A Parable about Healthcare in the United States

Budget Director Mick Mulvaney holds a copy of the 2018 budget proposal.

When he returned to Capernaum after some days, it was reported that he was at home. So many gathered around that there was no longer room for them, not even in front of the door; and he was speaking the word to them. Then some people came, bringing to him a paralyzed man, carried by four of them. And when they could not bring him to Jesus because of the crowd, they removed the roof above him; and after having dug through it, they let down the mat on which the paralytic lay. When Jesus saw their faith, he said to the paralytic, “Son, your sins are forgiven.” 
. . . . “Stand up, take your mat and go to your home.”And he stood up, and immediately took the mat and went out before all of them; so that they were all amazed and glorified God, saying, “We have never seen anything like this!”
Mark 2:1-5, 11-12

This story is a wonderful parable about some of the key issues in the current debate about healthcare in the United States.

But I need to begin with a footnote.

The healing stories in the Gospels are always problematic texts for preaching, because all of us know people who have not been healed. At least, not in the way that they would wish. 

And it is important that Christians never, never burden those who are already suffering with the notion that if they had more faith they would, in fact, be healed. The healing power of God must always remain a mystery. And the forms of God’s healing must also be a mystery. But in spite of that caution, these stories speak to us in a profound way about our need for healing and about God’s vision for our lives.

In those days, in Palestine, houses were often made with a mud and thatch roof. Sometimes they were built into the side of a hill, so that you could actually around he side of the hill and up on top of the roof. And that’s what they did. When they couldn’t get in through the door, they went around the side and up the hill onto the roof. Then they set their friend down and began digging through the thatch and the mud.

The scripture says, “He was teaching them the word,” which probably means he was teaching Torah (the first five books of the Hebrew Bible, what we call the Pentateuch, the Books of Moses). 

Suddenly, things begin to fall from the roof. 

Things begin to fall. First dirt and dust sifts down. Pretty soon Jesus can’t even tell his story. Everyone is looking up at the roof, and by now large chunks of things are falling on them. People scramble and cover their heads. And then the roof opens up. 

Jesus looks up there where there are these four guys looking down, probably pretty proud of themselves. What a great opportunity! They have been able to engage in an act of vandalism and do a good deed, a mizpah, at the same time. It just doesn’t get any better than that!

Before Jesus can say anything, the four guys are lowering a fifth guy down into the house right in front of Jesus. They lean down as far as they can, and then pass him to those in the house.

Jesus is amazed at what he sees. Mark observes, “When he saw their faith . . . .” Not the faith of the paralyzed man. He is marveling at the faith of the four guys who carried him through town and ripped up the roof. 

What a risk they took! 

“When he saw their faith, he said to the man, ‘Son, your sins are forgiven.’” 

Somehow, Jesus understands that what is paralyzing this man is an overwhelming sense of guilt. There may be fear also, but guilt apparently plays a major role. He is so scared and so guilty, that he cannot even move. Jesus understands that the only way for the man to be healed is for him to feel a sense of grace and forgiveness. 

Jesus turns to the paralyzed man and says, “Take up your mat and walk!”

The man stands up. And takes his mat. And walks out of the house. People are in shock. The crow gathered around the house saw the man carried up onto the roof, and now they see him walking out the door. They are excited and amazed, and they shout, “We never saw anything like this!” Which is the only proper response to the church in action. 

When the church is really the church, when we are really being the people God has called us to be, the only proper response is, “We’ve never seen anything like this!” It is always amazing to believers and non-believers alike. 

In terms of the current healthcare debate, the story makes at least three important points.

First, when people can’t walk, we need to carry them.

The basic theory of health insurance is that the healthy people carry the sick people. And when we are dealing with serious illnesses like cancer and heart disease, where the costs of treatment are measured in hundreds of thousands of dollars, we need a lot more than four healthy people to carry one sick one.

