Reflections on the Olympic opening ceremonies

Of all the quirky elements that went into the opening ceremony of the London Olympics (think Shakespeare, James Bond, Voldemort, and — Mr. Bean?), the quirkiest to me was the tribute to the National Health Service (NHS). Wondering whether the acclamation was the idiosyncratic view of the ceremony’s director or reflected the attitude of the British public, I went online to do a (thoroughly unsystematic) search regarding Brits’ perspectives the NHS. I found a wide range of opinions, from complaints and disgust (Google “I hate the NHS” for a sample), to praise, to prophecies of doom. But overall, even when the British have bad things to say about the NHS, most express some degree of pride in it: and the thing that they are most proud of is that their health system provides access to everybody in the country, for no cost at the point of care.

In my (totally unscientific) research, I came across many websites debating the relative merits of the NHS and US healthcare. Those who favor US healthcare, while acknowledging that it has its problems, also express pride in it: and the thing that they are most often proud of is its unparalleled technology, its shorter wait times for many tests and procedures, and its vigorous R&D.

Now I am not here arguing for an NHS-like system in the US. But change of one kind or another is coming to how we fund and deliver health care. Wouldn’t it be grand — wouldn’t it be right — if we end up with a system in which we can be proud of the fact that we provide access to health care even for “the least of these,” and not just our technological prowess?

The Missing Component

This past weekend at the 2012 CBHD conference, I attended Daniel McConchie’s seminar on the Affordable

Image courtesy of Baptist Medical Dental Fellowship

Care Act and its implications for a physician’s right of conscience.  It would have taken me hours and hours to sort through the complicated legislation that is the ACA, so I’m very grateful to Daniel for providing a clear and concise overview of what the law entails.   With a piece of legislation like the ACA, physicians are to be wary of the interference of government power, but I also reminded our group that insurance companies figured heavily into this law and they in their own way dictate to physicians how they are to practice medicine.  What is almost completely lost in the health care debate is the role of charitable institutions, once the mainstay of American healthcare.  Christians building hospitals and clinics as ministry outreach have a completely different motivation for practicing medicine from that of the government and the insurance companies.  In a charitable endeavor, physicians can feel free to care for the whole person and make interventions that are informed by a Christian ethic.  Even community-based and county hospitals bring a grassroots approach that frees physicians from large-scale plans managed from Washington or a skyscraper.  Since health care is about some of a person’s most intimate affairs, it makes sense to think of health care delivery beginning at the local level rather than with some big, national plan.

 

A few tentative thoughts on — what else? — the ACA

With all the hoopla surrounding yesterday’s Supreme Court decision upholding most of the Affordable Care Act or ACA (12 pages in today’s Chicago Tribune alone), and with my extremely limited understanding of Constitutional law and legal matters in general, it almost seems silly for me to weigh in. But I will anyway. Disclaimer: I am neither a Republican nor a Democrat (I can’t stand either party), and my views do not represent those of Trinity International University, the medical profession, Christianity in general, or God.

The fact that the Court upheld the law on the basis that it is really imposing a constitutional tax rather than a mandate got me thinking (and I want to bypass all of the idiotic political wrangling about who said it was a tax when). We tax to provide for many things that are considered public or common goods: roads, schools, libraries, police services, and the like. These common goods are things that are necessary, but that no one person or small group of people could possibly pay for, so the cost is spread over the large group of people who potentially benefit from such services. Is it reasonable to see health care not as a special privilege for those who can afford it, but as a common good?

In our current “system,” health care costs are spread over large groups of people through multiple private insurers, as well as the government-administered programs of Medicare and Medicaid. However, the private insurers, in an effort to maintain the skyscrapers they have erected in downtown Chicago, exclude those patients who are a threat to their profits.  This would be perfectly understandable and excusable if they were in the business of insuring luxury or discretionary items like large-screen TVs or designer clothes. But they are not insuring luxury items; they are providing payment for a common, public good.

The most direct solution would be a direct tax to pay for health care for everybody. That is not to say it is a simple solution; it is fraught with problems, and is probably currently politically untenable. Barring that option, the next most reasonable option would be to set up a tax structure that encourages or enables everyone to buy insurance, since that is the way health care is paid for in this country. It seems to me that this is what the current Court ruling has said the ACA does. (Whether that is what the ACA actually does is beyond my ability to discuss intelligently.)

