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Nationalized Healthcare: Prescription or Problem

A Debate
Today's Christian Doctor - Fall 2009

Editor’s note: We asked two Christian physicians to share their divergent perspectives on nationalized healthcare. References for Dr. Emil’s answers are first in the endnote section, in Arabic numerals; Dr. Van Mol’s notes follow, in Roman numerals. Reader response is welcome.

TCD: What are the three biggest issues facing the United States’ healthcare system?

Dr. Emil:

  1. Medical ethics: An increasing number of physicians are yielding to the seduction of corporatized medicine and advocating for their financial status rather than for patients.1 They see healthcare as another commodity to be bought and sold on the free market, rather than an essential humanitarian service. In my opinion, this crisis of advocacy underlies and contributes to all other issues.
  2. Access to healthcare: Millions of Americans have no or little access to healthcare, unless an emergency ensues. Conservative estimates put the number of deaths due to lack of access at 18,000 people per year.2 The number of non-insured is estimated at 44 million by the US Census Bureau,3 and the number of underinsured is thought to be as high. These numbers are expected to rise significantly in a bad economy.
  3. Lack of choice: Millions of Americans with insurance are locked into their plans, unable to choose their physicians, find a medical home, or enjoy continuity of care. In a country that values freedoms, there is little freedom in healthcare services.

Dr. Van Mol:

  1. Healthcare cost: It is 17 percent of the American economy as the nation’s top employer,i,ii but the expense to the patient for services rendered can be ruinous.
  2. Insurance availability and price: Former Surgeon General Dr. C. E. Koop asserts it is down to the “insured, uninsured, and the uninsurable.”iii Insurance has mutated from risk pooling to a skimming up of the lowest risk.
  3. Financing existing government entitlements: No industrialized nation can meet existing entitlement promises. In two years Medicare will start covering the first wave of 78 million Baby Boomers. By 2020, Medicare and Social Security will require 25 percent of all tax dollars. By 2050, Medicare and Medicaid will demand all of the federal budget.iv

TCD: Millions of Americans are said to lack access to healthcare, which is often framed in the context of justice. If this is so, how can this injustice be best redressed?

Dr. Emil:

Medicare for all. In Medicare, the rich and poor elderly alike have similar access and similar services, and all socioeconomic groups within Medicare express similar rates of satisfaction. Do you know of any rich Medicare recipient who refuses to use Medicare in lieu of a private plan?! This can become the case for the entire US population if there is a universal, single-payer, tax-financed plan, with the ability to buy supplemental insurance for services not covered by the plan.4

Dr. Van Mol:

Even the liberal Kaiser Family Foundation corrects the number to under 14 million, not the often quoted 47 million, for involuntarily uninsured legal residents not qualifying for government programs and making below $50,000 yearly.v No US emergency department can decline services due to inability to pay, a fact well enough known to motivate tens of thousands of “healthcare tourists” yearly from Canada and Europe to obtain services their national health system refused or unacceptably delayed. The issue is not access to healthcare, but the manner of the interface. The Obama administration deems preservation of the employer-based system covering 177 million Americans a priority.vi How to provide for those without coverage requires a multifaceted approach.

TCD: How can we expect a system that is profit-driven to provide healthcare based on need, and not based on means?

Dr. Emil:

We can’t. The reason healthcare cannot be treated as a commodity is that the more healthcare you provide, the more you lose financially. That is why it is different from any other commodity where the more you sell, the more you profit. If we look at “healthcare services” rather than “health insurance” as the product, as we should, then it is obvious that profit-driven healthcare can never produce justice. Patching the present system is doomed to failure. A new system is needed.4

Dr. Van Mol:

Government means are precisely the constraining point for nationalized healthcare, thereby leading to rationing and over regionalizing. Columnist Mark Steyn calls it “universal lack of access, equality of non-care,” and further laments, “We believe it’s more moral to take poor government healthcare than to make arrangements for our own.”vii Winston Churchill conceded the inherent vice of capitalism to be the unequal sharing of blessings, while that of socialism was the equal sharing of miseries. The past sixty years of American medicine has been anything but exclusively profit-driven. Yet for all its shortcomings, our record is remarkable for innovation, positive results, providing a framework which integrates numerous non-profit delivery entities, and makes feasible continuous improvements. Try that with government-driven medicine’s heartless juggernaut.

