A Time for Reform: How the Catholic tradition can shape the health care debate
According to the U.S. Census Bureau, nearly 46 million Americans were without health insurance in 2007. Families U.S.A., a health care advocacy group, has estimated that over the course of 2007-8, 54 percent of Americans under age 65 were without health insurance at some point. Unpaid medical bills are a primary reason people file for bankruptcy. At the same time, the cost of health care coverage continues to escalate, with the average cost exceeding $4,000 per year for a single person and $10,000 for a family. Health care expenditures now constitute 17 percent of the gross domestic product. These realities have contributed to a growing consensus that now is the time for us as a nation to address the related health care questions of cost, coverage and quality.
For several reasons, I am cautiously optimistic that substantive legislation will be passed and signed this year. First, health care reform is a clear priority of the new presidential administration, which, consciously avoiding some of the mistakes of the past, is working collaboratively with Congress. Second, congressional leadership in both houses seems committed to overcoming the turf wars that contributed to the demise of the Clinton health care proposals. Third, interest groups whose conflicts helped derail the last reform attempt have been involved in discussion with both the administration and Congress. Various coalitions of these groups have even tried to draft consensus statements to guide future deliberations. Notably, the president of the association that sponsored the infamous “Harry and Louise” ads in the 1990s pledged at a White House summit to be a constructive participant in the reform discussions. Finally, and unfortunately, the growth of joblessness during the current recession has exacerbated and highlighted the problem of lack of coverage.
Still, there are reasons for caution. First, we have been at this conversation for over 64 years; President Harry Truman called for “health security for all” in 1945. The momentum of history does not favor success. Second, when the 110th Congress began, there was near universal consensus that the State Children’s Health Insurance Program would be reauthorized and its coverage expanded. No one was against covering children. In fact, reauthorization did not happen in the 110th. Though it did occur in January, at the beginning of the new Congress, this failure shows how difficult it can be for our federal legislative process to translate aspirations into action. Third, the president is asking Congress to develop policies and programs that will provide coverage for all or nearly all Americans now and also to find a sustainable way of funding a reformed system. While theoretically this approach is preferable, many wonder whether the complexity of doing both will doom the entire effort; some question whether it would be better to take an incremental approach. Fourth, included under coverage, cost and quality are myriad distinct but interrelated issues that require attention and will not be easy to address effectively.
As an observer of political and legislative processes, I think cautious optimism is a reasonable perspective. But what if one changes the frame of analysis from the political to the ecclesial? Such a change radically alters my perspective; I turn from cautious optimism to deep concern. Why?
As a Catholic theologian, I was struck when President Obama recently began speaking of health care reform as a core element of an economic recovery program. While the president has spoken of expanding coverage in terms broader than containment of cost and a healthy economy, his use of an economic rationale for action is not surprising. Since the Reagan era, and most noticeably in the last administration, the public policy language of health care has shifted. Health care has come to be considered a commodity that should be subject to market forces. As an informed consumer, the patient should be entitled to the best product at the lowest cost. Competition will drive innovation and effective delivery. And the role of government is to be involved as little as possible, lest government impede market forces.
While that is a simplification of a complex series of social developments, it is fair to say that at the level of government and of some social theoreticians, the perspective has shifted significantly on the nature and role of health care in our society. That shift is increasingly is at odds with the Catholic social justice tradition.
In Catholic theology, access to health care is a fundamental social good, because health is essential to human flourishing and the preservation of human dignity; as such, health care is an aspect of the common good. Society and the state have a dual obligation to protect the right to health care and to provide the means necessary for its fulfillment.
Clearly this theological perspective is in tension with aspects of the current American ethos. Polling conducted several years ago by the Catholic Health Association of the United States indicated that Americans are uncomfortable speaking of health care as a “right.” Yet respondents did not consider it to be the same as any other “commodity.” For those polled, health care was “special.”
Building on that insight, I proposed in the Brennan Lecture at Georgetown University in April, 1999, that we consider health care an essential building block for a free society, much like the provision of public education or of police and fire protection, which are necessary for the well-being of society. The Catholic Health Association has outlined values and principles that can inform public discourse on the subject. Last year it published Our Vision for U.S. Health Care, which brings the richness of the Catholic tradition into dialogue with the American political and economic heritage.
