Access to health care is an imperative of our Baptismal Covenant

by

THE MAGAZINE

 

by Marshall Scott

 

Regular readers at the Café will know that I am a hospital chaplain and administrator of hospital chaplains, serving in an Episcopal hospital and health system. So, it won’t surprise anyone that, among all the questions of our current times, I am especially alert to the concerns about health care.

 

I’ve been a chaplain long enough that the question isn’t new. I was in my first CPE Residency when the Reagan Administration announced that some Medicare reimbursement would be based on Diagnosis-Related Groups (DRG’s), a tool that attempted to moderate costs by first coming up with a regional average of what a particular procedure might cost. I was a chaplain in practice during the Clinton Administration and its efforts to develop universal access to healthcare. I was in practice when Massachusetts adopted what came to be called “Romneycare” (I commented at the time here); and as the Affordable Care Act was adopted.

 

Throughout that time, I have been attentive to what the Episcopal Church has said in General Convention on healthcare for all. During the Presidential campaign in 2007 I posted here at the Café to note resolutions we had passed speaking to that. Now, as we watch to see what happens, I wanted to go back to the Digital Archives and the Actions of General Convention to note what we’ve said more recently.

 

I was not surprised when I saw that we had responded in 2009. That was early in the Obama Administration when the legislative effort was active that would result in the Affordable Care Act. We in fact passed three resolutions addressing the issue, as well as two we might call “corollary.” (Since I’m looking at the Digital Archives and not at the Journal, I can’t say off the bat in what order these were passed.)

 

Resolution 2009-C071, “Urge Advocacy for Comprehensive Healthcare Coverage,” sought to strike a balance between a communal commitment to care for neighbor and a recognition that resources are not limitless. While it called for “proclaiming the Gospel message of concern for others which extends to concern for their physical health as well as spiritual well-being,” it also called for “recognition that there are limits to what the healthcare system can and should provide and thus that some uncomfortable and difficult choices may have to be made if we are to limit healthcare costs….” Therefore, it urged us as Episcopalians to

“contact elected federal, state and territorial officials encouraging them to:

  1. a) create, with the assistance of experts in related fields, a comprehensive definition of “basic healthcare” to which our nation’s citizens have a right
  2. b) establish a system to provide basic healthcare to all
  3. c) create an oversight mechanism, separate from the immediate political arena, to audit the delivery of that “basic healthcare”
  4. d) educate our citizens in the need for limitations on what each person can be expected to receive in the way of medical care under a universal coverage program in order to make the program sustainable financially
  5. e) educate our citizens in the role of personal responsibility in promoting good health;”

 

2009-D048, “Urge Passage of a Universal Health Care Program,” was more focused on the discussions at the time. It called for the Convention to urge passage of a “single payer” health plan, and for our office of Government Relations “to assess, negotiate and deliberate the range of proposed federal health care policy options in the effort to reach the goal of universal health care coverage, and to pursue short-term, incremental, innovative and creative approaches to universal health care until a “single payer” universal health care program is established.” It also noted that we should “work with other people of good will to finally and concretely realize the goal of universal health care coverage.”

 

2009-D088, “Urge Passage of Comprehensive Health Care Insurance,” was short and sweet. Its action was “That the 76th General Convention urge the Congress of the United States of America to pass, and the President of the United States to sign legislation by the end of 2009 guaranteeing adequate healthcare and insurance for every citizen of the United States of America.”

 

As I noted, there were also two resolutions I would describe as corollary. The first was resolution 2009-A160, “Support Medical Care Reform to Include HIV/AIDS Treatment,”  The particular focus on HIV/AIDS included an appreciation that there were “high rates of HIV infection particularly in our African American communities and… discrepancies in levels of care and treatment of people living with HIV/AIDS based on poverty, prejudice, racism, ignorance and the lack of visibility.” It called “to include in comprehensive health care reform legislation provisions that would cover persons with pre-existing conditions such as HIV/AIDS and sexually transmitted diseases,” and for all of us to “advocate strongly for access to adequate medical care not based on any factor other than the need for health care.”