The proposed American Healthcare Act, says that healthy people should not have to carry sick people, at least they should not have to carry as many or carry them as far. According to the Congressional Budget Office, 23 million people would lose their health insurance under the AHCA.

In a Sunday editorial, The New York Times describes it this way:

“Consider the fate of Medicaid, a program that provides health insurance to more than 74 million people, among them 60 percent of nursing home residents and millions of people with disabilities. Trumpcare would slash Medicaid spending by $834 billion over 10 years, according to the C.B.O. The president’s budget would take a further $610 billion from the program under the pretext of reforming it. Taken together, this amounts to an estimated 45 percent reduction by 2026 compared with current law, the Center on Budget and Policy Priorities says.”

Second, some people cannot be healed unless we carry them.

Jesus’ first response is not to the paralyzed man but to the guys who are carrying them. It is their faith that moves him to bless the paralytic.

If they had not carried him, he would not be healed.

The Times observes that the proposed AHCA, “would make it impossible for millions of people with pre-existing conditions like heart disease or diabetes to buy health insurance. That’s because the law would let states waive many of the requirements in the Affordable Care Act, the 2010 law known as Obamacare. It would also greatly increase the cost of insurance policies for older and poorer people, no matter where they live. By way of illustration, a 64-year-old earning $26,500 a year and living in a state not seeking waivers would have to pay $16,100 a year for coverage, nearly 10 times as much as she would under Obamacare.”

We can debate the exact numbers, but we know that without health insurance thousands of  people will die sooner and a much larger group will have their quality of life reduced dramatically.

And this will be done in order to reduce the burden on those who are healthiest and wealthiest. The healthy and the wealthy will not have to carry as many poor people.

The third point is counter intuitive.

In the parable of the paralyzed man the happiest and healthiest people are the four guys carrying their friend. Human beings are happiest when they are helping others.

To be fair, the four guys are probably happy about more than helping a friend. They get to parade him through the village against his will, and they get to rip up a roof and terrorize the people inside the house, and be praised for it. It doesn’t get any better than that.

The theory behind the AHCA and the budget being proposed to congress is that the happiness of the wealthy and the healthy can best be achieved by doing less for others and keeping more for ourselves. As the Times editorializes:

“Apart from inflicting hardship, what would Trumpcare and the president’s budget achieve? Mainly a windfall for wealthy families. The administration has not provided enough information to make good estimates, so it’s hard to say how much the rich would gain from the budget, although it would be a lot. We know more about Trumpcare. The Tax Policy Center estimates that almost all of the tax cuts in that legislation would flow to the rich: The top 1 percent would take home an average of $37,200 a year, while people with middle-class incomes would get a measly $300.”

Maybe Jesus is wrong. Maybe what really makes us happiest is having more money and doing less for others.

But I don’t believe that’s who we really want to be as individuals or as a country.

Thank you for reading. Your thoughts and comments are always welcome. Please feel free to share on social media as you wish.

Healthcare Is a Universal Human Right

Thus says the Lord GOD: Ah, you shepherds of Israel who have been feeding yourselves! Should not shepherds feed the sheep? You eat the fat, you clothe yourselves with the wool, you slaughter the fatlings; but you do not feed the sheep. You have not strengthened the weak, you have not healed the sick, you have not bound up the injured, you have not brought back the strayed, you have not sought the lost, but with force and harshness you have ruled them.

Ezekiel 34:2-4

Healthcare is a universal human right.

The libertarians will disagree, but from a Christian perspective there is broad consensus that the conclusion is unmistakable.

Healthcare is a universal human right and most Christian denominations would agree with the United Methodists that, “it is a governmental responsibility to provide all citizens with health care.”

The United Methodist Discipline states:

“Providing the care needed to maintain health, prevent disease, and restore health after injury or illness is a responsibility each person owes others and government owes to all . . . Like police and fire protection, health care is best funded through the government’s ability to tax each person equitably and directly fund the provider entities.”

