Healthy Health Care

Editorial
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Our Great Physician doesn’t parcel out healing grace in measured quantities.

The Banner’s “Reformed Matters” column recently offered differing views on how we as Canadians and Americans can best meet the biblical principle of providing health care for those in need (Health Care: A Moral Imperative by Henry Holstege and Bob Ritsema, and The Complexities of Health Care by Jordan J. Ballor). That all God’s children should have access has always been a fundamental Christian tenet. Jesus himself eagerly provided health care to those who asked. And Scripture does not record that they were billed accordingly.

Decide for yourself which approach best works out that principle. But allow me to toss a few practical observations into the conversation. I grew up in Canada and pastored churches there for over two decades. I also spent seven years in the U.S. as a student and then another 10 years stateside working for the denomination. So I’ve experienced firsthand the universal health care approach used in Canada and the free market approach in the U.S.—though I’m certainly no expert.

For what it’s worth, some observations as a health care recipient and a longtime pastoral visitor. One heads-up: I’ve been living north of the line since well before the Affordable Care Act (also called Obamacare) kicked in.

  • Overall, both countries provide excellent health care by competent and devoted professionals.
  • Medical professionals make much more money in the U.S. but also have much higher costs.
  • The U.S. system has more of the expensive “toys” like MRI machines, and they use them more often—maybe too often—to keep from being sued. Balance that against wait times in Canada being so long that often Canucks hop the border to get their “pictures” taken—accompanied, of course, by a fat wallet to pay for the privilege.
  • My naïve perception is that more widely available technology in the U.S. may extend an average lifetime by some months. But that extra lifespan is spent on filling out form after form after form. In Canada you just flash your health card—then wait in line.
  • In the U.S. your work (if you are blessed with such) pays for your health care and you copay plenty for it. If you’re uninsured, you get dinged extra for medical services because you’re “out of plan.” In Canada you pay for medical services through taxes, including heavy “sin” taxes on such items as gasoline, alcohol, and cigarettes.

Two things I like better about the Canadian system: it covers (almost) everybody and it allows medical professionals, not bureaucrats, to decide on appropriate treatment.

Maybe you’ve heard the story of a dearly departed who knocked on the pearly gates and requested admission. When the gatekeeper asked about her profession, she answered that she had been an HMO administrator. “Hmm,” the angel said, “I’m not sure if I can let you in. Let me check the policy.” He returned with a wry smile. “Yes, you may stay . . . for three days.”

Praise the Lord that our Great Physician doesn’t parcel out healing grace in such measured quantities. Wonder what that means for health care?

About the Author

Bob De Moor is a retired Christian Reformed pastor living in Edmonton, Alta.

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Comments

"Access to health care" - what does that mean, precisely? 

If I have access to aspirin, I have access to health care. 

If I can exercise or get decent food, I have access to health care.

If I can get to the internet and run a search on symptoms, I have access to health care.

If I have access to a loving mother or wife who fixes me a bowl of chicken soup and makes sure I have some time of quiet rest to get over a cold, I have access to health care.

What we're talking about is access to medical professionals and hospitals, surgery, pharmacies, and trained nurses.  But then we need to ask ourselves how much access is necessary.  The sky's the limit, frankly, when it comes to health care - but that also means the sky's the limit when it comes to health care costs.  The problem comes in the fact that, while our desires for health care may be unlimited, both the available care and our ability to pay for it are not.  This is true whether we are talking about individuals or societies.

So, how do we ration care?  We must ration it in some fashion, for demand is unlimited but supply  most decidedly has limits.  Price, access, wait times, insurance regulations (such as that 3 day stay), and government budgets are all ways to place limits on - to ration - the health care received.  There are hard decisions to be made.  Do we do the surgery on a 92-year-old who likely will die in the next year, ten at the outside, anyway?  If we don't, he will die now.  If we do, then the operating room, the surgical team, the medications, and more aren't available to do surgery on someone else.  Is mere ability to outbid the other person wanting surgery to be the deciding factor?

Contrary to your assertion, the government in Canada does decide what appropriate treatment is.  Perhaps they do not say this procedure only allows 3 days in the hospital - I'm not familiar enough with it to say - but the fact that the government decides what resources are allocated to it and issues guidelines for prioritizing use determines appropriate treatment.  They - not physicians and patients - have decided, for instance, that MRIs are, to use your words, expensive toys.  Thus there aren't many and you have long wait times to access them.  The government has in effect deemed them inappropriate treatment.  Should government make these kinds of decisions?  Is it for them to say to the 92 year old who wants to live that his age means he's a low priority for use of that surgical team and operating room, but if he's still around we might get to him some 5 years hence?

Canadians are far more trusting of their government than we are in the States.  The relative behaviors of our government are sufficient to justify that difference.  There are other differences in our respective cultures that make a Canadian approach less viable here.

Regardless, the question of how we manage the limited supply of skills, knowledge, equipment, and consumables that go into caring for people's health in the face of unlimited desires is vexed, incredibly complicated, and not amenable to fully satisfactory answers no matter which way one moves.  But we can perhaps make far greater strides in coming to a conclusion we can all grudgingly accept if we stop accusing others of not caring about the poor when they do not fully agree with one's preferred method of rationing care.  Sadly, Holstege & Ritsema don't manage that.

Hear, hear. :)

I somehow doubt whether Almighty God likes Canadian Health Care that includes the murder of the most innocent and defenseless paid for by taxpayers.

Deuteronomy 21:9

So shalt thou put away the guilt of innocent blood from among you, when thou shalt do that which is right in the sight of the Lord.

 

In the above article, the clamin is made that the United States uses a free market approach in the area of health care.  A free market, of course, is simply a place where two parties may make voluntary exchanges without any type of coercion (regulations, mandates, subsidies, etc…).  On the demand side of the health care market the U.S. has Medicare and Medicaid - two very clear examples of institutions that use the force of government to benefit some at the expense of others.   On the supply side of the health care industry is the American Medical Association (AMA), which restricts the number of medical candidates by means of its accreditation process for medical schools with its decisions ratified by state governments.  For instance, nineteen states are limited to having a single medical school.  Also artificially limiting the supply of health care services is Certificate-of-Need (CON) regulation.  This allows existing hospitals themselves to decide whether a “need” exists for additional hospitals in a particular area.  This is clearly anti-competitive and a regulation that favors existing hospitals as it helps to protect them from competition.  Furthermore, Americans cannot purchase medical insurance originating in states other than their own, further limiting supply.  Another example includes state mandates that require insurance companies to cover certain disorders or treatments such as hair transplants and massage therapy, which results in higher premiums and less consumer choice making it difficult for people to find low-cost, high-deductible policies that can insure them against medical catastrophes.  So, a free market in health care?  Not in the United States, unfortunately. 

 

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