A Word From The Wounded Healer
To Contemporary Christians
Seeking Physical And Spiritual Health
Children's sermon
Illustration
Preaching
Sermon
Worship
Object:
Dear Fellow Preachers,
Yes, we know the so-called Suburban Sniper is at the top of every newscast these days, but we're moving attention to another major issue for this week's installment of The Immediate Word. Instead, we've chosen to tackle the health care crisis that is now a huge concern across America, one that demands a response from a Christian perspective. In this Sunday's gospel reading from the lectionary, Jesus says, "You shall love your neighbor as yourself ..." (Matthew 22:39). Jesus also made health care a religious issue when he said, "I was sick and you took care of me ... I was sick and you did not visit me" (Matthew 25:36, 43).
So we've asked TIW team member Carter Shelley, who is married to a physician, to write about the gospel imperative as it relates to health care.
As we've been doing each week, we have also included team responses, related illustrations, worship resources by Larry Hard, and a children's sermon by Wesley Runk.
A Word from the Wounded Healer
to Contemporary Christians
Seeking Physical and Spiritual Health
By Carter Shelley
Matthew 22:34-46
Had Jesus been born in 2002 instead of 3 or 4 B.C, had his parents been traveling through an American city not their own, the problems they would face might resemble those many Americans encounter today when the combined forces of job loss and ever higher health costs make decent medical care a challenge for middle class Americans, as well as for the ever with us poor. The problem wouldn't be no room in the inn, but that no lawsuit-fearing obstetrician would deliver the child of an indigent woman with no health insurance. No hotel or motel would open its doors to the weary and scruffy young couple because their Visa card and Mastercard already were charged to the max. And since they were not yet legally married, no local pastor or rabbi would intercede to solicit a spare bedroom at a congregation member's home where the young frightened couple might stay for the night.
In 2002 there seem to be no winners in the American Health care system -- not the doctors, not the lawyers, not the insurance companies, not the pharmaceutical researchers, and certainly, not the patients. We the people of the United States are having to adjust our own thinking and expectations about what risks and what price we are willing to pay for health care for ourselves, our employees, and our neighbors. This question is posed in the context of our lives as followers of the dear and glorious physician, Jesus Christ, who reminds us in this Sunday's lectionary text, "You shall love the Lord your God with all your heart, with all your soul, and with all your mind ... [and] ... You shall love your neighbor as yourself."
In Matthew, these two commandments stand on their own, but in Luke's version they are uttered in response to a lawyer's question, "What must I do to inherit eternal life?" Jesus' answer leads the lawyer to ask a follow up question, "And who is my neighbor?" Which Jesus answers with the parable of the Good Samaritan. Today, I share with you the 21st century version of Jesus' parable.
A middle class American's car broke down on the side of a secondary road in a bad neighborhood at 11 at night. Having left his cell phone at home, the man had to leave his car to go in search of a telephone from which to call for help. On his way, he was set upon by a gang of thugs. Beaten to within an inch of his life, he couldn't be sure of the identity or race of his attackers, but he did know that he'd had $127.32 cents in his wallet, four credit cards, and his health insurance card that came with a $1000 deductible before coverage would be provided.
Left to die in a ditch by the side of the road, no one saw him until the next morning. The first person to drive by was an elderly woman on her way to the drug store to get her monthly prescriptions filled. She was very worried about the latest medicine her doctor had prescribed, because he'd told her it was expensive but worth it. Easy for him to say. He wasn't the one living on a fixed income. He wasn't the one whose small savings was depleted now more than ever before due to the fall in value of her 401k at the very time in her life when all of her medical expenses were increasing. She and Henry, her deceased husband, had been careful planners and careful savers, but it seemed it was all for naught now. What she didn't spend on heating, gas and groceries went to pay for medicines. All were expensive, and all were said to be necessary. Driving along, she had to swerve to miss a dog chasing her car. Shaken, she pulled to the side and stopped to catch her breath. That was when she saw the man in the ditch. He looked like he was dead. Afraid to get out of her car, she drove away telling herself she would call 911 when she got home.
Thirty minutes later an insurance man pulled off the road to look at his road map. He was late for a meeting with a small business owner who wanted to discuss the increased rates and reduced benefits for employee health insurance the insurance company now provided. The insurance man had a headache, a bad one. Yesterday had been the pits. He'd been in the office until 8:30 p.m. First, had been the hysterical lady who'd showed up at closing time frantic about her coverage. She been dropped from their policy due to a pre-existing condition. "But I didn't know I had a kidney disease when I started on your insurance!" she'd cried. "My doctor didn't know I had it either! He thought I had something much simpler and easier to treat. How can you drop me when neither my doctor nor I knew I had a chronic illness when you first sold me insurance?" The insurance man felt bad for her, but he'd had no choice. His boss had called him in earlier in the day and chewed him out good for "being too soft" about payouts and benefits. "Our company's losing money left, right and center. If you want to keep your job and help this company stay afloat, you're going to have to be a lot tougher when it comes to claims and discontinued policies." The insurance man wanted to stuff this job and its policies, but he didn't dare. Unemployment was high right now, and besides, he couldn't afford to go without the company's medical insurance. His youngest child had cystic fibrosis and there was no way they could cover the incessant medical costs without good medical insurance. The man put the map back into the car's door pocket and drove on. He never even noticed the man in the ditch.
Dr. Hester Sims saw the body lying in the ditch but did not stop. One of her friends had recently lost her home and savings in a lawsuit brought by a man injured in a car wreck. Also a physician, her friend had stopped at the scene of a road accident to offer assistance. The man she'd treated until the paramedics arrived, claimed his accident-related permanent paralysis was her fault. That he hadn't asked for her help, and his being moved had made his injuries more severe. He and his attorney failed to mention that he'd been yelling his head off with pain and had been thrashing and rolling about despite the physician's attempts to calm him and keep him still to avoid further injury. It had been his word and his family's word against hers. The jury had ruled in favor of the man. After all, all doctors are rich. They can afford it. Only, Hester knew her friend couldn't afford it. Four years of medical school. Three years of residency. Student loans, childcare costs, home mortgage and car, not to mention the worst expense of all -- liability insurance which ran into $100,000+ per year. Hester knew that more than 50 percent of the time, physicians are sued without just cause, because patients saw it as an easy way to make a quick buck. Just the day before she had angered a patient who wanted Hester to sign off for disability insurance due to whiplash the patient had incurred when his car had been rear-ended. Hester had refused. Sure, the man's neck was sore, but it and his back were just fine. He had stomped out to the reception area shouting that she was a sorry doctor who didn't care about her patients, and he was going to find a doctor who did! Hester sighed. She made a note of some landmarks along the road and picked up her cell phone. No, she wouldn't stop, she couldn't afford to get involved, but she would call the police.
Enrique's secondhand truck needed a new clutch and a new muffler. He'd been lucky not to have been pulled over by the police for all the smoke his tailpipe was generating. He couldn't risked being stopped, not without a green card and work permit. Living a life of stealth was hard in America, but it was worth it. The 12 hours he put in at the Tyson chicken factory made it possible for his parents and brother and sisters in Mexico to eat regularly and live in a better place than had ever been possible before. It was lucky too that his wife also worked at the factory, because they now had a nice trailer to live in and were able to buy their young children things their own parents had never been able to afford. It gave Enrique great pleasure to see his children head off to school in the morning just as he came in from the night shift. They had toys, nice clothes and a chance to get an education. Of course, Enrique knew he wasn't paid as much as the Anglo workers, because he was illegally living in the U.S., but he didn't care, not much anyway. It was still more money than he'd ever be able to make in his home village. Enrique saw the man lying in the ditch. He drove a few hundred yards further, hesitated and then stopped. "For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me ... " Jesus would not pass a badly injured man lying in a ditch. Jesus would want him to help even at the risk of being discovered and deported. Enrique put the truck in reverse and backed up to beside the man.
We the people of the United States of America are facing a health care crisis that really had no parallel in the first-century world. In Jesus' day, the worst thing about physical disabilities or illnesses was the social stigma and isolation they caused. A leper, a person possessed by demons or sick with some inexplicable and incurable illness was often expelled from the community both for its safety and the accompanying assumption that some sin must be attached to one God had made so ill; thus there was an element of shame and stigma that accompanied any sickness or disease. In helping the lame to walk and the blind to see, Jesus not only restored a person's physical well-being, he made it possible for them to be restored to the community, to be in relationship with others.
