(originally published here)
This blog is about health care. But it could just as easily be about the financial crisis, the war, the environment, education, or any number of social issues before us today. Because, to my mind, there is a great confluence among the issues of our day. You can analyze them through the same lens and come to the same conclusion each time.
And that conclusion is this: we need change.
And my own personal conviction is: I believe we need change because of what I believe about God.
The title of the blog comes from an episode of a great new NPR show called "Intelligence Squared." The show originally comes from England. Participants engage in an "Oxford Style Debate," for and against a particular motion. Three speakers "for," and three speakers "against."
I picked health care because:
- It's on a LOT of people's minds, and
- Because Dr. Kellermann's essay is so good.
What follows after the jump is the speech by Dr. Art Kellermann from that program, and a long essay by me written just this morning.
I remember when the Clinton's first pushed for reform of the health care system. I have no desire to re-fight that war, or debate the merits/flaws of that plan. But I will point out that, back then, most docs were vehemently against that plan.
Most docs I know are desperately pleading for the system to change. They are drowning in a sea of red tape, forced on them not by the government, but by corporations trying to squeeze out another buck. They are feeling disconnected from their patients and feeling as if they cannot give patients the personalized care they deserve.
Patients are feeling squeezed too. As the Dr. Kellermann's essay so tragically notes, even IF you have health insurance, it is not likely to cover the high costs of a major catastrophic illness. And all the while we spend TRILLIONS on health care each year while our public hospitals teeter on the brink of collapse.
Something is not right.
I personally believe that the flaw in our health care system is that --like everything else in our nation over the past thirty years-- it's been "de-regulated."
When the Clinton plan failed, "we the people" opted for a "system" managed by the "marketplace." We deregulated health care, and left it up to market forces.
Just like we deregulated the energy industry (remember Enron?).
Just like we outsourced FEMA (remember Katrina?).
And just like we've deregulated the Financial Markets (you don't have to remember that one. We're living it.).
Since the time of Ronald Reagan, we have lived in a country ruled primarily by the conservative mantra made famous by the Gipper himself, who once said, "government IS the problem."
The Gipper's friend, Grover Norquist took that logic to its extreme, when he said, "I don't want to kill government, I just want to make it small enough that you could drown it in a bathtub."
I thought of that phrase, as I watched waters stream into New Orleans after Hurricane Katrina. During that pitiful governmental response --at the city, state and federal levels-- I thought "well, we finally got the government we deserve."
(That was before the financial crisis, of course...which had done nothing but solidify my views on this.)
This attitude --that government is ALWAYS a "problem," or even that government is "mostly" a problem-- has seeped into our pores and been seared into our cultural DNA.
The logical problem with this attitude is this: there is no "government" outside of us.
WE are the government. WE are the people. The dualistic, and overly simplistic, belief that there are the "good and kind" people of America, and then there are the "evil and lazy" members of government, is simply not true. Everybody IN government is also a part of WE the people. It's a false dichotomy.
And, frankly, it's anti-Christian dichotomy. Christian faith posits that God comes to "dwell among us." This is the "Good News" of Christmas. God come to earth in the form of a human being...not to reject the earth, but to redeem it....to live among us as a human, and to remind us to be God-like in our dealings with each other.
The message of the Christmas story is that there is no place outside of God's love. All creation is a part of God's realm.
Yes, even the government.
Demonizing the government has led to a cynicism about government workers. I hear it from friends who work for FEMA, the FTC, or for any number of government agencies. They hear this criticism that "government IS the problem," and it's seeped into their pores too.
Saying "government is the problem," is a nice, catchy line during a campaign. But it's a cynical and dangerous attitude to have toward the actual government itself. And thirty years of believing in the "god" of the free market has led to immense distrust in government, and the belief that government has little more function than to raise an army and build and road here and there.
