Prior to 1973 profiteering within the Health Care industry was illegal, a fact fairly known and dealt with in the arena of institutionalized public health. The 1973 Health Maintenance Organization Act under the administration of Richard Nixon changed the playing field. Many older physicians placed the care of their patients first until political and economic decision-making changed the medical landscape. New physicians graduate from medical school facing loans and the prospect of financing equipment and staff just to open a practice at an astronomical cost. Where is the middle ground? As a trained ethicist I have spent a large segment of my life thinking about “what is…in light of what ought to be” which is the definition and defining task of an ethicist. The immorality of greed in the healthcare system will not only put at risk the lives of many vulnerable citizens of this land but will also result in the demise of many. Can you imagine how many persons will die because they cannot afford a MRI, CT Scan or thorough physical exam to pinpoint life-threatening diseases? This brief statement borders the realm of medical ethics.
Is affordable Health Care for profit the foundation for a new genocide in a nation that can afford to do better? If the British can take care of their populace through socialized medicine, so can we. My theological mentor, the late Bishop OT Jones, Jr., who was a Pentecostal Christian existentialist, once told me “that if there is a major crisis in a church, in most instances it can be traced back to leadership.” I have never forgotten that delicate wisdom from the past. The same holds true for a nation in crisis. Henry Wadsworth Longfellow was right when he remarked, “the mills of God grind slowly, yet they grind exceedingly small… though with patience He stands waiting, with exactness grinds He all.” Is it immoral to earn a reasonable salary? Of course not. Is it immoral to live in an upscale neighborhood? Of course not. Is it immoral to formulate a marriage between major Health Care providers and the insurance industry for proprietary reasons so that the most vulnerable of the land will die prematurely because of the price tag on health care? With governmental involvement, it is not only immoral, it is irresponsibly sinful and reprehensible.
The revamping of the Affordable Health Care Act (Obama Care) under a new name (Trump Care) is merely switching labels on the same reality. The late William Temple once remarked that the modern world reminded him of a department store where someone crept in overnight and switched all the labels. They placed cheap tags on expensive items, and expensive tags on cheap items. In our volatile political environment anyone can die, and especially our poor and less vulnerable without simple health coverage in a nation that boast of being the greatest in the world. My warning and admonition is to be cautious, this may be the foundation and makings of a new form of genocide.
Richard Exley, stated in his book, The Peril of Power: “if money is your motive for ministry, you are already corrupt even if you never steal one dime.” The same rationale transposed to the Health care industry achieves the same negative outcome. Where are the prophetic voices of mega-ministry leaders ? Who will speak on behalf of the poor and oppressed since God “hangs out” with them? Unfortunately, what we call “prophetic” has come to mean “pathetic.” It is no wonder that Amaziah complained of Amos the prophet in Amos 7: 10 that “the land cannot bear to hear his words.”
Many older physicians believed that they had an obligation to take care of patients and that the primary issue was not how am I going to get paid? Such a person was David Molina a California physician who started his health insurance company focusing on quality care for poor and disabled patients on Medicaid. By attracting fewer doctors to Molina Healthcare network he was able to earn a modest profit during the first couple years of Obamacare. It is known by Industry analysts that several big firms like Humana, Aetna and UnitedHealth, et.al. lost money initially under Obamacare. They sustained losses because they did not focus on a simple reality, i.e. it is much easier to work down from a higher-cost posture than it is to work down from a higher-cost position according to Josh Weisbrod, a health care consultant with Bain and Company. Because of the competitive nature of the insurance industry, more business regulations are needed to insure a level playing field.
However, what is common practice in the medical arena is that insurers boldly make it clear on an insurance application that they would rather insure healthy clients rather than those with pre-existing conditions. Insurers and politicians continually struggle with making sure people have basic insurance coverage and figuring out who should pay. In 1973 when the Health Maintenance Organization Act A73 was introduced to Congress by surrogates of President Richard Nixon, insurers were told to merely treat the symptoms and not the cause because it was less expensive. Mandated clauses encouraged providers to prolong illnesses because there is no money to be made in curing the sick. * Nixon was rewarding his campaign financier, Edgar Kaiser CEO of Kaiser Permanente, all with government subsidies. This law enacted by Congress made it possible for medical insurance agencies, hospitals, clinics and physicians to begin functioning as for-profit business entities instead of the service organizations they were intended to be. Have you ever wondered about the proliferation of referrals, tests and prescriptions from a primary physicians to specialists and the plethora of over-treatment schemes for a common illness.
From 2013 to 2015 the top five insurers of the Health Care industry doled out nearly $30 billion in stock buy backs and dividends. Most of us will not forget the Martin Shkreli,a former hedge fund manager with Turing Pharmaceutical fraud case where a much needed 62 year old drug Daraprin that increased from $13.50 a tablet to $750 overnight.** Greed caused the Industry to enact a business strategy of buying old neglected drugs and turning them into high-priced “specialty drugs.” During testimony before a Congressional hearing on the drug, Martin laughed and displayed an arrogance that earned him jail time.
Disease means dis-ease. There are some diseases that medicine cannot cure. They are diseases of the human spirit. Avarice is excessive or insatiable desire for gain, money and possessions…it is old fashion greed…It was listed as one of the “seven deadly sins” during the Middle Ages. I find it rather ironic that upon graduation physicians are required to recite the Hippocratic Oath as a symbolic entre into the arena of medicine. A substantive embrace of this oath is needed to offset the fangs of avarice in our culture. Sin is a misuse of one’s freedom. The church is not exempt from the charge of avarice.
“Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play God.” ***
During the mid-eighties I served as a Board Member for six years with Watts Health Foundation United Health Care, the largest HMO West of the Mississippi whose primary demographic was low income clients in Watts an adjacent community of Los Angeles. Dr. Clyde Oden was the consummate and most capable CEO of the Non-Profit aspect of the operation that employed a fee-for-service modality. United Health Care was the proprietary component of the operation. We had multiple retreats and the opportunity to lobby Congress on behalf of a vulnerable demographic.
During the mid 2000 I was recommended by Bishop Gerald Glenn, New Deliverance Evangelistic Church in Chesterfield County, to serve as a member of the Virginia Board of Medicine. Governor Mark Warner (currently member of the Senate Intelligence Committee) appointed me the last week of the year. During my six years of service I was exposed to the worse kinds of abuse of the system by people who wanted to manipulate it for the purpose of excessive greed. The optics of the Oval Office under the leadership of 45 and his all white crew is focused on avarice for his friends and family. Dr. Ben Carson a retired brilliant pediatric neurosurgeon should come out of the basement and make the photograph with the Oval Office team, since he is over HUD. Unless he is too busy perusing dated books on poverty which was then defined as “a state of mind”(Wirth). Poverty as “lack of fate control” (Claerbaut) would be an improvement. These old “blame the victim” definitions exclude poverty as “lack of access and opportunity” for people born in ridiculous and incorrigible circumstances.
** see Andrew Pollack, Big Price Increase for Tuberculosis Drug Is Rescinded, NY Times 9/21/2015
*** Revised Hippocratic Oath in 1964 by Louis Lasagna. Academic Dean of the School of Medicine at Tufts University
Dr. Leonard Lovett, Chief Editor, theologian-ethicist, author, ecumenical officer, emeritus, COGIC