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For all the hemming and hawing over health care for the past year, medical ethicist Larry Churchill says the moral dimension of the debate has taken a back seat to political “sloganeering” and distortion.
Professor Churchill, the Ann Geddes Stahlman Professor of Medical Ethics at the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center, will speak Sunday at the University of Tennessee at Chattanooga on the historical and cultural factors underlying resistance to universal coverage and reform. He said he also will explore “what is at stake economically and ethically in the debate on health care reform.”
Q. What is the greatest barrier to health care reform in the U.S.?
A. The current system, and the fact that it accounts for such a huge amount of our national economy, and that a lot of people are making a very good living off of the way the current system runs, so there’s real reticence to change it. That’s a very profound barrier. … (Also) in 1965, we decided to insure elderly as a distinct population (by creating the Medicare program.) Because of that, they have been essentially removed from the debate as advocates for reform. If you take a segment of the population that is very needy and uses a lot of health care and … put them on the sidelines, then the debate becomes very different.
What are some of the cultural issues at the roots of the resistance to reform efforts?
I think most people don’t understand how health care works. They don’t understand the insurance system, and they don’t think too much about the kind of care they have besides their own needs or the needs of their immediate family, and maybe some close friends. But it’s thought of as a local problem, an individual problem, rather than as a social question.
(There’s also) massive distrust of government, but that’s ironic because, of course, the best-loved program is the government-run program for the elderly, Medicare.
How did our current employer-based system of health care develop?
When wages and prices were frozen during World War II, a decision was made that health care benefits wouldn’t count as an increase in pay. And so this is something labor unions began to bargain for and therefore health insurance became tied in a profound way to employment. … The employer-based system became the norm and then the government began to respond to people who were left out and who private insurers didn’t want to cover, because they weren’t profitable. The elderly were one, the poor are another.
As we begin to patch up around the edges of the basic employer-based system, inevitably certain groups are going to be left out and it’s roughly those people who are in poverty but aren’t covered by Medicaid and people (earning) two to three times the poverty level.
To what degree has a moral argument emerged in the health care debate?
Not enough, but polls repeatedly show that the American population generally understands the moral dimension of this. They don’t think about health care as a consumer good. They think about it as a very important kind of service, something like public education, or access to public utilities — the things that any decent society is trying to make provisions for how people can get access to it. … I like to put it in terms of what any decent society is trying to do for its citizenry, which is provide basic opportunities for advancement and just to enjoy the benefits of being as healthy as you can.
What do you think should be included in reform?
IF YOU GOWhat: Seventh Annual George Connor Lecture at UTCTopic: “What Is Really at Stake in Health Care Reform” by Larry Churchill, medical ethicist from Vanderbilt University Medical CenterWhen: 3 p.m. SundayWhere: Benwood Auditorium in the UTC engineering building, at the corner of Vine and Palmetto streetsInformation: Call 425-4627
We have a system in terms of fee-for-service which rewards doing more, it doesn’t reward quality. … There’s just a ton of waste in the system, and we need to address that. Otherwise, insuring another 25, 30 million people is just going to escalate costs. We need to do something about not only what we’re paying, but what we’re buying.
How have the past six months of debate — from the town hall meetings to debates in Congress — affected your view of the reform process?
Sometimes I think we’re just completely ungovernable as a people. We seem to take pride in our ignorance of issues and latch on to ideological positions. The amount of misinformation out there is just daunting. … Just tremendous distortion of the issues by people with vested in the current system. The Democrats are just as guilty of this as the Republicans are, I must say, in terms of sloganeering, (meaning) oversimplification and distortion.