Wednesday, June 25, 2014

The Real Problem Behind the Scandal at the VA

Now in Jerusalem by the Sheep Gate there is a pool, called in Hebrew Beth-zatha, which has five porticoes. In these lay many invalids—blind, lame, and paralyzed. One man was there who had been ill for thirty-eight years. When Jesus saw him lying there and knew that he had been there a long time, he said to him, “Do you want to be made well?”The sick man answered him, “Sir, I have no one to put me into the pool when the water is stirred up; and while I am making my way, someone else steps down ahead of me.” 
John 5:2-8

Like most everyone else, I have been watching the unfolding story of delays at Veteran’s Administration hospitals with both anger and frustration.

No one has waited as long as the man beside the pool in Jerusalem. Although that depends on how we count the time. Some veterans have died while waiting to be seen by a physician. If we count the wait times in those instances as eternity, then that would be a lot longer than the thirty-eight years that the man by the pool.

The outrage has focused on the employees who falsified the wait times in order to meet agency expectations and qualify for bonuses. And those folks certainly deserve our opprobrium. But I not could help wondering why no one was asking the obvious question: Why is this happening?

The schedulers were not falsifying wait times because it was easier than making appointments. They weren’t keeping secret lists because it was easier to keep two lists than one. And the long wait times were not caused by the falsified data.

Are doctors leaving at noon to play golf? Are they just spending too long with each patient? Are they routinely coming in late and leaving early? Are they using sick days when they are not sick? Or are there just not enough doctors to see the patients who need care?

The answer was not that hard to find, although I never heard it in any of the major news stories. They just don’t have enough physicians. Curiously, even the news stories that point to the shortage of physicians spend a lot of time going over the scandal of falsified wait times. The story of the doctor shortage is not nearly as titillating as the scandal.

The Department of Veterans Affairs is currently trying to fill about 400 vacancies among its primary care physicians, which last year came to a little over 5,000. But even a full roster would probably not be enough. The department is straining to accommodate the increasing needs of an aging group of Viet Nam era veterans as well as a large influx of veterans from the wars in Iraq and Afghanistan.

Physicians now have caseloads of about 2,000 patients per year, although department guidelines target the optimum number at 1,200. And they are being pressured to limit follow up visits to no more than two per year for each patient. As one analyst put it, they are overworked and underpaid. Primary care physicians at the VA typically earn between $98,000 and $195,000, while the median income among those in private practice is $221,000.

According to an article by Bruce Japsen in Forbes Magazine, the shortage in the VA is linked to the funding of Medicare. The Medicare health insurance program for the elderly is a major funding source for graduate medical education, known as GME. In 1997, the Balanced Budget Act put a limit on the number of residency positions available to medical school graduates as a means of limiting health care expenses. The shortage in funding has led to a shortage of physicians in the country, which is a significant factor in the shortage at the VA.

None of this excuses the VA administrators and staffers who falsified the data and hid the problem. And they should be held accountable. But punishing them will not solve the problem. We need more physicians, and one way or another we will have to pay for them.

Wednesday, June 18, 2014

There Is No Unmoved Mover

But Moses implored the Lord his God, and said, “O Lord, why does your wrath burn hot against your people, whom you brought out of the land of Egypt with great power and with a mighty hand? Why should the Egyptians say, ‘It was with evil intent that he brought them out to kill them in the mountains, and to consume them from the face of the earth’? Turn from your fierce wrath; change your mind and do not bring disaster on your people. Remember Abraham, Isaac, and Israel, your servants, how you swore to them by your own self, saying to them, ‘I will multiply your descendants like the stars of heaven, and all this land that I have promised I will give to your descendants, and they shall inherit it forever.’”And the Lord changed his mind about the disaster that he planned to bring on his people.
Exodus 32:11-14

In response to self-righteous right wing Christians, the late film critic Roger Ebert is credited with saying, “The problem with being sure that God is on your side is that you can't change your mind, because God sure isn't going to change His.” It is a clever double put-down. It makes fun of the right wing zealots while simultaneously ridiculing the whole idea of God.