While our Catholic social justice tradition has an internal coherency and the Catholic health care ministry in this country has a common voice, as a nation we do not have a similar consensus about the nature of health care and the terms of our social responsibility. Absent such consensus, we lack a framework for evaluating any forthcoming legislation. If our country were attacked, there would be overwhelming support for mounting a vigorous defense, even if that meant increasing the national debt, because we agree as a nation that collective security is essential to our well-being. We do not have a similar agreement about access to health care. Many argue that health care reform must be budget-neutral. But how do we know whether that is the best approach?
Resources Versus Rationing
Concern about the increasing share of the G.D.P. consumed by health care is understandable, but how does one determine what is too much? As a nation we seem incapable of having an honest discussion about what Cardinal Joseph Bernardin once spoke of as “the allocation of scarce resources.” Theologically and practically, there are limits to what government or society can or should do; it is a fiction to believe everyone can have access to everything they want or need with regard to health care. Attempts to address scarcity, however, are sidetracked by the way the conversation is framed, not in terms of the allocation of scarce resources but rather in terms of “the rationing” of health care. Because rationing is perceived as un-American, the public conversation ends at that point. But the scarcity of resources persists.
Without a national consensus, we make ad-hoc decisions with serious consequences. The uninsured are denied access to preventive health care, a primary physician or the full range of medical services and instead receive care in emergency rooms; Medicaid patients in one state have access to services not available in another state; providers who care for Medicare or Medicaid patients are not paid for the cost of providing services and so pass those costs on to patients who have insurance. We already ration health care; we just refuse to admit it.
While substantive, all these concerns do not preclude the possibility of good legislation being passed. But these concerns invite us as advocates for change to resist being trapped by the commonly used terminology of commodity and balanced budget. They also invite Catholics to become involved in the discussion of reform and to use the resources developed by the C.H.A. and others to raise the conversation to the level of principle: evaluating all that is proposed in light of social justice, with our first question being what any proposal will do to or for the poor and vulnerable.
The Question of Abortion
There is a second reason for deep concern: Will the issue of abortion block reform? While there were many reasons the Clinton health care proposal failed before it came to a vote, the issue of abortion was very much in play. Pro-choice advocates insisted that if there were to be universal coverage, abortion must be a covered benefit. From a public policy perspective, the U.S. bishops were strongly supportive of universal coverage, but they opposed expanding access to abortion by making it a covered benefit. The bishops also feared that as a condition of participation in the new delivery system, Catholic health care institutions would be required to provide abortions. Finally, the bishops were opposed to Catholic taxpayers supporting government funding of an immoral activity. There were many attempts to work through this impasse. I was present in the White House when a final effort was made. After it failed, the bishops were among those who raised objections to the Clinton legislation.
The current effort might avoid such pitfalls. That being said, it is a matter of fact that the current administration and a majority of the House of Representatives are solidly pro-choice. Will one or the other feel pressure (or commitment to principle) to use health care reform legislation to expand access to abortion? If they do, will they allow “conscience clause” protection for individuals and institutions morally opposed to abortion?
Though the president has demonstrated a commitment to common goals and an appreciation of the importance of religious discourse and values in advancing the well-being of society, it is not clear that his administration appreciates that for Catholics religion is not just a private matter. While our faith informs and guides our personal lives, it also guides us as faithful and responsible citizens. Opposition to abortion is like opposition to murder or slavery. Though at times there is disagreement among Catholics about the best way to advance this commitment in a pluralistic society, it would be a mistake for any policy maker to underestimate the Catholic commitment to the dignity of all human life.
Finally, the Catholic Church as a social institution— through its ministries of education, health care and social service—is an essential element of the public life of this nation. It is difficult to imagine that legislation could pass that would deny conscience protection to these ministries. But no one should doubt that if forced to make the choice, these institutions would leave the public square before they would abandon their commitment to life from conception to natural death.
The Preferred Route
How do we proceed? We should avoid the pitfall of some who seem to refuse to engage in reasoned dialogue. Our position is nuanced and complex. Many Catholics, including Catholics in public office, do not appreciate the threefold distinction: private practice, public voice and social institutional presence. We need to educate and inform our leaders about these and other Catholic principles. We must translate our faith commitments into language that can be understood in the public square. In a society increasingly influenced by 24-hour news cycles and shrill sound bites, we ought to provide a counterpoint of reasoned, respectful dialogue. A commitment to life does not replace the virtue of charity. The moment might come when moral outrage and prophetic witness are necessary. Until then, strength of conviction and participation in a political process that builds coalitions of support for the right cause are the preferred route. This requires that we reach out to others who share our perspective and that we work together as a church—laity, bishops and our Catholic ministries. Perceived internal divisions only diminish our effectiveness.
