Vinoth Ramachandra

Reflections on Healthcare

Posted on: March 26, 2010

The past two weeks have been emotionally fraught. My wife, Karin, was diagnosed to have a malignant tumour in the upper part of her colon.  She had it removed within a week of discovery. She is recovering well from the surgery, but we await the pathologist’s report for her prognosis. It has come as a complete shock to us, as there is no history of cancer in her family and her general health is excellent.

The operation was performed by one of the best surgeons in the field and in one of the best-equipped hospitals in Sri Lanka. Until the 1980s Sri Lanka enjoyed an enviable reputation as a Third World nation with an excellent system of free, high-quality, state-sponsored medical care.  But not any more.  State hospitals have been (intentionally) starved of funds, although they are the only medical services to which the majority poor have access. Medicine has turned into “big business” with corporations building state-of-the art hospitals in the capital. Many doctors who have received a free medical education in the state universities leave the government hospitals to work in these new hospitals and charge fees comparable to those of specialists in the rich world. Middle-class families pull out their entire life savings to pay medical bills.

There are many factors- economic, cultural, political- that account for this shift. One significant factor, however, that is not mentioned in public discussion is the following. As in the West, the influence of Christians in the medical and nursing profession has steadily declined. Until well into the 1960s, the proportion of Christians among doctors and nurses in the Indian continent was far higher than their proportion in the population as a whole. In India the medical care of women, tribals and “low-caste” peoples was pioneered by Christians. Sri Lanka had very few mission hospitals, unlike in India, because many Christians chose to work in the government hospitals. The exodus of Christians in recent decades, largely on account of the war and economic stagnation, has meant that money-making has replaced older ideals of compassionate care and public service. Of course there are individual Buddhists, Hindus and Muslims who practise these ideals admirably (while there are professing Christians who are a disgrace to the name of Christ), but the cultural ethos has shifted hugely. It may well be irreversible.

Middle-class as we are, the only reason we could afford such speedy, good quality and expensive care was because we are relationally rich. The support of friends, emotional and financial, both here and abroad, has been overwhelming. It has placed us in an awkward position: enjoying the privileges of private medicine while continuing to believe passionately in socialised medicine. I don’t think this is hypocrisy. We are not recommending the government system as it stands now. We are victims of an economic system which severely limits choice while proclaiming “freedom of choice”. We shall continue to advocate that the quality of healthcare that people receive should not depend on how much they are able to pay, and especially when it comes to life-threatening situations such as in Karin’s case. If the rich want special clinics for breast enlargements, liposuctions and Botox lips, they can pay for that themselves. But public funds, and perhaps public-private partnerships, should be devoted to providing services that every citizen can enjoy.

Our health depends so much on factors outside our control. Being born into a poor family means that we have poor nourishment, less access to information about health and nutrition,  more exposure to pollutants, less educational skills and job security, lack of political influence, and so on. This is what makes the right-wing rhetoric about “personal responsibility” for health mere hypocritical cant.

Economists limit their discussions of healthcare to the provision of medical services. But healthcare involves much more than good hospitals: concern for social justice in healthcare forces us to look at everything from sanitation, waste disposal, and climate change to the ethics of TV advertisements and food companies, the quality of secondary education and disparities in income and work opportunities. Prevention is far more effective than cures- and prevention mostly requires cash transfers to develop education and infrastructure, whereas curative medicine absorbs real resources.

Most of us non-Americans are naturally nonplussed at the fury that Barak Obama’s health care reform bill has unleashed. It perplexes us that so many suburban American Christians who do not care one iota about a trillion-dollar military budget, and wax eloquently about being zealously ”pro-life”, are now indignant about their state spending public funds to make the poor Americans more equal to them when it comes to receiving medical treatment and enjoying good health! Please, could some Republican party Christian explain these anomalies to the rest of the Body of Christ around the world?

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19 Responses to "Reflections on Healthcare"

Couldn’t agree more with you, Vinoth. We prayed for you and Karin at the All Souls prayer gathering on Tuesday. Hoping that all is very successful.

Do you really want an explanation? Or are you just venting?