In case you missed the meaning of that statement, we are talking about single payer insurance.

On the other side of the argument, writing for Freedomworks, Julie Borowski makes the libertarian case against the Affordable Care Act. “The dangerous philosophy behind the law,” she argues, “is that too many Americans now see health care as a human right rather than a good.”

“The Declaration of Independence states that we have an unalienable right to life, liberty and the pursuit of happiness. That doesn’t mean that other people should be forced to sustain our life or make us happy,” she writes. “These legitimate rights do not place obligations on anyone except to not infringe on the rights of others.”

Of course, when you boil it all down, the issue is money.

On Vox.com, Matthew Iglesias characterizes critics of the ACA this way:

“They think it taxes rich people too much, and coddles Americans with excessively generous, excessively subsidized health insurance plans. They want a world of lower taxes on millionaires while millions of Americans put ‘skin in the game’ in the form of higher deductibles and copayments. Exactly the opposite, in other words, of what Republican politicians have been promising.”

“What they fundamentally did not like is that the basic framework of the law is to redistribute money by taxing high-income families and giving insurance subsidies to needy ones.”

This, they believe, is immoral. The ACA, they argue, was never about healthcare, it was about the redistribution of income.

Whether intended or not, the ACA does redistribute income as this chart from Gary Burtless and Henry Aaron of the Brookings Institution shows, the Affordable Care Act enacts substantial income redistribution in the United States.

For those who care about economic justice and narrowing the gap between rich and poor, the redistribution does benefit the bottom two-tenths on the income chart. The bad news is first that it does not help a great deal. And second that as a percentage of annual income, the gains at the bottom come at the expense of the middle class. In raw dollars, of course, those at the top contribute the most, but the highest percentage is borne by those at the lower end of the middle class.

The ACA made some real gains in healthcare by making health insurance available to more than twenty million Americans who previously were uninsured. And it did modestly affect the distribution of income.

The plan presently being considered in congress will decrease Medicaid funding, throw millions of people off of insurance plans, make insurance more costly for those who are least able to afford it, and give tax breaks to those who need them least.

We can do better.

Thank you for reading. Your thoughts and comments are always welcome. Please feel free to share on social media as you wish.

The ACA Has Achieved Something Significant

Five Year Old James Cook of Cleveland, Ohio

When he returned to Capernaum after some days, it was reported that he was at home. So many gathered around that there was no longer room for them, not even in front of the door; and he was speaking the word to them. Then some people came, bringing to him a paralyzed man, carried by four of them. And when they could not bring him to Jesus because of the crowd, they removed the roof above him; and after having dug through it, they let down the mat on which the paralytic lay. When Jesus saw their faith, he said to the paralytic, “Son, your sins are forgiven.”

“I say to you, stand up, take your mat and go to your home.” And he stood up, and immediately took the mat and went out before all of them; so that they were all amazed and glorified God, saying, “We have never seen anything like this!”

Mark 2:1-5, 11-12


Modern readers tend to focus first on the miracle.

They may believe it literally, or they may see it as a metaphor. They may rationalize it, or they may see it pointing toward larger truths about healing and wholeness and forgiveness, they may focus on sin and guilt in relation to physical health.

But there is something else, central to the story, which is easily missed. What impresses Jesus is the four friends carrying the paralytic. “When he saw their faith” he offered the forgiveness that led to healing.

They picked him up and carried him.

When Jesus saw them carrying the man, he called that “faith.”

Over the past eight years of our national debate about the Affordable Care Act, one of the most contentious questions has been about whether or not healthy people have a responsibility to carry those who are ill.

And the good news is that we have made progress.

In September of 2011 CNN anchor Wolf Blitzer was moderating a Republican Presidential Candidates debate in Tampa Florida. He posed a hypothetical question to Dr. Ron Paul. If a healthy thirty year old man with a good income chose not to buy health insurance and then became catastrophically ill, what should happen? Paul tried to dodge the question by recalling (incorrectly) that years ago the churches took care of people who had no insurance, but a significant portion of the audience could be heard chanting, “Let him die! Let him die!”

