The White Lily Blog

Want Universal Coverage? Bring Back Virtue.

The July 13 edition of NPR’s Talk of the Nation almost asked one of health care reform’s most important questions: Are patients at least part of the problem in the explosion of health care costs?

Unfortunately, the show left the question unanswered.

Lynn Neary knew what she didn’t want, but not what she wanted. She didn’t want, and kept interrupting, guest Dr. Pauline Chen, New York Times house doc, who wasn’t delivering anything but double speak about ‘better communication’ being the preferred treatment for all ills.

The show had some powerful callers, all with different takes on the US health care experience. One savvy veteran teacher of ‘the working poor’ told of her efforts over time to help the families of her students get care, how they always ended up going to an expensive emergency room because all the free clinics had been closed or profitized, and wouldn’t see them without a credit card to run.

Another caller commented that his wife’s pregnancy care had included ‘far too many tests, because they would have continued the pregnancy exactly as they had anyway.’ His wife’s care, apparently, included lots of compulsory tests for fetal abnormality so that they could abort a potentially handicapped child, raising a different but equally compelling and thoroughly ominous subset of questions about health care reform.

The show did not, however, deliver any clues to the original question, are patients somehow driving up health care cost to levels being characterized as catastrophic, and even more pointedly, if the government underwrites care for those who do not have insurance and who are running up the tab so explosively, how will we possibly afford it, no matter how the bill is split? The show didn’t go there.

But here’s where Neary could have taken it. Besides wanting ‘the best’ care for ourselves and our loved ones, causing us to demand treatment and tests we might not need (the one on-topic observation of the program’s original question, which Lynn Neary herself finally had to generate) some patients’ behaviors are causing their own health problems, and here is what they are: gluttony and lust, those two behaviors of the seven known as the deadly sins. These two in particular are costing us big time and, added to the expense of an aging population, it could beggar us. If the government contractually obligates us to pay, it could be a long, slow death.

Generally when this question arises, defenders of universal, state-subsidized health care throw up ‘well Europe does it,’ and that is true.  The follow-up question ought to be, how do Europe and the US compare in the areas of gluttony and lust? It is possible to get data on this topic without looking directly into souls:  the data-driven answer is, Europe doesn’t have the number of sinners we here in the US have enabled in the past forty years. We are the whole world’s fattest, sluttiest sinners. We have thereby super-sized our health care costs so that nobody can afford to pay for it, whether the government picks up the tab, or the bill is paid piece-meal as it is now, through higher insurance costs, state government payments, or charity.

The reform effort was sparked in the first place, as President Obama repeats ad nauseum by the explosion of costs as presently funded. But shifting the payer will not substantially change either the treatment or the cost of expensive, self-induced illnesses, even if one layer of bureaucracy goes away. In mid-July, Congressional Budget Office Director Douglas Elmendorf warned that the Democrats’ health care bills won’t meet President Barack Obama’s goal of slowing the ruinous rise of medical costs. He stressed that the numbers show that all health care proposals would raise costs, not lower them.
Elmendorf said, “In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs.”

To slow that scary ‘trajectory of federal health,’ NPR should have invited a traditional Catholic priest, perferably one trained in exorcism, to Neary’s show. Gluttony and lust are treated by both doctors and priests. But Neary won’t go there. We banished sin back in the sixties. We declared all of ourselves officially innocent victims. The most we do now is make ‘bad decisions,’ and we look not to the practice of virtue but to medical magic to fix it: the abortions and the breast cancers that result from abortion, the insulins, statins and stomach staples subsequent to gluttony, and the auto-immunune suppressants that cost more than a new Buick.

That we ourselves might have taken a wrong turn or two, that the power to ‘fix it’ lies in honoring the design of the body through individual restraint and personal sacrifice, that we are responsible for our illnesses when we ignore our nature, is simply out of the question. It never came up at all July 13 on NPR.

The inescapable fact is, we are now a nation of the fat and the f*****. And we just can’t face it. The ordinary public forums that ought to weigh in are silent.

In our world, the whole conversation of “Mary Sue, you eat too much. You ought to be ashamed of yourself,” has to be left to the doctor, because at school, from the pulpit, and on the playground, that’s hate speech. No one should feel shame, ever! No one overeats. Everyone knows, fat people are special! Let’s staple their stomachs shut! That’ll fix it!

