…without health insurance.[6]

- Fact: Somewhere around 80% of the uninsured come from families with at least one person employed full time.[7] Quite the opposite of being 'ingrates', most people who are uninsured are working hard to make a living.

- Fact: In our current employer-based insurance system, 99% of large firms offer insurance, but only 55% of firms with fewer than ten employees do so. Is it fair that those who work for large companies get insurance, when those who are self-employed or work for small businesses do not? Here's a sidebar: this church is one of those 'small businesses' that does not offer a health plan to its staff.

- Fact: The US has higher infant mortality, higher surgical mortality and lower life expectancy than Canada and Germany…two countries who offer guaranteed treatment to their citizens.[8]

- Fact: America spends more on medical care than any other industrialized country. Local, state, and federal sources spend over a trillion dollars annually for health care, which amounts to 70 % more per person than Germany. Yet there's no evidence that we get better care.[9]

Is your finger on the pulse of our health care system? Does it seem healthy to you?

Is this simply a question of money? David Cutler is a professor of economics at Harvard University and served on the Clinton health care task force. His recent book Your Money or Your Life spells out a plan for Universal Health Care in the United States. He begins the book by making economic calculations as to the value of health. I won't bore you with all of the statistics (I do recommend that you read the book); let me just say that he consistently concludes that keeping people healthy, helping people to live longer, more productive lives, just makes economic sense. Cutler also concludes (and by the way, the Congressional Budget Office has reached the same conclusion[10]) that a single payer universal health care policy will not cost us any more than we currently spend, and would probably cost less. You see, the system essentially already pays for health care for everyone. As Dennis Kucinich has said, "Americans are paying for universal health care; they're just not getting it".[11]

See, the uninsured generally do get health care, but only when they desperately need it, When the uninsured need help, they go to an emergency room…the most expensive place to get care. Nearly half of the people treated in emergency rooms do not need urgent care, but they have no place else to go. The uninsured delay seeing a doctor even when symptoms persist, so that ultimately the care they need is much more expensive than preventative care, or early-intervention would cost. These unnecessary costs are already being paid for by the current system, absorbed into higher premiums and costs of services for those who can pay.

If it would cost about the same, why don't we have universal health care?

It's not that the problems with our health care system are invisible. We all know people who are without health insurance, and we all know people who need care that they are not getting because they cannot afford it. We all know people who are stressed out under the burden of high medical bills. Yet, it would seem that our system has taken on a life of its own, working against every effort to reform it. Those for whom maintaining the status quo is in their best interest are able to spend a fair amount of money defending those interests. Those who are most directly affected by health care reform (you and I) are at the furthest distance from those who make the decisions. We feel helpless. We shrug our shoulders.

Cutler offers a solution that makes a lot of sense to me. It is not my intention here to promote his plan, but I think he offers some creative suggestions. His compelling argument is that the ultimate goal of any health care system should be to improve health. Duh. That may seem obvious, but our current system discourages things as simple as making sure the right drugs are prescribed, it encourages costly procedures, and rewards insurers for cutting costs, not for improving health. An ideal medical system, Cutler says, would encourage services that have high value, services that are shown to improve health. He suggests that the financial incentives in our health care system be realigned so that the system gives us what we want, that payments to health care providers should depend upon the effectiveness of the treatment, making sure that we're healthy, not just treated.

Improved health…what would that look like? Health is a measurable…it can be seen in length of life, contribution to society, the health of newborns. The World Health Organization defines health as "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." In other words, health is a broader construct than a strictly medical one. Historically we have focused health care on our physical bodies… later began to pay attention to our mental health, and only very recently have we begun to consider health within the framework of social well-being. Health is social well-being. Our national leaders are focusing intently on 'homeland security' but haven't paid much attention to what it would mean to feel truly secure…to know that we have our health…to know that we'll be cared for when we don't…to have the freedom to change jobs without fear of losing health insurance…that's security. How much healthier and happier would our society be if we assured that everyone would be cared for?

The children's story today portrayed an idealic image of a community, a "village" where each person looks out for the other. But in today's fragmented society, it is difficult even to imagine such a construction. Hillary Rodham Clinton, in her book "It Takes a Village", described the modern village as something that transcends a particular place…the modern village is the network of relationships we form and depend upon.[12] Indeed our seventh principle paints a similar picture…the interdependent web of existence of which we are a part. Our village is the inter-relationships...the way we inter-be with all that is. But acknowledging our responsibility to and our interdependence upon others does not always lead us to take action.

Why don't we have a universal health care plan?

Senator Clinton goes on to say that these "village" relationships are the basis for our "civil society'…the way that we work together for common purposes. But what are our common purposes? It's sometimes hard enough to figure that out within our own congregation, let alone on a national level. Here, we can turn to our seven principles, our religious sources, and our mission statement and we find there plenty of wisdom to guide our discussions and directions. Likewise, our country can turn to the principles upon which it was founded. The Declaration of Independence insists that there are inalienable rights…life, liberty and the pursuit of happiness…none of which are very easy without good health. And our Constitution claims that the United States was formed to establish justice and to promote the general welfare. To my way of thinking, these are very clear directives. Good health is essential to functioning in a democracy, to living a decent life, and to reaching one's innate potential.[13] So, even if you can't quite agree with the idea that health insurance is a right, hopefully you can see that it is inseparable from a decent and equitable civil society.

