Why is health care reform so difficult?

February 27, 2010

~ by Rev. Linda Hanna Walling, Faithful Reform in Health Care

Yes, we were the first to talk about it! Well, maybe not THE first, but pretty close in recent history. In our desire to encourage values-based dialogue among people of faith, Faithful Reform in Health Care has offered insights into our century-long struggle over health care for all. Our Seeking Justice in Health Care Guide, workshops, PowerPoints, and adult study materials, have helped thousands of people understand why health care reform is so contentious.  Now, in the wake of the Health Care Summit, the columnists and pundits are answering the same question we addressed long ago: Why is health care reform so difficult?  Our answers are framed as five challenges, hoping that they are not a permanent indictment on our ability to move forward.

Challenge #1 – Moral Vision. The underlying challenge is the absence of a strongly articulated moral vision.  Do we want a health care future that includes everyone and works well for all of us — or not?  Without a clear answer to that question, reform efforts remain locked in conflict over competing views of who we are as a nation and where our responsibilities lie in caring for those who live here.

Over the years, we have accepted a collective moral responsibility for our most vulnerable populations — those with the lowest incomes, our elderly, our veterans, and our Native American and indigenous populations. The crisis facing us now is what to do about the 123 persons who die unnecessarily each day, and the millions more who risk that possibility, for lack of health insurance.

While most members of Congress would likely profess a commitment to health care for all, the lack of a national moral vision becomes evident as proposals are developed. Deliberations are informed by questions that focus on how much money is saved or what industry is protected, rather than on those who are left out as a result of the negotiations. Whether our goal is everybody in (or just some people) impacts how all other questions are answered and how challenges are overcome.

Challenge #2 – Access or Costs. Is our goal to improve access inspite of costs, or to restrain the growth of costs by reducing access and/or quality? Historically and currently, because these goals are often seen as contradictory, legislative efforts usually have polarized around one or the other. And because we don’t start with a commitment to include everyone, we argue over just how many/few more can be covered, and at what cost.  If money were no object, increasing access would be much less troublesome. But resources, though abundant, are finite, which means we have to practice faithful stewardship in using them. The difficulty lies in how to distribute these resources equitably and in how to determine who will bear the burden for controlling the costs.

In spite of the politics that might suggest otherwise, the truth is that successful reform will encompass both goals: improving access and containing costs while maintaining a high quality of care.  Neither goal can be fully achieved by itself; comprehensive reform will be impossible without a commitment to both.  All other industrialized democracies have found ways meet both goals, and so must the United States.

Challenge #3 – Marketplace or Government. The moral dilemma informs differing perspectives around the relative roles of competition and regulation.  Are human needs better served by markets, individual ownership, competition and profits, or by governments and laws that guarantee access and a fair distribution of costs and services?

Extreme ideologies in our country have failed to recognize that modern health care systems actually exist somewhere between unfettered free markets and complete government responsibility. A system that consumes one-seventh of our economy yet fails millions of us would benefit from both increased public accountability to protect the common good and improved private initiatives to encourage quality, innovation, and efficiency in covering 300 million people.  The most reasonable voices for reform understand the need for partnerships among all sectors to make this system work. The attempts by both sides to polarize the debate must be transformed into expectations that lawmakers will find solutions that demonstrate a creative mix of effective government regulation and fair market incentives.

Challenge #4 – Political Partisanship.
The three previous challenges and how legislators respond to them feed the political partisanship that paralyzes our efforts to achieve major reform. In spite of an initial goal to make health care reform bipartisan, the decline in cooperation between the two major political parties has limited their willingness to seek consensus for the common good.  In spite of broad and deep public support for reform, and in spite of numerous bipartisan agreements and compromises in the bills, legislators continue to fall into the usual and comfortable circles of partisanship. Party loyalty helps guarantee upward mobility, leadership and membership on key committees, funding for upcoming electoral bids, and campaign contributions from powerful stakeholders.

Ultimately, it will be dialogue around shared values, rather than debate over competing ideologies, that will lead to the possibility of transforming the public concience and creating the legislative priorities for successful and sustainable reform.

