One certainty about the historical Jesus is that he was not born in a hospital birthing center with the aid of obstetricians. One brief Bible story and some nativity carols suggest anything but a skilled and sterile environment for the birthing of Mary’s babe. Perhaps not even a lay midwife attended that advent.

Absence of professional healthcare at Jesus’ birth is not an issue for ethics. Few physicians would be found anywhere in ancient Palestine, much less at a birthing. Then and now, barring complications, pregnancy is no illness and neither is the neonate state. Even modern hospitals are dangerous places for contracting all sorts of sick-making bugs, so unsterility amongst the menagerie attending Baby Jesus may not have constituted a greater relative risk.

Yet the poignancy of Luke’s birthing account, apparently that of an early physician, is found in part by the disparities of healthcare it implies. In our era and in a society allocating more resources to healthcare than any other in history, the impoverished circumstances of Jesus’ birth seem symbolic of too many babies who still lack access even to basic medical services.

Conservative estimates of the medically uninsured are based on U.S. census data and have been reported widely. Those reports indicate that 45 million persons, including 8 million children, have been without healthcare insurance during the preceding year.

In all likelihood, the calculations of Families USA are more statistically accurate, and even more ethically distressing. Using all available data (i.e., both CPS and SIPP) from the Census Bureau, they conclude that 27 million children were without coverage for at least several months during the 24 month period of 2002-2003. This constitutes 33 percent of 82 million total uninsured in this country (ages 65 and under), and 37 percent of all Americans ages 0-17. Nearly 80 percent of their uninsured parents or guardians were employed during those months of medical vulnerability. Only a few had adequate personal resources for family health maintenance.

Many of our uninsured children would have obtained quality primary care through public health or nonprofit “free clinics.” For some, quality care, or at least specialty care, was lacking despite access to basic services. Others were brought to hospital emergency rooms for both primary and emergent care. We can be certain that too many slipped through the cracks of charitable healthcare altogether. And surely some of our nation’s babies were lost without so much as the comfort of a straw-lined manger in which to die.

The “uninsured” statistics do not take into account approximately 51 million persons, numerous children among them, covered only by Medicaid. While both Medicaid enrollees and those without any coverage are increasing annually, decreasing numbers of healthcare providers accept the insurance of the poor. Had there been need for more than a birthing barn that night, the poor Mother and Child might not have fared much better in modern Kansas City than in ancient Bethlehem.

Healthcare disparities constitute an ethics issue of immense proportions. Outside of the United States, in developing nations without adequacy even of basic healthcare, millions die for lack of childhood immunizations or potable water. Within the U.S., disparate healthcare conditions persist despite an annual per capita spending of about $5000 (approximately 14 percent of gross domestic product), twice that of most other wealthy nations and many times that of the rest.

Study after study demonstrates that greater privilege—by socioeconomic class, race or ethnicity—is the single most important factor determining healthcare status. Those less privileged, on the other hand, typically receive less and worse healthcare, suffer poorer health, and die sooner. Clearly, all who are created equal in this nation do not get an equitable share of the healthcare pie and its benefits.

Eventually, the advent of something new will appear on the horizon of healthcare here as elsewhere. Sooner or later, we will do things differently. As a society, we may be forced into a more sustainable and equitable system of healthcare delivery, or we may choose it freely. The question awaiting us now, while some children sing of a Savior’s birth, is how many other innocent little ones will die too young when they might have been saved.

Tarris Rosell is a program associate at the Center for Practical Bioethics in Kansas City, Mo. He is also associate professor of pastoral theology in ethics and ministry praxis at Central Baptist Theological Seminary in Kansas City, Kan.

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