Healthcare Justice for the Poor
by Scott Morris, MD
Today's Christian Doctor - Fall 2009
I work as a family practitioner at the Church Health Center, which I founded in Memphis, Tennessee in 1987 to provide quality, affordable healthcare to working uninsured people and their families. Recently, I saw a patient named Margaret, who had some good news and some bad news to share with me.
The good news was that she had just been promoted to manager of a sandwich shop. She had gotten a small raise, too, and health insurance coverage, which meant she would no longer need our services. Unfortunately, the increase in pay and added benefit had caused her to lose Medicaid coverage for her two sons.
When her 12-year-old, Joseph, complained of an earache, she decided to give him an antibiotic she had in her bathroom cabinet rather than take him to a physician. Joseph had an allergic reaction and began having respiratory distress. Margaret took him to the closest hospital, which then transferred him to the children’s hospital. He responded quickly to treatment, but Margaret is now facing two hospital bills she cannot afford to pay. In addition, her 10-year-old, Jason, is autistic. Because of the loss of Medicaid coverage, she can no longer afford the medicine that has kept him functioning at a fairly high level. When I first saw him, he had significantly decompensated.
How has the American healthcare system come to the point where a work promotion for a single mother leads to her inability to provide healthcare for one child and the treatment for autism for another? To my mind, advocating for healthcare reform that prevents this scenario is part of a Christian call for justice. During the coming months, there will be much opportunity for people to express their opinions about the direction healthcare reform in America should take. Relentlessly looking for a way to care for the “Josephs” and “Jasons” all around us, I hope, is a matter of justice on which all Christian healthcare providers can agree.
Justice in healthcare for Christians is not only about universal healthcare. The issues of justice go far deeper than affordable access. They include issues dealing with prevention, charity care, access to care for immigrants, dental care, repayment of our educational debt to the poor, as well as other matters including inequality in charges to the uninsured, addressed elsewhere in this issue of Today’s Christian Doctor. Each of these topics has a deep and wide reach that touches every Christian physician and healthcare provider at some point in time.
Preventive medicine, as reasonable as it seems, has been stymied because of our healthcare system’s reliance on technology. The demand for more technology to treat acute and existing disease absorbs the majority of the resources in our hospitals and in our research facilities – resources that could be working on preventing disease.
We are raising an entire generation of kids who go home from school, sit on the couch, play X–Box, and eat junk food. These obese children will be adults who have hypertension, diabetes, and trouble getting a job, a very expensive outcome on many levels – unless healthcare adjusts its sights and focuses more on teaching healthy lifestyles to them and their parents.
Were we willing to dedicate our resources to combating obesity, instead of focusing on developing pharmaceuticals to treat high cholesterol, erectile dysfunction, or the next generation of MRI, we would have a significantly healthier community in short order and for years to come. The church could be part of the solution, with our leadership. Yet in many cases, the least healthy meal we eat is at a church supper. How we care about and for God’s children, including bringing hope to the next generation, is an issue of justice.
Historically, Christian physicians have been very generous with their time and willingness to care for the poor. Yet, in 1965, with the advent of Medicare and Medicaid, all physicians began placing signs in their offices that read, “Payment is expected at the time of service.” Caring for the poor in one’s own community was replaced by taking overseas mission trips on a periodic basis. Local healthcare for the poor fell to community-based and government-funded safety net hospitals that usually were tied to medical education. Before 1965, one-third of every doctor’s practice was expected to be charity care – today, that percentage is usually less than five percent.
This shift in care has become increasingly problematic as safety net institutions have struggled financially in the last several years. As a result, both the quality of and access to healthcare for the poor has suffered. There are, however, examples of how Christian physicians have led the way to address these issues motivated entirely by a desire for justice.
In Memphis, uninsured patients with simple fractures, until recently, were initially treated in community emergency departments, then referred to the public teaching hospital for follow-up care. Because of recent financial cutbacks, the public teaching hospital is no longer able to provide the follow-up care. As a result, patients who cannot afford a private orthopedist are left to have bones heal without being set.
When the extent of the problem was realized (431 fractures from one hospital ED in a two-month period), the orthopedists themselves agreed to see all cases in their offices in follow-up based on the Emergency Department’s call schedule, without regard to the patient’s ability to pay. This is a simple solution based on the common practice before 1965, but one that would not have been implemented were it not for Christian physicians looking to act in a manner motivated by justice.
Healthcare Needs of Immigrants
Similar solutions must be sought for equally troubling problems, such as the poor healthcare received in America by the immigrant population. Regardless of a person’s immigration status, when someone is building our offices, caring for our children, cleaning our homes, and they or their children get sick, surely we have an obligation to care for them. Currently, this is not the case. The Latino population in America receives poor healthcare because they are afraid of being asked for their green card, and because they are often not fluent in English. Jesus’ call for hospitality to strangers surely implores us to improve the quality of care for those who work and live among us.
Certain areas of healthcare remain essentially not available to the poor. The most obvious of these is dentistry. There are very few dental practices that offer a quality service to people in low paying jobs. Yet, dentistry is extremely important to the poor. Most minimum wage jobs are working with the public, and if a person’s mouth is a mess, it can be hard to get a job or get a better job. The poor only see the dentist’s office as a place to go to have their teeth extracted. The long-term benefits of dentistry, including preventative treatment, are simply not available or realized. Dental care should not be a luxury. This is an issue of justice for all Christian dentists and healthcare professionals.
Our Educational Debt to the Poor
The cost of a medical education these days is a substantial sum for even upper-middle class students. The cost of a private school education can be staggering. The debt that is accrued over four years can take many years to pay off, especially if a young physician or dentist enters a relatively low paying primary care specialty. For this reason, it is easy to understand why many medical and dental school graduates are choosing not to enter primary care and why caring for the poor seems a luxury for a young doctor. What many doctors forget, however, is that every doctor in America acquires his or her medical or dental education because poor people provide their bodies for students and residents to learn from while they are in training. This gift from the poor is an educational debt that can never be repaid. Long after the medical school loan is paid off, the poor who continue to be with us deserve the benefit of the knowledge gained from those who gave of themselves to help you and me become doctors.
Many Christian physicians and dentists are very generous with their time when asked to take overseas medical mission trips or to care for an individual when someone who is a friend advocates on their behalf. But, justice and charity are not the same. The Bible does not call for charity to roll down like an ever flowing stream, but, rather, insists that justice is the duty of all who seek to follow God’s call. For many, healthcare has become nothing more than a business. I hope that for Christian physicians it continues to be a calling that is grounded in God’s justice.
ABOUT THE AUTHOR
Scott Morris, MD, is the founder and executive director of the Church Health Center, whose ministries provide healthcare for the working uninsured and promote healthy bodies and spirits for all. Dr. Morris is also the associate minister at St. John's United Methodist Church. For more information about the Church Health Center, call (901) 272-7170 or visit www.churchhealthcenter.org.