I am no proponent of the ACA (see here). There will be unintended consequences and unforeseen ramifications and nobody knows what will happen as it is implemented. (Don’t believe anybody from either party who tells you they know how things will turn out.) My personal biggest problem with it is that its provisions for cost control seem anemic at best. However, it was passed by the legislative branch of our government, signed into law by the executive branch, and now upheld by the judicial branch. It is time for our elected officials to get on with the task of governing, not posturing and jockeying for party power. There will have to be multiple fixes for the ACA and fixes for the fixes as time goes on. Let’s quit the fighting already and get down to the work of providing health care — and move our understanding closer to seeing health care as a common good, not a luxury item.

(I will be gone on vacation the next few weeks with no computer access. This means not only that I won’t post for the next couple of Fridays, but that I will not be able to immediately respond to any comments you might want to add.)

Undocumented immigrants and health care

 

In a Perspective piece in last week’s New England Journal of Medicine, Dr. James Breen writes of a segment of the population invisible to health care system reform: undocumented immigrants. Breen asks, If the currently proposed incarnation of health care delivery reform becomes reality, tens of millions of Americans suddenly have insurance, and charity medical care is drastically reduced as the need for it dries up, what will happen to those undocumented immigrants who currently receive that charity care but neither have insurance nor would be eligible to receive it under the Affordable Care Act?

This is a real concern in the current political and social climate. Just as in the past it was considered legitimate to treat certain groups of people as less worthy of respect than others — in our country, most notably African-Americans — so today it seems to be accepted, even respectable, to consider undocumented immigrants as something a little above vermin. This lower-class status is assumed in public discourse, is a plank in political party platforms, and is even becoming enshrined in the law of the land.

Whatever one thinks of how we should ultimately deal with the issue of undocumented immigrants, the fact is, they are here. Roughly 11 million of them. They are endowed with the same human dignity as anyone else. And they will need health care.

In the parable of The Good Samaritan (Luke 10:25-37), Jesus contrasted an expert in the law with a traveling Samaritan. The lawyer asked, “Who is my neighbor?” — that is, “Who is deserving of my care?” The Samaritan didn’t ask who was his neighbor; he was the neighbor, to a foreigner. And in Leviticus 19 we read, “When a foreigner resides among you in your land, do not mistreat them. The foreigner residing among you must be treated as your native-born. Love them as yourself, for you were foreigners in Egypt. I am the Lord your God.” (NIV) God does not make a distinction between “legal” and “illegal” foreigners.  If our health care system does, then here is another place for the Church to step in and demonstrate God’s heart for “the foreigner among you.” By our advocacy for caring for these fellow humans, as well our actual provision of that care where possible, we can embody the love of God in a way that will contrast starkly with the increasingly strident voices around us.

 

Making us be healthy

New York City’s mayor has proposed a drastic public health measure: banning sales of sugary drinks that are greater than 16 ounces in size, in an attempt to curb obesity.

Two questions: First, will banning a certain size of soft drink really make a difference in obesity? I guess we don’t know until someone tries it and measures the effects, but I’m a little skeptical that addressing a single caloric source in such a limited way will make a significant difference. (And what’s to stop someone from buying multiple smaller-sized drinks in order to achieve the same effect as a super-size sugary drink?)

Second, and more important, even if for the sake of argument we grant that the answer to the first question is yes, how far should the law go to try to coerce people to make healthier choices? If we accept the apparent logic behind this proposed law, then it seems we must accept that government should limit how many pieces of pizza one can buy, how many greasy-double-cheezies one can order at the burger palace, how many packs of cigarettes one can purchase, how many bags of candy one can acquire, and how many bottles of beer one can obtain. And as long as we’re talking about unhealthy behaviors, should the law proscribe the number of sexual partners one has, limit the number of hours of television broadcast each day, and regulate the number of hours we spend in direct sunlight without sunscreen? Most of us would agree that such measures would be onerous and intrusive, although they arguably might marginally increase the health of a population. But is that benefit enough to justify criminalizing certain actions? Should it be an illegal act to do things that might be bad for your health?

Government is good for a lot of things: keeping order, administering justice, defense, overseeing big public-good projects like roads and clean water, and, well governing. I think it’s OK for government to protect our health by doing things like making sure the eggs I’m sold aren’t loaded with salmonella or other toxic substances: there is a direct, preventable, cause-and-effect relationship between my eating infected eggs and developing salmonellosis. But protecting my health from someone else’s actions in this way is quite different from trying to enforce my health by micromanaging my dietary actions. Government is good for a lot of things; but it is not within government’s purview to make me be healthy.

