Rationalizing Rationing – Health Care Reform Exhausted

Before you sigh in exasperation, roll your eyes with irritation, and perhaps even let out an almost audible groan in sheer agony, I promise that in the remainder of what I am about to say, the words “health care” and “reform” will never appear adjacently. This has become the new MJ.

Having just graduated with a Masters in Health Management and Policy, I may seem an unlikely candidate to wish that my field received less media coverage, but my head might just combust if our president continues to appease the greater public with pledges of “no socialized medicine”, “no rationed care”, and “if you like your plan you get to keep it”.

By now we are well acquainted with the 1 in $6 that is sure to become the 1 in $3 in 30 years. We know it’s urgent, it’s dire, and the fiscal future of our country depends on it. We are also aware of the fact that in our current system 90% of health care dollars are allocated to 10% of our population, and nearly 28% of the Medicare budget is spent on patients’ last year of life. This is hardly an equitable appropriation or efficient utilization of scarce resources.

Wait, did I just say efficient? If it seems that I am making a judgment about the value of one’s last year of life, it’s because I am. But the monetization of American lives is not new. The EPA allows drinking water to contain 7 million Asbestos fibers per liter because they could not justify the amount of capital would be required to achieve a lower or zero fiber count. We tolerate a level of risk, chance of injury or death in all that we consume (e.g. bacteria on produce) and do (e.g. working in a factory), because to eliminate them would be exhaustive. We have, for everything else, allowed our government and various private industries to valuate human life and set standards accordingly. Why not for health care? Why not establish a standard guideline that excludes non-cost-effective treatments and procedures? Do I stand alone when I say that I’d rather receive a course of treatment endorsed by an elite team of medical experts rather than rely upon the knowledge of one physician I randomly encounter?

The 11th floor of St. Joseph’s (a community hospital in Chicago) is filled with elderly cancer patients, many of whom have lost most of their cognitive functions. They are confused and in pain. It may sound callused to say, but they are also consuming an exorbitant amount of resources. I am almost positive that the care they receive would not meet the QALY (Quality Adjusted Life Years) per $X standard many are proposing. I am okay with that. And I suspect that they would be too.

I realize that my life (as well as the lives of my loved ones) adds a certain amount of value to society and I feel comfortable knowing that this society may not choose to exhaust its resources to preserve it. So I extend this question to everyone, can you make peace with health care rationing?

Hiatus

Choice or circumstance?

In the spirit of some of the recent political posts, I’d like to take this opportunity to do some unscientific polling on the readership of this blog. The question is as follows:

Is your faith fundamentally similar to that of your parents?

It seems clear that family and ethnic background play an important role in the formation of a person’s views, ideas, and inclinations. Traditions are passed down from previous generations, leaving each culture with a rich variety of preferences. If I am Indian, there is a statistical likelihood that I enjoy curry. If I am Polish, there is a good chance I might like Polka music.

Should the same apply for my religion? After all, we are talking about the big questions. In many cases, we must deal in absolutes: God exists or he does not. In my view, cultural preferences need not apply.

Someone who has grown up in a happy Christian family with a loving and supportive church community might see no harm in continuing her parents’ traditions. After all, why change something if it works? The temporal comforts derived from her beliefs make them worthwhile. For many, this is entirely satisfactory.

But what about those concerned with truth? How can they ever be sure their answers to the big questions aren’t simply a result of the indoctrination they received as children?

6.7 billion people walk this planet; 2 billion of which are Christian. As hard as our missionary friends may be working, Christians must surely accept that their absolute truths would likely have been very different were they raised among the remaining 4.7.

The Ones Who Walked Away

The Ones Who Walked Away
In her short story, “The Ones Who Walked Away From Omelas,” Ursula K. LeGuin beautifully illustrates the tension present between the deontological and consequentialist ethical perspectives. This fictive story imaginatively describes a utopian city, where everyone is healthy, happy, and educated, and no one is in need. With this utopia, however, comes a terrible secret: the good fortunes of the city can only be had by the misfortune of a child, who is kept locked in a room, cold, dirty, and miserable. When the citizens of the town reach a certain age, they are required to see the plight of the child, and it is in that moment that they must decide whether to accept the miserable existence of the child in exchange for the utopian way of life, or to walk away from Omelas.

