Lessons from Abroad to America on Universal Health Care

by Douglas W. Kmiec

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Douglas Kmiec (CNS photo)

When the President’s extraordinary discussion of health care at Blair House was concluding, it was just beginning here in Malta. For several intensely interesting hours thereafter, the U.S. Embassy engaged in an equally extraordinary bit of reverse public diplomacy; that is, America was the student, and this ancient island civilization was the teacher.

As America’s Ambassador here with a penchant for trying to combine an inquisitive academic mind with newly grafted diplomatic effort, I invited the “best and the brightest” of the Malta medical fraternity (and they are legion, including having one of their own as cardiovascular chair at Mayo) to do a thorough public comparison of the universal health care system in Malta with the President’s far more modest, but important, effort at providing health care to millions of uninsured.

Malta has had universal health care for generations, and the discussion took place in the sprawling and new teaching hospital – Mater Dei. That’s right, in Catholic Malta, the public hospital is not at all bashful about acknowledging the mother of God – in name, and as discussed, medical deed.

While it was determined by the distinguished group of doctors and medical faculty and health care administrators that we assembled that the President should build in more cost-containment into his proposal, especially efforts to root out fraud. It was therefore gratifying to see the President build in the Republican suggestions of undercover spot checks.

The medical team here, however, had many more suggestions, including utilizing a single coding and claim form across insurance firms to avoid double billing and unneeded testing. There was a good deal of support as well for moving quickly to a health card that would have billing and medical history immediately available for continuity of treatment and administratively simplified billing.

Much was said about addressing the quality of care, too. The quality of care is very high – much higher – in Malta where health care is a matter of social justice, than in the U.S., which ranks lowest in quality of care among the industrialized nations, and somewhere between Chile and Cuba on measures of successful and satisfying treatment. Frankly, the lackluster record of America in longevity, infant mortality, and disease prevention will need to be addressed very quickly after the Obama measure is enacted.

Putting cost and quality to one side, my Maltese hosts discerned that there is no escaping the fundamental choice: either Americans are willing to help their young and their elderly and their less well off fellow citizens or they are not; either Americans who proclaim loudly respect for life when life is of pinpoint size in utero (a matter of enthusiastic and prayerful approbation here) will likewise affirm the life and health of born men, women and children or they will not. This is the ultimate and unavoidable question – no matter how many times the opposition says the problem is just too big -- for them at least -- to handle.

Malta is, as already noted, a highly Catholic country, and as spring arrives, the country is abuzz with happiness at the April visit of the Holy Father. He will find abortion is unlawful. Period. Yet, even the most adamant “no exceptions” doctors and nurses here are chagrined by the hypocrisy of how some in Catholic circles in the U.S. continue to hide behind abortion as an excuse for ignoring the plight of those needing care.

The medical ethicists here had a difficult time perceiving how theories of illicit moral cooperation could be stretched to the breaking point to suggest that abortion would be taxpayer funded under the President’s proposal, when any abortion coverage was wholly a function of private choice (which they and I disapprove), but which all must acknowledge exists now as a matter of law.

The law needs changing, the Maltese professionals insist, but it seems a tired and illogical argument to block needed help for that reason even to a culture that has resisted the harsh conditions and hard-heartedness that aid and abet abortion in America.

The President argues that his legislation does not support taxpayer funded abortion and insofar as the Hyde standard is the appropriate metric, and why would he not think that to be? – his legislation is abortion neutral.

Federal dollars do not pay for abortion under the President’s proposal, even as individual citizen dollars tragically still would. It is my view that no dollar, public or private, should be expended to expunge an unborn life. It is also my view that it is not pro-life to let those in need of surgery or prescriptive medicine to go without even the most rudimentary treatments just to demonstrate the claimed wrongfulness of a Supreme Court decision.

The most poignant statement in favor of President Obama’s leadership occurred near the end of the forum at the medical school. One doctor put it sadly, but bluntly, “you know, Mr. Ambassador,” he said, “in Malta we train for medicine because it is a unique way to be needed; to be of service, and in that service, we are fulfilled.” John Paul II, who visited Malta twice during his papacy said it well: We find ourselves by giving ourselves to others.”

In the provision of universal health care, the Maltese have taken this message and given it “life to the full.” Said one of the teaching faculty: “We do not train in medicine to be paid well in excess of our needs or of our countrymen. We frown on those who see hospitals or pharmaceutical or life science research and development, as profit—rather than people – centered. It is a question of empathy, really. We always saw our American brothers and sisters in that way, and we certainly still think of you as problem solvers. You are, aren’t you?"

Indeed, we are – or at least we can be.

Douglas W. Kmiec is U.S. Ambassador to the Republic of Malta; he is on leave from Pepperdine University, and these views are his own not necessarily those of the United States or his university.

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