Tuesday, March 24, 2009

On Health Care Reform

I hear very little public conversation from Southern Baptist pastors on the question of health care reform, although it seems to be a major topic in our culture. I can surmise good reasons why we do not opine frequently and loudly on this issue:

  1. Pastors have a sense that they are not qualified to speak about the nuances of health care, since these discussions often wander into jargon pretty quickly.

  2. “Health care reform” is a topic likely to be divisive in any congregation that contains people from two or more of the following categories: employers, employees, government workers, medical practitioners, unemployed people, retirees. That's every congregation that I know, so pastors who aren't looking for yet another controversy are likely to remain mute on the question of health care reform.

  3. The question of health care reform has become politicized, and therefore many pastors will perceive a danger of seeming to be affiliated with one political party or another based upon what they might say about health care.

In rebuttal, I would like to offer several reasons why pastors might want to try to form and publish an opinion on the matter of health care reform:

  1. Intermingled with the biological, legal, and technological aspects of the discussion about health care reform are several profound moral questions. What level of health care do I as a Christian owe to my neighbor? As one whose citizenship is in Heaven, how much is it moral for me to take away from strangers in an effort to live on longer in this world? Who has the responsibility to provide for the care of my parents? For my children? Do we as pastors really find ourselves unable to address these questions for our congregations? Can we really say that these questions are irrelevant to the faith?

  2. Sickness and death are prominent themes in the Bible and as pastors we have a responsibility to call people to a healthy biblical worldview regarding these issues as well as others. Whenever we have a health care discussion, we're really having a sickness and death discussion. Have our people accepted the fact that they are going to face death, and probably sickness as well? Is it not a matter of discipleship to cultivate in them a faith that survives that realization?

  3. Money is another prominent theme in the Bible. What are just ways to earn it and just ways to spend it? If I spend $500,000 to extend my life by three days, is that good stewardship? If I spend $12,000 per year in order to have a health insurance plan that will subsidize my elective surgeries, is that good stewardship? What percentage of our Gross Domestic Product is it good stewardship for us to spend on drugs and procedures and tests? What if I am spending not my money, but somebody else's? Does that change things? Surely God has something to say about these questions.

  4. The Bible strongly commends generosity. What is the role of charity in health care? Is the Bible silent to guide us in considering these questions?

It seems to me that this debate is in desperate need of the input of people precisely like Southern Baptist pastors, at least to place before people some of the clear teachings of the Bible to consider as we address foundational questions underlying our opinions about health care related issues.


Gary Ledbetter said...

Thanks for this. I often come across issues where there is no discernable consensus within our fellowship. I still think it is important to apply the mind of Christ to it as best we can. I'll watch with interest as bright people talk about it.

Alan Cross said...

The parable of the Good Samaritan comes to mind when I think about things like this.

Who is my neighbor?

What can we learn from that in relation to this issue?

Tim Rogers said...

Brother Bart,

As you know life experiences affect how people look at things. For some the life experience watching a grandmother die of cancer because she did not have the health insurance needed to have a diagnosis early. For others it could be the life experience of being taken advantage of by insurance companies using fear.

As we view the scripture should we not ask whose responsibility it is? If I cannot afford insurance for my family should my taxes increase to cover others who use the ER's as Family Practitioners?

Well, those are the questions and the rambling of a dummy. :) (Sorry Brother Gary I interjected before the bright people)


Bart Barber said...


I think you're well qualified to proffer an opinion! But feel free to watch.

Bart Barber said...


I do think that the parable of the Good Samaritan is applicable. And I think that the point of the Good Samaritan parable is that we should draw the circle of "neighborliness" very, very widely.

Applying that parable here only leaves me with a couple of questions, but I think that they are important ones:

1. What level of "health care" do I owe my neighbor? Life-saving emergency care? Absolutely (although that is already universally available without regard for ability to pay). But does the parable of the Good Samaritan obligate me to pay for Viagra for the guy down the street? I don't think so. And those two extremes mark the boundaries of a lengthy continuum. Where along that pathway does my obligation cease?

2. If God expects me to provide something for my neighbor in the name of Christ, does it follow that he expects the government to confiscate it from me and provide it for my neighbor in the name of the government? In some cases, perhaps. But I'm not comfortable with drawing a universal equivalency between the two.

