The 7 Principles of Healthcare

This last Sunday, I had the honor of speaking about universal healthcare as it relates to the 7 Principles of Unitarian Universalism. Below is the transcript of that sermon:

Hello everyone, and thank you for having me speak here today at Community Unitarian Universalists in Brighton. I would also like to thank my good friend, Pastor Julie Brock, for extending the invitation to speak here today. Julie and I have been friends since our teens, when we met during YRUU youth conferences. She knows that healthcare is one of my passions, and since this is a topic that is on everyone’s mind these days, she asked me to come and address how our quest for universal health care is related to our 7 UU principles.

Let me start by telling you a little bit about my background. I am a lifelong UU. I was raised in the Farmington UU Church, and am currently a member of BUC. I spent my youth as a leader of the Michigan Youth Adult Council (YAC) and YRUU, planning and carrying out conferences statewide, regionally and nationally. I attended Western Michigan University, and while earning my Bachelors of Science in Nursing, I worked with Diane Melvin at Peoples’ Church in Kalamazoo to form the campus UU group, Kalamazoo Unitarian Universalist Liberal Students or KUULS. (We love acronyms, don’t we?)

I have been a registered nurse now for over 10 years. I have spent the majority of my career working in ICUs, Neonatal, Pediatric and Adult. I’ve also worked as a nurse educator, and in hospital administration. These experiences have given me many different perspectives, from triage and life and death split second decisions, to the fiscal, reimbursement, business and employee related issues surrounding health care implementation.

I then made the change from hospital based care to nurse care management. I worked with the Medicaid recipients, specifically focused on Special Needs Populations. I quickly learned that my training as a nurse, to see my patients as whole beings, was not always reflected in the Medicaid benefit contracts for-profit Medicaid HMO companies had with the state of Michigan. I would hear jokes saying that healthcare could be broken up into two categories: the “Pinto vs. Cadillac” models of care. The joke was that Medicaid was the Pinto: basic care that wasn’t fancy but at least got you from A to B most of the time, even if you were embarrassed to be seen with it. They joked that private insurance was the Cadillac: luxury care that had all the bells and whistles, and that you liked to show off as a matter of conspicuous consumption. And in order to keep making record profits, these Medicaid HMO companies were dedicated to keeping everyone in the “Pinto” model of care. This was the model used by all the Medicaid HMOs, as “straight Medicaid”, paid directly from the state to providers, no longer exists, save a few extenuating circumstances. I quickly learned that basic healthcare, paid out by tax payers dollars to these HMOs, could be paid for in full AND be enough to make hearty profits for these HMOs. Let me repeat that, what the taxpayers pay for healthcare was enough to cover the full healthcare costs of an enormous pool of at risk people, and turn an incredible profit. All while giving the healthcare providers about $0.50 on the dollar for their services.

It probably goes without saying, I wasn’t able to stay working for this system for very long. I thought I was going into a situation to help with the conversion of the special needs servicecs from the locally controlled health departments into the managed health plans, as the state changed the laws about how these high risk childrens’ healthcare was to be managed. I went in hoping to ensure that no children or families would be left as collateral damage during this shift in the state’s priorities. When it became apparent that the only motives of those making these rules was making as much money as possible off of these vulnerable people, I couldn’t stay.

I started working instead as a nurse case manager doing catastrophic case management for people who had been injured in car accidents. Michigan may be lagging behind and at the bottom in many things, but auto insurance benefits is not one of them. When it comes to patient and consumer protections from auto accidents, Michigan is second to none.

If you’ve ever known anyone in a bad car accident, or survived one yourself, you will be able to tell stories of comprehensive care for a multitude of problems at zero out of pocket costs, for life. When someone has a life altering car accident, the auto insurance company is legally bound to cover all associated medical costs for the rest of your life, and wage loss if you’re off work, household replacement services for the first three years following an accident, transportation costs for medical appointments, and a host of other benefits, like vocational assistance and education assistance if you can’t do the job you were doing before, as well as home and car modifications if you now require a wheelchair, walker, chair lift etc.

