Christians and Health Care Reform
This is not intended to be a definitive treatment of the subject at hand – I’m not qualified to write a definitive work even if I desired. The historical picture I paint is with the broadest brush and certainly does not apply universally. However, I believe the historical flow depicted is representative. This posting is more of an apology for how a normally conservative type became convinced to support and work for health care reform in America, even when many of my conservative friends consider this a traitorous activity. For me this became a matter of conscience and not a political or economic decision.

Once upon a time in a land far removed from 21st century America (not geographically but sociologically) there lived a people heavily influenced by the Christian concept of charity. These people were followers of Jesus Christ and understood that part of the work left for the Body of Christ was to expand the Kingdom of Heaven into every aspect of life on this planet. They understood, as did the translators of the King James Bible, that 1 Corinthians 13 should more correctly be called the “Charity Chapter” rather than the “Love Chapter” of the Bible. The translators of the KJV knew that charity is a special type of the agape love (love involving action) presented in the New Testament. Charity, as described by several Biblical scholars, is the ultimate perfection of the human spirit because it is said to both glorify and reflect the nature of God. These people of an earlier time may not have known what a “worldview” was but they certainly lived with a “community-view.” They understood when something happened to one member of the community it affected everyone in some way. Though their practice of charity was certainly not perfect, there was no misunderstanding the concept that it was to be extended to every member of their community.

Some reading this may be familiar with the Mitford series of books by author Jan Karon. Mitford is a fictional small town in the mountains of North Carolina. The main character in the series is Father Tim, an elderly and well loved Episcopal priest. The mayor of Mitford is fond of reminding Father Tim of the town’s motto: Mitford takes care of its own (more on this later). This is the community-view that so many believers held to in times past. To them, this was the Kingdom of Heaven working itself out on earth. For the love of Christ, communities took care of their own. This included caring for the sick and dying.

As we move forward in time, we see how the Church responded to society’s change from primarily rural to urban. In medieval Europe, monasteries which were located close to towns began to add facilities to care for the sick and dying. These facilities were the earliest version of modern hospitals. They accepted all comers, regardless of their ability to pay or make gifts to the monastery. As industrialization and modern medicine developed, churches built hospitals: Baptist, Methodist, Presbyterian, Lutheran, Catholic, and others. These hospitals were not just mercy hospitals for the poor. These were general service hospitals, many with research and teaching facilities. For decades these hospitals were the backbone of medical care in America. The denominations which owned these hospitals saw the potential that these hospitals could become “budget neutral” as the ratio of paying beds to charity beds increased. Gradually, these hospitals moved further away from the “community-view” understanding of charity and became just another ministry of the denomination. Nevertheless, these hospitals continued the Kingdom work, even if individual Christians had little involvement. Maintaining the “budget neutral” operating model gradually became more important than treating all the poor who sought help. In many cities, the need for more charity beds increased and city-owned hospitals were built to fill this need. The government began to assume the role of “charity” provider when the Church failed to respond to the need.

About the same time, the Fundamentalist vs. Liberal debate was heating up in the Protestant community. One charge made by the Fundamentalists against the Liberals was that they had abandoned the true gospel for what was referred to as the “social gospel.” A very simplistic explanation is that the true gospel was about saving souls while the social gospel was strong on community service and weak on Biblical doctrine. The Fundamentalists (Evangelicals) began to move away from most of those activities that could be associated with the social gospel agenda, including owning hospitals. Most evangelical churches organized “mercy ministries” which were funded by tithes and offerings. However, other than educational institutions, these churches left the playing field of “social services” to the mainline denominations.

About forty years ago advances in medical technology began to accelerate rapidly. At the same time, smart businessmen began to see the profit potential in the health care field. For-profit hospital management companies began to be formed. Medical insurance companies discovered the concept of managed care. Pharmaceutical companies began to focus their research on drugs with high profit potential. The focus of health care in America shifted rapidly from caring for the needs of sick people to making a profit on every component of the health care delivery system. Health care today represents one-sixth of our gross national product. I am not inferring that there is some inherent evil having for-profit companies engaged in health care. However, most of these entities are publically owned corporations which must produce profits for their stockholders – that is their prime directive. Many of these companies have a strong self-interest in maintaining the status quo.

Returning our thoughts to the church, I believe it is fair to ask the question “do Christians still have the obligation to exercise charity (though the word is hard to find in most of our translations)?” I believe that we do. I believe the call to charity is just as strong today as it was 200 or 2000 years ago. I believe that bearing one another’s burdens includes the physical and fiscal as well as the emotional and spiritual. The problem is not a change in the Biblical command. The problem is that the playing field has so radically changed in our complex and interrelated society that it is hard for us to know how charity can be exercised outside that limited circle of close acquaintances. As mentioned previously, the church gave up much ground in rejecting the social gospel and that ground is difficult, if not impossible, to regain. I don’t think there is a church/denomination today which is considering getting back into the hospital business. It may not even be possible with the existing government regulations. However, there are areas where the church could still directly minister to the sick and dying. For example, churches could develop and operate hospice facilities. Last week I was in a hotel in Pensacola which was located next door to the corporate headquarters of a company that owns and operates for-profit hospice facilities in the southeast. If there was ever a place for Christian charity it is in caring for the dying, yet the only hospice facility I know that was started and operated by a church is located in Cape Town, South Africa.

Are the mercy ministries which are part of many churches fulfilling the Biblical mandate for charity? I have been a deacon in one PCA church and served as an elder in three others. In my role as elder, I have been involved in training men who feel called to serve as a deacon. In most churches today, the mercy ministries have funds to meet certain type of emergency needs (food, utilities, rent, etc.) but are not geared for the long haul or the large expense. Most deacons are trained to direct people with long term needs to various government agencies for food stamps, public housing, welfare, etc. Our “charity” then becomes directing those in need to some government agency for assistance. Surely we don’t expect these “social services” agencies to dispense their aid with the love of Christ, do we? Remember Mitford’s motto: we take care of our own. I don’t know of a single church today that practices this within their congregation. That is not to say that under special circumstances, congregations don’t rise up and care for some extraordinary needs. My home church has done that on several occasions I am aware of and covered some medical expenses that were beyond the family’s ability to pay. But such circumstances are the exception and not the norm.

So how does all this relate to health care reform? Today there are 46 million Americans without health insurance. In Tennessee there are over 850,000 people without any health insurance and the number is growing as further cuts are made to the TennCare program. The Church, which for most of its 2,000 years was the primary source for charity, has relinquished these roles to the government. I don’t agree with what the Church has done but I realize that to reverse this situation would take decades. I would love to see the Church begin to return to what I have called the “community-view” but I see few signs that this is occurring. We, as believers, are all called to a life of charity – it’s not optional. In some cases, that charity is worked out one-on-one. In other cases, it involves the community as a whole. Today there is a pressing need: millions of our neighbors (remember the definition of neighbor in the parable of the Good Samaritan) do not have access to even basic medical care. For me, extending charity to these people involves supporting sweeping national health care reform to provide every citizen with basic health care regardless of their ability to pay. For those who are saying that this would be the first step to socialism, I invite you to consider all the existing entitlement programs and explain how they don’t fit the definition of socialism. My strong preference is to see the Church recover its rightful role in Kingdom work and make charity its hallmark in the world. I pray that this occurs some day. In the meantime, to say to those without adequate health care that they need to wait for corporations to decide to give up some of their profits or for the Church to restore its charitable role is like blessing the hungry man with kind words but giving him no food.