On Thursday, September 10, 2009, Dr. Michael Brown and I attended a lecture on health care reform at Central Synagogue. The lecture, “Navigating Through the Scylla & Charybdis of National Health Care Reform,” was made available for religious leaders through Partnership of Faith in New York City. With remarkable perspicuity, The Rev. Dr. Walter J. Smith, President & CEO of HealthCare Chaplaincy, presented the many challenges as well as the ethical and moral imperatives of the current debate on health care reform.

The wonderfully apt image—drawn from Homer’s Odyssey—“between Scylla and Charybdis” (or “between a rock and a hard place”) has come to mean “being in a state where one is between two dangers and moving away from one will cause you to be in danger from the other.” Regarding health care reform, Dr. Smith says: “Scylla: what some of us currently have (and many don’t) and increasingly can’t afford; Charybdis: how we are proposing to change it and pay for it.” This is obviously a very complicated and sensitive debate.

In The Washington Post (8/26/09), Professor James A. Monroe of Brown University writes that this debate rests on honest philosophical differences: “basic rights vs. market competition, communal good vs. private responsibility, government provision vs. private insurance.” For me personally, the debate goes beyond philosophical differences between political groups or a hotly contested battle for “political control.” I would like to think we all know what’s at stake in these debates. Is it not our right to be afforded health, wholeness and human dignity, no matter who we are or where we live?

There are many who resist a renewed system of health care that is inclusive, accessible, affordable, and accountable. Why? Dr. Smith writes that there is a “deep fear of both the notion that individuals would be better off fending for themselves (the conservative impulse) or that the federal government ought to take over the job (the liberal impulse).” Basically, these two approaches tend to scare people. Moreover, many Americans remain deeply skeptical that our government has the ability to do anything right. For example, it is no secret that Medicare and Medicaid are both under the auspices of the government and have, at times, been guilty of wasteful spending and fraud. One could legitimately question whether our government, given an even bigger role in our health care system, would be able to “deliver the goods” on reform.

A recent survey by the Gallup reported that 36% of Americans expressed confidence in the medical system, ranking it in the middle of the broad range of American institutions that were tested. But a mere 17% said they have confidence that Congress could effectively overhaul our health care system by setting new standards and policing the market.

Health firms, drug companies, hospitals, and others within the current health care system have also been impervious to change. Why? Because they have invested significant amounts of money into their businesses and products, they will defend their positions until the very end. Such groups have a direct economic stake in the system and are obviously hesitant to take a “leap into the unknown.”

In Dr. Smith’s “Health Care Reform: A Compendium of Key Issues for Religious Leaders,” we are given the following facts:

1. The US has the most expensive healthcare system in the world, spending approximately $2.4 trillion last year (2008) on health care. It is almost twice as expensive as every other developed nation.
    
2. According to the most recent data (August 2009) from PricewaterhouseCoopers’ Health Research Institute, about half of that amount ($1.2 trillion) is waste—too many tests…inefficient claims processed… people ignoring doctors orders… ineffective use of technology… hospital readmissions (i.e. elderly patients discharged too soon), medical errors (i.e. ensuring correct dosage of medications in hospitals)
    
3. The US leads all industrialized countries in the share of national health care expenditures devoted to health insurance. The share is over 30% greater than Germany’s and more than three times that of Japan.
4. The costs of insurance administration alone in the US health care system totaled nearly $156 billion in 2007, and that figure is expected to double—to reach $315 billion by 2018.
    
5. Administrative costs to provide health care is in the US account for 19-25% of all dollars expended in taking care of people.

If you would like to read Dr. Smith’s Compendium, please visit the HealthCare Chaplaincy website.

How can we be satisfied with the status quo of US health care and health care insurance? We know the health care system in America is broken, ineffective, frustrating and ridiculously expensive. We complain about it all the time. We know that one in six children and non-elderly adults in our country have to live sicker and risk dying younger because they cannot get needed health care. We know that medical expenses can be a cause of financial ruin for families, individuals, institutions, businesses and governments. We know discrimination is wrong and that all people should be able to receive quality health care regardless of race, socioeconomic status, pre-existing conditions, sexual orientation or place of residence.

The bottom line: we must find a way to provide quality health care for all Americans! It needs to be affordable, restraining the growth of health care costs, effective, improving quality of care, and accountable, avoiding corruption and wasteful spending as it surfaces. Let’s not forget that we can do better as individuals as well. We should be repulsed by the rising “health crisis” in America and take better care of our own bodies, to the best of our ability, and care for one another regardless of individual circumstances.