READINGS [Following Hymn #395: Sing and Rejoice]
"Let all things living now sing and rejoice" while they can-because
living bodies are complex organisms that break down in complex ways in our
complex, dangerous environment. It is a fact of life that no one is immune
to the potential of declining health, let alone injury, and thus, a huge
healing industry has grown to address those moments when any of us might
need medical attention.
How a society organizes its resources toward healing its members says
a lot-about what and who matters, about power, about justice. Today, I will
examine this provocative, timely and critical subject from those angles,
after having closely followed relevant media reports for the past few months.
There is no shortage of material to consider, certainly, and much of it
is rather distressing.
I suspect there are plenty of you also deeply involved in this issue,
perhaps by necessity, who can testify to the demands on us from this often
extremely complicated topic. But the bottom line is not very complicated.
It's getting steadily better for large corporations and steadily worse for
most people who aren't thoroughly insulated by wealth.
Now, lest you think I am falling prey to the fear-mongering doomsayers
who are just stirring up trouble, let's get a quick reality check from our
first reading this morning, adapted from Time Magazine and a new book by
Donald L. Barlett and James B. Steele, called Critical Condition: How
Health Care in America Became Big Business-and Bad Medicine. Their summary
descriptions are well-documented and irrefutable, if painful.
This is the picture of health care in the United States. We spend more
money than anyone else in the world-and yet have less to show for it than
other developed countries. That's one reason we don't live as long. We don't
adequately cover half the population. We encourage hospitals and doctors
to perform unnecessary medical procedures on people who don't need them,
while denying procedures to those who do.
We charge the poor far more for medical services than we do the rich.
We force senior citizens with modest incomes to board buses to Canada to
buy drugs they can't afford in (the U.S.).
We clog our emergency rooms with patients because they can't get in to
see their doctors. We spend more money treating disease than preventing
it. We are victims of rampant fraud and overbilling. We stand a good chance
of dying from a mistake if we are admitted to a hospital, and we kill more
people with prescription drugs than with street drugs like cocaine and heroin.
We have an endless choice of health-care plans, but most people have
few real choices. We are forced to hold bake sales, car washes and pancake
breakfasts to pay the medical bills of family members when a catastrophic
Americans tend to believe they have the best health care system in the
world, but in truth it is a second-rate system, destined to get a lot worse
and much more expensive.
This dubious and deteriorating health care system of ours is based largely
on calculated risk, the bread-and-butter of most insurance companies, which
seek to profit by insuring a large pool of people. They use actuarial tables-statistics-to
improve the odds that more of their clients will hopefully require less
attention, which then pays for those who do need attention.
Our second reading wonders if continuing to tweak this dominant method
of private health insurance is ultimately appropriate. It raises the possibility
of a tumultuous shift to more universal coverage by a single, national operation.
It is adapted from an essay by Stanford University health care system
expert, Dr. Victor Fuchs, found in the highly-regarded New England Journal
of Medicine of June, 2002, called, "What's Ahead for Health Insurance
in the United States?"
Finally, there is the question of values. Should health insurance be
organized on the same principles as automobile or homeowner's insurance?
When drivers with good safety records or homeowners who install smoke detectors
are charged less for their automobile or homeowner's insurance, most people
see the system as fair and conducive to socially desirable behavior.
But the actuarial model applied to health care conflicts with a sense
of justice and collective responsibility: it attacks a core element of what
it means to be a society. In the long run, the extreme actuarial approach
will probably be rejected by the people of the United States as an unsatisfactory
way of providing basic health care for all.
The timing of such change toward a national insurance model, however,
will depend largely on factors external to health care. Historically, major
changes in health policy are political acts undertaken for political purposes.
For instance, the political nature of such change was apparent when Otto
von Bismarck introduced national health insurance to the new German Empire
in the late 19th century. It was apparent when England adopted national
health insurance after World War II. And it will likewise be apparent here
in our time as well.