In contrast, our American health care crisis is not about loss of community or loss of face. For us, the hardest impact is financial. The elderly can't afford to pay the ever-increasing medical costs that advancing age tends to require: more prescriptions, more visits to the doctor, more and longer hospital stays. For us, the hardest part is financial. Insurance companies seem like the "bad guys," but the fact of the matter is both they and many small businesses are running on empty or going out of business. That's because they can't make a reasonable profit and provide reasonable health coverage for clients due to the incredibly high medical costs at every level in the system -- doctor visits, tests, prescriptions, hospital operational costs and surgical expenses -- the list is practically endless.
For us, the hardest part is financial. Due to pressure from HMOs, hospital administrators and local practices, doctors are being asked to see many more patients and for far less time in order to make enough money to turn a profit for their sponsoring institutions. In addition, the threat of lawsuits are so much the norm these days that many physicians had concluded they can't afford to practice medicine anymore due to the exorbitant cost of liability insurance. That, in turn, is the result of the many successful suits brought against doctors practicing medicine. The result can lead to low morale and poorer medical care by doctors who can't afford to provide services, such as obstetrics and delivery, and an unwillingness to pursue any treatment plan that comes with an uncertain outcome.
For all of us the hardest part is financial. Who among us has not experienced higher monthly costs for medical insurance, higher co-pay and office visit costs and higher deductibles before insurance policies kick in? We have some of the best technology, physicians, facilities available anywhere in the world, but it all costs money. Lots of money.
It would be easy for each of us to point an accusing finger at someone else as being the source of the problem. It's the doctors! It's the lawyers! It's the insurance companies! It's the politicians! It's the poor and the elderly who rely on Medicaid and Medicare.
"The enemy is us," writes Dr. George D. Lundberg, MD and author of Severed Trust: Why American Medicine Hasn't Been Fixed. He states that our current health care crisis had its genesis after World War II, when regular, quality health care moved from being a luxury of the well-to-do and the desperately ill into an expectation of all American citizens. First, came an employee benefit by which medical insurance was tax-free because the employer provided it rather than the employee paying for it from wages earned. Since it became a cost of doing business, companies benefited tax-wise as well:
By creating the illusion that health care services for the insured came apparently free of charge, the new arrangement changed everyone's thinking about costs. So what if costs went up? The money didn't come out of the worker's pocket, and the employer simply wrote off the cost. This mentality was the genesis of funny money.
Physicians compounded the problem by enthusiastically accepting third-party health insurance payments when they became available, even though organized medicine -- as represented by the American Medial Association and state and county medical societies -- was critical of the practice.... at first physicians continued to bill patients, who then filed claims with their insurers and paid their doctors after receiving the insurance check. When it became apparent that many patients were not forwarding insurance payments but instead pocketing the checks, physicians worked out agreements with insurers for direct payment. When physicians began to bill insurance companies instead of patients, the perception was reinforced that care was free of charge.
If physicians hadn't done that, they would have kept third-party payers out of the patient-physician relationship.... But that would have been too much work for doctors and patients alike. When physicians accepted direct payment, they were freed from the disagreeable need to dun patients, who were freed up in turn from the bother of paperwork. Physicians didn't have to worry about reimbursement anymore; it came directly from the insurer. Physicians made it even easier for patients, by waiving the 20 percent co-payment that insurance policies required, a quasi-illegal practice that no one complained about.... Moreover, the cost of care increased since patients had no incentive to resist higher physician charges. Patients often didn't even bother to look at the charges. Twenty-five dollars for a lab test that cost fifty cents to perform? No skin off my nose.
When for all intents and purposes, health care services seemed to come at no cost to patients, not only were patients' anxieties relived, but physicians were encouraged to order and perform more services. For physicians the new mantra was, when in doubt, do it, and for patients, when in doubt, see the doctor (25-27).
"Who is my neighbor?" the lawyer asks, and Jesus responds with the parable of the Good Samaritan. "Who is our neighbor?" we 21st-century Christians ask. Jesus, from George D. Lundberg, MD and Homiletics professor, Kathy Black, author of A Healing Homiletic: Preaching and Disability, all recommend the same solution. If the enemy is us, then the solution is also us.
"The health care system as it has developed over the past two decades has led to an impossible situation for doctors and patients to have a trusting relationship." writes Lundberg. Patients don't trust doctors because they can't trust the health system. It used to be that the patient-doctor relationship was the main focus. Now, when a patient comes to see the doctor, it's more about what will the system provide for the patient and what it won't provide and how will doctors play his or her role in that. There's little time for caring relationships, because money drives the American health care system and not quality care." Lundberg goes on to say, "We helped to get ourselves to this juncture," therefore, it's up to us to get us out of it.
"In my dream scenario," he continues,
The government would pay for all scientifically proven preventive medical services, and insurers, whoever they are, would cover all scientifically established catastrophic, expensive care. In between those poles would be the private practice of medicine, in which routine care would be a matter between patient and physicians, with no third-party intrusion (271).
Kathy Black offers a Christian theological context for understanding our connectedness and interdependence both as Christians and as people disheartened by the current costs and morass of American health care.
"Who is my neighbor?" We ask?
And Black replies, "We are all interconnected and interdependent" (34).
Who is my neighbor?
"The universe is interdependent and God is a part of this interdependence" (37).
Who is my neighbor?
Who is my neighbor?
"The Bible gives no biblical or experiential reason to believe that life will be without problems or crises or heartache" (38), but "the church is the place where people can be accepted for who they are as children of God, the place where dependency is acknowledged and interdependency is valued" (41). [As Christians] "it is this interdependence in the midst of a culture that highly values independence that sets us apart" (42).
The late Henri Nouwen, Catholic priest, pastor and spiritual guide to many, would agree. In his book The Wounded Healer he notes: "A Christian community is therefore a healing community not because wounds and pains become openings or occasions for a new vision. Mutual confession then becomes a mutual deepening of hope, and sharing weakness becomes a reminder to one and all of the coming strength" (94).
As Christians we affirm our total dependency upon God in Jesus Christ to love us, forgive us, and save us. As Christians we declare ourselves members of a community of faith in which we are stronger together than we are apart. Trying to heal the American health care system is a daunting task, but it is not an impossible one. Think of all the talent and brains and creativity and hard work currently required to make our health care system operate. Think how much stronger and more effective (and maybe, affordable) it could be if more Christians saw themselves as part of the cure rather than leaving it all up to our legislators, presidents or state governments to solve.
The people who work in the various parts of the health care system: the doctors, the nurses, the technicians, the medical office assistants, the administrators, etc. etc. They are not people out there; they are here, sitting in our congregations. Wouldn't it be wonderful if we came to see health care as Sharecare and came up with ideas, solutions and resources from within our congregations in concert with other congregations in our local communities to get together church members who work in all these different arenas with ministers and other Christians to figure this all out. Interdependence rather than independence is a fundamental Christian concept.
Who is my neighbor?
Anybody in need.
How may I help my neighbor?
Through constant prayer, through regular communications with our legislators, president and the Supreme Court, through our ability locally to establish churches allied with other churches in the community to think and act creatively in support of positive changes. Remember, in God all things are possible. In Jesus' name, all people are our neighbors. Within ourselves can be found the resources and the heart to take on this challenge. Amen.
Wesley Runk responds: You have provided a great vehicle for delivering the sermon with your contemporary illustrations. I am not sure that an unmarried couple cannot stay in any hotel or motel today but everything else sure rings a bell.
My only thoughts are that we are very heavy on the problems and somewhat light on the solutions. I would like to suggest that there are things the congregation can do to intervene and provide a frontline defense. At our church in Florida, the congregation hires a nurse, which I understand is not that uncommon in Florida. She has a ministry with the many shut-ins, elderly and others who need a lot of attention. Many of the elderly live there without family. She is a main connection to the ministry of the church. She administers some frontline care with shots, (flu shots and other kinds.) She also takes blood pressure and diabetic blood counts, and a variety of other things that eliminate costs to the patient. Plus she is a visiting arm of the congregation and is commissioned to give Communion.
Many smaller congregations could not afford her salary but collectively they could.
Other ministries involve a couple of daily phone calls by members to the elderly or shut-ins to inquire of their health and welfare each day.
Retired physicians and other health workers can set up clinics, often supported by local health departments to assist the poor in care of children and parents. A number of congregations are involved in caring for children's immunity shots and are given on a regular basis.
The fact is that we do not see ourselves very often as caring communities to members of the church and to others. We think only of purchased services. I know of a number of instances where service clubs in our communities have been involved in health care projects for years.
Anyway, I think this could be part of the message. Not just what Jesus did but what we do in the name of Christ today to care for each other.
Finally, I want to say that while the government does have a role to play, I believe the church can be a much bigger player. We may not be able to set broken bones or administer chemotherapy, but we can share a sense of compassion and real love that often will do more than medicine. Prayer communities, support groups, clinics, mobile care groups, health patrols, multi-congregational nurses and aspiring physicians as well as retired physicians make a difference.
