Body Justice

“When she heard about Jesus..., she thought, ‘if I just touch his clothes, I will be healed.’ Immediately her bleeding stopped...” (Mark 5:27-29)

I claim no knowledge of the perfect solution to our nation’s health care crisis. I have not digested all relevant materials. I have not even probed all relevant Biblical teaching. And, I regret to say, I have not been given a special word of the Lord for this hour that fills me with supernatural wisdom. Even more important for the purposes at hand, I have not been given a miracle formula for summarizing complex information into an easily understood reading experience. You will have to work. You will have to work to comprehend, then work more to learn more, and then extend even more effort to find a way to add your word to this crucial national debate.

I am simply a Christian seeker, and a Christian citizen, seeking to discern what God wants Christians to contribute to the national debate on health care. God who dwells in our bodies, cares about our health. God cares about justice for all people. I am accountable before God, and so are you, for the moral conduct of my country. I will join my voice to those who are seeking justice and I will invite you to be guided by your Christian faith as you become an informed citizen and an agent of God’s healing love.

The National Health Care Crisis

As I have begun to do my homework on the National Health Care Crisis it has become obvious to me that if you want to solve the problem you have to ask:

1) What is the problem?

2) What caused the problem?

The Clinton health care proposals, and all others, are based on various answers to these questions. Let me briefly state my own answer to the first question. As a Christian I am deeply concerned about people who have no health insurance. I care about people who suffer because health care services are inequitably distributed--for example expectant mothers who lack adequate prenatal care. But these do not account for the health care crisis. National attention is focused on health care for only one reason--the total bill is too high. Costs are escalating and threatening individuals, corporations, the government and the whole country. We need a health care system that is both just and affordable or vast resources will be diverted from other critical national goals.

Before we go looking for such a system, that is just and affordable, I think it is only fair to tell you my bias--what I expected to find when I began to study the Clinton plan. I believed that Bill and Hillary Clinton showed enormous courage in tackling the health care crisis so early in their administration. I believed that their efforts were guided by deep compassion for the American people and by a commitment to resolve a crisis that threatens to bankrupt our nation. I believed their efforts would not be politics as usual. I was fully prepared to sup port their proposals. I assumed that they would dig below the surface to root causes and that their proposals would be fundamentally just and that they would work.

As I understand them at this time, the health care reform proposals of Hillary Clinton’s task force flow directly from that group’s belief that waste, including corruption and inefficiency, is the cause of the crisis. Specifically, the national health care crisis--the exploding cost of medicine--is caused by: ( Magazine “Faulty Diagnosis”, October 93, p. 58)

Greedy physicians
Corrupt pharmaceutical and insurance companies
Outmoded laws governing medical malpractice
Bureaucratic inefficiency
Paperwork
Expensive and overused technologies
And unnecessary procedures

If these deficiencies and failures of modern medicine are driving the health care crisis then the obvious solution is to curb the excesses. The Clinton health care plan proposes to do exactly that. The government, as a highly skilled efficiency expert, will trim the fat from the system. Once the fat is trimmed, everyone will get pretty much everything they want. Both horns of the health care dilemma will have been permanently resolved.

1) Everybody will get all the services they want--the system will be just.
2) Nobody will pay too much--the system will be affordable.

Some people believe this is too good to be true. The economics will never work, they say. The government is a creator, not an eliminator, of waste, they say. I suspect that the common sense wisdom of most readers is that Clinton’s twin goals of giving everybody everything that they want while containing costs will never happen.

I believe it will never happen for an even more fundamental reason than the inability of government to control waste. The health care crisis is driven by far more systemic and deeply en trenched forces than inefficiency. I believe that as currently framed the health care debate now underway in the United States is ignoring the fundamental issues. I believe President and Hillary Clinton have missed an opportunity to call us to participate in a wide open and far ranging debate on “our attitudes toward life and death, the goals of medicine, the meaning of “health,” suffering verses survival, who shall live and who shall die (and who shall decide).” (Harper’s, p. 57) The health care crisis is not going to be resolved by relatively narrow debates over such things as “managed competition,” HMO’s, and how much protection to give small businesses. There are life and death questions that must be considered. We must agonize over basic applications of justice. This is true because the driving forces behind the health care crisis include:

1) The success, not the failure, of the health care delivery system. Good medicine keeps sick people alive. The total demands on the system increase. Children, tragically, used to die of diphtheria. Now they live to contract cancer. They go into remission and live to receive a coronary by-pass operation. This is a miracle! It is also a force behind our health care crisis. Efficiency experts are not going to change the fact that we have a staggering in crease in the demand for health care services.

2) The meaning of health continues to change in our society, again adding to the cost of health care. The category of what constitutes mental illness continues to broaden. Conditions associated with old age, and never treated in the past, are now given names and expensive treatments. Knee operations are performed, not so that a person can walk or work, but so they can continue to jog or ski. There are hundreds of other examples.

3) Expensive technology, even when only marginally helpful, seduces us with its promise to decrease the risks associated with, for example, pregnancy. Fetal monitors and ultra-sound become state of the art and every body wants one. Doctors use expensive tests as protection against lawsuits and patients hope to gain an edge, however small, against death. We are so afraid of death that we fight, no matter what the odds, no matter what the cost. The price of our futile efforts drives the health care crisis.