I'm not suggesting that you have offered an answer to either of these questions, so I provide them neither to agree with you nor to disagree (for I do not yet know what you think of them). These are merely the thoughts that come to mind when I think of the Good Samaritan in conjunction with health care reform.

Bart Barber said...


You are absolutely correct in pointing out that people's views of health care reform are impacted by their life experiences. Experience is an inescapable influence, even if it so often leads us astray.

Thinking about American experiences with health care cause me to think about the recent YouTube video, “Everything's Amazing; Nobody's Happy” (my apologies for linking to something with PG-13 rated language, even after the bleep).

Bart Barber said...

I've often wondered how popular this health insurance plan would be:

1. Your premiums are guaranteed never to rise at all.


2. We're never adding any new drugs or procedures to the coverage. For the rest of your life you only get the health care that is available as of today.

Part of the problem with our discussions, it seems to me, is that we use the term "health care" as though it means something static and well defined. It doesn't. What we mean by health care does not at all resemble what our grandparents meant by health care when they were our ages.

So, if the product changes every year, why should the price stay the same.

Jeff Richard Young said...

Dear Dr. BB,

I'd like to throw this thought into the equation: part of "love your neighbor," perhaps 1/6th of it, is "Thou shalt not steal" from your neighbor. It cannot be, then, that we should steal money from neighbors who have lots of it, and use it to buy health care for those neighbors who don't.

Thanks very much for bringing up this subject. I've learned something already here, and I hope to learn more.

Love in Christ,


Dave Miller said...

Is it wrong of me to be so discouraged about the political direction of our nation that I just despair and ignore politics?

Please affirm that this is a mature, faith-based response!

Chris Poe said...

The church (construed very broadly for the purposes of this post, or Christendom if you prefer) used to be very involved in health care.

Think of all of the Baptist, Methodist, Presbyterian etc. hospitals that once existed. Some still do, typically in larger cities, but in many cases these hospitals have been sold off to private companies like HCA due I'm sure in large part to the vast changes in the industry over the past several decades. I know that has happened with a good many Baptist hospitals.

The Catholics are still very much in the hospital business but say they will shut down the hospitals without a second thought if the doctors are forced to perform abortions.

kws said...


I have given some thought to governmental healthcare reform. The cynical part of me always thinks of Judas and his objection to Mary's allocation of resources in John 12, "Why was not this ointment sold for three hundred pence and given to the poor?" John's editorial comments reflect my fears about healthcare reform in the hands of the federal government, "This he said, not that he cared for the poor; but because he was a thief, and had the bag, and bare what was put therein."

As Christians, we should be defenders of the poor and the oppressed (James 1:27). I have a difficult time knowing how far to take it, however. The poor get inferior service to the rich in every area of life due to their poverty (not just healthcare). For example, a poor person is more likely to spend time in jail for committing the same crime as a rich person because the rich can hire better lawyers. The rich can afford to send their kids to better schools, etc., etc. I think the point that James makes is that the church is the one place where the poor should expect and receive the same treatment as the wealthy. I am not convinced that it is the pastor's place to voice or publish to his people a positon on universal healthcare, but I'm still praying it through.

Bart Barber said...


I don't think that we can relegate all taxation to the level of "stealing," lest we miss the legitimate significance of Jesus' statement about rendering unto Caesar. However, in a democratic voting scenario in which people are able to point the government in a direction that lines their own pockets, I think that we do have to give thought to the propriety of spending other people's money on my health care. Even if we acknowledge the legitimacy of the concept, we have to give some pragmatic thought to how long it can work before the other people either run out of money or simply move outside of our jurisdiction.

Bart Barber said...

Dave Miller,

I can sympathize. Yet one of the points that I tried to make in the original post is that, although there are political dimensions to this question, this is so much more than a political issue.

If distaste for politics means that we drop topics the moment that the political world gets involved in them, then I believe that it is counterproductive. If, on the other hand, it means that we sometimes address the same questions as politicians, but do so in a manner that clearly rises above their methodologies—if that's what disdain for politics means—then I could applaud that approach.

Bart Barber said...


I think I would support the kind of health care reform that (rather than trying to discourage charitable giving) gave dollar-for-dollar tax credits to people who donate money to a charitable hospital or clinic or other entity providing charitable health care. Each of those dollars represents tax money that the government no longer needs in order to service people whose health care has already been provided.