Cautious optimism and deep concern are reasons for us as a community of faith and as a nation to see these next months as a time of opportunity. The momentum of history is against us. But who says that history mustrepeat itself?
"Health care has come to be considered a commodity that should be subject to market forces." This is a fundamental error in the Republican message. We the people assume we are the consumers buying the commodity of health care. But that is completely backwards. We are the commodity. We offer our health liabilities for sale to the insurance companies. The insurance companies buy us in negative dollars - meaning we have to pay the insurance companies to take us.
So each of us stands on the auction block. The prospective buyers check our teeth, feel our muscels and look for signs of disease. Some of us stand as individuals. Other stand in lots, large or small, so that the weak can be sold off with the strong. And we, like the slaves in "Gone With the Wind," are afraid of the unknown and convinced that our masters will care for us and provide for us forever.
When discussing such a complex and difficult subject, let us at least begin with accurate numbers. It is not true that 46 million Americans are without health insurance. Approximately 15 million out of that number are not Americans, but illegal aliens.
Ms Scott urges that discussants begin with accurate numbers. I could not agree more. For a good source of accurate numbers, I suggest all read:
U.S. Census Bureau, Current Population Reports, P60-235, Income, Poverty, and Health Insurance Coverage in the United States: 2007, U.S. Government Printing Office, Washington, DC, 2008.
On page 7 - Table. Income and Earnings Summary Measures by Selected Characteristics: 2006 and 2007 reports an estimated 8,211 foreign born non citizens. There are no figures for what Ms Scott terms “illegal aliens.”
Also, please check out: http://blog.seattlepi.com/larrydonohue/archives/174347.asp.
Health care or health insurance ? - you can't insure against "mortality" - and under our governing documents, we only have a few rights - and these describes aspects of society which you can't take away, not those which you are compelled to give. Washington can put in place programs as previously suggested by Republicans which at least can be tried (MSA's, credits etc.) and which won't break the system. There is a virtual certainty that the program espoused in the HR Bill will break the system.
And please as Penny reminds - get your numbers correct - of the 46mm uninsured a very large percentage elect to not participate in a health plan, despite incomes which place them in the upper middle class - they are young and don't see the necessity. They pay out of pocket when necessary, probably don't smoke either! Further, a large number of the so-called uninsured are children eligible under SCHIP. Perhaps CST, in its true implementation would instruct parents how to fill out the forms.
As I have mentioned before, one can not but read the Dave Leonhardt interview of Obama in the New York Times to see that the man is in favor of euthanasia. The criteria is going to subscribe to a very simple calculus - divide the cost of treatment by some value looked up out of an actuarial table to determine societal efficacy. Perhaps Randy Cohen figured this out for the New York Times. It shouldn't take a Talmudic scholar or Jesuit to figure out that time has no meaning for God, and that an infinite denominator makes every life infinitely precious.
I appreciate the tone of Fr. Place's article. I would have liked him to provide more specifics to support his main ideas. The recent ugliness of the town halls and the misinformation has spurred me to research some of the talking points. One of which was that abortion would be paid for by tax dollars. For more information see this article from Media Matters: http://mediamattersaction.org/factcheck/200908100004.
Penny and Scott above point out the writer's numbers are incorrect in his first sentence. It is hard to get past that point and on to his other thoughts. Indeed the "uninsured" include numerous categories, including voluntarily uninsured, that bear analysis.
Further, in this debate it is remarkable that almost no one integrates the concept of personal responsibility into their presentation. We have dramatically longer life expectancies now than at any time in history. Our food supply is so phenomenally improved that we have a preponderance of fat people among our population. We take a variety of drugs, from caffeine thru over the counter to cocaine-yet no one in the health debate wants to place blame on the individual, or family, for his/her bad habits. Rather, the assumption is that we should all pay, giving no thought to encouragement and motivation of healthy behaviors.
Given the above fatal deficiencies in the debate, i.e. persistent bad data and failure to acknowledge responsibilities, it is morally wrong to make policy changes. Until these failures are corrected, sauve qui peut is the wisest course for us all.