TCD: It is often noted that America spends the most per capita out of any industrialized nation on healthcare, while leaving millions uninsured and achieving inferior public health outcomes. Does the evidence endorse continuation of our system?

Dr. Emil:

We spend more because a third of every dollar is spent on nothing that has to do with actual provision of services, but on fueling the enormous healthcare industry bureaucracy. Medicare has an overhead of 3-4 percent and is one of the most efficient insurance plans (ask any biller!). The private industry has overhead ranging from 15 percent to 35 percent, and that is why we are spending much more than other countries.5 Detractors of a universal single-payer system often claim that Canadians flood the US seeking healthcare services. This has been looked at statistically in at least two welldesigned American studies, and has been shown to be completely false propaganda.6,7 Meanwhile, these same detractors fail to recognize tens of thousands of Americans who travel overseas to seek essential healthcare services each year.8 Finally, despite our heavy expenditure, our public health outcomes, and even many of our tertiary outcomes such as for cancer treatment and transplantation are inferior to other industrialized countries.9,10 We have been told for sixty years, since Truman advanced a public plan, that the free market will solve the problem. It hasn’t and it won’t.

Dr. Van Mol:

Our primary statistical liability is integrity – we keep honest records for all to see and criticize. Case in point, infant mortality, which we document from birth on despite prematurity, not as most countries do.viii Our peri- and neonatal medicine is the world standard. Severely premature infants are most likely to survive here, resulting in further statistical corrosion, as such have more problems than term babies.ix,x The Economist noted Americans die about two years earlier than west Europeans,xi which is irrelevant, as people die from all manner of causes unrelated to medical care. Examine specific outcomes for specific disease states, like cardiovascular and cancer, and we are number one.xii,xiii The US is home to most of the planet’s best physicians, hospitals, and research facilities.xiv

TCD: Is there sufficient proof that a market-based approach has failed to provide comprehensive, effective, and socially just healthcare to the American people?

Dr. Emil:

Is there sufficient proof?! Half of all bankruptcies in America are due to healthcare bills.11 Three quarters of those bankrupt by illness had health insurance when they fell ill. America is the only industrialized nation with a large uninsured population. Even children have been sacrificed on the altar of corporate medicine. Any random issue of Pediatrics is likely to have an article on the ill effects of the non-system on pediatric health.12-14 There is more than sufficient proof.

Dr. Van Mol:

US medicine is not a study in the free market process. We have five levels of nationalized provision - Medicare, Medicaid, Public Health Service, US Military, and the Veterans Administration. Government already spends over 50 percent of American healthcare dollars.xv Even as it is, our care is attractive enough to generate “health tourists” from Europe and Canada. It is the most comprehensive and effective in existence when examined at the level of results for specific disease state. No ED can turn away a needy patient. Our system includes numerous non-profit organizations supporting the poor through charity hospitals (e.g., Shriner’s and St. Jude’s) and clinics, community health centers, Indian healthcare clinics, Christian rescue missions, and pregnancy centers.

TCD: Is the private health insurance industry not vastly more bureaucratic and inefficient than a government plan?

Dr. Emil:

Of course it is. The government does not authorize every medical act before it can be accomplished. The government pays the agreed on schedule and does not harass physicians by delaying payments for months, in the hope of saving a few dollars. The government does not play physicians against each other by forcing them to compete for lower rates, not higher quality.

Dr. Van Mol:

Yes, a government plan is more efficient. There is enormous economy in saying “no” or “later” to service inquiries. Saves a fortune. It has also been said that death is the ultimate economy in medicine, but I am no fan. More to the point, there is considerable need to streamline and standardize a good deal of the administrative interface between private insurance and patients, or for that matter insurance and providers.

TCD: Is nationalization the best solution to America’s healthcare situation?

Dr. Emil:

It is the best solution and it is about time!15

Dr. Van Mol:

No. Rationing and extreme regionalizing would be ruinous in the unique US environment as the world’s third largest and third most populous nation. Canada’s Fraser Institute calls American hospitals Canada’s safety valves.xvi The Canadian government spends over $1 billion for US treatment of their citizens.xvii A 2008 report on Canadian medicine found diminishing care, increasing waits for specialists, and slower fielding of approved drugs.xviii,xix Canadian women with high risk gestations often come to the US for care.xx A 2000 report on Britain’s National Health Service found its cardiovascular disease and cancer outcomes among Europe’s worst.xxi The NHS limits to eighteen weeks the wait for hospitalization,xxii and 750,000 Brits fill the waiting list.xxiii Even Sweden’s universal health system is languishing.xxiv We won’t do better with nationalization.

