a sermon preached by the Rev. Dr. Tim W. Jensen
at the First Religious Society in Carlisle, Massachusetts
Sunday May 15, 2005
There's a TV preacher named Joel Osteen whom I sometimes like to watch late at night when I'm having trouble sleeping, and need to remind myself why I got into this line of work in the first place. Pastor Joel is the minister of the 30,000 member (and growing) non-denominational Lakewood Church in Houston Texas, and he always begins his uplifting, practical messages by telling a joke, which may or may not be related to the theme of the rest of his talk. And this past week one of you e-mailed me this joke, which reminded me a lot of the jokes I hear from Pastor Joel. So I thought I'd experiment by telling it to all of you, and seeing how it goes over.
A well-worn one dollar bill and a similarly distressed twenty dollar bill arrive at a Federal Reserve Bank to be retired. As they moved along the conveyor belt to be burned, they struck up a conversation.
The twenty dollar bill reminisced about its travels all over the country. "I've had a pretty good life," the twenty proclaimed. "Why, I've been to Las Vegas and Atlantic City, the finest restaurants in New York, performances on Broadway, and even a cruise to the Caribbean." "Wow," said the one dollar bill. "You've really had an exciting life!"
"So tell me," says the twenty, "where have you been throughout your lifetime?"
The one dollar bill replies, "Oh, I've been to the Methodist Church, the Baptist Church, the Lutheran Church...."
The twenty dollar bill interrupts, "What's a church?"
As I was thinking about what I wanted to say here this morning, I couldn't help but reflect upon how it's been two years (and ten days) now since I stood here in this pulpit on the threshold of another congregational meeting, after a very intense week of being interviewed and inspected and examined from almost every angle, in eager anticipation of being elected as your next settled parish minister. It really doesn't seem like all that long ago, and yet two years ago as I stood here I looked out over a sea of strangers, whereas today I see mostly the familiar faces of my "neighbours and fellow cretures" -- people who I know by name, and who I routinely see not just here at church, but also at the library and at the post office and the town hall, or at the ball field or the ice cream stand, or when you're dropping off your kids at school, and sometimes even in the hospital, or in your own home if you've invited me there, as many of you have. And of course I still don't know each of you as well as I would like, but I can't begin to tell you how lucky I feel, and how grateful I am that you invited me to be your minister, even if it is making all my hair fall out. But it probably would have fallen out anyway, right? So I really don't have anything to complain about.
One of the things that makes my job so interesting, but also makes it kind of challenging, is that it is really a lot of different jobs all at once, any one of which could easily take up all of my time and then some. Of course, whenever I actually take the time to think about all this, I naturally tend to start with the job I'm doing right now -- my job as a preacher/teacher, writer and scholar of liberal religion. It's the job everyone sees, it's the job I was educated to do, it's the job I probably do best, and also the one I often feel like I'm shortchanging a little when I look over at the big pile of unread books next to my chair while watching TV preachers late at night. But preaching is really is just the tip of the metaphorical iceberg.
I'm also very sensitive to my duties as a pastor -- as the shepherd (or as Woody described it at my installation, the sheepdog) to this flock, this "promiscuous assembly of believers and seekers" known as the First Religious Society. Someone who has taken on the responsibility to try, at least, to be a faithful counselor and comforter to those who are troubled, and to represent as best I can the loving concern of this entire community for its individual members in their moments of personal crisis. This is an aspect of my job that doesn't necessarily come easily for someone who is basically a shy and introspective bookworm at heart, but it's also something I have learned to cherish because of the depth of the pastoral relationships that often grow out of it.
