Soul Force

To Life!

Rev. Paul Sprecher

Second Parish in Hingham, www.secondparish.org

October 4, 2009

Readings: “Caretaking,” Jill-Beth Veronica Sweeney, in With or Without Candlelight: A Meditation Manual, ed. Victoria Safford, p. 2

“UUA President's Letter to UUs on Health Care Debate,” Rev. Peter Morales

Our centering thought this morning draws attention to one of the more striking aspects of the ministry of Jesus on earth – his ability to heal the sick. Jesus and his disciples arrive at Peter’s home, only to find that Peter’s mother is sick. Some might wonder whether Peter’s mother had adequate notice that thirteen presumably hungry men were about to descend on her house; others might note critically that she is pressed into service as soon as she has recovered. From the record of the Gospels, though, healing was clearly a significant part of the mission of Jesus. Of course, in that era, the ability to heal and to perform other deeds of power – walking on water, casting out demons, stilling the sea, feeding the multitudes – was one of the things that proved the authenticity of a prophet or, in this case, the Messiah, the Christ.

The story of the Good Samaritan, on the other hand, which we shared with our children this morning, involves no divine intervention – just a neighbor who is willing to get involved and help a severely injured victim recover. That, too, is a form of healing. One of the early theological divisions within Unitarianism in this country arose over the question of whether the miracles of Jesus – the healing and so on – were essential for believing in his teachings. Ralph Waldo Emerson famously declared that

… the word Miracle, as pronounced by Christian churches, gives a false impression; it is Monster. It is not one with the blowing clover and the falling rain.

These days, we think of the miracle of modern medicine as having a good deal more credibility than faith healing, though there are those with less access to care who may believe in less conventional treatments. We here also pray for those who are ill; our prayers help us to focus our own thoughts and attention on those who are in need of healing, and they also remind us that we are often the hands of healing and comfort. We also know that mental attitude can be a very important part of recovery from grave illness, and that our presence and caring can by itself help to bring hope and strength for recovery.

So there’s a good deal of theology lurking beneath the surface when we talk about health and healing, and it’s therefore difficult to avoid a discussion of the current attempt by the Congress and President of the United States to come up with some acceptable reforms of our current health care system. Now, I know that we in this congregation have not always been comfortable talking about political issues in church, and despite the fact that my contract guarantees my right to say whatever I believe to be true from this pulpit, I have in general been cautious about expressing my personal opinions in this context. On the other hand, I think that it is appropriate to lay down some principles on which I believe we can all agree in considering how we as individuals and members of this religious community might faithfully and effectively respond to the issues at hand.

Like many of you, I suppose, I’ve been inundated by emails about this topic, seen any number of ads on many sides of the issue, read news articles and editorials, and had discussions with people on every side of the many issues that arise when we discuss healthcare. I was finally forced to put my thoughts together, though, when my sister-in-law forwarded a particularly irritating email quoting the political consultant and commentator Dick Morris’ claim that “Obama will repeal Medicare.” You may have heard this claim on Fox or by email yourself. Part of what I found most irritating was the fact that Morris, who in an earlier missive had claimed shrilly that Medicare is going bankrupt and can no longer be afforded now turns around to claim that

“... the principal impact of the Obama health care program will be to reduce sharply the medical services the elderly can use. No longer will their every medical need be met, their every medication prescribed, their every need to improve their quality of life answered.”[i]

Dick Morris and the people he works for have never in the past been particularly interested in ensuring that elders would have “every need to improve their quality of life answered,” but now, it seems to me, they have been using an enormously successful federal program to attack any attempt to spread the benefits of healthcare to anyone not currently covered. I was reminded that Ronald Reagan and others had strenuously opposed the creation of Medicare in the early 1960’s – and it seemed frankly disingenuous that their successors should now pretend to clothe themselves as defenders of the program.

