Correcting Injustices in Health Care

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Introduction

We all recognize the need for adequate health care for ourselves and our families. In the last two decades there have been many options brought before the people of this nation and some have been serious attempts to provide for all. However, most proposals have continued to exclude some portion of society from access to adequate health care. The debates seem to have subsided, but problems of providing adequate care to individuals are actually increasing with time.

Tremendous Medicaid budget cuts are pending. These cuts would surely further limit health care access for the poor and the physically or mentally challenged. Health Maintenance Organizations (HMOs), and the like, interfere with physicians treatment plans. In effect, HMOs deny legitimate claims by developing regulations on getting approvals for treatment that both patients and doctors have difficulty understanding or satisfying. It has been estimated that today's physician spends about one-third of his or her time satisfying these regulations and seeking approvals for treatment, time the physician could be spending with patients. Because there are so many public and private health care insurance organizations the result is an insurmountable bureaucratic complex; a system which tends to confuse virtually every aspect of insurance coverage for the patients and the practitioners.

Now is the time for a comprehensive single-payer health care program that will provide adequate health care to all without placing further barricades to access.

Failed solutions

Private health insurance, in all its forms, continues to increase its premium cost while limiting care and/or increasing deductibles and co-payments for care. However, these increases do not necessarily reflect rises in the actual costs of treatments. Premiums must rise in order to keep adequate profit margins for owners and investors. It has been estimated that the cost of administration of Medicare is 4 percent to 5 percent of its budget, while the typical private company's budget for administration and profit is about 25 percent.

Furthermore, when there is no institutional or employer provider of health insurance, personal policies are offered by companies at extraordinary rates. The average family, much less the working poor, simply cannot afford personal policies. They can cost $ 2,000 or more in premiums with deductibles ranging from $1,500 to $5,000 per year for each individual.

Private insurance companies usually impose annual or lifetime limits on the amount of benefits payable, whether the policy is individual, group, or institutional. These harsh policies leave the lingering worry that with a catastrophic illness or injury such limits may be reached, abruptly stopping all insurance benefits and leaving the policy beneficiary completely uninsured. Then to get care, the individual must sell and/or spend all assets, including homes, financial holdings, lifetime savings accounts, etc., in order to qualify for Medicaid and restore any medical coverage at all.

Recently two bills were offered in Congress and defeated. There can be little doubt that active lobbying of Congress by health insurance companies and their associations was a factor in the defeats. These bills would have required some additional expenses for health care insurance companies, perhaps eating into current profits. We can be fairly certain, however, that those expenses would eventually have been passed along to the premium payer, preserving high profits.

[The Patients Bill of Rights Act of 1998 (S. 2529) (or its subsequent version) seeks to provide certain guarantees to patients in HMOs and other private systems. These guarantees included portable policies, rights to information, grievance procedures and other important accommodations for the patient. However, it offers to do this while preserving the current health care system. This bill may have been helpful to some but necessitated compromise with profit motivation and would have added another bureau.]

[The Healthy Americans Act (S. 2074) was "to guarantee for all Americans, affordable, and comprehensive health care coverage". This sounded good on the surface, but it still relied on private insurers in most cases. It did provide a way to eliminate cost to the very poor, and a sliding scale of premiums up to 400 percent of the poverty line income. It was to be administered by the individual states, creating fifty new bureaus responsible to a new national agency and eliminating none of the existing bureaus.]

Many states are developing programs to provide health care to all minors, regardless of family income. These programs stop at age 18, regardless of income. They are insufficient to the nation as a whole and, though significantly relieving distress on families and individuals, they are only temporary.

President Clinton's health care initiatives were an attempt to seek compromise between the private insurers and the needs of the nation. They were an attempt to place responsibilities and limits on insurers while providing a somewhat comprehensive package of benefits to the nation. He was accused of creating a massive bureaucracy and limiting the autonomy of private corporations. He was accused of creating a system that was too expensive.

However, then and now there exists a massive bureaucratic complex which manages health care: fifty state Medicaid systems, the Veteran's Administration, the Railroad Employees insurance program, federal and state employee systems, health care for retired military personnel (formerly know as CHAMPUS), Medicare and countless private insurance companies including, HMOs, PPOs, Medicare Supplemental Plans, etc. What makes this massive bureaucratic complex worse is that none of the bureaus communicate in similar terms: not to patients, not to physicians, not to hospitals, which barricades providers and patients from filing and receiving payments on legitimate claims. Furthermore, this system increases administrative costs for everyone: doctors, hospitals, patients, other health care providers, and the private insurance companies entrusted to provide our care. The bureaucratic complex has become an incredible burden to society.

Myriad injustices in the current system

It has become clear that Managed Care Companies, HMOs, PPOs, and the like, interfere with the physician's ability to develop comprehensive treatment plans for his or her patients. They require that a decision be made by the corporation about treatment cost and efficacy and, in most cases, decisions are made by individuals much less qualified than the patient's physician or the specialist a physician may recommend. In fact, persons with little or no medical training often make those decisions. Many insurance companies hire nurses to review the physicians diagnoses and treatment plans. While it is unusual for nurses to oversee doctors, it is also evident that these nurses have had no contact with the patient under review. Furthermore, those decisions are made with primary consideration for the costs to the corporation, not for the optimum health of the patient. In the current climate physicians who prescribe treatments or tests not pre-approved by the insurance corporation face severe financial penalties or other disincentives to optimum patient care.

Managed Care was supposed to be a way of providing care to increasing numbers of patients; however, there are actually increasing numbers of uninsured. The very poor, the affluent, the employees of government and large corporations, and many receiving adequate pensions plus Medicare are insured. The self-employed, recently unemployed, middle income, and working poor simply cannot afford personal policies. And even though some states are developing programs to provide health care to all minors regardless of family income, they are only temporary, leaving the child uninsured when reaching the age of majority.