And then there is yet another part of my job which is probably best described as institutional administrator and community leader. The most challenging thing about this aspect of my job is that I share it with so many other people. I'm hardly the CEO of this organization, or even its Executive Director; I don't really manage or supervise anyone, and yet when things don't go smoothly it eventually comes around to being my problem to solve. Like a lot of clergy, I have a lot more responsibility than I do actual authority, and what authority I do have is based more on personal or moral influence than it is real power. There are all sorts of good reasons for this, of course, and I'm not so sure that I would want to change things even if I could. But it does sometimes make it complicated to get things done -- even relatively simple things that you might think would happen effortlessly in most other contexts. And then there is also the fact that I am my own assistant: I answer my own phones, keep my own calendar, prepare all my own correspondence and do all my own filing, and copying, and whatever else good assistants do -- not such a terribly burdensome set of tasks really, except for the fact that I'm so terrible at them.
And there's lots more as well. The ministry is a job that's been around for thousands of years; I don't think there's anyone alive who really understands all its various nuances and expectations, much less anyone who has ever mastered them. But as I was saying earlier, it's an interesting, and a challenging vocation -- especially when the community of people you've been called to serve is also facing difficult challenges of its own. This has not been an easy year at the First Religious Society. We have struggled with issues that have come to us from the larger culture, and at times we have struggled with one another as we've attempted to discern a path forward that is compatible with our core religious values, and the spirit of our covenant with one another. And it hasn't always been easy, because even people of good faith don't always see eye to eye on every issue. And yet I like to think, for the most part at least, that we have done a fairly decent job at recognizing that people can have different opinions and perspectives on the same issues, and still respect one another as human beings, even when they don't see eye to eye. For the most part. With the larger culture as polarized as it is these days, along with the palpable loss of civility at the highest levels of our civil government, it certainly isn't hard to imagine how things might have been much, much worse than they were.
And let's not lose sight of the fact either that there are still more challenges ahead of us. There are always more challenges ahead. Like this past year's challenges, we will often have to address them on at least two levels -- one of content, and the other of process. And we're not going to get it perfect every time. But that doesn't mean that we can't learn from our experiences, and improve the next time out. It's easy to concentrate on minimizing friction if all you want to do is coast; in fact, it's really the only thing that matters. Developing enough traction and momentum to get out of a rut and on down the road, and maybe even over a few bumps in that road (never mind all the way to the mountaintop), is a somewhat more complicated endeavor. But we have a lot of engineers in this congregation, so I'm confident that we'll be able to figure out the technical aspects of the challenge. It's the emotional part I'm worried about. How do we keep ourselves all facing in the same direction, walking and pulling together toward a shared goal? How do we keep people from being run over; how do we make certain that no one gets left behind? And what do we do about people who want to get off the bus, because they don't want to go where the rest of us want to go? Do we wait around for awhile in the hope that they might change their minds and get back on board, or do we simply wave goodbye in our rear view mirror as we leave them behind in the dust?
From my own perspective, as a professional religious leader who has worked with other congregations facing similar challenges in very similar circumstances, the First Religous Society is now entering the final stages of a long period of transition in its natural, generational cycle of slow decline and gradual rejuvenation. Since its most recent heyday a decade ago, perhaps best characterized by the construction of what is still called by many "the new Addition," this congregation has faced and worked through the final few years and subsequent retirement of its previous, long-tenured minister, a dynamic two-year interim period coupled with an extensive ministerial search, and now two years of my ministry, as we have slowly gotten to know one another, and hopefully built-up trust and mutual understanding for the years ahead. And during that same ten year period (more or less), you have also witnessed the surrounding Carlisle community gradually change around you as well, in ways that are perhaps not quite so easily characterized -- younger (or maybe we've just gotten older), more affluent, less "rural," more "exurban," and so on and so on and so on. And in the even larger community beyond Carlisle, there have been even greater changes...and in the midst of all that change, the one compelling challenge that confronts you right here in this moment is answering truthfully, and honestly, and authentically, this two-part question. "What is at the Heart of our Religious Society? Where is our Center; what is it about us that makes us who we are, and gives us our identity as a people of faith?" And the second part of the question is "Where is our Growing Edge? How do we bring the essence of who we are to life, right here, right now, in this place and at this time?" How do we connect what is essential about who we are with the context in which we live, and do so in a meaningful and effective way? That's the big question we have to answer as an institution. And from our answer will flow everything else we want to do in the way of worship, and outreach, and education and program and everything else that churches do to express their faith in the real world.