TCD: Would Jesus support the concept of healthcare as a commodity bought and sold according to means, or as a service provided and received according to need?

Dr. Emil:

Jesus was a Healer. He healed first, and asked questions later! He directed His disciples to heal the sick anywhere they enter in His name. The Jesus I know would be saddened with what America has done with its many blessings when it comes to healthcare, and with what many Christians have supported over the last few decades. WWJD with our healthcare system? I believe He would treat it the same way He treated those who were buying and selling outside the temple!

Dr. Van Mol:

The limitation of means applies to services as well as commodities. There are a great many legitimate and pressing medical needs to which nationalized systems just say no where our system does not. Jesus said those that are sick need a physician, not a smothering nanny state, and said such when healthcare was exclusively a commodity. Far from fearing profit, Jesus used it as a positive teaching tool (Mark 8:36, Matt. 25:14-30). Luke was called the beloved physician, not the faith-challenged money grubber. The question remains how we can best care for “the least of these.” We are clearly not batting a thousand in this regard, but many superior options and combinations exist over the mistake of nationalizing our healthcare.

TCD: How can biblical principles like justice and compassion guide a Christian doctor in deciding how to be involved?

Dr. Emil:

  1. Work on the local level to compensate for the many deficiencies in the system, e.g. volunteering, free clinics, agreeing to see struggling patients, etc. Christians pioneered medical ministry, but means testing was never part of our Christian tradition. Let us return to our roots!
  2. Work on the state and national levels to see healthcare become a fundamental human right, and end the travesty of corporate healthcare.

Dr. Van Mol:

Jesus did not dictate delivery systems by which we are to love our neighbor. Our ideas matter to God. The body of Christ is not paralyzed from the neck down. We are free to be creative, co-laboring with Abba Father in assisting the needy. Christians pioneered and globally distributed modern hospitals, orphanages, hospices, and a vast number of mercy ministries. CMDA provides a wide variety of missions options at home and abroad, and asks us to offer at least 4 percent of our practice load for the poor. The kingdom of God is that of right relationships. We can all pursue the Lord for direct guidance on how we each might bring our gifts and time to bear.

Dr. Emil Notes

1 Geyman, J. “The corrosion of medicine.” Common Courage Press. Monroe, Maine 2008.

2 “Insuring America’s Health. Institute of Medicine.” The National Academies Press. Washington DC 2004.

3 US Census Bureau Report 2002.

4 Emil, S. “A startling transformation.” Bulletin of the American College of Surgeons. 93: 43-44, 2008.

5 Woolhandler S, Campbell T, Himmelstein DU. “Costs of health care administration in the United States and Canada.” New England Journal of Medicine 349: 768-775, 2003.

6 Katz SJ, Verrilli D, Barer ML. “Canadians’ use of US medical services.” Health Affairs 17: 225-235, 1998.

7 Katz SJ, Cardiff K, Pascali M, et al. “Phantoms in the snow: Canadians’ use of health care services in the United States.” Health Affairs 21: 19-31, 2002.

8 Milstein A, Smith M. “America’s new refugees – seeking affordable surgery offshore.” New England Journal of Medicine 355: 1637-1640, 2006.

9 Health Outcomes Report of the Organization of Economic Cooperation and Development, 2002.

10 Report of the Commonwealth Fund International Working Group on Quality Indicators, 2006.

11 Himmelstein DU, Warren E, Thorne D, et al. “Illness and injury as contributors to bankruptcy.” Health Affairs W5: 63-73, 2005.

12 Satchell M, Pati S. “Insurance gaps among vulnerable children in the United States.” Pediatrics 116:1155-1161, 2005.

13 Olson LM, Tang S, Newacheck PW. “Children in the United States with discontinuous health insurance coverage.” New England Journal of Medicine 353: 382-391, 2005.

14 Kogan MD, Newacheck PW, Honberg L, et al. “Association between underinsurance and access to care among children with special health care needs in the United States.” Pediatrics 116: 1162-1169, 2005.

15 “Proposal of the physicians’ working group for single-payer national health insurance.” Journal of the American Medical Association 290: 798-805, 2003.