Our neighborhood, which has been without a physician for more than 50 years, banded together, had chili suppers and other fundraisers to pay for a student's medical education. He came to our community on a five-year contract to provide services for the poor and elderly. It was a classic illustration of pulling together for a common good. The churches were the inspirational leaders and workers behind this.
The other side of it is the sadness that comes when the needy are denied because of the cost or the inability to find a healthy donor. I have seen this many times.
George Murphy responds: It's pretty good but I do think it's too long. I'd put some of the background material -- e.g., the long Lundberg quote -- in endnotes. That kind of thing is more to inform the preacher than to be used directly in a sermon.
Your updating of the Good Samaritan story is very effective, though I would probably condense the situations of the by-passers a bit. (Also, why do two have names and two don't?) I would begin with it and perhaps bring in the part about Mary and Joseph today later if at all. Then with the latter I'd leave out the maxed out credit cards and their unmarried status, which blur the focus.
A couple of minor points: "No lawsuit-fearing obstetrician" makes it sound as if the obstetrician is to be blamed for this concern. Something like "No obstetrician would deliver the child of an indigent woman with no health insurance because of fears of a lawsuit would be better."
These are matters of structure and detail. I think the basic approach is good.
Carlos Wilton responds: Thank you very much for a wonderful, provocative article. Your pairing of the various personnel from the health care system with the characters in the parable of the Good Samaritan was brilliant.
I would like to have seen a lawyer be one of them, though. The high cost of litigation is a significant part of spiraling health care costs.
Larry Hard responds: I like the way you use the Good Samaritan parable to put health care issues in story form. Your article is full of ideas and resources. My suggestion would be not to shorten it since the amount of material allows a preacher to choose those parts that appeal to her/him. This could lead to a sermon more to inform than inspire, but that is a major goal of presenting the complex issues of health care as you do.
Chuck Cammarata responds: Good stuff Carter! The contemporary parable is very nice. The only thing I would say about the parable is that you might use it to start off rather than introduce it and spoil the surprises it might hold for the listener. You can always move from it into your discussion of the issue.
As some of the others have said in their comments, your piece sparks thoughts on lots of other issues, which is a reminder of just how complex this issue is.
There is certainly the issue of American's virtual worship of medical science. This is witnessed to by the fact that there are still many out there who believe science will someday discover the secret of eternal life. Maybe we should tell them that we already have discovered it. BUT -- this is another issue -- you can't deal with this without taking away from the focus of your current piece. This is a prophetic call to take care of the poor among us. And even if you have a decent job, if it provides no health care, you are poor in America.
The question is, what do we do? Maybe we need to address this a bit more in the article. There are Christian health-sharing organizations out there. One is called Medi-share. It allows people to pay a small monthly fee -- based on their income -- and then share in other's medical expenses as well as have theirs paid for when they have a need.
We might also address what we know about current legislation that we can encourage our people to support. Or maybe our churches can set up forums with local legislators to discuss the issues. We have done a four-week Sunday school class with doctors, lawyers, insurance people and a local legislator. It was very informative and provocative. We also are developing a parish nurse program that will use members who are in health care to test for certain illnesses -- free -- and give guidance regarding health care.
Carter's prophetic call is powerful and poignant. It needs to be followed with some concrete ideas that will enable our people to respond faithfully to the plain will of God -- that being that we take care of the poor -- for whenever we do to the least of these, we do to HIM!
Wesley Runk responds to Chuck Cammarata: I commend your comments. I would love to see some follow up. Perhaps sending copies of Carter's article and comments to organizations. Is there a special day on the Christian calendar besides the Festival of St. Luke's that deals with healing?
Could we propose feedback, the establishment of clinics, nursing care, etc.?
One other thing we need to do is to start writing some letters to people in places where things can be done. Gather people together and give them some thoughts and names and addresses. We can't afford to put anyone out of business. Insurance companies are going out of business, hospitals are going out of business, doctors are going out of business. Not all of them. Some are growing very rich on the system. How do we distinguish between those who are efficient and well managed and those who are gouging? I don't know, but there are people who do know. Thanks again.
Charles Aaron responds: You have some wonderful insights. One of your most important insights is the interconnectedness of the health care issue with the rest of life. In your retelling of the Good Samaritan parable, the health care issue is directly related to crime (the man is beaten by thugs), and the state of the economy (the elderly woman's 401k was nearly depleted). You help us see that health care is not an isolated topic. Another strength of your piece is that you push us to see ourselves as a community. Your repeated quote from the Constitution, "We the people" reminds us that we are all in this together.
Your retelling of the Good Samaritan parable is quite skillful. Your characters are well-drawn and help us put flesh and blood on the problems of the health care system. Unlike Luke, you actually give us the motivation of each character's decision not to stop to help. Giving us that information helps us see how trapped we are as individuals by the system.
It seems to me that your use of Matthew (the lectionary text) is rather brief. Essentially, you use it only to link to the Lucan parallel. Maybe you could have used the idea of "neighbor" from Mathew to create your characters, and thereby stayed in Matthew. Along the same lines, your use of Luke's version of the birth story in your opening paragraph was not well-integrated into the rest of the article. (By the way, I am a pastor, and I would have helped a young unmarried couple. In three of the churches I have served, unmarried people who were involved with a romantic partner have been welcomed as members, and have even served in offices.)
Overall, you did a great job of putting this issue into a theological perspective. Our physical health is a spiritual issue.
I have a couple of thoughts that are related. I have read that if Americans would exercise more, eat better, smoke and drink less, wear seat belts, and practice gun control, we could reduce our health care costs dramatically. In addition, if we didn't expend so much effort prolonging the lives of terminally ill patients, we could reduce health care costs. Our denial of death robs us of resources for life.
W. Stephen Johnson (a reader of TIW) responds: The affordability of health care in this country is, indeed, a cause of concern for many. And people from all walks of life and religious and political persuasions struggle to find solutions. Certainly it is appropriate to lift up the issue and call people of faith to prayerfully work for solutions.
What is not appropriate, I believe, is to distort scripture to make a point. Joseph was neither itinerant nor unemployed. The singular reference to Joseph's profession as a carpenter suggests that he was a successful small businessman.
Just from a perspective of logic and reason, some other concerns I have are:
* The credit card issue is one of money management rather than health care.
* The issue of marital status is an issue of moral prejudice and, likewise, not a health care issue.
* In my town, a traveling couple at the point of delivery would go to the local ER, where they would, by law, receive medically necessary treatment regardless of their ability to pay. They would not need a room at the local hotel, because they would be at the hospital.
Carter Shelley responds to all: I agree that the introductory paragraph served to muddy the theological and homiletical waters by emphasizing the wrong aspects of the biblical text. What I intended to convey through the Joseph and Mary in the 21st situation was the possibility that most of us wouldn't have recognized the sacred in our midst any better than did the first century folks in Bethlehem long ago.
Related Illustrations
Lewis Lapham, editor of Harper's magazine, had some provocative things to say a few years ago about our health-care system:
"The American hospital-going public now asks of its medical advisers what medieval Christendom once asked of its priests and saints -- the remission of sins (of the flesh if not the spirit) and the hope of everlasting life....
"American medicine is best understood as a quasi-religious ritual that satisfies both the native trust in technology and the native worship of money. Wonders come to pass at sufficiently regular intervals to justify the heavy tithes imposed on the faithful by the insurance companies (the modern equivalent of the old ecclesiastical bureaucracies) and to sustain the popular belief in divine rescue...." (From Harper's, October 1994, quoted by Martin Marty in Context, January 15, 1995, 3.)
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This is too long (for copyright reasons) to quote in its entirety, but perhaps some excerpts would be useful: Estranged from death We need to regain our sense of place in the world, not use costly technology to increase life spans artificially
Giles Fraser, writing in The Guardian (May 10, 2002) tells of an impressive new hospital building which has been described as "a 21st-century answer to cathedrals." He finds that an interesting comparison, for like the great medieval cathedrals, the grandeur of hospital buildings "reveals a great deal about the hopes and fears of the societies that built them." And, says Fraser, these medical edifices "say much about the attitudes of their respective communities to death and dying." He concludes that Ecclesiastes and Shakespeare notwithstanding, "the idea of having 'a good death' makes little sense to us now, for the expectations of how long we live are no longer related to patterns of community life, or to a sense of our responsibilities discharged, but to the state of medical technology - very expensive medical technology celebrated in glass and steel. We now die when the medics have failed us, when the doctor cannot do anything more. We no longer share a sense of what a natural life-span might be or of any appropriate time for our life to come to an end." (The Rev. Dr. Giles Fraser is the vicar of Putney and lecturer in Philosophy at Wadham College, Oxford.)
