Ebola has killed more than 4,000 people since the current epidemic broke out in March, primarily in Sierra Leone, Liberia, and Guinea. These West African nations suffer from systemic poverty and lack a strong health care infrastructure, including a dearth of clinics, medical supplies, and trained health care providers. The epidemic is tragic in human terms. It also threatens economic catastrophe for the affected region, as crops go unharvested, food becomes scarce, and food markets are shuttered. Dr. Margaret Chan, the director general of the World Health Organization, or WHO, has called the Ebola outbreak “a crisis for international peace and security.”
In a September meeting with bishops from Ghana, Pope Francis said:
I pray for the repose of the souls of all who have died in this epidemic, among whom are priests, men and women religious, and healthcare workers who contracted this terrible disease while caring for those suffering. May God strengthen all healthcare workers there and bring an end to this tragedy.
Pope Francis’s prayer for an end to the Ebola outbreak echoes his responses to other crises, but it does not reflect the full breadth of his approach to health care issues. He has also criticized the ongoing structural injustices that contribute to such epidemics and has called for policies to eradicate injustice in health care systems.
Access to health care that respects human dignity
For the pope, health care must treat the whole person throughout their lives, protect human dignity, and be inclusive rather than restrictive and scarce. Furthermore, the global community should respond collaboratively to health emergencies and invest in systems that offer comprehensive care in order to reduce the risk that such emergencies will arise in the first place.
In his emphasis on health care that serves people at every stage of life, Pope Francis has frequently advocated for those at the vulnerable margins of society: children and the elderly. Last September, for example, Pope Francis asked an audience of physicians to remember that human dignity cannot be diminished by illness or age:
There is no human life more sacred than another, just as there is no human life qualitatively more significant than another. The credibility of a healthcare system is not measured solely by efficiency, but above all by the attention and love given to the person, whose life is always sacred and inviolable.
Pope Francis has noted that the many children around the world who live without adequate nutrition are part of a crisis of values and a “culture of waste” and has advocated for rethinking systems that prevent “sufficient and healthy food for all.” He has also shared his concern for the elderly, especially the sick and disabled, saying:
[P]oor health and disability are never a good reason for excluding or, worse, for eliminating a person; and the most serious privation that elderly persons undergo is not the weakening of the body and the disability that may ensue, but abandonment and exclusion, the privation of love.
To protect human dignity, Pope Francis knows that health care systems must provide beyond the immediate physical necessities. During an address in Rio de Janeiro in 2013, Pope Francis said, “[I]t is certainly necessary to give bread to the hungry—this is an act of justice. But there is also a deeper hunger, the hunger for a happiness that only God can satisfy, the hunger for dignity.” He went on to list the things that make promoting human dignity possible—such as integral education, security, and wellness. Health care, he said, “must seek the integral well-being of the person, including the spiritual dimension, essential for human balance and healthy coexistence.”
Because Pope Francis is attuned to the challenges of inequality as well as poverty, he has also spoken about the need to address gaps in access to health care services. Pope Francis, in a message similar to that of the WHO director general, highlighted the ways that health and other services are integral to peace during his World Day of Peace message. He implored, “[W]e cannot fail to recognize that there is a serious rise in relative poverty, that is, instances of inequality between people and groups who live together in particular regions or in a determined historical-cultural context.” He continued, saying:
In this sense, effective policies are needed to promote the principle of fraternity, securing for people—who are equal in dignity and in fundamental rights—access to capital, services, educational resources, healthcare and technology so that every person has the opportunity to express and realize his or her life project and can develop fully as a person.
A comprehensive approach to care must be widely available and cannot be prohibitively expensive in order to ensure that all people have access to health services that acknowledge they are equal in dignity. Pope Francis has repeatedly suggested that what he sees as a global crisis of values has skewed our priorities. In May 2013, he remarked, “If investments in banks fall, it is a tragedy and people say ‘what are we going to do?’ but if people die of hunger, have nothing to eat or suffer from poor health, that’s nothing. This is our crisis today.”
Pope Francis believes this crisis requires policy solutions. He highlighted health care as one of the three pivotal areas in which politicians must work to build justice in his papal exhortation “Evangelii Gaudium”:
I beg the Lord to grant us more politicians who are genuinely disturbed by the state of society, the people, the lives of the poor! It is vital that government leaders and financial leaders take heed and broaden their horizons, working to ensure that all citizens have dignified work, education and healthcare.
Policies to ensure wellness for all: Bringing Pope Francis’s values to the U.S. health care system
With the midterm elections approaching, we should consider the values Pope Francis has expressed around health care. The pope’s vision of a just society that provides quality, affordable health care to all can help guide us at the polls. Which policies will improve quality and access to medical care? Which policies will treat people holistically and recognize their inherent dignity without strangling them financially? Which policies can help build a culture that values each individual, no matter the state of their health? Voting this November offers an opportunity to support such policies, as well as candidates who connect creative reform ideas with real improvements to our health care system.
In the United States, we cannot talk about improving health care quality and access without discussing the Affordable Care Act, or ACA. Although the legislation has been politically controversial since it was first introduced in Congress—and experienced a bumpy rollout last fall—its implementation has expanded health care coverage for millions of Americans, especially for those who historically have been more likely to be uninsured. The ACA has slowed the rate of growth in health care costs, including premiums, and reduced unpaid expenses at hospitals. There has even been a reduction in the budget deficit thanks to reined-in health care costs.
