Oh boy. This might be a better in-person conversation than a blog-comment conversation, although since I talk and think about it every day at work, I am really over discussing it in general.

Full disclosure to your readers who don't know me. I work for a health insurer, but my views have pretty much always been what you see below and have not changed in the past two years. Also, so I am covered legally, anything I say is my opinion and not necessarily the opinion of my employer (which I do not name on public forums because this is my private life). I only represent myself. Plus I like to keep things civil, so if you disagree, let's do it nicely.

Let me start off by saying that there absolutely needs to be healthcare reform. Note I said healthcare and not just health insurance. I feel Obama's shift in language this fall was very detrimental to the whole process. When the cost of healthcare is driving small companies out of business, large companies overseas and placing people in the position of choosing to pay for insurance or heat or a home there is clearly a problem.

However, the problem and the solution are not as simple and clear cut as Baucas,Obama and Pelosi would like the American public to think. It is not simply a matter of creating a magical public option, punishing those evil health insurers and mandating costs.

The fact of the matter is that the ENTIRE system is broken. Insurers charge A LOT, providers do an insane number of unnecessary tests simply to cover themselves from malpractice charges or to increase the money they make and the American public does not take good care of themselves (and I include myself in that group). Even with all of those problems, the public only wants to address what seems easiest. If you don't know how the health care system works (and I'm not implying that anyone reading this doesn't, but many Americans don't know the ins and outs), it is very easy to say, "Okay, we need a public option. Insurance for everyone. Let's do it now. Immediately." After all, that is the American way. We're not good at delayed gratification.

The problem is that the public option will probably only make the public happy for a short time before they turn on it. When you can't see the doctor you want; when he or she won't order the test you want; when you can't get a prescription for pills to fix your problem; when you can't have what you want, when you want it, John Q. Public who previously had health insurance but paid a lot for it will be far less keen on the public option. Anyone remember the HMO era? Anyone really like that? It's kind of like that, but on a larger scale. I know people who pitch a fit because their insurer wants them to take a generic rather than a brand name pill. Are they really going to be happy when everything is fed through a system with much tighter controls (in theory)?

Plus, I'm not sure that current reform will really address the underlying issues that create a lot of our healthcare cost issues. Is it going to fix the obesity epidemic that is causing an incredible spike in diabetes and heart disease? Is it going to make healthy food cheaper for people who desperately need it? Is it going to offer the education that we need so that people understand how to make better choices? Is it really going to provide the emphasis on preventative care we desperately need?

Plus, will this new system be attractive to people in the medical field? Will they still want to be in the field? All medical professionals (and yes, there are more than just doctors and nurses)put in a lot of time and effort to learn the skills they need to keep us healthy. Doctors pay big bucks for their education and they need to make money to pay off their debt and pay for malpractice insurance. Many doctors do not currently accept Medicaid patients because they are imbursed at a much lower level. Do we really think that if the majority of people move to this system that people are going to want to enter the field? Where will we be in 25 years when the demand for care far exceeds the amount of people who provide that care?

I could go on and on (really, I am on a big tangent now), but I need to actually go do my real job. I won't say that I have all of the answers, but I do think that creating a viable safety net would be a better option than some of what is currently on the table.

Miles, I completely agree with you on the more holistic approach to health care and lowering the cost of medical school and malpractice premiums. I don't agree with your stance that it is better to be agressive and let future public officials fix the problems that pop up. I think it is better to roll it out right the first time rather than rush to a solution that won't work.

Some of my biggest concerns were summed up nicely by Kristy, but in addition...

the power this gives our government (via the Health and Human Services Secretary) is extremely alarming. Just reading the first 100 pages told me that and I think the American people (as a whole) are unaware of all the ramifications this bill holds for us as a nation and are rushing head first into what will prove less effective than current healthcare. Also, the fact that tax payer funded abortions are being pushed in this bill is extremely disturbing to me.

I also meant to add that I am in support of health care reform, just not in support of this bill AT ALL. (I am noticing that I leave things out when I am sleep deprived- I probably should refrain from commenting for the next few weeks or risk incoherency) :)

I agree that health care coverage is not the only thing that needs reform, but agree with you Miles that we desperately need reform.

What is Scandinavia - that by all accounts has universal healthcare and better health outcomes AND they are not living under tyranny as so many fear would happen - what are they doing that we can't?