I oppose the current House bill being debated. It exempts President Obama and the Congress from having to use the new system. If it isn't good enough for them it is not good enough for me. Second, although the aim is to reduce costs there is no provision for meaningfull tort reform. If President Obama is not serious enough to take on the fat cat lawyers that contribute to his campaign why should I take it seriously.
Third, President Obama is on record (I have heard the sound track) that he wants a single payer system like that in Canada and the U. K. That is fundamentally flawed. Down the raod when Congress is pressed to keep the deficit down, they will have to choose between health care and the favoite projects of their special interests and contributors. For example, health care or ordering more private jets for their use. You know who will win. Then health care has to be rationed and the elderly and the most vulnerable will lose.
I just learned that some of that is already underway. President Obama included the start of it in the huge stimulus bill that no one read. It created and funded a council to judge the effectiveness and cost of various medical proceedures. The president has already appointed the 15 members. One of those is Dr. Eziekiel Emmanuell, brother of his chief of staff. He is most notable for his comment that "the trouble with most doctors is that they are to loyal to their hippocratic oath."
Yes we need health care reform but we must go about it in a cautious and reasonable way including everyone in the discussion and formulation of the policy, not by ramming something through quickly before anyone knows what it is. Speaker Pelosi rails against the insurance companies as being behind the ooposition developing. She is dead wrong. What she doesn't understand is that many of us have a lot more confidence in our insurance companies than we do in her and the federal government.
Dr. Donahue seems to imply that there are no illegal aliens in the US, a claim that it is impossible to take seriously. Curiosity led me to go to his website, which interestingly enough yielded the following information:
"The number of the uninsured who aren't citizens is nearly 10 million on its own, invalidating all the claims of 40+ million "Americans" without health insurance. There are 8.3 million uninsured people who make between $50,000 and $74,999 per year and 8.74 million who make more than $75,000 a year. That's roughly 17 million people who ought to be able to "afford" health insurance because they make substantially more than the median household income of $46,326.
Subtracting non-citizens and those who can afford their own insurance but choose not to purchase it, about 20 million people are left – less than 7 percent of the population. The Kaiser Family Foundation, a liberal non-profit frequently quoted by the media, puts the number of uninsured Americans who do not qualify for current government programs and make less than $50,000 a year between 13.9 million and 8.2 million.
Kaiser's 8.2 million figure for the chronically uninsured only includes those uninsured for two years or more. It is also worth noting, that, 45 percent of uninsured people will be uninsured for less than four months according to the Congressional Budget Office."
I by no means contend that improvements to our system, or non-system, of health care are desirable. But again, let us start with reliable numbers.
By the way, one improvement that is never mentioned by Orszag, or Obama, or any Democrat, is reforming the abuses of malpractice litigation, which force doctors and hospitals to practice expensive defensive medicine, and serve mainly to enrich such worthies as John Edwards.
We have a GREAT health care system. In actuality, 95% of Americans are generally happy with their options, although many have opted not to pay for coverage in lieu of other things they prefer to do with their money. Importantly, I have excluded illegal aliens from the calculations for obvious reasons - they are here against the law and should not receive benefits available to citizens; coverage should be fought for in their own countries.
This doesn't seem complicated, yet the good Father and others are still eager to let government, an entity that turns to refuse everthing it touches - the black hole of productivity and prosperity here and elsewhere, ruin yet another thing that is generally working right. The first thing we need to do is have tort reform, then get government out of the way - eliminate medicare and start over with a private system.
Mr. Obama and his wife have had some very interesting and profitable relationships with
the University of Chicago Hospital system. Do they stand to profit now on the national stage? Two basic areas should be addressed now, tort reform and insurance industry regulation. Having a group of pagans forming and administering our health care is a very bad idea.
There are many improvements that could be made to American health care, and much disagreement as to what they are. To try to force through a thousand page bill with little opportunity for us to understand and discuss its provisions is indefensible, and incompatible with democracy. The arguments of Obama and his Congressional allies for the necessity of extreme haste are specious, unconvincing, and protean, and have severely damaged his credibility with independent thinkers.
This bill, which is longer than War and Peace and in places virtually incomprehensible, seems to include hundreds of pet projects and agenda that the framers favor. The transparency that Obama promised is scandalously absent.
The pity is that many improvements could be made without costing the taxpayer a penny. (This does not preclude other reforms which would require funding.) I recommend an excellent article by John Mackey, which can be read at http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html
I excerpt here the eight cost-free reforms he advocates:
1. Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs).
2. Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.
