Facts and compassion needed in health reforms
A couple of years ago a doctor was treating me for a health condition. I began to worry about the results, so I went to a different doctor. The new doctor told me, “Those treatments aren’t evidence-based.”
Medical knowledge can be frustratingly uncertain. I asked myself, has this actually been tested?
Being concerned with evidence isn’t new. I sometimes call the biblical Daniel the first scientist. Why? Because in Babylon, Daniel told the palace guard, in effect, “try giving us vegetables and water for two weeks, and then base your decision on the evidence of your eyes” (Daniel 1:12-13). Daniel was calling for evidence-based decision making on a matter of nutrition and health.
Health-care quality matters to United Methodists. Our Resolution #3207 “calls upon … health-care providers and government agencies to … devote needed resources to the promotion of quality health care (and) engage in programs of continuous quality improvement.”
“Effectiveness research,” to establish evidence-based findings on what medicines and medical procedures work and what don’t, is a feature of the health-care reform being discussed in the U.S. Congress.
A year ago, Comparative Effectiveness Research (CER) legislation was introduced by Senate Finance Committee Chair Max Baucus, (D-Mont.), and Senate Budget Committee Chair Kent Conrad, (D-N.D.). They wanted to create a health-care CER Institute that would be “responsible for setting national priorities” and “answer the most pressing questions about what works in health care.”
Karen Ignagni, president of America’s Health Insurance Plans, voiced her support, as did President Scott Serota of the Blue Cross & Blue Shield Assn. (BCBS). He was quoted as saying, “by promoting comparative effectiveness research … we can improve quality, value and expand coverage for all.”
CER has already been legislated into this spring’s stimulus bill, the American Recovery & Reinvestment Act. You may wonder if CER already exists, what’s the brouhaha about? Succinctly, those opposed to reform are interpreting CER as code for government rationing of health care.
Detractors of CER, like Peter Ferrara of the Institute for Policy Innovation, develop the arguments linking CER and rationing thus: You may want health care that your doctor has prescribed for you. But the rationing bureaucracy in Washington that doesn’t even know you, or your doctor, may decide that your doctor doesn’t know what he’s talking about, or that you are too old for the government to pay for your hip replacement to stop the pain, or to get an expensive triple bypass or a pacemaker operation to save your life.
Countless Internet blogs repeat the same false assertions. Specific assurances to the contrary that are built into the legislation seem to make no difference.
Referring to the CER in the stimulus bill, the Department of Health & Human Services emphasized, “The council will not recommend clinical guidelines for payment, coverage or treatment.”
The current HR 3200 legislation before the House, on line 14, page 524, unambiguously states, “Nothing in this section shall be construed to permit the Commission or the Center to mandate coverage, reimbursement, or other policies for any public or private payer.’’
The scare tactics about how CER will lead to government rationing mask the actual rationing going on right now, rationing that health-care reform is intended to help:
- Care, except emergency care, is rationed to those uninsured or unable to pay. David Leonhardt in The New York Times reminds us: The uninsured … get less care, and worse care, than they need. The Institute of Medicine has estimated that 18,000 people died in 2000 because they lacked insurance.
- Coverage for pre-existing conditions is rationed.
- Care is rationed when your insurance company says it’s not medically necessary and will not pre-authorize it, regardless of your doctor’s assessment.
- Care is rationed when it has become too expensive according to your insurance company, which cancels your policy just when you need it most. “At a recent House hearing, three insurance companies testified that they had ‘rescinded’ or dropped coverage for nearly 20,000 patients between 2003 and 2007,” Leonhardt reported, “often after patients had submitted claims they thought would be covered.”
- Quality is rationed, according to Leonhardt, when “billions of dollars (are spent) on operations, tests and drugs that haven’t been proved to make people healthier. Yet we have not spent the money to install computerized medical records — and we suffer more medical errors than many other countries.”
- Money is rationed, underpaying primary-care doctors, relative to specialists.
Your vision and voice are needed to help keep the conversation for health-care reform on track. Keeping vision foremost is hard, it’s similar to trying to remember that you came to drain the swamp while you are surrounded by alligators.
That’s why the United Methodist General Board of Church & Society selected the “John 10:10 Challenge” for the name of our campaign to support health-care reform: “I came that they may have life, and have it abundantly.”
Our vision is a vision of God’s abundance made tangible in health care for all.
Abundance is an amazing biblical word. It’s what the Psalmist meant when he wrote, “my cup runneth over.” If we lose the vision of abundance, we lose the ability to discern how much scarcity in our world is contrived.
Christ taught us that abundance comes from sharing, which is ultimately the basis for health-care reform. Isn’t that one of the messages of the story of the feeding of the 5,000? And we are taught in 1 John 4:18 that the answer to fear isn’t to clutch tightly to what we have, but to look on others with love, for “perfect love casts out fear.”
In these days of debate, the effort to dig out the truth is so important, to keep us from being swayed by rumors. Whether it is the truth of the Gospel, the truth about Comparative Effectiveness Research, or the truth about where rationing is already leading to sickness and death, each in its own way, we need the truth to set us free.
The Rev. Jackson Day, a retired Elder, is a consultant with the United Methodist General Board of Church & Society’s addictions and health-care program area. This commentary appeared in full in the Aug. 10 issue of Faith in Action, which may be seen at www.umc.gbcs.org.
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