4) The American appetite for health care is insatiable. Even as health-care’s percentage of our GNP climbs towards 16%, we refuse to believe there are limits. We want a complete fix and we want it now. No waiting. No talk about restrictions. No discussions about health- care rationing. No moral dilemmas to face. Americans want to have it all, and that appetite could bankrupt our country. We can afford as much health care as everyone wants, if we are willing to pay the price in reduced dollars for education, crime control, drug education, defense, services to the poor, and everything else we value in this country--including our standard of living. Just add the costs to the national deficit. Then our children can pay an ever higher price for our greed.

5) Not only is our collective national appetite for medical services insatiable, but few of us have any idea what these services are really costing us. As much as any other force, the growth of the health insurance industry since World War II has driven up the costs of health care. A man had surgery on his elbow. The cost was $7000. When asked if he would have had the surgery if he had to pay for it he answered, “Of course not. I would have just lived with a little discomfort.” The current health care system is designed to promote the financial irresponsibility of consumers.

6) The American public is still only dimly conscious of the role of the individual in resolving the health care crisis. I am responsible for my wellness, not the government and not even the doctors. But we are afraid to question the authority of professionals. Diet and exercise are keys to health that I control. Stress and overwork and immorality will destroy my body, which is God’s temple. It is my job to keep it healthy.

It is also my job, when the time comes, to let go of my body. But if I do not have a living will and a durable power of attorney I may surrender that right and responsibility. Suffering and indignities and costs may soar because I was afraid to act responsibly in defining the limits of medical interventions.

These are what I believe to be the major driving forces behind the health care crisis. They cannot be addressed by the efficiency experts and the managers. What is needed is a national debate that focuses our attention on extremely difficult moral and ethical choices. We are living in a fools paradise and one day the bill for our imprudence will have to be paid. America must acknowledge that everybody cannot have everything. Health care must be rationed, as it is now in the State of Oregon. Once that fact is accepted we can begin debating how limits will be set that are based on principles of equity and justice.

As long as I have just stepped out on a moral limb let me climb out just a little further by telling you what group in America is most responsible for our failure to engage in an ethical debate. It is not the scientists who invent the technologies. It is not the doctors and other medical professionals on the front line of health care delivery. It is not even the government. And it is not people as a whole. The responsibility falls squarely on Christians, the churches, the other religious communities, and all those who purport to be the moral guardians of our society. We have refused, for many years now, to guide our society in making tough moral choices.

Let me quote part of a probing and perceptive letter written to me by one member of our congregation, a physician:

“The religious community, which includes but is not limited to the Christian community, has failed society by not giving guidance to these questions. How do we create a balance between expensive technology which is good for the few and... (low cost and prevention programs).. .that are good for the many?

“We have, as society, taken the lazy approach and said that death and disease should be fought at all times, rather than looking at death and disease as a process of life. . . . Our religious upbringing should allow us to view death as the culmination of life. Certainly there are children who die. . . and their deaths are tragic, but there are some deaths on which we expend a great deal of resources knowing full well that we are only delaying the inevitable....

“The health care crisis is not a question of what can we do. We must answer the question of what will we do. That question cannot be addressed until we (after soul-searching ethical inquiry) have faced the issue of what we should do.”

CONCLUSION

A new technology is invented. It will save someone’s life! Just because we can employ it widely, should we? In the midst of my research for this sermon I was suddenly over whelmed by a very chilling thought. My father died of liver cancer about twelve years ago. Why, it hit me for the first time, why didn’t he receive a liver transplant? There was probably a good medical reason. But in that moment I wanted, with all my heart, for my father to be alive again. I could almost taste the joy of sharing my children with him. I longed to share with him the trials and the triumphs of ministry. I wept. And then I thought, how much would I have paid for medical treatments to keep my father alive? And of course the answer is, nothing. I would have paid nothing. Dad was a disabled veteran. The government would have paid everything, maybe even a million dollars? Should the government pay a million dollars to keep my father alive for one year? ten years? with a wonderful quality of life? with a terrible quality of life? how about ten million dollars? or just ten thousand? Who decides? Who discusses the tough choices? Do I get my dad for a year or do 300 children get food and Head Start for a year? Is there an age at which organ transplants are a bad investment? Who decides? A new technology costing a billion dollars could save 200 lives a year. Do we spend the billion? The Clinton health care plan calls for no discussion of such questions. Religious and moral leaders avoid them.

We can help change that. We can be a moral voice. Simply by speaking out we will challenge our leaders to broaden the terms of the debate to include the real issues. We can ask that the tough questions not only be considered but that they be considered in the light of Christian principles of justice and neighbor love. If we so choose, we can even make sure the debate takes place in our own community. What I am asking you to do as Christian citizens is simply to engage in the usual messy devices of the democratic process whereby the people take responsibility for their government. There is no reason we cannot do this.

The gospel of Jesus Christ provides us every reason we need for getting involved.

Once upon a time, the medical system was not working. A woman had depleted all her resources in her search for health. The establishment was not able to help her. So Jesus got involved. She was healed.

Once again, in our time, the system is not working. The followers of Jesus must get involved to make sure that the people are healed.