3. Repeal all state laws which prevent insurance companies from competing across state lines.
4. Repeal government mandates regarding what insurance companies must cover.
5. Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.
6. Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without
knowing how much they will cost us?
7. Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.
8. Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.
Sadly, I do not believe this Administration and Congress will do any of this.
I'm afraid Fr. Place addresses two aspects of concern in ways that will not promote universal coverage; also, his theoretical optimism regarding the role of government is issued in the face of a failed economy and a couple of failed wars and rising militarism such as Martin Luther King warned against. (the question of "illegals", reflecting a rising racism).
Wrongly, most people think that if someone is here illegally, then they ought not to enjoy to benefit from the system here so arguing that they have extensive rights falls on deaf ears. Secondly, the argument about buying health insurance on a salary of $50,000 forgets that catastrophic insurance would be much cheaper; but perhaps a better example would be the minimum wage worker of $7-$10/hour or $20,000/year. This is quite a common wage; not only that, but who can afford to get off of welfare which gives $12,000 in health care benefits to take a minimum wage job; therefore many people are stuck in welfare just to be able to have medical care. The very poor often this medical coverage they are stuck in.
Then, from personal experience, I worked 30 years in the medical system, including Catholic hospitals. Believe it or not, most of the time I did not have medical insurance! The hospitals did not care if I worked with very sick patients and had no coverage! How can this be? Well, at the level of say a nurse or chaplain, coverage never began until after 90 days on the job. Then, if you did "contract" work or worked for an agency, you were not covered; it was up to you to buy very expensive coverage and to go through all the paperwork to do it. Another thing - look at how many pensions Catholic and other hospitals have to pay to nurses. You won't find very many. Why? Because nurses were "burned out" on purpose and layed off periodically. I can say this - the only people who had good medical coverage from day one and pensions were the administrators! And, mostly they didn't get near a sick patient! Catholic or non- Catholic, same policies. I had a Jesuit friend who was actually killed, you might say, by the hospital. After they learned he had a rare very expensive to treat throat cancer, they switched his insurance policy -without asking him-to a policy that did not cover treatment for this cancer and he died untreated. He told me this himself.
I would still like an answer to my question about whether it is justified to block medical insurance coverage to more than 40 million people because of the abortion question of federal funding. Do you think that in the case where you were in the White House with the bishops during the Clinton attempt that you were justified to help deny coverage to mainly working people all these years over this issue? One can imagine the many dire effects that no medical coverage had on these family and individuals. On the other hand, nobody had to accept an abortion from the Federal Government.
Father Place asserts that illegal immigrants have the same rights as citizens to government-provided health care: "And, according to papal teaching, all 46 million have the same human rights, which include the right of access to health care."
Excuse me if I, along with many other Catholics, consider this "teaching" considerably less orthodox and binding than the Nicene Creed. In fact, we reject it.
Dear Ms. Scott,
Please forgive the judgment, but I'm puzzled by your comments. I believe you're confusing nationalism with Catholicism. With all due respect, why do you remain a disciple of the one who gave his life freely for all, the just and the unjust?
Fr. Place's pesentation offers reassuring affirmation that the Catholic Church has the answer and is well positioned to present a well structured, workable Health Care System grounded in liberty and justice for all. If only politicians who are expert in convincing people that something is true they themselves do not believe, would shut up and listen!
If ever our Church decided to take on the Government in the health care business showing how to do it, as it did in education, transforming health care from merely a "business" into a "ministry" as well, as mirrored by Jesus, Fr. Place would be my candidate to run it!
I agree with the hubris as expressed by some US politicians that the US has the best medical system in the world (as attested to by the slums of any major city). But, I would ask that the US stop raiding the graduates of our medical schools and our nurses, and stop crossing the border to deplete our medical services and pharmaceuticals.
In terms of test reform: if some hospital is going to charge you a hundred thousand to amputate your foot, and then cuts off the wrong leg, sue the buggers. Canada does not have a law-suit mentality.
Keep debating. Soober of later you'll see the wisdom of Canada's system, and the basic assumptions of the Gospel about the dignity of each person.
"Our food supply is so phenomenally improved that we have a preponderance of fat people among our population."
Sorry Chris, but the improvement in our food supply (which is a false assumption) is not the cause of obesity...it is the volume of the food and the opposite of what you say. If people ate in a healthy way, instead of cheaply, there would not be the terrible problem of obesity.
