The Subtext of Health Care Reform

How to provide for the health of ourselves and our families occupies center stage today with very good reason. Is there any other area that has as great an impact on our individual lives and those of the ones we love?

The delivery of health care is obviously ridiculous. As an editorial in the San Francisco Chronicle said last week, "We spend nearly twice the average amount that other affluent countries spend on health, yet our outcomes on bellweather statistics like infant mortality, life expectancy, and survival rates for heart attacks are consistently worse. The fact that nearly 50 million Americans are uninsured is a national moral failure. The list goes on and on and on."

To make matters worse, California's state budget morass continues its attacks on the lower middle class with a cruel attack on the health of the working poor. The most recent agreement contains $144 million in cuts to the Healthy Families Program. This program provides care for children of the working poor, parents who cannot afford private insurance but who have income that disqualifies them for Medi-Cal. Advocates for children's health cry that as many as 785,000 California children could lose coverage in the near future due to these cuts.

But cutting the Gordian Knot of true health care change seems too large to handle. And, like the grand plans of the Clintons, President Obama's proposals for significant change in the American health care system seem to be running on empty — although this could change. But without attention to matters of greed and self-centeredness, real change cannot come.

The greed effect is easy to see. Recently I was with a group of philanthropists. I was shocked to discover how many had made their money on health care. Executives and other highly compensated employees now receive more than one-third of all pay in the US, according to a revealing recent analysis in The Wall Street Journal. Personal greed imperils the ability of our nation to provide a secure future for all of us. Health care is the gold rush for these folks.

My favorite recent example of a greedhead in health care is Elaine Ullian, the CEO of the Boston Medical Center. This hospital recently sued the state of Massachusetts over the reimbursement system in its near-universal health insurance law. This system is a heroic attempt to provide coverage for all and thus is being attacked by the greedheads in the health care industry and their friends in Congress. The lawsuit has the possibility of wrecking Massachusetts' system, depending on the attitude of the judiciary. Most interesting was CEO Ullian's sound bite on the lawsuit: "We believe in health care reform to the bottom of our toes," she said, "but it was never, ever supposed to be financed on the backs of the poor, and that's what has happened in Massachusetts." These are very "noble" sentiments from a hospital CEO who makes nearly one and a half million dollars a year. Where does she think her salary is coming from? If Ullian truly believes her sound bite, a little self-reflection on her role in our mess is in order.

The constraint on our ability to rectify the health care mess is fundamentally due to an unwillingness to recognize our duties to others and the interconnectedness of us all. Twenty-first-century greed is only part of it.

We should all look inward and consider whether we are being self-centered in this difficult area. Many of us work in the grossly titled health care "industry." We are often told by our employers that any change will have an effect on our jobs. We react like Pavlov's dogs to protect our turf. Those of us who have health care are reticent to embrace any new system that might challenge even the problematic coverage we already have.

Unfortunately, few leaders in areas of health care not controlled by greedheads have stepped forward as they should. Unions have done heroic work to spearhead the movement for affordable universal health care. Yet those who run health funds that are fully or partially managed by unions, workers, or their advisors are often looking out for their own parochial interests, too. Leaders of health agencies that work with the poor often take similar stances. The lobbyists for these progressive groups work the halls in Sacramento and Washington, expressing concern about any kind of "mandates" from the government while at the same time trying to get financial assistance in the bills, such as federal support for the provision of care to those between 55 and 65, the so-called "catastrophic band" for private health insurers. This self-centered activity, though understandable in current society, hurts the movement that would ultimately assist all.

And since a huge percentage of medical care goes to the last few years of our lives, we need to begin a true national discussion as to how long life should be continued with medical devices and procedures. This will be a painful topic for all concerned. The Catholic Church will oppose any move to make it easier to die, and I respect their moral consistency here. But if those who hold such positions wish to maintain that consistency, they need to take a leading role in considering how society can afford these costs.

These are not easy questions. The heat needs to be kept on the greedheads. But those who are progressive and caring need to publicly discuss the changes they are willing to make. Without a concern for the many, or a willingness to take a little less for ourselves, we will not be able to provide quality health care for all, at least in our lifetimes. The dollars are in the pockets of the greedheads, but unless those who care are willing to take the first steps and grasp the larger picture, that is unlikely to change.