Health Care Exposed
July 2023
His disease was severe, yet even in his disease he did not seek the Lord but the physicians.
2 Chronicles 16:9b
People and priests alike were corrupt, and the Nation was almost devoid of true statesman or religious leaders of integrity. Exploring the Old Testament W.T. Purkiser 1965
“To fully understand health-care you need not only a tolerance for the gray, but a basic understanding of economics, politics, theology, business, and sociology.”
In 1976 I resigned my position as a commissioned officer with the US Public Health Service. The Carter administration was in the middle of a centralized government planning model for health policy. I did not agree with this direction. Despite decades of conservative leadership since then, health care continues to march toward a European style government dominated system. My conservative views on health care have not changed since those days. An optimal functioning health care policy and system require an honest moral foundation, responsibility for oneself, and free market economic principles. Frederich A. Hayek a noted classical economist said “the best alternative to socialism is a market system in a democratic polity with strong constitutional protections of the private sphere of economic activity and of individual liberties.” He also pointed out that there is so much rapid change in market knowledge that it is impossible for central government planners to possibly keep track.
INTRODUCTION
This writing will identify and critique the major and often overlooked issues facing our healthcare system, aware of the tension between what should be versus what is. It will provide a clear analysis of our healthcare system and aid in developing healthy discussion that generates lasting solutions. The author uses an inside perspective with an objective view to identify strengths and weaknesses. Professional ostracism and isolation are not factors to be considered in this analysis. In his book How to Think, Alan Jacobs states that: “You have to be a certain kind of person who, at least some of the time, cares more about working toward the truth than about one’s current social position.” To that end, I go on.
Government involvement in health care has helped push patients to expect the best of every healthcare service right now, and for free. Policy makers have developed a health care culture that values the idea that any incremental improvement in health is worth any cost. Ironically, at the same time, we have de-valued life. Pope John Paul II stated in The Gospel of Life, “A debate over abortion, euthanasia, and related questions are not about religious doctrine or policy options in the public arena; but rather about what it means to be human. Freedom divorced from moral truth is the death of freedom.” We have little community resolve to develop honest solutions to the problems facing our culture, especially regarding health. Physicians are experiencing an epidemic of burn-out, patients are becoming frustrated with the system, and hospitals have become power-hungry institutions. Instead of being watch dogs for the uninsured and low-income patients, they have made the poor a revenue center and charge them full fee for services while at the same time giving discounts of up to 80% for those insured. Hospitals have recently defied the legislative requirement to post prices for their services. Recently, a fellow at Massachusetts General Hospital wrote, “Hospital systems recently lobbied for policies that created a regulatory environment too thick and expensive for private practice to remain solvent.” Hospitals along with pharmaceuticals are major components of the health care industrial complex.
The health-care system is a big contributor to the national debt. Tax subsidies for the wealthy and a more than generous Medicare system are draining the public coffers. Today, government pays nearly 50% of all healthcare services and third parties have helped insulate almost all of the services from the competitive forces of a free market. Our nation has accumulated a staggering debt of well over 100% of our GDP. We are spending $2 billion per day in interest right now on the federal national debt and we were spending $1 billion per day just two years ago. This has brought the value of our currency to an all-time low, and some would call our system of finance “dishonest money”. The prophet Micah, long ago, warned us of “wicked scales and deceptive weights”. Early in my career, I learned health care leaders will protect their turf before developing an honest and optimal health care system.
A recent healthcare consumer survey concluded that one-half of our current population was dissatisfied with the healthcare system. Solutions are hard to find. On the one hand, most agree that we all should bear the health expenses of those, who by no fault of their own experience serious health conditions. On the other hand, there are many who are not responsible for living a healthy lifestyle and expect others to pay for basic health conditions that are clearly caused by lifestyle choices. This dichotomy ignites public passion. One side sees health care as a right and wants to provide for those in need. They want a greater role for the government to accomplish this. The other side wants more of an emphasis on the private sector, market forces, and individual responsibility to be primary in our healthcare system.
