Asian Americans and Health Care

Access to healthcare has been a main stage discussion for years.  So much of our enjoyment and success in life is influenced by the quality of our health.  As a result, there are fierce ethical debates around how health care should be distributed.  It is important to recognize that this issue does not affect all people groups equally.  Asian Americans have their own set of unique concerns when it comes to health care. As a Christian, I think it is important to pay attention to the cries and concerns of all groups.  I see the Bible as showing healthcare as a fundamental human right, and as such is something all humans should be afforded.  I will analyze how Christians should respond to this reality.  Also, I will look at how the Asian American experience speaks to equal access to healthcare.  I aim to argue for a base level of healthcare access, while also not demanding everyone always be provided the same level of care.

People from all political leanings will acknowledge that the U.S. healthcare system is in need of improvement.  One of the main issues is how the current healthcare structure makes it difficult for millions of Americans to find proper health coverage.  These Americans do not qualify for the governmental programs and do not have health insurance provided through their employer.  They are either not old enough to qualify for Medicare; or impoverished or disabled enough to qualify for Medicaid.  Simultaneously, they do not earn enough income to afford the premiums of private companies.

Many Asian Americans fall victim to this category.  Influenced by racially motivated historical reasons, Asian Americans are heavily involved in the small business environment.[1]  Typically, small businesses cannot provide health insurance benefits to their employees.  This leaves a significant proportion of Asian Americans uninsured.  There is also much discussion about the issue of social barriers to healthcare.  When considering the Asian American communities, we see two prominent social barriers.  Immigration status and language are two major factors that prevent Asian Americans from obtaining healthcare.[2]

It is becoming more and more popular to argue that health is a human right.  The World Health Organization (WHO) proclaims that the “enjoyment of the highest attainable standards of health is one of the fundamental rights of every human being”.  WHO also defines health as, “a state of complete physical and social wellbeing, and not merely the absence of disease or infirmity.”  What does the Bible have to say on health as a human right and how should Christians understand this concept?

For the Christian, it is important that a defense of health as a human right be rooted in the Bible.  We need to substantiate this claim with more than philosophic talk but also by theological claims and language.[3]  A good place to start is at the beginning.  Genesis 1:26-27 is the quintessential passage for showing all people are made in the Imago Dei.   All people have equal dignity and are equally valuable before God.[4]  Whatever is a human right for a white male is also a human right for a lesbian Asian American woman in virtue of the fact that they are both humans.  WHO has done work to show how health is intimately related to one’s quality of life and that if we are to care about one’s life, we must care about their health.  So, if life is to be valued, health must be protected to maintain our value of life.

Considering the realities of how much impact health has on one’s life, we see how God demands for the sick to be taken care of.  We see it very explicitly in verses like Matthew 25:35-40 and Luke 10:9. In the Matthew verses, we see Christ rattling off positions of vulnerability in the world and identifying himself with the “least of these”.[5]  He tells his listeners that, “whatever you did for the least of one of these brothers of mine, you did for me.”  One of these “least of these” is the sick.  In verse 46, Jesus ends the chapter by saying those who neglected the least of these earns eternal punishment while the righteous gain eternal life.  By identifying himself with these positions of vulnerability, Christ is saying these people deserve and are entitled to protection and care.  It is a requirement of us to meet these people’s needs and it is their right that we do so.

In Luke 10:9, Jesus is sending out his disciples to the neighboring towns and tells them in each town they are welcomed to heal the sick and tell them the Kingdom of God is near.  Healing sickness and restoring health is a characteristic and goal of God’s kingdom.  If we want to honor and respect the dignity of people, we need to treat them the way they would be treated in God’s kingdom.[6]  When it comes to the sick, this means caring for them and bringing them healing of their sickness, so they may be healthy.  Borrowing from Bonhoeffer’s distinction between ultimate and penultimate, God’s grace towards humanity is that which is truly ultimate and thus can bestow rights.[7]  God’s kingdom and how it moves is the manifestation of his grace towards humanity.  By requiring healing, it bestows the right of health for the sick.

There is a plethora of verses that solidify God’s focus on the sick.  Admittedly, these verses are less explicit.  Verses like Proverbs 14:31 says that those who are kind to the needy honor God, and James 1:27 states pure religion is visiting the widow and the orphan in their inflictions.  Neither of these verses explicitly cite caring for the sick, but the point in both is God’s concern for protecting and caring for the vulnerable.[8]  As we have seen, Christ has identified himself with the vulnerable and the sick have been named among the vulnerable. I see our human right to health founded on a few different foundations.  One is our equal dignity before God with the Imago Dei, giving the same value to all people.  Christ’s identification with the vulnerable and command to care for them.  Lastly, on the understanding that however God will treat someone in his kingdom is how we must treat someone here on earth.

