This reality is already known to many and yet I am often
startled by how many people do not seem to understand how the world of medical
coverage functions. I suppose if you've had a long-term steady job that
provided health coverage then you would have little reason to look into the
realities that many people face.
In addition to the states that haven't expanded Medicaid
coverage and as a consequence have left millions uninsured, there are the
privatisation schemes being advocated by Trump and the GOP. And then there are
all the loopholes or doughnut holes in coverage, and the various near mortal
clauses in the fine print which can bring financial ruin to even people of
reasonable means.
Contrary to the caricatured arguments of some on the Right, insurance
isn't about risk-benefit ratios. Not when it comes to health care. Insurance in
the United States is about access. I know it well because I lived for years
without it and was hung up on and did without a lot of basic things for many
years. Unless you have cash in hand, often for services that no one can tell
you what they will actually cost... you're excluded.
A lot of people don't realise Medicaid isn't just a programme
for the handicapped and those on welfare. The majority of people on Medicaid
work and there are specific requirements that demand it. If your kids are
school-age then you (as a mother) have to at least be seeking employment.
Additionally Medicaid also covers nursing home care for those who cannot afford
it. People usually don't associate Medicaid with senior citizen medical care
and indeed Medicare is the primary vehicle for dealing with those over 65.
However, nursing home subsidies fall under Medicaid. I wonder how many on the
Right lambast the programme and yet don't realise they're relying upon it for
their own parents?
The ACA or ObamaCare was a flawed system designed to favour
the insurance industry and yet so many holes have been poked in it, that it's
become gravely dysfunctional. This has been done deliberately, a result of
Right-wing politic maneuvers and powerful monied interests. The ACA will either
have to be shored up or discarded... although those in the industry have
candidly told me, that at this point such a move is pretty much unthinkable.
The system is already plugged into it, and has scaled itself to it and a sudden
elimination of the ACA would send shockwaves across the system leading to
large-scale bankruptcy. Small town hospitals are already suffering and due to
manpower shortages have to bring in outsiders to fill gaps. This is also
contributing to the billing disaster as doctors and services from 'outside'
groups are sometimes not covered.
Doesn't Medicaid interact with any hospital or medical
system? You'd think so and if it were truly a 'state' programme it more or less
would. But I know in Pennsylvania the Medicaid system has been privatised and
for many in the western part of the state, you really have only one or two
choices and for many there's only one choice.... UPMC, the University of
Pittsburgh Medical Center.
It's become the Wal-Mart of the region when it comes to
medicine. It's gobbling hospitals and medical groups so that unless your
insurance is plugged into UPMC, you're going to have to drive a long way to
find a doctor.
And since UPMC is one of the private entities which controls
one of the Medicaid plan options, many Medicaid users have no choice... it's
UPMC or nothing.
But then your local small town hospital might have to call in
a doctor from a couple of hours away to run the ER for the weekend or serve as
a hospitalist. Yes, there are doctor shortages and growing numbers of small
town doctors are unwilling to be on call, certainly not on successive weekends.
But these out of area physicians might not be plugged into the UPMC network and
the next thing you know you're getting a huge bill for thousands of dollars.
You went to a UPMC affiliated hospital but you weren't covered and no one told
you. It's happened to people around this area and like the AOL article, it has
broken and ruined not a few.
As far as forced sale of houses and that sort of thing, that's
been going on for years. As a consequence a lot of people are trying to gauge
their future and as they think they might be getting near the point of true old
age, constant medical care and perhaps a nursing home... they're transferring
their houses to their kids or giving away heirlooms early. Because if they wait
until they go into a nursing home, they may end up losing it all.... to the
state, or effectively (after moving some numbers around) to the private entity
that the state has contracted.
This is not a moral system and it's not one I could
participate in, not one I would want to take a nice paycheck from.
It's exploitative, usurious, dishonest and represents a
violation of the basic principles of medicine. Evangelicals are so busy crying
about the Hippocratic Oath vis-à-vis assisted suicide and abortion... what
about the foundation pillars of the system? The whole thing from top to bottom
is rotten and a violation of the so-called oath. 'Do no harm' is not a
functioning ethic within the US system which is built on a foundation of
profit. Profit and the actions of those motivated by it are hardly concerned
with a subjective category such as 'harm'.
