Thursday, August 20, 2009

Some thoughts on Health Care reform and the current "debate"

(Edited 8/21/2009 5 pm. Also have posted what I hope is a more pastoral post on Reconciler's Blog)
So that my reader will be able to know where the following comments begin from I will say that overall I think that our current system of providing health care to people in this country is deeply flawed. That our system creates a situation in which a large number of people mostly poor cannot afford basic regular health care and rely on emergency rooms for that care is unacceptable. I am avoiding talking about insurance because I am not sure relying upon health insurance to provide for good health care was the wisest course of action: profit motive is a bad reason to care for others. I believe part of the current problem is that health care is almost entirely based on someone making a profit off of our health or ill health.

I will admit that I read Sojourners, their weekly newsletter and blog etc., for much of my sense of the state of these things. Though, this is not my only source, I also read the NY Times and the Economist. I don't watch any TV news not even the Daily Show, though I do like the show when I have seen it. I say all this because I may have missed some of this so called "debate" over health care, and I am not familiar with all the sound bites out there.

Sojourners and other progressive religious types have been drumming the beat of the moral imperative of accessible affordable health care for all. Got it and I agree. Yet From what I have read and seen in response to the fear-mongering of the opponents of health care reform, there have been two responses from Sojourners et al. First is to say that all these things people fear, death panels, a fine for having private insurance, etc., are lies and point to the portions of the bill that show that the claims are lies. Second response is to simply repeat that it is a moral imperative that all have access to affordable health care, underscoring that to oppose the proposed health care reform because it isn't perfect is to deny this moral imperative. I agree with Sojourners that there is a moral imperative here and yet I find these responses ineffectual and unacceptable, and only a little better than the accusations, and lies flying about among opponents of reform. Let me say there is no debate currently about health care reform there is only assertions and countering assertions but not substantial debate (that I have seen) concerning the actual details of the bill.

I will admit that I have not read the bill in its entirety though through the internet I have ready access to it, I am a slow reader, and there are pressing responsibilities I have of community church and friends and family. Yet I believe that in the face of the lies we who are proponents of health care reform in the apparent absence of the opposition really wanting to look at and debate the actual details we should do so among ourselves. I will begin this by looking at the portion of the bill that is the probable source of the claim that the government would set up "death panels". As I read it the bill references various other legislation and regulations that I think have to do mainly with Medicaid. My understanding is that this fits with the nature of this overall reform which is simply an extension of Medicaid. First question I think should be asked and debated is if this is a good way to reform the system? Is expansion of Medicaid a good thing, or will it perpetuate aspects of our system that we do not want to perpetuate?
Now what this portion of the bill would legislate is that living wills are a good that all should have and that everyone should have access to a professional who understands the nature of living wills and be able to advise patients when they are creating a living will. When I was trained in chaplaincy at North Western Mememorial Hospital, chaplains were the professionals who provided this service, though not the only ones. I caried with me at all times living will forms to give to patients, though the impatus for creating a living will had to be from the patient and not from myself as the chaplain. If a situation warrented it and I knew that a patient did not have a living will I would suggested it, sometimes the patient would not want to fill it out. Then that was that. My second question is do we really need this legislated to the detail that the bill prescribes? Why is this even in the bill ? I think I understand the fear of congress legislating in the area of end of life decisions: What are we potentially creating when we have government funded advisors of living wills? What sort of subtle presures, and power dynamics are we suddenly introducing into the equation of end of life questions? As a chaplain I was not paid or mandated to offer living will advice, it was a service among others that I provided to patients in the hospital as a chaplain. The potential of a discussion of living will with me as chaplain being one of pressuring or coersing a patient to do something with which they were not comfortable was extreemly low. However a government mandated program and advisor coming to you in your hosptital room or your physician coming to you based on such legislation, that has power behind it and potentially coersive power. I think this potential is behind the lies about the "death panels". Yet by simply pointing to the legislation and saying there are no "death panels" legislated does not address the actual fear. Such a response also does not examine the moral and ethical issues of this bit of legislation. Sojourners, et al. tell me why this should be part of this legislation? Why must the government be involved here? What injustice does this right, and does it right it without creating other unethical and injust situations? Why should I accept this use of power, even if I believe living wills to be a good thing? to be clear I do, and I advise people even as a pastor to have them.

How much of this legislation is riddled with this sort of questionable (not because having X is a bad thing, but is it a good thing to have them mandated by the federal government) material? We are in a crisis, I agree, but I do not believe anything is better than nothing, and I think such thinking sells ourselves short. We need to get off our moral high horses and step back from the moral imperative rhetoric and start conversing about the details of such legislation, take our time, argue from details, ask questions of what should or should not be legislated, what and how should or should not the government use its power to achieve certain ends. If these are such high moral stakes as is claimed then lets start talking and arguing among ourselves about the actual virtues and potential dangers (real dangers) of the currently proposed reforms. I think if we would actually do this we could stop the fear-mongering in its tracks, because people would not feel pressured into accepting things they don't fully understand the consequences. Of course this may mean encouraging congress not to pass legislation immediately but to allow the time for the public to examine and allow time for churches and other civic organizations to gather in groups and discuss these issues. Stop advocating implicit trust of the goodness of our politicians; they are humans like us, they have a mixture of good and bad motives like all of us, they are fallible like all of us, they are perhaps more prone to expand their own power at the expense of others than many of us. We need to slow down not speed up. We need to stop with the high sounding rhetoric of morality and settle down into the muddy waters of the realities of the messiness of governance and the fallenness of all political powers, and seek the best possible solution, not the perfect solution, but one that doesn't unwittingly give power to the government bureaucracies that it shouldn't have, and that admittedly we have already given to for profit insurance corporations. However, we should no more trust government bureaucracies than we should trust corporations. Sorry Obama and Democratic legislators, I don't trust you and don't think we should, even if we elected you! Give us time to really examine this, face the reality of the emotions this stirs up, and the reality that even you can abuse power, not just those Republicans and those corporations! It is clear the citizenry is not clear about the details and the consequences of proposed reform, give us time to mobilize and educate ourselves, and lets have this be put on hold for a year or so. I know ridiculous idea, much better to just accept the nice comforting rhetoric than actually ask us to wade through the issues for an extended period of time. Obama after all has other things he needs to get to, and there's the war in Afghanistan etc. We need this solved and solved yesterday, now if we only accept what is proposed and be done with it. Sorry not buying that one.