46 Million Reasons for Health-Care Reform

December 5th, 2009

The moral imperatives for change.

by Jim Wallis, John DiIulio Jr., Carol Keehan, E.J. Dionne Jr., Janelle Goetcheus, Rose Marie Berger, Tom Sine, and Arthur Waskow

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For the Healing of the Nation: 46 million reasons for health-care reform

by Jim Wallis

Our history, both as the church and as a country, can be told as a story of confronting and overcoming great challenges. It has never been easy, and the conflict of this summer’s debate over health care and the health of our nation has shown just how difficult it can be.

We have been faced with missing and sometimes misleading information, challenged by both our greatest hopes and fears, and tested in our ability to stand for moral principles in the midst of genuine confusion, legitimate concerns, and aggressive ideologies. Sadly, we have seen even our communities of faith too often overcome by political polarization instead of helping to overcome it. But we know that real change only occurs when hope wins out over fear, when political ideologies are replaced with moral values, and when common ground can be found to achieve the common good.

In his September address to a joint session of Congress, President Barack Obama made the commitments that a broad coalition in the faith community had asked for—reform as a moral issue, affordable coverage for all, and no federal funding of abortion.

First, the faith community had been asking the president to make “the moral case” for health-care reform, not just the policy arguments—and he couldn’t have been more clear about the moral imperative for fixing a broken system. He quoted a letter from Sen. Ted Kennedy, written last spring but delivered to the president after Kennedy’s death, stating that health care “is above all a moral issue; that at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

Second, we told the White House that the faith community will accept nothing less than accessible, affordable, and secure coverage for everyone. The president said that “if you’re one of the tens of millions of Americans who don’t currently have health insurance, the second part of this plan will finally offer you quality, affordable choices.” And while there may be various means of achieving that goal, “I will not back down on the basic principle that if Americans can’t find affordable coverage, we will provide you with a choice.” He rejected the incremental approaches that will again postpone bringing everyone into America’s health-care system and making sure it is working for all of us—and so should we.

Third, we told the president that we needed to hear a clear commitment to prohibit federal funding of abortion and to maintain a strong conscience protection. He gave that public commitment: “Under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.” As the president said, “There remain some significant details to be ironed out,” but his commitment to these principles means we can now work together to make sure that they are consistently and diligently applied to any final health-care legislation. The practical application of that principle should mean that no person should be forced to pay for someone else’s abortion, and that public funds cannot be used to pay for elective abortions.

Now it is the job of the faith community and every concerned American to make sure the final bill reflects these moral principles. And the faith community will continue to be vigilant to ensure that each one is followed throughout the process of achieving health-care legislation. The president has set the stage for finally achieving real solutions to health-care reform by defining the deeper moral issues at stake and clarifying the policy debate. We will now be calling on our members of Congress—Democrats and Republicans, many of them members of our congregations—to support these moral commitments and to make sure, as they iron out the details, that each one is firmly upheld.

At the beginning of the speech, after noting the continuing economic crisis, President Obama said, “[W]e did not come here just to clean up crises. We came to build a future.” That future indeed involves a significant social transformation, and like most such change, it invokes strong reactions. We in the faith community have a special role in that process of change—to help the nation make the spiritual choice of hope rather than fear, and to believe that the way for all of us to move forward as a society is to make that choice.

Our hope for the future is bound up with the healing of the nation. That includes comprehensive health-care reform, but it also involves the way we discuss how to reach it. As we discuss and debate with our friends, families, religious communities, and legislative leaders about this critical task, let us reflect our best traditions of who we are, in our faith communities and in the democratic process. In both, we pray for healing.

Jim Wallis is editor-in-chief of Sojourners.


A Fundamental Moral Decision: How can we, in good conscience, deny health care to anyone who’s sick? We can’t.

by E.J.Dionne Jr.

The term “pro-life” is used with great seriousness in politics, and also as a political cudgel. If ever there were an issue on which those words have clear relevance and resonance, it is health-care reform.

Pro-life activists are deeply engaged in controversies around what care should be given at the end of life, and I strongly share their opposition to physician-assisted suicide. But who pays for end-of-life care when someone lacks health insurance? What sort of care can that uninsured person expect at the end of life? What good does it do to raise a ruckus around a general principle and not ask how the basic requirements of the sick can be met?

If a young woman is making up her mind about whether or not to have an abortion, is she not far more likely to choose life if she knows that she will receive decent health care while she is pregnant? Will she not feel more confident if she knows that both she and her baby will be able to see a doctor regularly after the child is born?

