A symposium on the dysfunctional state of the American health care system lured an impressive cast of government, religious, and industry leaders to the First United Methodist Church Sunday, including Representative Lois Capps. The event aimed to infuse questions of justice and ethics into a subject so crowded with economic theories and acronyms that many forget the billions of people who are affected by it.

Rabbi Arthur Gross-Schaefer, one of three speakers, got the crowd laughing when he likened the American system to the joke about a construction worker who, falling from his scaffold, is asked by the people seeing him tumble past their window how it is going. He replies, “So far so good.”

The talk began with an explanation of Santa Barbara County’s health-care safety net given by the person who understands it best, Elliot Schulman, M.D., director of the county’s Department of Public Health. The net, which Schulman says is unraveling, is designed to catch the uninsured, the underinsured, the difficult to serve, immigrants, and the discriminated against, categories of people that will be growing in this economic slowdown, he said.

“Health care is a commodity [in America] and it’s treated as a market commodity,” Schulman said. “How do we feel about that?”

Specifically, 47 million Americans are without any kind of health insurance today; 14 percent of the population in Santa Barbara was uninsured at the time of the last survey. Roughly 60,000 county residents are eligible for Medi-Cal, California’s primary health plan for the very poor. But with multi-billon-dollar deficits at the state level annually, and no mechanism for deficit financing, Medi-Cal (partially funded by the federal government) is forever on the verge of pushing a potion of its enrollees off its books. Other pressures on the safety net include decreasing property values, market philosophy, declining government dollars, and the ever increasing cost of care, Schulman said.

Gross-Schaefer kept returning to the subject of values. “We all agree that decisions [about health care] are being made without considering core values,” he said, and he outlined a list of five he and some colleagues wrote 10 years ago, including that all life is sacred and that all people have a duty toward each other. As a case in point, he noted that the county’s most troubled mental health clients are often treated by the professionals with the least amount of training. “It’s not fair, it’s not equal, and it’s not smart,” he said.

Capps, fresh from a voter registration event in Isla Vista, expressed optimism that health care was a major issue in the presidential campaign – right up there with the war in Iraq. But she warned that Republican candidate John McCain’s plan, which would eliminate the tax credit workers received for employer-sponsored health plans, would benefit the “healthy and the wealthy” and push the rest into a pool for people with little resources and little money.

Capps, who for years was a school nurse and still maintains a nursing license, said there were many smaller-scale things communities and government and individuals could do to lower costs and improve the system while more fundamental changes remain in the offing.

HIT (Health Information Technology), for example, would improve efficiency and lower costs, Capps said; electronic prescribing would reduce errors. Advanced directives, which detail people’s end-of-life wishes should they become incapacitated, could also eliminate billions of dollars in futile attempts to elongate life that in some cases people wouldn’t even want.

“There are things we can do that aren’t that expensive,” she said.

Capps noted that healthy Americans don’t experience the degree to which the health care system is broken here, unless and until they get sick or become disabled. Then they’re stuck battling the illness and the system. “It’s up to the healthy to take steps on behalf of the unhealthy,” she said.


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