The Bible and Health Advocacy: Ancient Vision, Modern Imperative
Introduction
I've been asked to give some reflections on faith and health care. Health care refers to the provision of certain services and products of a healing nature. One's faith in God, or a community's faith in God, can provide the philosophical and ethical undergirding for what services are provided, and to whom. In this room most if not all of us represent a Judaeo-Christian ethical tradition, which finds itself in competition with alternative understandings that have shaped health care delivery in today's America. I want to share with you four theological concepts from our tradition that are particularly in play in health care today. Each one expresses a major Biblical principle, and each one identifies a major problem in today's health system that requires advocacy to address it
I. Abundance vs. Scarcity
The first principle is abundance. We worship a God of abundance. Whether we look at the Genesis story of the Garden of Eden or try to count the stars in the sky or the blood cells in a human body, we are surrounded with a vision of God's abundance - and the abundance God wants for God's world. Thus a moral test to be asked of any policy is whether it promotes God's intention of abundance for all human beings.
Christians hear Jesus say in John 10:10, "I came that you might have life and have it abundantly." In the spirit of the Garden of Eden reflecting God's original intent for humanity, Jesus used the radical word abundance; it goes far beyond the leftovers that we may think of as minimal justice for the poor, the helpless, and the oppressed. Jesus said "abundance." Jesus did not restrict this abundance to a world we will enter after we die. And Jesus didn't make this statement in a vacuum. Jesus' words come in his role as a shepherd, and they come in the context of a warning about those who would rob from the sheep.
To step from a theology of abundance to today's world of health care is a major jump. It shouldn't be, but it is. In contrast to Jesus' mission of bringing abundant life, the world of healthcare is a world of contrived scarcity. Things that are attractive or desirable or necessary go up in price and produce more profits when they can be made to be scarce. That's a powerful motivator to people to make things scarcer than they need to be.
The issue of contrived scarcity leaps out at us when we look at access to health care. In
2002 U. S. health spending per person was 2.1 times the average in Canada, France,
Germany, Italy, Japan and the UK - nations that had a higher proportion of elderly people,
who use more health resources - and yet all of these countries provided health care for all
their people." (2)
What are we missing? Are we short of doctors and nurses? Is it knowledge of how to
practice medicine? Is it ability to buy modern equipment? Are we less compassionate than
these other countries? Are we, who spend so much more time in church than people in
these other countries do, so much less moral than they are? Or could it be that all of our
virtues are diminished because we are saddled with a system which rewards the promotion
of scarcity? When we hear about the number of uninsured, we are hearing about contrived scarcity
where there could be abundance. In 2003, 15.6% of the American population - 45 million
people - were without health insurance. Compared to the previous year, 1.3 million fewer
Americans had employment-based health insurance. Most distressingly, 11.4% of America's
children - 8.4 million of them, were without health insurance in 2003. Among poor children,
an even higher percent - 19.2%(3)
were without insurance. Contrived scarcity makes people sick and it kills them. Those who are uninsured(4)
1. are less likely to have a usual provider 2. often go without screening and preventive care 3. often delay needed care or do without
4. often have unnecessary hospital stays - if had been treated earlier. 1998 this was 11.6%
5. are sicker and die earlier, and
6. pay more for health care .
Contrived scarcity results in ethnic treatment disparities. Many non-Caucasian ethnic groups receive health care which is inferior to that received by whites. Even if you totally discount the possibility of this resulting from any lingering prejudice, disparities occur because minorities are often poorer and less able to afford the things that keep white people healthy. Disparities also happen because minorities are less likely to have health insurance.
(5)A system of contrived scarcity hits minorities the hardest.