If we believe that all life is sacred, does that not mean that everyone should receive medical help in the early stages of an illness, before the illness becomes life-threatening? If we believe that human lives should not be bought and sold, doesn’t that require us to limit the impact that wealth and income have on access to life-enhancing and life-saving health care?

There is a terrible gap between the rhetoric people use in the health-care debate and the reality of our health-care situation. In particular, there is an enormous disconnect between the anti-government pronouncements we hear from opponents of universal coverage and the fact that government is already deeply enmeshed in our health-care system.

According to 2006 figures from the Organization for Economic Co-operation and Development, government expenditures on health care in the United States already amounted to 7 percent of our Gross Domestic Product. That was identical to the Canadian government’s share, and not far off from Sweden’s 7.8 percent, Germany’s 8.1 percent, or France’s 8.8 percent. In other words, our government already spends a great deal on health care, and yet 45 million to 50 million of us still lack regular insurance.

As a society, we agreed more than 40 years ago that it was unconscionable for the elderly to lack health coverage. With Medicare, we socialized—yes, I used that word—the provision of health care for all senior citizens.

Medicare is not perfect, but what a world of good it has done. But why offer that guarantee only to the elderly? Shouldn’t their children and grandchildren have the same right to regular medical care that they do? Isn’t that what the elderly themselves want? How can so many who say they oppose “government meddling” in health care at one moment go on to declare their firm support for Medicare at another? They cannot have it both ways, although they keep trying.

Medicaid has also brought needed care to many poor Americans. But isn’t there something terribly arbitrary about saying that one group of poor Americans can rely on government for help, while members of another group, nearly as needy, are left to fend for themselves? What principle is involved here?

One of the best pieces of legislation signed into law by President Obama this year was the substantial expansion of the Children’s Health Insurance Program. It was an excellent step in the right direction. But what do we say about the parents of those children? If a parent gets sick and has no health care, how does that affect a child—even if the child is insured?

There are many roads to universal coverage. There are many practical reasons—related to controlling costs to government, businesses, and individuals—for supporting reform. But the most compelling argument, finally, is moral: A country that values life should not be placing so many obstacles in the way of those seeking health care.

An essential book for this fall is T.R. Reid’s The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. Reid, a former Washington Post reporter, embarked on an international search for better approaches to health coverage. Here’s what he concluded:

Those Americans who die or go broke because they happened to get sick represent a fundamental moral decision our country has made. Despite all the rights and privileges and entitlements that Americans enjoy today, we have never decided to provide medical care for everybody who needs it. In the world’s richest nation, we tolerate a health-care system that leads to large numbers of avoidable deaths and bankruptcies among our fellow citizens …

All the other developed countries on earth have made a different moral decision. All the other countries like us—that is, wealthy, technologically advanced, industrialized democracies—guarantee medical care to anyone who gets sick. Countries that are just as committed as we are to equal opportunity, individual liberty, and the free market have concluded that everybody has a right to health care—and they provide it.

And we should, too.

E.J. Dionne Jr. is a syndicated columnist and senior fellow at The Brookings Institution in Washington, D.C.


No Citizen Left Behind: Getting beyond the “single plutocrat” system

by John J. DiIulio Jr.

A nonpartisan study by a dozen experts highlights the “fundamental truths about health care in the United States”:

The system is in bad shape. Some citizens have no health insurance at all … Costs are spiraling … Swift and simultaneous reforms of health insurance coverage, care delivery systems, cost control mechanisms, and medical education will not be easy and may well be impossible.

I used those words 15 years ago to introduce a Brookings Institution-edited volume about health-care reform.

Today, as in 1994, America is an affluent society in which tens of millions of people are without health insurance and millions more have thin or easy-to-lose coverage. This is what the catechism of the Catholic Church terms a “sinful inequality,” and it results from what Pope John Paul II denounced as deifying “profit and the law of the market” to the “detriment of the dignity … due to individuals and peoples.”

Survey data stretching back decades indicate that most Americans want no citizen left uninsured, but the bipartisan- majority opinion favoring universal coverage has never dominated health-care reform debates.

The fundamentals of health-insurance reform are the same today as they were when President Bill Clinton pushed for universal coverage: guaranteed issue, portability, limits on exclusion of coverage for preexisting conditions, and so forth.

