You might not like the Religious Rights answers. But, on the subject of health reform, they at least ask some of the right questions.
In a recent attack on the Clinton health reform proposal, Pat Robertsons so-called Christian Coalition avoided the current tendency to nit-pick the plans intricate administration or complex financing. Instead, Robertsons group went right to the heart of the issue, framing the health reform debate as one that is essentially about ethical values.
It is a point that Hillary Rodham Clinton has herself been emphasizing for some time. But the proposed Health Security Act, which embodies the Clintons reform plan, obscures their moral vision under the deadening weight of its 1,300 pages of legal verbiage.
The bills sheer length and complexity play into health industry-cultivated fears of burdensome government regulation, and seemingly confirm the lobbyists assertion that health reform is a complex matter best left to the "experts." For months, voters have been relegated to the role of bewildered spectators, while technocrats and lawyers have debated the arcane details of managed competition, health care purchasing alliances, and global budgets.
It is time to move on. For one thing, the Clinton bill, at least in its original form, is dead. None of the myriad competing health reform bills currently command enough congressional support to win passage. Whatever is enacted will therefore be a compromise, stitching together elements of various different proposals. In these circumstances, it is now easierand more important than everto get beyond the technical intricacies of a particular bill and focus on the broad ethical issues at stake.
Unfortunately, the Religious Rights position on those issues is more partisan than principled. The Christian Coalition is funding a political campaign against the Clinton plan, and supporting a status quo position that mirrors the stance of the Republican Partys right wing. The coalition condemns the Clinton plan as unChristian and "anti-family." Coalition statements make it clear that the group will apply these labels to any bill that covers mental health services, that imposes controls on health care prices, or that provides for universal coverage of all Americans. It is a political platform remarkable for its meanness.
PAT ROBERTSONS campaign at least has the virtue of demanding that other people of faith express their own convictions on these issues. Among the ethical challenges posed by health reform:
Universality of coverage. Any bill that excludes part or all of the 37 million uninsured, or the millions more with only meager coverage, will perpetuate the cruelty of a system that presently rations medical care on the basis of wealth. And, not incidentally, given the distribution of wealth and commercial insurance coverage in America, the practical effect of this method of rationing is to allocate treatment on the basis of class, race, and disability. Providing universal coverage is, therefore, the defining moral challenge of the debate.
President Clinton has said as much, yet his own proposal would deny care to undocumented foreign workers and their children. Other leading proposals, such as that sponsored by Tennessee Con-gressman Jim Cooper and favored by the health and insurance industries, would leave millions more without coverage.
Financing. Clinton would impose much of the cost of broader coverage on employers, by mandating that businesses provide insurance for their employees. This approach reflects the reality that the more straightforward financing alternativefunding through the tax systemis seen as politically suicidal. But an employer mandate may jeopardize the jobs of marginal workers, so attention is turning increasingly to an individual mandate, which would make purchase of insurance the obligation of each individual.
The ethical and practical worth of an individual mandate depends upon the adequacy of public subsidies for those unable to pay for their own coverage. After all, it is the unaffordability of care that accounts for the growing numbers of those with no, or inadequate, insurance. Simply ordering people to buy what they cannot afford will only add to their burdens. In a political climate resistant to new federal spending, protection of these families is especially challenging.
Services covered. People of faith will express their convictions on the question of whether abortions should be covered under a national health plan. But the ethical challenges do not end there. Many of the services offered in the Clinton plan are in danger of being stripped from the final legislation, in part because of the opposition of groups like the Christian Coalition.
The threatened benefitsmental health, long-term care for elders and people with disabilities, public health programs for underserved populationsare the very ones that are of special importance to the most vulnerable of Americans. The religious community has a particular responsibility to advocate on their behalf.
We are indebted to the Christian Coalition for framing health reform as a moral challenge to America. In response, the community of faith must now move the nation past the coalitions narrow partisanship, toward a just and compassionate health care system.
GORDON BONNYMAN is a legal aid attorney in Nashville, Tennessee.