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The Moral Ambiguity of Present Health Care Options

posted by Scot McKnight

From Nicholas Kristof, of the NYTimes. Who has faced this sort of situation? Any response to Kristof’s article?

So what would you do if your mom or dad, or perhaps your sister or brother, needed a kidney donation and you were the one best positioned to donate?
Most of us would worry a little and then step forward. 

But not so fast. Because of our dysfunctional health insurance system, a disgrace that nearly half of all members of Congress seem determined to cling to, stepping up to save a loved one can ruin your own chance of ever getting health insurance.

That wrenching trade-off is another reminder of the moral bankruptcy of our existing insurance system. It’s one more reason to pass robust reform this year.

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Kyle J

posted October 4, 2009 at 7:51 pm

I’m not sure “ambiguity” is the correct word to use in the title of this post. Very few people would look at this situation and say the choices are ambiguous from a moral perspective. Rather, the choices are impossible to make–due to the moral bankruptcy of the current health insurance system.
I suspect very few readers of the blog have faced a situation like this one. It’s an extreme situation–but, of course, the basic idea behind insurance is to protect people against extreme situations.

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Ted M. Gossard

posted October 4, 2009 at 9:56 pm

This is just one reason why the Republican Party has lost me. Maybe my comment is simplistic, but to ignore this problem, and as a nation to think we have no societal moral obligation to provide affordable good health care is simply beyond me.

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kevin Chez

posted October 4, 2009 at 10:12 pm

Not to downplay the seriousness of the medical situation. It is obviously heart wrenching. What did strike me was his perception (or maybe just his choice of words?) of “opponents of reform”. I don’t think anyone is opposing reform. I think that is something everyone will agree on, reform is needed. The debate is over what/how/who pays for that reform.
What is interesting is that we who do have insurance probably have no idea what that exactly means. I know i have a 20 dollar copay and just assume everything else is covered. If I’m in an accident, it is covered.
My wife and I just had a baby. Even with insurance we paid over $1500 out of pocket. I estimate that the total bill for the delivery and hospital stay was $12,000. Add on to that about another $5000 during the pregnancy which we paid about $500 out of pocket. This was a normal pregnancy, no surprises (of course we are in Long Island, NY where things do cost a little more). No one ever counseled/advised us on what it would cost us. No one in the medical profession, my wife’s HR dept at work, or the insurance company. I guess we just need to find this out on our own? I’m not complaining or shirking responsibility. I should be the one to be asking the questions and it should be my responsibility to know how I am covered. But we as Americans just don’t do that, right?
When it comes to issues of kidney transplants, etc., how many of us know how we are insured until it is too late?
Another question that comes to mind is how much should the insurance companies be responsible for? Do we just assume that they have an unlimited amount of money?

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Scot McKnight

posted October 4, 2009 at 10:18 pm

Kevin, thanks for your thoughts. No one but an ogre would say they are against health care for everyone, but what folks say and what they do are not the same. The contention of the this Admin is that, no matter whom you choose to blame, we have not done enough and reform is needed — and there’s not sufficient evidence that others have cared enough to get something passed on Capitol Hill. Would you agree?

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posted October 4, 2009 at 10:34 pm

Any consideration of morality, as it relates to health care, simply must consider the price providers place on their goods and services.
By all accounts the charges are high; higher than most people can afford. Even so who’s asking the providers to give an account for their prices? Is it moral to become wealthy from the sickness and suffering of people; your neighbors?

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posted October 4, 2009 at 11:01 pm

Our heath insurance system is perfectly designed to deliver the results we see, like the story in the article. Tweaking it is not the answer.
We have to decide if the purpose of health insurance in this country is to spread the risk and finance health care for everyone or to maximize the profits of the health insurance companies.
I am not one who believes profits are evil, but in this case those two objectives are mutually exclusive. One has to yield to the other.
I think we can do this with a privately run system with plenty of choices of insurance providers, but it has to be regulated and profit limited, like the systems in Germany and Switzerland, and everyone has to be in the system. I know this won’t solve everything. We have to have tort reform and change incentives in the medical delivery system that reward waste instead of results, in order to control costs on both the public and private side. But health insurance has to be thought of as a public utility and not a way to make as much money as you can.
If we don’t act very soon, the system will be both morally and economically bankrupt.

