Getting to a Unified System? Is It Desirable? Will It Ever Happen?

            I’d like to begin my last essay by thanking Clarke Cochran for an engaging three weeks of conversation.  Dr. Cochran represents what is best about dialogue concerning hard problems.  He is civil.  He is clear.  And, in what is best about Christian engagement with difficult conundrums, he presents his interlocutors’ positions with charity.  It’s been a pleasure “conversing” with him this month.  I hope we’ll have a chance to think together again about the place of Christian conviction as it relates to the American healthcare system.  Cochran is obviously an expert, and his ideas and positions are well worth reading.

To no one’s surprise, our conversation about healthcare in America ends inconclusively. The topic is too large for a month’s discussion, even with as engaging partners as Jeff Hammond and Julie Kuhl! I learned much, and I hope contributed some to advancing the conversation. Which is a good thing. A few steps on a long journey beats waiting for a ride that never comes.

The United States is on a long journey of healthcare reform; it may end well; it may not. The end is not in sight. The best I can do is suggest a path forward and some guiding principles. I hope that my first two essays have done that. Here I address some gaps in my account and some nagging issues that could not fit into the first two essays, and I make a closing plea for social justice.

It’s a struggle to move beyond binary thinking. Both Jeff and I (and Julie Kuhl in her thoughtful comments) struggle in different ways to find a healthcare language beyond Left and Right, beyond Liberal and Conservative, and beyond Rights versus Responsibilities. How often political and policy conversations degenerate into either/or confrontation! The beauty of Respectful Conversations, like the beauty of some forms of Christian theology, is to entertain three/four/more approaches to a topic.

However, this beauty sometimes minimizes real disagreements that help to move conversations ahead! This unfortunate possibility is higher when there is so much respect between participants that they are afraid to disagree. When Jeff began his first essay with such kind words about my own writing on healthcare and about my former employer, Texas Tech University, I started to worry that we would not have sufficient scope for difference. I do appreciate Jeff’s kind words, but even more I appreciate his deep engagement with the conundrums of the American healthcare system. Fortunately, I discovered key differences that I hope will move the conversation productively.

First, I would like to thank Dr. Cochran for his excellent and edifying essay, “Healthcare in America: Diagnosis. Cure?”  There are many commendable observations and suggestions found in it.  I’m particularly struck by Dr. Cochran’s generous and conciliatory tone.  Throughout his essay, Dr. Cochran maintains a posture of what I will call firm civility.  At no time does he compromise his hard won and long considered positions, yet, he makes his case in a respectful and moderate tone.  In what is best about religiously-based discourse, Dr. Cochran writes with a genuine Christian meekness, and that is much appreciated. 

My plan in this initial follow-up essay is to do two things: I will discuss two of Dr. Cochran’s “fundamental Christian social principles”.  I will then discuss one practical problem with America’s healthcare system and a couple of ways that problem may be dealt with.

I am working with the famous aphorism attributed to Karl Barth – I have my Bible in one hand and a newspaper in the other.  I try, however imperfectly, to make the Word of God the rule for my life in all things.  As I read it, I find precious little guidance as to how a government should structure the services it provides to its citizens.  In particular, I find nothing, either approving or disapproving, large-scale, top-down provision of health care services to a polity.

            A.  I find a strong injunction in the New Testament to give myself for the benefit of my fellow suffering human being, who Jesus likened to himself in Matthew chapter 25.  I am to visit the prisoner, feed the hungry, and yes, care for the sick.  Indeed, what’s sobering about this little parable in Matthew 25 is that Jesus seems to say that the Christ follower’s salvation depends on how conscientiously he attends to the physical needs of others.  This parable is a biblical personification of the little ditty “if it is to be, it is up to me.”  If the sick are to be cared for, it is up to me. It’s not another’s responsibility.  It’s my responsibility.  If I am to demonstrate my faith in Jesus, well, I really have to do it and get out there find some sick people to minister to.  I don’t mean that I can curry God’s favor by doing good deeds.  What I do mean is that I show Christ himself and the world that I am truly his disciple if I get down to peoples’ suffering where they are.

An overly ambitious title? Ridiculously hopeful? Yes. Of course. We’re talking about healthcare after all – a subject almost as contentious as race or immigration. And twice as complicated. We’re considering a system that accounts for 20% of the entire economy and that touches every person. It is both highly technical and deeply personal. A mix of government (at all levels), of private, for-profit institutions, and of not-for-profit, often faith-based organizations.

There’s little disagreement that healthcare in the United States is broken; yet also little understanding of how and why. And no consensus on a fix or fixes.