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12:59=20 PM

Justice=20 and Health Care Access

Mark=20 2:1-12, Psalm 41:1-4 &n= bsp; &nb= sp; &nbs= p; = ; = =20 Douglas Kaufman

November=20 2, 2003 &n= bsp; &nb= sp; &nbs= p; = ; = =20 Benton Mennonite Church

Experiencing=20 and Sharing God=92s Healing 8 &n= bsp; &nb= sp; &nbs= p; =20 Benton, Indiana

As=20 most of you know, my family has experienced a major health crisis this = past=20 week. It began two weeks ago, at the end of retreat, when we thought = Isaiah had=20 a stomach virus. Because he was so sick so long, we took him to our = pediatrician=20 who also thought it was caused by a virus. Last Sunday evening, he was = becoming=20 so dehydrated that we decided to take him to the ER. The ER physician = noticed=20 how painful his appendix felt, so she ordered a blood test and called = for a=20 surgeon to look at him. Last Monday morning at 1:30 am, we kissed our = four and a=20 half year old son good bye as he was wheeled on a gurney into the = operating=20 room.

During=20 the surgery and recovery I continued reading Dr. David Hilfiker=92s = book, Not all=20 of us are saints, his look at being a doctor among the homeless poor in=20 Washington DC. After the surgery the surgeon, our neighbor Jon Smucker, = told us=20 that the appendix had ruptured, but that the amount of pus was not = great. At=20 about 3 am we went into the recovery room where Isaiah was crying in = fear and=20 pain. Eventually he calmed down and we went up to room 317 in Goshen = General=20 Hospital, where he is right now.

Because=20 Isaiah is only four, Jill or I have been at the hospital since Monday at = all=20 times except for an hour here or there when a grandparent was present. I = have=20 never spent so much time in the hospital, not after a motorcycle = accident, not=20 after the births of any of our children, not after Jill=92s surgery for = thyroid=20 cancer. A ruptured appendix requires the use of antibiotics to stop the=20 infection. So he will be there until his fever is gone. He is doing = better each=20 day, but still has a ways to go.

While=20 Isaiah napped or watched the same video for the fourth time, I took the=20 opportunity to read in preparation for this sermon. So I have done = plenty of=20 research for this sermon. What has been more difficult is finding the = time and=20 energy to actually prepare the sermon. Several days I came home from my = night at=20 the hospital exhausted, barely able to feed and clean myself and care = for our=20 two other children at home. But somehow by God=92s grace I am preaching = this=20 morning. After all this research and medical experience this week, how = could I=20 not preach on it while the iron was hot?

I=20 am in awe of what medicine can accomplish today. I was told that 60 = years ago=20 Isaiah would have died from a ruptured appendix. Today through the = miracle of=20 antibiotics our little boy is still with us. Medicine has accomplished = so much=20 even in the past century. It has been transformed from a profession that = primarily cares for the sick and dying to one that primarily cures the = sick.=20

This=20 incident reminds me that illness is no respecter of persons. Sickness is = visited=20 on the rich, the poor, and the middle class, the good and the bad, the = cute and=20 the ugly, the young and the old. Disease is the great equalizer.

Jill=20 and I know a family with great financial resources. Yet their children = have been=20 stricken with a mysterious illness that is difficult to stop. Disease is = no=20 respecter of wealth or rank.

However,=20 medical treatment is a respecter of wealth. This family has taken their = children=20 to the best places for treatment. And my guess is that it is families = with money=20 like theirs that helps fuel the exploration of the frontiers of curing = disease.=20

At=20 the Goshen Hospital, it is posted that they will provide you with a = screening=20 examination, stabilizing treatment, and transfer to another facility, = even if=20 you have no money, no health insurance, nor Medicare/Medicaid. They will = stabilize you, but they will not cure you.

This=20 is the dilemma today and the reason that many people are saying our = health care=20 system is in a state of crisis. The Health Care Access resolution passed = at the=20 Mennonite Church USA Assembly, Atlanta 2003, cites several problems = connected=20 with this crisis.[1]

First=20 and foremost is the number of uninsured people, which has reached 40 = million in=20 the United States, or 20% of those under 65. Many of these people are = children=20 and their single parents. Over the past two years, almost twice as many = people=20 have not had insurance at some time, so people go in and out of health = coverage.=20

Another=20 major issue is affordability. In the past year employers experienced an = average=20 cost increase of 15% in their health insurance plans. To manage this = huge cost=20 increases employees are seeing cuts in benefits or are being asked to = shoulder=20 more of the premium costs. As I think about our own experience of the = past=20 several years, it seems that most of our pay increases go for increased = health=20 care costs. How do you support a growing family in these = circumstances?