I have no problem with the first part. Self-righteous and rigid biblical literalists have done more harm to Christianity than all of the atheists combined.

But I take issue with the second part of the statement.

As we see in the passage from Exodus, God is quite capable of “changing his mind.” When God declares that because the people of Israel have worshiped a golden calf, God will destroy them and let Moses start over with another group of people that God will create, Moses argues with him. And eventually, his argument prevails. “And the Lord changed his mind about the disaster that he planned to bring on his people.”

There are plenty of places in the Bible where God “changes His mind.”

We need to be clear that in Exodus, the Bible is speaking symbolically. God is not a being like other beings, making threats and entering into arguments, and then finally “changing His mind” like a person deciding what pair of shoes to wear. In biblical terms, God is the great “I AM.” God is not a being like other beings. God is not even a Supreme Being. God is, as Paul Tillich said so well, the Ground of Being. God is being itself. As Jesus said, “God is Spirit.”

The Bible is speaking symbolically, but my guess is that Ebert was speaking literally.

The larger point is that the One we meet in the Bible is not the “unmoved mover.” When the people of Israel were freed from captivity in Egypt, “The Lord went in front of them in a pillar of cloud by day, to lead them along the way, and in a pillar of fire by night, to give them light, so that they might travel by day and by night” (Exodus 13:21). It is the nature of God to lead. God is the One who goes before us.

And God is continually “doing a new thing.” We speak of faith as a journey, because it continually calls us to new places and new ways of thinking.

Jesus calls his disciples to “come and follow me.” When we listen to some so-called Christians, they seem to think that what he meant by “follow,” was “Stay where you are. Keep doing what you are doing. Don’t change. Don’t grow. Don’t learn.” It is not surprising that they are treated with scorn. What they don't realize is that in their rigid self-righteousness they totally miss the point of biblical faith.

Thursday, June 5, 2014

Schism Is a Bad Idea

From now on, therefore, we regard no one from a human point of view; even though we once knew Christ from a human point of view, we know him no longer in that way. So if anyone is in Christ, there is a new creation: everything old has passed away; see, everything has become new! All this is from God, who reconciled us to himself through Christ, and has given us the ministry of reconciliation; that is, in Christ God was reconciling the world to himself, not counting their trespasses against them, and entrusting the message of reconciliation to us. So we are ambassadors for Christ, since God is making his appeal through us; we entreat you on behalf of Christ, be reconciled to God.
II Corinthians 5:16-20

If you Google “Schism in the UMC,” you will find plenty of news articles, essays, blog posts, and editorials. Last week the Huffington Post published a report from the Religious News Service (RNS), about a group of 80 United Methodist pastors who are laying the groundwork for what they are calling an “amicable” separation. The Rev. Maxie Dunnam, retired president of Asbury Theological Seminary in Kentucky summed up the sentiment of many when he said, “We can no longer talk about schism as something that might happen in the future. Schism has already taken place in our connection.”

After forty years, we can see the present status of the conflict summarized in two related episodes.

Earlier this winter, Frank Schaefer, a former Pennsylvania pastor, was found guilty of violating church law when he officiated at his son’s 2007 wedding. He was given a thirty day suspension and told to come back at the end of that time and report to the Conference Board of Ordained ministry on whether or not he could agree to uphold the whole Discipline. He said that he could not deny the calling he felt to minister to LGBTQ Christians and would not promise to uphold the exclusionary paragraphs in our United Methodist Book of Discipline. The Board of Ministry revoked his orders.

Like many others, I was shocked by that decision on the part of the Board of Ministry. They claimed to have no choice, but they really had many choices. They could have done nothing. They could have deferred a decision. Since service on the Board is voluntary and unpaid, they could have resigned.

