Tag Archives: health care

religious freedom and the job market…

I recently had a short exchange with a Facebook friend 0ver a Washington Post column — “HHS Mandate: An Attack On All People of Faith” — that she had shared on her page.

While I found my friend’s defense of the column troubling (and I’ll get to that in just a moment), the piece itself — authored by Rev. Dr. Matthew C. Harrison, of the Lutheran Church-Missouri Synod, and Rev. Samuel Rodriguez, of theNational Hispanic Christian Leadership Conference — is rife with problems.

Take, for instance, their explanation of what conditions religious organizations must meet to be exempt from the contraception coverage mandate —

In order to pass the strict guidelines of the exemption, our services as religious institutions must be provided primarily to people of our faith, and we must primarily employ people of our faith to perform these services. Most religious organizations, including hospitals, social services organizations, publishing houses, schools and more, will fail to meet the required provisions and will thus be subject to this mandate.For the first time in our country’s history, we will have to impose religious tests on those we employ and those we help, in order to maintain our status as exempt religious employers.

It is interesting to me that Harrison and Rodriguez focus on just these two criteria for religious exemption, and that they do so in order to suggest that the criteria place an undue burden on the types of religious organizations they mention.  This is misleading.  According to the final rules,

…for purposes of this exemption, a religious employer is one that:  (1) Has the inculcation of religious values as its purpose; (2) primarily employs persons who share its religious tenets; (3) primarily serves persons who share its religious tenets; and (4) is a non-profit organization described in section 6033(a)(1) and section 6033 (a)(3)(A)(i) or (iii) of the [Internal Revenue] Code… [these sections refer] to churches, their integrated auxiliaries, and conventions or associations of churches, as well as to the exclusively religious activities of any religious order.

Taking a look at the four criteria as a whole, it becomes clear that any organization meeting the first and last are almost certainly going to meet the remaining two (the converse being true, as well).  In other words, the criteria seem to operate on the assumption — and a pretty solid one, I would argue — that a house of worship for a particular faith community is going to employ and primarily serve fellow members of that faith community.  Meeting the two criteria Harrison and Rodriguez cite would, then, be a natural consequence of meeting the two criteria they duly ignore.  Thus, their concern that they will have to execute a “religious test” is not only completely unfounded, but intellectually dishonest.

After attempting this argument, Harrison and Rodriguez then present the reader with the following awful prospect:

A multitude of religious organizations will be forced to carefully consider if they can in good conscience continue to provide services because they cannot and will not go against their fundamental convictions to provide service to all regardless of whether those served share their beliefs… Nursing homes, hospices, counseling and rehabilitation centers, after-school programs, food and shelter efforts for the poor, homes of refuge for victims of violence and abuse, hospitals, schools, thrift stores and more would no longer be able to contribute to our society. The care provided by these organizations, which are currently operating out of faith communities in every state, city and town, provides a vital web of life-sustaining support for people in need.

This, too, is grossly misleading, and in a far more insidious way.  They go to great length to portray religious institutions as having a terrible choice thrust upon them — do we continue in our noble mission to serve all who come to us, regardless of their faith; or do we restrict those whom we serve so that we may retain a religious exemption?  But this is a manufactured dilemma.  The Obama administration has made perfectly clear that even non-exempt religious organizations will not be subject to the contraception coverage mandate, and that, instead, the employees will be offered this coverage directly by the insurance issuer.

And yet, religious organizations (the Catholic Church, in particular) have rejected this compromise as being not good enough.  Perhaps it’s because Catholic hospitals and universities don’t even want the insurance issuer they contract with offering contraception coverage, even if said coverage is not provided by the specific plans they contribute to.  But surely this begs the question:  just how many degrees of separation are we supposed to establish before the Catholic Church is satisfied that its religious liberty is sufficiently unmolested?


Now, after reading this piece, I commented on my friend’s page:

[O]ne question I am still trying to wrap my head around is why it is more important that a Catholic employer be able to refuse coverage of a certain service than it is that a non-Catholic employee have access to that service. In other words, is it necessary, and just, that a non-Catholic seeking employment at a church-affiliated business would have to waive their equal protection under the law (in this case, access to health services) in order to be given a job?

She replied:

That person knows the beliefs of the Organization for which they are intending to work, if they don’t agree with those beliefs they have the freedom to seek employment elsewhere. These are not life or death issues. This is contraception, which is a moral choice, and, not that expensive if the cost has to be born on their own.

