by Father William J. Byron, S.J.
I’ve been reading and talking a lot about health care in recent weeks. Whenever someone mentions health care “reform,” I find myself always thinking (and sometimes saying), “No, it’s health care finance reform that is the issue,” not reform in general.
No one wants to dismantle or reform the whole system. It is how we pay for care, how we purchase insurance to cover care, how we lower or control the costs of health care, and how we come up with the money to care for the sick and poor that is up for discussion.
Money is at the bottom of this debate.
It helps to recall that there are essentially three basic reactions that we humans have to vexing societal problems: fatalism, reform or revolution.
Happily, the nation seems to be waking up and shaking off the immobilizing wraps of fatalism. We agree that something has to be done. No one appears to be seriously advocating revolutionary change.
Reform Doesn’t Just Happen
But, although we talk a lot about reform when we discuss health care, we don’t seem to realize that reform does not just happen to us; we have to make it happen. And we also tend to avoid precision in defining the problem by omitting the specifics of finance.
Some people are surprised when I suggest that there is an accompanying vocational problem that requires attention in the health care debate: We want more talented and generous young people to consider careers in health care.
It is distressing to see medical students opt for specialties such as cosmetic surgery and dermatology instead of choosing to commit themselves to primary care, internal medicine and oncology, just to mention a couple of current trends.
We need more nurses and nurse practitioners, more physicians, more physical therapists; and we need them in face-to-face, one-on-one helping relationships with the seriously ill.
We won’t get them unless we address the issue of the crushing student loan burden that confronts high-minded young people. Some choose to go into high-paying subspecialties in order to earn enough money to pay off their student debt.
Why can’t that debt be reduced or eliminated in return for a commitment to primary care and oncological service?
Those who claim that we do not need more physicians sometimes say it is a distribution issue, not a question of inadequate supply. They choose to ignore the economic principle that the response to burgeoning supply is lower price, because they recognize that price to the patient is income to the provider.
Whoever said that health care providers had to be among the highest-paid professionals?
There is another window on the vocation issue. The talented and generous young need encouragement to let their deep-down desire to help others be the driver of their decision to dedicate their lives to medicine and nursing and not to make the choice primarily for money or social status.
Cooperation between Catholic health care and Catholic colleges could help in this regard. Let college students see firsthand and close-up what Catholic health care providers do, especially what they do for the poor.
Two physicians made a startling proposal in a New York Times op-ed piece in May: Make medical school free for those who agree to go into primary care. The cost of this would be met by requiring those who choose high-income specialties to pay for their own specialized residency training.
Medicare and Medicaid are under attack. Their survival will represent a triumph of common sense and regard for the common good. Revenue enhancement (a gentle way of saying higher taxes) is the inevitable price we’ll have to pay.
Jesuit Father William J. Byron is a professor of business and society at St. Joseph’s University, Pa. His e-mail is email@example.com.