Monday, September 21, 2009

Health Care if I needed any more reasons!

Here are opening paragraphs describing the Harvard study obn death rates among uninsured Americans.

Nearly 45,000 annual deaths are associated with lack of health insurance, according to a new study published online today by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

“The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health,” said lead author Andrew Wilper, M.D., who currently teaches at the University of Washington School of Medicine. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications.”

This number is roughly equivalent to the number of people killed in automobile accidents in the U.S. each year. Over a ten year period, we are talking about almost 500,000 largely preventable deaths. This fact alone should be enough to demonstrate the failure of our current private enterprise based health care and insurance system.

Monday, September 14, 2009

Health Care Reform

We are at a historic moment for the financing of the American health care system. In the 44 years since the establishment of Medicaid and Medicare, we have never been closer to fundamental reform that can have systemic impacts on the financing and quality of American health care. In this discussion, it is important to keep certain facts in mind:

  • Among developed, industrialized countries (Organization for Economic Cooperation and Development) the United States spends vastly more than any other country.
  • 16% of GDP which is almost double the OECD average.
  • Highest per capita with $7290 which is two-and-half times the OECD average. (Adjusted for differences in purchasing power)
  • Despite this large difference in effort, 45 million Americans are not covered by health insurance
  • Health outcomes (life expectancy and infant mortality) are far from the best.
  • There are fewer doctors per capita than in most other developed countries.
  • Most other countries spend substantially less than the U.S. and provide health care with at least equal and in some cases better health outcomes.

As a nation we have been clear that a market mechanism—while obviously superior in terms of the economic production—was not an effective or just method of allocating resources the fields of education, national defense, police and fire protection, and criminal justice. However our free market ideology has led us down a path in which market mechanisms and private ownership have been the determining structures of our health care system. After 40 years, I think we can conclude that this has only added cost without benefit to a health care system. We need to move away from a failed ideology and move toward an approach that every other industrialized country has found both efficient and effective.

However, simply changing the financial and institutional structures of the health care system will not solve the more fundamental problem: the deteriorating health of American citizens. When Medicare was established, 13 percent of adult Americans were obese; today 32 percent are. Fully two-third of all adult Americans are overweight or obese. In 2008 $147 billion in health care costs were spent on health issues related to obesity. This is 9 percent of all expenditures. There is nothing to suggest that these trends will not continue.

It is well established that Americans consume substantially more of the world’s resources than our share of world population. While this over consumption has provided us with a comfortable and easy life style, it is now becoming apparent that this very over consumption—whether of oil or of food—carries costs that we simply cannot afford. Sooner than later we need to reform our health system in ways that effectively incentivize health and wellness rather than treating chronic diseases caused by our life style. If we do not address both issues, it is hard to see how an unhealthy and bankrupt America can provide the political leadership the world desperately needs.

Monday, May 25, 2009

Mt. Irenaeus

Last weekend I went on retreat with members of the men's spirituality group of which I am a member. We went to Mt. Irenaeus a ministry of the Friars at St. Bonaventure. The following is the final entry in my rpayer journal for that weekend.

Just back from an hour’s walk in the woods. As I walked I kept repeating to myself that I just needed to trust myself. It seems so simple. Why haven’t I done it? I began to think of all the people who saw me as fundamentally good: Grandma, Marilyn, Paula, Fran Blighton, Sr. Therese, Tim, Richard, Tom, Anola. There are so many; why didn’t I hear them? Why did I think I had to be different, had to have some kind of agenda for change? It was because of my attachments, beliefs, fears just as De Mello writes. Where did these come from and why were they and are they so powerful that I distort myself in light of them? De Mello is right in the sense that they come from culture, society, family. Sometimes these are innocent and unavoidable; sometimes they are intentional and diabolical. Why would a five year little boy think that people were trying to poison him except for the fact that he sensed there was something wrong with the way he was.

No matter how deep and how strong, these are lessons that can be unlearned but awareness and understanding. No program of change will accomplish anything other than reinforcing the attachments. Joyce’s description of a retreat in Portrait of an Artist as Young Man struck home to me and my classmates because it was exactly our experience. We were told that we were bad, yes basically bad and that we needed to change. Discipline was the key and it carried within it the seed of destruction. Nothing ever worked, at least not for very long. It could never work but it kept us in an inferior position. Unfortunately the Church has used this approach and continues to use it.

We begin in a blessed condition because of that fundamental existential relationship to the Divine. We are not sullied or wounded with original sin. The world is wounded in that way and it is the world that wounds us, not the other way around. Our struggle is to keep the world from distorting that fundamental relationship and the freedom and life that come with it. That is the human task. That is my task.

