[Dialogue] 10/22/09, Spong: Honesty and Dishonesty in the Health Care Debate

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Thursday October 22, 2009 


Honesty and Dishonesty in the Health Care Debate


The debate on reforming health care in the United States seems to be winding toward a final decision. This debate has revealed new depths of irrationality, dishonesty and anger in political discourse. I recognize that the reform of our health care system is threatening to many, but there is no rational person who believes it can continue as it is without bankrupting business and individuals alike. The fact is that we in the United States have the most expensive health care system in the developed world, and this despite the fact that some forty million of our citizens presently have no coverage. Ours is also not the best health care system in the world as so many defenders of the status quo continue to suggest without the slightest bit of documentation. The United States ranks 23rd among the nations of the world in infant mortality, 21st in life expectancy for men and 20th in life expectancy for women. How could anyone view these facts and still seriously make the claim for the superiority of our system? American health care is quite probably the "best health care system in the world" for something like the top 20% of our population, but beyond that it is less and less competitive with other nations and for the bottom 20% of our population it is an outrageous embarrassment.
The issues in this health care debate are not as clear as we wish, but a major reason for that is that it is in the vested interests of certain people to make sure that these issues stay unclear. Fear, scare tactics and even incredible misstatements of facts thrive in that kind of environment. Great numbers of people in our society have their mouths in the proverbial feeding trough of our current health care system, having dined well there for years. The lawyers are one such group. They resist tort reform because they make enormous money by suing doctors for malpractice and being awarded huge settlements by a jury of a victim's peers. Drug makers are also reaping huge profits, even though far too often they have to use some of those profits to pay for the dramatically, devastating painful deaths that have accompanied certain drugs. The makers of medical devices are another group frequently shown to be guilty of deliberately hiding defects that have been disastrous. Of course, all of us wind up paying the costs of these legal settlements in the ever-expanding cost of our insurance. Doctors today are not nearly as negative to things like the public option as they once were. In fact, one recent poll suggested that 70% of America's doctors favored the public option. I talked with a highly regarded doctor recently who favored, and thought we would eventually adopt, the single payer system. He cited the fact that doctors have worked with Medicare for years now and they know that the government interferes in patient health and in medical decisions far less than private insurance companies do. Doctors also know that Medicare, unlike the health care companies, will pay them promptly and fairly for the senior citizen section of their practice. Many doctors also resent the lack of freedom and the massive amount of paperwork that is primarily an insurance company effort to manage costs and thus to maximize profits. Paperwork connected with insurance forms has forced doctors to hire staff just to manage the pap er flow, which in turn raises medical fees. For these reasons doctors are not as negative to a national health service as they once were. 
If the truth were fully disclosed we would discover that the insurance companies are making huge profits. There is no other reason for them to be spending billions of dollars to lobby against any reform. All of the proposed bills in Congress are designed to cut the cost of medical care, and that means cutting the profits of the insurance companies. Spokespersons for this industry are the people primarily responsible for the loaded rhetoric that has been dumped into the debate. It comes straight out of unscrupulous public relations firms. Whenever one hears in this debate emotionally loaded words like "government takeover," "government death squads" (who, they suggest, will decide which elderly people will live and which will die), and "government bureaucrats" (who will stand "between you and your doctor"), all of us should know that this rhetoric is the result of paid lobbyists seeking to manipulate public opinion. What we have operating in the economy today is an insurance company takeover of American health care and they do not want to be challenged by what they call "a government takeover of American health care." The insurance companies are today the ones who decide what services will be covered. They thus are already making the decisions as to who will live and who will not. Their rhetoric simply projects what they are already doing onto their favorite bogeyman, "the government." At least a government program would be responsible to its constituency, the people of the United States, while the insurance companies must satisfy their constituency of profit-driven management and dividend-seeking stockholders. Few people recognize that 35% of the premiums people pay for health insurance goes to executive compensation, bonuses and dividends. There is enormous profit in health care. One wonders how moral it is for a few to profit from the illnesses of the many.
