The Subtext of Health Care Reform

Greed and self-centeredness are the real hurdles.

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

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.

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