Guest Column on the State of Health Care
Travis Grasley, M.A., RRT
Manager, Cardiopulmonary Services
Mercy Tiffin Hospital
[Publisher-Editor's Foreword: A reader e-mailed me last me describing how his eighty year-old grandfather had been dehydrated to a weight of 135 pounds in order to make him, according to one of the health care professionals who spoke to him, "easier" to lift when he returned to the hospital for yet another round of removing the fluid build-up caused by his congestive heart failure. The reader believed that the amount of fluid, thirty pounds, removed was excessive. I was appalled by the utilitarian reason given for removing so much fluid. One of the reasons that the grandson is so interested in making sure that his grandfather survives for the time being is that the latter is in need of returning to the Faith which he abandoned decades ago (I've got a similar case right in my own family; Sharon's dear father was away for seventy years before he returned on January 3, 2007, just one month to the day before his death on the feast of Saint Blase).
[Another reader, Mr. Travis Grasley, the author of this guest column, wrote to me to note that the course of treatment the other reader's grandfather had received was the correct one, also doubting that the true motive of the health-care professional was to make the reader's grandfather easier to physically move. I assured him that it was. However, I also expressed interest in reading Mr. Grasley's expert judgment on the matter, inviting him to write a guest column for this website. He has done so, and I find it very worthwhile and thank him very much for taking the time to write the article.
[I have only a few observations to make about Mr. Grasley's article. Mr. Grasley has reviewed my observations and believes that they will serve to complement the substance of his article.
[The first point concerns Mr. Grasley's discussion of what he refers to as a justifiable utilitarian mindset in the treatment of patients.
[It is not utilitarianism that determines proper medical treatment or the the manner in which individual patients are treated. It is the by the application of the binding precepts of the Divine Positive Law and the Natural Law in the concrete circumstances of individual patients that those who are suffering long term illnesses must be treated. The removal, say, of a ventilator can be undertaken as breathing is an involuntary function of the body; removing the ventilator simply permits the body to do what it will or will not do on its own. A death that might occur as a result of the removal of the ventilator is a foreseen but unintended evil consequence of the morally licit action of removing the respirator. Even this, however, cannot be done until a patient has received the Sacrament of Extreme Unction and can be prepared for the moment of the departure of his soul from his body after death.
[Furthermore, the Catholic moral principle of proportionality--by which we are required to take into consideration whether the prosecution of a good, morally licit end may result in foreseen but unintended evil consequences that make the pursuit of the good end immoral or unwise or impractical to pursue--must be differentiated from any kind of utilitarianism. Let me give but one theoretical example.
[An eighty-five year-old man who is in need of coronary bypass surgery is certainly within his rights to seek such surgery. Is it prudent for him to have such surgery? Will he be draining his family's bank account by doing or or unnecessarily depleting the coverage on his health insurance policy? Are there any other complications that could result? At what point is one impeding his return to God by the seeking of treatment that is costly and not absolutely necessary in the moral realm unless there is someone who depends on the income produced by such a patient for their survival, at which point a case can be made that it might be morally necessary to at least consider treatment that one might not be otherwise morally required to undergo? These are all questions of human judgment that may vary from one case to another. A Catholic understands that these considerations are not utilitarian. They are done with a view to making, as far as is humanly possible as one seeks the enlightenment of God the Holy Ghost in the decision-making process, a decision that is consonant with the binding precepts of the Divine Positive Law and the Natural Law.
[As Mr. Grasley states near the end of his article, it is the loss of the Faith produced by many forces, including conciliarism, that has produced the situation we face today.
[There is one other point I would like to elaborate on in this foreword to Mr. Grasley's.