I will admit to having a hard time when I hear Christians who are oppposed to 'government-run' healthcare (which is a bit of a misnomer) but aren't willing to help people out themselves. If you don't want the government messing in it, and you aren't helping people yourself, exactly what do you think is the answer?

BethAnn,
You are right that Christians aren't fulfilling our calling- I am opposed to "government-run" healthcare (especially in the current proposed form) as the church SHOULD BE playing the biggest role. However, I am very wary of allowing the government that privilege.

I just oppose government controlled healthcare because I don't think they'll do a good job. We don't have a great track record. To be fair, I also look at each presidential election as selecting the lesser of two evils and I don't think the system sets people up to be honest and ethical in Washington, so I do start off more biased against anyway.

Has anyone else read Tom Daschle's book, Critical? It's interesting food for thought about the government's role in healthcare. I was bummed when he was involved in the whole scandal and it took him out of the running for a role in the whole reform process. I'd be interested in hearing your thoughts if you've read it. If anyone wants to read it, I have a copy I'm willing to lend out.

Beth, I do think that some countries do a decent job with government run healthcare in a lot of ways. However, I don't think it is always as positive (or again as clear cut)as the press would like us to believe. A couple of quick thoughts on this:

1. These countries do ensure everyone has some access to care, which depending on your status before reform could be a great thing for you. However, I do think the process involved could leave a lot of us unable to be the best advocate for our own care and realistically fewer choices. I am not trying to feed into fear by saying that; I merely believe it is a supply and demand issue that will arise from cost controlling. I also think that countries who employ "socialized" healthcare do a great job at drawing a line to avoid excess in some areas. For instance, at some point this year, I was attending a general healthcare 101 class that included several Canadians who had worked as nurses there and in the US. They saw positive and negatives to both systems. In the US, access to the highest quality of care was more available to most people. In Canada, everyone has access to some care, but it isn't always timely. However, they do a better job at things like end of life care where sometimes measures are excessive.
2. I also think that Scandinavia has other factors going for it besides just government run healthcare. For instance, to my knowledge (and before anyone jumps on me, I am not claiming to be an expert), there is a general culture there that promotes health. People bike and walk instead of taking a car. They eat differently. A lot of times, things like that are policy issues (making side walks available, encouraging farmers markets, making it possible for people to make good choices). Those things aren't addressed in this bill; consequently, I don't think it will have the same outcomes. Somehow there needs to be a more holistic approach than what we currently see.

Olivia - a couple of requests for you. I feel very uninformed about how healthcare reform will affect mental healthcare options. Any insights you could share there? Also, we are on the same page about the church/Christians/people in general needing to care for each other; however, I was interested in your take on what the solution is when people don't step up. If we fail to do that as Christians, is there a certain point where we say, "Well I guess we need to let someone else do something since we are not?" It's an issue I think about on a lot of fronts (not just healthcare). Beth, I'd be interested in your thoughts on that too.

I strongly agree with most of what Kristy says about the comparitive national systems and wider health factors.

I guess this is simply a difference in philosophy, but I'm just more of a believer in our government system. I think the government can do things well, and often does do things well. With all of the problems of social security, medicare/aid, and the VA, can you imagine the US without these services? And while the election process rewards a certain amount of dishonesty, it also provides a means of policing our officials. And dispite what the opposition would have you believe, I would bet that the vast majority of office holders do have our best interests in mind (even if we would disagree about what our best interests are).

So I'm not afraid of giving the government some control of healthcare when the current controling interests are not working. I feel like it's better that my elected officials try to fix a broken system than a for-profit healthcare industry remain happy to provide mediocre service at exorbitant prices.

Kristy, I tend to agree with your comments about Scandinavia. From what I know of the area, and with several friends from there, I think your assessment is pretty accurate. People walk/bike more, there is better access to fresh, nutritious food. AND there is less poverty per capita (reasons behind it are a discussion all their own). But I think we're missing part of the poing if we DON'T look at their universal healthcare systems.

I'm not a huge fan of the government taking control of much of anything either, but we are not doing something right when a couple dozen countries spend less than we do on healthcare and have better outcomes pretty much across the board.