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posted October 4, 2009 at 11:40 pm

All people may be created equal, but all heath care reforms are not. To say there are no alternatives to government run health care is not correct. Some of us happen to believe that the government is not the best guarantor of quality health care for the largest number of people possible. This is not to deny that reforms are needed and necessary, but it is to say that alternatives should be considered. It is better to measure twice and cut once.
The stampede to pass a bill now without attending to the flaws of the current bill seems to be based on the belief that passing this bill is some kind of moral imperative. I believe as a Christian that this too easily conflates ideology with the divine command. I don’t know if Obama’s bill will pass, but if it does fail it will not be because a near majority of Congress (and a near majority of the American people) oppose all reform but because most want a change they can believe in.

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Mike M

posted October 5, 2009 at 12:30 am

There seems to be confusion here that “health insurance” = “health care.” I trained for a triathlon this last summer yet was denied health insurance because I took two blood pressure medications. This is despite the fact that my blood pressure was controlled. That is exclusion up-front which seems to be the issue here with the kidney donation.
Universal coverage would guarantee that there is no up-front exclusion. But the overlooked fact is that there is also exclusion paid forward with government run programs. If I order a test, treatment, medication, or any therapy that MIGHT be turned down by the government, I have to have my patients sign an “Advanced Beneficiary Notice” which states that the government will not pay for anything it doesn’t consider “medically necessary.” So even if the kidney donor is guaranteed enrollment, is there any guarantee of coverage?

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posted October 5, 2009 at 1:41 am

To add a more realistic spin that most of us can relate to, let’s suggest the advances made in genetic mapping. Scientists and medical doctors know many of the genetic indicators of disease exist before the onset of symptoms. So, if our paternal side of the family suffered from heart disease with early onset (e.g., heart attacks before 50 years old), and our maternal side of the family had a particular type of cancer that could be tested for, many of us would choose NOT to get genetic testing, even if early detection might prevent more medical expenses later. This choice must be made because, if we had the actual medical report indicating that we will develop a condition later, this would mean that insurance companies would reject coverage for a pre-existing condition. The irony is that every single person has some pre-existing condition(s), but ignorance of those conditions is the only guarantee that we can purchase coverage.
I’ve heard so much spin that it’s not reform that many conservatives oppose, it’s this particular reform bill. Well, instead of rejecting the package wholesale, why on earth don’t we all encourage our representatives to listen to us and not to the money being dumped by the pharmaceutical and “only-the-healthy” industry lobbyists? If a conservative says, “but we need tort reform, too!”, then let’s agree to encourage Dem representatives to provide the choice of a public insurance option AND tort reform. (77% wanted the choice of a public insurance option at the end of August.) Let’s not do all we can to slam on the brakes just because we didn’t vote for the driver, rather let the people do their best to know the issues and steer the reform in healthier ways for all of us!
I’ve lived in a country with universal health care, and our relatives there get excellent care without anything like the anxiety we face here. For the vast majority of care issues, there is not an “if” it will be covered. The doctors have the ability to order tests, prescribe medication, etc., without interference from insurance companies or government bureaucrats.

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posted October 5, 2009 at 8:21 am

Thank you. You speak my mind.

