How Has Our Health Care System Become Such a Mess?
The current system is incomprehensible and expensive — not the service to God and to the common good that it should be.
I write today about the current health care debate as a novice. I am bewildered as to how we got into the mess we are in today. You may call some of my observations naïve or unrealistic, but something tells me that the views of ordinary people like me have been ignored for too long on too many issues. We have conceded too much ground to experts, whom we surely need, but who should still be held to a standard of common sense.
At the heart of the problem, as I see it, is the fact that when we talk about health care today we aren’t really talking about the type of medical insurance we used to have. Today’s notion seems to be that absolutely every single medical expense, down to the most minor prescription and doctor’s visit, should be covered by insurance, regardless of one’s ability to pay. This idea has introduced grave economic distortions and has depersonalized the doctor-patient relationship, transferring much of it to an insurance middleman.
Even in the Church, many of our leaders (both lay and clergy) seem to imply that the only truly “Christian” health care plan is a massive (likely government-run), mandated plan that covers nearly every imaginable expense nearly 100%, and then strangely ties those plans to employers. We do not expect our employer to pay for our food or our house, so why do we expect them to pay for our health care? Is this really the only moral and Christ-like way to proceed?
Clearly, some level of health care should be made available to those who cannot afford even basic coverage, but it often seems that the sky is the limit when it comes to what is covered, no matter the income of the people in question. Can there be no reasonable limits on what is covered? At some point we are no longer talking about insurance against catastrophe (which used to be the case), but rather about covering nearly any conceivable medical expense regardless of the cost. I am not sure that Catholic teaching holds this approach as the only morally acceptable one.
As a result of this thinking, most of us have become part of a large system that is so complex that we don’t have any idea how much something costs or why it costs that much—and often don’t even bother to ask! So many things occur to me to ask, but there are few good answers. Should an ankle x-ray cost $700? Why? I know the machine is initially expensive, but so is my car. After driving my car for ten years, the three years of payments are a distant memory. Surely after the 10,000th x-ray the machine should be paid for!
And why do we expect our health insurance to pay for every little thing? I don’t expect my auto insurance to pay for the cost of new tires or an oil change. Medical insurance used to be to protect against financial ruin in the event of catastrophic expenses. Now it covers the annual check-up and even the most elective of drugs such as Viagra. Why?
Obviously we consumers are part of the problem. We can’t just pin this all on insurance companies or “big pharma.” We now expect the smallest incidental expenses to be covered. Further, we sue doctors and hospitals over a tiny scar or a minor oversight. We can barely abide the least inconvenience or suffering related to our health.
I suspect that part of the problem is that we have handed everything over to someone else to pay; as a result, we don’t consider the shared cost we are all now carrying. It’s all just too remote to us. Having now removed most of the economic impact, cost is no longer a consideration. Someone else is paying; who cares what it costs? Just try to pay cash for an x-ray or even a doctor’s visit and you’ll get blank stares from the office staff. They don’t even know what it costs! Everything is done through insurance claims; prices are negotiated by large conglomerates rather than the parties directly involved. What is the true cost of my recent x-ray? Who knows? Who cares?
Once the government enters into the fray, things get even murkier. Our unlimited sense of entitlement combined with politicians’ desire to curry favor with voters creates a perfect storm of escalating costs, distant oversight, arbitrary decisions, and the demand for perfect solutions. Few market forces are in play to keep costs in check and to maintain supply/demand equilibrium.
But Father, but Father — if people have to pay for doctor visits or medicine, many will forego them and/or make poor decisions! Perhaps, but if market forces really were allowed to be operative, maybe visits to doctors, x-rays, and medicine wouldn’t cost so much. Maybe medical costs would actually adjust to what people can reasonably afford to pay. Large items like computers, electronics, cars, and even homes, adjust to market forces, both local and national. They may start out to be very expensive and then decline in price, sometimes quite dramatically, as more people want them.
There probably is no perfect system. I am sure that many of you will want to comment in order to educate me on why my view is too radical or not radical enough. I admit it; I need some schooling.
From a Catholic point of view, people have a responsibility to take care of one another, but what we have now is too big and impersonal. Few if any really understand the system, and too often it prevents the very support we want to offer one another. Even if a doctor wants to help the poor, tell that to the insurance company that sets the rate for his services and to government regulators. They will surely limit and/or interfere with his or her capacity to informally advise or to supply health care outside all the administrative procedures. One doctor I know converted her entire practice to a cash-only basis for basic appointments in order to avoid all the rigmarole.
There is an emerging alternative that may work for some who want to get out of the system. Evangelicals are advertising heavily in the D.C. area what have been called “health care sharing networks.” Thankfully, there is at least one Catholic version of this, sponsored by the Christ Medicus Foundation, a solid voice for biomedical ethics and religious liberty in health care decisions.
In these networks, members share one another’s medical expenses. And while that may sound a lot like insurance, it is more personal; many of the members become aware of how their money is directly helping other members. I’m told it is less expensive than typical medical insurance and simpler to use as well (payment via a debit card or other direct method). At least it restores the personal dimension we seem to have lost with these third-party payer players. It also reminds us of our obligation to care for one another and to consider others when we make health care and lifestyle choices. If I do foolish things and rack up medical expenses, some faceless entity isn’t going to pay the price, my fellow Christians in my network are going to share in the expense.
Faith-based health care sharing networks really picked up speed when government intrusion into health care led to requirements for coverage of “medical” procedures that are objectionable to us. Health care sharing networks were exempted from these requirements, which are an onerous burden on our religious liberty. These networks grew in popularity among Christians who care (as all of us should) about ensuring that their plans do not pay for abortion, contraception, and other unacceptable practices.
While such programs are not for everyone, I am amazed to see how they have grown over time. I read recently that Christ Medicus Foundation and its Christian partner Samaritan Ministries International have over 60,000 households enrolled, creating a large enough pool that the overall economic burden is not too heavy.
Regardless of your opinion, it is another option. As the health care debate heats up again, we can see that the mess it is likely to continue. There’s a saying, “A camel is a horse designed by a committee.” We’d better fasten our seatbelts for another wild ride; politicians (most of them not doctors, nurses, or insurance specialists) are going to design a plan for us! And we, with our nearly unlimited demands, are not helping matters either.
Alternatives like health care sharing are starting to look more and more appealing, or at the very least worth investigating. These are my thoughts, anyway. Options, anyone?