President Barack Obama appeared on national television recently to promote his plan for reforming the American health care system. He is involved in a high stakes contest against the massive American health insurance lobby and its political friends among Republicans, but also some so-called Blue Dog Democrats who are opposed to reform. Obama is not proposing a publicly-administered, single-payer system such as we have in Canada (which, it appears would be too much for Americans to accept) but rather a patchwork of private and public insurance that would assure coverage to everyone, including those 47 million American who lack it entirely. The provision of health care to citizens is an ethical as well as a political issue and one would expect that churches and religious organizations would have something to say about it.
The Catholic bishop conference in the U.S. has long favoured health care reform but is now focusing on its fears that the plan might provide money for therapeutic abortions, which are legal in the U.S. even if access is restricted in many states. The National Association of Evangelicals is focusing upon abortion as well, and the 16-million-member Southern Baptist Convention appears to be lining up with Obama opponents. Richard Land, president of the SBC’s Ethics & Religious Liberty Commission, said this: “They are going to take money from our pockets and force us to take part in health insurance programs that will subsidize and underwrite the baby-killing industry. ” The Episcopal Church is on record as supporting universal access to health care (and supports choice) but its priorities appear to be tilted more toward race relations and gender equality than health.
This debate occurs in a context where health care is exclusionary and increasingly expensive. Most Americans with health insurance receive it through their employers. Those whose employers do not offer it or who are unemployed must either buy costly insurance or pay medical bills out of pocket. The elderly and indigent receive coverage from the government and 47 million Americans have no coverage at all.
The U.S. spends more on health care than other industrialized nation. Total health spending in 2007 was $2.4 trillion, representing an expenditure of $7900 per person. In 2008, the annual premium for an employer health plan covering an individual worker averaged over $4,700. For a family of four that premium averaged nearly $12,700.
American health care spending in 2008 represented 17 per cent of the gross domestic product and it is rising by nearly 7 per cent a year, well above the rate of inflation. By comparison, health care spending accounted for 10.9 per cent of the GDP in Switzerland, 10.7 per cent in Germany, 9.7 per cent in Canada and 9.5 per cent in France, according to the Organization for Economic Cooperation and Development.
What do Americans get for that vast expenditure? The rich get a designer service while the poor may get little or no service, and as Michael Moore pointed out in his documentary Sicko even those who have an insurance plan are regularly excluded from benefits through shady dealing by their insurance companies. The National Coalition of Health Care concludes: “Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families. ”
It is that situation that Obama wants to tackle and he is investing his popularity to do so. If he cannot achieve health care reforms early in his presidency, the opportunity may be lost for another generation. An earlier attempt by the Clinton administration to reform the system was opposed by the powerful health lobby and it went down in flames.
With the U.S. spending almost twice per capita what Canada does on health care, it is interesting to say the least, that the American health lobby and Republican politicians are using Canada “socialistic” health care system as a bogeyman to instil fear into their own population. Canada’s system has its problems but on balance it is superior to that of the U.S. in providing a good quality of service to every one of its citizens, whether or not they have a fat wallet.
Churches have been involved in the Canadian debate from the beginning. Saskatchewan’s premier Tommy Douglas, a Baptist minister, promised in the 1960 election campaign to introduce public health care if his CCF was re-elected. He was opposed strenuously in that election by the Canadian medical establishment and the American Medical Association. Later, when the Saskatchewan government introduced the first public health insurance plan on the continent in 1962, it triggered a 23-day strike by doctors. The CCF government of the day faced a situation similar to the one that President Obama faces today — an attempt to introduce a basic health care reform in the face of powerful opposition. Obama’s of course, is a much larger theatre.
The Saskatchewan government won the battle in 1962 and the action then shifted to the national scene. Prime Minister John Diefenbaker appointed Supreme Court Justice Emmett Hall to lead a royal commission into health care. Hall weighed the evidence in a most judicial way and concluded that publicly insured health care was the way to go. He found that Canada’s existing patchwork of private health care insurance was highly inefficient and that it failed to cover 30 per cent of the population, something eerily reminiscent of the situation in the U.S. today.
Hall took the view in his report that a commitment to improved health services for the common good took precedence over the self-interest of individuals. Hall was a devout Catholic and to buttress his point made reference to a papal encyclical of Pope John XXIII. In 1966, the Liberal government of Lester Pearson accepted Hall’s recommendations and Canada introduced publicly financed health care modeled on what the CCF had done in Saskatchewan.
Fast forward to 2007, when the Canadian Council of Churches (CCC) released a book called A Health Care Covenant, which described the involvement by churches in Canada’s various debates about health care, including their appearance before the Hall Commission in the 1960s to support medicare. The churches also appeared before a recent royal commission in 2001-02 led by former Saskatchewan premier Roy Romanow. They asked him to reaffirm the public health care system and called for improvements to it, without the various, specific caveats demanded by religionists in the U.S.
One of the authors in the CCC book is Janet Sommerville. She writes that public health care not only makes good economic sense, but that the choice of systems is also a matter of what she calls applied ethics. “[The] principles guiding our health care system,” she says, “have an unmistakable affinity with the love of neighbour urged on us by Gods word in Scripture.”
Obama would be well served if he had more church spokespersons such as Sommerville on his side during the current health care debate.