Now I recognize this is all rather abstract, but if you like, there's another, more tangible way of coming at this same question from a little bit different direction. If this all sounds just a little too theological for your tastes, you might try looking at things the way you would if you were Peter Drucker. What is the core business of this enterprise? Are we in the entertainment business -- providing uplifting music and inspiring intellectual stimulation at regular intervals for all who wish to attend? Are we in the "fellowship" business, creating opportunities for congenial social interaction between sympathetic, like-minded individuals? Are we a social service agency, in the business of assisting the less fortunate; are we child-care providers, with an emphasis on facilitating appropriate peer socialization, ethical reasoning, and moral development? Are we in the historic preservation business? The investment and property management business? Or is our core business something slightly more profound, something toward which all of these other activities play a part?
I personally believe that churches are (or ought to be) in the business of healing and human transformation: of calling people into a disciplined process of self-discovery, which changes their lives for the better, and in doing so makes the world better as well, one person at a time. That's what I think churches do, and that's what I think this church ought to do. We have everything we need, right here in this room. We have one another. In my time in the ministry I've served a lot of UU churches, and I've visited plenty more, in three very distinct regions of the country; I've also studied and taught on several college campuses, but I don't know that I've ever met a more interesting, a more talented and accomplished, a more creative, committed, and genuinely kind-hearted group of people as I have discovered here in Carlisle. And I don't think it's just because I need to get out more either. You routinely amaze me -- you come from so many different places and backgrounds (some of them quite modest); you enjoy various levels of education, and span a wide range of ages; your experiences in life are as varied and diverse as the opinons you have formed from them, and yet you care about one another and the future of this community, you are generous and resourceful and hard-working, and you generally know how to have fun together too, after the work is done. Good will, forgiveness, a genuine interest in one another and a profound concern for the well-being of all -- these are the qualities that allow churches to grow and thrive, and you possess them in abundance. The best days of this congregation are just ahead of us. It is simply a matter of walking together on the way forward to tommorrow, hand in hand, and one foot in front of the other.
Sunday, May 15, 2005
Sunday, May 1, 2005
SNAKE OIL, FAITH HEALING, AND OTHER DISMAL VOODOO QUACKERY: DNR
a sermon preached by the Rev. Dr. Tim W. Jensen
at the First Religious Society in Carlisle, Massachusetts
Sunday May 1st, 2005
The crisis in the American Health Care system is one of those topics that is so large, and complex, and overwhelming, that it can sometimes seem futile to try to get one's head all the way around the entire scope of the thing. It's a problem that each and every one of us, to some degree or another, has to deal with every day of our lives, whether we are consciously aware of it or not. Certainly it's something that's often on my mind, as I make my way in and out of our local hospitals visiting members of this congregation, especially now that I've started so struggle a little with some of my own chronic mid-life health issues.
But when it comes to examining the larger issue of health care policy here in the United States, just trying to figure out where to begin can be a little daunting. Is the most urgent aspect of the crisis the question of costs? -- the price of prescription drugs, the cost of health insurance, or malpractice insurance, or the ever-escalating percentage of our GDP that we spend as a society on health care? Is it the problem of coverage? -- the tens of millions of Americans (nobody really knows for sure how many) who lack adequate health insurance, or even convenient access to health care providers at any price, simply because of where they live? Or is it really the question of quality? -- how despite our amazing medical technology and the rich pharmacopeia of "miracle" drugs which inspire our politicians to boast that America enjoys "the best health care system in the world," as a people we Americans are not especially healthy when compared to the citizens of other industrialized nations: we don't live as long, have higher rates of infant mortality, suffer more chronic disease, and so on and so on and so on.