National health insurance will probably come to the United States after
a major shift in the political climate-the kind of change that often accompanies
a war, a depression, or large-scale civil unrest. Until then, the chief
effect of smaller innovations, such as new medical savings plans, will be
to make young and healthy workers better off at the expense of their older,
SERMON: The Promised Land of Health Care
I recently decided to take the plunge and send in my $12.50 a year to
join AARP-the American Association of Retired Partiers. I avoided it for
a few years after becoming eligible, but it was like fighting the Borg in
Star Trek: "Resistance is futile."
So now I'm part of a huge lobbying group for the increasingly huge sector
of our population that is aging more or less gracefully. Yessiree, day by
day we Baby Boomers are adding our demographic weight to the already significant
political power of the AARP. As we have throughout the life journey of our
collective bulge, we are a force to be reckoned with, especially
once we actually start retiring.
But what, to make of predictions like "young and healthy workers
(will be) better off at the expense of their older, sicker colleagues"?
This doesn't seem right, given the political influence a booming elder generation
should have. However, I've investigated the prediction and it holds up under
scrutiny, the key word being "workers." As more and more healthy
(read: younger) employees move out of comprehensive medical insurance and
into various "remedies" like Health Savings Accounts, which may
be to their advantage, it does shrink the pool that insurance companies
depend on to spread the risk.
And for those who have to remain in comprehensive plans, usually because
of ongoing medical concerns (read: older workers), the premiums will continue
to go way up and the coverage way down, severely compromising the older
worker's health security. But this allows the insurance companies to still
turn a profit, which is, after all, their business. The cost of medical
care and pharmaceuticals is skyrocketing, along with malpractice insurance,
and of course these expenses get passed along to consumers.
It's called our health care "system" for good reason; everything's
connected. We may envision a grand American "Promised Land" of
effective, inclusive health care, but there are plenty of shortcomings to
go around, with fingers pointing every which way, and I shall add my share
this morning. But I do this from a religious commitment to community, near
Religion has, in various ways throughout history, provided a setting
where morals and values are held up and hopefully lived out. Religions all
teach how we should care for one another. Islam, for example, requires its
adherents to give to the poor and not gather up too much wealth for themselves.
Christianity reminds its believers to love their neighbors as themselves.
These beliefs certainly should influence how people respond to those nearby
who are sick or injured.
In Unitarian Universalism, we affirm "justice, equity and compassion
in human relations" as one of our core principles. All three of these
values relate directly to the current crisis in American health care, and
those plus our first UU Principle, "the inherent worth and dignity
of every person," were cited when this congregation voted last June
to select Health Care as its social action focus for the year. It is indeed
time for people of faith to bring our hearts minds and spirits to bear and
find a better way to manage this interdependent system, a better way than
the status quo, a more just, equitable, and compassionate way.
As most preachers try to do, I'll first portray my sense of the issues,
which in this case are rather outrageous, literally, and then I'll close
on a hopefully hopeful note. I'm trying to include both specifics and big
picture angles that have helped me understand some of the forces at work
in our current dilemma. And if you don't consider it a social dilemma or
don't feel some outrage yourself, let me gently suggest that your may either
be numb or not paying attention, or both.
But then, some of the forces as work here have become quite adept at
distracting us, or hiding the true nature of changes so that the odds are
improved we won't notice. One critic of the American health care
system (Dr. David Himmelstein, professor at Harvard University
and a founder of Physicians for a National Health Program, quoted in Public
Citizen Health Letter, Oct., 2004, pg. 5) invoked a time-honored
and graphic image. If you put a frog in very hot water, it will jump right
out. But if you start out with cold water and gradually raise the heat,
the seduced creature will stay in it and get boiled alive.
Individual consumers might not notice the increasing heat these days
until they stumble into a health crisis and find out just how much coverage
they really have-or really don't have-from their insurance policies.