Not a republican and being a mennonite I do have a problem with our military budget but abortion has become retail politics in this country. It’s a shame.
While I think most of the pro-life republican Christians in this country didn’t want health care reform because they are beholden to partisan identity politics that told them it was wrong for the country I think an interesting question for democrat christians (pro-life or pro-choice) is why wasn’t it worth have a health care bill that didn’t fund abortions. Health care reform is such an important issue why would they risk it over abortion? And the answer is just as simple: they are being controlled by interests that aren’t their own.

I am not an advocate of this position, but a reporter of it, as I live in a Midwest ‘Bible Belt’ and attend a fairly large evangelical church that leans heavily Republican.

Here is my understanding of a few key points of opposition…..

1. Practically: Many who oppose want smaller government all around. In our scale of economy, we typically associate federal programs with waste, corruption, etc. Care and decision making should be made at the state or local level.

2. Theologically: Big government also echoes a certain eschatological persuasion where large government forces believers to participate in things they don’t believe in.

3. Politically, for better or worse, this group is beholden to John Locke. Usually, folks I know believe in a small federal government that oversees the defense of the country, defense of basic rights, and only what we choose to participate in. Many Evangelical Republicans also have a narrative about the founding of this country and the Consititution being based on Christian principles. And the federal seizing of powers they weren’t meant to have is part of the opposition.

4. Compassion-wise, many Republican evangelicals are persuaded that we already have a large enough social net. It is my understanding talkign to doctors and nurses in the area, that if you come in off the street and need acute care, you will not be refused even if you do not have the means to pay for it. Medicare covers many low-income families, all refugees the U.S. accepts each year, etc. This is a stretch, I know, but most in this crowd fear an entitlement state that will take away incentive to work hard.

5. Practically, in my view, I agree with mshedden that many are beholden to partisan identity politics. Abortion becomes the controlling factor associated with the Republican Party, and the echo-chambers of Rush, Foxnews, etc. feed a worldview that finds it difficult to engage in other arguments.

Obviously these are broad brushstrokes, but these are some of the factors involved, I think.

I live in Canada where we have public health care and private clinics are forbidden. This prevents the two tiered system you mention in your country. However, our medical system is currently consuming over 50% of all tax dollars and this will only increase as our population ages. Every time our doctors and nurses complain about wages or threaten to strike they mention how much more they could be paid in the US or the Middle East. Even with this level of spending it is usual for people to spend four or five hours in the emergency room awaiting treatment. Our current system is unsustainable without a radical change in values and I can’t see that happening anytime soon.

Vinoth-

I am so sorry to hear about your wife, and I pray all will be well. (You do not know me, but I recall meeting you and your lovely wife at an event in Atlanta a few years ago.)

I’m not certain that I speak for everyman Republican party Christian, but I will share my reflections. Many of us opposed to the recent healthcare bill believe that it will (and is in fact intended to) further break the American medical system (raise costs, create provider scarcity, punish the poor that it is intended to help) so that in ten years or so, there is no option but for voters to beg the U.S. government to take over the medical system entirely.

And why is this bad, you ask? Because ultimately, we think that universal access to high-quality healthcare provided by the government is a fleeting dream. You give the perfect example of Sri Lanka in the 1980’s–it didn’t last. I am not an expert on Sri Lankan economic and social policy, but the “common human condition” approach of most regulated free-market Republicans would argue that it doesn’t matter. Someone is going to figure out how to play the system and make money doing it. Would we rather that it be private enterprises who can be regulated by the government, taken to court, have their medical licenses revoked, etc., or would we rather it be the government? We extend the skepticism that our Democratic friends have for the interests of insurance companies, doctors, or what-have-you to the government. Government officials are fallen human beings, too, as are the systems they create.

And yes, we know there are countries in which state health care seems to be doing well — Canada, the UK, France, etc. We’re talking about fractions of the people and (for Europe) land mass included in this, with different histories regarding states’ rights and different national experiences that affect their citizens’ approach to health care. The health systems of the UK and France grew out of WWII rationing and rebuilding. Those closely familiar with the U.S. medical system have seen that in the U.S., healthcare provided to the poorest individuals is widely abused, even in the face of great strides in health education and preventive care. Our cultural differences (and particularly a culture of entitlement) are likely to make socialized medicine a nightmare in the U.S.