Bart Barber said...


I'm not necessarily calling for pastors to articulate a yea or nay on any particular political platform. Rather, to try to speak more clearly, I'm saying that preaching the Word necessarily involves advocating certain positions on the stewardship of resources, the value of human life, the treatment of the poor, the importance of generosity, the reality of death, the need not to cling to this fleeting life, personal responsibility toward parents and family, etc., that are all involved in this question in one manner or another.

kws said...

I agree with you as far as the scripture is clear. For example, we all should be promoters of generosity, justice and simplicity as these are clearly taught in scripture. However, the present healthcare debate is extremely nuanced making it very difficult for pastors to find firm scriptural ground from which to voice a clear position. On the issue of stewardship of resources,
Tim's comments on personal experience are helpful. As you know, our three year old daughter was recently diagnosed with autism. Though she is perfectly healthy physically, her linguistic and emotional development are far behind her peers. All of her prescribed treatments are theraputic (physical, occupational, speech, etc. and taken together will exceed $60000 annually.) Some would say this is poor stewardship as the success rate for those with her condition is less than 50%. Further, if the insurance company does agree to pay for these therapies (still unknown) it will cause all of our premiums to rise. The truth is, as I Dad, I could not care less if your premiums go up, if by doing so my daughter is healed. I think I stand on biblical grounds in that positon(I Timothy 5:8).

Bart Barber said...


Thanks for giving us a specific situation, and one that is personally important to me, to keep this discussion real. I observe:

1. Rather than being a matter off-limits for me, I feel that it would be perverse for me not to have strong feelings and opinions about the well being of your daughter (I went back through this response and carefully edited out her name...thought you might not want that all over the Internet). Her situation shows clearly that there are powerful moral questions and people's real lives affected by this question.

2. I think that there is a difference between voluntary insurance and mandatory taxation. You correctly note that any person's medical expenses (your daughter's are no different from my son's eyeglasses in a qualitative sense) will raise all of our premiums. But, for you to establish that her treatment will be covered would mean a corresponding increase in coverage for me alongside the increase in premiums—I would then know that any child of mine afflicted similarly would be covered for similar therapy. I'm then in a position either to determine that the changes are not a good deal (and to take my insurance business elsewhere) or that they are a good deal. For us to enter voluntarily into a common risk pool is a different thing from us being compelled by the coercive force of the state to underwrite the medical costs of one another's children.

3. If you had a need, I would open my (nearly empty) wallet to you, my brother. I believe that charity is different from taxation as well.

4. I'm not ready to declare that there is no room for taxation and government-based involvement in health care (which we have had for quite some time already). I'm merely saying that I observe moral differences among those three things (charity, insurance, and taxation).

5. The stewardship question is, as you note, a difficult one. Basically, according to U.S. per capita income calculations, $60,000 represents two people's full-time labor for nearly an entire year (10 months). It is a different way to look at it, I think, to imagine two people giving away 30 hours per week doing nothing but working with your daughter.

But the underlying reality is that her therapy will not really take anywhere near that many man-hours each year, will it? The "is it really worth that much?" question may be reworded "should it really cost that much?" Any examination of health care reform should, I think, look to see whether our present system contributes to excessive inflationary pressures upon the cost of care. I suspect that it does.

So, there's an example of what I'm saying. I think, although it is not a clear teaching of Scripture, I might be on solid pastoral ground as well as right in line with the logical outcome of scriptural principles, were I to say, "It ought not to cost the entire annual income of a household for a Dad and Mom to treat their daughter for autism."

6. The stewardship questions are ultimately unavoidable if we move more and more toward a government-based solution for health care reform, I think. Because of the figures that I listed above, I fear that government actuaries would rapidly conclude that your daughter's treatment is not a wise investment. That part really scares me the most about some kinds of health care reform discussed.

I think about the daughter of our mutual friend, diagnosed in vitro with a horrible disfigurement and given a dour prognosis involving certain death soon after birth. Abortion was the universal prescription. She's a pre-teen now, I think, and perfectly healthy. Under a government sponsored health plan, might some Nancy Pelosi in training have declared that the government would cover the abortion that everyone prescribed, further declining to provide health care for the baby if she were carried to term against doctors' advice? I think that sort of thing is inevitable under some proposed systems. This is what I mean when I say that there are some very deep, very profound moral questions tangled up with all of these political and legal and biological questions involved. I don't care whether we have an opinion about the tangential matters, but I think we ought to give attention to the moral dimensions of it.

