BY: JEFF TIEMAN
Mr. Tieman is communications director, Covering a Nation, Catholic Health
Association, St. Louis.
"Health care reform" is hardly a phrase that gets people excited.
Although there can be no doubt that our health care system leaves many outside
its boundaries and is in dire need of repair, the topic is just not as sensational
as many we see on TV. In a media-saturated world, distractions are close and
constant. Even people with a strong sense of social conscience can easily fall
victim to the 24-hour news cycle and its tendency to skim over complexities
When television producers and news directors decide what is important, even
stories as serious as increasing poverty and diminishing access to health care
are often ignored on the page and screen. With the war in Iraq, the journalism
motto "If it bleeds, it leads" is employed on a daily basis. Other
important topics often take a back seat to the story that sells.
This phenomenon, of course, is nothing new. But when we ask ourselves why there
is no national movement to reform the broken health care system, no concerted
cry for action—despite the evidence that people are marginalized and even
harmed by the current system—we must also ask how to engage people on the
issues within a broader context than is allowed by a brief newspaper account
or MSNBC report.
Quite simply, health care is not a topic of community conversation, particularly
as it relates to the poor and vulnerable. No one has made the issues compelling
or personal enough to get people talking or to help them make important connections
with related social problems that conflict with our moral and democratic values.
No one has created the language and the images that will resonate with the public
and prompt a call for change. The health care system is profoundly important
to us all, even to the healthy and wealthy, but that message has not been effectively
As members of a ministry long committed to promoting social justice and defending
human dignity, Catholic health care providers can create the images and the
words that will be needed. Those working on the front lines of health care are
in a uniquely powerful position to spark the conversation and humanize the problem.
Describe the Connections
One way to accomplish that is to embrace complexity rather than hide behind
it. We need to describe important connections between related issues and how
those connections affect real people in real ways. The problems with access
to health care and the growing poverty ranks are two excellent examples. These
two social dilemmas are clearly related, but not everyone will think about how
or why, and what that means.
Last August the U.S. Census Bureau announced that the number of people without
health insurance grew to nearly 45 million in 2003, representing an increase
to 15.6 percent of the population. The bureau also reported that between 2001
and 2004 some 4.3 million people fell into poverty. Although these statistics
came out at the same time—and from the same source—they were not always
conveyed together, or in a way that advanced the public's understanding
of the related issues.
It is easy to see how news outlets might cover the poverty and uninsured stories
separately or incompletely. Take the example of a daily city newspaper processing
the census figures. If an editor decides to run one story addressing both poverty
and the uninsured, the article is likely to use up most of its space listing
the facts but without exploring in any depth how they are provocative and interrelated.
Alternatively, the editor assigns the poverty and health care stories to two
reporters who cover these issues under their pre-ordained beats. The reader
may not even see both stories in the first place; but even if he does, he's
unlikely to find in either story an explanation of how medical problems can
lead to poverty and how poverty can exacerbate medical problems.
In a cursory review I did of recent news stories that mention both poverty
and the uninsured, I found poverty mentioned only in the context of explaining
eligibility thresholds for Medicaid and other public assistance programs. Except
for an op-ed piece here and there, most newspapers do not examine the degree
to which someone's health and access to care can threaten his or her economic
Whether or not the media make clear and useful connections between the two
problems, they are related. A recent Harvard University study offers
direct evidence. As many as 2.2 million Americans who filed for personal bankruptcy
in 2001 cited medical causes for their financial trouble.1 More than
one quarter of bankruptcy filers cited illness or injury as the specific reason
At least one critic has argued that the Harvard researchers must have surveyed
only the lowest income earners, whose employers did not provide long-term disability
insurance as a safety net. Another claimed that the study authors exaggerated
their findings or used nonrepresentative sample populations to bolster their
own agendas for a single-payer health care system.
Even if those arguments have any degree of validity, the study still highlights
a problem that should be considered and discussed. Even considering the possibility
that only half of the 2.2 million cases cited in the study actually filed for
bankruptcy because of medical expenses, that still leaves more than one million
people who saw their financial and personal stability collapse because they
could not afford health care. As Martin Luther King aptly observed, "Injustice
anywhere threatens justice everywhere."2
Many of the news stories generated by the Harvard study did not cite its possible
limitations or biases, which in this case may not be so bad. If all the study
did was teach us how easy it is for a person to lose his or her financial footing
because of medical problems, it accomplished something important.
Reaching the Middle Class
The Harvard study is not alone in identifying links between access to health
care and economic viability. According to the Commonwealth Fund's 2003
Biennial Health Insurance Survey, two out of five adults—including both
people with and without coverage—said they either had problems paying their
medical bills or were paying off medical debt.3 Sixty percent of
the uninsured reported similar problems, and more than one-quarter of those
struggling with medical bills said that they had been unable to afford such
basic necessities as food, heat, or rent.
Of course, it stands to reason that poor people would find it more difficult
than others to afford health care and that medical expenses can drive even middle
class people into poverty. Fr. Robert J. Vitillo, the former executive director
of the Catholic Campaign for Human Development (CCHD), recently said, "It
does not take a great leap of logic to understand that poor and low-income people
are heavily represented among the uninsured in our country and the situation
with poor children is especially tragic."4 Logical as it may
be, the connection is still not clear to many people.