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In Newsweek's "My turn" column, April 1, 1996 (21), Alden Bloget, a teacher at Lawrence Academy, Groton, Massachusetts, wrote about the death of his father six years previously, due to an error by his doctors. Rather than calling his lawyer, he decided to try to speak with the doctors:
"...As they spoke, I understood the reason Dad had chosen and trusted them to repair his knees. He'd always insisted on finding the best people for any job -- the best lawyers, teachers, mechanics, doctors. His vast network of professional friends had led him to these surgeons. And they were clearly good. They guided me carefully through the details of my father's last few days -- the blood clot that appeared in a lung, the difficulty of determining quickly the level of coumadin in the blood, the unanticipated changes in my father's chemistry since an earlier knee operation.
"When they described the sudden jump in his coumadin count and their scramble to redo it, I noticed one doctor swallow. It was a moment in the Emerald City. The tremor of his Adam's apple shook the curtain aside to reveal the small, frantic man behind the image of the wizard. I was in a fancy room in a big building. They were men -- imperfect and fallible -- frightened to appear so in a society that expects perfection and infallibility from its professionals, especially its doctors.
"These men were just like the rest of us. They'd spent years working hard to become competent in a field they care deeply about ... They'd made mistakes that they could see only in hindsight, the perspective from which society makes it judgments. In hindsight everything is obvious....
"(I am not) opposed to lawsuits that seek to punish those who hack off the wrong leg or knowingly sell products laced with danger. But to sue someone of failing to be the god we wanted strikes me as wrong...."
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Most illnesses do not, as is generally thought, come like a bolt out of the blue. The ground is prepared for years, through faulty diet, intemperance, overwork, and moral conflicts, slowly eroding the subject's vitality. And when at last the illness finally shows itself, it would be a most superficial medicine which treated it without going back to its remote causes, to all that I call "personal problems."
There are personal problems in every life. There are secret tragedies in every heart.
"Man does not die," a doctor has remarked. "He kills himself." Every act of physical, psychological or moral disobedience of God's purpose is an act of wrong living and has its inevitable consequences." (Paul Tournier, M.D.)
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Somewhere in her extensive writings, anthropologist Margaret Mead makes the point that the mark of civilization is a healed femur.
No one, she goes on to say, could have survived long enough for that thigh bone to heal, were it not for help received from comrades.
A healed femur meant that someone took time to care for the injured person (not just the broken bone), bringing food and taking time away from the hard labor of hunting and gathering. Compassion, Mead says, is the first sign of civilization. The healed femur is evidence of that. (From Carlos Wilton)
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The famed heart surgeon Dr. Christian Barnaard once remarked that he never had anyone ask him, after one of his pioneering heart transplant operations, "How much longer did the patient live?" No one asked about quality of life following the surgery, whether it had all been worth it; there was a universal assumption that extending life, by even the least little amount, was a laudable goal.
"Medicine," says maverick physician Bernie Siegel, commenting on Barnaard's remark, "has more to do with avoiding death than with enhancing life."
(From Carlos Wilton)
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"A hospital corridor can be a mysterious place, a terrible and holy threshold upon the boundary of the soul. Here you will find an opening through which you might apprehend and embrace unexperienced aspects of God. Uprooted from your ordinary days, the hospital confounds the peaceful soul with the realization that the God of daily living is also the God of sudden dying. The God of the comforting parish sanctuary is also the God of the Intensive Care Unit. The God of beeswax candle and incense is the God of vomit and pus; the God of white linen and embroidered chasuble is the God of plastic curtain and sweaty sheet; the God of organ and flute is the God of squeaky gurney wheels and crying children; the God of deep port wine and delicately embossed communion bread is the God of infected blood and wounded flesh.
The God of all those corridor smells and sights and sounds is also the God of profound silence. When despair has obliterated ordinary prayer, when the psalms fail and all words are stupid and meaningless, the mantle of loneliness surrounding me becomes a mantle of dark and wordless love. This darkness reveals the paradox of prayer: in the absence of God, all there is, is God."
(From Suzanne Guthrie, Grace's Window: Entering the Seasons of Praye" [Cowley Publications])
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If I'd known I was going to live this long, I'd have taken better care of myself.
(George Burns)
Related Worship Resources
By Larry Hard
These worship resources focus on the timely subject of health care. Physicians, nurses, hospital, nursing home, urgent care and hospice workers plus other health care providers could be asked to participate in the service. Contact them with an invitation to attend. During the service they could be invited to either come forward or stand to receive a prayer of blessing that is included in what follows.
An offering could be received for a fund to aid those of the church/community who need financial assistance with health care needs not covered by insurance. If the church does not have such a fund, it would be a good time to announce the beginnings of a fund for this purpose.
CALL TO AWARENESS
L. We praise God for healthy bodies and minds.
P. We think of those suffering from illness and disease today.
L. We praise God for pain-free moments, days and weeks.
P. We are aware of those who live with continuing pain.
L. We praise God for physicians, nurses and all who work in health care.
P. We know there are those who do not have access to trained health care providers.
L. We praise God for hospitals and homes where we can go for help.
P. We know there are places in the world where health care is not available.
L. We praise God for medicines that bring medical relief and healing.
P. We wonder what we can do to make medicines available to all people.
L. May God grant us awareness of what we need to do.
P. May this time of worship open us to receive God's guidance.
PRAYER OF CONFESSION
God of healing and health, forgive us for indifference to the sick and suffering. In times of good health it is easy to forget what it is like to be in pain. We admit that we fail to remember and pray for those in hospitals and homes. We don't like to think about those in our nation who do not have the means of paying for health care needs. We forget that there are nations where health care is not available. Forgive us God, and put us on new paths of concern, prayer and service to care about the health of all your people on this planet.
SILENT PRAYER
(If silent prayer is used, the leader or liturgist could ask the people to picture in their minds those they know who are ill, and pray for them by name. If the practice of the church is to receive written prayer requests before or during the service for those who are in hospitals, at this time the names could be read.)
PRAYER FOR PARDON
In the name of Jesus who healed the sick and cared for the suffering, receive forgiveness and healing for yourself. Amen.
AFFIRMATION (Read in unison)
God wills our health and the health of all people. Jesus ministered to the sick and the suffering in body and mind. The Holy Spirit is a present power calling us to be the continuing healing ministry of Jesus. The church is a community reaching out to us and all peoples of the world to bring wholeness and health. Prayer is a means of working with God to care for the sick and suffering. Loving words and actions are used of God in healing. Education, research and understanding of the body and mind is a holy calling for those whose vocation is in health care.
Thanks be to God.
HYMNS
"O Christ the Healer"
"Dear God, for All in Pain"
"There Is a Balm in Gilead"
OTHER SELECTIONS
"Awesome God" (words and music by Rich Mullins)
"Someone's Crying, Lord" (stanza from Kum Ba Ya)
"Healer of Our Every Ill" (words and music by Marty Haugen)
PRAYER OF BLESSING
(Invite physicians, nurses and other health care workers to stand or come forward)
Healing God, we thank you for these who care for the health needs of persons. Bless them in their labor and their leisure. Keep them aware that your work of healing is being done through them. Give them insight in every situation, and grant that the blessing of love and faith shine in and through them. Amen.
OTHER SUGGESTIONS
Many congregations also sponsor blood pressure check ups. Arrange to have volunteer nurses or others qualified to check blood pressure on hand to do the check up following the service.
Many of the doctors and local health agencies also have interesting handouts that can be distributed or included as bulletin inserts.
Plan a health fair either in one congregation or in a coalition of congregations that serve a neighborhood.
There is a program sponsored by the Rotary Club which you could introduce in the worship service. Every year, through Rotary International, South American and Central American countries send delegates to propose projects. These projects are as inexpensive as $1000 up to the establishment of clinics. But most of the programs involve the sending of old medical equipment to villages in countries where almost nothing exists. Beds, wheel chairs, lab equipment, etc. that otherwise would be pitched is collected and sent through the cooperation of transportation companies to responsible private citizens and Rotary clubs in these countries where it is put to use. Through these kind of programs Rotary has eliminated the threat of polio in the western hemisphere and is presently working in Asia. By 2005 polio will be eradicated in the world.
The Evangelical Lutheran Church of America's Occasional Services lists a number of Sundays for which the gospel reading make it appropriate to have a service of healing. This is done with the Lutheran Book of Worship but it would be easy to make connections with Revised Common Lectionary. The calendar of the Lutheran Book of Worship includes a commemoration of the nurses Florence Nightingale and Clara Maass on August 13.