I stood before the wooden cross at the end of trail and spoke to Jesus. He knows exactly what I go through; he faced the same human condition. It is not original sin as personal but original sin in the world. He kept himself free from that or understood his circumstance in a way that freed him. It was that world that crucified him, not me and my sins as we were taught. I asked him to help me follow his same path, not by following a set of rules but by freeing myself as he freed himself, by taking up his cross which is really no cross at all but radical existential freedom. Surely this is the meaning of grace, divine life in me. I heard him tell me that he and I were in exactly the same situation. The divine life at the core of his being is the same divine life at the core of mine. I am to become like him. The divine deeply desires that I be so and sends me a superabundance of life through that relationship. All I have to do is be open to that life by freeing myself of attachments, beliefs, and fears. I have gained a deeper appreciation for the meaning of sunder warumbe.

What now? I desire to be more faithful in my prayer and reflection. An hour a day is not too much to ask of myself. I would spend the hour reading scripture and works that feed this understanding: Meister Eckhart, De Mello, Fox and others I am sure. I can do this each morning as soon as Marilyn leaves for work. It is quiet and peaceful.

All this puts the Church in a difficult position for me. It has been and continues to be a source of my problems. How can it be otherwise? It is part of this sinful world that seeks to control me and distort my view of who I really am. Have not most of those who have written in this vein been punished or excluded by the Church? How can this be? It is part of the human condition and must be seen in that light. Salvation does not lie in the Church. My involvement with the Church must be such that it sustains this life in me. Every reform movement in the Church began with similar insights, namely that the relationship with the divine is central and happens outside the structures and institutions of the church.

Sunday, March 15, 2009

I must be a Very Unimportant Person

On March 10 I joined 1,000 Catholics from the eight dioceses in New York State in Albany to lobby our state senators and assembly members on the public policy issues important to Roman Catholics in the state. I had gotten up at 4:00 am in order to board a 5:00 am bus with 50 other people from the Diocese of Rochester. When we arrived at the Albany Convention Center, we went to the registration tables where our name tags were arranged alphabetically. I easily found mine and picked up a packet of materials for the day.

That's when I noticed a table at the end with a large sign that said: "Bishops and VIP's." Although I wasn't sure how a VIP would know he or she was one, I knew immediately that I wasn't one...even though I and the 1,000 other volunteers were there to do the work of lobbying. Frankly, I found it to be offensive and unchristian. Why create classes of people? Surely even Bishops and VIP's were not alphabetically challenged. Surely they could find their name badge just as easily as I did. It can only be that Bishops and VIP's are different from the rest of us, special, and in fact better and thus deserving of special treatment rather than being treated like the rest of us.

This may seem like a small thing but I think it speaks volumes about the problems with a church that creates status levels to no good purpose and in contradiction to the words and actions of Jesus Christ. "You know that those who are recognized as rulers over the Gentiles lord it over them, and these great men make their authority over them felt. But it shall not ge so among you. Rather, whoever wishes to be great among you will be your servant. Whoever wishes to be first among you will be the slave of all. For the Son of Man did not come to be served but to serve and to give his life as a ransom for many." (Mark 10:42-45)

Those who have ears to hear, let them hear!

Monday, February 9, 2009

Do Republicans think we are all idiots?

I know we elected and then re-elected George W. Bush president. (OK, I know we elected Al Gore the first time but the Democrats didn't have the right lawyers in the right state.) But really, do they really think we have any interest in listening to the people who put us in this financial quagmire as they mumble on about the economic stimulus plan. Don't they understand that the American electorate rejected their policies of reckless foreign wars, overt militarism, monumental deficit spending to fund those wars as well as tax breaks for the rich, undermining the Constitution, and general incompetence due to decisions based on political ideology? Apparently not.
The Republican Party happily stood by as the economic disparity in this country reached historic levels. Republicans thought it was just great that the credit system was manipulated to extend an economic expansion in an irresponsible manner. They cooed approvingly as government oversight was emasculated so that even the SEC could find it appropriate to ignore specific warnings about Ponzi schemes, of all thing. They thought it wonderful that political rather than professional qualifications were used to appoint FEMA directors, U.S. attorneys, and God knows how many others. Ordinary Americans--the middle class--benefited not at all from these policies and schemes.

Last fall these ordinary Americans continued the protest that started with the Congressional elections of 2006: Enough is enough. Stop it with giving even more money and advantages to those who are already obscenely wealthy. Start worrying about us...because we are drowning out here beyond the beltway in all those ordinary places that the Republic media masterminds have portrayed in "patriotic" ads.

So when the man we elected to do just that along with his team says this is the direction in which we need to go, get out of the way. Sure make constructive suggestions; I don't agree with everything in the stimulus package. But don't pontificate political ideology. WE NEED HELP AND WE NEED IT NOW even if NOW will take two to three years.