Before=20 I began preparations for this sermon, I saw the problem as primarily = these two=20 issues. But after some of my reading I need to add a third, treatment of = the=20 poor. Teresa Maldonado, an immigrant living in Washington DC, eloquently = speaks=20 of how the health care system for the poor is dehumanizing, belittling,=20 impersonal, and blaming.[2]

Reading=20 Dr. Hilfiker=92s book opened my eyes to the deep problems of the poorest = of the=20 poor, not just the working poor. When you consider the healing we often = need to=20 undergo even after our release from the hospital, you have to wonder how = a=20 homeless person can heal at all. Each day they must leave the shelter = and then=20 return each evening with beds available on a first come, first serve = basis. That=20 is why the Church of the Saviour opened Christ House, a place for = homeless=20 people to recuperate.

But=20 the health problems of the extreme poor are intractable. As someone has = pointed=20 out, the health of the very poor may be benefited more by things like = food,=20 clothing, and shelter than health care reform. So my own modest proposal = is that=20 we fully fund welfare programs so that all people who qualify actually = receive=20 benefits at the time of their need, rather than several years later. My = little=20 experience in helping people receive benefits like Medicaid, Section 8 = housing,=20 and welfare has left me appalled at the state of the system, which seems = more=20 intent on punishing the poor rather than helping them.

Of=20 course a question is why should we even be concerned about health care = access?=20 Why is this something worth preaching about? Why should the church = concern=20 itself with this?

Throughout=20 this series on healing we have emphasized God=92s concern for healing. = We see this=20 emphasis especially in the ministry of Jesus and the early church. In = Matthew 10=20 Jesus sends out the twelve with these words: =93As you go, proclaim the = good news,=20 'The kingdom of heaven has come near.' Cure the sick, raise the dead, = cleanse=20 the lepers, cast out demons.=94 James advises early Christians: =93Are = any among you=20 sick? They should call for the elders of the church and have them pray = over=20 them, anointing them with oil in the name of the Lord.=94 (Jas. = 5:14)

The=20 Hebrew Prophets emphasize God=92s concern for justice. To give just one = example,=20 in Isaiah 1:15-17 God says: =93When you stretch out your hands, I will = hide my=20 eyes from you; even though you make many prayers, I will not listen; = your hands=20 are full of blood. Wash yourselves; make yourselves clean; remove the = evil of=20 your doings from before my eyes; cease to do evil, learn to do good; = seek=20 justice, rescue the oppressed, defend the orphan, plead for the = widow.=94

These=20 concerns for healing and social justice are brought together in Psalm = 41, where=20 God is portrayed as the protector and the healer of the poor. Healing = and=20 justice also come together in the ministry of Jesus in Luke 4:18-19. At = his=20 first sermon in Nazareth Jesus proclaims: =93The Spirit of the Lord is = on me,=20 because he has anointed me to preach the good news to the poor. He has = sent me=20 to proclaim freedom for the prisoners and recovery of sight for the = blind, to=20 release the oppressed, to proclaim the year of the Lord's favor.=94

The=20 Mennonite Church Statement on Health Care passed in 1993 says: =93The = concern for=20 justice in health care arises from our belief in the sanctity and = dignity of=20 persons created in God's image and calls us to free people from social=20 structures which deny them that dignity. The rising cost of health care = widens=20 the gap between the rich and the poor, between those who have access to = health=20 care and those who do not.=94

The=20 United States Roman Catholic bishops also passed a resolution on health = care=20 reform in 1993. Remember that was the year that President Bill Clinton = made it a=20 top priority? In the resolution they build upon the foundation provided = by=20 several papal pronouncements recognizing basic health care as a = fundamental=20 human right, based on the sanctity and dignity of every person. What I = found=20 interesting about this statement is that in it they offer eight = practical=20 criteria for judging the moral adequacy of any health care reform. They = are:=20 respect for life, priority concern for the poor, universal access, = comprehensive=20 benefits, pluralism, quality, cost containment and controls, and = equitable=20 financing.[3] In the end, the bishops call the current health care = system=20 =93clearly unjust.=94

This=20 is an impressive list, but one that contains several purposes that = conflict with=20 one another. For of course we want to provide comprehensive benefits to = all at a=20 good price. But how?

This=20 is what has led theologian Allen Verhey to speak of the tragedy = confronting=20 contemporary medicine. He defines tragedy in the same way as Sophocles, = the=20 place where =93goods collide and evils gather.=94 For Verhey the problem = is that=20 medicine is poised between sanctity and scarcity. Sanctity: We believe = that each=20 human being is a sacred reflection of God. Scarcity: We simply do not = have the=20 resources to do all we can do and all we want to do for all = patients.

The=20 practice of medicine is to intervene in tragedies like the one my family = has=20 experienced the past two weeks and to turn these tragedies into happy = endings.=20 This is what medicine is all about. But the tragedy confronting medicine = is that=20 we simply do not have the resources to provide everyone with complete = access to=20 all treatments.[4]

What=20 any kind of major health care reform will bring, then, is new forms of=20 rationing. I say new forms because currently we ration health care = primarily=20 according to economics. The wealthiest receive the best care. This is = offset by=20 some minimal coverage for the elderly and some poor and the fact that = the=20 majority of Americans, who are in the middle class, have some kind of = basic=20 coverage.