Even in establishing health as a human right, we need to be clear in what that means.  One area of contention is how it relates to equality in the realm of health care.  Often talk around equality claims to be about equality of opportunity or access, but really end up looking like equality of outcomes.[9]  Indeed, I find demanding equality of access as favorable over demanding equality of outcomes.  It should be acknowledged that even though opportunity, not outcome, is the goal, disparities in outcomes have a way of reflecting disparities in opportunities.  Health care being a human right means that nothing besides your own personal choice should stop you from being able to receive healthcare.  This means social and economic factors should not prevent someone from receiving needed healthcare.  In this sense, everyone should have equal access to healthcare.

There should be a base level of healthcare access to all so as to honor the dignity of each person and their human right to health.[10]  Beyond that, we must not demand that people cannot seek out healthcare services or access to healthcare that go beyond the requirements of health as a human right.[11]  A common analogous argument is that everyone is entitled to food, but that does not mean anyone is entitled to steak.  If you have the funds to buy steak that is fine, but someone’s ability to buy steak does not mean now everyone else is entitled to steak.  It also does not mean that we are no longer honoring someone else’s right to food if we don’t provide steak for free or at a lower cost to those who can’t afford it.

We need not be so concerned with equal access to all health care, but more towards equal access to a level of health care that honors the dignity of humans and their right to health.  So, everyone should have access to cancer medicine that effectively fights the disease, but it is not wrong if there is cancer treatment you only get if you pay for.  An example can be seen in the way a drug could be administered.  Imagine there is a medicine that comes in three different forms; a vile and a syringe, pill form, and then as an implanted drip or timed disbursement.  All things equal, and as long as healthcare professionals say this form is sufficient, I would say anyone needing this drug would be entitled to the vile and syringe form.  Beyond that, the pill and implant are conveniences to be acquired through payment.  You have a human right to the drug and the “lowest form” of administration with the syringe, but not a right to the pill and implant.

Equality of opportunity and access is not as straight forward as one may think.  Evening the financial playing ground for all people does not equate to equal access to healthcare.  There are social considerations.  This would include things like how close someone lives to healthcare centers, do they have transportation to get to these healthcare centers, can they afford to take time out of their day to get medicine or go to doctor appointments.  For Asian Americans, these social factors are dominated by immigration status and language and cultural barriers.  Depending on someone’s immigration status, they may or may not even have access to healthcare at all.  Also, language and cultural differences can make communication between healthcare professionals and patients painstakingly difficult.  This brings higher risks of misunderstandings.  As a result, healthcare professional may not really understand their patients and cannot provide as quality of services.  The patient then leaves not being diagnosed properly and misunderstanding treatment plans and instructions.

A sizable portion of Asian Americans technically have equal access to health care, at least on paper.  In reality, their different language and culture act as a barrier hindering them from receiving the fulness of the services they are entitled to. If health is a right awarded to all humans, language and culture, even immigration status, should not hinder someone from receiving equal access to health care options.  Now some will object, and reasonably so, with practical concerns and cost benefit analyses.[12]  These need to be considered and dealt with head on.

For example, as discussed above, a difference in culture or language can easily result in someone not fully being able to access all the resources they need.  At the same time, it is not reasonable to think that every health care professional be linguistically and culturally proficient in all cultures and languages, especially if some of those languages or cultures are not prevalent in their community.  We also would need to factor in the costs necessary to assuring all cultures and languages be represented in all health care providing venues.  In directing funds towards these concerns, opportunity cost tells us that a different concern is now receiving less support.  Are these extra costs worth the opportunity costs of spending our money here and not elsewhere?  I would like to point out that this question and concern is usually acknowledged much quicker by those who do not need the extra services in order to attain equal access to health care.  The practical implication of how we fight against the cultural barriers is a big question, but we can start with providing language services.[13]

When discussing equal access to healthcare, we have to discuss the role of the government in distributing health care.  2 Corinthians 15:10 reminds us that we all will give an account of what we did in our lives.  Indeed, many of God’s commandments require you to become personally involved in caring for people.  As a result, many Christians are concerned with the way society is trying to outsource our duty to care for the sick by putting it all in the governments hands.[14]  I too am concerned by the way many try to relinquish themselves from the obligation to personally care for the sick.  Throughout history, the church has been the entity to step in for those who are not provided access to health care.[15]  Often times the best people to solve a problem are those who are closest to it, which would be churches in the community.  So, bringing the government in to handle healthcare problems allows someone who is distant from the problem to provide solutions.

Also, thinking of the government as our first line of defense against social issues is detrimental not only to instilling and maintaining convictions of personal responsibility, but it also does not allow for full healing.[16]  Indeed, Christ’s healings were not only about just healing a sickness but were about healing the full person.[17]  We need to be careful not to ignore the deficiencies in an impersonal government meeting personal needs of the sick.  When people, the community, are engaged in helping the sick, they do not only fight the illness but also build and strengthen relationships as they work through the illness together.  This is why it is imperative for the church and people, in the form of non-profits or individually, to be involved in providing health care to the sick.  In relation to non-governmental efforts to care for the sick, I see the government as our last line of defense, filling in the inevitable gaps.