I would like to use the story of Omelas--not to discuss the difference between ethical perspectives--but as a foil to talk about Christian doctrine. I claim that in orthodox Christianity there is a similar tension between the doctrines of grace and justice. Thus, traditional Christianity offers the vision of a beautiful city, which is traditionally called heaven, which is the supreme utopia, in which everything is reconciled and there is no weeping or pain. However, this Omelas too has a dirty room, which is traditionally called hell. I find it an interesting parallel that just as for the citizens of Omelas there is a maturity point which demands knowledge of the suffering child, so also a significant developmental event in the life of Christians involves grappling with the idea of hell. My question then, is whether we can stay in the city of traditional Christianity, acknowledging that hell is the price to pay for the abundance and joy that is offered in heaven, or shall we walk away from this Omelas, unable to live in an eternal utopia all the while aware of the secret of the basement.

Here I will acknowledge a couple things. First, I realize I am somewhat begging the question by comparing the injustice of the suffering child to the recipients of hellish punishment. In traditional Christian thought, hell is reserved for those who deserve it, while presumably in the story of Omelas, “child” is used primarily because children represent innocence. My response is two-fold: a) a foundation for modern law is the notion that the punishment must fit the crime—eternal hell seems an overwhelming punishment for a finite amount of sin; b) recent development theories in psychology suggest that humans have much less control over their actions than we tend to credit to ourselves—genetics, environment, and a finite amount of choices rather force one’s hand in many decisions made throughout life. Second, the idea of hell is fundamentally tied to a certain Christian view of anthropology—namely, that the paradigmatic characteristic of humanity is that of lostness, or alienation from God. In challenging the doctrine of hell I am also challenging the doctrine of Fallenness that has pervaded Christian theology. Secondary to this view of anthropology is the concomitant theology of salvation, which also must be fundamentally changed if one were to walk away from Omelas. I realize that in bringing up these other topics I open up the scope of conversation tremendously, and perhaps too broadly, but what can I say? Theology is a tapestry, to unravel one idea is to fundamentally change the picture. Finally, I would like to state that when I speak of walking away from Omelas, I do not mean walking away from the Christian faith, but rather walking away from the faith as articulated in orthodoxy (which I suppose one could, if so inclined, say is the Christian faith, but I would debate that). This is where my foil of the Omelas story falls apart a bit, because in the end, I’m not so much asking “will you walk away from Omelas,” as I am asking “will you get the hell out of Omelas?”

Book Update:

I have been reading ferociously this year…I will highlight some of my favorites so far:

The Fidelity of Betrayal. Peter Rollins, a postmodern philosopher, asks whether to be truly faithful to Christianity we must betray it in search of a “religion without religion” that Derrida speaks of.

Dawn. Elie Wiesel writes a powerfully compelling story that grapples with tensions between justice, retribution, violence, and situatedness. This was one of the most-best books I have ever read.

The Weakness of God: A Theology of the Event. John Caputo is another postmodern philosopher and former student of Derrida. I am only partially through this book but it is one of those that will forever change my theology. Caputo undoes the theological construct of the sovereignty of God in favor of a “weak” God who is present with those who suffer precisely in his weakness rather than strength, an idea springboarding off of Paul’s “logos of the cross.”

Spreading the Wealth

"Spreading the wealth," "European-style socialism," "Robbing from the rich to give to the poor." It seems like these phrases have become curses and slander these days among conservatives and even among Christians.

In a way I'm responding to last month's post about "political theology," but from the reverse direction and with a focus on one concept: the redistribution of wealth. Though I am cautious about the government/President Obama's bailouts and stimulus packages, I can't help but question his opponents' objection to the "redistribution of wealth."