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Kyle J

posted October 5, 2009 at 8:46 am

“Some of us happen to believe that the government is not the best guarantor of quality health care for the largest number of people possible.”
Let’s look at the people who are relatively happy with their health care/insurance right now. Those people either:
1) Receive government-funded health care (Medicare, Medicaid, VA) or
2) Benefit from government subsidization/protections through the tax exclusion for employer-provided health insurance, which comes with protection against being denied coverage due to a pre-existing condition.
If we’re going to create a system in which government doesn’t play a major role in guaranteeing access to quality/affordable health care, we’d have to start almost completely from scratch. Alternately, we can take steps to ensure that the millions of people that lack health insurance coverage (or have inadequate coverage) receive the same kind of subsidies/protections that 70-80% of us already receive.

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posted October 5, 2009 at 12:15 pm

With all due respect to those who insist that they agree that health care reform is needed but that it’s just THIS health care bill (whatever it is) that they oppose, what were conservatives doing about the problem during their 6 years in complete control of government? The problem we face today isn’t really any worse than it was 9 years ago. So it seems very disingenuous to insist that, “of course we support some sort of health care reform” when during their years in power the republicans did absolutely nothing about the problem. As a matter of fact, Newt Gingrich was pushing health care reform with a group of specific proposals (mostly good, a couple not so good) during the Bush years and couldn’t get any traction. IMO, anyone who wants to say that they support health care reform but not what Obama is doing must preface anything they have to say with, “I understand that my side failed to address this very real problem and that was inexcusable. All we can do is beg forgiveness. I also understand that now that we are not in power, we have to compromise with people whose approach is very different than what I would like. But that is the price we must pay for the failure of conservatives to take up this cause when we had the chance. Having forfeited that chance, the best we can do is humbly work with those who are now in power to make the bill that is implemented as good as possible and make sure it does as little damage as possible.” Start like that and people might be able to take conservatives seriously. However, without taking responsibility for their failures and insisting that their “no, no, no” is principled, it’s hard to take them seriously.

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posted October 5, 2009 at 4:00 pm

“a disgrace that nearly half of all members of Congress seem determined to cling to”
Bold-faced lie. Opposition to Obamacare is not automatically a vote for the status quo

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Kyle J

posted October 5, 2009 at 4:42 pm

To go at this question one more time: What is the specific alternative plan being proposed by the GOP? There was the bipartisan Wyden-Bennett plan that the GOP cosponsors have been running from over the last several months. There’s the Ryan-Coburn plan which would blow up the employer-based system we have now and put everyone in charge of buying their own insurance (with a relatively small tax credit)–running counter to the overall GOP talking point of protecting people’s current health insurance. And then there are the vague series of talking points (see: the GOP response to the President’s prime time speech and the op-ed by Bobby Jindal in today’s Wash Post) that don’t add up to a real plan (you can’t require insurance companies to cover pre-existing conditions if you don’t have an individual mandate).
As posted by rebeccat above, the GOP approach to health care during the 6 years they had complete power over the federal government was . . . to maintain the status quo.

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posted October 5, 2009 at 7:07 pm

With all due respect to Rebeccat, my private healthcare policy was quite affordable just two years ago, on par with what most group plans caost. Now it is not. Just two years later and it cost 2.5 times as much. That’s ridiculous. And it has nothing to do with partisan politics.
At the core of the problem is lawsuits and lawyers. Medical lawsuits, while relatively uncommon, still exist at such a rate that doctors must overcompensate to avoid being sued. This drives up the cost of healthcare like mad. Given that most of our politicians are lawyers, well, don’t expect any legislation that will take away business from their fellows!
States that have abolished noncompetition and forced insurance companies to compete have seen costs dramatically drop. States that have capped malpractice payouts have seen costs plummet. States that require more evidence of physician impropriety in medical procedures have seen costs drop. Thia all adds up. But it also means less income for the lawyers. And that means the best answers are made harder to come by when practitioners of the law are the very cause for a good deal of the problem.
As for the issue of insurance companies denying people underwriting, it’s worse than some imagine. A single overnight stay in a hospital for any reason is enough to get you denied underwriting elsewhere, making it impossible to switch companies for five years. And even then, good luck. Free and open national competition would eliminate that kind of nonsense. But as long as states protect insurance companies so that we get Anthem of Kentucky, Anthem of Pennsylvania, and Anthem of Georgia, the system will continue to screw people.