I was on the online conference with the clergypeople and the President earlier, and the story of the self-employed people struggling with and without health insurance made quite an impression. I heard an interview by Bill Moyers, where the link between employment and health insurance was thought to be one of the big problems in our system. It made me think.
Today attorneys get to shoot at the participants in the medical arena and see who they can kill. They enjoy the sport enormously and keep changing the rules so they can acquire more arrows. However, it pains me that moralizing advocates for a new 1000 page unreadable and unenforceable law haven't paid any attention to the barbarians in the stands shooting arrows at us. But wait . . . aren't the barbarians the very ones in the center of everything-in Washington?
Canada has a fairly good system, providing mediocre to excellent care to everyone, but it has enough problems that it cannot be our model. The flight of its nurses to the US indicates that there are serious problems there. The US does not go up and kidnap them.
Opening up health care to illegal immigrants, who have already bankrupted many US hospitals, caused emergency rooms to close, and raised costs for citizens, would be an open invitation for millions more to cross the border. A completely irresponsible idea.
But the above are peripheral questions. The American people deserve to know specifically what is in the various bills being produced, and to have an opportunity to react and petition their representatives. The attempt to rush something into law in the dead of night is shameful.
It has always surprised me that the name "Jesus" is seldom mentioned when talking about Catholic concerns and positions. Fr. Place's article is sorely lacking in connecting his article to Jesus' teachings and abdicates its opportunity to teach the teachings of Jesus.
Jesus did not organize the Jews to pressure Herod and Pilate to solve the financial woes of society. He practiced personal acts of charity and asks all to do the same, not to abdicate that personal responsibility to an unfeeling government. Mother Teresa did not rail against the Indian government but strived to be beside the hopelessly dying.
Look at the liberal Democrats today that call for compassion through government action. The data shows that for decades, the compassionate liberals have on the average contributed to charity less than half of what the heartless conservatives have. They parade their works in public. Are they whom Jesus has asked us to emulate?
Lastly, if we are to have a reasonable debate, why is your article so nuanced? I ended the article with no clear idea of what your position and beliefs are. We live with strong Christian beliefs. At times in our history, dialogue was not practical and in the end, we had in our communion of saints the martyrs that have stood steadfast by their faith when no compromise in our beliefs was possible. And please do not equate in weight universal health care with the problem of abortion. Jesus had some "shrill" words for the Pharisees of his time.
Lena, we are all thinking. Can you tell me what Obama's health care plan is? I sure don't know. He has never given a coherent presentation in understandable English. And perhaps he can't, since something unknown is going to emerge from the hands of Reid and Pelosi and their minions. I'd rather trust Squeaky Fromme than that crowd.
What a sad spectacle! A blundering President expecting us to take it on faith that he knows best and is looking out for us, an overwhelmingly Democratic Congress filling thousand page bills with no one knows what, angry citizens demanding answers and being maligned as rednecks and no-nothings by their elitist representatives.
If anything good comes out of this it will be a miracle. Let us pray!
Whatever one's opinions on the virtues and faults of the current US heatlh care delivery system, most people would agree, I think, that many people fall through the cracks and are able to receive health care only through emergency facilities and at much higher costs than those who have insurance are obliged to pay. The issue at issue seems to be whether or not this situation needs to be remedied and, if it does, how that should be done.
I suspect that much of the congressional resistance to comprehensive health-care-financing reform is due to a sense on the part of the politicians who control the law-writing and money-dispensing mechanisms that a substantial number of their constituents feel that the present system is basically not in need of reform.
At the same time, a consensus seems to be building - although it's been building for more than sixty years - that something needs to be done to cover the currently uninsured and to provide ways to ensure that the current large numbers of uninsurable people will not grow again in the future. Perhaps, alas, universal health-care coverage remains an issue whose time has not yet come.
"As a Canadian I find the US debate on health care fascinating; In Canada education and health care are basic rights of citizenship as in all industrialized nations except the US. In the US it is seen as a salable commodity."
Very good point. Something needs to be done.
"But, I would ask that the US stop raiding the graduates of our medical schools and our nurses.," Bad point. A certain number are apparently leaving voluntarily for a variety of reasons. This points to an internal issues with in the Canadian system. Blaming the U.S. is not a solution.
Internal modifications should be made. Make medical students sign a legally binding service contract if they receive a tax payer supported education. U.S. and Canada have extradition treaties. Also, allow more of a profit system (to a degree) to encourage those already trained to stay.