A Doctor Makes Sense of the Health-Care Debate

As the debate over health-care reform heats up, conflicting claims from both sides make it increasingly difficult to sort out the issues and choose a position for which to advocate. The temptation is to stay on the sidelines and let the "experts" and special interests decide our future course.

I have practiced medicine among a poor and largely medically uninsured patient population at the Lawndale Christian Health Center for the past 25 years and so follow this with great interest. I will try my best to objectively define the positions. I will break it down into two main concerns, that of social justice and that of our country's future fiscal health.

The United States spends 16% of its GNP on health care. Other countries spend less than 11%, Japan only 8%. Despite this, 26% of American adults aged 19-64 were medically uninsured for at least part of last year. The uninsured are not distributed equally among races, as 44% of adult Hispanics were in this uninsured category. Two-thirds of the uninsured have at least one family member working full time. Previously insured may suddenly find themselves without medical coverage when they are laid off, downsized, or work for employers who can no longer pay for escalating health-care costs and either drop coverage or decide to place an unaffordable share of health insurance costs on their employees.

Others lose insurance coverage when they decide to start their own business, go back to school, choose to stay home to care for a child or sick parent, or try to escape an abusive marriage through divorce. Those who are self-employed or working for small employers may not be able to find anyone willing to insure them if they have a chronic illness, even something easily controlled such as hypertension. It has been repeatedly documented that the uninsured enter the medical system later in the course of their chronic illness, more than half skip doses of medications because they can't afford them, and they are much less likely to have the preventive and screening services known to improve health. We do a pretty good job of providing medical coverage once the uninsured become disabled from chronic illness.

The U.S. ranks near the bottom of a group of 19 similar westernized countries in mortality before age 75 from causes considered amenable to health care. If we indeed adhere to the greatest commandments of not only loving God with all our hearts, souls, and minds but also loving our neighbor as ourselves, we should advocate for a just system that allows equitable access to our health-care system. This could be accomplished by requiring Americans to carry at least minimal health insurance, mandating employers contribute at least a minimal percentage of total employee compensation to health insurance coverage, governmental assistance for those who genuinely can't afford that coverage, eliminating the current barrier to coverage placed by insurance companies due to pre-existing health problems, and leveling the playing field on tax policy so both those in the individual market as well as those covered through their employers get the same tax break.

[To be continued ... ]

Arthur Jones, M.D., is a founding physician at Lawndale Christian Health Center.