Private insurance, on the other hand, puts you in the driver's seat for choosing coverage and premiums and then choosing either covered treatment or choosing to expend whatever personal funds you have in order to go above and beyond that treatment.

And private charity gives me the choice to help you if necessary, along with the choice to decline to help if I disagree vehemently with your choices.

IN CONCLUSION: As I said above, I don't know that we need to be stating our support or opposition for any particular political platform. I do believe, however, that we have something to contribute to a conversation about the deep moral and theological issues involved in this very complex issue. The important part of it, I think, is that our contribution to those moral and theological concepts may not be made at all if we do not make it.

Certainly I do not trust any of those at the helm of the movement on the political side to be addressing these questions at all, much less providing good answers to them.

kws said...

Very well said. My primary point with using a personal example is that this is far from a black and white issue. I am unusually blessed in that I have a wonderful health plan provided by my employer through our denomination. Further, I have wonderful family and friends (like you) who have volunteered to help with any shortfall to make sure that our daughter gets the best care possible. However, if I were not so fortunate and uninsured, my love for my daughter would be no less, and my opinion of healthcare reform might be quite different. I certainly believe that the family should be the primary provider for all needs (healthcare and otherwise). Beyond that, Christians should assist one another in times of need while showing mercy to all those made in God's image. I'm simply saying that as pastors we must not go beyond the scripture in our political pronouncements. The same can be said for immigration reform and many other issues in which I have rarely been directly impacted. However, one of our custodians (a believer) who is seperated from his wife and infant son because of immigration issues has a very different perspective than I do. You know that I am a theological and political conservative and uphold the rule of law, but mercy and kindness are not enemies of lawfulness. I know that I am preaching to the choir at this point. In short, I will, most likely, not address helthcare reform from the pulpit anytime soon. However, where the scripture is clear (abortion) I am perfectly willing to take on issues that are perceived to be political in nature.

Bart Barber said...

"Mercy and kindness are not the enemies of lawlessness"

Indeed, I agree.

Also, I hasten to clarify, it is because of mercy and kindness that I believe that some sort of reform in our health care system is needed.

Perhaps we pastors are better suited to point out the problems than to specify solutions! ;-) Because I don't know that I have any foolproof ideas about how to solve the health care situations ongoing around us, but I do see that there are problems both with the status quo and with some of the proposed solutions.

As a proponent of exegetical preaching, I am not (as you might suspect) calling for a sermon on health care reform. I was thinking more about, for example, blogging or newsletter articles or other forms of communication to highlight what are the moral and theological issues involved in this debate. It might be offered more by presenting the answers to the clear scriptural foundations and then simply presenting the questions (as I did in this original post) without answers for the specific policy implications.

kws said...

Love you.

Anonymous said...

I dont know what the answers are, but I have a few ideas.

Here is what I know - the govt program of medicare causes tremendous cost shifting to those of us covered by private insurance. For example, if covered by medicare an individual who is on kidney dialysis is billed on average $8,000-$10,000 per month for dialysis, an individual with private coverage is billed an average of $25,000 to $30,000 (and you wonder why guidestone insurance costs so much). doctors have recently begun to perform chemo therapy in their offices - and charge 400% to 600% more for the drugs than they pay, other injectable drugs are also marked up at a similar percentage. Pacemakers are incredibly marked up.

In an average group of 100 or more employees the old 80/20 rule applies, (actually 85-15 or even 90-10), that is 15% of the employees of a group are responsible for 85% of the cost.

The only real "insurance" that takes place in group medical plans is the cost for high dollar claims, those that exceed $20,000 or more. Other than that the old adage of premium = claims + administration applies.

Here are my answers to the medical "crisis" and I would have the govt play a role. I would set up a national, or state reinsurance pool that all groups paid into. That pool would assume the risk for claims in excess of a certain dollar amount based on the size of the employer group starting at about $15,000 for small groups to as much as $1,000,000 for fortune 500 companies. Those claims would all get medicare pricing.