Or maybe the real problem is the way these three factors seem to be so enmeshed, and then interwoven with the financial and personal interests of various specialized constituencies like insurance companies, the pharmaceutical industry, physicians, nurses, hospitals and health maintenance organizations, medical schools, patients rights advocates, alternative healing practitioners, and dozens of others. The equation seems to be that if we want to cover more people it is going to cost us more money, unless we somehow cut quality somewhere, or cut into the profits of one or more of these other essential stakeholders, which again has ramifications for the entire system. Or if we decide the real priority is to hold down costs, how can we do that other than by limiting coverage or paying less money to the people who provide our health care services for us in the first place?
That just seems to be the hard reality of the numbers. And yet, in places like Canada (for example), they spend less money (both per person and as a percentage of GDP), cover virtually everyone, and on the whole are healthier than we are here in the United States. What is the secret of their success? Is it simply their different system? Say the words "single payer" in some circles here in the U.S. and you and you are likely to evoke a tirade against "socialized medicine," along with a litany of horror stories about triage, and rationing, long waiting periods before receiving care, and then not being able to pick your own doctor in the bargain. Yet judging from the numbers and my own experience, I have a hard time seeing how so-called "market forces" have done any better at holding down costs or increasing access...and I don't think for the life of me I will ever understand how protecting bad doctors from good lawyers helps anyone in the long run...except maybe the bad doctors.
No matter what you may believe personally, I think it's important for us all to recognize and acknowledge that ideology inevitably drives policy on some level. Our values are shaped by our ideals; and the choices and decisions we make, both as individuals and as a society, are informed by those same ideas. But when it comes to the debate about health care policy, one seemingly insurmountable problem is that there are two fundamentally incompatible ideas which are being advocated and put forward...basically by the same group of people. The first is sometimes characterized as "the Culture of Life" -- a belief that life is sacred, and should therefore always be extended for as long as possible by any means available. And the second set of values are those of the so-called "ownership society," which places individual self-determination and economic freedom within the marketplace at the top of the list of one's personal, God-given rights. In the Ownership Society, if you can afford something, you're entitled to it (and by extension if you can't, you aren't). But according to the values of the Culture of Life, if something is available that may (or may not) extend your life you are entitled to that as well, regardless of what it may cost or other any other consideration.
These two widely-held sets of beliefs work together to drive up medical costs, especially for expensive and dramatic end-of-life procedures (even those of questionable efficacy), and for so-called "elective" procedures where there are high profits to be made catering to the fears and desires of those who can afford to pay, while at the same time they tend to limit the influence and availability of more mundane public health and individual "wellness" programs where life or death not immediately at issue and there are no large profits to be made. Yet even to suggest that simply because a person can afford something DOESN'T necessarily mean that they are entitled to it, or that society has the right to refuse someone potentially life-extending therapy (regardless of their ability to pay) simply because some "authority" (other than the individual in question) has decided that the potential benefits aren't worth the expense seems a little shocking to us. Certainly it seems a little shocking to me. Like heresy really, or a sign of failed compassion and creeping totalitarianism. Yet is this really the best or only way to frame the issue?
Here are a few other considerations that have been missing from this morning's discussion so far. An effective health care system is a Social Good -- it's not just individuals, but society as a whole, that benefits when people are healthy. So shouldn't the policy be to include as many people as possible, as routinely as possible, and then to share the costs broadly and equitably? I heard the other day that General Motors lost over a billion dollars last quarter, and that one of the principal reasons they are struggling is that they need to include over $1000 worth of employee (and retired employee) health care costs in the price of every vehicle they sell, while overseas competitors from countries with single payer systems are able to avoid this expense, and price their vehicles accordingly. I don't know whether that's actually true or just an excuse, but I do recall hearing somewhere once that what is good for General Motors is good for the country. And a single payer system would certainly be good for General Motors, and other American companies struggling with the cost of providing adequate health insurance for their employees and still remaining competitive in the global economy.
I also think it's important to ask whether a health care system that is driven by "profitability" rather than by patient care is truly ethical. A system which was supposed to insure that no outside party ever come between an individual and their self-selected health care professional in the determination of appropriate patient care has now placed the interests of "health care sector" investors ahead of the rights and the needs of both patients and physicians. Pharmaceutical companies in particular have interposed themselves into the doctor/patient relationship in a particularly invasive way, in order to maximize their profits by marketing directly to "consumers" drugs intended to treat chronic conditions rather than cure specific diseases.