The partisan and ideological battle lines are much the same too. The one notable difference is that, unlike in 1994 when multiple single-payer plans received serious consideration (for example, the bill proposed by Democratic Rep. Jim McDermott and Democratic Sen. Paul Wellstone), in 2009 the opposition lambasting any “government-run” reforms as “socialized medicine” or worse has been so influential that Democrats in Congress (lonely exceptions such as New York Rep. Anthony Weiner duly noted) have said little about single-payer, while the Democratic president has dallied over a “public option.”

The irony here is that in 2009, unlike in 1994, government is close to being the single biggest payer:

• In today’s $2.5 trillion health-care economy, nearly half of all Americans—led by senior citizens, low-income children, public employees, and veterans—are in one or another government-financed program.

• Medicare and Medicaid, the two largest federal health programs, began in 1965. President George W. Bush expanded Medicare’s prescription drug coverage and backed targeted expansions in Medicaid even as the two programs’ combined annual budgets surpassed $750 billion.

• Government at all levels now finances about 40 percent of total annual U.S. health expenditures, and governments will finance more than half of all U.S. health expenditures by 2018.

And here is the kicker: While the post-1994 health-care finance system has become ever more highly “nationalized,” the post-1994 health-care administration system has become ever more highly decentralized:

• Today the Centers for Medicare and Medicaid Services has 4,400 federal employees, but tens of thousands of state and local government employees, for-profit workers, and nonprofit staff actually administer the two giant “federal” programs.

• Many senior citizens now receive expensive, multiyear services without ever actually encountering a single federal employee.

• Medicaid, financed as a federal-state program, varies widely from state to state not only in per capita expenditures but in how it is administered.

Metaphorically speaking, the nation’s health-care system is almost up to its waist in the single-payer pool. It will soon be in even deeper. Everyone fears drowning (health-care expenditures rising above 18 percent of Gross Domestic Product). Yet nobody advocates leaving the pool (the Republican National Committee’s August 2009 “Senior’s Health Care Bill of Rights” pledges to protect and grow Medicare). The policy debate is over whether to tread water (policy status quo), dog paddle (most plans that have any real chance in Congress), or swim hard (varieties of single payer).

Whatever one’s policy preferences, rhetoric about “rationing” is counterproductive: There is not a single example of any current health insurance plan, private or public, that affords beneficiaries, without regard to age or medical condition, unfettered access to favorite physicians, unlimited authority to define and dictate treatment for a disability, automatic disbursements at desired rates for institutional care, and no limits whatsoever on “allowable charges” or “coverage determinations.” (Actually, there is such insurance, but it is available only to the self-financed super-rich: I call it “single plutocrat.”)

Generally, the bad reasons behind post-1994 America’s spiraling health costs include profit-plumping private insurance companies and antiquated information technologies, but the good reasons include expanded (though far from universal) coverage and better quality. No American in 2009 wants circa-1969 brain scans, circa-1979 heart bypass surgery, circa-1989 breast cancer treatment, or circa-1999 prosthetics. Today’s best diagnostics, treatments, and other medical goods and services cost more on average in part because they are worth more on average.

For both moral and practical reasons, I would probably vote with some reservations for a federally regulated but state-administered single-payer plan, but I have had 15 years to mourn the last missed chance for universal coverage, and I do not believe in legislative miracles.

My more modest prayer is that our evolving single-biggest payer system, in all its administrative complexity, will be incrementally tweaked over the next five to 10 years so that every American man, woman, and child gets quality health care without regard to socioeconomic status or zip code.

John J. DiIulio Jr., the first director of the White House Office of Faith-Based and Community Initiatives, is the Frederic Fox Leadership Professor of Political Science at the University of Pennsylvania and author of Godly Republic.


It’s About Life and Death: I attend far too many funerals for those who are far too young.

by Janelle Goetcheus

As a physician I often say that what I see daily are persons with complications of illness that never should have happened—that could have been prevented if my patients had health insurance. Complications that ravage the human body—that destroy essential body organs, like the heart and kidneys.

I see young people with strokes from not having their high blood pressure treated, and who, even when diagnosed, were unable to afford their medications. Daily I see diabetics who, even at young ages, have severe damage to their kidneys because of lack of treatment and are now on dialysis. Many others end up needing early amputations of gangrenous limbs.

I see persons who, because of lack of health insurance, delayed seeking help for beginning symptoms of cancer and often had not been able to access preventative health evaluations. Thus by the time they are seen, they have advanced cancer.

Several years ago I was part of the American Cancer Society’s hearings held around the U.S. I listened to person after person’s testimony of how their cancer was now in advanced stages, how they had feared seeking early medical care because of lack of health insurance, and, being uninsured, the difficulty of finding health care even when they tried to seek help.