Another rather ingenious attack on health care reform heard recently in Congress by the perpetual naysayers is that the provision requiring everyone to carry insurance amounts to a "new tax" imposed on young Americans. Behind this charge is the fact that among those who have no health insurance is a significant number of young Americans who refuse to get it for two reasons: one, it is very expensive and two, they feel no need for it, given their youthful and robust health. To me this is one more manifestation of the selfish greed that so deeply affects this nation. I was responsible for an urban hospital in Jersey City for 24 years while I served as the bishop of Newark. It was not only our desire to serve the poor, but also a government mandate, that we had to treat any patient in need who appeared in our emergency room whether they were insured or not. Under this law we in turn billed the government for "uncompensated care." The government obviously passed on these costs to the taxpayers. So the fact is that all of us today are already paying for those who have no insurance, even though those in the young adult category are quite capable of paying for it. If all the young and healthy Americans were forced to come into the health care system at appropriate levels, we would discover that the cost of health care would go down for all. We require those who drive a car to have insurance. Is that a tax? I think not! It is an act of responsible citizenship. This fact also counters the fear, so often expressed in this debate, that this nation cannot cover the uninsured without adding hugely to the national deficit. It is amazing how opponents of health care can argue both sides of an issue whenever it serves their purpose, even if the two sides are radically contradictory. That is when you know that the real agenda is hidden.
The biggest scare tactic of all has been the suggestion that under a new plan the health care of the elderly would be rationed by setting up "death panels" to determine which senior citizens to euthanize. Here again behind this fearful and dishonest rhetoric there are some facts that need to be made clear. An enormous percentage of our health care dollars is expended in the last year of a person's life. Some of that is normal and to be expected, since death comes to most people after a sickness in old age. There is, however, a large elephant in the room in this debate that is never mentioned, which is the systemic over-treatment of the elderly. As Evan Thomas noted in a recent Newsweek article, researchers at Dartmouth have discovered and documented that the average cost of a Medicare patient in Miami is $16,351 while in Fargo, North Dakota, it is $5,738. This study also revealed that the average Medicare patient undergoing end-of-life treatment in Manhattan spends 21.9 days in the hospital while in Iowa, it is 6.1 days. There is no evidence to suggest that there is any difference in care or longevity related to the difference in cost. The primary difference was in the number of tests and procedures that doctors ordered. Medicine pays by the procedure. According to Mr. Thomas some studies estimate that Americans nearing death are over-treated by roughly 30%. Some of this I am certain is motivated by the fear of malpractice suits, some by the "fee for service" way we practice medicine and some by greed. In places like the Mayo Clinic, where doctors are paid a salary to care for patients, the costs go down and the effectiveness of care goes up.
Another important issue, which has been demonized in this political season, is the effort to encourage end-of-life conversations between doctor and patients. This has never been a prelude to euthanasia as the hysterical Senator Charles Grassley of Iowa has irresponsibly suggested. It is designed to give a patient a major role in managing his or her disease. Where this has been done effectively, patient costs have dropped 35% while the quality of life has been improved. People with this counseling tend to die at home in the care and arms of their loved ones, not in an antiseptic environment surrounded by strangers.
I applaud the ingenuity of our health care professionals, which has expanded both the length and the quality of life. I have had two diagnoses in my life that my grandfather would not have survived. There is a fine line, however, between expanding life and postponing death. I do not believe that life and existence are the same. Insurance should not pay for guilt, but for meaningful life. I want to wring every ounce of sweetness possible out of my length of days, but I also do not want to live one moment beyond the time when my life loses meaning and contact with those I love. I do not want anyone's religious values to be imposed on me. I do not ever want life to be defined as extended time. There is a difference and someday I hope unscrupulous politicians and those with clearly vested interests will understand that as I do.

