23 August 2009

How healthy is your healthcare?

Healthcare seems to be a big issue in the American blogosphere at the moment. Normally I try to keep out of such debates, for the simple reason that I don't know enough about the issues at stake. When the debate intruded into a newsgroup discussion on another topic, I had to ask what "single payer" meant -- a term bandied about by Americans on the assumption that everyone knows what it means, but one which I had never heard of before. Don't worry, someone has explained it to me now, but I'm not really interested. The manner in which healthcare is provided in the USA is something for the citizens of that country to decide. I'm not so much a disinterested spectator of the debate as an uninterested one.

Two things happened to weaken my resolution to stay out of the debate.

The first is that the debate seems to be largely ideological, and some proponents of ideologies have been propunding slogans based on ideological principles that they regard as universally applicable. One of these was the statement that "universal healthcare is theft", which seems to me diametrically opposed to the basics of the Christian faith, and to have huge theological implications. Those who find theology too boring and abstruse will be glad to know that I'm not talking about that now, since I've blogged about that already at Health, disease, theology and politics: Khanya.

The second thing that made me think that this wasn't a purely domestic matter for the USA was a rather vicious campaign among some in the USA about the British National Health Service (NHS), full of lies and innuendo. It certainly caused a reaction in the UK Twittersphere, with lots of tweets tagged #IlovetheNHS. Bishop Alan has responded at Bishop Alan’s Blog: How healthy is your healthcare?:
Stephanie’s birth as an undiagnosed extended breach in a strange hospital (she arrived early and unexpected on Christmas night) was supervised by one of the finest obstetricians in the world, who gave Lucy the choice, then delivered her faultlessly without a C-Section, using an old midwives’ routine called the Burns-Marshall technique. Both these ace bits of effective medical care were delivered with nary a credit card or insurance policy between them, and I would take a lot of persuading that the kind of medical system we use for Max the Cat would have served us any better.

We had a similar experience with the birth of our daughter. She was born in the provincial hospital in Utrecht, Natal. Shortly before she was born the cat had kittens, and because she had previously had obstetrical problems we took her to the vet. The kittens cost us four times what our daughter's birth did.

But such anecdotes prove little or nothing. One can collect anecdotes of both good and bad treatment in any kind of hospital, whether private or public, commercial or non-profit. A lot depends on the ethics, skill and dedication of the staff, and that is often very much a matter of the luck of the draw.

I think healthcare in South Africa is something of a disaster. First because the apartheid policies of the previous government, which nationalised the non-profit church hospitals in the 1970s for ideological reasons, and there was an immediate very rapid decline in the standard of healthcare in the rural areas that had been served by those hospitals. The reasons are not hard to find. When the hospitals were run by Christian churches, they were able to recruit staff who saw healing as part of their Christian ministry. Young Christian doctors, newly qualified, saw this as an opportunity of Christian service. Highly qualified and experienced surgeons when they retired did the same. Well qualified nurses would go to serve in such hospitals with a similar motive, and try to pass on their dedication and enthusiasm to a new generation of student nurses.

When the government nationalised them, the former church hospitals were immediately taken out of the recruiting network of the international Christian conspiracy, and very often the only people the government could get to work there were medical students who had been conscripted for military service, and were sent to do their national service in rural hospitals.

Of course dedicated Christian healthcare professionals did not have to work in church hospitals, but church hospitals did have a better recruiting network for such people. Some years ago I visited the Orthodox seminary in Nairobi, Kenya, and there were two other people in the guest house. One was a young Ukrainian doctor who had come with a United Nations relief group to work in Rwanda after the genocide there. The other was a top Greek heart surgeon who had become a priest, and was spending a few weeks providing healthcare to the clergy in Kenya and their families, and helping out at clinics run by the church. The young Ukrainian had to pass exams to be licensed to practise in Kenya, and so was going through the stuff he had to learn with the priest, which shared his knowledge, and I heard the more experienced one catechising the younger one after dinner in the evenings.

But whether in Kenya or South Africa, very few commercial healthcare providers are going to establish a practice in the poorest rural areas. Anyone who puts the commercial model forward as the ideal and universal one might be following the best free-market economic principles, but for Christians that comes up against the parable of the rich man and Lazarus.

There is now a stnchroblog on this topic, with various Christians writing on it: Square No More: Synchroblog on a Christian Response to Healthcare


Fr. Andrew said...

Thanks for this. It seems to me that a truly free market would be free both in terms of allowing those who seek to profit from their labors to do so as well as allowing those who seek to offer their labors charitably to do so. It's Keynesian-style economics which tends to choke both approaches and favor only a corporatist/statist model, which yields the sort of problems like you mentioned in South Africa—no one is hardly *permitted* to act on the motivation (whether for profit or for charity) to be able to offer quality, innovative care.

Anyway, based on this post, I think we probably think more alike on this question than our previous interaction on it might lead one to believe.

My ideal health care model would be one in which all the hospitals, etc., would be run by churches.

Tauratinswe said...

The real issue is whether profits are valued more than people. I find it immoral that the health and drug industries seek to maximize profits at the expense of the sick. All health care should be non-profit. Which brings us back to your observation about religious based hospitals/clinics. Unfortunately, in the USA, they, too, are religious in name only and seek profits, not for shareholders, but for management.

James Higham said...

First because the apartheid policies of the previous government, which nationalised the non-profit church hospitals in the 1970s for ideological reasons, and there was an immediate very rapid decline in the standard of healthcare in the rural areas that had been served by those hospitals.

This sort of thing always happens when the government goes near it.

Anonymous said...

I'm inclined to agree with Taurantinzwe. To me, that's the whole issue behind the topic of my recent blog post about Pfizer's response to the growing trend of Lipitor users switching to a generic medication to treat their high cholesterol.

I'll also note that the rhetoric about the mantra "universal healthcare is theft" is that it's a variation of a common mantra in American politics in general: The belief that people are poor and in need of assistance solely because they are "lazy" and want to take advantage of other people's hard work rather than help themselves. It's a mentality that thinks the worst things about a person's fellow neighbors. It's frightening to behold.

Anonymous said...

I think if we had a good public option plan it would create enough competition that companies that want to make a profit off of health care would have to create a culture within their organization that cares about the people they serve - they would have to charge more fairly and stop denying claims just because it would cost them more money. My biggest fear is that some sort of insurance reform will get passed without a public option getting passed. Then the ins. companies will just charge more because of the new restrictions and guidelines.


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