As far as a patient and consumer protection program, Michigan Auto No-Fault is the envy of every other state. The catch? They will only pay for injuries that are DIRECTLY related to the accident, and nothing more. They are cracking down on covering anything that can be possibly construed as “un-related.” For example, say I have a patient with a traumatic brain injury, which is incredibly common with motor vehicle crashes. While the bones heal from an auto accident, severe brain injuries are for life. Severe brain injuries can keep people from controlling their impulses. Commonly, many patients with severe brain trauma will attempt to walk, get out of bed, or out of a chair without assistance, and will fall. The auto-insurance is now starting to reject these claims as being unrelated to their original accident, despite the fact that someone without a brain injury would better understand their limitations, and wouldn’t attempt to get up without help. Nevertheless, these are seen as “new injuries” that are unrelated, and no longer covered by auto-insurance.

Michigan Auto No-Fault however, remains the best policy for consumer, patient and provider protections in the country. However, while this insurance is good for consumers in Michigan, it is also not widely available to all. The practice of “red lining” the residents of Detroit has left the residents of this city largely unable to utilize this great consumer protection, and it has kept the “Motor City” from legally driving cars. For those of you unfamiliar with “Red Lining”, it’s the practice that auto insurance companies have of basing car insurance premiums on multiple factors, including zip code, which then prices out any resident of Detroit. As soon as that Detroit zip code pops up, car insurance premiums go through the roof. The only way someone in Detroit gets this kind of coverage without paying through the nose for auto insurance is when they are hit as a pedestrian or while riding a bicycle by a car, are the passenger in the car, or a child injured by a car in any circumstance.

As a nurse case manager, I have been forced to compartmentalize my care for patients into silos, based on either Medicaid benefit guides, primary insurance rules, whether care was “auto related” or not, and those services which fall outside all realms of reimbursement, despite the fact that we all need them. When faced with those needs no one is willing to address in quick order, I open my own wallet to ensure my patients’ basic needs and dignities don’t fall through the cracks. I’ve bought my clients car seats, Christmas presents, and “luxury items” such as diapers, wipes, and toothpaste. I’ve paid for cabs, so someone could get to the hospital to see their injured child. I’ve bought so many meals for beaten down patients and families, when they had nothing but empty pockets after putting all their money into prescriptions, co-pays and deductibles. I do what I can, but I am one person, and there are so many people who fall through these cracks every single day.

It’s with all these experiences under my belt, and the various silos of treatment based on various payers, rules related to divvying up healthcare, and those at the top making a profit off of pain, that I’ve come to the same conclusion that most of you have probably already come to: the only way we can truly be treated as whole patients and get the care we all need to not just survive, but thrive, in a just and equitable system, is through universal healthcare coverage.

When I sat down to think about how much universal healthcare is supported by medical ethics, evidence based practices, and just common sense, it is also occurred to me that is supported by all 7 of our UU Principles.

The idea that everybody deserves access to quality, truly affordable healthcare is most supported by our first principle: We believe in the inherent worth and dignity of every person. It is this basic agreement, that all people are deserving, is the basis for universal healthcare. In our current system, only those deemed worthy by a small group of people are able to receive quality healthcare. And in our current system, those who are worthy are those who are rich. We used to believe that we should also take care of the poor, the disabled, and the elderly, because that’s what good and decent societies do. But the proposed cuts to Medicaid in the current US Senate bill has cruel, inhumane and almost Dickensian tones to it. I can just hear someone defending these cuts to Medicaid exclaim on the senate floor “If they’re going to die, they better do it, and decrease the surplus population!” It’s this very idea, that some peoples’ lives are worth more than others, that have led to our current state, where we even have to have this debate on whether or not we should care about our fellow human beings!

