Healthcare Access
“Affordable and accessible health care is an essential safeguard of human life and a fundamental human right. Any plan to reform the nation’s health care system must be rooted in values that respect human dignity, protect human life, and meet the unique needs of [people who are] poor. We support health care that is affordable and accessible to all.” U.S. Catholic Bishops, Faithful Citizenship: Civic Responsibility for a New Millennium
NETWORK believes, on the basis of Catholic Social Teaching, that access for all to affordable, quality healthcare is a fundamental social good – i.e., something that benefits all of us. The current state of healthcare in the United States constitutes social sin that must be eradicated through broad and deep engagement of the public conscience. We advocate for a healthcare system that is:
- Accessible to everyone in the U.S.
- Affordable, funded and administered in a simple, direct way
- Comprehensive, including preventative, primary, acute, long-term, and hospice care
- Quality, including care that is culturally appropriate.
As we continue to ground our actions in our faith values, NETWORK is working in the 111th Congress for:
- Comprehensive healthcare reform*
- Increased funding to states for their Medicaid programs
- Stronger children’s health program.
* Our work for healthcare reform is based on the following:
- Healthcare is a social good for our country and a right for every individual.
- Quality healthcare for everyone is needed in our country.
- We must have systemic cost controls for individuals, families, businesses and government.
- Everyone is responsible for making our health system work.
Recent Updates on Healthcare Reform:
Letter to Speaker Pelosi (1/19/10)
We are almost there! (1/11/10)
Compare House and Senate Healthcare Proposals (12/2/09)
House passes healthcare reform bill (11/7/09)
Current analysis of healthcare reform efforts (9/2/09)
Healthcare debate - Questions to Ask (7/28/09)
NETWORK's Connection issue on healthcare
List of healthcare resources
What is the specific issue/problem?
Even before the recent economic downturn, over 45 million Americans lacked health coverage. It is true that the number of uninsured declined in 2007 from the number of uninsured in 2006, but this was because increased enrollment in public programs like Medicare and Medicaid offset the decline in the portion of the population with employer-based coverage (Source: Center on Budget and Policy Priorities, http://www.cbpp.org/8-26-08pov.htm).
The national economic downturn created added pressure for healthcare reform. In economic hard times, employers are less and less able to provide health coverage as a benefit to employees. Therefore, government efforts to restore our economy should include healthcare reform that moves us to quality, affordable healthcare for all.
What is the dominant view on this issue, and how does NETWORK’s view compare?
Note: The analysis below applies to healthcare access in general. For more information about the current healthcare reform debate in Congress, click here.
There does not appear to be serious opposition to the idea of a more adequate, accessible healthcare system. The differences lie in the details:
Should healthcare coverage be based on employment? Or should a national system be created?
The dominant view is that the employment-based system, with most coverage available through employers, has worked since World War II and should be continued. NETWORK believes the large percentage of uninsured people demonstrates that the employer-based system does not work well enough. NETWORK advocates for a national solution. That doesn’t necessarily mean a single system run by the government, but it does mean a system that is accessible to everyone.
Should there be a role for “managed care”?
Managed care was invented because it was thought the then-current “blank check” system of health insurance was a big factor in fueling the incredible increases in healthcare costs. That is, whatever the doctor ordered, the insurance company paid for. Further, the track record for preventive care was not good under the old indemnity insurance model; there was no coverage for preventive care and no financial incentive to healthcare providers to keep people healthy. However, managed care developed a bad reputation because managed care companies were seen as limiting needed care in order to improve their own bottom line. NETWORK believes that we cannot afford to return to the “blank check” approach of the old indemnity insurance model. On the other hand, whatever managed care techniques are to be included in the new system should be geared to improving the quality and value* of care, not to improving executive compensation. (*Improving the value of care means more quality for less cost – or, to put it another way, paying for the least expensive way to solve the medical problem.)
Should the new system include coverage for drugs?
Interestingly, there has been some significant lobbying to NOT include coverage for drugs, this despite the increasingly important role that drugs play in healthcare. It has been reported that the lobbying has been coming from the drug companies themselves. Ordinarily, one would expect companies to lobby FOR getting additional money for their products; however, it has been argued—based in part on the history of Medicare’s strict rules on physician payment—that if government starts paying for drugs, government will start capping drug prices. The advantage of high drug prices, so the argument runs, is that high prices generate the money needed to find new drugs; the current process for finding new drugs is very expensive.
NETWORK believes that because drugs play a critical role in healthcare, the healthcare system should help make drugs available to those who need them. NETWORK further believes that the jury is still out on whether affordable drug prices would significantly reduce the opportunities to find new drugs. It is also possible that, if public monies were required to support drug research, the resulting decisions about what research to pursue might support the development of more necessary drugs, not more “sexy” drugs.