As a physician I sometimes become a beggar—begging specialists or hospital clinics to see an ill patient. However, even if the specialist is willing to see the patient, the specialist faces the same hurdles as I do: How do I get the needed blood tests, x-rays, etc., since the patient has no insurance?

Every day I see people who will die early because of not having had insurance and not having had early enough health care.

Health-care reform is about life and death. If we see a child start to run in front of a car, we do not just stand there and observe and do nothing. If possible we try to prevent the child from being hit and killed.

But we are willing to just stand still and observe people who are sick remain unable to obtain health care—even when we know they will suffer needlessly and they will die early. I attend far too many funerals that should not have happened, for those who are far too young.

Health-care reform is about life and death.

Janelle Goetcheus, M.D., is the founder of Columbia Road Health Services, a medical clinic serving refugees and other poor residents, and Christ House, a live-in care facility for homeless men and women in Washington, D.C.


A Strange Kind of Revolution: Corporate con artists and ‘populist uprisings’

by Rose Marie Berger

When the history books footnote the heated “Summer of ’09” town hall health-care debates, they may get tagged the “Status Quo Uprising.” Unlike most liberal or conservative American populist uprisings, which are a backlash against the established order, the people lining up to yell at their senators this summer appeared to want the health-care system to stay exactly as it is. It’s a strange kind of revolution.

When I started digging into the funding and organizing strategy behind the anti-reform “grassroots” movement, I found an interesting family tree. Under the surface, a network of about 10 very well-funded PR agencies and conservative groups are making most of the anti-reform noise—along with a coterie of Far-Right, super-rich, ideologically committed movers and shakers.

Whom do Far-Right political operatives call on when they want to defeat major health-care reform? They go to the master, Ralph Reed. In 1997, before his fall from political grace because of his ties to lobbyist/felon Jack Abramoff, Reed and protégé Tim Phillips started Century Strategies, a political consulting firm whose clients have included Enron, online gambling companies, Indian gambling interests, and the cable industry in its fight against decency measures proposed in Congress.

In 2006 Phillips was tasked with heading up the political nonprofit Americans for Prosperity. A significant portion of AFP’s funding comes from Kansas-based Koch Industries. Koch, a global energy firm that runs coal plants, agribusiness, major oil refineries, and more, is one of the largest private companies in America.

Center for American Progress researcher Lee Fang notes, “The rate at which the Koch Industries-funded Americans for Prosperity churns out front groups to promote its right-wing corporate agenda sets the organization out among similar conservative ‘think tanks.’”

AFP spawned health-care-targeted subsidiaries Patients First and Patients United Now. Patients United produced the “Survivor” TV ad with Canadian brain “tumor” survivor Shona Holmes describing how she had to go to the U.S. for treatment because “government health care isn’t the answer and it sure isn’t free.” (Holmes, who actually had a non-life-threatening pituitary cyst, is suing the Canadian government in an effort to get it to pay for her U.S. surgery.)

Another group, Conservatives for Patients’ Rights, founded by Richard L. Scott, claims to be hugely influential in the town hall meetings. In the late 1990s, Scott, who also founded Columbia/Hospital Corporation of America (“the Wal-Mart of health care”), was forced to resign his leadership of that corporation amid the biggest health-care fraud scandal in U.S. history. He also co-founded Solantic urgent-care walk-in centers, whose primary customers are the uninsured or underinsured.

Interestingly, some major pharmaceutical companies and health insurance companies are not heavily involved in fanning the flames of the status quo—primarily because they are at the negotiating table on Capitol Hill making sure the Democrats’ “reforms” reflect the industries’ economic interests.

It turns out that the “populist” part of the uprising is less grassroots and more “astroturf.” True populist uprisings tend to be rich in people and poor in funds. Astroturf campaigns have lots of money, access to the best electronic databases, massive phone banks, and well-paid organizers, but they only need a small group of supporters. With this little, but loud, group, the astroturfers create a media “echo chamber” to make it appear that the “cause” they are advertising represents the views of a much larger percentage of citizens than it actually does. (Look for more of this tactic soon from coal, nuclear, and electricity industries when the cap-and-trade climate initiatives come up for debate.)

“Calling these protesters ‘extremists’ or ‘wingnuts,’ suggesting that they are … mere puppets of elite rightist spinmasters, or demanding that they be silenced undercuts basic concepts of the democratic process,” says Chip Berlet, senior analyst for Political Research Associates. “At the same time, being aware of how historic right-wing populism has played out in ways that promote scapegoating of immigrants, people of color, Jews, and other targets is vital to protect the democratic process.”

