OP/ED: The political will to reform health care

1/20/2009

The political will to reform health care
As appeared in the Sunday, January 18, 2009, edition of The Plain Dealer
By Sister Judith Ann Karam, CSA
While the nation and our new leadership debate the way forward out of our economic challenges, it's important not to lose sight of the connection between the health of Americans and the health of the economy. Embedded in solving the problems of our economy is the will to confront our challenges in providing a basic level of health care for all.
By now, many people can recite the numbers by heart - 46 million uninsured Americans, 25 million more who are underinsured, 18,000 annual deaths as a direct result of lack of insurance. Hospitals have a mandate to provide emergency care. Beyond that policy is the deep desire to provide the very basic component of human dignity, i.e. health. The crisis in health care has created an untenable situation in which health providers are struggling to be a safety net for all in the midst of a market-driven environment. The Sisters of Charity Health System alone, which includes five hospitals in three markets in its network of 20 health and human service ministries, provides significant dollars in uncompensated care. Our belief in health care access for all is integral to our mission.
The majority of uninsured persons are working, at least for now. But there are a number of underinsured people who may have a limited health plan in which their first costs are out-of-pocket either through high deductibles or co-pays. They are worried that tests and prescriptions won't be covered.
Recently, a 41-year-old man came to our emergency department at St.Vincent Charity Hospital. He had been treated more than a year ago for a stroke, but because he lost his job and his insurance, he did not follow up with necessary medications and treatments and arrived much sicker than he should have been. We see this kind of financial versus health care choice made regularly in our ministries.
Health care spending comprises 16 percent of the gross domestic product. What is this spending? Employers who cover their workers are spending more to provide coverage and are often delaying improvements in technology, hiring additional staff or expanding a product line. Hospitals and providers are spending more to cover charity care, labor costs, supplies, technology and capital improvements. Consumers are paying more for prescriptions, co-payments, premiums and deductibles.
In addition to costs of care and insurance, Medicare and Medicaid reimbursements are shrinking as government struggles with reduced revenues and, at the state level, the requirement of a balanced budget. Often hospitals' public and private reimbursements are not meeting costs. Can we afford to keep delaying this public policy conversation?
The economic realities of the past few months have shifted our focus away from health care reform. But this is not the time to table reform. Exit polls conducted on Nov. 4 showed that two-thirds of voters ranked concern about affordable health care as their top concern behind the economy and the wars in Iraq and Afghanistan.
That's because Americans - the mother whose coverage ends with the death of her husband, adult children who can no longer be covered under their parents' plan and the small business owner who can't afford coverage for herself or her employees - know that the current system is too often neither affordable nor accessible. The economic situation we're in demands reform.
What will it cost to fix this problem? Some economists believe that it would cost this country $160 billion to provide health care for all Americans - a fraction of billions of bailout dollars that Congress has approved for Wall Street, banks and automakers. The New America Foundation estimates that the economic cost of doing nothing in 2007 was as much as $207 billion when one quantifies the economic impact of poor health and shortened life spans for uninsured persons.
What health care reform requires even more than money, however, is political will and courage. For the first time in memory, we're seeing participation of all the stakeholders - providers, employers, insurers and consumers - in pushing for reform. It's complex but, as we've seen in the past, Americans have never been afraid to rise up to meet tough challenges.
The Sisters of Charity of St. Augustine have been caring for the health of Americans since the Civil War. We believe that health care is not a product or commodity, but that it is a fundamental right in a healthy, flourishing society.
As we move through the transition of national leadership, let's remember that health care reform won't happen unless we demand that it happen. Let your voice be heard by letting your legislative leaders know that health care reform is one critical step forward in our economic recovery.
Karam is president and CEO of the Sisters of Charity Health System.