 

Ethical questions about health care

A recent article in Time notes that the typical American way to address our economic problems, particularly related to heath care, is evasion and denial. They suggest that this is even truer of the underlying ethical issues regarding health care that need to be addressed by our society. They cite such questions as “When should aggressive treatment be limited for someone who is terminally ill?” “Does everyone deserve the same care?” “Is medical progress always a good thing?” “How much happiness do people deserve?” that get answered by default if we don’t address them ahead of time.

It is clear that what they are saying is right. If we don’t address these ethical questions as a society we will blindly proceed with our dysfunctional system of care and economic forces will prevail.

The question is what to do about it. How do we get our society to think about these things and come to a consensus for the good of all? Sometimes government can help, many times in response to something. After Tuskegee we got the Belmont report. After court cases about stopping life-sustaining care there was a presidential commission to address that. When President Bush had to address human embryonic stem cell research we got the President’s Council on Bioethics that tried to be a forum for national discussion of broad underlying issues in bioethics. Some times government focuses more on specific policy issues as is the agenda for the current Presidential Commission for the Study of Bioethical Issues.

However, what government does is not enough. Organizations like CBHD can play a major role in helping to define the issues and engaging people in the conversation. Those of us involved in the church and in education can also play a significant role. Having discussions in our churches can help people engage these questions in a Christian context. Helping students to think about these issues can prepare future leaders to be ready to lead the discussion in the future. Each one of us has a part we can play in helping our society think about these issues so that we are not led blindly into the future by economic forces alone.

Health care and incarnation

Sometimes things that come to us from different directions come together to help us see things more clearly.

Joe Gibbs’ and Jon Holmlund’s most recent posts look at different aspects of how we provide health care in our society. Joe expressed the need for a theologically grounded understanding of the need to provide health care for those who currently are unable to afford it. Jon discussed the need to have reasonable expectations in the treatment of cancer. These two ideas address two of the significant things that are broken in our current way of providing healthcare in the US. Both of them contribute to why we have a very expensive system that does not meet the basic needs of the most needy.

Today in chapel I listened to Skye Jethani give a very thoughtful talk about how we as Christians should interact with those with other religious beliefs. He suggested that in our increasingly multicultural world we should not retreat into isolation to protect ourselves from contamination. Nor should we hide our Christianity as we try to work with others for the common good which in turn benefits us. His recommendation was that we model how we engage those who are unlike us after Jesus’ incarnation. Jesus came to earth revealing God to mankind and intentionally engaging us to express his sacrificial love. Since love is willing what is best for another person, our faith should motivate us to engage those who are not like us to do what is best for them without hiding who we are.

As I reflected on what I had read and heard I realized they all fit together. As Christians we should be engaging not only those who are unlike us in faith, but all who are in need as we model Jesus’ incarnation. That leads us to seek out what is best for those who are not provided for in our current system of health care as Joe was saying. It means Christian physicians should help patients with cancer and others throughout our society better understand that what is best for them may not always be more treatment, but wise care with an understanding of our mortality and the hope we have beyond that. As we address the needs of the poor and the sometimes unrealistic expectations we have as a society about medicine with a focus on what is ultimately best for everyone we will begin to have the perspective needed to address our broken health care system.

Can the Church have a distinctive take on health care insurance reform?

The Supreme Court has finished hearing the case for and against various provisions of the Obama health care plan. All that remains now is to wait for the decision, which will be handed down sometime in June.

There is much to be opposed to in any scheme of health care insurance reform. If we are waiting for a perfect plan before we will declare our support, then we will never support any reform plan. However, I believe the problem of how to justly provide health care to all is an opportunity for the Church to counter the perception of alignment with partisan political agendas and show instead its alignment with an agenda that transcends political or personal preferences.

The doctrine of God’s love, of the self-giving agape which God demonstrates toward us and enables us to show to others, should surely influence our attitude towards health care reform. One expression in Scripture of what our attitude should be is found in Philippians, where Paul writes, “Each of you should look not only to your own interests, but also to the interests of others. Your attitude should be the same as that of Christ Jesus . . .” (Philippians 2:4-5) Much of our resistance to reform comes from considering only our own interests, to the neglect of the interests of others: placing our own desire for limitless choice over the interests of those who have virtually no choices; putting our desire to keep more of our income out of the hands of the tax collector over the interests of those with much more meager incomes who would benefit from the care increased taxes might provide; placing our general principled distrust of government higher in importance than the real good limited government intervention might be able to accomplish in this particular situation. As Christians, we can be concerned not first of all with our own rights and interests, but with those of others, and can willingly insist not on a right to maximum health care but only to a level that is socially equitable and affordable.