Next I would do away with charging individuals different amounts based on who their ppo/hmo/insurance carrier is. I would have true transparency - each facility would post their costs so that consumers could shop which ever facility provides the best results for the best price.

I think we would see the cost of medical care drop 30% almost overnight, we would still have flexibility and availability of coverage that Americans have come to expect - without the long waits in line that the Canadians and Europeans have.

At that point I would require that all employers with more than 25 employees provide coverage for their employees, those with less than 25 ees would either pay or play (offer coverage or pay a tax and the employees get a tax credit to provide their families with coverage.

Jim Champion

Dave Miller said...

Bart, I'm not sure my sarcasm came through in my last column. I know my response isn't right, but I get so frustrated reading the news and seeing what our current admin is doing that I just want to hide.

Nonetheless, my last comment was sarcastic.

I'm usually sarcastic, unless I'm going for obnoxious. Once in a while, I try sincerity for a change of pace.

Bennett Willis said...


An interesting article along the line of what we do and why when we are very ill.

Bennett Willis

Olon Hyde said...

I think you are absolutely correct Bart, we as pastor do need to be addressing these issues. We cannot be afraid and think they will resolve themselves. The people in our congregations are lanblasted everyday with these issues and we need to be helping them answer the questions that arise from these and other topics. That is why I have written a short series of posts on the issue of embryonic stem-cell research at my blog. Thanks for the thoughts and I must confess I didn't think their was any spiritual aspect to health care reform. I know I have had to think about this isuue a little more.

Anonymous said...

Very thought provoking, this type of blogging could actually become an innovation in group problem solving. I'm wondering if what we need to consider is a new type of insurance company (for lack of a better term). A not for profit cooperative of Christians concerned with stewardship in relation to health care costs. For example a group of 100 people could agree with a GP that for $75.00/mo they would receive general wellness care no insurance forms or fights. Remember this is a very rudimentary example. Consider what services 10,000 could negotiate for on that basis, or 100,000. Think medicare with a Christian perspective. I don't know if it could work, but the premise might be worthy of discussion by better minds than mine.

kws said...


Great idea, but I'm afraid the Amish beat us to it. They have been doing this with healthcare providers for years.

Anonymous said...

KWS, One of many ideas we might consider adopting/adapting from the Amish. They shared friendship bread and toothbrush rugs, and those worked out well.-)

kws said...

I'm in. I'm starting my beard tomorrow:) Perhaps Dr. Barber could make an historical case for cooperation with the Amish by invoking the name of Menno Simons in our shared Anabaptist heritage.

selahV said...

Bart, for nearly 56 years of my life my husband and I were insured. Then came retirement and not enough money to afford the luxury.

In all the 63 years my husband carried insurance, he used it once for hand surgery. That's it. Never went to the doctor. Cause he was healthy. I, on the otherhand, used it quite often.

Now, we face thousands upon thousands of dollars in bills for my husband's 5 bypasses, and my recent tests. Healthcare. I don't have a clue how to fix it. But I don't think it is the responsibility of everyone else to pay my way. I just don't know how to keep up with it all. Hubby's now working 2 part-time jobs totally 50 hours a week to try and pay off the bills. We know if we live to be a hundred, we might still owe money because as we age, we're sure to have other medical needs.

I have a cd-collection from Sagemont Church in Houston. They share how they always take care of their members in this way if they cannot pay their bills. I don't understand how in the world they do that. But the pastor says it is living out the faith. They also help supplement the incomes of over 175 retired ministers. It seems we as So. Bpt. could figure out a way to do that for the ministers in our convention (especially the small church ministers). But I haven't a clue how that could be done, either.

Nationally? It bothers me a great deal that our Christian brothers and sisters will be paying for abortions, and multiple other health needs that are in direct opposition to how we believe morally and yet we cannot help our own brothers and sisters. And with charitable giving now losing exemption, I'm sure it will hurt us even more (it shouldn't because we need to give because we have the spirit of generosity).

I know if it had not been for our church helping us when my husband had his heart attack, I don't know where we'd be. And if it weren't for Sagemont, I wouldn't have the money to even have internet. Indeed, I am a grateful person right now. Extremely grateful.

I do hope you great thinkers can come up with some great solutions. selahV