Wednesday, April 05, 2006

An Episcopal Perspective on the Massachusetts Insurance Experiment

The big news today in health care is the new legislation passed in Massachusetts which has the object of bringing all the state’s residents into some form of health insurance. While the new law will expand somewhat the state’s Medicaid coverage, the largest push will be to move most, and certainly almost all those employed, into some kind of private coverage. The law uses a combination of tax incentives and penalties for individuals, and incentives and penalties for employers, to bring this about. You can see a good description of the plan here.

I have posted recently on the action of General Convention in 2000 (Resolution 2000-A079) and of the Formative Statement on Health Care that was one result. But I want to put that statement in context. In fact the General Convention had been speaking on health care for all as far back as 1988. That 69th General Convention passed Resolution 1988-D108, titled, “Advocate for Appropriate Health Care for All Who Are Ill:”

Resolved, the House of Deputies concurring, That this 69th General Convention direct the Presiding Bishop and the Executive Council, in light of the strains upon the health care system exerted by the AIDS Epidemic, to direct the Washington D.C. office of the Episcopal Church in the United States of America to adopt a strategy to advocate for all persons suffering from illness by creating appropriate levels of cost-effective health care, for example, hospices and alternative health care facilities.

This resolution was followed at the 70th General Convention in 1991 by two resolutions, A010, “Advocate Legislation for Comprehensive Health Care;” and A099, “Call for a System of Universal Access to Health Care.” Both called for universal health care as a basic right, the former calling for advocacy from agencies of the Episcopal Church, and the latter for action in the federal government.

The most complete statement, however, was passed at the 71st General Convention in 1994. That resolution was A057, “Adopt Church Principles on Access to Health Care:”

Resolved, the House of Bishops concurring, That this 71st General Convention of the Episcopal Church adopt the following four principles as the position of the Episcopal Church regarding health care:
That universal access to quality, cost effective, health care services be considered necessary for everyone in the population.
That "quality health care" be defined so as to include programs in preventive medicine, where wellness is the first priority.
That "quality health care" include interdisciplinary and interprofessional components to insure the care of the whole person--physiological, spiritual, psychological, social.
That "quality health care" include the balanced distribution of resources so that no region of the country is underserved.

The most interesting aspect of these principles is their inclusion under the definition of “quality health care.” In the early 1990’s we were first seeing the spreading within the health care industry of principles of performance improvement and quality management (about which I have also written). The understanding of “quality health care” in the quality management environment has been based on clinical and organizational outcomes. In 1994-A057 we as the Episcopal Church asserted that to provide “quality health care” also required certain social justice outcomes. For us, I believe these outcomes would be considered essential if we were to “seek and service Christ in all persons, loving [our] neighbor as [ourselves],” and to “strive for justice and peace among all people, and respect the dignity of every human being.” (From the Baptismal Covenant, Book of Common Prayer, page 305).

It remains to be seen whether the social experiment in Massachusetts will produce quality health care, either in the sense of better clinical outcomes, or in the sense of fulfilling the social outcomes that we as the Episcopal Church would seek. It will be, I think, worth the effort. But however it turns out, we have made clear in actions of General Convention our own goals and standards: to provide health care for all persons, care for whole persons from cradle to grave. You know, it looks like this will be an issue in the next few elections. Think what it might mean if we all made clear to those we support that we also support these statements of the Church in General Convention.

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