A Related Children Sermon
Scripture: Matthew 22:34-46
Text: "He said to him, 'You shall love the Lord your God with all your heart, and with all your soul, and with all your mind'...And a second is like it: 'You shall love your neighbor as yourself.'" (vv. 37-39)
Object: Hands folded in prayer and arms in the form of hugs.
Good morning boys and girls. Today we are going to try something a little different. Instead of me bringing you something to look at as an object for our sermon, we are going to use something that all of you brought along with you. Do you have any idea what you brought to our children's sermon that we can use? (let them answer) Well, let's get right to it.
Jesus told some lawyers who were questioning him that the most important commandment was this, "Love the Lord your God with all your heart, and with all of your soul, and with all of your mind." How many of you have a heart? (let them answer) Everyone does! How many of you have a soul? (let them answer) Good, everyone has a soul; we were born with it. How many of you have a mind? (let them answer) Just like the other two, we all have minds. And the way we use our heart, soul and mind to love God is to worship him. I want you to fold your hands like you were going to pray, bow your heads and close your eyes and thank God for his love. When you fold your hands in prayer you are doing as Jesus asked and following the first and great commandment.
But Jesus said there was a second commandment that was also very important. Do you know what that commandment is? (let them answer) Jesus said we should love our neighbor as much as we love ourselves. How many of love yourself? (let them answer) Everyone who loves himself or herself, give yourself a big hug? (show them how to wrap their arms around themselves) That is a very funny hug? When you want to hug, you hug someone else, don't you? (let them answer)
Give somebody a hug! (begin by giving hugs to the kids) Hugging others is wonderful, isn't it? It gives you a good feeling. It shows other people that you care about them. Jesus wants us to care about other people. He wants us to care about babies and old people. He wants us to care for people who are rich and people who are poor. He wants us to care for people when they are healthy and when they are sick. There are lots of ways to show people how much you care.
Suppose you knew someone who was really hungry. How would you show them that you cared? (let them answer) Right, you would give them food. You might also give them a hug after you gave them the food. How would you show someone who was very tired that you cared? (let them answer) Great, you would give them a place to rest, like a chair or a couch or a bed. You could give them a hug after you helped them rest. How can you show someone who is sick how much you care? (let them answer) Very good, you can visit them, help them take their medicine, call a doctor or nurse or just sit with them until they get better. Sick people like hugs also.
So the next time you hear about Jesus telling us to love God with heart, soul and mind and also loving our neighbor like ourselves, you can think about folded hands and big hugs. I love you boys and girls. I really do love you.
The Immediate Word, October 27, 2002, issue.
Copyright 2002 by CSS Publishing Company, Inc., Lima, Ohio.
All rights reserved. Subscribers to The Immediate Word service may print and use this material as it was intended in sermons and in worship and classroom settings only. No additional permission is required from the publisher for such use by subscribers only. Inquiries should be addressed to permissions@csspub.com or to Permissions, CSS Publishing Company, Inc., P.O. Box 4503, Lima, Ohio 45802-4503.
Yes, we know the so-called Suburban Sniper is at the top of every newscast these days, but we're moving attention to another major issue for this week's installment of The Immediate Word. Instead, we've chosen to tackle the health care crisis that is now a huge concern across America, one that demands a response from a Christian perspective. In this Sunday's gospel reading from the lectionary, Jesus says, "You shall love your neighbor as yourself ..." (Matthew 22:39). Jesus also made health care a religious issue when he said, "I was sick and you took care of me ... I was sick and you did not visit me" (Matthew 25:36, 43).
So we've asked TIW team member Carter Shelley, who is married to a physician, to write about the gospel imperative as it relates to health care.
As we've been doing each week, we have also included team responses, related illustrations, worship resources by Larry Hard, and a children's sermon by Wesley Runk.
A Word from the Wounded Healer
to Contemporary Christians
Seeking Physical and Spiritual Health
By Carter Shelley
Matthew 22:34-46
Had Jesus been born in 2002 instead of 3 or 4 B.C, had his parents been traveling through an American city not their own, the problems they would face might resemble those many Americans encounter today when the combined forces of job loss and ever higher health costs make decent medical care a challenge for middle class Americans, as well as for the ever with us poor. The problem wouldn't be no room in the inn, but that no lawsuit-fearing obstetrician would deliver the child of an indigent woman with no health insurance. No hotel or motel would open its doors to the weary and scruffy young couple because their Visa card and Mastercard already were charged to the max. And since they were not yet legally married, no local pastor or rabbi would intercede to solicit a spare bedroom at a congregation member's home where the young frightened couple might stay for the night.
In 2002 there seem to be no winners in the American Health care system -- not the doctors, not the lawyers, not the insurance companies, not the pharmaceutical researchers, and certainly, not the patients. We the people of the United States are having to adjust our own thinking and expectations about what risks and what price we are willing to pay for health care for ourselves, our employees, and our neighbors. This question is posed in the context of our lives as followers of the dear and glorious physician, Jesus Christ, who reminds us in this Sunday's lectionary text, "You shall love the Lord your God with all your heart, with all your soul, and with all your mind ... [and] ... You shall love your neighbor as yourself."
In Matthew, these two commandments stand on their own, but in Luke's version they are uttered in response to a lawyer's question, "What must I do to inherit eternal life?" Jesus' answer leads the lawyer to ask a follow up question, "And who is my neighbor?" Which Jesus answers with the parable of the Good Samaritan. Today, I share with you the 21st century version of Jesus' parable.
A middle class American's car broke down on the side of a secondary road in a bad neighborhood at 11 at night. Having left his cell phone at home, the man had to leave his car to go in search of a telephone from which to call for help. On his way, he was set upon by a gang of thugs. Beaten to within an inch of his life, he couldn't be sure of the identity or race of his attackers, but he did know that he'd had $127.32 cents in his wallet, four credit cards, and his health insurance card that came with a $1000 deductible before coverage would be provided.
Left to die in a ditch by the side of the road, no one saw him until the next morning. The first person to drive by was an elderly woman on her way to the drug store to get her monthly prescriptions filled. She was very worried about the latest medicine her doctor had prescribed, because he'd told her it was expensive but worth it. Easy for him to say. He wasn't the one living on a fixed income. He wasn't the one whose small savings was depleted now more than ever before due to the fall in value of her 401k at the very time in her life when all of her medical expenses were increasing. She and Henry, her deceased husband, had been careful planners and careful savers, but it seemed it was all for naught now. What she didn't spend on heating, gas and groceries went to pay for medicines. All were expensive, and all were said to be necessary. Driving along, she had to swerve to miss a dog chasing her car. Shaken, she pulled to the side and stopped to catch her breath. That was when she saw the man in the ditch. He looked like he was dead. Afraid to get out of her car, she drove away telling herself she would call 911 when she got home.
Thirty minutes later an insurance man pulled off the road to look at his road map. He was late for a meeting with a small business owner who wanted to discuss the increased rates and reduced benefits for employee health insurance the insurance company now provided. The insurance man had a headache, a bad one. Yesterday had been the pits. He'd been in the office until 8:30 p.m. First, had been the hysterical lady who'd showed up at closing time frantic about her coverage. She been dropped from their policy due to a pre-existing condition. "But I didn't know I had a kidney disease when I started on your insurance!" she'd cried. "My doctor didn't know I had it either! He thought I had something much simpler and easier to treat. How can you drop me when neither my doctor nor I knew I had a chronic illness when you first sold me insurance?" The insurance man felt bad for her, but he'd had no choice. His boss had called him in earlier in the day and chewed him out good for "being too soft" about payouts and benefits. "Our company's losing money left, right and center. If you want to keep your job and help this company stay afloat, you're going to have to be a lot tougher when it comes to claims and discontinued policies." The insurance man wanted to stuff this job and its policies, but he didn't dare. Unemployment was high right now, and besides, he couldn't afford to go without the company's medical insurance. His youngest child had cystic fibrosis and there was no way they could cover the incessant medical costs without good medical insurance. The man put the map back into the car's door pocket and drove on. He never even noticed the man in the ditch.
Dr. Hester Sims saw the body lying in the ditch but did not stop. One of her friends had recently lost her home and savings in a lawsuit brought by a man injured in a car wreck. Also a physician, her friend had stopped at the scene of a road accident to offer assistance. The man she'd treated until the paramedics arrived, claimed his accident-related permanent paralysis was her fault. That he hadn't asked for her help, and his being moved had made his injuries more severe. He and his attorney failed to mention that he'd been yelling his head off with pain and had been thrashing and rolling about despite the physician's attempts to calm him and keep him still to avoid further injury. It had been his word and his family's word against hers. The jury had ruled in favor of the man. After all, all doctors are rich. They can afford it. Only, Hester knew her friend couldn't afford it. Four years of medical school. Three years of residency. Student loans, childcare costs, home mortgage and car, not to mention the worst expense of all -- liability insurance which ran into $100,000+ per year. Hester knew that more than 50 percent of the time, physicians are sued without just cause, because patients saw it as an easy way to make a quick buck. Just the day before she had angered a patient who wanted Hester to sign off for disability insurance due to whiplash the patient had incurred when his car had been rear-ended. Hester had refused. Sure, the man's neck was sore, but it and his back were just fine. He had stomped out to the reception area shouting that she was a sorry doctor who didn't care about her patients, and he was going to find a doctor who did! Hester sighed. She made a note of some landmarks along the road and picked up her cell phone. No, she wouldn't stop, she couldn't afford to get involved, but she would call the police.