It's perhaps ironic to some but as the article rightly points
out a lot of these changes were born of the Clinton Era 'Welfare Reforms'. The
supposedly Leftist president functioned as a Right-wing wrecking ball to some
of the foundation blocks of The Great Society. Some would celebrate this but
the irony is in that from the time Clinton left office and even up to this
present hour there are still people who think he was a Left wing operative and
a friend to the poor and working people. The Right absurdly still tries to
paint the pro-Wall Street imperialist president as a Marxist. The Clintons are
tale in corruption and I don't say that because I wish to grant an ounce of
credence to the rhetoric of Trump. Both camps are deplorable, hypocritical and
no Christian should have anything to do with either of them... or the systems
they represent.
I'm not an advocate of Classical Liberalism. I don't speak of
'rights' and don't apply such language to health care. However, medical care
should not be a profit-based industry. The very notion is immoral and usurious.
Capitalism is just as much part of the Liberal heritage. In this case the ideas
are conflicted and undermine each other, a signal that the system itself is
deeply flawed, dominated by inherent contradictions and divorced from reality.
I don't expect our godless avaricious society to fix this but
I also grow weary of fellow churchgoers being plugged into this system and
making out very well from it. I know that for the most of them, they're not
looking at the big picture. They were looking for a secure well paying job and
there's a good chance they have nothing to do with the rules, the numbers or
the money... although some are part of the bureaucracy and have daily contact
with issues of billing and access. I'm less sympathetic to these folks.
I urge professing Christians to take a step back and take in
the big picture, to see the forest through the trees. I've been arguing this
point for most of my Christian life and it's a large motivating factor in why I
write about these things.
Do I want everyone to quit their job? I know one PCA pastor
who seemed to think this is what I'm advocating.
That's not what I'm saying. But I am saying that Christians
should be willing and ready to do so. I'm saying that if more Christians
reflected on the system and applied Christian ethics to their decisions, goals,
finances and lives in general, then the status of the Christian Church in our
society would be very different. The Church would have a distinct identity. It
would not be part of the Middle Class or connected to the ruling order. It
would look very different and thus would function differently both in its
internal relations (fellowship and identity) and in how it interacts with the
world... a role of witness and antithesis.
For years I have contended that if the Church was faithful
and actually followed the Scriptures we would have had Christian persecution in
this country long ago. But the Church has sold out and compromised and everyone
signs on to this wicked system. Yes, we have to use Caesar's coin but it's his
and we don't flourish in Caesar's system when we render to God the things that
are God's, when we serve Christ instead of mammon.
Could Christians set up alternatives that challenged the current
medical order? And could this be done in other sectors? Of course. And I'm not
talking about all the medi-share 'ministries'. These are little more than band-aids
geared to the middling and upper classes and I consider them to be somewhat
fraudulent in how they represent what they're doing. I'm talking about
Christians becoming doctors and running clinics that actually cater to fellow
believers and perhaps the poor. But of course such clinics and doctors would
have to approach their work in terms of a 'calling' or an ethical and emotional
burden... not for wealth accumulation. Christians would also need to change
their expectations and overall philosophy concerning medicine. I realise there
are problems with university costs and the like. Yes, the system is broken and
badly at that. There are solutions but Christians are going to have to think
outside the box... something we're not even close to doing at this point.
At this point the Church isn't even 'in it' together.
Everyone is seeking their own and most play by the world's rules and as long as
that continues, not to mention the Christianisation of Middle Class values
(security and respectability), nothing is going to change.
In my own experience the Evangelical doctors I've encountered
have been the worst and the most mercenary in terms of payment. In frustration
I slapped down the mandated access cash at one office years ago just so I could
see a doctor that I knew was only going to give me a referral and a bill for
the balance. I had a work related injury but since I'm self-employed I was on
my own. I was treated like scum because I had no insurance. After handing over
the cash, in a state of frustration and despair I sat in the waiting room and
took in the World magazines and other Evangelical literature. I grew disgusted,
got my money back and left. I found some nice New Age semi-pagan doctor who
didn't demand cash up front and bent over backwards to help me out, even doing
a procedure (a cyst removal) in office to save me the costs associated with the
use of the surgery center. I had after a couple of visits paid about $100 and
when I went (post-procedure) to make another payment at her office I was told
the balance had been canceled. She liked me and apparently pitied me and showed
great kindness.
I of course rejoiced but at the same time it made me kind of
sick. I have continued to reflect on just what is wrong with American
Christianity and the Evangelical world. The boiled down answer is... it's not
Christian. It's baptised worldliness, backed up by centuries of corrupt social theology
and ethics. It's largely a fraud that is (in the end) probably doing more harm
to the true testimony of Biblical Christianity than anything else.
And it really comes out in the dog-eat-dog profit oriented
world of American medicine.
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