The government tries to fill the gap with the Medicaid systems. While Medicaid (some states have different names for similar programs) provides some care to the poor, it does not encourage primary nor comprehensive care and disqualifies applicants with borderline incomes. Also, the Medicaid systems remain under constant attack as one of the first places to cut state budgets. Our civil leadership may claim health care as a priority but this tendency belies their credibility on this issue. When Medicaid budgets are cut, the poor suffer. After cuts, those in the greatest need and at highest risk have fewer benefits. In an already crippled system further cuts to Medicaid spending result in leaving more people with inadequate health care.

Private insurance companies, also, impose insurmountable limits to health care, even in the best of plans. Annual or lifetime limits on the amount of benefits payable leave the lingering worry that, with a catastrophic illness or injury, such a limit may be reached, abruptly stopping all insurance benefits and leaving the premium payer uninsured. The current private health insurance system, with its high profit margins, further contributes to an unhealthy society by forcing people to choose between health insurance and sustenance, housing, or the other needs of a family; thus basic health insurance becomes too expensive for the average individual or family.

An increasing number of middle income families, the working poor, the elderly, and many in minority communities do not receive health insurance benefits from their employers, cannot pay for any health care insurance, and do not qualify for Medicaid. If a health catastrophe should strike, they must deplete all assets in order to qualify for Medicaid, including selling of a home or surrendering a lifetime of savings. While not only placing these families in financial jeopardy, these circumstances contribute to poverty, constant worry, and despair among many. The devastating expense of a long-term or terminal illness, inadequate care in general, and the extraordinary cost of insurance all contribute to keeping many minorities in the poverty cycle, dependent on welfare and other forms of assistance, and imprisoned in struggling and dangerous communities.

Even in our United Methodist connection more and more annual conferences and more and more parishes are feeling the burden of providing health care to their clergy and their lay staff. Small churches, even multiple point parishes, have difficulty paying for private health insurance. If conferences institute "ability to pay" programs, the wealthier churches become benefactors for the smaller ones, possibly eroding their own financial security over time or depleting funds for other important ministries.

Virtually no one can pay cash for health care and the profit motivated private health insurance companies depend on this, making the system usurious. Moreover, the insurance corporations and associations, with money to spend, lobby and cajole our representatives to keep the current system in place, in spite of its inadequacies and its injustices. Even now, these same companies want to limit a patient's right to sue in civil court when the company breaches its own contract to provide benefits, regardless of the suffering or death a benefit denial may cause. In these types of cases a benefit denial is tantamount to medical malpractice. Competition for premium dollars and concern for high profits have taken priority over necessary care at actual cost. It is evident that private insurance companies are prone to deny claims while continuing to receive premiums, favoring higher profit over the "health and wholeness" of the weakened, the worried, and the sick.

Resolution

Therefore, as it is unconscionable that any human being should ever be denied access to adequate health care due to economic, racial, or class barriers; and The United Methodist Social Principles state in the introduction to paragraph 162, "The rights and privileges a society bestows upon or withholds from those who comprise it indicate the relative esteem in which that society holds particular persons and groups of persons . . . .", and in ¶ 162 C, ". . .Children have the rights to food, shelter, clothing, health care. . . .", and in ¶ 162 T, "Health care is a basic human right. . . . It is unjust to construct or perpetuate barriers to physical wholeness. . . . We also recognize the role of government in ensuring that each individual has access to those elements necessary to good health."; and the Council of Bishops has endorsed the Universal Declaration for Human Rights which clearly claims health care as right due to every world citizen;

Therefore, be it resolved, that The United Methodist Church expressly adopt the claim of health care as a "basic human right" and that this claim be the hallmark of our United Methodist efforts in this area of advocacy; and

Be it further resolved, that The United Methodist Church now demands health care as a basic human right and as an entitlement for all Americans, including Native Americans, and legal resident aliens; and

Be it further resolved, that The United Methodist Church will exert its influence in any arena and wherever possible to bring about substantive change in the health care system, respecting the hallmark of health care as a "basic human right"; and

Be it further resolved, that compassion and healing be the primary motivation in developing a health care system that is just and inclusive and recognizing this, The United Methodist Church now calls for implementation of a totally nonprofit health care insurance system, a single-payer system administered by the federal government; and

Be it further resolved, that The United Methodist Church endorses the health care system described in the American Health Security Act of 1995 (H.R. 1200, The McDermott Bill), or a very similar system, one which guarantees complete freedom for patients to choose their physicians and health care providers and for physicians to provide and prescribe needed and appropriate care; and

H.R. 1200 combines all government health care programs (e.g. Medicare, CHAMPUS, Federal Employees, Railroad Employees, etc.) into one, eliminates Medicaid by providing care to the poor, and eliminates all the layers and permutations of health care insurance administration and service bureaus, both public and private. This bill provides a comprehensive package of health care including: primary care, emergency and hospital care, long-term care, drugs and prescriptions, drug and alcohol recovery treatment, dental care, etc. This care is paid for by an across-the-board employers excise tax of about 8 percent of gross wages for each employee and about a 2 percent personal income tax and reasonable "co-pays" with no lifetime or annual limits on coverage. No health tax would be collected from anyone whose income is 100 percent of or below the poverty line. A sliding scale is used for those whose income is between 100 percent and 200 percent of the poverty line.

Be it finally resolved that, The United Methodist Church publicly advocate and fervently lobby the federal government to protect and provide for rights to health care and to take up measures such as the American Health Security Act.

ADOPTED 1992
REVISED AND ADOPTED 2000