Or if we are forced to admit that obese people do overeat, they just ‘need more communication-education’ (ala Dr. Chen of the New York Times) on ‘how the molecules of glucose pass through the lower intestine into the blood stream, causing the pancreas to overproduce insulin, but yours is broken, so you have to take these pills that cost a hundred dollars per. See?’ The patient must be educated enough to deduce he’s supposed to uh, limit those molecules of glucose passing into the bloodstream.

And, get real, no doctor’s going to even try to do the job alone, with no backup from the other various community resources, from the church, the classroom, the evening news. Even if that is what he should tell them. Even if it’s the truth. We wouldn’t be the first culture where the truth wasn’t even whispered aloud.

Imagine a doctor using his fifteen minutes to teach his young patients that, ‘The surest way to avoid sexual diseases is to postpone all sexual relations until you meet one very special person of the opposite sex, and then limit your sexual activity to that person for the rest of your life. That’s called marriage. Have all the kids that come with the sexual activity. Only use natural family planning. Because the research shows, all contraceptive barriers, whether chemical or physical, fail. They are expensive. The body fights them and most typically uterine or breast cancer and sterility are the result, and that’s even more expensive. And they’re really terrible on the environment when you pee them out. So just wait until you are married and then have kids.’ Got that?

That is what he should tell them. If he is true to the data streams converging now on breast cancer, diabetes, AIDS, heart disease, and other lifestyle- induced illnesses.

But don’t hold your breath. We will, short of divine intervention (and we shouldn’t rule it entirely out because we’re courting catastrophe of biblical proportions), continue to fail to address how the patients are sometimes the too-expensive problem that will cost us rational, reasonable national health care, again.

Because, how can a reform plan pass? Elected reps on the one side of the Republicrats will sit there going, ‘we can’t afford health care reform,’ which is true, and the other side saying, ‘we can’t afford to pay for it the way we’re paying for it now but we gotta have it,’ which is true, and both sides will have turned as pale as ghosts as they realize the enormity of what we have wrought in the past forty years. Out of which there is no affordable way. Except to say the party’s over. The first guy to say that will be crucified, of course.

Or maybe this time, fueled by Obamamania, we will risk everything, and ‘go for it’–and fail, as Massachusetts just did. Then the system as we know it will break down completely, which for the poor means even the emergency rooms will close to them. We’ll be bringing our own linens and pillow and toilet paper with us to the hospital, as they do in Mexico’s public health system.

Let’s be specific about costs related to sin. Here’s some pricey items from the party menu, not the complete list:

• From the 4/1/2006 issue of the Chicago Journal of Infectious Diseases: annual expenditures for 635 HIV-Infected Patients ranged from 13,885 for those with CD4+ in the moderate range [not very sick] cell counts to $36,533 per patient in those with more severe infections.

• A study presented at the Third International AIDS Society Conference on HIV Pathogenesis and Treatment estimates that of the annual 40,000 newly infected US adults who begin antiretroviral treatment when their CD4-cell counts drop below 350 cells can be expected to live 24.1 years and will run up a medical tab of between $405,000 per person in total drug costs just for their HIV infection, with drug discounts, to as high as $648,000 without them.

The same article said that the 40,000 people newly infected with HIV each year in the United States will require about $12.8 billion in medical care.

• New York City has been so swamped by new AIDS cases that as early as 1995 they gave up their attempts to provide health and social services and are passing the care on to ‘community providers,’ a solution that will not be open to the federal government when the proposed health care reform contractually obligates all taxpayers to the astronomically expensive care of HIV infected men who have sex with men, the category where the infections continue to grow ‘for complex reasons,’ according to government statistics, in spite of wide-spread education and free condoms. This category, coyly known as MSM, accounts for the majority of increases in HIV.

• Europe’s public health systems, usually seen as the model for those advocating singer-payer health care reform (the next model we will have to adopt when the ‘public option’ plan we are being presented proves unable to deal with the contractual obligations the government would assume) are not dealing with these kinds of numbers or rate of infection. Western European countries had 17,355 new cases in 2007, compared to the 40,000 new cases every year in the US. Their rate of obesity is similarly smaller. According to World Health statistics, 74% of the American public is overweight. Compare that to Poland’s 47% or France’s 40%.

• The Center for Disease control reported that in 2000 obesity cost us $117 billion—$61 billion for direct medical costs and $56 billion for indirect costs.