Contrived scarcity results in waste. Among a list of symptoms of our broken health system, many
reflect contrived scarcity - unnecessary…clinical service…uneven use of existing evidence,
dissemination of inaccurate or misleading information by self-interested parties… financial incentives to
over- or under-serve associated with various methods of payment, excessively self-interested behavior
by some caregivers…demands by some patients for unnecessary care….failure by …patients to seek
needed care, financial barriers associated with lack of insurance that prevent many patients from seeking
care, and non-financial barriers like lack of nearby caregivers all often lead…costly complications. .(6)
In a theology of abundance. health is God's gift to humanity, and treatment of illness must be regarded
as a right to be defended, a ministry to be provided, not a commodity to be bought and sold. As a
ministry, our human role is to create the conditions for God's healing to take place, and then get out of
God's way. II. Community vs Individual
A second theological principle is community. Throughout the Hebrew Scriptures we meet a
God who covenants with a whole people, a community. When people of my own faith --
United Methodist -- share our Communion meal, we pray that the bread and wine may be for
us the body and blood of Christ - so that we may be for the world the body of Christ,
redeemed by his blood.(7)
Each in their own way, people in the world's major faiths are people of
community. So a moral test to be asked of any policy is, "does it promote God's intention for
community?
To affirm the community principle of social responsibility doesn't mean denying individual responsibility. When the Christian apostle Paul wrote to the church at Galatia, he affirmed both.in the sixth chapter. His words in the fifth verse, "For all must carry their own loads," is an important reminder that we must never neglect the important role of individual responsibility. But three verses earlier his words, "Bear one another's burdens, and in this way you will fulfill the law of Christ," affirm the role of social responsibility.
America's cultural divide has been called a clash between those who support individual responsibility and those who support social responsibility. Paul's words remind us that individual and social responsibilities are not mutually exclusive alternatives but necessary complements to each other.
Proponents of individual responsibility point to the annual growth in health care costs. Last year we
spent $6423 for every man, woman, child; by 2014 that figure will increase to $11,045 in today's
dollars.(8)
If the consumer pays more of these costs, they say, the consumer will force health care costs
down. But an analysis reveals that "it is physicians' decisions that control fully 87% of the personal
health care dollar."
(9)
Nonprofit organizations express the ideal of community. They serve a public purpose. They don't have
private owners. In the United States today, that principle is under powerful attack as non-profit health
insurance and health care institutions restructure to be for-profit corporations. The State of Maryland
only with difficulty averted the theft to private interests of its Blue Cross - Blue Shield plan. Most
other states have not been so fortunate. In the face of alien philosophies, it is hard for people of faith to
maintain a vision of social responsibility Medicare and Medicaid express the values of community. Medicare expresses it as part of the social
insurance compact in which each succeeding generation provides for the generation that came before. Medicaid expresses community as our social responsibility for those who cannot care for themselves.
Who are these people? In 2001, 48% of Medicaid(10)
was spent on nursing home care. In 2002,
Medicaid provided for 25 million children, 13 million low income working parents, 5 million seniors, 8
million persons with disability. In 2005, the states will spend $132 Billion on Medicaid which will generate a $367.5 billion state-level
output of goods and services. Our exercise of social responsibility has a major dollar impact on our
local economies. The moral value of community is sacred ground that we must strongly defend. Benjamin Franklin
captured that value in another context when, as he signed the Declaration of Independence, he said,
"We must all hang together, or, most assuredly, we shall all hang separately." III.Humanity vs. Corporations A third theological value is humanity. In our Hebrew Scriptures we are reminded that there is
something special about human beings because we are created in the image of God. The
Christian New Testament complements that with the Christian Gospel message that God
loves us so much God is willing to suffer agony on the cross on our behalf. In today's world, we are confronted by the legal fiction that entities created in the image of
man called corporations are to be treated with the same respect and given the same rights
and privileges as humans who are created in the image of God. But corporations are not
human beings. They have been given specific legal exemptions from liability so that they
can more easily amass capital. They can exist indefinitely, but they cannot inherit eternal
life. They can commit enormous sins, but they cannot obtain salvation. They are unable to
love or care, and yet because they have no physical being - nobody has ever actually seen
a corporation -- they are spiritual entities. The Christian apostle Paul states in Ephesians 6:12, "For our struggle is not against
enemies of blood and flesh, but against the rulers, against the authorities, against the cosmic
powers of this present darkness, against the spiritual forces of evil in the heavenly places.