This is not to say that no legislation or regulation was necessary–perhaps this bill will really do what it says it will and we will have the “best of both worlds” in the American medical system. I wouldn’t say that I am indignant about the state spending my tax dollars on extending social services. It is right to provide so many of these things. But I am skeptical that government-run health care really would provide equitable access to quality health care in the U.S.

So I hope you really were asking for an answer.

Vinoth,
A great article. I am sorry to hear about your wife and pray that she makes a good recovery.
As a non American living in America I get very frustrated at the panic over socialized healthcare. America has the highest child mortality rate of any Western country. It spends about twice as much on health care as any other nation and does not have a better success rate in treating disease. Life expectancy is not the highest in the world – longevity is best in countries with socialized medicine – like Scandinavian countries and Canada. A little ironic in view of the last comment. As well as that chronic illness is one of the major causes of bancruptcy. So how can we possibly think we have the best health care in the world?
No country has a perfect health system and the concern is that all systems are unsustainable as the population ages – I think that has less to do with the type of health care in a country than with our unrealistic expectations. The more we buy into heroic and expensive procedures for the last few months of life (the major reason for escalating costs) that do little if anything to improve quality of life, the more we will see health care prices spiral upwards.
Blessings and good to find your blog after many years of not being in touch.
I can understand why non Christians want these procedures but surely as Christians we should be more willing to

Most of us non-Americans are naturally nonplussed at the fury that Barak Obama’s health care reform bill has unleashed. It perplexes us that so many suburban American Christians who do not care one iota about a trillion-dollar military budget, and wax eloquently about being zealously ”pro-life”, are now indignant about their state spending public funds to make the poor Americans more equal to them when it comes to receiving medical treatment and enjoying good health! Please, could some Republican party Christian explain these anomalies to the rest of the Body of Christ around the world?

I am a suburban American Christian, and I happen to also be nonplussed by this attitude so many in my demographic seem to have.

The whole point of health insurance is that it insures you against the unexpected. Unless you are a billionaire, you have no guarantees you will have enough money to cover whatever may happen to you. You could need a transplant and be on immuno-suppressant drugs for the rest of your life (we’re talking thousands of dollars per month, on top of the cost of the transplant procedure itself). You could lose your job and then be considered to have a preexisting condition when you try to buy health coverage for yourself.

Even rich people who currently have health coverage shouldn’t feel smug about having coverage… it could leave at any time under the current system.

I don’t know if I’m a big fan of the health reform that’s passing now, but I know I’m totally against our lack of reform we’ve had up until this point.

Vinoth,

This is a great article. I thank you for sharing your views on what, in America, is completely frustrating for us on all sides of the aisle.

Emily,
I think you missed the part where he said the system was “intentionally” blighted. As in, someone wanted to make more money so that they sabotaged the system in Sri Lanka. Why? Perhaps they saw the model of the US system.

Thomas,
Perhaps you’ve never visited an ER in the US. “Sometimes” wait for several hours? Please, that’s the one thing that is universal here.

[...] Filed under: Personal Musings — v02468 @ 11:15 am This is a quote taken from a Sri Lankan Christian. (HT: Idle musings of a [...]

[...] Ramachandra, in the midst of a very stressful situation, writes trenchantly from a Sri Lankan perspective about the Healthcare debates in the USA. I have to say I’m inclined to [...]

Healthcare is expensive. Medicines cost money, equipment and buildings cost money, wages cost money.
If we want people to be able to receive healthcare that they cannot afford on their own, then it has to be paid for. The question then is how should this be done?

“Each man should give what he has decided in his heart to give, not reluctantly or under compulsion, for God loves a cheerful giver.” — 2 Corinthians 9:7

Wouldn’t it be better for Christians do give to Christian mission hospitals, and to organisations like Samaritan Ministries – http://www.samaritanministries.org/ – rather than support obtaining money involuntarily through taxation? Christian ethics says “Freely you have received, freely give.” Government ethics says “pay or go to jail”.