This leads to our second principle: Justice, equity and compassion in human relations. There is no justice in setting up an economic system that is rigged against the majority of a population which limits their ability to earn enough money to survive their day to day lives, and then telling them the only way they can stay alive is to pay even more money. There is no equity when the only people who have access to comprehensive medical care are those who can pay tens of thousands of dollars out of pocket, up front, annually for it. There is no compassion when we entertain ideas like “why should men have to pay for maternity care?” Universal access to healthcare, regardless of ability to pay is the only justice. Giving everyone the opportunity to participate in this system is only way to equity. And saying to each other “we will make sure all your needs are covered, even if they are not our own” is the only compassionate answer we can give our fellow human beings. Justice, equity and compassion in human relations is the crux of the argument for universal access to healthcare.

Our third principle leads with “acceptance of one another.” While the second part about our spiritual growth does not directly tie into the healthcare debate, the call to accept one another does. There are many different ideas on how other people should live their lives. We tend to see other people struggling as failed versions of ourselves. There is an ease with which people dismiss anyone else who does not have what they have. This is how we have found ourselves considering policies that punish people for not being rich, for being in poor health, or for making decisions about their bodies that are contrary to what someone else would decide. The concept of universal care would ensure that we accept one another. Universal healthcare meets people where they are, and doesn’t discriminate against those with pre-existing conditions. We must also ensure that our system of universal healthcare accepts the choices women make for themselves, the choices trans Americans make for themselves, and our choices to decline and withdraw care for ourselves, and die with dignity if we so choose.

“A free and responsible search for truth and meaning” is our fourth principle, and it very much supports our quest for universal healthcare. Healthcare laws need to be based on scientific truths and facts. I know facts seem to be passé, but our quest for truth requires that we continue to base our actions based on facts and evidence, math and science. There are countless examples of increased positive healthcare outcomes from those countries that have universal healthcare. I don’t think I need to remind you that the United States remains the only industrialized nation in the world to have a for-profit, market based approach to healthcare coverage. We also spend per capita more money on healthcare than anyone else in the world, and we don’t have much to show for it. We continue to have rates of infant and maternal mortality on par with third world countries. We have rates of avoidable, early deaths from heart disease, stroke and blood clots that are embarrassing. And we have all seen and been touched by the growing opioid epidemic. And while we have studied for decades how to cure diseases, stop infections, make fatal home, workplace and public accidents less frequent, make car crashes less deadly, we are barred from treating gun deaths as a public health crisis, in order to keep gun manufacturers in this country making record profits. Despite gun deaths soaring ever higher, we do not treat it as a public health crisis, and are doing absolutely nothing to address it.

What we ARE addressing are non-existent threats to public health. We have hundreds upon hundreds of bills proposed across the country every day trying to restrict access to abortion, despite it being one of the safest medicals procedures available. These bills are based on nothing but lies, junk science, fabricated issues and plain old misogyny. Legislators are threatening to stop reimbursing Planned Parenthood for the Medicaid patients they see (which is what actually happens when Planned Parenthood is “defunded”) not based on the truth in medicine or public health risks, but based on their purely religious motives, as revenge against an organization who provides completely legal, medically safe, and incredibly wholistic and compassionate care for some of the most at-risk populations in America. Nothing in these reproductive healthcare restriction bills are based in truths, which is entirely against our religion, as dedicated truth seekers.

We are constantly distracted with false flags. While our family, friends, and neighbors continue to die from preventable deaths, we are told that we have the best healthcare system in the world, and the real issues we need to worry about are abortion and not having enough guns in schools.

While death is inevitable for us all, early death, pain and suffering don’t have to be. For some reason, these statistics of preventable morbidity & mortality are not taken seriously in the healthcare debate, and we tend to look for excuses as to why these death rates are as alarmingly high as they are. Reporters blankly stare into the camera as they report on these almost daily, horrific news stories of the sorry state of our national health and safety, and they wonder aloud “What can we do about it?”