As Christians, we have a unique opportunity at this time in history to be a singular witness to Christ by approaching health care and its reform from a theological standpoint rather than the standpoint of a political party agenda or our own rights and interests. By overcoming the tendencies that naturally make us resistant to health care reform, we will show that we are conformed to something other than our culture or our own private interests. By making clear that the followers of Christ are advocates for those unable to afford care, even when it may be disadvantageous to ourselves, we will take our place among the ranks of our Christian forebears who, as they started the first hospitals and hospices in Europe, were at the forefront of health care reform in their day.

The real reason the Patient Protection and Affordable Care Act should be repealed (and it’s not the one the politicians give)

 

First, the bad news: Between 1980 and 2009, annual real per capita health expenditures grew by 4.1%. In the same period, per capita GDP (adjusted for inflation) grew by 1.8%.  In other words, health care costs grew faster than the money to pay for them. The inevitable endpoint, if such trends continue, is eloquently demonstrated in the graph from this 2005 study from the Robert Graham Center (a center for the study of health care policy), which projected that an annual US family health insurance premium would equal the average family’s annual income by the year 2025.

Now, the good news: A study in this week’s Annals of Family Medicine updated the projection, taking into account the passage of the Patient Protection and Affordable Care Act (PPACA) and the recent slowing of health insurance and wage increases. The new calculations push the date when the family’s premium will equal the family paycheck all the way back to 2033!

The PPACA got a lot of people hopping mad, and in an election year, it has become a huge political hot potato. Many feel it went too far, and therefore should be repealed. However, if the studies mentioned above are even close to accurate, the thing should be repealed, not because it went too far, but because it didn’t go far enough. It provided cosmetic surgery when what the patient needed was a heart transplant.

Many Christian voices have joined the chorus attempting to shout down the PPACA. However, this seems to me to be fiddling while Rome burns, because with or without the PPACA, our health care system is becoming unsustainable, and people — real people, like you and me, and disproportionately the poorer among us — are suffering physically, financially, emotionally, and yes, spiritually, because of the ruin they face from health care costs. And without radical change, more and more will join their ranks.

A large portion of Jesus’ recorded ministry involved healing the sick. The main difference between the sheep and the goats in the Matthew 25 parable is how each treated “the least of these.” It is those “least” that will suffer the most as health care costs become increasingly untenable. Therefore, as Christians, we should be at the forefront of efforts to ethically control healthcare costs and provide some level of basic, dignified healthcare to all. These efforts may or may not entail greater government involvement in health care. The recent controversies over contraceptive coverage show what can happen when the responsibility for health care reform is left solely to the government. But either way, it would reflect well on Jesus Christ if his followers took the lead in ensuring that compassionate health care is within the reach of all people. This will require radical change, as well as self-sacrifice; but who is in a better position to lead the way than the followers of the One who changes lives radically because of his self-sacrifice? The PPACA cannot deliver this; if the PPACA is repealed, it should not because it went too far, but because it didn’t go far enough.

Eight is Enough

 

In response to a family’s having eight babies by IVF and gestational surrogacy:

“In this society, if you have money, you can have miracles!”

“Having children is now a luxurious game for the rich!”

“This completely topples the traditional meaning of parents.”

“From the sound of it, they just tried to have some kind of baby machine.”

“Gestational surrogacy is the business of renting out organs.”

“Why did they have to hire so many people to have babies for them? Did they think they had the right to bear children just because they were rich? Secondly, what respect to life did they show? Multiple pregnancies are super risky.”

These are reactions from the public, press, and government officials to a wealthy couple having two sets of triplets and one set of twins via IVF and two surrogates in China, where there has been an official one-child-per-family policy since 1978. Last month a southern Chinese newspaper broke the story of this family, and you can sense the angry reaction of their society in the quotes above.

(There is apparently a large surrogacy industry in China, despite a 2001 ban on Chinese hospitals doing the procedures. The manager of one surrogacy agency reports being overwhelmed with applications from aspiring surrogate mothers, most of whom are having emergencies and “need a large sum of money.”)

In the uproar, we can see erupting some of the tensions surrounding these technologies that are still somewhat under the surface in our own society: What about the divide between those who can and can’t afford reproductive technology? What does it mean to be a parent, especially where surrogacy is involved? Is surrogacy the commodification of women, the reduction of woman to womb?

There is a lot of worrying that China will catch up and surpass western economy and culture. It seems that in some areas they have already caught up with us: pushing the envelope of societal norms with the use of reproductive technologies, and the commodification of women in the process. In another area they are still far behind us: they have not yet lost the ability to be uncomfortable, shocked, even a little disgusted at the ethical implications of these technologies for families and society.

 

(Sources: Here and Here)