[Mr. Grasley notes the importance of subsidiarity very well. I do think that it should be pointed out, however, that the decay that has occurred in health-care (as in everything else) is the direct result of the Protestant Revolution and the rise of Judeo-Masonry. Holy Mother Church provided health-care gratis for those who could not afford to pay. The faithful (usually the very wealthy in a diocese) funded a hospital's operations. It is the rise of for-profit medical service, which itself is the result of Calvinism, and the rise of profit-making insurance companies that do indeed consider the care of patients on a purely utilitarian, cost-benefit basis that has led inexorably to the steady decline of the present day.
[With these few observations, therefore, I present to you Mr. Travis Grasley's very fine article on the state of health-care at this time, thanking him again for writing the article, keeping in mind the importance of invoking the loving protection of Our Lady Help of Christians, Saints Cosmas and Damian, Saint Camillus de Lellis, Saint John of God, Saint Aloysius, and Saint Frances Xavier Cabrini as we pray our Rosaries for the conversion of this nation and the world of the Social Reign of Christ the King and Mary our Immaculate Queen.]
Healthcare is on everyone’s mind these days. Its quality and affordability seem to be the two biggest topics of discussion when it is brought up in conversation. Everyone seems to agree that our current system is broken and needs to be fixed. However, the actual debate revolves around how best to accomplish this massive feat. No real solutions for the problem can be effectively deliberated, though, unless the general public has a basic understanding of how our current system operates. The goal of this article is to shed some light on how healthcare has progressed from its infancy in our country to the giant behemoth we have today, offer a basic explanation on how and why it’s broke, what it will look like in the future if we continue to try to tackle it’s problems utilizing strictly secular humanistic philosophies, and how to reverse our current destructive social trends. The reader should keep in mind that the topics addressed in this short article are extremely complex; therefore, many important issues cannot be addressed, and the ones that are cannot be addressed in a lot of detail. Neither will everyone agree with all of the ideas and conclusions presented on the matters brought forward. The following is simply the articulation of one man’s opinion who works in the current system on why healthcare is what it is.
Only decades ago, when life was much simpler, individuals and families were able to pay for the vast majority of their medical care on a cash-for-service basis. If you go roughly a century back, people could even substitute cash for a goat, or a chicken, or any other miscellaneous service that the physician was willing to accept for their services. Having only minor medical conditions, and ordered by their physicians to stay in the hospital for weeks at a time, many within these earlier generations could personally afford these lengthy stays without the assistance of any type of insurance, or charitable care. This affordability was primarily due to the fact that the resources it took to treat a typical patient were not as varied and technologically advanced as they are today, and most patients received their medical care from their families in their own homes under the direction of a physician or nurse. The treatment patients received was not effective as it is today, but the earliest nurses and doctors had the freedom to spend much more time focusing on their social and spiritual needs, which in some cases, was just what was needed to pull a person through a difficult illness. Furthermore, these physicians and nurses did not receive the kind of high-level compensation that their successors receive today. Many of the healthcare workers of yesteryear were poor religious or laypersons who had dedicated their lives to care for the sick and impoverished.
As scientific discoveries progressed, and technology expanded over the years, more and more patients recovered from illnesses that once carried higher mortality rates; however, those who had access to these life-saving therapies had to leave their homes to go to where the technology was located—the hospital. But it was worth the cost. Bad cases of pneumonia, especially for the young and the aged, used to carry an almost certain death sentence before the appearance of antibiotics in the first half of the twentieth century. Now, with a modest use of antibiotic and respiratory therapy, children and the elderly can expect a full recovery within weeks.
All the progress and technology that saves lives also requires a diverse team of highly-skilled people who can not only effectively deliver, but can also efficiently produce such medical technology within their respective areas of expertise. A nurse cannot adequately learn and effectively deliver all the various technical aspects that occur within the routine care of a typical patient. This is the reason why today’s patients need other allied healthcare professionals to help meet their complex needs. What’s more, each one of these patients has specific, physician-directed goals that must be met each day. These responsibilities are very numerous and many times very critical. The results from the potential neglect of these duties can range anywhere from patient discomfort to death.