And the changes taking shape in recent years are clearly going to support
well off, healthier Americans and mercilessly boil our struggling, less
For instance, just this past week, a new study announced that "illness
and medical bills caused half (50.4 percent)
of all (1,458,000) personal bankruptcies in 2001." And most of those
people had health insurance at the start of the bankrupting illness. The
lead author of the study (the same Dr. David Himmelstein,
quoted immediately above) commented, barely exaggerating: "Unless
you're Bill Gates, you're just one serious illness away from bankruptcy.
Most of the medically bankrupt were average Americans who happened to get
sick." ("Illness and Injury as Contributors to
Bankruptcy," Himmelstein et al, Health Affairs Web Exclusive, February
2, 2005. Copies of the paper are available on-line at www.pnhp.org/bankruptcy,
with the password "uninsured.") And that was way back
in 2001. Take a wild guess which way the medical bankruptcy statistics have
headed since then.
As has generally been the case over the past four years, the business
world seems to get primary consideration in whatever changes are proposed.
The latest tweakings of our health care system, for instance, are certainly
going to help employers, who now can force employees to take on more and
more of the burden of health insurance, again seeking to maintain a healthy
In fact, there is reasonable concern that the job "benefit"
of health insurance will soon all but disappear. According to one Human
Resources executive (Neil Trautwein, National Association
of Manufacturers, quoted in Public Citizen Health Letter, Oct., 2004, pg.
3), "We see the wheels coming off employer-based health
We've come a long way from the halcyon days of medical insurance for
employees, which first emerged as a side-effect of wage and price controls
during World War II. Labor was scarce then, but businesses weren't allowed
to compete by raising salaries, so they increased benefits, such as paying
the cost of health insurance. (From a booklet by Ken Frisof,
MD, "Affordable Health Care for All: Turning a Dream into a Reality,"
published by the Democratic Socialists of America, 2004.) That
was seen as an acceptable cost of doing business in those days, as well
as adding value to society, encouraging healthier workers, who were then
more able to contribute productively to the "common-wealth."
We're in an entirely different ballgame today, when the barely disguised
effort of a business/government partnership is to dismantle many of those
kind of improvements for individuals in favor of corporate profits, which
then go clinkety-clink into re-election coffers. This feeds a disastrously
insatiable cycle-disastrous for everyone except those who profit from it,
of course. For instance, thanks to the recent shift in political climate,
the profit margin for all Health Maintenance Organizations, which was zero
in 1999, has grown by leaps and bounds in each of the past four years. (Source: Weiss Ratings, Inc., as reported in the Frisof booklet
Meanwhile, you may have heard that the number of uninsured Americans
has also grown by leaps and bounds each of the past four years, what a coincidence!
It now stands at 45 million-including almost 2 million veterans, which seems
like it should be a crime! The percentage of children included in this swelling
figure is also scandalous.
The astonishing number of uninsured people in the US is probably the
biggest reason we have "a second-rate system, destined to get a lot
worse and much more expensive." It is why we are ranked 37th in health
care efficiency, according to the World Health Organization. We do indeed
top the world chart in health care spending, both per capita and in percentage
of Gross Domestic Product, but we are no better than 10th in both Infant
Mortality Rates and Healthy Life Expectancy. (All figures
from WHO, The World Health Report, 2004 - Changing History, as reported
in Frisof booklet above.)
Another reason we are so regressive about health in these United States
is our collective attitude and philosophy about medical care, which we treat
as a commodity, much like car insurance and homeowners insurance. And our
system is designed to use market forces to regulate it. You know, good old
But in a true market, if you can't afford something, you don't get it.
Can't afford car insurance or homeowners insurance? Well, you figure out
how to get by without a car or your own home. But this is not true with
health care. Most of those 45 million uninsured people do, eventually, get
their medical needs addressed-usually through very expensive Emergency Rooms,
and often so much later than they should that treatment is also more demanding
And the only way for "The Market" to accommodate that extreme
expense is by socking it to those who are paying. Hospitals and health
plans pass those costs on to consumers because, after all, this is just
a commodity and corporations have to make their profit, so someone has to
The attitude in many other cultures is decidedly different. The three
dozen countries that rank ahead of us in health care system efficiency,
for instance, all have one thing in common: they make sure every citizen
has access to comprehensive care (Frisof, pg. 5).
