Daily Bread and Medical Care

I have been thinking about how to fix health care, and the injustice in it, which now seems outrageous to a majority of people. The underlying question is whether health care is a right or a privilege, and whether there should be a uniform standard, or gradations of care which respond to money. Because we can't get the minimum wage up, and because we tend to believe that everyone deserves to have the best care available, we have rising costs which will make it untenable to give "basic care" to huge numbers of people. In other countries there is an acceptance of the problem that there are not infinite resources, and that some unfairness is going to occur. I am afraid of an increasingly complex bureaucratic system; over-legislated, and very cumbersome. While the government threatens to lower the Medicare payments to docs by more than 30 percent over the next 6 years, the costs have been rising at 12-20% per year. Also 36 governors met to try to decide what to do with what the feds won't cover. In California, the elderly now account for 12% of Medi-Cal, and it will go to 20% in the next several years. We have the lowest payments for Medi-Cal (Medicaid) in the entire USA. The California budget is the seventh largest in the world, and we are running with about a third of the budget costs in shortfall from inadequate taxes. So the pressures are extreme, and no single answer is going to solve them all. We are the "canary in the coal mine" for the whole US system because of the extremes of overhead costs and low payments here. I hope we get national structural malpractice reform, and insurance regulatory relief and support. The highway robbery of the insurance companies, giving money to Wall street and investors, is unconscionable. Health care should be regulated as a sort of "Public Utility". One idea is a "Federal Reserve Board of Health" which would help to distribute the health-care "pie" more fairly. But we are still left with the aging population, more sophisticated medications and diagnostic and surgical options, and the question about when resources need to be evaluated against some scale of cost-effectiveness; and norms for how much we should pay for things which will give minimal gains in treating patients at end-of-life.
Also, we have a lot of people frightened to death that they will have no job-security and health-care benefits as they age. Last year the new workers at top companies wanted lots of guarantees of job security, retirement benefits, and health-care fail-safe contracts. Currently Boeing employees are striking for union job security-- as the company wants to outsource jobs to non-union workers.
Meanwhile I listen to Rachel Remen, MD, my mentor for patient-centered care and wisdom, and I watch and try to learn from my own patients. We all will die, and for some of us, it is coming soon. We all want to be loved, respected, handled with dignity, and given a voice in our care. We need to be "witnessed to," and to share our common humanity. We want someone to hold our hands and kiss us good night. We need pain medicine when things hurt. It is amazing that we sometimes have "redemptive" insight, when our own suffering is seen in a context with others' suffering. There are so many people who feel their victimization, yet very few who seem strong enough to look beyond their personal sufferings, to care and help by being the nurturers. The women are working, and can't come home, and lose their benefits and seniority to nurse the aged, infirm and sick in their families.
In my opinion, one of the most important functions of Jesus as a human person is to make us all have a larger-than-self paradigm of life, in which our uniting ourselves to Christ's redemptive purpose allows us to look beyond our own well-being and selfish interests. Uniting ourselves to Christ gives us a way to make sense of our experience, both sufferings and joys.
Recently at Mass, I was touched by how many of us see ourselves "in community" there. It is the only place not work-related, where large numbers of people meet-- which is not shopping. To many of us, it appears that the real religion in our country is shopping! Father Ron mentioned a couple going through the excruciating suffering of a stillbirth. She still had to go through labor, when he left the hospital that morning. He asked us to keep this couple and their family in our prayers. Aggie, who has diabetes, was overcome with grief for this family. She was brought out of her focus on her own pain, and her family's problems, in thinking about this couple's pain. Father said we all come with our struggles, with imperfect choices, with our problems, acute and chronic. We come to be fed, and to be healed by the only source of real peace; peace the world cannot give. We come to ask for daily bread and daily help in our struggles, and we ask for this help for each other, also.
One of the baptismal questions, which strikes me as more and more apt, is "DO you reject the glamour of evil, and refuse to be mastered by it?" I would like to say that I have always recognized and refused to be mastered by the glamour of evil, but since it usually is ego-enhancing glamour, it is hard to renounce it, even to recognize it. In my experience, glamour always masquerades as a great good, and is very tempting. I frequently have been taken in by the glamour of evil. Giving up glamour is hard. And then there are the other things I need to be forgiven for, and to actually ASK forgiveness for. Snapping turtle behavior. Entitlement. And darker feelings. The easy road to cynicism and resentment. The fast road to selfish concerns. I just could not make it a day without faith. Not triumphalism, but the kind that is begging for daily bread, daily help. And it somehow seems more true, when we are not asking each for ourselves alone, but we are standing there holding hands, praying and asking for these needed goods for all of us together. To believe we are children of the same God is to realize that none of us has more right to having our needs met than any other of our siblings. And perhaps that is the beginning of an understanding of justice and charity.