Welfare & Subsidiarity
November Tue 17, 2009
Sister Carol Keehan is the president and chief executive officer of the Catholic Health Association of the United States (CHA). In this interview with Il sussidiario, she describes the significant contribution of Catholic institutions to health care, especially for the poor, and the commitment to a universal health care plan which respects the dignity of every person.
Catholics play a large role providing healthcare in this country. Could you describe the extent of this commitment?
In the United States, there are over 600 Catholic hospitals and over 1400 other Catholic health insertions such as nursing homes, surgery centers, clinics, etc. One out of every six Americans who goes into a hospital in the United States goes into a Catholic hospital. This means that every day in the United States, thousands of people, of every race and religion, are cared for in our hospitals, nursing homes and clinics. Catholic healthcare is characterized by a commitment to services needed by the community, as opposed to services that are the most lucrative. Catholic hospitals are often the only hospitals in their communities and all Catholic hospitals make a serious effort to reach out to the poor, the materially poor and others who are poor because of their vulnerability such as the elderly or the disabled.
Increasing numbers of people are currently uninsured in our health system. What happens when an uninsured person becomes sick? And what happens in the case of an illegal immigrant?
Currently in the United States, there are well over 47 million people uninsured. There are millions more who are what we call underinsured, that is when they need their insurance, they find that it only covers a small amount and often not what they desperately need such as long term chemotherapy or major surgical procedures such as an open heart procedure or kidney transplants. When an uninsured person becomes sick, they often have put off treatment or tried to treat themselves and finally because they cannot get into a private physician’s office, either come to one of our clinics or into an emergency room. This often means that they have had a health problem that could have been resolved much more simply and with far less pain and permanent damage if they had been able to be seen earlier in their illness. Often when an uninsured person comes to an emergency room and is seen, they will receive prescriptions for tests or medications. Unfortunately, unless there is a good follow up system, often they don’t get the medications and/or the tests because they cannot afford them and their condition continues to deteriorate. The Institute of Medicine in the United States estimates that there are about 18,000 unnecessary deaths each year in the United States because of an inability to get timely and complete healthcare. In the case of a person who is not in this country legally, it is even more problematic. They are faced with the same dilemma of trying to get coverage and at the same time, fearing that they and/or their family members will be identified and deported or arrested. For both the citizen and the illegal immigrant, it is a very challenging and demeaning journey to even basic healthcare. Many clinics and emergency rooms try to respond to their needs with gentleness and quality care, but it is difficult to finance not only the initial care, but follow up testing and medications for these patients.
Some hospitals have closed because of a lack of insured patients. On the other hand, new for-profit clinics siphon off some of the better paying procedures which once helped the hospitals’ balance sheets. How can insurance reform help health institutions stay open and available for all those needing care?
Certainly one of the great benefits of Catholic healthcare throughout the years has been that the excess income from caring for patients who had insurance or private means to pay has been used to care for those who did not have the ability to pay any or part of the cost of their care. In addition, it has been used to bring new technology to a community and to keep programs that communities need but cannot afford because the programs don’t pay for themselves, such as psychiatric care. Many for-profit companies only do profitable services and locate themselves in neighborhoods that have a very small percentage of uninsured patients. Insurance reform as contemplated currently by the Congress would bring the number of uninsured people in the United States down from 47 million today to 18 million in 10 years. This would mean that there would be 29 million people who previously did not have insurance, but now do have some kind of insurance. Clearly some of the insurance they would have such as Medicaid would not pay the total cost, but would certainly pay for some of the cost of care and many of the 29 million who would have new forms of insurance would have commercial insurance that would certainly cover the cost of their care. These are often people who have worked for small businesses, who simply cannot in the current insurance market place buy insurance at a reasonable price. Having 29 million new patients with insurance will help hospitals in continuing to provide care for the remaining 18 million who will not have insurance.
How can healthcare insurance better cover more people? Is the public option necessary? Is there a role for cooperatives or non-profit health insurance groups?
As noted above, if 29 million people who had no insurance now have some form of health insurance, this means they can not only pay for the care they get when they are sick, but they can afford preventive care which will hopefully prevent many illnesses, as well as find health problems much earlier when they’re more amenable to treatment. The programs contemplated by the health insurance bill that is currently under consideration include making predatory practices of insurance companies such as denying coverage for pre-existing conditions and refusing coverage to certain people, as well as setting limits on the out-of-pocket expenses an individual can be expected to pay will all help particularly those patients who have underlying conditions such as diabetes and change insurance companies, it will help those who have serious problems such as cancer and when they reach a certain limit, their insurance company will have to continue to pay and the amount the patient will be responsible for, will be limited. A public option means many different things to many different people. Currently in the House of Representatives bill, it is defined as a program that would be available to about 6 million uninsured people who would not be eligible in the other kinds of programs and it would be required to negotiate rates with providers. One concern has been that would the public option simply be another Medicaid program which is well known for paying under the cost of care for patients. Because of this payment system, many patients cannot get in to see some specialists such as neurologists or oncologists. If the public program is a basic insurance program begun by the government, but paying reasonable rates slightly above Medicare, it would be very helpful for the patients and the providers. There is a role for cooperatives or non-profit health insurance groups and I think we will see more of them develop in the exchange. In addition, a number of for-profits will want to be able to be part of the healthcare market.
The bishops and CHA have asked for a plan that will respect all life and the freedom of conscience of healthcare workers. What needs to happen for this to be assured?
The bishops and the Catholic Health Association have said that respect for life from the moment of conception until natural death was an absolute requirement in health reform. We have both asked that no federal dollars be used to advance an abortion agenda and have looked to get legislative language that fulfils President Obama’s commitment that no federal funds will be used for abortion. We have also asked that conscience rights be protected for healthcare workers and institutions. At the present time, there is considerable activity in the House and Senate in trying to get language that does this but doesn’t go beyond Hyde. There are significant numbers of people who are concerned to be sure we get this legislative language correct and there is in the bill passed in the House legislative language that includes the Hyde amendment provisions. Whether this will be the same language used in the Senate and in the final bill remains to be determined. It is important that we work together with the legislature and the White House to get this language correct. There are reasonable conscience protections in both bills at this time, and we think that they provide the appropriate protection for conscience.
What are the most important features of the healthcare reform which the Catholic bishops and institutions are looking for?
First of all, that it respects the life and dignity of each person from conception to natural death. This includes not only not covering abortion and euthanasia, but it also includes giving healthcare to those who need it, not those who can afford it. Doing this in a respectful and high quality manner is essential. Doing it in a way that focuses on prevention and with special concern for the most vulnerable in our society is another important piece that we are looking for, that it is fairly funded and there is a sense of shared responsibility on the part of providers and individuals, as well as the business community. Several years ago, the Catholic Health Association, in preparing for health reform, worked together to develop our vision for what we wanted in health reform and it includes that healthcare is available and accessible to everyone, paying special attention to the poor and vulnerable, that it is health and prevention oriented, that it is sufficiently and fairly financed, that it is transparent and consensus driven, that it is patient centered and that it is safe, effective and designed to deliver the greatest possible quality care. We believe these are the essential components and have been working with our elected leadership to achieve that.
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