The NHS is the UK funds abortions as well as lifesaving treatments. How many Christian mission hospitals provide elective abortions?
NHS hospitals will suspend a nurse for wearing a cross round her neck, or for offering to pray for a patient. Wouldn’t Christian mission hospitals be a nobler cause to support that hospitals run by a secular state?

Vinoth,
You and Karin are in our prayers.

I agree, in India as in SL, it is often difficult for middle-class people to go through the public healthcare system unless we know someone in the system, who will see to it that we are able to quickly wade through all the red tape and get access to whatever facilities are available.

There are exceptions, though, which function ok. My parents steadfastly cling to their Military Hospital healthcare, and the new public-private partnership scheme the government has launched. I myself worked and was admitted for care in the government systems for a few years – and didn’t find them that bad. I think the more middle-class people take the plunge and use the systems – at least occasionally – the better they will get. If only the poor are recipients, quality tends to suffer. Shouldn’t be so, but it tends to happen that way. :-(

Vinoth, I agree with you entirely, but before saying any more I do want to convey our love to you and Karin, and assure you of our prayers.

By world standards the health system in the Australian state of Victoria is exceptionally good. Nevertheless, two systems prevail, one for the rich and another for the rest. A similar situation exists in our education sector. The willingness of successive governments at state and federal level to cooperate with the entrenching of dual systems in health and education is not only anti-development, contrary to the well-being of our community, and utterly unjust. With respect to health, if I suddenly come down with a life-threatening illness, I will immediately benefit from the highest quality health care. But if I am waiting for elective surgery I can be waiting for years in the public system or, in the private system, book almost immediately into a 5 star hotel (sorry, I mean hospital), at my convenience, and be operated upon by a surgeon whose training has been subsidized by my taxes. By the way, I am finally having my simple surgery for a hernia tomorrow, provided that there is still a spare bed in the hospital!

Your blog has been one of my favorites of all time. … Thanks for writing such a great blog. I always enjoyed reading it,

Hi Vinoth, well-wishes and prayers for your wife. Let me offer one answer to your question.

I can’t explain to you all the contradictions of suburban megachurches. I can, however, explain to you my grandparents. They are by far the most generous people I have ever met. When they see someone in need they meet that need. They let others live in their home, offer meals to strangers, and help people find jobs. They have taken a major hand in raising dozens of children whose parents were unwilling or unable to raise them. Still, they cannot stand this idea of universal healthcare. Why?

In the most recent post you write, “ultimately if the moral ethos of a culture is disposed towards chronic dishonesty and corruption, obviously no economic system can work.” For my grandparents, government handout programs are deleterious to a culture’s moral ethos. They represent not suburbanites but actual country folk; they go to the rodeo for fun and until retirement didn’t even live in a named municipality. They’ve never had any significant amount of money but they are able to do almost everything themselves; they grew their own fruits and vegetables, fixed their own cars, and built and maintained most of their own house. Only recently have they come to depend on specialists, as old age has pushed them to live near a hospital.

These are people filled with both joy and charity, and they see big government and centralization of any sort as a force which destroys their way of life. (I won’t sentimentalize it, by the way. While I’ve seen some incredibly virtuous and intelligent country folks, I’ve also seen rampant drug abuse and misogyny.) While you are certainly right to identify the deep contradictions in the Fox News-esque suburbanism, in this case I don’t see a tension. They see big government and centralization as creating the very problem it would seek to solve with universal healthcare.

(Their Congressman, by the way, is an eccentric fellow you may have heard of named Ron Paul. While I think in him country values have been co-opted into a bourgeois narrative, he is an unwavering opponent of the size and actions of the American military, and his criticism of government healthcare is matched by a long record of criticism of government subsidization of corporations and the rich.)

Yep.This is great blog Lisa.I also enjoe this lots.:)

[...] Ramachandra, ‘Reflections on Healthcare’ [via Jesus [...]

i always like to stay on 5 star hotels because the ameneties and the ambiance is always great ‘

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