Why Healthcare Is Broken
In today’s healthcare environment, we are blessed to be given access to so many experts that can adequately address the vast array of medical maladies that individual patients present each day to their physicians. However, long lists of patients, and the responsibilities that accompany them, force healthcare providers into being less patient-centered and more process-oriented. “How can I accomplish all my tasks safely and efficiently today?” is the question on the minds of those who work with a relatively large number of patients each day. It isn’t that they lack compassion for their individual patients; it is simply a matter of how our current healthcare environment forces the caregiver to be focused on the processes involved in taking care of an individual patient and not the individual’s soul in and of itself. So what the patient has gained in receiving pain-relieving and life-saving therapies via technological progress, they have lost in having to leave the comfort of their homes and the spiritual and emotional care they would have otherwise received from their families during their recovery.
The responsibility to handle a patient’s spiritual needs thus falls upon the team of employees of the particular healthcare facility in which the patient is receiving care. Most of these caregivers are sympathetic to the needs of their patients and do their best in assuring that these needs are met; otherwise, they would never have entered the field of medicine in the first place. But, these compassionate people have lives and families of their own outside of their careers, so their ultimate concerns lie elsewhere. Some may care deeply for their patients, but in the back of their minds during their shifts is the subconscious urge to get home and make sure their own families’ needs are met. So at the end of the day, most patients do not get the kind of support needed to maintain an overall healthy spiritual and emotional well-being.
Many within healthcare struggle with these issues on a daily basis. They would love to take extra moments in just doing the little things that would mean so much to their patients, like having the opportunity to give them a long, healthy back rub, or to just be able to sit for a while at the bedside talking about their grandchildren. But, the patient next door needs also needs their attention, and so does the next one after him, and the next one, and the one after that one, until the nurse discovers it’s time to conclude her shift and clock out. Many are saddened not only because that extra touch couldn’t be provided, but also because the sweet, little old man in Bed 5 has had no visitors, nor anyone to sit with him for his entire stay.
Most healthcare providers eventually become calloused as a result. There’s nothing they can ultimately do, and they cannot carry this type of emotional baggage home day in and day out to their families. So they adapt. Most do not cease from caring for those whom they serve; they simply begin to take the utilitarian approach whether they know it or not, or whether they like it or not. “After all,” many professional care-givers begin asking themselves, “If a patient’s own family is unable or even unwilling to take on the responsibility for their care by sending them to nursing home, what are the ultimate benefits of taking heroic measures in order to prolong their lives for only a few short years of time spent alone in a nursing facility?”
So, when an elderly gentleman comes unable to breathe on his own with pneumonia super-imposed on end-stage chronic lung disease, and the time comes to help the family decide whether or not to place him on mechanical ventilation, most clinicians will encourage the patient’s family to refrain. Not because they do not value life, but because of the experiences they’ve had with everything described above. Are some of these types of recommendations utilitarian in nature? Yes. Unjustifiably so? No. Does this mean that there aren’t cases in which the utilitarian mindset that has infiltrated our culture hasn’t resulted in evil? Definitely not. Did we intend to set up a system in which patients would be looked at as a number and a problem to solve rather than an individual created in the image and likeness of God? No. It occurred almost unnoticeably at a slow pace, step-by-step, with apparently very good intentions in mind.
It all began to take shape when the cost of technology started becoming out of the reach for the average patient, and private and public insurance systems, such as health maintenance organizations (HMO’s) and the Centers for Medicare and Medicaid Services (CMS) were implemented to help improve access to healthcare. (Coincidentally, this was the time in our nation’s history that we became overtly modern and became more liberal in how we looked at sin in public life. It is also around the time in which the Second Vatican Council was in session.) These systems were introduced with the goal of improving the public’s access to the best healthcare available. But insurance companies are like any other organization that exists in this world, which means that they cannot spend more than the money they actually have on hand or are due to receive. So they must limit their financial expenditures by placing limits on whom and what they cover.