Other Questions of Interest
Why did healthcare coverage start to become more employment-based during World War II?
Because of wage freezes during the war, employers couldn’t compete by offering higher salaries so they competed for talented employees by offering health coverage. Before the war, the market for health coverage was dominated by the Blue Cross (hospital) and Blue Shield (physician) plans; these not-for-profit plans were “community rated” – that is, the price was set according to how expensive it was to provide care to all the members of the community. And, indeed, in some communities, the Blue Cross/Blue Shield plans covered nearly the entire community. However, when for-profit insurance companies started to compete for employer groups, they decided to “experience-rate” – that is, set their prices according to how expensive it was to provide care just to fulltime workers and their families. Generally speaking, fulltime workers and their families are less expensive; this group does not include the elderly, for example, who have more medical conditions and are more expensive to treat. So experience-rated plans were generally cheaper than community-rated plans.
As the commercial insurers started to pull more and more of the less “expensive” people out of the Blue Cross/Blue Shield community, it was becoming increasingly difficult for the Blue Cross/Blue Shield plans to survive. So they convinced Congress that the government should pay for people who are poor and elderly. That is why Medicaid (coverage for people who are poor) and Medicare (coverage for the elderly population) were both signed into law in 1965. Notice, too, that the basic structure of the Medicare program – Part A for hospital coverage and Part B for physician coverage, mirrors the structure of the Blue Cross (hospital) and Blue Shield (physician) plans it was replacing.
Does healthcare still fit an insurance model?
That’s a great question! The indemnity insurance model assumes that a small percentage of the population will have a disaster; you just don’t know who it will be. So if you assume that a disaster costs $100,000, but that only one person in 100,000 will have one, it’s worth everyone chipping $1.10 into the insurance pool (the extra 10 cents is to pay the costs of administering the insurance). If it turns out you’re not the one who has the disaster you haven’t lost much; if you do have the disaster, then there is enough money in the pool to pay for it.
This works and insurance companies can compete for customers within the larger community if you don’t know who is going to have the disaster. However, as more and more people live with chronic conditions such as diabetes or congestive heart failure, as correlations are made between some conditions and expense (persons with depression will, generally speaking, cost more), and as more correlations are made between healthcare costs and lifestyle (e.g. obesity and smoking), it becomes easier to identify the more “expensive” people. It is easier to reduce healthcare expenses by not admitting these people than it is to admit them and then try to control costs afterwards. In at least one area of the country, a person seeking individual coverage (coverage on their own and not through an employer) will not be insurable if he or she has both diabetes and high blood pressure.
This suggests that if coverage is to be affordable again, then everyone will have to be covered. To carve out the “expensive” people and put them in “high risk” plans, suggests that those plans will be very expensive – unaffordable – for any except the independently wealthy.
But note, too, another critical change. When chronic conditions and lifestyles are involved, what individual patients do or don’t do to manage their own conditions has a significant impact on cost. A person who is not staying on top of their asthma – and therefore has several emergency room visits a year – is going to be more “expensive” than a person who has his/her asthma under control. A diabetic who carefully manages his/her blood sugar and weight, and who has the recommended tests (like more frequent eye exams) will have fewer medical complications – will be less “expensive” – than the diabetic who is not being so careful. This suggests that in order to keep healthcare affordable in the future, it will be necessary to address these problems in an effective way.
Links to Current Legislation
January 11, 2010
We are close!
November 7, 2009
House passes healthcare reform.
July 28, 2009
Congress continues to work on healthcare. Here is some important information to help you sort out the issues.
April 2, 2009
Congress is currently working on the FY2010 federal budget. Click here for information about budget issues related to healthcare.
February 4, 2009
President Obama signed final SCHIP legislation within hours of its passage by the House. NETWORK applauds today's vote in the House, where the bill passed by 290 to 135, with 40 Republicans supporting the bill and two Democrats voting against it. On January 29, the bill had passed in the Senate by a vote of 66 to 32, with nine Republicans joining Democrats to support the bill. Healthcare coverage will now be extended to about 4 million previously uninsured children. For more information, see our SCHIP update.
Additional Information and Important Links:
Comparison of healthcare systems in different parts of the world
Catholic Health Association
View CHA's "I Can't Wait" video on YouTube at www.youtube.com/catholichealthassoc.
See CHA's photo collection at www.OurHealthCareValues.org.
Center for Healthcare Reform
Faithful Reform in Health Care
Families USA
The Henry J. Kaiser Family Foundation