As far as Christians not doing their job...we've had our chance for centuries. Had we been doing our job, this nation (maybe even the WORLD) might not be in the shape it's in. Since we haven't, and by most accounts don't seem willing to pick up the slack, I think single-payer healthcare is the next best thing. That doesn't mean I think we need to stop caring for each other individually - there will still be plenty to do in that area.

I'm reminded of what Gandhi said: "The difference between what we do and what we are capable of doing would suffice to solve most of the world's problems."

I don't mean to monopolize the thread - but I do agree with the point that Miles makes about the for-profit healthcare industry. (We must have been posting about the same time.)

And, can I just say that this is by far the most civil debate I've seen on this issue? THANK YOU! I moderate a website for nurses where this topic comes up often - and most of the time it gets very nasty very fast.

Kristy,
The way that the proposed plan would most likely affect mental health is definitely a concern of mine. A disclaimer- I am speaking primarily to the population I have worked with for the past 9 years (abused/neglected and/or at-risk children ages 5-12 and their families). In essence, the limitation of choice of healthcare providers will negatively affect not only immediate mental health care (psychiatry apppointments, therapy, etc) but also the placement of children in psychiatric residential treatment programs like the Yahweh Center. Yet, many mid- and community level services (such as community support, level III residential services) have now been done away with, leaving the extremes of therapeutic foster care and psychiatric care (both hospital and residential care like ours). The Feds cuts the funding to the States so the state cut out the programs. We are actually already seeing this problem in spades and I don't want to think about how much more compounded it will become. It is, quite literally, becoming a nightmare for many of the children and families we serve.

It will play out like this- there are already very few child and adolescent psychiatrists that understand this population of children- current changes in NC mental health are now placing an extraordinarily large burden on these psychiatrists to engage in in-depth assessments of children before they can be authorized for any service. This doesn't sound bad at all in theory, and assessments are extremely important, however...the reality is that it can take, on average, 3-6 months to get an appointment. Meanwhile, these children, as little as they are, are dealing with very high levels of acute behavior (fire-setting, sexual acting out, running away, and so forth). While waiting to see a doctor to get services, there are major safety issues involved and the child is not safe at home (where they may be getting abused) and cannot be hospitalized the whole 3-6 month period as ValueOptions (our state's Medicaid money gate-keeper) will not authorize a psychiatric hospital stay for that long.

These changes already have occurred this year- add to that further limitations on doctors that can be seen and the problem worsens. Further, ValueOptions is going to be given a larger amount of power than they already have, as they are the ones that decide whether a child qualifies for mental health service or not and have been increasingly denying children as it is. The state of NC already owes the Yahweh Center thousands of dollars because Medicaid dollars are not being issued in a timely manner, partly due to the lack of doctors to review children (children already in care also have to be reviewed periodically of course). Because we are a Christian agency, we often hold on to children or admit children when we know there is a chance we won't be paid in a while, because it is the right thing to do. Sometimes this is occurring to the point where we can't pay employees until a few days after payday, especially since the most recent "reform"...and this recent "reform" is deliberately supposed to pave the way for what Congress hopes will pass in the form of the current bill.

There are also other mental health issues it will create, but that is one of the primary issues. Hope it made sense.

Oh, one other thing- we are very concerned about our freedom as a Christian agency to hire only professing Christian employees and even more than that, to continue to operate as a Christian agency at all, should the current bill pass, as we are already receiving increasing pressure regarding our mixture of clinical expertise and Christian faith as well as increasing pressure to allow homosexual adoption as we search for families for our kids that are free for adoption. While there may not be specific language in the bill regarding these issues, the fact remains that the Health and Human Services secretary is given an impressive amount of power in this legislation and with the narrowing of service providers, who's to say that a Christian agency won't be taken out of the running to provide services?

In regard to the church's role in this process, it does play a part now- our agency is an example (even though we are not officially a church of course, we are a Christ-centered ministry). There are churches and ministries that are doing things on a "smaller" scale. Will and I were recently discussing this issue, and the fact that the church is called primarily to care for the poor, widowed, and orphans was discussed. So that may add on another dimension to this discussion. But in regard to a large-scale meeting of all health care needs, I don't believe the church nor the government can do that. I don't know what the answer is...I wish I did. But I vehemently believe that to allow the government to enact the legislation as it is currently proposed will be a great mistake on our part and will result in a greater disaster than we are currently experiencing. Especially for the poor, widowed, and orphans...