Only recently did I realize, or maybe just internalize, that the practice of spreading the wealth began as a Christian principle, encouraged by the disciples and the early churches. How can contemporary Christians object to it, then, as if it were morally wrong?

I think this is yet another way that Christian beliefs in America have been shaped by our economics and politics (it certainly happens the other way around also). Somehow "God helps those who help themselves" has become an unquestionable truth for Christians in this country, even though that phrase neither appears in the Bible nor can it be implied from what the Bible says about wealth. If it is easier for a camel to pass through the eye of a needle than for a rich man to enter heaven (Matthew 19:24), it seems that possessing riches in itself is wrong, or it leads all to easily to wrong.

Therefore as Christians we should be doing everything we can to spread our wealth by living simply and giving any excess to the poor!

But what does this mean in terms of government? Do I really want Congress in charge of redistributing the wealth? Do I want Obama to wear a little cap with a feather in it and carry a bow and arrows? Well, no. I think history has proven that government, no matter how right its aims, is not the best decider of how money should be used and where it should go. The more local an organization is, the more it understands the needs of the people it serves. The further away it is, the more it's bound to screw things up and slow things down. Nor do I think the government should be the enforcer of Christian principles, as Jimmy pointed out last month.

Then how should the redistribution of wealth be managed? I don't know the answer. As a Christian in America, my beliefs conflict with the fierce individualism and independence in our country's character. I don't know how to reconcile the two, and it's got to be more complicated than Ayn Rand and libertarianism - the solution I'd subscribed to until now. I guess it's easier to subscribe to a political system that will never be enacted, because then I'll never discover that the solution is more complicated than any political system can work out.

Book Discussion by Joe

Thank you to Allison for sharing a little space on this post for a great book worthy of reading:  Revolutionary Road by Richard Yates.

At the heart of the book is the question of what makes a life in America meaningful.  The 1950s young couple that are the main characters have a big dream (to pick up and move to Paris so that they can find themselves despite having kids, a well-paying job, and a nice house in the suburbs already).  They fail, partly because they have already been crippled by the easy suburban life they disdain and feel they are better than (even though they are not) and partly because they are ridiculously selfish.  Their selfishness rakes the people that know of their plan even as its boldness inspires.  This book is important because it does not simply put down the conventional life (which it does beautifully and scathingly), but it questions those who dream of escape from it, leaving little else.  It left me wishing I could find a manual for escape from selfishness and that I could resolve the tension between big dreams and reality in my own life.  There is a grave danger in America: becoming glutted with contentment; there is also danger in flight. scooters

Political Theology

There are two questions I want to put on the table this month.  I think the second one is more interesting, but I have to get past the first one in order to discuss the second one.

An often ignored but critically important question that Christians should ponder is to what extent our religious values should shape our political values.   For a strangely vocal minority, this question sounds ridiculous.  Of course, they would say, your political perspective should be entirely derived from your faith.  This is why we must hang the Ten Commandments in every courtroom, and why it would be deeply offensive if we took God out of the pledge of allegiance.  After all, isn’t this supposed to be a Christian country?

Because of my location and occupation, I hear this mode of thinking quite often.  It drives me crazy.  No, this isn’t supposed to be a Christian nation.  The founding fathers were Deists, and they worked hard to make sure the nation had freedom of religious expression.  Why is it that so many Christians today are working hard to preserve some false sense of a Constantinian state?  Why is their religious identity wrapped up so tightly in their national identity?  Perhaps I’m cynical, but I don’t really want this to be a Christian nation.  Or, to be more precise, I don’t want us to call it a Christian nation.  I think doing so is hurts the kingdom of God more than it helps.

In the recent election I heard more discussion about this than usual.  People get themselves worked up almost into a frenzy because they are so passionate that the people for whom they vote must represent certain (not all) of their religious values.   I’m confused about how a Christian should translate their religious beliefs into political stands.  It’s clear to me that there is a limit to this… for example there is no way I would advocate legislation that would illegalize lust, anger, jealousy etc., despite the fact that my religious beliefs say these things are wrong.  On the other hand, I believe that I should stand up for certain beliefs (even politically) even though they are religiously motivated (i.e., social justice).