I’ll tell you what. One, we can enshrine healthcare as a right in this country. We can provide robust, comprehensive, and widely available medical treatment to everyone. We can remember that an ounce of prevention is worth a pound of cure. Two, we can ensure that mental health and substance abuse treatments are more abundant than heroin dealers. We can eliminate the stigma of needing help, and work on the root causes of the pain and despair that drive people into addiction. Three, we can study ALL forms of preventable death, and constantly strive to make our public safer, no matter which for-profit industry may suffer. Four, we can base our healthcare laws on actual science, and leave religious dogma out of our public policy.

When we base our healthcare and public policy on truths, cynical manipulations by corporations and religious zealots ring hollow, and we won’t have to be held hostage by them any more.

Our fifth principle “The right of conscience and the use of the democratic process within our congregations and in society at large” immensely supports our quest for universal healthcare. Our conscience calls us to defend our fellow humans. Our conscience calls us to base healthcare laws on medical best practices, not on the religious dogma of our elected leaders. Our conscience calls us to defend human health and dignity, not corporate profit margins. And it is this consciousness that leads us to participate in the democratic process. As imperfect as it is, our use of the democratic process is our best tool to make real and lasting change. This of course includes voting. But this does not mean just showing up to the poles every 4 years during a Presidential election. This means showing up to vote every single election. Local and state elections are just as important, if not more so, than national elections. And it’s not just enough to show up to vote. We must also hold our elected officials accountable while they are in office. This means making your voice heard. Call their offices, write letters, show up at town halls. So many of you have already been doing this, and we have seen bills that were assumed to be slam dunks stopped in their tracks. The use of the democratic process is sacred to us as Unitarian Universalists, and we are duty bound to continue to raise our voices to those we give the ultimate honor of serving us. Those who are not in favor of universal healthcare, who are pushing to send us back to the days of being at the mercy of the merciless insurance companies, will try to point to the 2016 election outcomes as the proof that the people want them to do this. They want to pretend that democracy ends at gerrymandered district outcomes. They want us to believe that democracy only happens every few years, on one day in November. We, as people of conscience who believe in the democratic process, know that this democracy happens every single day. It is not enough to simply elect personalities, and let them perform whatever acts of cruelty their corporate backers want. We are engaging in democracy every single day, and we must remind those who wield the gavels of power, that true power is only given from the consent of the governed. The American people are voicing their consent for universal healthcare louder and louder every day. It is incumbent upon us as Unitarian Universalists to ensure that our democracy is strong, and that our voices are not silenced. We must also remember, not to allow the perfect be the enemy of the good. Universal healthcare will come, but it will not come overnight. Universal healthcare is our long-term goal, and we must meet a multitude of short term goals in order to attain it. We must keep the goal of universal healthcare as our ultimate ending place, and be willing to work on each step to get there, such as solidifying the protections provided in the ACA, expanding Medicaid enrollments, and supporting a pubic option as we work towards the Medicare for all system. No major social safety net happened overnight, and this, too, will take a significant transition. We need to remember we are all working for the same goal, and not be fooled into believing that if we just yell loud and long enough, it will just be. We must use our democratic process to keep our goals in the forefront, and realize the steps needed to get us where we want to go. I know it sounds good to demand universal healthcare or bust, but friends, we have lived the “bust”, we are living “or bust”, and we should never put that option back on the table.

Our sixth principle is reaching the goal of world community with peace, liberty, and justice for all. We cannot be one world community, while millions of our own citizens suffer needlessly due to lack of quality, affordable healthcare. We cannot practice our own liberties while under the thumb of for-profit insurance companies. And there is no justice in a system who seeks to weed out the “haves” from the “have nots” and hand down death sentences to those without. We lag behind the rest of the world in this respect, as it was discussed earlier. We can never be true world leaders in the areas of human rights and justice, when we continue to treat life and health as a luxury purchase item. Universal access to quality healthcare will bring the US up to par with the rest of the world, who figured this basic tenant of human decency for its people ages ago. This goal cannot be reached without a promise of life, dignity and body autonomy for us all.