This belief has birthed:
-- A failed health care system
-- An outsourced war, costing billions
-- An outsourced FEMA
-- Unmitigated greed on Wall Street
I personally believe health care IS a right and that, because of this, the federal government does have a roll. My own convictions about health care come from my Christian faith, where God tells me a society is judged not by how it treats its wealthy and powerful, but by how it treats the powerless and oppressed.
Even the most dictatorial and brutal regimes find a way to coddle their rich. But God says it's how we treat the poor...how we treat those on the margins...how we treat "the least of these" that will determine whether or not our society is great in God's eyes.
I was grateful to get the chance to sit in a Bible study with one of my mentors, Dr. John Holbert, earlier this week, in which he reminded me again how many passages deal with treating the "least among us" fairly.
In Jeremiah, chapter 7, God says this to the people:
"If you really change your ways and your actions and deal with each other justly, if you do not oppress the alien, the fatherless or the widow and do not shed innocent blood in this place, and if you do not follow other gods to your own harm, then I will let you live in this place, in the land I gave your forefathers for ever and ever."
You see, the people are judged most by how they treat the "least" among them...the aliens ("legal" or "illegal") the elderly...the orphan.
In fact, in other places, God makes it plain that not only are we to care for such persons, but we are to treat them as if they were a citizen among us. Way back in Exodus, God says this to the people:
"Do not mistreat an alien or oppress him, for you were aliens in Egypt. Do not take advantage of a widow or an orphan. If you do and they cry out to me, I will certainly hear their cry. My anger will be aroused, and I will kill you with the sword; your wives will become widows and your children fatherless."
Holbert reminded us that the beauty of this command is that the people are challenged to remember that "you were once aliens in Egypt."
Far from an attitude of "pull yourself up by your own bootstraps," God calls us to remember that all of us have benefitted from the hard work of others. None of us are self-made. Our forefathers/mothers worked hard to help us get to where we are today. And for this, we are called to an attitude of grateful sharing.
We don't get to keep what we have, because all things belong to God, and are for the common good. In fact, if we have more it means we have a greater responsibility to share it with those who don't have enough.
This constant theme is repeated so often in the Bible I literally cannot list all the scripture references here. It continues in the New Testament too, where James says this:
"Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world."
Now, of course, in our world the issue of actual widows and actual orphans is not as challenging as it was long ago. But "widows and orphans, aliens and outsiders," exist in many forms.
And it is clear: the Bible assumes, Jesus assumes, that true religion means to love your neighbor as yourself...to treat no one as better or worse that you...and to pay special attention to those who are marginalized in society.
Having said all this, I give you the essay I mentioned before, from Dr. Art Kellermann.
Kellermann is an ER doc at Atlanta's big public hospital (for those in Dallas, think Parkland), and also serves on the staff of Emory's medical school. On the show where this essay first appears, Kellermann speaks for the motion "Universal health coverage should be the federal government’s responsibility."
I first heard this speech while driving home late one night when it was being broadcast on KERA. It was a "driveway moment" for me. I couldn't leave my car until I'd heard the whole thing.
And so, as I offer my own thoughts this morning on the theological basis for providing health care to all, I thought it worth sharing the thoughts of this doctor with you too:
Thank you. Actually, I'm not a surgeon, I am just an ER doc, and I don’t have the distinguished background of my fellow panelists, but I have treated thousands of patients, insured and uninsured, and I’ve also broken bad news to hundreds of families. I want to tell you about one of them that I’ll never forget. It took them two hours to reach Atlanta from the north Georgia mountains. I faced them across the outstretched body of their son. The ventilator hissed rhythmically, ten breaths per minute. I spoke first.
"Your son was in a terrible crash," I said. "The ambulance crew could tell he was severely injured and called a helicopter.
He reached us about three hours ago. He has several injuries, a collapsed lung, internal bleeding, but these aren't his most serious problem. His brain injury worries us the most."