There=20 have been several ill-fated attempts to ration health care. In the 1960s = the=20 Swedish Hospital in Seattle formed a committee to select those eligible = to use=20 the then-scarce resource of kidney dialysis. They used social and = economic data=20 to determine those must worthy of dialysis, with the idea that the = person who=20 had the most potential to make social contributions in the future would = get=20 first place. As one critic observed, =93the Pacific Northwest is no = place for a=20 Henry David Thoreau with bad kidneys.=94[5]

Others,=20 recognizing that the majority of health care expenditures are for the = elderly,=20 think that priority should be given to the young. Yet some elderly are = in better=20 physical shape than younger people. And this also tends to value humans=20 according to their productivity and social contribution, rather than = valuing=20 them simply for their humanity.[6]

In=20 1989 Oregon embarked on an experiment where, rather than provide = comprehensive=20 coverage to a few poor, they would offer the most effective procedures = to all=20 peole below the federal poverty line. They would draw line between what = was=20 covered and what was not according to the amount of money available each = year.=20 So in the first year 568 of the 700 procedures were covered, so that = treatment=20 of common colds and of mononucleosis were excluded.[7]

Canada=20 has a national health insurance system. I have not read any = comprehensive=20 critique of the system. I have never heard a Canadian complain about the = system.=20 What I have noticed is that my young Canadian friends and relatives are = happy to=20 receive what seems like free coverage compared to ours. At the same time = I hear=20 stories about older people having difficulty receiving treatment that = would be=20 easy to receive here.

As=20 I said earlier, though, in a sense we are rationing health care now in = that the=20 poor and the working poor have very little access to health care. = Something must=20 be done.

In=20 its 1993 statement the Mennonite Church called for a health care system = that=20 provides access to basic health care for everyone, everywhere in the = United=20 States; emphasizes health promotion and prevention of illness; places = the curing=20 of individuals in the larger context of healing and caring for one = another;=20 recognizes our mortality and the limits of our financial resources; and = is=20 guided by a national health care policy which controls cost while = emphasizing=20 quality care.

It=20 is important for us to advocate on behalf of those in our country who do = not=20 have access to health care. But we can do more. At Atlanta 2003 = Mennonite Church=20 USA called for drafting a new health care access resolution for 2005. In = addition to drafting a resolution as a witness to the broader society, = there was=20 also a call for congregations to become models of health care access. = While the=20 ultimate goal is for universal access across the United States, the = recognition=20 is that this must start with us. The question for us is: What will we be = willing=20 to contribute in order to provide universal access to health care for = all=20 Anabaptists and the lives they touch in a given geographic = community?

We=20 will be looking at this issue during Sunday School today with Dale = Wentorf from=20 the Center for Healing and Hope and then next week when we look at the = new=20 Mennonite statement on health care access.

There=20 is yet another task for us. If indeed our health care system today = confronts a=20 tragedy, then perhaps we can take inspiration from the Greek tragedies. = When=20 =93goods collide and evils gather,=94 then what counts is the integrity = of the=20 protagonists. At the heart of the profession of medicine is a commitment = to care=20 for one another in the midst of tragedy. We can nurture the character of = the=20 doctors, nurses, EMTs, and other health care professionals among us. =

In=20 our story from Mark 2, the friends of the paralyzed man confronted a = health care=20 access problem. They could not get their paralyzed friend to Jesus = because of=20 the great crowd surrounding him. So they thought of an alternative = route. They=20 went up to the roof and created a hole to lower him down in front of = Jesus.=20 Amazed at their creativity and faith, Jesus healed the man. Like those = friends=20 of the paralyzed man, we want to use our creativity and faith so that = all God=92s=20 children can find a way to healing.

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[1]=20 Found at http://www.mennoniteusa.org/NewItems/delegates/statement_healthca= re.pdf

[2]=20 Teresa Maldonado, =93Sick of Being Poor,=94 in Stephen E. Lammers & = Allen=20 Verhey, eds., On Moral Medicine: Theological Perspectives in Medical = Ethics, 2d=20 ed., Grand Rapids, MI: Eerdmans, 1998, pp. 1001-1004.

[3]=20 B. Andrew Lustig, =93Reform and Rationing: Reflections on Health Care in = Light of=20 Catholic Social Teaching,=94 in Ibid., p. 965.

[4]=20 Allen Verhey, =93Sanctity and Scarcity: The Makings of Tragedy,=94 in = Ibid., pp.=20 974-5.

[5]=20 Quoted in Gene Outka, =93Social Justice and Equal Access to Health = Care,=94 in=20 Ibid., p. 951.

[6]=20 See John F. Kilner, =93The Ethical Legitimacy of Excluding the Elderly = When=20 Medical Resources are Limited,=94 in Ibid., pp. 979-995.

[7]=20 Lustig, op cit., p. 968.