2007-04-17 issue:
Health care for everyone
Six hours before my heart stopped
by Glen E. Miller
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In a few hours I was to have coronary bypass surgery —the sternum-splitting, heart-stopping operation to improve the circulation through my coronary arteries that supply the heart muscle with nourishing blood. I lay in the dimly lit hospital room when the nurse stopped by.
Following protocol, she asked, “Do you have any questions?”
Yes, I said, “can you tell me why I deserve this top-notch health care when so many millions don’t even have access to basic care?” The nurse looked perplexed. This clearly was not the usual question about plans and procedures.
With a reassuring hand on her arm, I told her I didn’t expect an answer.
But the question deserves an answer. What had I done and who was I that expensive and superior care was available to me? So many people lack ready access to basic health care. Eighteen thousand of them die needlessly every year.
Mothers are forced to make choices between buying medicine and food for their children. To the parent of a sick child, there is the added anxiety that the rest of us don’t face because we know how to find a doctor and medical help.
The short answer to my question is that I deserve health care because I am over 65. The Medicare bill of 1965 made that the law. The bill passed in part because 39 percent of senior citizens were living in poverty. Medicare and the provision of health-care benefits are a major reason the current poverty rate among seniors has fallen to 10.1 percent On the day I passed my 65th birthday, I was entitled to the national insurance program that provides health care. The law says so.
Then it hit me.
What I was entitled to at age 65, all other developed countries in the world grant to newborn babies and continue throughout their life. The United States alone does not view health care as a right of citizenship. Here, health care is available to those who can pay for it; for others it a struggle to find access to health care.
The contrast between the U.S. attitude to health care and other developed countries became real to me after two incidents.
Shingles: In 2003, Marilyn, my wife, and I went to serve as interim hosts at the London Mennonite Center. The day we arrived, the staff asked us to register at the local health clinic. The very next morning, Marilyn woke up with a painful swelling on the upper right side of her face. In several hours we saw the general practitioner, who immediately diagnosed shingles. Because of the possible involvement of her eye, we were sent to the specialist eye clinic in downtown London.
Within three hours we saw two doctors and filled four prescriptions. At no time did anyone ask who was going to pay the bill or the identity of our insurance carrier. Because of the early diagnosis and treatment, Marilyn recovered quickly from a malady that can be painful and persistent.
Contrast that experience with that of Irish friends accustomed to the British system of health care. They are living in America to study at a Mennonite seminary. The first week of school, their 7-year-old daughter fell off the monkey bars and broke her arm. Her father told me with some emotion, “When we went to the emergency room, before anyone asked what was wrong with my daughter, they demanded to know who was going to pay the bill.”
I was amazed at the progress in the weeks following my surgery, walking a half mile a day within 10 days. I felt I had a “new lease on life.” I am grateful for many things: that the surgery was available to me when I needed it, for the advancements that make this kind of surgery almost routine, for the caring and prayers of family and friends. In the midst of these good things, I try not to forget that many people who lack health-care access have not even a stable first lease on life.
Immediate and appropriate health care was available to me because I am covered under a comprehensive program, Medicare. Millions of Americans (and billions of people in Third World countries) lack an assured and ready access to even basic health care. Imagine my added anxiety, when acutely ill, if I did not know where to go for health care. Imagine a mother’s anxiety who does not even know the name of a doctor she can go to for her sick child; or she may have been told she can be seen only if she pays prior to care. She will likely go to the emergency room and is then faced with the problem of finding a doctor who will accept her child as a patient for follow-up care.
Bankruptcies: Forty-eight million Americans lack any health-care insurance. Many others are underinsured. It is said that 150 million Americans are only one serious illness away from financial disaster. More than 50 percent of personal bankruptcies are related to medical bills. Our system of health care is based on employer-supplied health-care benefits. In recent years, escalating costs have forced employers to discontinue health-care benefits or transfer more of the costs to employees. Increasingly, private citizens and politicians alike are calling for some system of providing basic health care for all.
If health care is to become available to all, there will necessarily be limits. Society will not be able to afford to do everything that can be done medically for all people. Choices will need to be made about who is eligible for the most expensive forms of health care. Everyone is likely to agree that a 55-year-old father or mother of growing children deserves this kind of expensive care. But will a 74-year-old retired person be eligible for coronary bypass surgery? What if he is 84? Or 94? What if he is 74 and has been in and out of prison? What if he is 64 and has clear evidence of early Alzheimer’s disease?
What about the tremendous cost of care for premature babies? The English health-care system is currently wrestling with the possibility of setting limits on when to provide the expensive care to premature newborns. They are considering setting a birth weight limit under which a child will not receive the intensive care necessary to sustain life. We may find this crass and unfeeling, but the huge expense of nursing these premature infants will go a long way toward providing quality care to all citizens, irrespective of the ability to pay. These are a small sampling of the difficult choices that need to be made.
Where will we look for guidelines that will inform these decisions?
As Anabaptist Christians, we look to the Bible for principles that may guide our decisions. We believe that as communities (whether congregational, local or national) we have responsibility to care for one another. Jesus’ words at the beginning and end of his ministry (Luke 4; Matthew 25), when considered with his holistic ministry (spiritual, physical, mental) throughout the Galilean countryside, suggest that “care for one another” was essential to his message. This approach is summed up in Jesus’ statement, “By this everyone will know that you are my disciples, if you love one another” (John 13:35).
The poor in our midst are the most vulnerable—the least—in our society. Jesus said, “Whatever you did for the least of these … you did for me.” As an Anabaptist Christian, what do these words of Jesus mean as related to health care? I believe I must do the following:
• assume responsibility to make healthy life-style choices, seeking ways to reduce the risk of accidents and disease and to reduce the cost of my own health care;
• support environmental changes that promote healthy communities and the need for clean air, clean water, nutritious food or places to exercise;
• support local initiatives that address the needs of those who lack access to quality health care, particularly the uninsured;
• actively promote equity in health care so that what is available to me is available to all—rich and poor alike—where risks and costs will be the responsibility of all.
It is still a source of wonder to me that a surgeon can split open my chest, stop my heart for several hours and put me back together again. Modern medicine has wrought wonders, prolonging life and bringing comfort not available when I started medical practice many years ago. I am grateful for Medicare, which took away any hassles over finances in considering what should be done. I yearn for the day when all Americans will have the same privileges.
Glen E. Miller is the program manager of Mennonite Church USA Healthcare Access. He had open heart surgery on Nov. 2, 2006.