The second episode also involved Thomas Ogletree, a United Methodist clergyperson and former dean of Yale Divinity School who officiated at his gay son’s 2012 wedding. In that case, Bishop Martin McLee announced in March that he would drop the case against Ogletree, and he called for an end to church trials for clergy who perform same sex weddings.

Those who identify as “traditionalists” were outraged.

Publicly, what they say about this latest episode is that they are shocked (shocked!) that a Bishop in the United Methodist Church would openly refuse to uphold church law. My guess is that what really troubles them is that they can see the writing on the wall. They know that other bishops will follow Bishop McLee’s lead. Bishop Sally Dyck has already stepped up with a bold statement against schism and in favor of inclusion.

They know that public opinion is shifting rapidly. Of course, we don’t base our Christian social ethics on public opinion, but there is something to be said for common wisdom. In our Wesleyan Quadrilateral, we look at Scripture, Reason, Tradition, and Experience as the four categories of exploration that undergird our interpretation of scripture and our ethical decision making. Public opinion is part of our experience.

In a post on the "ChurchLeaders" website, blogger Matt Brown, writes, “There's so much talk lately in the news media and from liberal political groups about ‘being on the right side of history.’ They are saying: one day we will all regret standing for Scriptural values, because everyone else in the nation will agree we were wrong for not agreeing with them.” The real point, he argues, is that Christians need to be “on the right side of eternity.”

At first glance, that doesn’t sound as bad as it is. After all, don’t we want to be on the right side of eternity? And don’t we want to stand for Scriptural values, even if everyone else is on the other side?

Burgess is right to call for theological reflection on the issues, but that is precisely the point that reformers are making. The question is not about whether or not we will embrace “Scriptural values,” the debate is about what those values are.

When Dr. King, channeling the great Abolitionist preacher Theodore Parker, proclaimed that in the struggle for civil rights, we know that we will prevail because “the arc of the moral universe is long, but it bends toward justice,” he was summing up a fundamental belief of our heritage. The people of Israel believed that God acts in history, in Exodus and Exile and Restoration. When Jesus talked about the Kingdom of God, he was talking about establishing God’s vision for humanity on earth, in history. When we speak of being on the right side of history, we are making an affirmation of faith. There are times when the arc is so long it may seem flat, but eventually it will bend toward justice. To be on the right side of history as the moral arc bends toward justice is to be on the right side of eternity.

Those who have been working for the full inclusion of our LGBTQ sisters and brothers have been at it for a long time. In the beginning, and for many years, we were in the minority. We did not shy away from “standing for Scriptural values,” even though it was not popular.

Adam Hamilton and Mike Slaughter, pastors of two of the largest United Methodist congregations in the United States, are charting “A Way Forward” that is far from perfect, but it avoids schism. Their plan is very simple:
  • · Let each local congregation decide for itself where it stands.
  • · Those who favor full inclusion can do so.
  • · Those who want to support equal marriage can do so, and the clergy of those churches can perform same sex weddings (subject, of course, to local laws).
  • · Annual Conferences that want to ordain LGBTQ candidates for ministry can do so.
  • · Those that don’t want to don’t have to.
  • · Churches that do not wish to have a gay pastor can say so.
Apart from the obvious criticism that it looks a lot like congregationalism (oh no!), it would mean that a final resolution to the debate would be postponed for a very long time, and we would remain divided. On the other hand, it would avoid a schism that would permanently split us into separate denominations.

The list of church leaders who have signed on is impressive. In addition to Hamilton and Slaughter, they have a long list of pastors from the usually conservative areas of Texas and Florida, including Rudy Rasmus, who was pastor to President George Bush. They also have Dean Snyder and Ginger Gaines-Cirelli from Foundry UMC in Washington D.C., one of the most progressive and inclusive congregations in the country.

The local and regional option proposed by Hamilton and Slaughter is not perfect, but it might provide a graceful way to back out of our current impasse.