Healthcare: Could We Get A Moral Commitment?

Is there a simple way to get universal healthcare in this country? In a word, yes. Or rather, in two words: moral commitment. If we were to make a moral commitment to what is, after all, only the fair, humane, equitable thing to do, author/reporter T. R. Reid told an audience at San Francisco’s Commonwealth Club today, there would be no problem.

Reid, a reporter for the Washington Post, documentary film maker and NPR commentator, was in town to promote his new book, “The Healing of America: A Global Quest for a Better, Cheaper and Fairer Health Care .” In it he tells the story of his journey around the world in the company of a painful shoulder, consultations about which were his introduction to personal encounters with health care systems of every sort. He also met with government representatives and policy makers across several continents.  It is an informative and highly readable (no pun intended, that’s just an appropriate adjective) book.

Reid outlined the four primary models of health care currently in existence on our small planet, each with different versions of who pays and who provides. In Britain’s socialized medicine model, health care is the government’s job and it does both. A “mirror image” of this plan is that put into place in Germany shortly after the country was established in the late 18th century, a “National Health System” in which the providers — doctors, clinics, etc. — are private but the payer — government — is public. Workers are covered through their employers. One advantage to both, Reid points out, is that everyone buys into preventive care. He told of British ads asking passersby if their feet hurt, and urging them to visit a podiatrist right away if so; “It’s free.” Or commercials featuring a coughing “Mum” and giving a phone number to call so a nurse may visit. “It’s free.” Each is aimed at diagnosing other illnesses early, and/or preventing the spread of disease.

The Canadian Medicare (that’s where Lyndon Johnson got the name for our elder care) system now copied by Australia, Taiwan and others would have had Reid waiting an long as a year for consultation and treatment of his shoulder. Although he proclaimed his pain to be a very present issue, it was not seen as an urgent need to the primary care doctor he consulted. It is this often extensive wait for non-urgent care that is most criticized (especially by Americans) about the Canadian system. But Reid got a Canadian answer to that. “We Canadians,” he was told, “don’t mind waiting, as long as rich Canadians have to wait as long as poor Canadians.”

The fourth model cited is the out-of-pocket model, which Reid illustrated with a story of climbing a mountain in Nepal to seek shoulder relief. At the top of the mountain, in an extremely simple one-room building with its four walls painted in four different colors, the doctor explained his payment was generally in whatever the patient could afford. Someone relatively well off might pay in funds, others in whatever they had. Many of the patients could pay only by painting the facility, the doctor said; they seldom had the same color of paint, and thus the many-hued room.

“We have them all,” Reid told a hushed audience: Native Americans and veterans have the British/NHS; over-65, the Canadian Medicare; working people, Germany’s system. But 40+ million Americans have medical care equivalent to Afghanistan or Angola, and tens of thousands of Americans die every year because they cannot afford medical care.

One audience member called Reid on that issue, saying hospitals were required to treat people who came to them, but he was not backing down. True, he replied, if someone is actively dying or about to give birth, hospitals cannot turn him or her away. But for cases (such as one cited at the beginning of The Healing of America) of lupus, or diabetes, or in countless other instances, the inability to pay for necessary care causes ongoing pain and death for thousands.

Other audience questions raised the illegal immigrant issue. In most countries, it simply would not be an issue, he said. Citing Britain as an example, he said “you get (care) whether you’re a citizen or not.” Reid also said the public option is a non-issue elsewhere, because “you don’t need it.” And he threw in another few illustrations that argue for reform: In Britain, you have to cover everyone, you have to pay every claim, and you have to pay every claim fast. In Switzerland, if a claim is not paid within five days, the next month’s premium is free. In Germany you have a choice of well over 100 insurance companies; if you don’t like one, you simply switch to another.

Having set out to answer the question of how other countries provide health care for all of their citizens, Reid said he then turned to the why. Why every other wealthy, industrialized, developed country in the world has universal coverage and the U.S. does not. Others have it, he said, because “they think it’s fairer, equitable, humane, just — and these are moral issues. Health care reflects a country’s moral values.”

It was clear that Reid, like most in his audience, sees the U.S. as having moral values. “If we had the political will,” he commented, “other countries could show us the way.”

But the author was pessimistic about the possibility of universal care coming out of the current reform efforts. Asked how it might somehow come to the U.S., he said it could well be the way Canada’s plan came about; “we might get it state by state.” The Californians listening might have taken heart. Twice that state has passed single payer plans, only to have them vetoed by their governor. Reid suggested that other states might also be ready to implement statewide health coverage.

As to his painful shoulder, its current status was not given. Presumably, it will be necessary to read the book to find out.

11 responses

  1. Getting a “moral commitment” from the teabag crowd (and their supporters on The Hill) would be quite stretch. What has become quite evident in the health care debate is that there is a very large segment in this country lacking in morals.

    • I suspect you’re right, Brian, on the degree of difficulty ahead. Actually, I don’t think it’s as much lack of morals as lack of will, and ofwillingness to make hard (read: costly) choices.

    • Yes, I think any increase in transparency anywhere is a good thing. And I agree with many of the Chamber’s arguments such as the need for protection against litigation for doctors. But I still support the public option, and believe there are ways to reduce waste beyond eliminating defensive medicine. Your opening line says a lot: if we can reduce emotionalism and focus on facts we might get some real reform accomplished. I think we have got to do that now, not in another 20 years.