One important benefit of the ACA is Medicaid expansion, which provides insurance for those who would otherwise fall into an insurance coverage gap—in other words, Americans who have too much money to qualify for Medicaid but not enough money to pay the high costs of medical care. The 27 states and District of Columbia that have expanded Medicaid are seeing impressive results, including reduced mortality, increased savings, and economic benefits to the state’s economy. Unfortunately, after the Supreme Court ruled that states could opt out of expanding Medicaid, a number of states did so, rejecting federal funds and refusing to provide health coverage to their low-income citizens.
Failure to expand Medicaid is politics at its most dangerous—rejecting funds that provide essential health care to citizens who cannot afford it in order to cling to a cruel ideology or to scapegoat political leaders who support the ACA. However, a number of states, including Kentucky and Ohio, that initially resisted Medicaid expansion have seen the benefit of expanding Medicaid in neighboring states and changed course. However, a number of holdouts remain, and millions of low-income residents who deserve health care will go without it. Providing health care to those who cannot afford it is a fundamental piece of a more just health care system, and states that have so far refused to expand Medicaid need to do so.
In order to be most effective, Medicaid needs to work in concert with other programs to ensure that low-income Americans receive the holistic care they need. For instance, while many Americans qualify for Medicaid and federal food aid under the Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps, there is no current plan to track whether they actually receive these benefits. Basic food security is a critical building block for health, and a plan to regularly assess how many Medicaid- and SNAP-eligible people receive these benefits would help improve delivery of both services to low-income families.
Additionally, millions of low-income children whose families are not eligible for Medicaid receive coverage through the Children’s Health Insurance Program, or CHIP. Unless Congress acts, CHIP will expire next year. Although many of these families may be eligible for subsidies to purchase coverage through the health insurance marketplaces, these plans may not have the same child-specific care as CHIP and may feature higher cost sharing. CHIP needs to be extended to ensure low-income children have access to the pediatric services they need.
Beyond focusing on expanding access and affordability for low-income Americans, steps need to be taken to ensure that health care is more affordable for everyone. Over the past decade, health care costs for families have risen significantly. Medical debt cost Americans $21 billion dollars in 2012, which is especially egregious given that health care expenses have increased while median incomes have declined. While the ACA included safeguards, such as a cap on out-of-pocket spending to protect people from medical bankruptcy, high costs continue to be a concern for too many households. One way to help keep health care affordable for all Americans is to increase the transparency of health care costs. Several pieces of pending legislation can help federal and state governments increase transparency with regard to health care services. For example, the Hospital Price Transparency and Disclosure Act of 2013 would require hospitals to report on the frequency and average cost of certain services in order to facilitate easier dissemination of price and quality information.
Controlling costs and ensuring all Americans have access to health care is important. So is ensuring that the care they receive acknowledges their inherent dignity. Pope Francis has repeatedly decried a “throwaway culture” that does not respect the lives of the sick, disabled, and aging populations and that marginalizes the poor. While delivering comprehensive health care services is complex, better-coordinated provider services are one place to start. To shift toward paying for quality of care rather than quantity of care, the ACA established pilot programs to test new models of delivering and paying for care. These reforms, including patient-centered medical homes, bundled payments, and accountable care organizations, or ACOs, are helping reduce Medicare spending and coordinate services among a variety of providers that serve Medicare recipients. For example, some centers in the Pioneer ACO model are saving money and providing more holistic, comprehensive care to thousands of patients by recognizing the interplay of education, housing, and medicine in the overall health of older Americans. These innovative reforms must continue to be funded, improved, and expanded in order to provide more comprehensive, less costly services to as many patients as possible.
Values in the voting booth
Pope Francis’s invitation to create a culture of encounter challenges us to build a society that values all human lives, no matter their ages, abilities, or physical well-being. Health care initiatives that improve access and affordability to comprehensive care for all people will help restore the protection of human dignity as a priority in our health care system. Americans need access to all levels of medical care without fear that the cost will burden them beyond recovery. Protecting the ACA from politicians who would repeal it in an effort to score partisan victories and expanding Medicaid in the states that have not already done so are the first steps to living out Pope Francis’s call to value the dignity of all.
Improving access to affordable, quality health care will help reverse the destructive effects of economic inequality that are weakening our communities. Elections provide opportunities for voters to act on their values and determine where candidates stand on issues of justice in the health care system, such as Medicaid expansion and the transparency of health care costs. We know that many Americans are burdened by uncertainty and debt in their search for medical care—and that is wrong. This November, it is important to vote our values and to connect our conscience with our obligation to support policies that benefit everyone.
In the weeks leading up to the election, the Faith and Progressive Policy Initiative will examine three issues that Pope Francis is highlighting in his papacy—work, education, and health care. We will use his statements—and the moral philosophy in which they are grounded—as a lens that reflects on voters’ opportunities to, as Pope Francis says, “be builders of the world, to work for a better world.”
Claire Markham is the Outreach Manager for the Faith and Progressive Policy Initiative at the Center for American Progress.