The Bible and Health Advocacy: Ancient Vision, Modern Imperative
Rev. Jackson Day, M. Div, MPH
Ecumenical Advocacy Days, March 2005

Introduction

I've been asked to give a theological basis underlying healthcare as a moral imperative. Of all the theological concepts one could turn to, four catch my attention. 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.

In John 10:10 we hear Jesus say, "I came that you might have life and have it abundantly." Jesus used the radical word abundance; it goes far beyond the leftovers that elsewhere in the Bible represent 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."⁽¹⁾

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%⁽²⁾ were without insurance.

Contrived scarcity makes people sick and it kills them. Those who are uninsured ⁽³⁾

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.⁽⁴⁾

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. ⁽⁵⁾

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. In the Christian view of God we meet a God whom we refuse to reduce to the simplicity - however complex -- of one individual. Yes, we say, our Trinitarian God is One, but it takes three persons to express that one. Our Trinitarian God is a Community of Persons. When we bless people, we offer them the grace of the Lord Jesus Christ, the love of God, and the communion of the Holy Spirit. ⁽⁶⁾

When we 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⁾ Christians 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 St. 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 Christians 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 are. 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 $132B on Medicaid which will generate $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 New Testament complements that with the Gospel message that God loves us so much God is willing to suffer the agony of 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 for-profit 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.

St. 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, contrast with 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. ." ⁽¹²⁾

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 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. With the resources they 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? The March 9 Las Vegas Sun reports the FDA has recently seized 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." ⁽¹⁴⁾

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⁽¹⁵⁾ "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 but it bluntly: "The sea belongs to God who made it, and the dry land, because God formed it." ⁽¹⁸⁾

In the New Testament, Jesus 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. In Luke 16:2-4 Jesus reminds us that we are to be generous in our management of others. In Luke 12:48b Jesus reminds the more we have to manage, the more God expects of us. As Christians, we 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?"

The administration's ideal of individual ownership leads directly to the current nightmare of individual claims billing with the enormous waste of the cost of administration of services and payments to caregivers. ⁽¹⁹⁾

A recent article makes the point that we all want hospitals to be there when we need them. When we are in need of the services that only a hospital can provide, it is too late at that point to go out and build a hospital to meet our needs. So if we need a hospital to exist before we need it, it only makes sense to share in the hospital's costs before we need it. But our present financing system places the entire burden of maintaining this hospital on those who are sick, wounded, and dying, and those who insure them. What could be crazier than insisting that those who are least in the position to pay, should pay the entire cost of something that all of us want to be there all the time?

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 abolition of restraints on powerful corporations, and who claim it is they, and not God, who can be owners of society. 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. ¹ 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.

2. ² Census Bureau, "Income, Poverty and Health Insurance Coveage in the U. S., 2003

3. ³ Families USA, "Why insurance Matters", June 2004, from One in Three: Non-Elderly Americans without Health Insurance 2003-2003.

4. ⁴ Commonwealth Fund Issue Brief: Addressing Unequal Treatment: Dispartiies in Health Care. Gillian K. SteelFisher. Nov 2004, p. 2-3

5. ⁵ 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.

6. ⁶ 2 Corinthians 13:14, NRSV.

7. ⁷ United Methodist Communion ritual; United Methodist hymnal, page ___

8. 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. 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. ¹⁰ Kaiser Commission on Medicaid and the Uninsured, Medicaid Fasts, Jan 2004.

11. ¹¹ Henry Wallace, Vice President under Franklin Delano Roosevelt.

12. 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. ¹³ Robert Pear, "Health Care Costs Will Keep Rising, U. S. Says, Along with Government Share, Feb 24, 2005

14. ¹⁴ Maura Kelly Lannan, "FDA Seizes Some Drug Orders fo I-Save RX", Las Vegas Sun, Mar 9, 2005.

15. ¹⁵ Robert Pear, "Health Care Costs Will Keep Rising, U. S. Says, Along with Government Share, Feb 24, 2005

16. 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. 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. ¹⁸ Psalm 95, verse 5. Inclusive language translation found in the United Methodist Hymnal, p. 814

19. ¹⁹ 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.