The US healthcare system is a paradox between excess and deprivation. Some receive too little care, and are uninsured. Others receive too much care, which is costly and harmful. A recent study found that elderly patients in some areas of the country receive 60% more services for the same condition than in other parts of the country. About 20 to 30% receive care that is not appropriate, and up to 40% of all medication is not necessary. For example, Germany’s Institute for Quality and Efficiency in Health Care, an independent agency under contract with the German Ministry of Health, found that of 216 new drugs entering the market from 2011-2017, only 54 were of major or considerable benefit. In the past, “sacred bond “described well the physician lead medical, and health care system; now descriptors fit to publish include “inattentive,” “no one in charge,”and “money grubbing”.
Many citizens feel the healthcare system is dishonest. A recent article in National Review stated: “We saw, during the pandemic, public health authorities or institutions act in craven and self-serving ways; viewing American citizens through a demeaning anti-populist lens as mere rubes, bigots, and ignoramuses. Dr. Anthony Fauci openly admitted that he lied to the public about certain matters – for instance his estimates of herd immunity based on his gut sense of what they could handle hearing.” This recent experience with Covid did little to inject trust into the national debate regarding health care.
In order to further understand the modern health care delivery system in the United States, a clear understanding of the word “health” is very important. The World Health Organization defines health as “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. The US Public Health Service writes in Healthy People 2020 about four overarching goals for health:
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
Theologically, the subject of health actually begins at the time of creation when man was made in a perfect state of health, holy, and happy. However, when Man fell from his relationship with God and this perfect state, the consequences were significant. The effects of the Fall cannot be overstated. Humans became estranged and disconnected from each other, to the point of even committing murder. Pain and suffering became prevalent in all aspects of daily life. Sickness became widespread and seemed overwhelming and hopeless. Man disobeyed and rebelled against God's commandments, and as a result, death entered the world along with various forms of spiritual, physical, and psycho-social diseases. The future of mankind on earth was destined to be marked by suffering and death.
However, from the beginning of eternity, God had a plan of salvation in place. Salvation encompasses the restoration of both spiritual and physical health. It is based on the sacrificial death and resurrection of Jesus Christ, which provides a means to be freed from the curse of death. This plan culminates at the end of this world with a new heaven and a new earth, where we will receive our resurrection bodies and experience perfect health. Jesus Christ is described as the light of the world and the bread of life. He offers us springs of living water. It is important to recognize that our focus should not be on worldly measures such as wealth, honor, or physical health, but rather on our eternal relationship with God and the hope of living with Him forever in heaven. Neglecting such a great salvation would have grave consequences.
Some devotional notes from Nick Cash, chaplain for Mercy Ships, further explain the spiritual nature of healthcare. He states, "Healthcare - physical healing - is a sign. It signifies something greater. It points to something greater than itself. Healthcare improves the quality of our earthly lives and points us to the eternal wholeness offered to us in Jesus. Healing transforms our lives in the here and now and reminds us of our ultimate transformation in eternity in the presence of God. Healthcare is a resource that points us to the Source of all life and healing. All healing comes from God. God is the source of all healing. All health has its origins in Him, all wholeness is fulfilled in Him, so all earthly healthcare - surgeries, medicine, rehabilitation, infection control, disease prevention - all healthcare is a resource. Surgery does not exist from its own power. Medicine is not self-created. All earthly healthcare is derived from some higher infinite eternal Source of healing."
It is difficult to see benefits from sickness and poor health, but they allow for a close examination of our relationship with God. They can reveal deception and deep corruption in the heart. They provide appreciation for the great love and mercy of God and the value of heaven, and deepen our dependence on God alone. We can benefit from the value of time and become more serious about preparations for death. Suffering refines our character and leads to sanctification, the process of becoming more like God. Isaiah 53:5 says, "But He was pierced through for our transgressions. He was crushed for our iniquities; the chastening for our well-being fell upon Him, and by His scourging we are healed."
Considering Harvard's original mission statement, "Let every student be plainly instructed and earnestly pressed to consider well the end of his life. The purpose of studies is to know God and Jesus Christ, which is eternal life... the only foundation of all sound knowledge and learning," we can understand that faith and holiness are the only ways that lead to true happiness. It is worth noting that the majority of health expenses occur at the end of life, and there seems to be no limit on what we spend to prolong life.
Consider this poem about the end of life by John Donne.
Hymn to God My God in my Sickness
By John Donne
March 1631 about a week before his death.