There are legitimate issues of debate that require deep and honest civil discourse if we are to provide fiscally responsible, truly accessible, morally accountable, high-quality health care to all Americans. But to have that conversation, we need to be able to hear ourselves think.

Rose Marie Berger is an associate editor of Sojourners magazine.


The Public Option and the End Times: Searching for sanity in the health-care debate

by Tom Sine

“This is about the dismantling of this country … We don’t want this country to turn into Russia,” declared Katy Abram, 35, to prolonged applause. Abram was sharing her concerns at a town hall meeting in Lebanon, Pennsylvania, as the health-care debate began raging in August. I am sure Sen. Arlen Specter, who hosted the gathering, and many others wondered what Russia has to do with the American health-care debate.

To get a deeper picture of what’s undergirding the health-care conversation, it’s important to unpack the “end times” sub-text for millions of conservative Christians who are intent on defeating this initiative. As I explained in Cease Fire: Searching for Sanity in America’s Culture Wars, “To understand the Christian Right, you need to understand not what they think or even what they believe. You need to begin by discovering what they are afraid of.”

Many of these good people, deeply influenced by popular prophecy theories, live in abject terror, in these “last days,” of being collectivized into a one-world Marxist gulag in which their liberties, faith, and guns are taken away and their families are placed at severe risk.

One of the most influential prophecy buffs is Tim LaHaye. His Left Behind series and his first book, The Battle for the Mind, sought to persuade evangelicals that their lives, families, and country will be taken over by the socialists as the first step in preparing for the reign of the Antichrist and the creation of a one-world government. For many religious conservatives, “socialism” has become the code world for this terrifying one-world takeover. I am convinced that politicization of eschatology is one of the major reasons for the migration of so many American evangelicals into the arms of the Far Right over the last 30 years.

In February, Tim LaHaye was interviewed on The Rachel Maddow Show. According to the online magazine Religion Dispatches, “LaHaye repeatedly returned to the dual claim that prophetic scenarios foretell a stage of socialism in which ‘government controls everything’—redistributing wealth from the haves to the have-nots—and that Obama is [such] a socialist working for such a world.”

This fearmongering is used extremely effectively by both the political Right and the Religious Right to galvanize opposition to President Obama’s health-care initiative. Not surprisingly, these conservative activists particularly link the socialist threat to the public option, since it would be government funded.

The Christian Coalition helped defeat the last health-care initiative, during the Clinton administration, by raising the specter of a socialist takeover of America. “Stop the Government Takeover” is a new campaign sponsored by today’s much-less-powerful Christian Coalition to defeat current health-care reform. The Coalition encouraged conservative Christians to download its “fact sheet” to take to town hall meetings this summer. The “fact sheet” reads in part: “It’s socialized medicine, plain and simple … This plan represents the ‘foot-in-the-door’ to a massive ‘single-payer’ system, where private insurance is completely abolished and all medical personnel work for the government.”

Clearly, it is extremely difficult to reason with anyone who lives with such deeply held fear. But perhaps we can help cast another eschatological vision of hope that transcends right and left and reflects God’s deep and abiding commitment to bring justice, wholeness, and healing to the most vulnerable in our midst in these turbulent times.

Tom Sine is author of The New Conspirators: Creating the Future One Mustard Seed at a Time (www.msainfo.org).


A Matter of Social Conscience: The goal is health security for all

by Sister Carol Keehan

It is hard to hear through all the noise on health-care reform. Average Americans are struggling to understand the details as well as the big picture.

This is not easy in a media environment that highlights and thrives on the most contentious of issues, and not always in the most helpful way. Add in the blogosphere, and you have a mix of messages that is far more confusing than it is clarifying.

At the Catholic Health Association, our message has always been clear: Health care must respect and protect human dignity from conception to natural death. In that spirit, coverage for everyone is a moral imperative and a matter of social justice.

Nearly two years before the national reform conversation began, CHA put forward a set of principles to guide the effort. The “Our Vision for U.S. Health Care” document, developed collaboratively with members of the Catholic health ministry, begins with values from Catholic social teaching, including human dignity, justice, and the common good.

The Vision then outlines elements of a strong, equitable health-care system starting with access for all. We have used this document to present our case for reform, and now to evaluate the legislation moving through Congress.