Now that my dander was up, I proceeded to respond the my sister-in-law’s email. I pointed out that at that point President Obama had not proposed a specific plan (this was before his recent speech to Congress) but had laid out three broad principles: Reducing Costs, Guaranteeing Choice, and Ensuring Affordable Care for All.[ii] I went on to say that as we all know, every need is NOT met (can't be, by definition) and every medication is certainly not paid for – certainly not when you fall into the infamous "doughnut hole" in the Medicare Prescription Plan. In particular, our desire to live forever cannot be met by any medical system, but end of life care – frequently very painful and with very low quality of life – saps enormous resources from our health care system. The real facts are very simple: We pay a LOT more per person than any other advanced industrial country, and our outcomes are a LOT worse. I provided the World Health Organization statistics on longevity, where the U.S. Ranks 24^th, and on overall healthcare, where we rank 37^th, just below Costa Rica.[iii] I pointed out that our expenditures for healthcare are far higher than any other nation in the world, 15.9% of GDP, $6,657 per capita, roughly twice the level of our peers among developed nations.[iv] Especially distressing is the fact that the United States ranked 29th in the world in infant mortality in 2004, tied with Poland and Slovakia, down from 12^th in the world in 1960.[v] Finally, I pointed out that the compensation for the CEO’s of the top 23 healthcare companies in 2005 totaled just under $560 million – an average of $24 million apiece – and the total over five years was $14.9 billion. At the top of the heap was the CEO of United Health Group, who earned $342 million in the course of five years.[vi]

I let the next few forwarded emails go by and then felt I had to respond to one which claimed that the proposed healthcare reforms would impose rationing. I replied that we already ration healthcare all the time – we just do it on the basis of age – everyone at age 65 becomes eligible for healthcare and most children of poorer parents are covered under SCHIP or Medicaid; and on the basis of who can pay and who can’t – if you’re poor enough you get Medicaid, if you’re not and you don’t have insurance from your employer, you have to pay out of pocket – if you can afford it. President Bush claimed that everyone on America can get healthcare, since after all the law requires that emergency rooms serve everyone regardless of means. That’s technically true, of course, but I experienced a clear form of rationing when I was serving as a hospital chaplain in training as part of my preparation for becoming a minister. Our hospital in New York made a deliberate decision to reduce staff in the emergency room and to slow down the processing of those who came there in order to discourage too many people from showing up. They asked those of us who were volunteer chaplains like myself to spend extra time in the emergency room helping to maintain calm because they fully expected some of the patients to become belligerent when they figured out what the hospital was doing. Yes, we ration. There are people in our immediate neighborhood who must decide between buying medicine for themselves or for their loved ones. We ration. We just don’t notice it because we are, on the whole, fortunate enough not to experience it very often.

Then there was the lawyer from Texas who claimed that healthcare reform was unconstitutional, because the right to manage healthcare is not mentioned in the Constitution; I replied quite simply by pointing out that Social Security and Medicare are also not mentioned in the Constitution – perhaps she wished to give those up as well? And finally, inevitably, the death panels. Here’s a case in which demagoguery twisted a very important discussion completely out of context. It is in fact important for all of us to consider what sorts of medical decisions we would want made if we were unable to speak for ourselves. Many of us have created living wills giving authority to someone else to make decisions for us, and have filled out advance directives which give specific instructions about what kinds of medical care we wish to have available under various circumstances. Many people, for example, would prefer to die at home surrounded by loved ones to rather than in a hospital surrounded by medical personnel and medical equipment. The wide availability of hospice care in our homes has begun to make that option much more widely available of late. I believe most of us here would share that preference, if it were possible. The problem is that unless those instructions are written out while we are able to do so, hospitalization becomes the default choice at end of life, and hospitals by their nature are designed to save life, not to prepare for the end of life.