Since I am coming to that holy room,
Where, with thy choir of saints forevermore,
I shall be made the music; as I come
I tune the instrument here at the door,
And what I must do then, think here before.
Whilst my physicians by their love are grown
Cosmographers, and I their map, who lie
Flat on this bed, that by them may be shown
That this is my Southwest discovery
Per fretum febris, by these straights to die,
I joy that in these straights, I see my West;
For, though their currents yield return to none,
What shall my west hurt me? As west and east
In all flat maps (and I am One) are one,
So death doth touch the resurrection.
Is the Pacific sea my home? Or are
The eastern riches? Is Jerusalem?
Anyan, and Magellan, and Gibraltar.
All straights, and none but straits are ways to them,
Whether where Japhet dwelt, or Cham, or Shem
We think that Paradise and Calvary,
Christ’s cross and Adam’s tree stood in one place
Look Lord and find both Adam met in me;
As the first Adams sweat surrounds my face,
May the last Adam’s blood my soul embrace.
So, in his purple wrapped receive me, Lord.
By these his thorns give me his other crown;
And as to others’ souls I preached thy word,
Be this my text, my sermon to mine own,
Therefore, that he may raise, the Lord throws down.
C. Everett Koop, the former Surgeon General, states, “Americans lose sight of the fact that they have to die of something. And we must recognize that sometimes the best thing a reasonable physician can do in an elderly person's terminal illness is to step back and let nature take its course.” Timothy Johnson MD adds, “The secularization of healthcare has elevated physical existence to a near idolatrous level, but this need not be a terminal condition. Healthcare that is infused with Judeo-Christian values will not only teach us to respect human life but also to accept and respect the inevitable end of earthly existence.”
Another aspect of the healthcare debate is the subject of care itself. Rick Carlson has said, “Medicine has effective technologies, but healing also occurs without sophisticated technology.” It is estimated that 70-80% of office visits to a primary care office are or will be resolved without modalities or pharmaceuticals. A major ingredient that addresses this approach to healing is caring. It has been stated that the tools of the healer include:
Unconditional love
Gratitude
Certainty
Presence
We should also remember the greatest commandment in our mission to care: "Thou shalt love the Lord thy God with all thy heart... and thy neighbor as thyself." David Neff wrote in Christianity Today: "As Christian citizens, we must be the outspoken social conscience of the nation. And as giving members of Christ's church, we must be his hands in the non-medical ways that can bring comfort and a sense of belonging to those for whom the system doesn't work."
Furthermore, the placebo effect is real. This effect demonstrates the power of healing through positive caring and a positive attitude toward healing. We are now in between a perfect re-created body and one that is influenced by sin and disease. Caring for oneself is as important as caring for others. Generally, living according to God's guidelines leads to a healthy life.
Leonard Sagan, a healthcare sage of a prior generation in "The Health of Nations," wrote about the true causes of sickness and well-being. He states, "Clearly, the concept of health, just as the concept of disease, is value-laden and subjective." It is evident that "modernization" has been a significant factor in health and the growth of life expectancy. Sagan also describes what patients desire from their doctors: compassion, a sympathetic listener, relief from symptoms, information on their prognosis, and advice and treatment to prolong life and prevent illness.
Summary and Conclusion
We often look to our health system as our savior instead of turning to God and His ways. The tax deductibility for medical expenses has distorted the demand for healthcare and has contributed greatly to the uncontrollable growth of our national debt. The healthcare sector continues to grow at a faster rate than the rest of the economy, yet there is little progress in improving key health indicators such as average life expectancy. Despite spending $4,300 per capita, the average life expectancy in the US is 77 years, while in Japan, with an expenditure of $1,050 per capita, it is 81.5 years. The healthcare industrial complex, led by hospitals, government, and pharmaceuticals, distorts the fundamental efforts of healthcare delivery reform.
As Oliver Wendell Holmes said in 1869, "The state of medicine is an index of the civilization of an age and country – one of the best, perhaps, by which it can be judged." Our healthcare system is a wonderful gift, but we must use it wisely and ensure it is efficient and effective. We must not allow it to be held hostage by the healthcare-industrial complex. Sound moral principles should guide the reform of the current system, and we should take full responsibility for our health.