Photo: Anne Blackwood at work. Photo by Scott Byram
This article comes from the September issue of The Mennonite, which focuses on “Faith-filled responses to health-care costs.” Read more reflections here or subscribe here to receive more original features in your inbox each month.
Beloved, let us love one another, because love is from God; everyone who loves is born of God and knows God. Whoever does not love, does not know God, for God is love. —1 John 4:7-8
Love must be at the center of a faith-based response to any social issue. This is what Jesus meant when he said all that God expressed through “the law and the prophets” hangs on love of God, self and neighbor (Matthew 22:40).
According to 1 John, love grows out of our awareness of God’s unqualified love for us. John expresses God’s love in terms of Jesus’ willingness to die. Whether in death (as in Jesus’ case) or in life, God loves first—consistently, patiently, perfectly. As we experience and appreciate being loved, we respond with love for God, whom we have not seen, and for our sisters and brothers, many of whom we have seen. When we pay attention, within and beyond our usual circles, we can bring these brothers and sisters into sharper focus, perceiving them with love, as God does.
Who, then, are God’s beloved in the health-care system? Being bound by a body is one of the great democratizing attributes of being human, being created, being God’s beloved. At some point between birth and death, every human has some experience that could benefit from medical, nursing, nutrition, counseling or other health-care service.
Under the best of circumstances, expectant mothers receive obstetric care, children receive regular pediatric care, a burst appendix receives emergency surgery. In middle age, as blood vessels, metabolic processes, immune systems or the fidelity with which our cells turn over demonstrate that all things change with time, we expect a doctor, nurse, social worker, appropriate medication and eventually hospice will be available to assist us. We expect these things even, or especially, for more severe illnesses, or when an accident or illness occurs “too soon.” These expectations are consistent with our being beloved children (creatures) of the loving God (Creator).
This “best of circumstances” appears to be the reality for most of us. But these are not assumptions 14% of Americans can make. These 28 million people are no less beloved. According to the Commonwealth Fund, in 2016, almost one-third of those with health insurance had plans with high deductibles and out-of-pocket expenses compared with their income. Among these “underinsured,” almost half reported medical debt problems. Even among those with “adequate” health insurance, 25% reported difficulty with their medical bills.
As a juvenile diabetic, I advocate with my insurance every month about coverage for insulin pens, pump supplies and more. At a minimum, this is time consuming and taxing. As a physician, I can afford high premiums for a comprehensive plan and know who to call to get these needs covered. Yet my experience underscores the reality that necessary health care is uncomfortably close to being out of reach for all of us.
Many factors drive health-care costs. Innovation is one. It is expensive to develop and improve on antibiotics, cancer or heart-disease drugs, vaccines and devices to diagnose, treat and manage many conditions. In addition, U.S. consumers pay more for medical innovation than do people in other countries, even wealthy countries. In the United States, we assume that limiting regulation facilitates progress. Unfortunately, when unregulated: (1) drug developers require U.S. consumers to pay more for advances from which worldwide patients benefit; (2) less scrupulous developers encourage unnecessary and thus harmful prescriptions, as we see in the opioid crisis; (3) health systems develop monopolies; and (4) insurance companies maintain profits, while patients sometimes purchase policies with out-of-pocket costs that are too high to protect them.
Uninsured patients also increase costs. In a system where some can’t afford to pay for care: (1) lower-cost, more effective preventive care is not delivered; (2) more severe, less treatable conditions cost patients and society more; and (3) those with comprehensive coverage end up paying inflated expenses that cover some of the costs for those who cannot pay. The alternatives to inflated costs are either that those without insurance are turned away or that hospitals close and accessibility is reduced for everyone. We overvalue high-cost specialty care, while as a society we fail to vaccinate children or provide broad access to proven health screening and preventive services. Finally, those for whom health-care access is most limited are the same beloved ones for whom basic needs consistently go unmet—those in rural areas or inner cities, people of color. Market factors do not and cannot facilitate equity.
As God’s beloved, our values, advocacy and creativity should move us to bring change, a reorientation of priorities and balance. We are to “seek peace and pursue it” (Psalm 34: 14) and are called by Jesus to be salt.
Anabaptists have a history of acting boldly and compassionately, even when facing complex systems. We have been change makers, including providing health insurance in our own communities, and modernizing mental health services through the faithful efforts of Anabaptist conscientious objectors, who requested socially significant work for their Civilian Public Service and eventually established and became aides in government mental-health units. These ordinary men and women not only resisted war but gravitated toward these positions, which paid less than other civilian wartime jobs. They resisted and reformed the inhumane mental-health practices they witnessed in government hospitals during World War II, wrote letters to newspapers about the harsh conditions, continued their advocacy after the war, established their own mental-health hospitals and impacted mental-health practices nationwide. These actions lived up to the highest ideals of what we are called to be as beloved ones, as those who act with mercy, justice and compassion among God’s beloved.
Today, we are called to be similarly creative and bold, guided by love, with a view toward equity. Many of us do this in our chosen professions. As people of God, we must ask, How do we educate ourselves about the health-care system, who is left out and why? How does this impact our volunteer efforts? Our pro bono offerings? How does this impact our votes? What do we need to know about candidates’ policies on the Affordable Care Act, Medicaid expansion, Medicare for all? How do we advocate? Who writes letters and to whom? Who are the policy makers among us? Who are our visionaries? Our allies? Our potential allies? How do we amplify the voices that inspire and multiply the actions that make God’s love practical, even in this arena?
This is God’s work of love. Beloved, this is the life we are called into.
Anne Byram Blackwood is a member of First Mennonite Church of San Francisco, a medical oncologist and a spiritual director.
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