Solving the Nation's Health Care Crisis With Justice ~ Reboloke

Last weekend I attended a Justice Summit sponsored by Leadership Now, the youth program of Lancaster Theological Seminary. Discussions were intense and often difficult, but enthusiasm was abundant and it was an incredible weekend. There are many things I could write about the weekend, but for now I'll focus on one of the last activities we did.

A professor from the Department of Sociology/Anthropology at Millersville University planned and led the simulation game we used as a closing activity. In the overview/instructions he wrote “The US Senate has established (for our purposes) a consultative session with major stakeholders in America's health care crisis. Your task is as a group to agree upon one of an already-existing set of proposals for reforming the health care system to cover all uninsured and under insured individuals in the US.” Groups of about eight people were each given one of the following identities to represent: American Medical Association (AMA), Insurance Companies (I forget the name of the group they were), Employers (a group I forget the name of, which may have been made up, including Starbucks, which pays more for employee health benefits then for coffee beans), National Coalition on Health Care (NCHC, which is the group I was in), Democratic Senators, and Republican Senators. Each group was given a short profile of the group they represented and it's values. After reading the profile they had to decide which proposal the group they represented would choose and how they would argue for that proposal.

My group found that the group we represented, NCHC, feels health care coverage for all, improvement in health care quality and safety, cost management, equitable financing, and simplified administration are central to any health care reform movement. A recent NCHC report found that a universal publicly-financed program would result in a total decrease in spending of about $1.136 trillion between now and 2015. Keeping our groups interests in mind we reviewed the proposals.

Proposal #1: “Earned Income Tax Credits Increases: This proposal would increase the amount of the Earned Income Tax Credit (EITC) that low income families would be able to claim so that they will have more income to pay for health insurance.”

Proposal #2: “Expand Health Savings Accounts: President Bush signed the Health Savings Account (HSA) into law with the Medicare reforms in 2003. ...only people who have a high-deductible health plan (HDHP) can sign up for an HSA.” Could be expand to cover everyone without insurance, or contributions eligible HSA holders may make to their accounts can be increased.

Proposal #3: Expand Medicare to Cover All the Uninsured: Expand Medicare, which is currently available to those over age 65, or Medicaid, state-run programs generally available to very-low-income or low-income families, to cover all medically uninsured making less then 150% of the federal poverty line; or expand State Children's Health Insurance Program (SCHIP) to cover all member of medically uninsured families with at least one qualifying child.

Proposal #4: Develop Single-Payer System for the US: (Universal Health Care Program) Would (A) expand the Medicare program to cover everyone, or (B) contract with existing insurance providers and have the federal government pay insurance premiums for everyone.

After reading the proposals and the NCHC profile, we decided proposal #4 made the most sense for our group. In fact we felt it was the only proposal that made sense for our group. Proposal #1 does not meet our goals, since it only covers those with earned income. Proposal #2 is basically major medical coverage, and doesn't provide much help when it comes to preventive care and day-to-day health needs. More of the people who have the greatest need can be reached with proposal #3, but the expense becomes a burden to those who have to pay for both their own insurance and insurance for those who can't afford it. Also proposal #3 is based on charity (giving or “helping” in a way that the benefit ends as soon as you stop giving; the “if you give a man a fish he'll eat for a day” part), which undermines the recipients dignity, rather then justice (educating and giving in a way that the benefit will last longer then the initial gift; the “if you teach a man to fish he'll eat for the rest of his life” part [but only if you're willing to go fishing with him]), which raises people up, allowing and encouraging them to become healthy and productive members of their communities.

Acting as the NCHC, we gave the following arguments for choosing proposal #4:

Everyone's covered regardless of age, income, employment status, etc.
Doesn't place the burden of paying for insurance on businesses, which often spend a large portion of their budget on just basic employee health benefits.
Eliminates hassle of changing insurance companies when you change jobs.
Eliminates coverage “gaps” for those between jobs or between school and a full time job. (Getting kicked off of parents insurances plans when you graduate college, or at 18-19 if you aren't going to college right away, was of particular concern to some in our group.)
Encourages people to use preventive care rather then waiting until they're unable to function to seek medical care, by making prevention more accessible.

After about an hour of deliberating between the groups, two thirds of the room was in support of proposal #4 (B). The employers group chose this proposal from the start, and the AMA wanted a combination of proposals #3 and #4 (B), but was willing to shift their focus to primarily proposal #4 (B). The Democratic Senators initially wanted proposal #1 with several amendments (there's a reason why we're all guessing a certain member of this group will really be a senator, or even president, someday), but later changed their mind and choose to ally with the employer group, AMA, and NCHC (even though it's “rigorously non-partisan”) in support of proposal #4 (B). The Republican Senators would not budge in their support for proposal #2, but since the primary spokespersons for this group were younger and seemed to have a harder time being serious with this I'm not sure how much their unbudging opinion had to do with the group they represented and how much it had to do with the actual group. The insurance companies strongly opposed proposal #4, since, even using plan (B), it would over turn the way they do business. They chose to support proposal #3, which is less likely to cut in to the $3 million per year salaries of many insurance company CEOS, and leaves the government to pick up the bill for those who can't pay their own insurance.

We ran out of time long before we could have reached a consensus between all six groups, but it was very easy for us to see that the insurance companies could not base their decisions on justice, since they were too busy protecting their own wallets. If only it were so simple as ignoring the greedy and stubborn we could solve the health care crisis in an hour. When we discussed our real opinions rather then the opinions of the groups we represented, it was much easier to reach a consensus (in favor of proposal #4), but then none of us were really CEOS in the insurance industry.

I found this activity to be very empowering, because I didn't think I really knew that much about this problem or understood a lot of the information we were given, but as we discussed the issue and got into the activity I found I understood it better then a lot of the group (both my small group and the group as a whole), and was even told by my group that I should be our spokesperson, since I explained the issue so clearly in our small group.

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