Enrique's secondhand truck needed a new clutch and a new muffler. He'd been lucky not to have been pulled over by the police for all the smoke his tailpipe was generating. He couldn't risked being stopped, not without a green card and work permit. Living a life of stealth was hard in America, but it was worth it. The 12 hours he put in at the Tyson chicken factory made it possible for his parents and brother and sisters in Mexico to eat regularly and live in a better place than had ever been possible before. It was lucky too that his wife also worked at the factory, because they now had a nice trailer to live in and were able to buy their young children things their own parents had never been able to afford. It gave Enrique great pleasure to see his children head off to school in the morning just as he came in from the night shift. They had toys, nice clothes and a chance to get an education. Of course, Enrique knew he wasn't paid as much as the Anglo workers, because he was illegally living in the U.S., but he didn't care, not much anyway. It was still more money than he'd ever be able to make in his home village. Enrique saw the man lying in the ditch. He drove a few hundred yards further, hesitated and then stopped. "For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me ... " Jesus would not pass a badly injured man lying in a ditch. Jesus would want him to help even at the risk of being discovered and deported. Enrique put the truck in reverse and backed up to beside the man.
We the people of the United States of America are facing a health care crisis that really had no parallel in the first-century world. In Jesus' day, the worst thing about physical disabilities or illnesses was the social stigma and isolation they caused. A leper, a person possessed by demons or sick with some inexplicable and incurable illness was often expelled from the community both for its safety and the accompanying assumption that some sin must be attached to one God had made so ill; thus there was an element of shame and stigma that accompanied any sickness or disease. In helping the lame to walk and the blind to see, Jesus not only restored a person's physical well-being, he made it possible for them to be restored to the community, to be in relationship with others.
In contrast, our American health care crisis is not about loss of community or loss of face. For us, the hardest impact is financial. The elderly can't afford to pay the ever-increasing medical costs that advancing age tends to require: more prescriptions, more visits to the doctor, more and longer hospital stays. For us, the hardest part is financial. Insurance companies seem like the "bad guys," but the fact of the matter is both they and many small businesses are running on empty or going out of business. That's because they can't make a reasonable profit and provide reasonable health coverage for clients due to the incredibly high medical costs at every level in the system -- doctor visits, tests, prescriptions, hospital operational costs and surgical expenses -- the list is practically endless.
For us, the hardest part is financial. Due to pressure from HMOs, hospital administrators and local practices, doctors are being asked to see many more patients and for far less time in order to make enough money to turn a profit for their sponsoring institutions. In addition, the threat of lawsuits are so much the norm these days that many physicians had concluded they can't afford to practice medicine anymore due to the exorbitant cost of liability insurance. That, in turn, is the result of the many successful suits brought against doctors practicing medicine. The result can lead to low morale and poorer medical care by doctors who can't afford to provide services, such as obstetrics and delivery, and an unwillingness to pursue any treatment plan that comes with an uncertain outcome.
For all of us the hardest part is financial. Who among us has not experienced higher monthly costs for medical insurance, higher co-pay and office visit costs and higher deductibles before insurance policies kick in? We have some of the best technology, physicians, facilities available anywhere in the world, but it all costs money. Lots of money.
It would be easy for each of us to point an accusing finger at someone else as being the source of the problem. It's the doctors! It's the lawyers! It's the insurance companies! It's the politicians! It's the poor and the elderly who rely on Medicaid and Medicare.
"The enemy is us," writes Dr. George D. Lundberg, MD and author of Severed Trust: Why American Medicine Hasn't Been Fixed. He states that our current health care crisis had its genesis after World War II, when regular, quality health care moved from being a luxury of the well-to-do and the desperately ill into an expectation of all American citizens. First, came an employee benefit by which medical insurance was tax-free because the employer provided it rather than the employee paying for it from wages earned. Since it became a cost of doing business, companies benefited tax-wise as well:
By creating the illusion that health care services for the insured came apparently free of charge, the new arrangement changed everyone's thinking about costs. So what if costs went up? The money didn't come out of the worker's pocket, and the employer simply wrote off the cost. This mentality was the genesis of funny money.
Physicians compounded the problem by enthusiastically accepting third-party health insurance payments when they became available, even though organized medicine -- as represented by the American Medial Association and state and county medical societies -- was critical of the practice.... at first physicians continued to bill patients, who then filed claims with their insurers and paid their doctors after receiving the insurance check. When it became apparent that many patients were not forwarding insurance payments but instead pocketing the checks, physicians worked out agreements with insurers for direct payment. When physicians began to bill insurance companies instead of patients, the perception was reinforced that care was free of charge.
If physicians hadn't done that, they would have kept third-party payers out of the patient-physician relationship.... But that would have been too much work for doctors and patients alike. When physicians accepted direct payment, they were freed from the disagreeable need to dun patients, who were freed up in turn from the bother of paperwork. Physicians didn't have to worry about reimbursement anymore; it came directly from the insurer. Physicians made it even easier for patients, by waiving the 20 percent co-payment that insurance policies required, a quasi-illegal practice that no one complained about.... Moreover, the cost of care increased since patients had no incentive to resist higher physician charges. Patients often didn't even bother to look at the charges. Twenty-five dollars for a lab test that cost fifty cents to perform? No skin off my nose.
When for all intents and purposes, health care services seemed to come at no cost to patients, not only were patients' anxieties relived, but physicians were encouraged to order and perform more services. For physicians the new mantra was, when in doubt, do it, and for patients, when in doubt, see the doctor (25-27).
"Who is my neighbor?" the lawyer asks, and Jesus responds with the parable of the Good Samaritan. "Who is our neighbor?" we 21st-century Christians ask. Jesus, from George D. Lundberg, MD and Homiletics professor, Kathy Black, author of A Healing Homiletic: Preaching and Disability, all recommend the same solution. If the enemy is us, then the solution is also us.
"The health care system as it has developed over the past two decades has led to an impossible situation for doctors and patients to have a trusting relationship." writes Lundberg. Patients don't trust doctors because they can't trust the health system. It used to be that the patient-doctor relationship was the main focus. Now, when a patient comes to see the doctor, it's more about what will the system provide for the patient and what it won't provide and how will doctors play his or her role in that. There's little time for caring relationships, because money drives the American health care system and not quality care." Lundberg goes on to say, "We helped to get ourselves to this juncture," therefore, it's up to us to get us out of it.
"In my dream scenario," he continues,
The government would pay for all scientifically proven preventive medical services, and insurers, whoever they are, would cover all scientifically established catastrophic, expensive care. In between those poles would be the private practice of medicine, in which routine care would be a matter between patient and physicians, with no third-party intrusion (271).
Kathy Black offers a Christian theological context for understanding our connectedness and interdependence both as Christians and as people disheartened by the current costs and morass of American health care.
"Who is my neighbor?" We ask?
And Black replies, "We are all interconnected and interdependent" (34).
Who is my neighbor?
"The universe is interdependent and God is a part of this interdependence" (37).
Who is my neighbor?
Who is my neighbor?
"The Bible gives no biblical or experiential reason to believe that life will be without problems or crises or heartache" (38), but "the church is the place where people can be accepted for who they are as children of God, the place where dependency is acknowledged and interdependency is valued" (41). [As Christians] "it is this interdependence in the midst of a culture that highly values independence that sets us apart" (42).
The late Henri Nouwen, Catholic priest, pastor and spiritual guide to many, would agree. In his book The Wounded Healer he notes: "A Christian community is therefore a healing community not because wounds and pains become openings or occasions for a new vision. Mutual confession then becomes a mutual deepening of hope, and sharing weakness becomes a reminder to one and all of the coming strength" (94).
As Christians we affirm our total dependency upon God in Jesus Christ to love us, forgive us, and save us. As Christians we declare ourselves members of a community of faith in which we are stronger together than we are apart. Trying to heal the American health care system is a daunting task, but it is not an impossible one. Think of all the talent and brains and creativity and hard work currently required to make our health care system operate. Think how much stronger and more effective (and maybe, affordable) it could be if more Christians saw themselves as part of the cure rather than leaving it all up to our legislators, presidents or state governments to solve.