Challenge #5 – Economic Self-interest of Key Players. Almost everyone in the United States would benefit from health care reform. Some groups — low-middle income workers, persons with pre-existing medical conditions, the uninsured, racial and ethnic minorities, people living in under-served areas — stand to gain a lot. But a number of well-financed, tightly organized health care industries and trade associations fear what they could lose.  In spite of concessions to keep them engaged as supporters, in the end, they are now using their influence and affluence to derail reform.

As long as the discussion is dominated by those who fear the loss of their profits, the rest who have so much more to lose will continue to be crushed by the inequities and injustice of U.S. health care. Ultimately, strong public demands for change, coupled with substantial campaign finance reform, will be needed to promote the common good as a benefit to everyone’s self-interest and to prevent special interests from blocking progress.

Living into Our Health Care Future.
Good people with good hearts and moral grounding sit on both sides of the aisle in Congress, seemingly unable to recognize the value in one another’s perspectives. In spite of agreement that health care is a people, not partisan, issue, the ideologies embedded in a two-party system make differences appear to be insurmountable.

Faith communities, however, with members representing the full spectrum of political views, are uniquely positioned to create the opportunities for dialogue and collaboration. In fact, in these moments, it is our calling to help move the debate surrounding health care reform from what is politically prudent or economically feasible to dialogue which embraces compassion and justice and the common good.  It is our task to transform these challenges into opportunities for moving forward by identifying the shared values that bridge the partisan differences.

In doing such work, it is in hopeful expectation that we will touch the hearts and minds of the American people so that together we may envision a health care future that fully embraces health, wholeness, and human dignity.  It is in transforming our collective conscience on the issue of health care that we eventually will make comprehensive, compassionate and sustainable reform a reality.


After the Health Care Summit: A Question about Moral Commitment

February 25, 2010

~ by Rev. Linda Hanna Walling, Faithful Reform in Health Care

Finally… toward the end of the Summit… the heart of the issue was raised when President Obama noted that we as a society have to decide whether we think everyone should have needed health care — or not!  He continued by saying that if we don’t want to leave people out, then we have to figure out how to pay for it.  It is clear that voices of faith are needed more than ever!

People of faith have been saying throughout this debate that YES, EVERYONE should be included. AND we’ve been saying that we believe we are blessed with the abundant resources, wisdom, and talent to do it.  What we lack are the moral vision, and the political will to act on it.  Yes, it is clear that our voices of faith are needed more than ever!

We are called at all times to make people’s needs and the common good a priority for our life together. That the President even has to ask whether we really want to include everyone in our health care system suggests that we have not yet arrived at agreement on the priority of health care for all.  That ambivalence underlies every other part of the debate. In the absence of that commitment we argue about who should/should not be covered; how generous the benefits should be; who should pay for it, and who should be in charge.  And with every compromise and every amendment, we exclude more and more people. Yes, our voices are needed more than ever!

In these days, one of our important tasks is that of transformation — changing hearts and minds on behalf of the common good.  We can begin that process by recommitting to raising our voices — beginning with praying today and in the days to come for our country and our lawmakers. May our prayers call for renewed commitment to health, wholeness, and human dignity, and reflect a special concern for those who struggle the most.

We may begin this transformation with a commitment to prayer and with words adapted from a prayer offered by the Justice Coordinating Team of Sisters of Mercy of the Americas:  “Loving and gracious God, we remember that your plan for us is fullness of life, lived with love, mercy and justice. Be with us and our whole nation as we work together in reforming healthcare delivery and financing throughout our country. Help us design a system that will be fair for everyone. Let our work be rooted in respect for life and human dignity and in Your special concern for people who are economically poor. Enable each person to take responsibility for the gift of health You give us. Throughout the debate and deliberations, strengthen our gifts of insight, courage and respect for others’ views. Teach us prudence, patience, and gracious determination. Grant us the generosity needed to embrace the changes reform will bring. Amen.” (from Vision and Voice: Faithful Citizens and Health Care)

Visit the Faithful Reform in Health Care website for more prayers along the way.

And then… following your time of prayer… take action!  Let your lawmakers know that YES everyone should have needed health care!

Send a letter to the President and Congress today.

Faith letter delivered to President & Congress

February 25, 2010

~ by Rev. Linda Walling, Faithful Reform in Health Care

“A Call for Political Courage, Vision, Leadership, and Faith” — our current sign-on letter — is making its way through the halls of Congress and the White House with signatures from 4000 individuals and hundreds of organizations.