Finally, our last principle: respect for the interdependent web of all existence of which we are a part. Not only does our environment impact our health directly, but our health as individuals affects everyone else in our webs. As I look at the incredibly dangerous proposals coming out of DC to address healthcare, the biggest portion that keeps me up at night is the inevitable downward spiral that these changes would bring, because we are all related. When fewer people have access to care, not only will they get sicker, and have worse health outcomes, but they will not seek care. As fewer people seek care, providers start to receive less and less for their reimbursements. Without revenue coming in, those providers can’t pay for the people who work for them; nurses, office managers, home health aids. Those people are then taken out of the work force, and their money is also taken out of the circulating economy. As the sick and elderly are forced out of nursing homes because their Medicaid payments stop, family members will be forced to leave their jobs to stay home and care for them. As babies, children and adults with illnesses and disabilities start losing their healthcare funding, the treatments and supports needed to fully receive or participate in their own care will vanish. Those who survive will either need to have family members quit their jobs to care for them full time, or will have to be institutionalized, taking away their liberty to remain in the greater community. The sicker we all become, and the fewer supports there are in place to help us when we need it, the more we, as a community, a society, and an economy suffer. Healthcare is 1/6 of our economy. 1/6th! The largest job growth industry in our country is in the healthcare field.

Starving healthcare in America by making it unaffordable, inaccessible, and tied to a market based, for-profit model of care will starve us all in the end. As goes healthcare, so goes the American economy. It is all inter-connected. We are all interconnected. When we have healthy moms, we have healthy babies. When we have healthy babies, we have healthy kids. When we have healthy kids, we have healthy adults. When we have healthy adults, we have a population that lives longer, with fewer costly end of life care needs. When someone has an illness or disability, early intervention is the key to the best outcomes possible. When someone is struggling with pain, addiction and mental health issues, comprehensive, robust intervention is essential. When people aren’t forced to pay gross amounts of money just to stay alive, they have money that can be put into other areas of the economy, and the rising tides lifts all the boats.

When the people of a society have what they need, we all benefit. We are all interconnected, and your health, is my health. Universal healthcare is the best way to ensure that everyone in the interconnected web gets what they need, even if it isn’t clear how I personally, immediately benefit.

So, I hope that you can see how our quest for universal healthcare in America is not just a moral, ethical or logical imperative, but for we Unitarian Universalists, it is a religious imperative as well. Very often, we hear religion used as a means to hurt people. We hear religion used as a reason to excuse discrimination. Very soon the right to discriminate against someone you don’t like using your religion as an excuse will be heard and ruled on by the US Supreme Court. We’ve seen similar rulings that state so long as a business owner has a “deeply held religious belief” that they can then impose their beliefs, practices and dogmas onto their employees. The right of religion to excuse any number of hateful behaviors has been used as a weapon for ages.

When it comes to our debate with healthcare, I propose that we turn that debate on its head, and cite our deeply held religious beliefs as the reason for universal healthcare. Let us frame this debate as a moral, ethical, logical AND religious one. We, as Unitarian Universalists, agreed to very little. We have no set dogma, rules, or ethos. But we agree on our 7 uniting principles, all of which support the right to universal healthcare. As you continue to have these discussions with your friends, family, co-workers, and hopefully your elected officials, I hope you will remember the points I’ve made today, and the idea that universal healthcare is our religious imperative as a gentle, angry people.

Thank you again for giving me the chance to address you here today. I want to also extend a heartfelt thank you to Pastor Julie Brock for the invitation to speak. I will be around for coffee and conversation following today’s service.

Julia A. Pulver, RN, BSN, CCM

Written by

Julia A. Pulver has been an RN for over 12 years. She has spent her career working with the most at risk populations in Southeast Michigan. @VotePulver

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