"You shall know the truth, and the truth shall make you odd." ~Flannery O'Connor

Tuesday, April 03, 2007

The spirituality of health-care financing

Today I was meditating on the line from the Prayer of St. Francis: "In dying we are born to eternal life." Like much else in Christianity, that is true spiritually and physically, the latter being a sign and instrument of the former. We must die to the old, corrupted self in order to be a new creation in Christ, destined to eternal and blissful communion with God; if we're moving in that direction when we die physically, that destiny is just what we achieve. But there's no guarantee: only those who have their priorities straight in life die a good death. In one of life's many ironies, the lesson applies to health-care politics too.

I had a conversation with my roommates today about the various proposals for health-care reform coming from candidates for the Presidency. Any such discussion must begin with an undeniable premise: no system of health care will provide every American with the level of care most want at a price most are willing to pay. It's a question of tradeoffs: how much subsidized care are we willing to forgo, collectively, in order to get the care we believe we can, collectively, afford? It matters not whether the subsidies come from "government"—i.e., tax revenues—or from subscribers to private health-insurance plans. The question remains the same, and the system we have now doesn't answer that question in a way that satisfies most people. Yet it remains as is because we can't agree, politically, on how to change it. Why is that?

One problem is that we cannot seem to decide whether health care is a right to be rendered unto all or a commodity that should be paid for on an as-needed basis by those who can afford it. Right now, it seems we agree that health care is a right for children, the elderly, and the disabled but a commodity for everybody else. Sounds reasonable; but given the costs involved, what that means in practice is that a great many able-bodied, working people cannot afford adequate health care. We're not happy with that either. But how to change it?

By every account I've read, a very substantial percentage of our health-care dollar is spent on people in their last few weeks of life. That is a very substantial drain on resources that could be devoted to care for people who, like me, are not at death's door but cannot afford health insurance at current and future premium levels. If we expect a health-care system that's equitable for all, the imbalance must be rectified. But there's no sign of that happening, because the beneficiaries of the imbalance are mostly elderly, and the elderly as a bloc are politically quite influential. But why do the elderly expect such measures?

In my observation, it's basically because dying patients (and/or their families) and physicians cannot accept the fact that death is not only inevitable but near. Everything possible must be thrown at the last enemy in order to postpone facing reality, salve consciences, and avoid lawsuits. Such an illusory view of life and death, though natural in a highly technological society, motivates an allocation of resources that is not only futile but also, given the needs of others, objectively unjust. But given current incentives and attitudes, we seem to be collectively trapped in it, like addicts. It's time for it to stop.

In order for the necessary shift in attitudes and allocation to occur, we need to accept the fact that death is part of life. People will only do that if they truly believe that there are things objectively more important for individuals and their loved ones than the earthly life of any particular individual. By divine revelation, Christians have the information necessary for embracing that belief. Yet too many ostensible Christians in this country are part of the problem, not of the solution. We must learn to view our physical as well as our spiritual dying as part of our life with and in God. If we do, the health-care problem will become politically soluble. This Triduum, let us come to realize that our choice to "put on the new man" in Christ has political implications too, from which all could benefit,.
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