The letter focused on those who would suffer if meaningful reform is not passes, and concluded:  “This is your moment for political courage, vision, leadership, and faith.  We urge you to take heart and move meaningful health care reform forward.”

The release of this letter began Wednesday with a full-page ad in The Hill and hand-delivered print copies to many participants in the Health Care Summit.  All Members of Congress, plus key White House and Health and Human Services staff, have now received the letter via email.

View the letter with all of the signatures;view a copy of the print ad that appeared in The Hill;  view the online ad.

Now it’s your turn! We know for a fact that such letters are more likely to be read by Members of Congress if they come from the people they represent.  Please help ensure that this letter is read by your lawmakers by sending it today.

Send the letter now to the President and your Members of Congress!

Health care reform on the 2 yard line

February 1, 2010

~ by Rev. Linda Hanna Walling, Faithful Reform in Health Care

It’s really only the last five minutes of the game that count! While my husband and son dismiss me as a nut every time I say it, it’s true!  Of course, they love everything about what leads up to the final moments in any game — and I don’t. Yet, I have fond memories of their excitement (and mine) at the end of sporting events, knowing that the last at-bat, the last free throw, the last pass, or the last kick will determine the final outcome. It is certainly true for the New Orleans Saints, who are going to the Super Bowl following a sudden death field goal — in overtime, no less!

Given that this week will be dominated by football news and ads, is there any better imagery for health care reform at this moment than that of getting the ball over the goal line?  Apparently President Obama likes the idea, because he told his advisors on Friday that we are on the 2 yard line and we’re going to finish the job!

So what does that mean for us — people of faith who REALLY care about making meaningful reform happen?  After hanging around and listening to Washington insiders for 3 days at the Families USA Health Action conference last week, I think it means three things:

We have to keep cheering! We know what the home field advantage and a cheering crowd mean to a team. At this moment, legislators are working hard to resolve their differences. They need to hear that we want them to keep working. In spite of missteps, dropped passes, and hard tackles, there is enough good in the team and their efforts to cheer them to victory.  It will take all of us — the fans in the stands — to make sure that the players stay energized for the final minutes of the game.  Here are a few suggestions for your part:

  • Call President Obama, your Senators, and your Representative
  • Add your name to “A Call for Political Courage, Vision, Leadership, and Faith”
  • Join the Interfaith Virtual Vigil of Prayer, Hope, and Action
  • Send an email to President Obama, your Senators, and your Representative
  • Join this week’s Faithful Reform conference call on Wed at 2 pm EST to preview a new PowerPoint that focuses on where we are and what needs to be done.

We have to remain hopeful for what can be! Our faith histories have taught us what it means to wander in the wilderness and to live with hope for more promising days ahead. Our hope rests in a moral vision for our health care future — and in our belief that we as a country have been blessed with the wisdom, the talent, and the abundant resources to do this. This is one of our gifts to this process. Our messages and our actions must demonstrate our judgment that comprehensive health care reform is possible because our care for one another is ultimately greater than either political ideologies or the influence of powerful lobbyists.

We have to remain positive! On one of our conference calls, our friend Nick Unger reminded us that if any single piece of legislation fully achieves our vision, then our vision isn’t big enough. While we were working for a more perfect plan, we neglected to affirm the really strong provisions that will move us forward in the current legislation. We have failed to celebrate that even the weakest versions of the reform proposals move us toward a more inclusive, affordable, accessible, and accountable system of health care in the U.S.  We must remind ourselves that:

  • Nearly 3 out of the 4 of us currently without insurance will be in the system.
  • The numbers of community health centers will be generously expanded.
  • The prescription drug doughnut hole in Medicare will shrink, perhaps disappear.
  • None of us will be denied coverage because of pre-existing conditions.
  • None of us will be dropped from insurance because we get sick.
  • Insurers will be required to use a greater percentage of premium dollars on medical care, rather than on paperwork and perks.

We’re at the 2 yard line and we can make it over the goal line, even if it requires overtime.  Together we CAN win this one, but it will take ALL OF US to make it happen.

To our health care future!