Real injustices in health care demand that we take action
Those without insurance are less likely to receive help and we all pay the price
By Kathy Markeland
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
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
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
(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.)