As medical care has grown more and more scarce over the years because of increasing governmental regulations, non-competitive private insurance environments, more people demanding more of it, and the number of those trained well enough to provide it has shrunk, it has naturally grown more and more expensive—to the point where even CMS has gone bust over the situation.
The bottom line is that hospitals and healthcare facilities are struggling to remain financially viable in the face of such an environment. Over twenty-five hundred hospitals have been forced to close their doors over the past several years due to financial inviolability. It is expected that the same amount, or more, will be forced to close their doors over the next five to ten years as CMS further reduces reimbursement rates to physicians and healthcare facilities. CMS is broke. It doesn’t have the financial resources it once had. It is being forced by economic law to make cuts in the amount it pays for the services rendered to its constituents.
What the Future Holds
Our current economic situation has only added to the financial crisis of healthcare. Our current recession has resulted in the loss of employment for many average Americans. These people, in turn, have lost their employer-sponsored healthcare coverage. Even those who are still gainfully employed with insurance are getting stuck with the responsibility for paying a larger portion of their health insurance through increases in premiums and deductibles. Thus, the procedures these patients would have otherwise obtained are now being put off because they cannot afford the high out-of-pocket costs. Many of those who actually go through with acquiring medical care are unable to pay their bills causing their medical providers to write-off an increasing amount of bad debt to charitable care, the end result being that many medical facilities are being forced to make cuts in human and technological resources, which in turn, will further limit the public’s access to healthcare.
If medical professionals are less accessible due to cuts in human resources, and funds aren’t available for the purchase of new, additional equipment, patients will necessarily have to wait in line, travel farther, or be declined altogether the benefits of receiving these types of expensive medical services. This is rationing at its most fundamental level; it will be necessary; and, it is the logical progression of the socialized medical system we have currently in place with CMS and HMOs. Moreover, with the newly passed national healthcare legislation that is intended to insure both the young and the old, there won’t be enough resources to cover everyone equally, so somebody (in our case the federal government) is going to have to make the decisions on who gets what. The Who will be those whom the government believes will give them the most “bang for their buck” when footing the medical bills for the entire population. Thus, socialism naturally begets utilitarianism. This is why socialism is contrary to Church teaching.
In socialist-structured societies, the value and dignity of the individual is based upon his value to society as a whole. The more utilization society can gleam from an individual, the more value or dignity that person holds with those who hold the purse strings. After all, if the group is responsible for the individual, the group is also responsible for deciding what is best for him. Just like a parent-child relationship, the one in authority gets to make the important decisions. So we must ask ourselves, “Who will be in charge, and what moral framework, if any, will they use in addressing these critical questions?”
Today, most individuals maintain control over the important questions in their lives such as how and when to cease life-supportive medical care; tomorrow, now that CMS and HMOs are in the process of morphing into an all-encompassing entity of the state, and as the love of most is growing ever colder, individuals may lose complete control over all end-of-life issues. It won’t be because all those in charge necessarily want to see patients medical needs neglected; it will simply be result of having only so much medical care to go around. Some who have already been making these types of decisions will continue to cope with these situations by looking at the patient less as a person and more as problem that needs dealt with effectively and efficiently. This devaluing of human life is intrinsically evil, but it the inevitable conclusion of such a system that exists in a world with less and less moral restraint.
Thus, a lot of the callousness some of us have witnessed with those in the medical profession stems from a direct result of this type of system. But we have no one to blame but ourselves; we are all a part of the problem. We in the West who’ve been blessed to have ridden on the coat tails of Christendom have decided that it’s finally time to cast off the principle of Subsidiarity and surrender our personal liberties for the promise of state-granted security. No, we don’t want to see anyone suffer. And universal healthcare sounds like the right thing to do, especially if we can help lessen all the suffering that exists in the world. But we live in a cruel world governed by evil. There’s no escape from it no matter how hard we try, more especially so when our attempts to build our utopian state is based upon a humanistic, social model.