To fill in these gaps, governments use taxes for funding.  I think Christians should be weary of the governmental taxes for two reasons.  One is the coercive nature of taxes[18], and stemming from that is how taxes do not consider one’s heart in giving.[19]  Indeed, it was for freedom that Christ set us free, so we could freely do good.  Also, God is not like man who looks at the outward appearance, rather he looks at the heart.  Taxes can come into conflict with these biblical principles.  This does not preclude the government from taxing.  Again, practicality needs to be considered, plus other justifications of taxation coming from social contract theory.  Besides only focusing on how taxation could be doing something wrong to accomplish good, maybe we should start trying to get people to see the benefit of government taxation to run social programs.  Then taxes will not be so forced and coerced but agreed to.

We must not totally disparage the government though.  Indeed, Bonhoeffer’s incarnational ethics highlight the reality of the responsibilities of the collective and not just the individual.  This requires us to engage with public policy and the government.[20]  Being faithful to God is about using what you can in your environment to bring about God’s kingdom.  This includes government.  The government must also care for the least of these.  Some want to suggest that the government is not under the same moral obligations as individual people.[21]  There is legitimacy to this claim.  We must not forget though, the government is not some entity running itself.  It is run by a collection of individual people.  Just because someone puts on their “government hat” when going to work doesn’t mean they are not still a person.  This means that these people still are under the moral obligations of individuals.  We should not be so easy on letting them disassociate themselves from moral obligations of individuals just because they are operating within an organization.

Many Asian Americans find themselves sick and unable to help themselves.  This can be from the way they have been pushed into small businesses that generally do not carry employer benefits, or from the cultural, language and immigration barriers we discussed earlier.  Paying attention to the Asian American experience shows the need and urgency for equal access to health care up to a “bottom line”.  Asian American unique health needs like the rising rates of HIV/AIDS diagnoses, and high level of those diagnosed with Tuberculosis or Hepatitis B can best be combated with equal access to healthcare.  By removing all other barriers that hinder Asian Americans to receive access to healthcare, we can help minimize the illnesses that plague them.

Health as a human right is supported by biblical and theological reflection.  We must pay special attention to the sick.  One’s health should not suffer because of anything other than one’s choice.  This may require radical changes in how people live individually in their day to day lives, and the way the government operates.  The change should come on both levels.  We can provide a base level of health care for free, without condemning situations where some may pay to have other and extra services of medicines.  The Asian American experience gives us insight into the challenges of assuring that our health care is accessible to all.  It also shows us where we must do better to honor this human right.

[1] Kao, Grace. Asian American Christian Ethics: Voices, Methods, Issues. Waco, TX: Baylor University Press, 2015. 167.

[2] Kao. Asian American Ethics. 167.

[3] Clarke Chapman, G. (2013). Bonhoeffer and universal health care as a human right. Journal of Religion and Health, 52(4), 1392-401. 1393.

[4] Gronbacher, Gregory M.A. “Understanding Equality in Health Care: A Christian Free-Market Approach.” Christian Bioethics: Non-Ecumenical Studies in Medical Morality 2, no. 3 (January 3, 1996): 293-308. Academic Search Premier, EBSCOhost. 298.

[5] Kao. Asian American Ethics. 158.

[6] Chapman. Bonhoeffer and Universal Health Care. 1397.

[7] Ibid. 1395.

[8] Benn, C., & Hyder, A. A. (2002). Equity and resource allocation in health care: Dialogue between Islam and Christianity. Medicine, Health Care, and Philosophy, 5(2), 181-9. 184.

[9] Gronbacher.  Understanding Equality in Health Care. 299.

[10] Ibid. 301.

[11] Ibid. 300

[12] Ibid. 306.

[13] Jang, Deeanna, and Ann Surapruik. “Not the Model Minority: How to Address Disparities in Asian American Health Care.” Asian American Policy Review 18, (January 2009): 91-106. Academic Search Premier, EBSCOhost. 94.

[14] Engelhardt, H. Tristram. “Equality in Health Care: Christian Engagement with a Secular Obsession.” Christian Bioethics: Non-Ecumenical Studies in Medical Morality 2, no. 3 (January 3, 1996): 355-360. Academic Search Premier, EBSCOhost. 357.

[15] Kao. Asian American Ethics. 158.

[16] Gronbacher.  Understanding Equality in Health Care. 306.

 

[17] Ben and Hyder. Dialogue between Islam and Christianity. 185

[18] Gronbacher.  Understanding Equality in Health Care. 301.

[19] Engelhardt. Christian Engagement with a Secular Obsession. 358.

[20] Chapman. Bonhoeffer and Universal Health Care. 1396.

[21] Gronbacher.  Understanding Equality in Health Care. 298.

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