There are a couple of major problems with this argument, not least of which are the legal implications.  What my friend is essentially advocating is a de facto “non-[insert faith here]s need not apply” sign outside any religiously affiliated organization, which would be a blatant violation of Title VII of the Civil Rights Act of 1964.  While religious liberty in hiring practices recently received a vigorous defense from the Supreme Court, the right of an organization to hire according to religion is still quite narrowly defined.

The most obvious qualification, of course, is that the nature of the organization’s work must be religious, not secular.  Granted, this is not always a cut-and-dried distinction to make, but I wholeheartedly disagree with those who would argue that Catholic hospitals and universities are engaging in primarily religious activities.  While I accept that, for instance, Catholic hospitals are founded in order to put into practice the teachings of Jesus Christ, it does not follow in any way that one must be an adherent to those teachings to be an effective employee in that hospital.  One need not feel motivated by the Sermon on the Mount in order to be a good and caring nurse.

Beyond the legal ramifications of the attitude expressed in my friend’s comment, there is the troubling fact that it is rooted in hypocrisy.  It says that, on the one hand, an individual who makes the choice to seek employment at a religiously-affiliated institution must submit to that institution’s creed (whether or not the creed is necessary to fulfilling the job) or else seek employment elsewhere; whereas, on the other hand, a religious institution that makes the choice to engage in the wider world of secular activities (all those services listed by Harrison and Rodriguez above, and more) should not have to submit to the rules and regulations governing those activities.

That is not an arrangement I accept.


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catching up on the news…

I realized sometime yesterday that I’d been neglecting the news, so I’ve been doing some binge-reading of the New York Times and there were a few items that caught my interest enough to warrant comment:

  • The city of Chicago is already preparing for effects of climate change that won’t even come about till the end of the century.  Seriously.  It’s an effort begun by former mayor, Richard Daley — and by all indications will continue under the new Emanuel administration — and it really blows my mind in terms of the sheer  ambition and comprehensiveness of the plan.  Everything from repaving alleyways to be more conducive to water runoff, to planting Southern trees more able to handle what are expected to be significantly warmer temperatures.  They’ve even got consulting firms — working pro bono! — to develop plans for making the city a zero-waste community.  The article mentions that Chicago intends to be a national leader, and I hope that intention is realized.  There truly is no excuse for further delaying efforts such as these to accommodate the changes in our planet’s climate, and Chicago deserves a lot of credit for taking the lead.
  • Speaking of health care, cardiologist Rita Redberg had a fantastic Op-Ed in yesterday’s Times in which she outlines just one of the ways money can be saved from Medicare:  ending the coverage of unproven and ineffective practices, such as the use of cardiac stents and unnecessary implantation of cardiac defibrillators.  While defending the right of the doctor and patient to freely make decisions, and also recognizing the political difficulty of discussing care-appropriateness in the context of a patient’s age (recall the row when US Preventive Services Task Force advised against annual mammograms in women over forty, for instance), she strongly argues for administrative changes within Medicare that would allow it to save taxpayer money by not spending it on tests and procedures proven to be useless.  There is no easy way to have this kind of discussion, but we must have it if we truly care about keeping Medicare sustainable rather than using it as a blunt political instrument.
  • Finally — and I normally skip over these things — this week’s Home section had an intriguing article on the concern designers and such have over impending light-bulb changes and the near-paranoid collecting of incandescent bulbs it has prompted.  Apparently, there is widespread confusion over the actual impact of the bill, in spite of repeated efforts by various manufacturers’ associations to clarify, and, not surprisingly, there’s no help to be had from conservative commentators (ie, Glenn Beck) who are more than happy to decry the “nanny state” law and encourage the hoarding of the endangered lighting instruments.  They ignore the fact — I assume by not actually bothering to read the bill — that it, quite reasonably, requires an increase in bulb efficiency and that a wide range of bulbs (including my beloved three-way bulbs) are totally exempt.  But what really got me was this quote from Joseph Higbee, spokesman for the National Electrical Manufacturers Association:  “My hope is that the media can help the American people understand the energy-efficient lighting options available, as opposed to furthering misconceptions.”  I feel like I can almost hear the resignation in his voice, and it breaks my heart.
Anyway, that’s more than enough for today.  Stay safe in the Midwest!