  2. Ms. Johns,

    I have to disagree, this is not principally a moral issue, it is a principally a political issue. Politics is clash of interests, the side that is able to muster greater political force and apply that force effectively will have its interests met (too bad about the other side). I know it sounds so uncongenial to put that bluntly but that is how it is done. In this case, insurance companies, the Republican Party, various and a sundry conservatives have an intense interest in preventing health care reform. Others have an intense interest to pass Mr. Obama’s health care reform and there are great many people in between who can support one side or the other. Whoever can achieve a critical mass of support, will win and the side will lose, it is just that simple. Reposing the question in moral terms does not change those truths.

    (As an aside, despite the lead-in to your piece, you never actually argue in your blog for how health care is a “moral issue”. Your arguments are merely that it would “work”, which is not a moral argument. It is a pretty good piece on how it would work, dispelling misunderstandings, but it never actually makes the moral argument.)

    • OK, David, my husband agrees with you, and he and I are still friends. (He is probably more moral than I, too, but I’m not getting into that.) Certainly everything that’s going on right now is political, and the forces are power, money, those details. But here’s what I mean about the morality thing: If someone is sick, in pain, in distress, I believe it is immoral to deny that person access to care & relief. If my healthcare need, beyond urgent care, interferes with his or her basic need, I believe it is immoral for me to claim first dibs. I believe it is immoral for us, as a nation, to allow citizens — ours or anybody else’s — to suffer and die for want of health care, when it is clearly in our power to provide that care. I believe that if we were able to look at this as a principle, a moral principle to which we might subscribe, we might be tackling the details differently. There are those who maintain my middle name is Pollyanna. Not being a policy wonk, I don’t have any real insight into what can or cannot be made to work at this point. But just as I believe a broader realization that torture is morally wrong may finally get us out of the torture business, I cling to the belief (& hope) that realizing denial of health care to all is morally wrong may add impetus to a just solution.

      You are kind to concede it’s a pretty good piece… does this help any with the moral argument?

  3. Hell, yes it’s moral. The fact there’s even a debate about that makes me crazy and has, for the first time in three recessions, made me consider leaving the U.S. I am so disgusted by the “debate” which is nothing more than self-interest whipping itself into a frenzy.

    Fran, I, too, cannot fathom how anyone can get up in the morning, if they have decent access to healthcare, shrug and walk away from knowing, for a fact, that millions of others do not — because they cannot get or keep a job with benefits, or their employer does not offer benefits or they do not earn enough freelance to buy health insurance…it can cost $1200/month or more to insure a family or $300-700 a month for an individual in NY state (much, much cheaper in some other states, which also have much lower costs of living)…That’s $1200 after-tax dollars you have to earn every single month, no matter what service or product you are selling or how dismal the current market for your product.

    It’s a punitive, ugly double whammy — you’re supposed to be a rugged entrepreneur and make your own fortune, blablablabla (which you may be forced to do because you simply cannot find a job) — then pay the absolute maximum cost for full-priced health insurance (why!?) for the privilege of being tossed out of work. Or, hey, step up to that craps table, skip insurance, and gamble on medical bankruptcy.

    Yeah, that seems smart, fair and moral. Not.

    • Thanks for that seconding, Caitlin. You would have enjoyed T.R. Reid’s comment (I hope EVERYbody buys his book) about Americans grousing that the Canadian Medicare plan requires long waits for non-urgent care. A friend there confirmed that, but said,
      “We Canadians don’t mind waiting, just so rich Canadians wait as long as poor Canadians.” Not a bad theory.

    • Ms. Kelly,

      I believe that you are replying to my posting. I was careful to state that I did not believe that health care reform was PRINCIPALLY a moral issue which is not to say it is not a moral issue but rather that the moral element is secondary to the political. I say this because there are many moral issues in the world but when we want to legislate morality, and fund them with taxes, they become political issues. It is the political process that will decide what gets legislated and funded, irrespective of morality. One may view this as good or bad but it is a fact that cannot be ignored.

      • Perhaps we can agree, David. The moral issue has indeed become secondary to the political. And no, you cannot legislate morality. My hope remains that you can keep it in mind. If every time a legislator sat down to vote on one piece of a bill or another he or she would say (assuming he or she has a moral fiber somewhere within), “It is immoral to let a person suffer or die because health care is denied,” it might eventually affect the way we frame the debate.

  4. Fran, I look forward to reading his book. What very few of these “debates” really address is the very fundamental — and often ugly — underpinnings of every nation and its policies, which essentially exemplify larger cultural values. For whatever reason, Canadians (and others) are totally fine (in fact really like) with the idea that — yes, really — we do pay higher taxes even when illegals, and fatties and smokers also get health insurance. The relentless fetishization of 1) wealth 2) special status that wealth/hard work/achivement should therefore buy you (or what’s the point, right?) 3) the individual’s needs over the collective are so American. It is not surprising there’s blood in the water over this as it truly lays bare these very very basic beliefs so usually glossed over in vague, polite, abstract language — if at all.

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