Why does the United States spend so much on health care for such poor quality?
The World Health Organization broadly defines health as a “state of complete physical, mental and social well-being.” It is not simply marked by the absence of suffering from injuries or illness but is a state of optimal human functioning and flourishing. As such, health is an indispensable foundation for truly wholesome and fully functional personal, family and social life. It holds the key to the progress of individuals, families, nations, societies and humanity at large.
A society advances when its members enjoy good health and overall well-being. By contrast, a society whose members lack health—as broadly defined—is prone to collapse and destined to fail. Where there is health, there is life; there is work; there is housing; there is education; there are working institutions. There is social progress. The absence of health, on the other hand, causes suffering, death and, ultimately, social ruin.
Optimal health care, then, is of the utmost importance for the strength of our social fabric. Accordingly, creating the most efficient and effective health care system should be a top priority for every government.
Obviously, there are great discrepancies in this regard around the world. In some dire cases, the fundamental right of human beings to have access to good health care has become the privilege of a favored few. That is what happens when the pursuit of profit outweighs respect for fundamental human rights; that is when access to health—as well as education and other social benefits—depends way too much on an individual’s economic means. In such cases, adequate health care becomes out of reach for the great majority of poor citizens.
In a world and culture where having trumps being, health care—like other social benefits—is treated like a commercial commodity that is managed and distributed by both government and the business realm according to economic criteria. Access to medical therapies and medicine, to hospitals and all their specialized services—as well as access to medical schools—is determined according to the free-market dynamics of supply and demand; a vital societal good has become prey to a game of buying and selling.
This essentially closed system allows only a small elite to flourish, while the majority of people in so many places around the world suffer the denial of their right to adequate health care and basic social protections. Their quality of life suffers severely as a result of being shut out from so many benefits of society and culture, including adequate employment, proper housing, quality education and opportunities for social advancement.
The bottom line, regrettably, is that one has to have money in order to enjoy quality health care.
Today, no one would deny that the medical and pharmaceutical industries are managed like enormous trading centers in ways that serve the interests of national and multinational economic monopolies. That is how the cost of health care is determined, along with the means to gain access to it. The bottom line, regrettably, is that one has to have money in order to enjoy quality health care.
A prevailing social system built on an economic and social structure that impoverishes the vast majority of people is incompatible with the importance of creating and sustaining healthy and flourishing societies of individuals whose leaders support the common good—the progress and welfare of all citizens. It is, therefore, imperative that both government and the business sector—on both the national and international level—take responsibility for ensuring the best possible care for all, especially the poor and the marginalized.
In theory, medical science should serve human beings, not the other way around. Science, learning, the pursuit of knowledge must have as their highest goal the well-being of all men, women and children. Instead, it appears that, more and more, people serve the world of science and technology as objects of study and experimentation—with the highest goal being innovation in treatment whose enormous cost put it out of reach for most people. That is a grave wrong. Medical science, rather than being in effect driven by a profit motive, must answer its highest calling: the promotion of the health and well-being of all humankind.
The United States spends billions of dollars annually on health care programs, be they public or private. However, this enormous outlay has not resulted in universal coverage; quite the opposite is true, with coverage being clearly limited and precarious at that. What is lacking, profoundly lacking, is a comprehensive vision of human health, as hinted at by WHO’s definition: an understanding that an assessment of an individual’s state of health must also take into account his or her spiritual and emotional well-being.
In addition, our country’s health care industry—again, both private and public—does a poor job at preventing illness. There is no consistent and well-thought-out strategy for providing people with effective preventive care. A substantive preventive strategy would work to strengthen the health and overall well-being of a person well before the potential onset of disease; such a strategy would take into account various dimensions that go into a person’s well-being, including psychological factors that may be linked to poverty, for example. Such a strategy would work on promoting the overall human flourishing of all members of society.
Just imagine the savings that such an upfront regime of intervention and prevention would produce. Imagine the many millions of dollars saved that would otherwise go into very costly treatment of serious disease, a grave condition that smart spending on prevention would keep from ever developing. Indeed, “an ounce of prevention is worth a pound of cure.” In such a system, rich and poor can thrive alike thanks to good health—and such a system makes both economic and human sense.
It starts with a horrible special preference AGAINST the poor. The poor who cannot afford high priced doctors who buy a new Mercedes every year, hospital bills packed full of extraneous charges to boost profits, insurance companies who negotiate medical payments, hospital who seldom discount any rates for the self or uninsured, pharmacology that uses the excess profit margins to supposedly fund drug research, and doctor training programs that are profit centered and designed to graduate specialists rather than general practitioners. Alternative and superior systems are readily visible in Canada, Europe, and even Cuba!
Mr. Paredes, do you know of one or more multidisciplinary teams at one or more Jesuit Universities doing comprehensive analysis to support establishment of a program or legislative proposal along the lines that you suggest? I think that any readers interested in this topic would welcome an article or even a series of articles on progress being made. Collectively, surely the Jesuit academic community has the human resources to work on a project like this. What is the potential for donor grants to support such a project? Congress could use the help. Maybe they could be shamed into giving it serious support.
We know how to provide better health care than we do, and other countries provide an array of models by which to pay for it. We lack the political will to make it happen. The Church has obstructed efforts to get universal coverage passed in legislation by its objections to contraception being included in government-supported healthcare. This obstructing makes little sense given that Catholic couples use contraception at the same rate as the general population.
The blind spot in the healthcare debate is the lack of understanding that healthcare is a new industry. The vast majority of effective interventions are less than 50 years old. People didn't need healthcare coverage in the days when the medical profession had few tools to prevent or treat diseases. In those days, people who had serious accidents or diseases simply died. Dying is inexpensive.
Prevention is cheaper than treating illnesses and high-tech is usually cheaper than low-tech. An example is polio vaccine. Preventing polio with a vaccine is far less expensive than putting people in an iron lung. Prevention also reduces the burden of human misery caused by disease. Healthcare should have gotten much less expensive over the past few decades, but it has been driven by profit rather than the common good.
Until we acknowledge our unwillingness to confront power in order to serve the common good, we will be part of the problem in burdening the poor and the vulnerable with a lack of healthcare. We know how to fix the problem, but we are not willing to.
Thinking about health care as part of the common good is in my opinion a logical perspective. As the author states, that framework recognizes :
“…the importance of creating and sustaining healthy and flourishing societies of individuals whose leaders support the common good—the progress and welfare of all citizens.”
I think of the common good as something that members of a community both make deposits in, and make withdrawals from. So those who undergo the rigors of legal and medical and science education, financial and managerial education, and the gaining of political, ethical and judicial experience, draw from the deposits of knowledge and the educational infrastructure built up by those who have gone before. Their preparedness to serve based on the knowledge and ability thus gained is also deposited in the common good. The benefits thus available to members of the community from all of these deposits are allocable in some way to everyone in the community. The allocation and provision of the common good are acts of justice informed by prudence. I am referring to the moral virtues of Justice and Prudence. In the context of the issue at hand, what is allocated and provided is health care such as the author described.
But, as in every other problem of allocating the common good, what is actually paid to the member of the community to whom justice is owed is entirely dependent on the virtue of the community leaders. In this country we have the opportunity, should we be sensible enough to take advantage of it, to choose leaders fulfilling that requirement. In fact, one could argue that it is our moral obligation to do so. Do we have the virtue to do so?