Perhaps a pertinent example would be the debate about an amendment banned same-sex marriage.  Let’s say for the sake of argument that Christians decided that this was wrong.  Would we necessarily need to oppose such an amendment because of our faith?  My inclination is to say no.  After all, why should the government dictate morality?  The problem is, if another issue came up; say something that would involve showing grace to the poor or some likewise marginalized group of people… I would want to say, yes, all Christians need to support this.  Do you see my contradiction?

So the two questions I’d like to hear opinions on are (1) Is this a Christian country, or should it be? And (2) how do we translate religious values into political ones?  On what criteria do we base the decision of whether a belief is individual or should be advocated universally?

Books I’m reading:

Christ, History, and Apocalyptic: The Politics of Christian Mission.  This book discusses how the church should engage the world, and how it should view history in a Christocentric way.

Outliers.  This was given to me, it sounds interesting.  He’s evaluating the nature of success.  I’m hoping it’s more of a sociological study than a self-help kind of thing.

What Saint Paul Really Said: Was Paul of Tarsus the Real Founder of Christianity?  N.T. Wright is challenging some of my preconceptions about Paul.

 

 

 

True Religion

Just so you know, I wrote this back in November. I'm editing this right before January when it goes up, but the thoughts remain timeless!

Channeling my inner Joe – On this unusually cold November night in China I am sitting in my apartment … forget it. I’m not a writer, I’m a mathematician. On to the logic!

The topic I have chosen is similar to Joe’s previous topic of politics and religion but jettisons the idea of politics and gets down to the religious part. As someone who has traveled to several countries and have visited several places of worship for different gods, I find a constant question echoing in the halls of my mind: what does it mean to be truly religious? I have been to temples honoring Taoist gods which seemed to be simple representations of moods. The sad people go in, pray to the happiness god and leave happy. The angry people go in, pray to the anger god, and leave peaceful. The rich people go in, pray to the giving god, and leave with their fortune. They seem satisfied with their gods Isaiah mentioned were simply the opposite end of the tree from their firewood. But at the same time, I have visited orthodox churches in Eastern Europe which resemble the same setup but with paintings instead of gods. The people walk in and go to the painting representing God as a giver and ask for fortune, etc. Then I see how surprisingly similar these two types of places are, how corrupt both of their governments and religious institutions have become, and therefore how removed people become from true religion. They leave me with a huge letdown.

We know what James wrote on this subject, help widows and orphans and keep unspotted from the world, but the second part is still quite vague. How can one be spotted in the world? Is it simply an action?

In November we discussed whether a politician should be a Christian to get elected. One of the major problems with the positive answer most people give is the practical problem of no politician living up to that standard. But as mentioned, someone who answers the negative may not feel obligated to a higher power and can become corrupt (absolute power corrupts absolutely). So as we plunge to a new year, my question this month is:

With the myriad of attempts to worship the One God, how can one truly live up to James’ standard and are Americans falling into the indifference trap of the polytheists and Christian idolaters?

I was told to give a book to read, also. Most people who know me know I love to talk about anything, but mostly politics and ecnomics. In light of the economic crisis hitting the world right now, it's been interesting to see those with money verses those with debt. Therefore, I recommend my favorite American, Dave Ramsey. Some of you may be aquainted with him, but for those who are not, let me give you his opening for his radio show:

"Welcome to the 21st century, where debt is dumb, cash is king and the paid off home mortgage has taken the place of the BMW as the status symbol of choice!"

He's written several books, but the one that is the most up to date is the Total Money Makeover. If you're going through an economic crisis, pick it up. If you're married, it'll change your family tree. If you aren't it'll help you be like me and not take part in the recession.

If you're already in good standing financially, look for Dan Miller's book 48 Days to the Work You Love. It'll help you find a job that's not a j-o-b.

Sorry the books weren't related to the topic, but that's all I can come up with at 1:30 in the morning. They reflect my personality.