The Healthcare Question

By Ryan Clark 

It is about time we come to terms with what is going to need to happen with healthcare in the United States and we have two options.

My wife gave birth to our son in the Philippines four and a half years ago while we were field personnel with the Cooperative Baptist Fellowship. At the time, I was professor and Dean of Students at a Baptist seminary there. This also meant I was the administrator of the student health reimbursement plan, a plan students were required to pay into and then could rely on later to help pay medical costs.

Not long after my wife went into labor and had our son in the new, private hospital in town, a Bangladeshi student had what appeared to be appendicitis and went into the emergency room at the city’s public hospital.

Functionally, the Philippines has a two-tier medical system. There are public community clinics and hospitals that have large public wards. The care is pay as you go and the emergency room is first-come-first-serve. There is a national program like our Medicare that provides a very small reimbursement to public hospitals for care. These hospitals, like the one in Baguio, offer good basic care at a very affordable price. This is where the Bangladeshi student went at my direction after visiting him in his dorm. This is where he waiting for nine hours until another professor joined me in the intervention…(More on this later.)

My family had American-based international health insurance that functioned like a reimbursement plan. We paid up front, then  would submit receipts and hope for a reimbursement check from the U.S. company. Planning for the birth of a child at a private hospital means stashing away lots of cash. We budgeted for the epidural (that failed), the doctor’s fees, private labor and delivery room and the presidential suite (yes, we stayed in the presidential suite). When it was time to check out with our new son, I went to the finance office with a very large stack of cash and paid one large, very detailed bill.

In the public hospital, the doctor writes a prescription then a family member takes it to the pharmacy. The pharmacist writes out a bill. The family member takes it to the finance office, pays and gets a receipt. Then the family member gets back in line at the pharmacy, gets the medication and takes the medicine to the nurse, who then administers the medication. The patient is also required to have a “watcher” — someone who sits with the patient 24 hours a day, and in addition to getting prescriptions filled, does the feeding and bathing of the patient. This helps keep costs very low.

I am not a medical doctor, but I could tell the Bangladeshi student’s health was declining rapidly.

The doctor who did the assessment was pretty sure it was an appendicitis, but there was no ultrasound to confirm. The student was in the queue for an exploratory surgery, but there were still many people ahead of him. When another professor arrived — Dr. Ahn — we went to the E.R. administrator and asked if there was anything we would do to speed things up. The administrator replied that if we could find a private-pay surgeon and sign off on financial responsibility then he could have surgery very soon. The other professor and I stepped out, talked for a moment. Dr. Ahn offered me an important re-framing of the situation: “The hospital can have all the money in my bank account if it will save the student’s life.”

The choice was obvious.

We went to the financial administrator, signed some papers and 45 minutes later the student was in surgery. Dr. Ahn and I went to the ATM.

The student’s appendix had ruptured. His surgery was long and tenuous, and the surgeon was very clear on how serious the situation had become. The student had a long recovery in the hospital. We opened an account and allowed the entire community to contribute to the student’s medical expenses. The community paid the whole amount, which ended up being more than what the student had budgeted for the entire year of seminary (tuition, room and board). The surgeon said if we had waited for the public surgeon, the student would have died. The whole situation ended up being a wonderful story of how a community came together to save a student’s life. And I learned another lesson.

We can either have a two-tiered medical system like many developing countries, or we can have a universal system like many developed countries.

We cannot sustain systems set up to allow insurance companies to extract too much cash out of the healthcare system.

I think healthcare should have two beneficiaries: patients and care-givers. If another entity has to make money based on my health, then it’s not possible either for the patient to afford the care or the care-givers to be paid what they deserve. I’m not an economist, but this seems to be the reality we refuse to face. I have nothing against all the wonderful people who work in the health insurance industry, but I’d rather the doctor, nurse and CNA get wealthy on my surgery.

In the U.S., we all have the mindset, no matter our socio-economic situation, that we deserve to have access to the entire array of available healthcare. So if there’s a new drug, or therapy, or a better specialist, we feel entitled to have it. But the truth is, either we are entitled to it or we are not. It makes sense. If you have worked hard enough in the right fields and have earned enough wealth to have a nice home and nice cars then you should have access to better healthcare. But what is the line between better healthcare and regular healthcare?

Eventually, someone is going to need to make this list of diseases we’re going to let the working poor suffer and die from, along with what the acceptable higher infant mortality rate will be. Like in the Philippines, if you can get access to some cash, you can have improved care. But when it’s all said and done, you can’t have steak on a burger budget. If you cannot afford the better chemo, the newest antibiotic or the C-section, you simply can’t have it. There are consequences to lacking material wealth in this world and these are simply some of them.

The other option is that the U.S. create a universal system. We come to an common understanding that in the midst of vast economic diversity, our country would benefit in the long-run, both  economically and socially, if everyone was on the same essential system. And, of course, in any system, those with wealth can pay cash for an upgrade to the presidential suite.

I don’t see any way around one of these two options: Two Tiered vs. Universal Care.

I think they’re both valid and would work. I also think they each say different things about us as a society, as well as our personal theologies.

You and I have to do some soul searching: Is it acceptable for my neighbor to die of a curable disease because she doesn’t earn as much money as I do? The answer to this question is the answer to our healthcare debate.

Ryan Clark serves as the Church Engagement Manager for the Cooperative Baptist Fellowship.

Note: The views expressed here in columns and commentaries are solely those of the authors.

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