I don’t think I’m sharing secrets out of school if I tell you that we are all going to die. Mortality is as much a part of our nature as everything else in our lives from birth all the way through. One of our tasks as mortals and especially as religious people is to prepare ourselves for the time when we will say farewell to all the loveliness of this world and depart. The text for our class on Back to the Beginning: Genesis this week was Genesis 2-3 – the story of the Garden of Eden and the expulsion of Adam and Eve from the garden so they could not eat of the Tree of Life. This story is one of the earliest written accounts we have of the attempt to deal with human mortality, and in reading it again we talked about what it means to be mortal and to know about and face our own death. Every human being for millennia has had to wrestle with this reality, and we are perhaps better able at this point in history to control at least some aspects of the end of our lives than ever before. But we have to be willing to think about it and make plans, or the medical systems we have in place will go into autopilot and do whatever is necessary to prolong life, even if only briefly and with a great deal of pain. So it makes sense for us to prepare, to talk to our doctors, ministers, rabbis, loved ones, attorneys or counselors and write down our plans. The problem for doctors is that they are largely paid on a fee for service basis, and Medicare does not reimburse the service of sitting down with a patient and talking about end of life planning. Hence a modest provision was included in one of the bills in the House of Representatives to provide such reimbursement to doctors at most twice per decade. To me, this seems like an excellent provision as long as medical care is paid for on a fee for service basis. In an earlier, less hurried age, such conversations would have been a natural part of regular meetings with ones doctor. These days, with doctors and medical practices stressed by the need to justify the amount of time spent with each patient, such conversations can be harder to come by unless they are defined as an appropriate part of medical practice and hence reimbursable.

I have the feeling that this issue became a flashpoint because we want to maintain the illusion that we do not have to face death, that somehow the miracle of modern medicine will come up with a solution to the reality that we will all die, a reality with which human beings have been wrestling since long before the writers of Genesis talked about how Adam and Eve missed out on their chance to live forever. I can’t help but feel that much of the anxiety being whipped up over the attempts to make any changes at all in the way we provide healthcare stems ultimately from our anxiety, each of us, to ensure that we at least will not be denied any possible care when we need it. That is a legitimate concern, but I believe that it is made worse by the reality that medical care is also tied up with the prospects of living and dying, and that raises the stakes a great deal.

As I said before, it is not my intention to provide a preferred political solution from the pulpit – that is not what we do in church. I am reporting on my own personal responses to a particular set of conversations with my sister-in-law because they seem to me somewhat representative of the moral and ethical issues this matter raises for us. One of the main reasons miraculous healings came to seem implausible to me at a certain point in my life was the fact they were said to come to some and not others; ultimately I had to begin asking why I was so lucky as to have been born into a family where miracles could happen because we believed in them, where we could be saved while others were damned to hellfire for eternity because we chanced – through good fortune –to be born into a family of believers. What about the others? Why me? These are the questions Universalism ask of us, and the questions that great ethical principles raise for us. Jesus tells the story of the Good Samaritan to make a point about the fact that those remote from us, even reviled by us, are in fact our neighbors, and we are commanded to love our neighbors as ourselves. The golden rule tells us to do unto others as we would have others do unto us. If we were not the privileged ones, if we didn’t have excellent insurance ourselves, if we were unable to pay for our necessary medications, how would we want our neighbors to act toward us? That, it seems to me, is how we ought to judge what changes might be needed in how we as a society manage healthcare.

I return to the principles articulated by the president of our Association, Peter Morales, in our reading this morning. We commit ourselves to promote justice, equity and compassion in human relations. That raises our eyes beyond our own immediate and personal needs to a consideration of the needs of others. We also commit ourselves to the use of the democratic process, and that means ensuring that everyone’s voice can be heard, that passionate advocacy by some does not drown out reasoned discussion for all.[vii]

Finally, we are responsible for ourselves, for taking care of our own precious bodies as long as we are privileged to inhabit them. As Jill-Beth Veronica Sweeney put it in our reading this morning:

Take care of your home, your remarkable body.

It needs blueberries, brisk walks, and backrubs.

Take care of your home, your mind and soul.

It craves stillness, friendship, a pile of books by the bed.

Take care of your home, the roof over your head.

It asks to be filled with music and candlelight, to be free from cobwebs and shadows.

Take care of your home, your community.

It expects you to protect the weak, to visit the lonely, to love the children.

Take care of your home, the earth.

It cries out for abundant green forests, clear blue waters – and peace.[viii]

Amen.