CHA has not endorsed any of the bills under consideration. We support health reform that is consistent with our values, matches our Vision, and expands care to the greatest possible number of people. The process is still unfolding, and the details big and small are still subject to major change. Unfortunately, as lawmakers work to reach consensus on important and controversial matters, the tone of the national conversation has reached a sometimes poisonous pitch.

Much of the press coverage and town-hall shouting is focused on false and often frightening claims devoted to bringing down reform. Even when correcting the misinformation, the media still spends a lot of time repeating the falsehoods, which only keeps them in the headlines and brings more people to believe they are some version of the truth.

Here is our truth: A nation as wealthy and smart as this one can create an equitable and sustainable health-care system. Reforming the system means legislation consistent with protecting life—on behalf of the unborn, the cancer patient, the addicted, the dying, the frail elderly. It also means reform that comes as close as possible to meeting our other principles relative to quality, cost, and access.

Two of the most harmful misinformation campaigns have focused on the most important and sensitive of issues: the beginning and the end of life. I’d rather state the facts than repeat any of the distortions. Here are the facts:

• Along with the U.S. Conference of Catholic Bishops, CHA is working to keep health-care reform abortion-neutral, meaning it will not further the pro-life or pro-choice position, will continue longstanding and widely supported conscience protection policies, and will prohibit both federal abortion funding and mandated abortion coverage.

• CHA and many other provider groups have long supported efforts to improve palliative and end-of-life care. The House reform bill would allow Medicare to reimburse physicians for the time they spend with patients discussing advance directives and other matters related to care at the end of life. By reimbursing doctors for these conversations, they are more likely to take the time needed for a thorough consultation with their patients. Patients, meanwhile, are not obliged to have such discussions with their physician, nor is there any particular course of action required of them if they do or do not.

The social justice component of health reform has largely been lost in the misinformation frenzy and the exchange of harsh rhetoric. This will not deter us from the ultimate goal of a health-care system that works for everyone. Toward that end, CHA continues to bring the voice of Catholic hospitals and health-care providers to the reform discussion to be sure that our preferences are heard and our principles are not violated. At the same time, we are working to mute the misrepresentations and publicize the importance of reform for our nation.

As Catholic health-care providers, we are privileged and proud to serve our patients, our communities and our country—and to be sure the most vulnerable are always represented and cared for. Now, as the reform conversation reaches a pivotal point, our message stays the same: It’s time to create a health-care system the American people deserve and can be proud of. n

Sister Carol Keehan, DC, is president and chief executive officer of the Catholic Health Association of the United States.


Rehab, Quick: When private insurers interfere with good medicine

by Rabbi Arthur Waskow

For 25 years, I have been a member of a private health insurance plan that seemed to be meeting my needs. My problems were routine, and so were their responses.

No longer.

I was recently involved in a moderate auto accident, driving on I-95 south of Philadelphia. My first resting place after the accident was a hospital bed in Chester, Pennsylvania, where I was diagnosed with a fracture of the “tibial plateau” in my left leg, four broken ribs, and a broken breastbone.

My leg was put in an “immobilizer,” with the expectation it would take about eight weeks to heal. The broken ribs make it very hard to use crutches or a walker. So my own primary doc and the hospital docs agreed I should go to a rehabilitation center that would focus on physical and occupational therapy to get me quickly strengthened and trained to function well. The rehab people agreed I was the perfect candidate.

But not the health insurance company.

Rehab is too good. Services higher-level than I need. Costs them more than “skilled nursing,” which does PT only one hour a day—rehab does three. Rehab costs more, reduces insurance-company profits. If I had broken both legs, yes. “But,” we said, appealing the decision, “remember the ribs? This is hard and painful work. The more intensive time and energy I can put in, the quicker it will be over!” Nope.

Now this kind of decision, remember, was what some people claimed would result from a “government-sponsored public option”: The government would interfere between me and my doctors. But in tens of thousands of cases, the companies do exactly what they say the government would do. They are ensuring not good medicine but high profits. The public option would be able to say, “It’s good medicine, and we don’t seek a profit. Rehab, quick.” They would compete with the private insurers, and keep them honest.

When I told the hospital doc what had happened, he muttered, “What is wrong with us?” Then he said, “Universal health care is what we need.” Then he was quiet for a while and muttered again, “There’s too much power in too few hands.”

“See,” I said. “You knew all along what was wrong with us.”

Rabbi Arthur Waskow is director of The Shalom Center (http://shalomctr.org/), author of Godwrestling, Round 2, and co-author of The Tent of Abraham.

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