Life or Death

When Sarah Palin incited fear about “death panels” a few years ago, it struck a nerve with me. Not because I was afraid of healthcare reform, but because what she was implying already exists within healthcare in America. “Death panels” are the principles at work behind who gets treatment and who does not – not for lack of medicines, doctors, nurses or hospitals – but simply because one cannot afford to pay.

It was about a year ago when a member of my church became ill and was told she needed a liver transplant. However, because she was considered homeless she wasn’t eligible to be a transplant recipient. Lisa was not an addict – her issue was poverty. When death was imminent, she went into an in-patient hospice facility where she received more mercy in preparing to die than she did in fighting to live. Even that care was confined to a particular period of time - they could only keep her for so long without insurance. Her homeless friends spoke about caring for her in an abandoned warehouse – they all wanted to stay by her side. Mercifully, she died in a comfortable bed at hospice. She was 42.

When I travel outside of the U.S., I expect to hear stories like this. Poverty dominates much of our world and medical assistance is lacking in general. My conscience won’t let me rest, especially in a country where so many are quick to proclaim that we are a Christian nation. Letting people die when help is available is an affront to all faith traditions.

While politicians speak about repealing healthcare reform, I ask, “What will your solution be?” Healthcare is a problem in America. Look around you. At first glance, you may be able to quickly name 5 people who struggle with getting medical help – whether it’s because they have a pre-existing illness, are self-employed, are disabled or simply work for a large corporation that only hires part-time to alleviate having to pay benefits.

Some developing countries have great wealth held only in the hands of the few. These same countries lack social justice for the poor – creating an environment that depends upon the compassion of those acting from the outside. These systems weren’t built overnight. A system that marginalizes large numbers of people creeps its way in little by little. The “creep” began in the U.S. decades ago – a groundwork of apathy and blame on those who suffer is allowing it to grow.

Today, a young woman I know needs medicine that is not covered by insurance. It’s a preventive medicine and since she can’t have it, she’ll have to wait until she gets sick. Then whatever surgeries are required will be covered. For a country that has traveled to the moon, is this really the best we can offer?