If I were to believe everything I see on TV, there is now a pill for every ill afflicting the middle-aged American male: Lipator, Nexium, Rogaine, Prozac and Viagra....yet I suspect a lot of us would do just about as well (or maybe even a little better) with half the beef and twice the broccoli, less time at the office (or in front of the television), and an hour's brisk walk every evening in the company of someone who delights in running their fingers through what's left of our hair, and telling us how sexy we look now that we've cut it short to match its thinness, rather than trying to hide the fact that there isn't as much there as there used to be. Meanwhile, all the marketplace can really do is to offer men a range of equally-expensive alternative choices like Cialis or Levitra....But if I ask for it, and my insurance will pay, what physician won't write me that prescription if they want to keep me from simply packing up and taking my business somewhere else?
Finally, I think it's important to remember what so much of contemporary culture seems constantly to be conspiring to help us forget: that no matter how good a system of health care we may create, we are never going to defeat death, nor even postpone it long, no matter how much money we may spend. The most important question for medical ethicists isn't really "what does it mean to be alive?" The question is what does it mean TO LIVE! What gives life meaning? What gives life purpose? What is the value of being in relationship, and the importance of being of service? How do we best make use of this amazing gift that we have been given by the Universe, by our Creator; and how do we help others best make use of their gifts? What does it mean to care for one another?
From a spiritual perspective, the goal of good medicine has always been the preservation of health rather than the denial of death. Yet market driven medicine plays upon our fear of death in order to satisfy the desire for profit, and thus is ultimately grounded in the sin of avarice, in greed. A generation ago, most hospitals in this country were still affiliated with religious organizations and administered by people of faith, as they had been since their creation. And their mission, as places of healing and hospitality, was one of charity, of loving service. Other hospitals were affiliated with teaching institutions, or run directly by the government for the benefit of the public...and many, of course, still are. But when health care became big business, much of this ethic of charitable public service was lost, and we have all suffered greatly for it. When ideology tempts us to worship the "invisible hand" of the marketplace as if it were a God, and distracts us from our more basic responsibility to help those who need our help, the essential values which make our lives ultimately worthwhile are discounted by the demands of the bottom line, and the basic quality and value of life itself is much diminished.
Now obviously there is a lot more I could say about this, and I'm sure many of you also have insights that we might all benefit from hearing. But before I go any further, just let me say that I am not suggesting, in any way, shape, or form, that hospitals don't need to worry about balancing their budgets or that health care professionals are not "worthy of their hire." Nor do I think that we should all simply throw away our meds and start taking long walks in the woods instead. Ask your Doctor. What I AM suggesting is that the most critical issues concerning our American health care system are not technical problems, but rather adaptive ones -- problems that will require us to look at the entire system from a new and different perspective, and to make changes in our own attitudes about the way that medicine should be practiced, and our own ownership of and participation in the care of what is perhaps our most (or at least second-most) precious personal possession -- the health and vitality of our physical bodies.
Reading: the Hippocratic Oath -- a Modern Version
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
at the First Religious Society in Carlisle, Massachusetts
Sunday May 1st, 2005
The crisis in the American Health Care system is one of those topics that is so large, and complex, and overwhelming, that it can sometimes seem futile to try to get one's head all the way around the entire scope of the thing. It's a problem that each and every one of us, to some degree or another, has to deal with every day of our lives, whether we are consciously aware of it or not. Certainly it's something that's often on my mind, as I make my way in and out of our local hospitals visiting members of this congregation, especially now that I've started so struggle a little with some of my own chronic mid-life health issues.