That’s when his mother interrupted me. She said, "doctor, I don't know how to ask you this, but I must. My husband lost his job six weeks ago, I work, but my employer doesn't offer health insurance. Is my son going to get the care he needs?"
Momentarily taken aback, I replied, "ma'am, you're at Grady Hospital, one of the finest trauma centers in the south, I swear to you, we will do everything in our power to save your son."
I meant what I said that night, but I didn't tell her the whole truth. I didn't tell her that our best probably wouldn't be good enough, and that if her son survived he’d probably be disabled for the rest of his life. I didn't tell her that she and her husband would be billed for the helicopter flight, and the days or weeks to come in the intensive care unit, and that the total would probably reach a hundred thousand dollars, maybe a whole lot more. I didn't tell her that she and her husband would empty their savings and mortgage their home in an effort to pay the bill, and that it wouldn't be enough. And that the coins put in a coffee can at the local diner wouldn't come close to covering the difference.
I didn't tell her that the unpaid balance of her son’s bill will push Grady hospital closer to insolvency, closer to its own crash, and if Grady closes, north Georgia, a region of more than five million people, will lose its only level one trauma center, its only burn unit, its only poison control center, its only emergency psychiatric unit, and seven hundred and fifty inpatient beds. And that’s not all. If Grady closes, metro Atlanta’s private hospitals, already overburdened by population growth, will topple like dominos one after another.
Ladies and gentleman, for me this debate is not an idle intellectual exercise, it’s about lives. Three hundred million American lives. I support this resolution for three reasons. First, because our failure to cover every American is a national disgrace. Second, because we’ll never achieve universal coverage if we don’t make health care in this country more affordable. And third, because the only way we can make health care more affordable and cover everyone is through a well-regulated health care marketplace, and to do that the Federal Government must be involved.
Now let me be clear, the majority of Americans do not want a government-only health care system, but they absolutely want the government involved, as a referee, as a cop, to make sure that everybody plays by the rules. The other side of this debate will try to convince you that rising health care costs are due to government interference. Well, they’ve got it backwards. The problem is not government interference with the health care industry, the problem today is health care industry interference with government. That’s why the business of medicine is booming. Record profits, huge executive salaries, bonuses, health care costs spiraling out of control year after year after year.
But the caring side of medicine is failing. On the front lines, doctors, nurses, and other health care professionals are nearly as frustrated as you are. The nation-wide crisis in emergency care is a case in point. Every major challenge we face, ER’s packed with patients, dangerously long waits to be seen, a half million ambulances a year turned away to more distant hospitals, and fewer specialists than ever willing to take ER call. All of them are due to the fact that the economics of health care encourage hospitals to favor elective cases over emergency cases. Good for business, bad for patients.
And it’s terribly expensive. Country music star Dolly Parton once quipped, "you have no idea how much it costs to look this cheap." [LAUGHTER] The same can be said about American health care. You have no idea how much it costs to run this poorly. We spend two trillion dollars a year on health care, and a trillion dollars is a lot of money. Put this in perspective, a million seconds ago was last week. A billion seconds ago Jimmy Carter was inaugurated president. A trillion seconds ago was thirty thousand BC. For two trillion dollars we can take good care of everybody in this country and have a lot left over, and you don’t have to look outside the US for proof.
If everybody practiced medicine as efficiently as they do in Rochester, Minnesota and Salt Lake City, Utah, Medicare could pay thirty percent less to doctors and hospitals, and everybody would get better care. But it won't happen on its own, because one person’s waste is another person’s revenue stream. That's why we need a cop on the beat, and the only cop with the clout to get the health care industry to play by the rules is the federal government. My side has given you several reasons to vote for tonight’s resolution, but the most compelling one of all is your own self interest, because a health care system that doesn't work for everyone may not work for you when the chips are down.
Take it from me, an ER doc, no one can predict when a life threatening emergency may strike, but if it does, you’ll want your hospital to go the extra mile, not your ambulance.