Not our finest moment, though the Ayn Rand crowd must have rejoiced in the triumph of “the virtue of selfishness.”

No one is really happy with the individual mandate requirement of the Affordable Care Act. But without some means of requiring everyone to buy coverage it is impossible to pay for the very popular provisions protecting those with pre-existing conditions and eliminating the lifetime limits on coverage.

The ACA is far from perfect. But it has achieved something significant. It has shifted the terms of the debate.

When we first began discussing the ACA, one of the primary objections was that “we can’t afford it.” In other words, we won’t carry sick people. If people need to be carried they will have to pay for it on their own.

In the initial debates and in subsequent attempts at repeal, those against the ACA did not mention the folks without health insurance. And they did not seem worried that repeal would take away insurance from twenty million people who were previously uninsured and now have health insurance through the ACA.

But now that has shifted.

President Trump’s official position is that the ACA should be repealed and replaced with Health Savings Accounts, which is not really a viable alternative to insurance. But in his public statements he has repeatedly said that we can’t have twenty million people losing health insurance. And other opponents of the ACA have said the same thing.

In the long run we need some version of single payer health insurance like almost all of the developed world. And we could do this using the present Medicare model.

But for now at least we seem to have taken a small step toward.

Thank you for reading. Your thoughts and comments are always welcome. Please feel free to share on social media as you wish. 

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.

Health Care: Economics and Morality

As he went, the crowds pressed in on him. Now there was a woman who had been suffering from hemorrhages for twelve years; and though she had spent all she had on physicians, no one could cure her. She came up behind him and touched the fringe of his clothes, and immediately her hemorrhage stopped.
Luke 8:43-44 

I got a note last week from a young woman in our church asking me to pray for her aunt who “has been diagnosed with lung cancer, lost her job in September and has no insurance. A day later a colleague told me of a friend who was recently diagnosed with Crohn’s disease. The good news is that her doctor has found a medication that gives her relief. The bad news is that it costs six hundred dollars a month, and she has no insurance. And last week I also heard from a young friend who was hit by a car while riding her bicycle. She was wearing a helmet, so the impact of her head on the hood of the car did not, apparently, cause serious injury, but she was reluctant to get checked at the hospital because (you guessed correctly) she had no health insurance.

Americans pay more for health care than any other developed country, and we get worse results. We don’t live as long and we are not as healthy as the residents of other developed countries. The difference is that they have universal health care and we don’t.

The woman with Crohn’s disease is a Canadian citizen who has lived and worked in the United States for several decades. After listening to her problem, a friend suggested gently, “Maybe it’s time to go home.”

We spend over $8,000 per person on health care. That’s more than twice the cost of other developed countries. We have fewer practicing physicians, 2.6 per thousand people compared with an average among other developed countries of 3.1 per thousand. Our life expectancy is 78.7 years, compared to an average among the developed nations of 79.8. And we have 2.6 hospital beds per thousand people, compared to an average of 3.4 beds per thousand in the rest of the developed world.

We spend more and we get less.

Health care is a moral issue, but it is also an economic issue. Universal health care improves lives and it saves money. It is not economically efficient for uninsured people to use the hospital emergency room when a visit to a doctor’s office is what they really need. Routine care can improve health and reduce the number of crisis situations that lead to emergency hospitalizations.

The Affordable Care Act, aka “Obamacare” is less than perfect, but it makes a beginning. Fewer people will be uninsured and fewer people missing out on routine screenings or going to the Emergency Room when they have a bad cold. And fewer people will face bankruptcy as the result of a catastrophic illness.

And there is an added bonus for those concerned about the national debt. The CBO (Congressional Budget Office) estimated that the Affordable Care Act would reduce the debt by $143 billion between 2010 and 2019.