The principle of Subsidiarity is a tenet of the Church that teaches that the power of self-governance should be kept in the hands of smaller, local organizations for as long as it is in their ability to successfully self-regulate. This principle is best put into practice when citizens maintain responsibility for administering to the needs of their own neighborhoods and cities. Subsidiarity works because citizens at the local level are better equipped to make responsible decisions, and enforce greater accountability within their ranks, than can a large bureaucracy located in a different area that is not familiar with the local customs of those they are trying to govern.
For example, citizens of a city or state who wished to live by Catholic principles, and were free to self-govern, could better assure that those who wanted to live in their communities were living up to their established standards and laws. This is because local governments are more knowledgeable of their own particular needs and wants, and can act more quickly and effectively in weeding out undesirable social behaviors that are destructive to the harmony of their social structures. But we in the West don’t seem to like this principle anymore. We have been slowly drifting away from its practice in direct proportion to the rate in which we’ve been adopting the philosophies of materialism and secular humanism. This is why it shouldn’t be too difficult to understand for those who have eyes to see why we’ve been on a crash course of self-destruction.
Since the introduction of Original Sin in the Garden of Eden, we humans have acquired the tendency to covet much more than what we actually need, and in our pride, we continue to believe that we can rule our own lives without God—essentially divinizing humanity as a result. It’s the continuance of the lie that Satan first told Eve in that she had the potential to be like God. It’s the rebuilding of the Tower of Babel where Humanity proudly believes it can accomplish great feats without divine assistance. It’s the rise of the Beast out of the Sea as envisioned by St. John in the pages of the Apocalypse where the Beast represents a world system that rejects Christ and places Man on the throne of divinity.
We see how this type of anti-Christ, human-centered religion eventually plays itself out in that the more we stray from ordering ourselves according to the divine revelation of Christ, the more we sell ourselves in bondage to the Beast as we go into debt attempting to build happy, content families and societies where no bad things happen to anyone. Please note that government-ran healthcare is the Antichrist system; however, the more we accept the lie that we can order our nations without the direct influence of the Church, the larger the Beast will grow where socialized medicine exists as only one tool in its arsenal in establishing its reign. And once the Beast has fully emerged, we will finally come to know what it ultimately means to have a culture of death.
Thomas A. Droleskey postscript: The reader who had prompted Mr. Grasley's initial e-mail to me wrote back this evening, Wednesday, June 9, 2010, interestingly enough, to say that he had finally found an ally to help his grandfather regain weight after all of the efforts to remove more fluid from his system that absolutely necessary:
I finally found an ally in my battle to bulk my grandfather up again, and he was released from the hospital today. A cardiologist named Brian Beanblossom completely reworked both his medication schedule and his diet, and he has progressed rapidly in these last few days. For this I pray he might be blessed with the grace of conversion. He was truly a Godsend.
A couple of years ago the Jewish hospital system in Louisville merged with the Catholic system, so the hospital he stayed at for this sojourn was very ecumenically signed "Sts. Mary and Elizabeth Hospital - A member of the Jewish-Catholic Health Services Network." This ecumenical spirit meant I got to tangle with one novus ordo nun and one Baptist preacher during my visit, both members of the hospital's "ministry team." I should probably send in a complaint because I never saw a rabbi.
My initial reaction to the reader's first note to me was that, no matter the standard regimen of removing fluids, the deliberate effort to make a man "easier to handle" is indeed inhuman. I stand by that initial reaction. While the points made by Mr. Grasley are well taken as they explain the difficulties faced by many in the health care profession on a daily basis, it is also nevertheless true that those who understand the true purposes of medical care will never treat a fellow human being as they would a cow. The reader has gone the extra measure for his grandfather in order that he will live long enough to return to the Holy Faith. He knows his obligations as a grandson very well even though he is a relatively recent convert to the Faith.