Issue Paper: Domestic Access to Health Care

Caring for Health: Domestic Access to Health Care

Background
“God creates human beings as whole persons—each one a dynamic unity of body, mind, and spirit. Health concerns the proper functioning and well-being of the whole person” (“Caring for Health: Our Shared Endeavor” [ELCA 2003], page 3[1]). “We of the Evangelical Lutheran Church (ELCA) in America have an enduring commitment to work for and support health care for all people as a shared endeavor” (page 2). The crisis in health care today includes rising costs of health care, growing numbers of people with inadequate health care resources, and the system in distress. The church is called to be an active participant in fashioning a just and effective health care system (page 1).

Health care coverage is dwindling, according to the National Coalition on Health Care, a nonpartisan alliance of business, labor, and the community. They report over 41 million people without health care, or 14.6%, with no health insurance in 2001 as reported by the U.S. census bureau.[2] With costs rising, coverage falling, and more costs being shifted to employers, the numbers of uninsured are predicted to reach 52 million by 2006. The hidden fallout they see from this includes higher risks of developmental delays seen in children and the impact of families spending upwards of 20% of their income on health care. In addition, there is lost work productivity and increasing costs for medical care for the uninsured, on which the U.S. spent $98.9 billion in 2001.

Families USA reports[3] that prescription drugs continue to disproportionately contribute to increases in health care costs due to three factors: more drugs being prescribed, new and higher-priced drugs prescribed more frequently, and the cost of all drugs rising. Specifically, the 50 prescriptions used most frequently by the elderly rose 3.4 times the rate of inflation in 2002. At the same time, the Center for Health System Change reports that one in 12 Medicare beneficiaries reported they could not fill a prescription in the last year due to its cost. This is compounded in African American communities, which report the number to be one in six unable to fill a prescription.[4]

The association of pharmaceutical researchers and manufacturers, known as PhRMA, also realizes the need for systemic change. They call for enactment by Congress of a prescription drug benefit for seniors and the disabled that will provide full access to innovative medicines that help patients lead longer, healthier, and more productive lives.[5] The stress on the overburdened health care system is compounded by rising liability costs, hospitalization costs, state fiscal pressures, and concerns about quality assurance.[6] Other issues fall into this category, including smoking policy, elimination of toxic chemical compounds in health care, the development of safer alternatives for toxic compounds, and overall health and safety policies.

ELCA Social Policy
The ELCA social statement “Caring for Health: Our Shared Endeavor” (August 2003) develops this church’s vision of health, illness, and healing. Part of that vision is for equitable access to health care. An individual’s responsibility for caring for his or her own health—such as eating well, avoiding tobacco use, and avoiding alcohol consumption—is cited. In addition, the church’s ministry in health care is highlighted at both a congregational and social ministry organization level. A major component of this social statement is the issue of access for all. Justice requires health care to be provided on the basis of need, giving particular attention to those who are disenfranchised from the system (page 19). At the same time, the statement says that a combination of individual, market, and governmental approaches is necessary to begin to provide equitable access (page 20).

Corporate Response
As the problems above indicate, all privately and publicly held corporations face issues associated with wellness, provision of health care, and access to pharmaceuticals. Every corporation and family business faces decisions about health insurance for their employees, the health care available to their employees, and the costs to their employees for such care. All have to make decisions related to their ability to be part of the solution to the health crisis. The pharmaceutical companies in this country have an additional challenge to face in that they provide some of the basic materials needed for health and wellness and must address how these goods can be distributed equitably. In response, many pharmaceutical companies have developed free access programs that work for some individuals, but create a patchwork of response that does not include access for all.
 
Shareholder Work History
For over 15 years, the community of faith-based shareholders (mainly through the Interfaith Center on Corporate Responsibility [ICCR]) has been working with companies on issues related to health in the United States. In the last 10 years, the ELCA was an active participant in the resolutions leading to major changes in national smoking policies. Some of this work has included smoke-free work places, including eating establishments. In the late 1990s, much of the work at ICCR began to focus on access to pharmaceuticals in the United States. Since that time, dialogues have been conducted with a variety of pharmaceutical companies about domestic and global access to pharmaceuticals. 

The ELCA has been a dialogue participant for the last three years with resolutions at pharmaceutical companies about patent extensions and HIV/AIDS drug accessibility. The ELCA Church Council has approved resolutions relating to these issues.

Resolution Guidelines for ELCA

• We support resolutions asking for both the development of ethical criteria for the extension of patents on prescription drugs and reports on the implications of such criteria.
• We support a report on the company’s initiatives to create, expand, and implement policies and programs to extend pharmaceutical accessibility, taking into account the costs and benefits.
• We support reports disclosing the extent and types of payments, incentives, or rebates that are made to doctors, pharmacy benefit managers, and other pharmaceutical purchasers in order to influence the selection of a particular drug.
• We support policies that phase out the manufacture of PVC- or phthalate-containing medical supplies where safe alternatives are available.
• We support reports evaluating the feasibility of removing dibutyl phthalates, parabens, and mercury from devices and products.
• We support resolutions asking for warnings on products and for marketing programs that discourage youth from using tobacco products.
• We support companies having the same policies in developing nations restricting marketing of tobacco products as in the United States.
• We support proposals asking for smoke-free facilities and expanded smoke-free boundaries around building entrances.
• We support reports to the board about the health risks of products involved with tobacco sales.
• We support reports on the health impacts on teens that result from exposure to the portrayal of smoking in (Disney, Universal, Time Warner, Viacom) movies.