Dr. Van Mol Notes

i “A Health Reformer’s Scary Diagnosis,” George Will, Jewish World Review, Jan. 1, 2009. (http://www.jewishworldreview.com/cols/will010109.php3)

ii “Ruin Your Health With the Obama Stimulus Plan,” Betsy McCaughey, Bloomberg.com, Feb. 9, 2009. (http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs)

iii Koop, C. Everett Koop (NY: Random House, 1991), p. 302.

iv “A Prescription for American Health Care,” John C. Goodman, Imprimis, March 2009, Vol. 38, No. 3.

v “Health Care Life: ’47 million Uninsured Americans,’” Julia A. Seymour, Business and Media Institute, 7/18/2007. (http://www.businessandmedia.org/printer/2007/20070718153509.aspx)

vi “Consensus emerging on universal healthcare,” Noam N. Levey, Los Angeles Times, Dec. 1, 2008. (http://articles.latimes.com/2008/dec/01/nation/na-healthcare1)

vii “Government Health Care is for Sissies,” Mark Steyn, The Western Standard, Oct. 11, 2004.

viii http://www.esds.ac.uk/themes/health/case3.asp

ix www.tinyurl.com/ck9lz2.

x http://archive.newsmax.com/archives/articles/2005/3/9/184540.shtml

xi www.tinyurl.com/cujo8l.

xii “The Mythology of Health Care Reform,” Michael Tanner, CATO Institute, March 3, 2006. (www.tinyurl.com/ck9lz2).

xiii “Another Bogus Report Card for US Medical Care,” John Stossel, Human Events.com, 8/29/2007. (http://www.humanevents.com/article.php?id=22148).

xiv “The Mythology of Health Care Reform,” Michael Tanner, CATO Institute, March 3, 2006. (www.tinyurl.com/ck9lz2).

xv “Sweden’s Government Health Care,” Walter E. Williams, Townhall.com, March 04, 2009. (http://townhall.com/columnists/WalterEWilliams/2009/03/04/swedens_government_health_care)

xvi “Bypassing the Wait,” Michael Cannon, nationalreview.com, Sept. 10, 2004. (http://www.nationalreview.com/comment/cannon200409100700.asp).

xvii “Sweden’s Government Health Care,” Walter E. Williams, Townhall.com, March 04, 2009. (http://townhall.com/columnists/WalterEWilliams/2009/03/04/swedens_government_health_care)

xviii “What Canada Tells Us About Government Health Care,” Doug Wilson, Townhall.com, Feb. 25, 2008.(http://townhall.com/columnists/DougWilson/2008/02/25/what_canada_tells_us_about_government_health_care)

xix http://www.fraserinstitute.org/commerce.web/product_files/PayingMoreGettingLess2008.pdf.

xx http://www.komonews.com/news/10216201.html.

xxi http://www.civitas.org.uk/pdf/cw55.pdf.

xxii http://www.oxfordradcliffe.nhs.uk/forclinicians/18weeks/18weeks.aspx.

xxiii http://townhall.com/columnists/WalterEWilliams/2008/10/22/affordable_health_care.

xxiv http://www.jpands.org/vol13no1/larson.pdf.

xxv http://www.britannica.com/EBchecked/topic/272626/hospital

xxvi Alvin J. Schmidt, How Christianity Changed the World, (Grand Rapids: Zondervan, 2001), p. 132.

xxvii Kenneth R. Samples, Without a Doubt, (Grand Rapids: Baker Books, 2004), p. 219.


ABOUT THE AUTHORS

Sherif Emil, MD, CM, is an American academic pediatric surgeon who trained and practiced in Southern California for 15 years, following completion of his medical studies at McGill University in Montreal, Canada. He recently moved back to Canada to occupy the position of Director of Pediatric Surgery at the Montreal Children’s Hospital. He is a member of Physicians for a National Health Program, and an enthusiastic activist in support of single payer universal health insurance. His detailed views, particularly as they relate to his Christian faith, can be read on: www.thisIbelieve.org.

Andre Van Mol, MD, is a board certified family physician in private practice. He speaks and writes on bioethics and Christian apologetics, is experienced in short-term medical missions, and is a former US Naval officer. He and his wife, Evelyn, live in Redding, CA, with their two sons, guardianship daughter, and currently parent their sixth foster daughter. For more of Dr. Van Mol’s writing, see “Obama: change for good?” at http://www.cmf.org.uk/literature/content.asp?context=article&id=2220. His series “Bioethics and Christian World View” is available at http://www.ibethel.org/store/p2274/Bioethics/product_info.html.

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