Why don't we have universal health insurance in this country?

An extensive ABCNEWS/Washington Post poll conducted in 2003, found that Americans prefer a universal health insurance program by a 2-1 margin over the current employer-based system.[14] If the American public supports a universal health care plan, why don't we have one? Well, that same poll found that our support of universal health care coverage is conditional. Our support falls to fewer than 4 in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments. See, it turns out that we're insatiable. As long as we're getting the coverage and health care that 'we' need, and getting it pretty much on demand, whenever we want it, there's little impetus for demanding a change. Retired UU minister Dick Gilbert worries that comfortable Americans, living in a culture of contentment, may have lost the capacity for moral outrage.[15] Is this part of why we don't have universal health care?

Contentment…easy access and expensive treatments is what many Americans have come to expect as health care consumers. Is our expectation of unlimited, immediate, and expensive health care sustainable and equitable in the face of 45 Million Americans who have no health insurance at all?[16] What is fair? And what are we willing to give up to ensure that there is an equitable system for everyone?

One of the respondents to my informal poll of this congregation made a very interesting connection between universal salvation and universal health care. This got me thinking. We are Universalists. In the beginning of this movement, Universalists believed that God was benevolent and therefore would not send anyone to eternal condemnation. Salvation was not connected to deservedness, but was available to all because of ultimate goodness. Today, some of us believe that this life is all there is and others of us believe that god or goodness becomes incarnate in our human deeds. This leaves it up to us to ensure salvation for those who have been condemned to an existence without the assurance of quality health care. We as a faith community are uniquely poised to demand that compassion and justice stand at the center of any health care dialogue.

There is enough. I sincerely believe that. But enough for everyone may require that some must relinquish unfair privilege. There is enough, but only if we take no more than our fair share, if we use what we have responsibly, and if we pass our abundance on to others. There may not be unlimited resources for health care, but we can trust that there is enough. We must carry the ideal of the village in our hearts and in our souls. May we always have an abundance of compassion.

Blessed be and amen.

Responsive Reading

Universal Health Care Resolution (adapted)

General Assembly 1994

Leader 1: BECAUSE Unitarian Universalists affirm the worth and dignity of every individual;

Leader 2: BECAUSE, as set forth in the United Nations Universal Declaration of Human Rights, all people have a right to high-quality health care; and

Right: WHEREAS access to both adequate health coverage and quality health care in the United States is neither equitable or compassionate;

Left: WHEREAS more than 15% of the United States' gross national product is spent on health care, more than in any other nation;

R: WHEREAS 43 million people living in the United States have no health care coverage whatsoever, and increasing numbers cannot buy individual medical insurance at any price;

L: WHEREAS the infant mortality rate in the United States is the highest in the industrialized world, and life expectancy in the United States has fallen to nineteenth in the world;

All: THEREFORE BE IT RESOLVED that the Unitarian Universalist Association, affirm that comprehensive health care is a basic human right, and call for the development of a more just and compassionate system of health care delivery in the United States;

Leader 1: BE IT FURTHER RESOLVED that the systems now in existence in other industrialized countries be considered as a model for the United States; and

Leader 2: BE IT FURTHER RESOLVED that, consistent with appropriate and affordable level funding, the system provide:

R: Equitable access, cultural sensitivity, and basic treatment for all people;

L: Adequate preventative care, including prenatal and holistic health care;

R: Comprehensive treatment and coverage for long-term care and catastrophic illnesses;

L: Access to and coverage for medications and prosthetics; and

R: A complete range of voluntary and confidential health care, including family planning and reproductive services;

All: BE IT FINALLY RESOLVED that the Unitarian Universalist congregations and individual Unitarian Universalists in the United States be urged to support adoption of a national, comprehensive system of universal health care.

Singing Together Oh for a World Words by Miriam Therese Winter

We cannot own the sunlit sky,

the moon, the wildflowers growing,

For we are part of all that is

within life’s river flowing

With open hands receive and share the gifts of God’s creation,

That all may have abundant

life in every earthly nation.

When bodies shiver in the night and, weary, wait for morning,

When children have no bread by tears, and warhorns sound their warning,

God calls humanity to wake, to join in common labor,

That all may have abundant life in oneness with their neighbor.

God calls humanity to join as partners in creating,

A future free from want or fear,

life’s goodness celebrating.

That new world beckons from afar, invites our shared endeavor,

That all may have abundant

life and peace endure forever.

Benediction

Give up your fear. Feel the pulse of change, and know that there is the possibility of a more just health care system. Go from this place and be the village crier…prodding us all to remember our deepest value…the inherent worth and dignity of each and every person.

Amen.

For more info about the UUA's statements of conscience regarding health care, go to www.uua.org/actions/health/. A resolution of immediate witness regarding the lack of a group medical plan for UUA ministers and staff, see www.uua.org/programs/ministry/finances/health_ins_riw1998.html.

This Sunday's sermon drew from many resources, including the following:
Your Money Or Your Life, by David M. Cutler

Hard Choices, by Donald Drake, Susan Fitzgerald, and Mark Jaffe

It Takes a Village, by Hillary Rodham Clinton