Health Care

The presidential campaign is a little more than three weeks old and the indications are that health care has fallen off the radar screen. One measure is each candidates' acceptance speech at the convention. The speeches give a clear indication of their priorities and their sense of where they think the campaign and country are focused. As a Democrat and the "agent of change," the expectations that Barack Obama is committed to do something important on health care are fairly high. Furthermore, in a speech devoted to distinguishing his and John McCain's philosophies and priorities, health care would seem to be, well if not Exhibit A, then at least B or C. Thus, it was hard for a health policy wonk not to be disappointed. Mr. Obama spent less than a minute on health care, about 100 words out of 4,900. The expectations for Mr. McCain were much lower. He is not running as a leader on domestic policy, and his proposals on health care have been anemic. His proposals do not even aspire to actually fix the broken system. He spoke all of two sentences, less than 50 words of a 4,000 word speech, on health care.

Since 2001, the government has spent almost $50 billion for national biodefense at sites such as Fort Detrick and other specialty laboratories and universities, and this amount is likely to increase further with ambitious plans to build high-containment laboratories across the country. However, there is a largely unaddressed biological threat that does exist in America today - especially in places where poverty is concentrated, such as Baltimore. It is a hidden underbelly of poverty-related diseases that are ordinarily thought of as health problems in less-developed countries. The mainly Hispanic and African-American populations living in inner cities and rural areas are suffering from high rates of these ailments, known as the "neglected infections of poverty."

On few issues do Barack Obama and John McCain diverge as dramatically as they do on healthcare. Both say they want to reduce costs and expand coverage to the 47 million uninsured. But while Obama wants to build on the existing employer-based system with new coverage plans for families and businesses, McCain aims to move the country away from work-based insurance and toward a system in which all Americans cut their own deals with private insurers. If the national campaign ever gets past lipstick and the collapse of investment banks, these differences on healthcare may get the attention they deserve.

Chaplains are one of the newest methods used by the Department of Veterans Affairs to treat the nation's veterans. Their job: to assess the spiritual and emotional health of such veterans as Ratajczak and report back to nurses and doctors, in hopes of developing a more "holistic" course of treatment. Such "spiritual assessments" are now routinely conducted on entering patients, though they are not mandatory. Critics, however, say the program runs afoul of the separation of church and state, and say a patient's "spiritual" health should have no bearing on his or her physical treatment. Chaplains at the Baltimore VA hospital do not promote any particular religion, said Thomas, a Protestant, but add a "spiritual dimension" that patients often need.

The Catholic Church in Latin America is changing its approach to the continuing epidemic of HIV and AIDS, and many are welcoming the changes. "While moral double standards and stigma remain strong elements of the response to HIV and AIDS in many evangelical and Protestant churches, I've recently seen an enthusiastic willingness to deal openly with the epidemic from Catholic leaders," said Dr. Eduardo Campana, an Ecuadorean who heads an AIDS program for the Latin American Council of Methodist Churches. The bishops urged people to work together to fight discrimination against those with AIDS and to avoid judging them.

The pioneering Massachusetts program to provide health insurance for all citizens looks more and more successful with each passing month. The number of uninsured has dropped - Massachusetts now has the lowest rate in the nation - and so have the number of those who turn to costly emergency rooms for routine care. And while the state has had to seek additional sources of revenue - mainly because of the program's popularity - the gains in the first 21 months suggest that the plan could become a model for universal health coverage for other states or the nation. The plan requires everyone to take out health insurance or suffer a tax penalty and requires employers to offer coverage or pay a small assessment if they don't. Low-income residents can enroll in an expanded state-federal Medicaid program or receive subsidies to pay all or part of the premiums for private insurance. Those who earn more than 300 percent of the federal poverty level (about $63,000 for a family of four) receive no subsidy but can buy private policies through a new insurance exchange at much lower rates than before.

A s the presidential campaign goes into full swing, the American public is likely to be bombarded with the kind of misleading clichés and false dichotomies that distort serious discussion of health care reform in this country. One of these false dichotomies is "private market versus government" health care or "private market versus socialized medicine." Both terms mislead because their users seem not to understand precisely what the terms mean or, if they do, use them mischievously. The term "socialized medicine" in particular conveys to some an objectionably "un-American" form of government: socialism.

The two major presidential candidates agree on at least one thing: health care reform must be a high priority for the next administration. But when it comes to the details, much of the common ground between Republican Sen. John McCain and Democratic Sen. Barack Obama falls away. In their 2007 document on political responsibility, "Faithful Citizenship," the U.S. bishops said any efforts to reform the health care system must respect human dignity and protect human life; meet the needs of the poor and uninsured, including pregnant women, unborn children, immigrants and other vulnerable populations; protect the conscience rights of Catholics and Catholic institutions; and provide effective, compassionate care for those with HIV and AIDS.

The black church - traditionally a loud voice for social change - has been curiously silent on the crisis of AIDS in the African-American community, and some say, even negligent. Despite the fact that pastors across the south have offered small consolation to people infected with the virus, AIDS activists say they need black churches the help stem the growing tide of new HIV and AIDS cases. While African-Americans represent 19 percent of the south's population, Pinkston reports they're 56 percent of new AIDS cases in the region. It is an issue that the people of God must address, said Reverend Claude R. Alexander, Jr., of the University Park Baptist Church in Charlotte, N.C.

With prospects quite good for a Democratic Congress and administration in 2009, the United States is on the brink of joining all other industrialized nations in ensuring the provision of some form of basic health care for all Americans. Reforming American health care is the single most important public-policy issue on the Democratic agenda, and policy experts are weighing in from all sides. I will confine this article to offering some practical reflections on issues that may bear on the final shape of any approved plan.