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Kyle J

posted October 5, 2009 at 8:13 pm

1. Malpractice reform makes a lot of sense. But it simply isn’t that big a piece of the health care cost equation.
2. Opening up competition across state lines would require moving health insurance regulation from the state level to the federal level–something I have a hard time seeing conservatives support. Further, I fail to see how the pre-existing condition problem is addressed by increased competition. Private insurers are going to compete to insure people who are more likely to have higher medical costs?

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posted October 6, 2009 at 9:15 pm

To avoid misunderstanding, I did not say that the government should play no role in the health care industry. The government already finances 47% of the health care industry through Medicare and Medicaid. Both of these programs face fiscal insolvency in the near future.
I hold no brief for the conservative movement. I am a political independent and vote as I see fit, regardless of party. Neither party has a monopoly on truth nor a monopoly on virtue. I simply do not equate massive expansions of the size and scope of the federal government with the will of our Father being done on earth as it is in heaven, regardless of the end in mind. The reality is that there are many unintended consequences to large government interventions and advocates of such interventions rarely show awareness of them, whether they advocate wars on foreign powers or wars on poverty.
It is a little odd to hear that to oppose the current prevailing proposals sponsored by the Democrats one must be a conservative and preface any dissent with an apology for one’s “side” not doing enough for health care reform when they were in power. It is possible not to buy into the binary thinking of right and left and advocate positions or oppose policies based on one’s own thinking. As Christians we can be informed by ideology but we should not be determined by it.

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Mike M

posted October 6, 2009 at 11:18 pm

Napman @17: Amen. There is a dichotomy-type thinking here in the US that one is either Republican or Democrat, Conservative or Liberal. There is no tolerance from either side for independent thinking.
I have been reviled here in Wisconsin for not being a true Christian because I didn’t support George Jr’s “War on Terrorism.” I have been reviled on the Internet for not being a true Christian because I don’t support Obamacare. The truth is that a “war” on anything except an invasion of this country is unconstitutional and is just an excuse for more massive governmental interventions. For example: the “Cold War;” the “War on Drugs;” the “War on Terrorism;” the “War on Poverty.” I understand there’s going to be a new war against freedom on the Internet coming soon, too.

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Kyle J

posted October 7, 2009 at 8:58 am

Medicare and Medicaid’s financing issues do not inherently spring forth from the fact they are government programs. A good chunk of Medicare’s problem is demographic–as the ratio of retirees to workers increases. Ultimately, the financing crisis is with health care overall. In fact, private health insurance costs have increased more rapidly than Medicare costs. We’re just shielded from directly seeing the cost increases on the private side because of our employer-based system.
Why do you rule out an expanded government role as potentially being part of God’s will for the world? Has Social Security played a role in providing economic safety for the elderly? Have environmental policies helped protect God’s creation in many instances? Has the public education system not ensured a basic level of opportunity for all children? These things, while coming with some unintended consequences, seem consistent with God’s will to me (and are not things that would happen absent government intervention).
There certainly needs to be balance between the government’s role in providing justice and individuals’ roles–but the very case study in the blog post above (a situation in which market forces are creating some pretty serious “unintended consequences”), to me, would indicate that balance is currently out of whack.

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posted October 8, 2009 at 7:53 pm

@Kyle J
There are examples of government intervention that are just and worthwhile. I do not oppose governmental actions that better secure justice for the poor and needy. And I agree that the fiscal insolvency Medicare and Medicaid face are not caused by their origin in federal law.
The prevailing proposals of the Democrats have, it seems to me, deficiencies and likely, if unintended consequences, that their advocates are not addressing. Health care reform is needed, I just favor a different model. And while I respect my brothers and sisters who disagree, I do not believe that opposing these specific proposals requires one to either endorses the status quo or abdicate from one’s Christian duty.

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