Real injustices in health care demand that we take action

In a recent health journal, researchers from Columbia University reported their findings that uninsured individuals were less likely than insured individuals to have access to the latest medical technology. Perhaps unwittingly, their research offers a reminder as to why access to health care is an issue with moral implications for our society.

The researchers focused on adults 55-64 and reviewed the receipt of health care services related to three health conditions: heart attack, cataracts and depression.

The research revealed that the uninsured patients were 7% less likely to receive an invasive cardiac procedure. While up to 20% of insured patients received cataract surgery, only 2-5% of the uninsured received the same level of care. And while uninsured individuals are more likely to suffer depression, uninsured patients were half as likely as insured patients to receive anti-depression medications.

These data open up two interesting avenues of discussion as we reflect on the state of health care in the country today.

First, some may be surprised that those without the means to pay have access to these services at all. In the instances noted - where an uninsured patient undergoes an invasive heart surgery - who pays? The short answer is that we all do. And the study reveals that while there are inequities in accessing the services, people still receive care, as justice requires.

The reality is that we already have a health care system that extends services to most citizens. Some of us pay for it and some of us don't, but the system has already recognized that there is a moral obligation to care for those without insurance. Society expects it, because we cannot fathom living in a culture that leaves those who can't afford life-saving treatment out on the street to die.

So why is universal health care coverage such a leap? If we are already paying for it by subsidizing charity care and if public funds currently account for over 40% of the overall health care expenditures in this country, why is the discussion of universal coverage such a stretch for so many?

One possible answer leads us to the second avenue of discussion this research raises: Who benefits from advances in medical technology?

The battle on health care may be less about the cost of paying for services for everyone, than the struggle over how to equitably dispense the medical treatments we already have.

In countries with universal access systems, policy makers bemoan the inevitable "rationing" of health care services. These concerns about the potential for a universal system to erode the overall quality of our health care system should not be dismissed. Yet, as this study shows, we must recognize that rationing is what the uninsured are living with.

We continue to justify exorbitant investments in new medical technologies and even morally problematic means of research on the basis that these advances in medical technology are necessary to save human lives. Embryonic stem-cell research has been sold to the public on this very premise. Yet, this research starkly reveals that we have a track record of failing to equitably distribute those treatments already available.

As we continue to grapple with the monumental challenge of reforming the health care delivery system, studies such as this will be invaluable to help focus the discussion on the real fears that paralyze us and the real injustices that demand we take action.

(Markeland is associate director of the Wisconsin Catholic Conference, the civil arm of the state's five diocesan bishops. Its website is www.wisconsincatholic.org.)