They may or may not imagine it as a "Promised Land" of health
care, and they accomplish it in many different ways, but their national
commitments are to provide care for all. Compare that with the US, where
medical insurance is a market-driven commodity providing huge profits to
a few while 45 million have to go to the Emergency Room for any care at
This market mentality feeds a three-headed beast that is undermining
our health care system: high prices, wasteful practices and fragmentation
of care, which all persist for one main reason: vested interests influence
any attempts to significantly change the status quo. This has long been
the case, I suppose, but lately we are seeing the even more profound effect
of large-scale government collaboration with those vested interests.
It is not a reach to suggest that there is a "radical reordering"
of our entire federal culture underway under our noses. The title of a recent
Washington Post (1/31/05) op-ed piece by commentator William Raspberry says
it all: "Cutting Out the Poor." Because of a huge fiscal crisis-created
largely by "an unnecessary tax break abetted by an optional war"-our
government is making immoral budget choices that will eviscerate programs
for people who struggle to get by in the lower third of our economy. Is
it a coincidence that these voters have little, if any lobbying presence?
And so it goes in 21st century America: the influential rich get richer
and the voiceless poor get poorer. The insulation between these classes
is so thick that our leaders can't even hear the clanking echo of their
euphemisms. We didn't swallow "privatization" very well, so now
it's "personalization" of social security and health insurance
that is supposedly so good for us. This basically means, "You're on
your own, folks. Figure it all out for yourselves and enjoy the market ride."
So much for justice, equity and compassion.
But (and here's where I finally shift into what hope I can find), there
are other, increasingly loud voices clamoring for a major redesign
of our health care system (versus just another round of tinkering). And
unless one has a vested interest in the status quo, it's not hard to see
why. The American health care machine, assembled in a mish-mash of pieces
over the past century, is clunky and unmanageable, and for more and more
of us it just doesn't fly. Tweaking it is making things worse, not to mention
more inequitable. We need an overhaul.
Even though there are problems with Medicare, especially with drug costs
soaring and a suddenly tenuous connection to Social Security, it is the
closest thing we have toward a "Promised Land" of health care.
At least some people still have a safety net left under them. So a few renegade
politicians are touting it as a model for a national health insurance system
that would cover all the people. And Capitol Hill yawns.
But a growing chorus of other voices are also clamoring for this kind
of a large move. Groups like Physicians for a National Health Program
are quite vocal, with significant credibility. In our state, there's
the Maryland Citizens Health Initiative (www.healthcareforall.com)
and a local, two-county group called Coalition for Universal Health Care
(CUHC, Bob Rochlin, chair, email@example.com).
Virginia Richardson, a leader from the Health Care Task Force of River Road
Unitarian Church in Bethesda, is here today and will join the discussion
There are lots of proposals worth considering, but nothing makes more
sense than looking seriously at a national health plan that's already working,
even if only for those over age 65. Perhaps the most dramatic comparison
between government-run Medicare and private insurance plans is in administrative
costs, which are estimated at 2% for Medicare, and 10-15% for managed care
plans (Wash. Post Health Section, 10/26/04: "Medicare's
a Solution, Not The Problem" by Abigail Trafford). What
are we who are not yet 65 getting for five times the administrative expense?
And for more and more of us, getting squeezed is forcing our dander up,
which is probably what it will take to have any effect on this entrenched
system. Unfortunately, the way things happen in our world is that only when
there's enough pain, spread around into enough lives, is there incentive
enough to force change. The powers-that-be clearly aren't feeling enough
pain; they're effectively insulated from the effects of their policies,
so they're just tinkering, carefully turning up the heat in small increments,
hoping the people don't notice their lack of leadership. I predict things
will continue to get worse until, as our reading earlier suggested, "large-scale
civil unrest" or some other kind of societal trauma boils over.