 

Resolution 2009-A077, “Urge Congregations to Implement a Health Ministry,” both encouraged establishment of parish-based health ministries, and called for “congregations to raise awareness of health ministries and promote the understanding that health includes body, mind and spirit.”

 

For more than thirty-five years, the General Convention has expressed support for access to healthcare for all Americans, whether defined specifically as citizens, or more broadly to include everyone. The breadth of such services has also been great. Resolution 1985 –A088 described “such health services as food kitchens, shelters for the homeless, legal aid centers, mental health centers, neighborhood health clinics, homes for persons with physical and mental disabilities or both, home health care, hospice care for the dying and their families, and halfway houses.” With that long a history, this is a principle that can’t be tied to a single law or legislative initiative. Rather, for the Episcopal Church this is an expression of the Baptismal Covenant.

 

By the same token, in each resolution it is an expression of the Baptismal Covenant that we communicate with those who govern, both elected and appointed, to express our concern. The current situation may seem acute, but it is not new. Our responsibility continues to speak out as a church and as individual members of it for those who need healthcare; and no standard seems more appropriate than that expressed in 2009-A160: healthcare for each for no other reason than because they need it.

 

The Rev. Marshall Scott is a hospital chaplain in the Diocese of West Missouri. A past president of the Assembly of Episcopal Healthcare Chaplains, and an Associate of the Order of the Holy Cross, he keeps the blog Episcopal Chaplain at the Bedside.

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Paul Woodrum
Guest

Two of the problems of the Affordable Care Act are that it is administered through the states and dependent on private insurance companies. Some states have taken full advantage of it. Others, usually those with large minority populations, have refused to implement it. It seems the Republicans are moving toward a system of block grants to the sates. Some would even include Medicare in this system. This will not only perpetuate present inequities, but increase them.

Just the opposite -- single payer Medicare for all -- would be far more equitable, less expensive and more efficient than block grants and dependence on insurance companies most of which are so large they collogue rather than compete.

Like education, health care should be considered a basic, human right.

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Norman Hutchinson
Guest
Norman Hutchinson

Paul,
Your accessment is correct and what should happen.

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David Allen
Guest
David Allen

The ACA was supposed to be a single payer plan, but congressional Republicans blocked that because that's not what their big insurance contributors wanted, nor did Big Pharma.

It is what it is because that is all that the Republicans would allow to pass congress.

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Member

Actually, while the thought was circulated at the time, the Patient Protection and Affordable Care Act was never conceived as a "single payer" plan - for the reasons you cited. However, not only was it modeled on Massachusetts' plan; but both were modeled on the plan practiced in Germany. The German plan combines insurance through employment with government safety net and social welfare programs, and achieves nearly 100% access. The big difference is that the mandates so abhorred by some in Congress are included, so you have both near-universal access and near-universal participation. The bigger difference is that the Germans see themselves as part of a single society and so accountable to one another (both as individuals and in the structures of society). It is that belief that all are in it together (as opposed to every person for her- or himself) that allows them to reach so far with a hybrid system.

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David Allen
Guest
David Allen

As I understand the backstory, Obama & friends didn't persue the single-payer option, that had been around since the Clinton Administration, although they would have preferred it, for the very reasons I have stated, that it would not receive fillibuster-proof support in the Senate.

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Member

And we're certainly in agreement about how Congress would have reacted to a true single-payer plan.

There are certainly opportunities and difficulties with a single-payer system. On the one hand, and for one benefit, it would allow the transparency to accurately inform patients of the costs associated with care. In our current situation, as each insurer negotiates independently with each provider, different contracts produce different structures for costs.

On the other hand, and this would be a challenge, since no government is likely to provide the resources for "anything goes" in a public health plan, someone would have to make hard decisions, i.e., rationing care. We at least get to pretend we don't ration care. In fact we do, based on economic resources and insurance. We get to pretend in part because people self-edit, if you will: out of fear of debts they forego care that, in many cases, would over the long haul greatly reduce expenses and healthcare use, but that seems unattainable at the moment.

What does seem clear is that those nations that have chosen a national healthcare plan have made a decision that more people benefit when everyone can get some care, even if some don't get all the care they might imagine.

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