What to look for in each presidential candidate’s proposals for correcting our country’s health-care system.

Rachel Fecho understands how it feels to be without health insurance.

She is a busy mother of four children under 7 years old, including 2½-year-old twins. When I met the Fechos in October 2006, Rob’s job offered group health insurance at the individual’s expense. With Rob’s salary of $9.50 an hour, the insurance premiums would have left little money for food and electric bills. Because of the low salary, their children were eligible to receive care from Medicaid. However, Rob’s salary was too high for the adults to qualify for Medicaid, and Rob and Rachel went without insurance.

Fecho family (left to right): Lara, Rob, Nathan, Rachel and Maya, Isaiah

Fortunately their health was good—except for Rachel’s bouts of depression. In order to save money, she looked for cheap medicine for herself through the Internet but was fearful about taking medicines from this source. There was also the nagging fear of an expensive illness or injury, a fear shared by her parents.

Eighteen months later, Rob had a job that provides health benefits at lower cost to them. At Rob’s current salary level ($23,000 per year), the children continue to qualify for Medicaid. Rob and Rachel are covered through the employer’s insurance.

Rachel is well aware that their story is not unique. The Agency for Healthcare Research and Quality says more than 60 million people will be without health insurance for some portion of any 12-month period. Studies show that 78 percent of these families have at least one person with a regular job. The number of businesses that supply employee health benefits has decreased from 69 to 60 percent during the five-year period, 2000-2005. In the same period, insurance costs went up 59 percent while salaries increased only 12 percent. More than 50 percent of personal bankruptcies are due to medical bills.

In spite of the highest per capita health care costs in the world, we are getting inferior results. A recent World Health Organization report ranks the United States 47th in life expectancy and 23rd in infant mortality. Eighteen thousand people die unnecessarily each year due to lack of health care.

Despite the wars in Iraq and Afghanistan and the public concern over the economy and immigration, anxiety over health care remains high. The presumptive presidential nominees, Senators McCain and Obama, agree that health care in this country is failing and in need of major changes. They have outlined their approach to bring relief to families suffering from lack of health care. As individual citizens, we need to become aware of what is being proposed so that our vote will be informed. What do I look for in the proposals?

1) Is there a commitment to providing health care for all? Does the plan provide for basic, affordable health care to all without any refusal due to poor health or financial ability to pay?

With health care for all, no longer will people be refused health care because they don’t have insurance. No longer will people be excluded from health care because they have preexisting health issues. No longer will people delay needed health care because they don’t have insurance. Mothers will not be faced with making a choice between food and medicine for their children. Families will not have the added financial stress of caring for mental illness of a family member. People of color will not need to worry about inferior care, as is now the case.
Such a plan will share the cost of catastrophic health problems with those who seldom need health care but need insurance for those rare times when illness or injury occurs. The costs for all are shared by all. This system would assure health care for the poor and equal access for people of color.

2) Is there a commitment to preventive care, public health and wellness promotion? Education is a key to reducing the risk of disease and chronic diseases, such as obesity and diabetes. A healthy environment is essential to improve the health of individuals, such as efforts to control pollution and provide hiking trails. Self-responsibility to make healthy choices will require education and incentives. Think what it would mean if half of the present advertising for medicines (now $4 billion a year) were given over to the promotion of good health habits. Perhaps we could adopt a different motto than “Ask your doctor if this is right for you.”

3) Is there a plan to simplify the health care system and reduce cost of services? Anyone who has had an extensive illness knows the stack of bills that arrive from all sources. Does the proposed plan simplify the system of billing? By simplifying the system, we will lower cost of administration. Currently, the cost of health care administration is over 25 percent. Medicare, essentially a single payer system has administrative costs of 4.6 percent.

When I was hospitalized several years ago, three different staff members asked me the exact same questions about my medical and family history. The last interview was at 2 a.m. There was no way to share the same information. Readily available medical information would streamline care and reduce costs.

4) Does the plan combine private and government services in ways that utilize the strengths of each to provide quality health care for all at a reasonable cost? Solutions to the health-care crisis will require the best efforts of both government agencies and private companies.

In considering the best way forward, we need to keep uppermost in our minds that the goal is to provide quality, affordable care to all. That approach will keep the necessary focus as there is jockeying for position and advantage among government and private concerns.

In 2006-07, I served as the manager of the Healthcare Access Initiative of Mennonite Church USA. In that capacity I heard the stories of the problems of access, cost and quality of health care. These experiences are widespread. Many experts now see the need for a major overhaul of the system of health care. New sparkplugs or a new set of tires won’t do.

There is a growing interest in a single-payer system. Anyone who was hospitalized knows the stack of bills from the hospital, laboratory, surgeon, anesthesiologist, physical therapy—and the list goes on. A single-payer system, such as Medicare, would eliminate the many bills. All bills would be submitted to a central agency that pays the bills. This system could be organized on a national, regional or statewide basis.

The single-payer system has been endorsed by professional doctor groups, the Council of Mayors and many labor unions. The General Assembly of the Presbyterian Church USA, in endorsing this concept, said that single-payer universal national health insurance is “the program that best responds to the moral imperative of the gospel.”

Is it possible to establish health care for all? In 2007, a New York Times survey showed that 54 percent of Americans feel health care is in need of major reform. Sixty percent said they would be willing to pay higher taxes to fund a system of health care for all. Taking note of the 95 percent approval of Medicare among seniors, 18 cosponsors introduced a bill in Congress (See HR676.org) entitled, “Medicare for All Act.” It would extend Medicare-like benefits to everyone. A grassroots movement of support will be essential to its passage.

Another example: Taiwan recently established a program of health care for all. A blue ribbon panel of medical experts surveyed seven national healthcare programs. Ironically the Taiwanese program most closely resembles Medicare. See http://www.guardian.co.uk/commentisfree/2007/oct/07/taiwangetshealthy.

How can we be better informed? Delegates at the San José 2007 convention received a copy of a small booklet, Healthcare Access: Public Policy Advocacy Guide. The committee that prepared this booklet suggested three uses for the booklet: as a means to talk to other church members and to our neighbors about concern for the problems of health-care access, as effective ways to speak to government consistent with Anabaptist theology, as a yardstick to measure proposed solutions to the health-care crisis. I recommend reading this booklet available free from Mennonite Church USA offices or online at MennoSource: http://os.mennoniteusa.org/

To know the Fecho family is to covet for them the same kind of health care I enjoy under Medicare. To know Rachel is to realize there are millions of Rachels—mothers who only want their child to have a chance in life. Basic health care is a necessary part in making that possible. We all have a part in providing health care for all. We can all become a part of a society that cares for the least among us to provide health care for all.

Glen Miller, a retired physician, directed the Mennonite Church USA Healthcare Access Initiative in 2006-2007.