• On July 28, the networks were reporting 147 billion of costs indirectly related to obesity. The Center for Disease Control reported that obesity increases the cost of care for a patient by an average of 42%.

• Bariatric surgery cost the US $948 million dollars in 2002 and if following the trend from previous years, this figure is expected to grow 400% each year. Insurance, meaning everyone, paid for 97% of the surgeries, as well as the whapping $18,000 yearly maintenance costs per patient.

• Breast cancer, at epidemic levels in the US and stemming largely from controllable factors like abortion and hormone replacement therapy, chemical contraceptives, chemical abortifacts, failure to conceive children and failure to nurse children, costs the US 3.8 billion per year. Statistics reported in the Journal of Obstetrics and Gynecology admit that abortion is the single best predictor of breast cancer, followed by the behaviors just listed.

We can afford broken arms. We can afford innoculations. What we cannot afford are the injections and hospitalizations for self-induced diabetis in record-breaking numbers. We can afford the simple pre-natal care of a woman who does not have multiple STD’s and consequent complicating conditions, but treating the infertility of that other ‘sexually liberated’ woman with severe uterine scarring from her last abortion is pushing it. We can afford handicapped children (we cannot afford not to have handicapped children–or do we not realize what handicapped children give to their families and indeed to the civilization to which they are born?). We can afford to treat the health problems of a virtuous population, including its handicapped members. What we cannot afford is sin. What we cannot afford is silence in the face of sin.

As the Budget Office lectured, we need the fundamental change you promised, Barack!

The kind of real change that virtue produces, of which sin is the opposite. We must humble ourselves and call it sin. Our society must help us in repenting of it by calling it what it is. Not “mistake.” Not “wrong decision-making,” as if it were a boardroom. They must shame us about our sexual practices. (Yes, honeys, we must go there.) Our communities must demand more responsible behavior of us, especially at the table and in the bedroom, and then health care reform is possible, will be supported even by those pesky Catholics. All these efforts presently underweigh are simply magicians’ slight of hand to shift the financial burden upward. That is the subtext of the outcry.

Want universal coverage we can afford? Bring back virtue.

2 Comments so far
Leave a comment

I agree with a lot of what you have written.

I think another important thing to note is that obesity is even more common among the poor. Many of America’s poor live in “food deserts,” with very little access to fresh food. (An example: Southeast Washington D.C., Ward 8, an area of 70,000 mostly poor residents, had no full-service grocery stores until 2007. ) And many people living in poor neighborhoods are afraid to exercise outside, and can’t afford gym memberships.

So in addition to encouraging healthy choices by everyone, I think we also need to provide greater access to healthy choices for everyone, including the poor.

Comment by Emily

Emily, you could add that skinny food is more expensive than fat food to the list of ways that the poor are discriminated against in the health area. But nothing would do as much good for the poor than teaching them that to walk to where they are going, or to climb the stairs rather than take the elevator or escalator, is an act of mortification that helps cancel the temporal punishment due to their sins, and that exercise (or discipline in general, including in sexual matters) shares the redemptive cross of their Lord and Savior Jesus Christ.

The latter argument especially gives an incredible dignity to simple exercise that can reach especially the young in ways that arguments to their own selfish benefit (like say, better looks or longer life) will not. I say especially the young because they have hearts so open to love of any kind and that includes love for God. For our secular society (and Catholics as well, for Catholics do not teach these things anymore, either) to deny young black men and women the dignity of voluntary mortification for Christ is the greatest cruelty and is to engage in the most serious racism of all.

There are no neighborhoods in the United States today, and that includes Ward 8 in southeast Washington, in which one cannot walk in the daylight hours or in which one cannot eat less of the food that is available, even if that food is McDonald’s, if one has a reason that touches the heart. The fact is, the poor do not do these healthy things that they could do. I have taught at the poorest schools in the poorest neighborhoods in Oakland, California, Tampa, Florida, and Pittsburgh, Pennsylvania for thirty five years, I observed carefully and with compassion, and I am speaking the truth. The obesity of the poor there would not be fixed simply by higher income or more Whole Food stores in the neighborhood, any more than it is fixing it in the rich neighborhoods in Oakland, Tampa, or Pittsburgh.

The poor need Christ and the concept carried by the word virtue. Just like you and I do.

Comment by thewhitelilyblog

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