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Rev. Thomas, the former General Minister and President of the United Church of Christ, is now a professor and administrator here at CTS. Follow his timely, provocative writings on the issues of our day.

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Hearts of Stone

Former Vice President Dick Cheney got a new heart last week, an organ transplant that is.  I leave the comedic opportunities to Bill Maher and Steven Colbert.  I wish Cheney well.  His struggle with heart disease has been long and difficult, I suspect much of the most painful challenges kept from public view.  That said, I have no interest in seeing him return to the public stage where his smug arrogance has been the face of the deceptions and foolish vanity that led us into disaster following 9/11 and left in their wake such profound suffering. Unless this medical procedure mimics Ezekiel’s prophecy of a heart of flesh replacing a heart of stone, I hope Cheney reserves the gift of new strength and vitality for his family and friends.

The New York Times reports that the typical cost of a heart transplant and the extended years of follow up care is about $1 million.  This, of course, does not include the years of specialized cardiac care that has kept Dick Cheney alive.  As a former Vice President, congressman and corporate executive Cheney had the gold standard of private health insurance and an income capable of managing the costs that insurance didn’t cover.  While he had a great deal to worry about with his health, worrying about paying his enormous medical bills was probably not something he spent much time thinking about.

This brings us to the drama unfolding at the Supreme Court this week where the nation’s best change at reforming our health care system and reversing the alarming loss of health care coverage for millions of Americans hangs in the balance. [Note:  This is the Court shaped significantly by the Bush-Cheney Administration appointed by the same Court in the wake of the flawed 2000 election.]  While the justices are focused on the constitutionality of the insurance mandate, let’s not forget the human face of this debate.  According to the 2010 census over 16% of the population was without health insurance, representing nearly 50 million people.  Even those who have health insurance are facing challenges.  Rising deductibles, higher copayments, and escalating out-of-pocket expenses have increased costs to American families with health insurance by 25% to 30% over the last decade.  And, of course, the burden falls more heavily on low income people.  Four years ago 37% of low income families spent more than 10% on health care compared to 8% of high income families.  As employers face higher and higher premiums, the temptation to shift toward higher and higher deductible plans is significant.  Employers save, employees pay.

Over the last two months I have had several doctor visits, diagnostic tests, and pharmacy costs as I have switched to a new doctor in Chicago.  I am fortunate to have an employer provided health care plan, a comfortable salary providing sufficient “disposable” income to pay for my share of family coverage and the copayments and out-of-pocket expenses for all of this, not to mention the education and background to read complex “explanation of benefit” forms from insurance companies and to fight with them when benefits are denied erroneously.  In other words, I am privileged.  But even I am aware of the significant expenses I’m incurring as a very healthy individual. If you’re poor, unemployed or a low wage worker, or even middle class these days, and if you have serious or chronic health problems, the story is ominous.

No one is accusing Dick Cheney of buying his new heart or gaining preferential placement on the waiting list because of his health insurance or personal wealth.  Poor and middle class Americans do get heart transplants though there is clear evidence that ability to pay is a factor in many places in determining whether a patient can even get on the waiting list.  Assuming he could find a medical center willing to assume the high cost of surgery and the years of follow up immunosuppressant medications, statistics suggest that a poor, uninsured man with the same heart problems Cheney has faced would have been dead long before he became eligible to even be considered for the waiting list for a new heart.

Opponents of health care reform have followed a clever strategy.  Refusing to allow consideration of a government funded health care plan for all, they forced proponents to go the route of market driven reforms that rely on existing insurance programs and, as a result, require some form of mandate for purchasing insurance for everyone in order to make the plan financially viable for the industry.  Having done that, the opponents then attacked the constitutionality of the very approach they forced.  And that’s where we now stand as the nine justices begin their deliberations.

It will be easy this week to be caught up in the arcane world of Constitutional law as if this debate were really about principle.  In fact, it is about a nation that heartlessly refuses to acknowledge that basic human rights like education, housing, and health care are increasingly doled out disproportionately to the wealthy and the privileged.  It would be nice to think that Dick Cheney, bolstered by his new heart, would issue a statement from his VIP medical accommodations calling on the justices to turn aside the challenges to health care reform.  But that may take more of a heart than even his skilled surgeons could provide.

John H. Thomas

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