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  1. JS says:
    In spite of the complexity of the health care issue, and because of the complexity, there is no easy fix, of course. We may have seen the regulation described relative to "the inability to sell insurance across state lines" and the inability for the self employed to pool to have access. Having experienced being one of those self employed, in the practice of medicine, our "pool" was accepted but then rejected when one of the members became quite ill and was an expense to the insurer. Since the industry loves to insure the well, it would behoove us to provide preventive care and education; to provide people with the means to access medicine for their hypertension, rather than pay for their subsequent stroke and disability on an emergent basis, and on and on. Health care reform is not introducing health care rationing....that has been happening in the private sector for many, many years now. It took years to see mammograms as an insurance covered tool for early diagnosis, the same with colonoscopy, etc. I can recall clearly calling for "precertification" for a young woman with a breast tumor who needed biopsy based on the clinical findings, only to be told by the representative for the carrier that she wouldn't qualify because she was too young to have cancer and didn't fit the profile because of her age! And then, hid from any liability for refusing by saying she could have the surgery; she would just need to pay cash! After lots of phone calls, records, tests and pleading, this young woman was approved for her surgery and did have cancer. But, that took advocacy on her behalf and persistence. Rationing is real and happens every day now, just as it has for a very long time. But, the rationing for those who have no access to health care is 100%---they don't have even a chance for advocacy. In an economy such as we are experiencing, even those who used to have health insurance don't now and we often end up losing any chance at being cost efficient because treatment is not instituted until the condition has worsened or become intractable. Everyone understands the need for research and development of drugs, new therapies, clinical trials and the like and a free enterprise system supports those very spite of cost containment rendered by contractual agreements by private insurers that cover medicines as well as Medicare Part D, the bottom line for pharmaceuticals has not kept their stocks from doing pretty well, even in this market, excluding those who have had huge settlements for liability issues. And yes, private insurers do make decisions, particularly for new drugs just approved by the FDA for less common diagnoses, that they either won't cover them or the rate of reimbursement to the drug company is at a low percentage of their charge (not cost.) So, health care reform, though imperfect, has an example to follow, not set. The concentration of power has many homes.
    Jan 14th, 2012
  2. KD says:
    You wrote that "some developing countries have great wealth held only in the hands of the few." I don't think that wealth is as great a threat as the concentration of power in the hands of a few. Before healthcare reform there were around 1500 insurance companies in the US. Power in the hands of state governments kept the choices for people to in some cases less than 5 because these companies were not allowed to sell across state lines. The "powers" told self employed were not allowed to pool together to have the same purchasing power as large companies. These powers dictated what the companies had to offer. Now the power of the federal government will dictate to all companies what they must cover, what they can charge and through electronic records what treatments will be covered. A 15 member panel will determine these treatments, not someone's wealth, an insurance companies policies or a large donation from a church to help one of it's children. When the power of these 15 people says that men won't get PSA screenings, women can't have Avastin for breast cancer , or the old and disabled aren't as worthy when resources are scarce (read the white house health advisor's "complete lives system") couldn't this be considered a single death panel on steroids. When HHS said last August that all policies in the US MUST offer free birth control there naturally HAS TO BE less money for transplants and preventative medicine. Another factor is pay to doctors which will now be controlled by the new "power" in Washington. Is it fair to assume that all doctors will work for lower wages. Even churches adorn themselves with pipe organs and beautiful stained glass, etc not giving it all to the poor in their midsts so why should doctors be singled out for wage control. What new treatments, procedures and medical devices will never be discovered because the risks aren't worth the reduced compensations. Many things that we all take for granted today were developed because the rich could afford to pay for them when the costs were out of reach. If the 15 member panel existed decades ago and decided that certain HIV/Aids drugs weren't cost effective or the pharmaceutical companies couldn't make enough money at government rates to recoup their development costs how many milllions would be dead today in developing countries? You wrote "These systems weren’t built overnight. A system that marginalizes large numbers of people creeps its way in little by little. The “creep” began in the U.S. decades ago" As the power over our lives is hoarded by people in government ask yourself why they want to get rid of our motto "in God we trust" or why they leave God out of the pledge or quotes from our Declaration of Independence. You said "letting people die when help is available is an affront to all faith traditions." There are not unlimited resources. Not everyone can get unlimited treatments. The money is not there no matter how much we wish it was. I believe that a greater affront to all faith traditions is allowing the powerful few to become the "god" in people's life.
    Nov 18th, 2011
  3. Dale Lature (@dlature) says:
    Great post Nancy. I was especially struck by your description of the "creep" that began in the U.S. We are now seeing the inevitable backlash of our decades of inattention to the "creep". I am especially inspired by the waking up of churches to the movement. Health Care is a major issue that I hope will become a larger and larger piece of the Occupy movement. And it will, the moment the present trends of cutting infrastructure and ignoring health care as "justification" to tax cuts and subsidizing the rich and corporations. It's been happening for a while now, of course, but OWS should be looking for that showdown between further funding the richest and paying attention to health care.
    Nov 20th, 2011
  4. Michael Airgood says:
    Thanks for a great article. As a United Methodist who happens to be part of the occupy movement (I was arrested on the Brooklyn Bridge with 700 others protesting corporate greed and influence in politics) I can assure you that many in the movement care deeply about health care. Many of us have lived without insurance and know how scary it is to feel powerless in medical situations. Thank you for bringing more attention to the issue of health care as it pertains to the millions of Americans living in poverty: the millions of Americans we are in ministry with!
    Nov 21st, 2011

Neelley Hicks

A United Methodist Deacon, Neelley Hicks is a Special Projects Manager for Rethink Church, and Change the World at the United Methodist Committee on Communications in Nashville, TN.

About This Blog

Read and comment on a range of personal reflections and perspectives about poverty and Ministry with the Poor. Our goal is to attract diverse voices and points of view from United Methodists and friends, including people and communities living in conditions of poverty, other experts, religious leaders, community organizers, advocates, policy makers, volunteers, and all engaged in Ministry with the Poor.