Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.
Our Faulty Health Care Anchors
Clarke E. Cochran
By Clarke E. Cochran
November 22, 2013
American political and social life is driven partly by obvious ideological and partisan commitments – liberal, conservative, progressive, and libertarian; Democrats and Republicans and Independents. Underlying these, however, are deep cultural anchors, unacknowledged beliefs and commitments that possess a quasi-religious character.[i] I count at least five such anchors that profoundly affect the health care system and perpetuate its ills:
Fear, especially fear of lost privileges. Those with good insurance and providers with comfortable incomes worry about health care reform, including Medicare reform, which might upset their prerogatives. Physicians fear loss of income and loss of independence if spending is reined in or if they must join Accountable Care Organizations or follow evidence-based guidelines. Average citizens fear “rationing” and “death panels;” they fear undocumented persons and “socialized medicine.” Seniors fear tampering with “my Medicare,” especially if tampering favors groups perceived as “undeserving.” Yet, Jesus’ first words after the Resurrection are “Do not fear.” How is it that American politics has become so fear-driven? The first move that Christians can make in health care reform or on many other social problems is to recognize our own fears and to address them in light of Christ’s triumph over fear.
Individualism. American culture is deeply individualistic: my rights and my responsibilities; my property and my opinions. Christ’s salvation and His message are truly for each individual, yet they are not “individualist,” but profoundly communal. He gathered a group of disciples and formed a church, whose mission is to reach out and include all persons. His action suggests a political language of justice and the common good, a language of inclusivity and care for the poor. Yet this language is less common in our politics and in our churches than language of individual rights and freedom of choice. A classical liberal ideology of individualism and self-reliance, coupled with a naïve faith in free markets, impedes the kind of commitment to solidarity and the common good that could anchor a better and fairer system of care for all, particularly the disabled and elderly.
Refusal to recognize limits. Although inspiring in many ways (space exploration, athletic achievement), the American denial that life in this world is limited and ultimately unsatisfying drives two other deep anchors of health care injustice: the denial of death and technological imperialism. Americans seem predisposed to seek new frontiers, to test the limits of space and time and energy. Admirable as this cultural character trait is in many respects, it is often out of control and out of sync with a fundamental tenet of Christian faith: we are a pilgrim people passing through this world to a better home. Every action and every achievement is limited and temporary. Fascination with the new and the latest, with exciting breakthroughs, is dangerous and feeds pride and ambition.
Denial of death. At its most extreme, the refusal to recognize limits produces an implicit denial of the reality of death. Of course, few claim explicitly that death can and will be conquered.[ii] Yet we act as though death can be indefinitely postponed if only we find a cure for cancer or if only we find a cure for diabetes or if only….. An inordinate amount of medical and Medicare financial resources are devoted to keeping people alive (and often suffering) when death is clearly at hand. We admire the “fighters” in the face of serious illness. Yet our model is supposed to be Jesus, who went like a lamb to his death.
Technological imperialism. The previous two cultural anchors produce an American fascination with technology, especially medical technology to improve and to extend life. Undoubtedly, advances in imaging, pharmaceuticals, and surgical procedures bring multiple improvements to life and health, and they are to be applauded. However, I believe that our appreciation for and fascination with the latest medical breakthroughs exceeds reasonable bounds and stems from our refusal to accept limits, thus feeding the denial of death. We would do well to remember that technological developments and the speed with which Medicare and private insurance reimburse new technologies fuels the out-of-control growth of health care spending. Yet the general public and political actors from all parts of the political spectrum resist any reduction in spending for medical research and development, and public campaigns to accelerate insurance coverage of new and often experimental treatment modalities are quite common.
One of the greatest challenges for Christian action in the public sphere of health care is to attend to both the specific proposals under debate and the deep cultural anchors that distort our health care system and indeed all of public life, anchors which infect our own cherished beliefs, commitments, and actions.
- Clarke E. Cochran is Vice President of Mission Integration at Covenant Health in Lubbock, Texas.
[i] I owe the cultural anchors image to the late ethicist and theologian Jack Glaser.
[ii] Though some do. Cryogenics is one example. Another is the statement by a prominent geneticist that death is just a series of preventable illnesses.
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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”