Can anyone argue that St. Paul is not speaking about for-profit corporations? The image of fire is a useful comparison. The discovery of fire was essential to the
development of civilization. Fire heats our homes, powers our automobiles, and makes our
steaks taste wonderful. But out of control, fire can take our lives and consume our forests,
and so it is the image that comes most quickly to mind when we try to imagine Hell. Corporations, too, need to be carefully controlled, lest they consume us. A half century ago,
Henry Wallace, Franklin D. Roosevelt's Vice President, stated that "democracy, to crush
fascism internally, must…put human beings first and dollars second…..We must not tolerate
oppressive government or industrial oligarchy in the form of monopolies and cartels."
(11)
When you turn to the world of health care with these thoughts in mind, can you not think of today's
large pharmaceutical corporations? Patent protection gives the discoverer of a drug monopoly rights for a period of more than a decade,
during which time they can charge whatever the market will bear for their medicine. Often publicly
supported research helped in the discovery of the drug, but no compensation is offered to the public for
this help. As a result, American consumers, where drug companies can charge what they please, are
punished in contrast with those in Canada, where drug prices are regulated. "If the U.S. paid Canadian
prices for brand name prescription drugs in 2004, some $60 billion would have been saved. ." Prescription drugs are predicted to be the fastest growing sector of the US economy.
Prescription drugs were 11% of all health spending in 2004, and may rise to 14.5% by
2014(13)
. In 2004 the prices of 30 brand name drugs prescribed for Seniors rose by 4.3 x the rate of
inflation. Drug companies prove that they can sell these drugs at a lower cost and still do business
because they are willing to sell them in countries like Canada which control drug prices to keep them
from being excessive. When last year's Medicare law was written, pharmaceutical companies wrote in a prohibition against
the government negotiating prices; we must pay whatever is asked. In behaving with unchecked greed,
the drug companies, like fire, are simply doing what they were designed to do. The failure lies in the
failure of society to regulate them and dictate the level of profits they are allowed in exchange for the
grant of monopoly rights. Health care corporations have been at the forefront of the fight against health care reform. They have
the most to lose when consumers gain. The March 9 2005 Las Vegas Sun reported the FDA seizing
prescription drug orders for more than 50 customers of I-Save RX, a drug importation company
launched by the Governor of Illinois. These customers had an average age of over 70, they were all
uninsured, and they all needed these medications." With their vast resources, corporations corrupt government. Drug companies pay fees directly to the
FDA for drug approval expenses; how can the results of such a conflict of interest be trusted? Corporate greed, like an untreated cancer, will eventually destroy its host. Health spending is 15.4% of
the economy today and will go up to to 18.78% by 2014 "Rising health costs force many people to
drop insurance and make it harder to cover all Americans. The unsustainable rise in health costs also
threatens the stability of hospitals, doctors, nursing homes, drug makers and other caregivers. It
burdens all who pay for care, and weakens the U. S. economy. "(16)
Health care as part of overall
government spending is increasing. "In 1955, Defense consumed 9/7% of US Gross Domestic Product,
Health 4.3% and Education 3.8%. In 2005, Health is consuming 15.5%, Education 7.9%, and Defense
4.4%. ." (17)
At some point, the public will have to say, "enough." IV.Stewardship vs. Ownership There is a fourth theological concept that calls for our attention: stewardship. The idea of
stewardship flies in the face of a popular slogan promoted by the current administration --
the "ownership society." Who must Christians and Jews view as the owner in society? The
Psalmist put it bluntly: "The sea belongs to God who made it, and the dry land, because
God formed it."