– John Shelby Spong
 




Question and Answer 
With John Shelby Spong



MiddleAgedMama, via the Internet, writes: 

I was raised as a Roman Catholic, but I left the church long ago and have never found another that suited me. My partner remains a Catholic, and when we adopted our children I agreed to raise them in that religion. Now the older child is six years old and is signed up for religious instruction in preparation for her First Communion, and I find myself wondering how to respond to the learning and questions she will undoubtedly bring home from her classes. When they teach her about the literal virgin birth of Christ, or the resurrection, or prayer, or God, or just about anything I remember from my own instruction, what do I say (if anything)? I don't want to undermine her instructors, but I also want to plant the seeds of the concept that faith cannot be opposed to knowledge. She recently asked who "the first person" was, and I could not honestly answer "Adam," as her teacher would no doubt say. What do you say to your own grandchildren about religion? 

MiddleAgedMama, via the Internet, writes: 

I was raised as a Roman Catholic, but I left the church long ago and have never found another that suited me. My partner remains a Catholic, and when we adopted our children I agreed to raise them in that religion. Now the older child is six years old and is signed up for religious instruction in preparation for her First Communion, and I find myself wondering how to respond to the learning and questions she will undoubtedly bring home from her classes. When they teach her about the literal virgin birth of Christ, or the resurrection, or prayer, or God, or just about anything I remember from my own instruction, what do I say (if anything)? I don't want to undermine her instructors, but I also want to plant the seeds of the concept that faith cannot be opposed to knowledge. She recently asked who "the first person" was, and I could not honestly answer "Adam," as her teacher would no doubt say. What do you say to your own grandchildren about religion? 





Dear MiddleAgedMama,

Yours is a difficult position. You in effect withdrew from this decision when you agreed to raise your child in the Roman Catholic Church. There is a certain expectation in Roman Catholicism that "the truth" is to be communicated to each generation in a predictable, traditional way. If this church were to cease to do this, it would call all of its authority claims into question. That is not likely to happen any time soon. This is why the only alternatives that people who are raised in the Catholic Church have are to acquiesce or depart. Vast numbers of people today have chosen to depart. The Roman Catholic Church is held up in America today statistically only by the immigrant population. You need to be true to your partner, true to your commitment and true to your own integrity. That is not easy.
With my own children and grandchildren, I was committed to never telling them that something was true if I did not myself believe it. I did not want to be dishonest. I did not have the burden of having them taught things in the church that were not considered debatable, so I said: "I do not believe that" whenever they asked a direct question. In your case, I hope you will listen to your children and engage them in conversation about what they are learning. Ask them lots of questions that show different ways of viewing an issue. If you disagree with something they are being taught, say so without judgment by simply stating, "Well, I have a different understanding of that," or "No, I do not think that's the right answer." 
I think you can say that every ancient people had a myth about the first man and the first woman. The Adam and Eve story in the Bible was actually written in the 10th century BCE. Scientists today have identified human-like beings, but not yet really human beings as we understand them, from as early as 4.4 million years ago. The story of Adam can hardly be literally true given that time frame. Even if we make the emergence of self-consciousness part of the definition of human life, then human life is about 250,000 years old, still far too much time to suggest that a 3,000-year-old tribal story about the first human being is actual history. That, however, might be too much for a six-year-old child to embrace, so I would simply discuss the issues and use questions to destabilize certainty, but not to attack taught conclusions.
Your daughter will learn enough to raise questions herself someday. As she does, answer each one honestly, but try to avoid using authoritarian words. Say something like, "This is what my study has led me to believe and your study must lead you to your own conclusions."
In time if she studies religion in an academic setting, she will learn that the virgin birth tradition was a 9th decade addition to the Christian faith and not original to it at all, and that understanding the resurrection as the physical resuscitation of a deceased body was not the original understanding of the Easter experience, and in Christian academic circles it is widely rejected as the meaning of Easter today. When your child learns these things, she will also learn that you have always been caring and honest with her and she can share her questions and even her doubts with you in the same way that you shared your questions and doubts with her. The most important thing is that you be loving and supportive. Nonjudgmental honesty is a big part of that.
My best and good luck,

– John Shelby Spong








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