If you think about it, those who decide health care policy in our land
are probably well off enough that they can afford whatever kind of health
insurance they want. To my mind, it's not unlike the way old people sit
far from the action pushing buttons that send young people off to die in
war. As long as politicians stay disconnected from the real stories of real
people caught in the machinery they've set in motion, they're not likely
to advocate for change.
So I'm encouraged by productions like the short video the River Road
Health Care Task Force put together, called "Faces of Maryland's Health
Care Crisis." Also, the UUA Washington Office's Health Care Campaign
(contact Amelia Rose at firstname.lastname@example.org or 202- 296-4672
x21) is working with Families USA (http://www.familiesusa.org)
to collect vivid stories of vulnerable households in America, in an effort
to humanize the related crisis in Medicaid funding. Showing the all-too-human
impact of their action or inaction is one way to impact those hardened politicians,
who mouth platitudes and then distance themselves from change for the common
Almost 150 years ago (1857), Frederick Douglass provided an insight that
remains stunningly true: "Power concedes nothing without a demand;
it never has and it never will." These days it seems that as there's
less accessible health care for more and more people, there's also less
accessible politicians with more and more excuses for resisting opportunities
to do the right thing.
Some kind of national health plan is the right thing, affirming the inherent
worth and dignity of every person, in whatever degree of health. The UUA
General Assembly voted a resolution to that effect in 1998 (see
addendum). Universal coverage will require an organizational
revolution, to be sure, but without it, many Americans are very likely to
get slowly but steadily boiled. Such change faces an uphill battle, and
even when there's finally some agreement, the actual conversion will be
a huge job. But it is rapidly becoming clear that taking the risk to steer
the course of our collective future toward some kind of national health
care system is much preferable to the status quo, which is a dead end-indeed
"a second-rate system, destined to get a lot worse and much more expensive."
I want to believe that momentum is beginning to shift. There's already
enough pain to go around and we can certainly tell that the water's heating
up around us. I believe that we will create a "Promised Land"
of health care worthy of this great country's vision and resources. We can
have a more just health care system, with comprehensive coverage accessible
to all and costs spread fairly. But we're going to have to demand it of
our policy-makers, because they will have to go up against powerful vested
interests, which they're just not going to do without a strong mandate from
So I urge you to add your voice to this clamor, wherever you can. Don't
get mad at the embodiment of an unjust system, however, such as the workers
you encounter at clinics and hospitals. Get after their bosses and the policy-makers,
who must feel the pain, too. Tell them health care is a human right not
a commodity. Tell them that the Universal Declaration of Human Rights
articulates this in Article 25:
"Everyone has the right to a standard of living adequate
for the health and well-being of self and family, including food, clothing,
housing, necessary social services, and medical care."
Tell your stories and join the growing ranks of coalitions across the
country that will carry the day, I do believe. We want to be able to
tell the policy-makers, "Resistance is futile."
We do this because it is the moral thing to do, because our religious
values urge us toward the common good, because we know we can do better
as a civilized society. We know there is more love, more hope,
more peace, more joy somewhere, and we're going to keep on 'til we find
[Sing Hymn #95: There is More Love.]
UUA Resolution of Immediate Witness
WHEREAS millions of Americans are presently denied medical insurance
and, in effect, denied the right to basic health care because the United
States government, employers, and the insurance industry have been unable
to implement a national health insurance program; and
WHEREAS this has been brought home to our Association by the June
1998 action of the Blue Cross Blue Shield of Massachusetts, which has notified
the Unitarian Universalist Association that its group medical plans will
not be renewed on September 1, 1998, so that our Association, along with
several other religious groups in the United States, is being forced to
discontinue medical insurance for its clergy and staff because of costs;
and over 70 clergy, their families and/or partners, are in danger of not
being able to obtain replacement health insurance with affordable premiums,
if at all;
THEREFORE BE IT RESOLVED that the 1998 General Assembly of the
Unitarian Universalist Association:
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