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the email…

A little over a week ago I received a forwarded email, the content of which I found atrocious enough to warrant a written response.  The email addressed two issues:  health care — specifically, how amazing America’s system is; and President Obama’s cabinet — specifically, how few members of it held jobs in the private sector.

The section of the email pertaining to health care had this to say:


A recent “Investor’s Business Daily” article provided very interesting statistics from a survey by the

United Nations International Health Organization.

Percentage of men and women who survived a cancer five years after diagnosis:

U.S.              65%

England        46%

Canada         42%

Percentage of patients diagnosed with diabetes who received treatment within six months:

U.S.             93%

England       15%

Canada         43%

Percentage of seniors needing hip replacement who received it within six months:

U.S.             90%

England       15%

Canada         43%

Percentage referred to a medical specialist who see one within one month:

U.S.             77%

England       40%

Canada         43%

Number of MRI scanners (a prime diagnostic tool) per million people:

U.S.             71

England       14

Canada         18

Percentage of seniors (65+), with low income, who say they are in “excellent health”:

U.S.             12%

England        2%

Canada         6%

I don’t know about you, but I don’t want “Universal Healthcare” comparable to England or Canada .

The above is wrong on so many levels.

First, we’ll start with the fact that the text offers neither citations nor, at the very least, links to the article it’s referencing.  It assumes you will take the “facts” presented at face value – which would be a mistake.

Second, let’s take a look at some of these “facts”.

Investor’s Business Daily did indeed publish an article featuring statistics on health care – “How U.S. Health Care Really Stacks Up”.

This article does not, however, quote statistics from the UN International Health Organization.  Why?  Because such an organization doesn’t exist.  What does exist is the UN World Health Organization (WHO), which the IBD article does quote – but only to mention that the WHO ranked the U.S. health system as 37th in its 2000 World Health Report.

What the article also cites (and what is, presumably, the actual source of the email’s statistics) is a brief analysis published by the National Center for Policy Analysis (NCPA) – an organization that “develops and promotes alternatives to government regulation and control.”

The publication is “10 Surprising Facts about American Health Care” and, unlike the email it spawned, includes numerous, legitimate citations and makes a clearly presented and articulated argument.*

The ten facts, as published by the NCPA and reiterated by IBD, are these:

  • Americans have better survival rates than Europeans for common cancers
  • Americans have lower cancer mortality rates than Canadians
  • Americans have better access to treatment for chronic disease than patients in other developed countries
  • Americans have better access to preventive cancer screening than Canadians
  • Lower income Americans are in better health than comparable Canadians
  • Americans spend less time waiting for care than patients in Canada and the U.K.
  • People in countries with more government control of health care are highly dissatisfied and believe reform is needed
  • Americans are more satisfied with the care they receive than Canadians
  • Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K.
  • Americans are responsible for the vast majority of all health care innovations.

All of these items, in the context they are presented, are true.  But we should also note the conclusion to which the author of the paper (Scott Atlas, M.D. and professor at the Stanford University Medical Center) came:

Despite serious challenges, such as escalating costs and the uninsured, the U.S. health system compares favorably to those in other developed countries. (emphasis added)

The reason I quote his conclusion is to point out this – that the purpose of this short, but informative, paper is simply to say, “Yes, there are problems with our country’s health delivery, but let’s not criticize it beyond reason.”  It is not, in itself, a condemnation of the other countries’ systems; merely an informed defense of our own.  What it is also not is an argument against the health care reform legislation that was recently signed into law; but an insistence that as we debate what our system does wrong, we should also acknowledge what it does right.

Ultimately, then, what I received was an email containing (mis)information (very) loosely based on an article which itself refers to a policy paper that is actually pretty fair and reasonable.

What I find so objectionable about the whole affair is twofold:

 1.)   That while the source paper does provide substantial data allowing for a favorable assessement of the U.S. health care system, it ignores certain questions that would, rather starkly, reveal the weaknesses of our system.  For instance:  the number of emergency room visits that are a direct result of a lack in primary care coverage, as well as the cost of those visits to the insured public; the number of people who are unable to seek timely care due to cost; the percentage of catastrophic conditions that are a result of peoples’ inability to seek care; and the number of bankruptcies due to medical expenses.