Ninety percent of respondents to the CCHD's most recent Poverty Pulse
survey said they are concerned about poverty as a problem in the United States.5
An equal number said they are very concerned about health care. In a separate
question, however, respondents were asked to identify what they feel are the
causes of poverty. Lack of education topped the list, with 27 percent of respondents
citing it as the cause. Meanwhile, only three percent of the respondents identified
illness or health problems as a cause for poverty.6 People who live
comfortably tend to spend little time thinking about poverty and exorbitant
health costs. Indeed, many of us never have to imagine being unable, because
of poverty, to visit the doctor when we are sick.
The CCHD survey bears this out. Only 23 percent of non-low-income respondents
said they were concerned they will become poor at some point in their life.
It is easy to be complacent when one's own needs are met; people who struggle
for basic necessities can be invisible to those of us who have adequate or plentiful
resources. Although 97 percent of survey respondents said it is important to
reduce or eliminate poverty in the United States, and more than 90 percent said
the government should help low-income populations afford health coverage, poverty
was not prominently debated or discussed in last fall's presidential and
Although health care reform was featured in the 2004 campaign, it was usually
ranked below such issues as national security and the war in Iraq. Concerned
as many of us are about our friends and family members fighting overseas and
about the threat of terrorism at home, we find it easy to forget about those
who are wondering how to meet their daily needs for housing, education, and
"If we guaranteed health insurance for everyone under 200 percent of poverty,
45 million uninsured Americans would probably become five million," observes
Tony Garr, director of the Tennessee Health Care Campaign, which works to expand
affordable health care to residents of that state through education, outreach,
and advocacy.7 As Garr and others point out, covering the poorest
Americans would also help prevent them from getting sick or needing hospitalization
in the first place—which would ultimately save money for the system and
the taxpayers supporting it.
A New Rights Movement
How, then, do we summon the public will to acknowledge these facts? How
do we create an environment wherein people not only view poverty and health
care access as part of the same social problem but are persuaded to give them
high priority on the nation's action agenda?
A large part of the answer, as envisioned by CHA's Covering a Nation
initiative, involves exchanging ideas community by community and shaping a national
dialogue. Until we Americans collectively see related social problems as urgent
and begin to engage in a substantive, all-inclusive national discussion of them,
true progress will not occur. In this discussion, everyone must be "at
the table"—rich and poor, minorities and other ethnic groups, the
employed and the unemployed, insurers and hospitals, physicians and lawyers—all
the strange bedfellows.
The U.S. civil rights movement was successful because committed activists worked
together to persuade local communities of the injustice of segregation, and
eventually these local voices helped form a national consensus. Once that consensus
was formed, the federal government had no choice but to take action. Something
similar occurred with other movements, from women's suffrage to the elimination
of apartheid in South Africa. We who serve the Catholic health ministry can
help create the same sense of urgency when it comes to health care access, particularly
that of the poor and vulnerable.
The challenge is twofold. First, we must help people understand that lack of
access to health care touches every aspect of life, offends human dignity, and
stifles progress. Second, we must catalyze public interest in the problem and
get people everywhere talking about it in a serious and concerted way. Those
who are on the front lines of the access issue can and should prompt dialogue
in their communities, making it clear that when any person is unable to gain
access to health care, it is not only that person who suffers—society as
a whole suffers as well.
This work is not new to the Catholic health ministry. But we must now commit
ourselves to doing it in a more focused way. In May, the ministry joined other
health care providers and organizations nationwide to rally on behalf of health
reform during the Robert Wood Johnson Foundation's Cover the Uninsured
Week 2005. As was the case last year, ministry participation was substantial,
and for at least a week there was an uptick in headlines covering the issue.
Now the challenge is to make Cover the Uninsured Week 2005 happen every
week. A discussion among hospital employees would be a good place to start.
What are their frustrations and hopes for the health care system? Having
launched discussions among health care workers, we might initiate community
discussions at local branches of the Rotary Club and Chamber of Commerce. We
could organize town-hall meetings in local elementary school gyms. We could
put up posters in local grocery stores, reminding shoppers that their neighbors
may not be able to afford a visit to the doctor. The smallest steps can encourage
conversation and enlightenment.
As we go about this work, we should remember always to put a human face on
our message. Statistics, studies, and policy journal articles are all well and
good. But one reason people are not attracted to news stories about health care
and poverty is that these stories often lack the human touch. They provide little
with which the average person might connect or sympathize.
The reason so few people imagine being poor is that they have not seen poverty
up close. They have no frame of reference. Let us give it to them, and in the
process help make connections that shed light on the series of problems we must
face as a nation. If it is indeed easiest not to care, the least we can do is
make it a little harder.
- David U. Himmelstein, et al., "MarketWatch: Illness and Injury as Contributors
to Bankruptcy," Health Affairs, February 2, 2005.
- Martin Luther King, Jr., "Letter from Birmingham Jail," April 1963, p. 1,
available at www.stanford.edu/group/King/popular_requests/frequentdocs/birmingham.pdf.
- Commonwealth Fund, 2003 Biennial Health Insurance Survey, chart 16,
available at www.cmwf.org/usr_doc/Collins_biennial_hlt_ins_surveycharts.pdf.
- Catholic Campaign for Human Development, news release of January 2005, available
Fr. Vitilla is now special adviser to Caritas International, Rome.
- Catholic Campaign for Human Development, Poverty Pulse Survey Low-Income
Survey, January 2004, p. 5, available at www.usccb.org/cchd/LOWINFNL.PDF.
- Catholic Campaign for Human Development, Poverty Pulse Survey, p.
- Tony Garr, telephone conversation of February 16, 2005.
Copyright © 2005 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.