But when it comes to examining the larger issue of health care policy here in the United States, just trying to figure out where to begin can be a little daunting. Is the most urgent aspect of the crisis the question of costs? -- the price of prescription drugs, the cost of health insurance, or malpractice insurance, or the ever-escalating percentage of our GDP that we spend as a society on health care? Is it the problem of coverage? -- the tens of millions of Americans (nobody really knows for sure how many) who lack adequate health insurance, or even convenient access to health care providers at any price, simply because of where they live? Or is it really the question of quality? -- how despite our amazing medical technology and the rich pharmacopeia of "miracle" drugs which inspire our politicians to boast that America enjoys "the best health care system in the world," as a people we Americans are not especially healthy when compared to the citizens of other industrialized nations: we don't live as long, have higher rates of infant mortality, suffer more chronic disease, and so on and so on and so on.
Or maybe the real problem is the way these three factors seem to be so enmeshed, and then interwoven with the financial and personal interests of various specialized constituencies like insurance companies, the pharmaceutical industry, physicians, nurses, hospitals and health maintenance organizations, medical schools, patients rights advocates, alternative healing practitioners, and dozens of others. The equation seems to be that if we want to cover more people it is going to cost us more money, unless we somehow cut quality somewhere, or cut into the profits of one or more of these other essential stakeholders, which again has ramifications for the entire system. Or if we decide the real priority is to hold down costs, how can we do that other than by limiting coverage or paying less money to the people who provide our health care services for us in the first place?
That just seems to be the hard reality of the numbers. And yet, in places like Canada (for example), they spend less money (both per person and as a percentage of GDP), cover virtually everyone, and on the whole are healthier than we are here in the United States. What is the secret of their success? Is it simply their different system? Say the words "single payer" in some circles here in the U.S. and you and you are likely to evoke a tirade against "socialized medicine," along with a litany of horror stories about triage, and rationing, long waiting periods before receiving care, and then not being able to pick your own doctor in the bargain. Yet judging from the numbers and my own experience, I have a hard time seeing how so-called "market forces" have done any better at holding down costs or increasing access...and I don't think for the life of me I will ever understand how protecting bad doctors from good lawyers helps anyone in the long run...except maybe the bad doctors.
No matter what you may believe personally, I think it's important for us all to recognize and acknowledge that ideology inevitably drives policy on some level. Our values are shaped by our ideals; and the choices and decisions we make, both as individuals and as a society, are informed by those same ideas. But when it comes to the debate about health care policy, one seemingly insurmountable problem is that there are two fundamentally incompatible ideas which are being advocated and put forward...basically by the same group of people. The first is sometimes characterized as "the Culture of Life" -- a belief that life is sacred, and should therefore always be extended for as long as possible by any means available. And the second set of values are those of the so-called "ownership society," which places individual self-determination and economic freedom within the marketplace at the top of the list of one's personal, God-given rights. In the Ownership Society, if you can afford something, you're entitled to it (and by extension if you can't, you aren't). But according to the values of the Culture of Life, if something is available that may (or may not) extend your life you are entitled to that as well, regardless of what it may cost or other any other consideration.
These two widely-held sets of beliefs work together to drive up medical costs, especially for expensive and dramatic end-of-life procedures (even those of questionable efficacy), and for so-called "elective" procedures where there are high profits to be made catering to the fears and desires of those who can afford to pay, while at the same time they tend to limit the influence and availability of more mundane public health and individual "wellness" programs where life or death not immediately at issue and there are no large profits to be made. Yet even to suggest that simply because a person can afford something DOESN'T necessarily mean that they are entitled to it, or that society has the right to refuse someone potentially life-extending therapy (regardless of their ability to pay) simply because some "authority" (other than the individual in question) has decided that the potential benefits aren't worth the expense seems a little shocking to us. Certainly it seems a little shocking to me. Like heresy really, or a sign of failed compassion and creeping totalitarianism. Yet is this really the best or only way to frame the issue?