 2.)   The resulting email manipulates all this information and concludes with an exhortation to resist “universal healthcare” comparable to the UK or Canada.  This manages to confuse the concept of universal healthcare (in which every citizen has some form of health coverage) with a single-payer system (in which, like the UK and Canada, the government is the sole holder and disburser of health coverage funds).  And, thankfully, the new health care reform law establishes nothing at all resembling the single-payer system that the UK and Canada have in place.  In fact, the notion of a single-payer system was never even on the table.  In deference to the conventional wisdom that ours is a center-right country, the most liberal  proposal considered was a “public option” – a federally administered insurance plan that would compete with private plans in the marketplace.  And even that didn’t make it into the final legislation.

I’m fine if people are opposed to parts – or even all – of the new health care law.  But I would prefer they base their opposition on actual facts.

* It should also be noted that, upon examination, the statistics listed in the email just barely come close to possibly resembling those in the actual NCPA paper.

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my first health care town hall…

This afternoon, I attended a town hall meeting that was organized by Senator Evan Bayh’s office.  The Senator himself was not there, but in his stead was acting Regional Director, Sandi Stewart.  Though I spoke at the meeting, comments were limited to only a couple minutes, so I sent the following email to Ms Stewart to follow-up on my remarks.

Ms Stewart,

I wanted to thank you again for holding today’s town hall meeting and for taking comments from those of us in Bloomington who are very much in favor of a public health insurance plan.

I would like to reiterate, and perhaps expand upon, the remarks I made this afternoon.  I spoke about my desire to see Sen Bayh take the lead on two issues that I consider essential to a successful health reform bill — an emphasis on prevention; and an emphasis on biomedical research.

The Senator is, I believe, ideally placed to lead on these issues.  He is known (some might say notorious) for being a conservative Democrat, and therefore he is concerned about the costs involved in any plan for healthcare reform.  It has been demonstrated time and again that informed preventive practices can reduce the cost of health care — in the very obvious sense that it may flat-out keep certain conditions from occurring; but also in that early detection and treatment affords the opportunity to address a medical condition before it becomes so advanced as to require extraordinary means.  

If the Senator is concerned about the cost of health care, he will push for a system that emphasizes preventive care — fully covering annual physical examinations; covering regular screenings for conditions which patients are specifically at risk of developing; providing comprehensive support, guidance, and medical attention for expecting mothers (especially first-time mothers), so they may decide, with confidence, to bring their child into the world; and an ongoing list of actions that can keep people healthy, instead of merely waiting for them to become ill.

The best way for these preventive practices to be established is, I believe, through a universally available public health insurance plan that sets, for the rest of the health insurance industry, a basic standard of best practices.

The second issue, biomedical research, is related.  The deeper our understanding of conditions, the greater our ability to preempt their development or, barring that, treat the condition at its root instead of ameliorating symptoms.  My thinking on this has for years been guided by the writing of the late Lewis Thomas — specifically, his essay “The Technology of Medicine”, which is included in the volume THE LIVES OF A CELL (Penguin, 1973).  In summary, Thomas breaks medical technology into three types —

1.)  the “non”-technology, which includes hospice care, pain management, and other actions which do not aim to affect the outcome of a disease or condition, but instead “waits it out”

2.)  the “halfway” technology, in which category he includes organ replacements, chemotherapy, iron lungs (now long obsolete, thankfully), and other methods of treatment that, lacking a fundamental understanding of a condition, aim to address how the condition manifests itself; these are inevitably more expensive and, though sophisticated in appearance, are rather quite primitive

3.)  the “real” technology, such as vaccines and antibiotics, which treat a condition’s cause instead of its symptoms; this technology can only come as a result of knowing the inner mechanism of a condition — a knowledge that itself only comes from constant, vigilant, innovative research

The Senator is already an advocate of this issue through his involvement with the Senate Medical Technology Caucus and, outside of the Senate, the Medical Technology Leadership Forum, now based in Indianapolis.  He is in a perfect place to emphasize the need to continue, and even expand, federal research spending with the long-term goal of developing treatment technologies which ultimately lower health care costs.

And, finally, with both prevention and research in mind, I hope Sen Bayh will lead a shift in the debate that will move us away from the language of cost and towards a language of investment.  Whatever the government spends on health care is not simply an expense, but an investment in the health and welfare of our citizenry.  It must be acknowledged, and repeated over and over, that only a healthy citizenry can effectively educate and defend itself, and compete in the global market.

Thank you, again, for listening to me and my fellow voters this afternoon.  I hope our comments and concerns will be welcomed and taken to heart by the Senator.


Eric Anderson, Jr

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