The people who work in the various parts of the health care system: the doctors, the nurses, the technicians, the medical office assistants, the administrators, etc. etc. They are not people out there; they are here, sitting in our congregations. Wouldn't it be wonderful if we came to see health care as Sharecare and came up with ideas, solutions and resources from within our congregations in concert with other congregations in our local communities to get together church members who work in all these different arenas with ministers and other Christians to figure this all out. Interdependence rather than independence is a fundamental Christian concept.
Who is my neighbor?
Anybody in need.
How may I help my neighbor?
Through constant prayer, through regular communications with our legislators, president and the Supreme Court, through our ability locally to establish churches allied with other churches in the community to think and act creatively in support of positive changes. Remember, in God all things are possible. In Jesus' name, all people are our neighbors. Within ourselves can be found the resources and the heart to take on this challenge. Amen.
Wesley Runk responds: You have provided a great vehicle for delivering the sermon with your contemporary illustrations. I am not sure that an unmarried couple cannot stay in any hotel or motel today but everything else sure rings a bell.
My only thoughts are that we are very heavy on the problems and somewhat light on the solutions. I would like to suggest that there are things the congregation can do to intervene and provide a frontline defense. At our church in Florida, the congregation hires a nurse, which I understand is not that uncommon in Florida. She has a ministry with the many shut-ins, elderly and others who need a lot of attention. Many of the elderly live there without family. She is a main connection to the ministry of the church. She administers some frontline care with shots, (flu shots and other kinds.) She also takes blood pressure and diabetic blood counts, and a variety of other things that eliminate costs to the patient. Plus she is a visiting arm of the congregation and is commissioned to give Communion.
Many smaller congregations could not afford her salary but collectively they could.
Other ministries involve a couple of daily phone calls by members to the elderly or shut-ins to inquire of their health and welfare each day.
Retired physicians and other health workers can set up clinics, often supported by local health departments to assist the poor in care of children and parents. A number of congregations are involved in caring for children's immunity shots and are given on a regular basis.
The fact is that we do not see ourselves very often as caring communities to members of the church and to others. We think only of purchased services. I know of a number of instances where service clubs in our communities have been involved in health care projects for years.
Anyway, I think this could be part of the message. Not just what Jesus did but what we do in the name of Christ today to care for each other.
Finally, I want to say that while the government does have a role to play, I believe the church can be a much bigger player. We may not be able to set broken bones or administer chemotherapy, but we can share a sense of compassion and real love that often will do more than medicine. Prayer communities, support groups, clinics, mobile care groups, health patrols, multi-congregational nurses and aspiring physicians as well as retired physicians make a difference.
Our neighborhood, which has been without a physician for more than 50 years, banded together, had chili suppers and other fundraisers to pay for a student's medical education. He came to our community on a five-year contract to provide services for the poor and elderly. It was a classic illustration of pulling together for a common good. The churches were the inspirational leaders and workers behind this.
The other side of it is the sadness that comes when the needy are denied because of the cost or the inability to find a healthy donor. I have seen this many times.
George Murphy responds: It's pretty good but I do think it's too long. I'd put some of the background material -- e.g., the long Lundberg quote -- in endnotes. That kind of thing is more to inform the preacher than to be used directly in a sermon.
Your updating of the Good Samaritan story is very effective, though I would probably condense the situations of the by-passers a bit. (Also, why do two have names and two don't?) I would begin with it and perhaps bring in the part about Mary and Joseph today later if at all. Then with the latter I'd leave out the maxed out credit cards and their unmarried status, which blur the focus.
A couple of minor points: "No lawsuit-fearing obstetrician" makes it sound as if the obstetrician is to be blamed for this concern. Something like "No obstetrician would deliver the child of an indigent woman with no health insurance because of fears of a lawsuit would be better."
These are matters of structure and detail. I think the basic approach is good.
Carlos Wilton responds: Thank you very much for a wonderful, provocative article. Your pairing of the various personnel from the health care system with the characters in the parable of the Good Samaritan was brilliant.
I would like to have seen a lawyer be one of them, though. The high cost of litigation is a significant part of spiraling health care costs.
Larry Hard responds: I like the way you use the Good Samaritan parable to put health care issues in story form. Your article is full of ideas and resources. My suggestion would be not to shorten it since the amount of material allows a preacher to choose those parts that appeal to her/him. This could lead to a sermon more to inform than inspire, but that is a major goal of presenting the complex issues of health care as you do.
Chuck Cammarata responds: Good stuff Carter! The contemporary parable is very nice. The only thing I would say about the parable is that you might use it to start off rather than introduce it and spoil the surprises it might hold for the listener. You can always move from it into your discussion of the issue.
As some of the others have said in their comments, your piece sparks thoughts on lots of other issues, which is a reminder of just how complex this issue is.
There is certainly the issue of American's virtual worship of medical science. This is witnessed to by the fact that there are still many out there who believe science will someday discover the secret of eternal life. Maybe we should tell them that we already have discovered it. BUT -- this is another issue -- you can't deal with this without taking away from the focus of your current piece. This is a prophetic call to take care of the poor among us. And even if you have a decent job, if it provides no health care, you are poor in America.
The question is, what do we do? Maybe we need to address this a bit more in the article. There are Christian health-sharing organizations out there. One is called Medi-share. It allows people to pay a small monthly fee -- based on their income -- and then share in other's medical expenses as well as have theirs paid for when they have a need.
We might also address what we know about current legislation that we can encourage our people to support. Or maybe our churches can set up forums with local legislators to discuss the issues. We have done a four-week Sunday school class with doctors, lawyers, insurance people and a local legislator. It was very informative and provocative. We also are developing a parish nurse program that will use members who are in health care to test for certain illnesses -- free -- and give guidance regarding health care.
Carter's prophetic call is powerful and poignant. It needs to be followed with some concrete ideas that will enable our people to respond faithfully to the plain will of God -- that being that we take care of the poor -- for whenever we do to the least of these, we do to HIM!
Wesley Runk responds to Chuck Cammarata: I commend your comments. I would love to see some follow up. Perhaps sending copies of Carter's article and comments to organizations. Is there a special day on the Christian calendar besides the Festival of St. Luke's that deals with healing?
Could we propose feedback, the establishment of clinics, nursing care, etc.?
One other thing we need to do is to start writing some letters to people in places where things can be done. Gather people together and give them some thoughts and names and addresses. We can't afford to put anyone out of business. Insurance companies are going out of business, hospitals are going out of business, doctors are going out of business. Not all of them. Some are growing very rich on the system. How do we distinguish between those who are efficient and well managed and those who are gouging? I don't know, but there are people who do know. Thanks again.
Charles Aaron responds: You have some wonderful insights. One of your most important insights is the interconnectedness of the health care issue with the rest of life. In your retelling of the Good Samaritan parable, the health care issue is directly related to crime (the man is beaten by thugs), and the state of the economy (the elderly woman's 401k was nearly depleted). You help us see that health care is not an isolated topic. Another strength of your piece is that you push us to see ourselves as a community. Your repeated quote from the Constitution, "We the people" reminds us that we are all in this together.
Your retelling of the Good Samaritan parable is quite skillful. Your characters are well-drawn and help us put flesh and blood on the problems of the health care system. Unlike Luke, you actually give us the motivation of each character's decision not to stop to help. Giving us that information helps us see how trapped we are as individuals by the system.
It seems to me that your use of Matthew (the lectionary text) is rather brief. Essentially, you use it only to link to the Lucan parallel. Maybe you could have used the idea of "neighbor" from Mathew to create your characters, and thereby stayed in Matthew. Along the same lines, your use of Luke's version of the birth story in your opening paragraph was not well-integrated into the rest of the article. (By the way, I am a pastor, and I would have helped a young unmarried couple. In three of the churches I have served, unmarried people who were involved with a romantic partner have been welcomed as members, and have even served in offices.)
Overall, you did a great job of putting this issue into a theological perspective. Our physical health is a spiritual issue.
I have a couple of thoughts that are related. I have read that if Americans would exercise more, eat better, smoke and drink less, wear seat belts, and practice gun control, we could reduce our health care costs dramatically. In addition, if we didn't expend so much effort prolonging the lives of terminally ill patients, we could reduce health care costs. Our denial of death robs us of resources for life.
W. Stephen Johnson (a reader of TIW) responds: The affordability of health care in this country is, indeed, a cause of concern for many. And people from all walks of life and religious and political persuasions struggle to find solutions. Certainly it is appropriate to lift up the issue and call people of faith to prayerfully work for solutions.