(18)
Reflecting his Jewish upbringing, Jesus of Nazareth likened us several times not to the owner of a
household, but to the steward who is responsible for managing it well on behalf of the owner. Those
who follow in his steps, then, are called not to believe in an ownership society, but in a stewardship
society. A moral test for any policy we review should be, "in this policy, are we trying to act out of
stewardship or ownership?" For the prophet Ezekiel, the concept of stewardship was expressed in the picture of the shepherd's
responsibility, and it was a specific responsibility of the rulers in their capacity of the peoples'
shepherds. In the 34th chapter of Ezekiel, the prophet cries out against the failure of Israel's rulers to
act as shepherds. They fed themselves, he says, when they should have been feeding their sheep.
Specifically, he addresses those who govern, you have failed because "you have not strengthened the
weak, you have not healed the sick, you have not bound up the injured."
Ezekiel goes on to
state that this misconduct of the rulers who acted as if they owned the government resulted in the
destruction of the country and the exile of its people. The administration's ideal of individual ownership leads directly to the current nightmare of
individual claims billing with the enormous waste due to the cost of administration of services
and payments to caregivers.(20)
A stewardship approach to the needs of all of us in a whole society would find a means of
allocating resources to hospitals so that the burden would be primarily borne by the healthy and
the fit, so that when the moment comes - as it will come to virtually all of us - that we need the
help of this public resource - we will not be punished for being sick. Conclusion Abundance, community, humanity and stewardship. Each of these principles has deep Biblical roots. Each gives us access to a better understanding of God's will in our world. Each has powerful enemies in today's discussions of health care policy in America - enemies who profit by scarcity, who are threatened by community, who seek destruction of restraints on powerful
corporations, and who claim it is they, and not God, who can be owners of our world. Each of
these principles can help us understand who our friends are, and how to combine our efforts so
that God's will may be done on earth as it is already done in heaven. 1. An earlier version of this paper was presented to a United Methodist / Christian audience in Washington at the Ecumenical Advocacy Days, March 2005. This paper has been revised to reflect an interfaith perspective. 2. Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005, www.healthreformprogram.org 3. Census Bureau, "Income, Poverty and Health Insurance Coveage in the U. S., 2003 4. Families USA, "Why insurance Matters", June 2004, from One in Three: Non-Elderly Americans without Health Insurance 2003-2003. 5. Commonwealth Fund Issue Brief: Addressing Unequal Treatment: Dispartiies in Health Care. Gillian K. SteelFisher. Nov 2004, p. 2-3 6. Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005. www.healthreformprogram.org p. 18. 7. United Methodist Communion ritual 8. Report by Centers for Medicare & Medicaid Services released Feb 23, 2005, by Julie Appleby, USA Today "Nationls Health Care Tab Ready to Explode." 9. Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005. www.healthreformprogram.org 10. Kaiser Commission on Medicaid and the Uninsured, Medicaid Fasts, Jan 2004. 11. Henry Wallace, Vice President under Franklin Delano Roosevelt. 12. Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005. www.healthreformprogram.org. p. 17. 13. Robert Pear, "Health Care Costs Will Keep Rising, U. S. Says, Along with Government Share, Feb 24, 2005 14. Maura Kelly Lannan, "FDA Seizes Some Drug Orders fo I-Save RX", Las Vegas Sun, Mar 9, 2005. 15. Robert Pear, "Health Care Costs Will Keep Rising, U. S. Says, Along with Government Share, Feb 24, 2005 16. Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005. www.healthreformprogram.org 17. Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health
Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005.
www.healthreformprogram.org Exhibit 7, p. 9. 18. Psalm 95, verse 5. Inclusive language translation found in the United Methodist Hymnal, p. 814 19. Ezekiel 34:4, New Revised Standard Version 20.
Alan Sagar and Deborah Sokolar, Directors, Health Reform Program, Boston University School of Public Health, Health Costs Absorb One-Quarter of Economic Growth, 2000-2005, Data Brief No 8, 9 February 2005. www.healthreformprogram.org p. 17-18.
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