Here are a few other considerations that have been missing from this morning's discussion so far. An effective health care system is a Social Good -- it's not just individuals, but society as a whole, that benefits when people are healthy. So shouldn't the policy be to include as many people as possible, as routinely as possible, and then to share the costs broadly and equitably? I heard the other day that General Motors lost over a billion dollars last quarter, and that one of the principal reasons they are struggling is that they need to include over $1000 worth of employee (and retired employee) health care costs in the price of every vehicle they sell, while overseas competitors from countries with single payer systems are able to avoid this expense, and price their vehicles accordingly. I don't know whether that's actually true or just an excuse, but I do recall hearing somewhere once that what is good for General Motors is good for the country. And a single payer system would certainly be good for General Motors, and other American companies struggling with the cost of providing adequate health insurance for their employees and still remaining competitive in the global economy.
I also think it's important to ask whether a health care system that is driven by "profitability" rather than by patient care is truly ethical. A system which was supposed to insure that no outside party ever come between an individual and their self-selected health care professional in the determination of appropriate patient care has now placed the interests of "health care sector" investors ahead of the rights and the needs of both patients and physicians. Pharmaceutical companies in particular have interposed themselves into the doctor/patient relationship in a particularly invasive way, in order to maximize their profits by marketing directly to "consumers" drugs intended to treat chronic conditions rather than cure specific diseases.
If I were to believe everything I see on TV, there is now a pill for every ill afflicting the middle-aged American male: Lipator, Nexium, Rogaine, Prozac and Viagra....yet I suspect a lot of us would do just about as well (or maybe even a little better) with half the beef and twice the broccoli, less time at the office (or in front of the television), and an hour's brisk walk every evening in the company of someone who delights in running their fingers through what's left of our hair, and telling us how sexy we look now that we've cut it short to match its thinness, rather than trying to hide the fact that there isn't as much there as there used to be. Meanwhile, all the marketplace can really do is to offer men a range of equally-expensive alternative choices like Cialis or Levitra....But if I ask for it, and my insurance will pay, what physician won't write me that prescription if they want to keep me from simply packing up and taking my business somewhere else?
Finally, I think it's important to remember what so much of contemporary culture seems constantly to be conspiring to help us forget: that no matter how good a system of health care we may create, we are never going to defeat death, nor even postpone it long, no matter how much money we may spend. The most important question for medical ethicists isn't really "what does it mean to be alive?" The question is what does it mean TO LIVE! What gives life meaning? What gives life purpose? What is the value of being in relationship, and the importance of being of service? How do we best make use of this amazing gift that we have been given by the Universe, by our Creator; and how do we help others best make use of their gifts? What does it mean to care for one another?
From a spiritual perspective, the goal of good medicine has always been the preservation of health rather than the denial of death. Yet market driven medicine plays upon our fear of death in order to satisfy the desire for profit, and thus is ultimately grounded in the sin of avarice, in greed. A generation ago, most hospitals in this country were still affiliated with religious organizations and administered by people of faith, as they had been since their creation. And their mission, as places of healing and hospitality, was one of charity, of loving service. Other hospitals were affiliated with teaching institutions, or run directly by the government for the benefit of the public...and many, of course, still are. But when health care became big business, much of this ethic of charitable public service was lost, and we have all suffered greatly for it. When ideology tempts us to worship the "invisible hand" of the marketplace as if it were a God, and distracts us from our more basic responsibility to help those who need our help, the essential values which make our lives ultimately worthwhile are discounted by the demands of the bottom line, and the basic quality and value of life itself is much diminished.
Now obviously there is a lot more I could say about this, and I'm sure many of you also have insights that we might all benefit from hearing. But before I go any further, just let me say that I am not suggesting, in any way, shape, or form, that hospitals don't need to worry about balancing their budgets or that health care professionals are not "worthy of their hire." Nor do I think that we should all simply throw away our meds and start taking long walks in the woods instead. Ask your Doctor. What I AM suggesting is that the most critical issues concerning our American health care system are not technical problems, but rather adaptive ones -- problems that will require us to look at the entire system from a new and different perspective, and to make changes in our own attitudes about the way that medicine should be practiced, and our own ownership of and participation in the care of what is perhaps our most (or at least second-most) precious personal possession -- the health and vitality of our physical bodies.
Reading: the Hippocratic Oath -- a Modern Version
Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
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