Friday, September 18, 2009

Health Care as a Commodity?

It occurred to me during a recent discussion around the currently debated health care reforms, that underlying the current debates are assumptions that rarely see the light of day.

On the one hand, arguments for current means of health care provision look at health care, in the form of insurance and access to facilities/medication, as a commodity. Like all commodities, it is to be valued according to the market, as mediated by insurance companies, legislation, and other factors. It is to be used by those who can afford it, who will hoard it if possible.

This commodity is sometimes in the form of an employee benefit. Like the use of the company car, if one loses one's job due to illness, or if one's employer can no longer afford it, one must do without or pay for one's own.

Those who cannot afford either insurance or out-of-pocket health care have few nets in place to catch them. One of the big ones is the local Emergency Room, which is required to assess and stabilize, though not necessarily treat, serious medical conditions. For hospitals which are required to offer treatment, usually a county hospital ER is required. The use of an ER as a primary health care provider often means putting off getting timely care, and runs up the cost to the hospital and to the taxpayer through otherwise nonrecoverable expenditures.

Under the commodity model, there is only so much to go around, so providing for more means less for me.

There is another assumption at work within the discussions of those seeking reform. Adequate basic health care is not a commodity but a fundamental human right. As a recent Facebook meme put it:

No one should have to die because they cannot afford health care. No one should go broke because they got sick.

Here is where the underlying assumptions clash. The commodity idea is intimately linked to capitalism, which in our time expresses itself in rapacious acquisition, rabid individualism and sees limits upon the available amount of any given commodity out there. So attempts to move beyond current models get labeled socialism and the specter of rationing is invoked. The human rights view of health care is intimately linked to community based thinking and a view of being one's brother's keeper which flies in the face of the ideals of individual achievement and control of commodities.

So the question for us in our time, is health care a commodity or a basic human right? Similar questions are also being asked of related areas, such as clean water, clean air?

In the U.S., much of the church has overly allied itself with capitalism. It often seeks to offer better ways for people to cope with the pressures of achieving individually, and strategies for more personal acquisition. Preaching on God's commandments are often limited to those which deal with individual sins, and we have a particular fondness of focusing on sex, usually someone else's.

However, we find that when the prophets speak to Israel for "three sins and for four," quite often they are being condemned for idolatry. This idolatry is intimately linked to not caring for the poor, the widow, the orphan, the foreigner in their midst. Such prophetic oracles, so often quoted around end of the world ideas, speak far more plainly and openly about taking care of those in need.

Jesus spoke of the purpose of following him as the love of God and the love of neighbor, acted out in concrete ways and with real bread, real care, and real relationships.

The apostles took caring for people as a matter of life and death in ways that the church has never been able to muster the guts to replicate since.

I believe if we are to be faithful as Christians, then health care has to be much more than a commodity to be used by those who can afford it and hoarded against those who cannot.

Unless we want to be Egypt, Babylon, or Rome. And by my reading of the Bible, those empires don't fare too well.