What is not appropriate, I believe, is to distort scripture to make a point. Joseph was neither itinerant nor unemployed. The singular reference to Joseph's profession as a carpenter suggests that he was a successful small businessman.
Just from a perspective of logic and reason, some other concerns I have are:
* The credit card issue is one of money management rather than health care.
* The issue of marital status is an issue of moral prejudice and, likewise, not a health care issue.
* In my town, a traveling couple at the point of delivery would go to the local ER, where they would, by law, receive medically necessary treatment regardless of their ability to pay. They would not need a room at the local hotel, because they would be at the hospital.
Carter Shelley responds to all: I agree that the introductory paragraph served to muddy the theological and homiletical waters by emphasizing the wrong aspects of the biblical text. What I intended to convey through the Joseph and Mary in the 21st situation was the possibility that most of us wouldn't have recognized the sacred in our midst any better than did the first century folks in Bethlehem long ago.
Related Illustrations
Lewis Lapham, editor of Harper's magazine, had some provocative things to say a few years ago about our health-care system:
"The American hospital-going public now asks of its medical advisers what medieval Christendom once asked of its priests and saints -- the remission of sins (of the flesh if not the spirit) and the hope of everlasting life....
"American medicine is best understood as a quasi-religious ritual that satisfies both the native trust in technology and the native worship of money. Wonders come to pass at sufficiently regular intervals to justify the heavy tithes imposed on the faithful by the insurance companies (the modern equivalent of the old ecclesiastical bureaucracies) and to sustain the popular belief in divine rescue...." (From Harper's, October 1994, quoted by Martin Marty in Context, January 15, 1995, 3.)
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This is too long (for copyright reasons) to quote in its entirety, but perhaps some excerpts would be useful: Estranged from death We need to regain our sense of place in the world, not use costly technology to increase life spans artificially
Giles Fraser, writing in The Guardian (May 10, 2002) tells of an impressive new hospital building which has been described as "a 21st-century answer to cathedrals." He finds that an interesting comparison, for like the great medieval cathedrals, the grandeur of hospital buildings "reveals a great deal about the hopes and fears of the societies that built them." And, says Fraser, these medical edifices "say much about the attitudes of their respective communities to death and dying." He concludes that Ecclesiastes and Shakespeare notwithstanding, "the idea of having 'a good death' makes little sense to us now, for the expectations of how long we live are no longer related to patterns of community life, or to a sense of our responsibilities discharged, but to the state of medical technology - very expensive medical technology celebrated in glass and steel. We now die when the medics have failed us, when the doctor cannot do anything more. We no longer share a sense of what a natural life-span might be or of any appropriate time for our life to come to an end." (The Rev. Dr. Giles Fraser is the vicar of Putney and lecturer in Philosophy at Wadham College, Oxford.)
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In Newsweek's "My turn" column, April 1, 1996 (21), Alden Bloget, a teacher at Lawrence Academy, Groton, Massachusetts, wrote about the death of his father six years previously, due to an error by his doctors. Rather than calling his lawyer, he decided to try to speak with the doctors:
"...As they spoke, I understood the reason Dad had chosen and trusted them to repair his knees. He'd always insisted on finding the best people for any job -- the best lawyers, teachers, mechanics, doctors. His vast network of professional friends had led him to these surgeons. And they were clearly good. They guided me carefully through the details of my father's last few days -- the blood clot that appeared in a lung, the difficulty of determining quickly the level of coumadin in the blood, the unanticipated changes in my father's chemistry since an earlier knee operation.
"When they described the sudden jump in his coumadin count and their scramble to redo it, I noticed one doctor swallow. It was a moment in the Emerald City. The tremor of his Adam's apple shook the curtain aside to reveal the small, frantic man behind the image of the wizard. I was in a fancy room in a big building. They were men -- imperfect and fallible -- frightened to appear so in a society that expects perfection and infallibility from its professionals, especially its doctors.
"These men were just like the rest of us. They'd spent years working hard to become competent in a field they care deeply about ... They'd made mistakes that they could see only in hindsight, the perspective from which society makes it judgments. In hindsight everything is obvious....
"(I am not) opposed to lawsuits that seek to punish those who hack off the wrong leg or knowingly sell products laced with danger. But to sue someone of failing to be the god we wanted strikes me as wrong...."
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Most illnesses do not, as is generally thought, come like a bolt out of the blue. The ground is prepared for years, through faulty diet, intemperance, overwork, and moral conflicts, slowly eroding the subject's vitality. And when at last the illness finally shows itself, it would be a most superficial medicine which treated it without going back to its remote causes, to all that I call "personal problems."
There are personal problems in every life. There are secret tragedies in every heart.
"Man does not die," a doctor has remarked. "He kills himself." Every act of physical, psychological or moral disobedience of God's purpose is an act of wrong living and has its inevitable consequences." (Paul Tournier, M.D.)
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Somewhere in her extensive writings, anthropologist Margaret Mead makes the point that the mark of civilization is a healed femur.
No one, she goes on to say, could have survived long enough for that thigh bone to heal, were it not for help received from comrades.
A healed femur meant that someone took time to care for the injured person (not just the broken bone), bringing food and taking time away from the hard labor of hunting and gathering. Compassion, Mead says, is the first sign of civilization. The healed femur is evidence of that. (From Carlos Wilton)
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The famed heart surgeon Dr. Christian Barnaard once remarked that he never had anyone ask him, after one of his pioneering heart transplant operations, "How much longer did the patient live?" No one asked about quality of life following the surgery, whether it had all been worth it; there was a universal assumption that extending life, by even the least little amount, was a laudable goal.
"Medicine," says maverick physician Bernie Siegel, commenting on Barnaard's remark, "has more to do with avoiding death than with enhancing life."
(From Carlos Wilton)
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"A hospital corridor can be a mysterious place, a terrible and holy threshold upon the boundary of the soul. Here you will find an opening through which you might apprehend and embrace unexperienced aspects of God. Uprooted from your ordinary days, the hospital confounds the peaceful soul with the realization that the God of daily living is also the God of sudden dying. The God of the comforting parish sanctuary is also the God of the Intensive Care Unit. The God of beeswax candle and incense is the God of vomit and pus; the God of white linen and embroidered chasuble is the God of plastic curtain and sweaty sheet; the God of organ and flute is the God of squeaky gurney wheels and crying children; the God of deep port wine and delicately embossed communion bread is the God of infected blood and wounded flesh.
The God of all those corridor smells and sights and sounds is also the God of profound silence. When despair has obliterated ordinary prayer, when the psalms fail and all words are stupid and meaningless, the mantle of loneliness surrounding me becomes a mantle of dark and wordless love. This darkness reveals the paradox of prayer: in the absence of God, all there is, is God."
(From Suzanne Guthrie, Grace's Window: Entering the Seasons of Praye" [Cowley Publications])
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If I'd known I was going to live this long, I'd have taken better care of myself.
(George Burns)
Related Worship Resources
By Larry Hard
These worship resources focus on the timely subject of health care. Physicians, nurses, hospital, nursing home, urgent care and hospice workers plus other health care providers could be asked to participate in the service. Contact them with an invitation to attend. During the service they could be invited to either come forward or stand to receive a prayer of blessing that is included in what follows.
An offering could be received for a fund to aid those of the church/community who need financial assistance with health care needs not covered by insurance. If the church does not have such a fund, it would be a good time to announce the beginnings of a fund for this purpose.
CALL TO AWARENESS
L. We praise God for healthy bodies and minds.
P. We think of those suffering from illness and disease today.
L. We praise God for pain-free moments, days and weeks.
P. We are aware of those who live with continuing pain.
L. We praise God for physicians, nurses and all who work in health care.
P. We know there are those who do not have access to trained health care providers.
L. We praise God for hospitals and homes where we can go for help.
P. We know there are places in the world where health care is not available.
L. We praise God for medicines that bring medical relief and healing.
P. We wonder what we can do to make medicines available to all people.
L. May God grant us awareness of what we need to do.
P. May this time of worship open us to receive God's guidance.
PRAYER OF CONFESSION
God of healing and health, forgive us for indifference to the sick and suffering. In times of good health it is easy to forget what it is like to be in pain. We admit that we fail to remember and pray for those in hospitals and homes. We don't like to think about those in our nation who do not have the means of paying for health care needs. We forget that there are nations where health care is not available. Forgive us God, and put us on new paths of concern, prayer and service to care about the health of all your people on this planet.
SILENT PRAYER
(If silent prayer is used, the leader or liturgist could ask the people to picture in their minds those they know who are ill, and pray for them by name. If the practice of the church is to receive written prayer requests before or during the service for those who are in hospitals, at this time the names could be read.)
PRAYER FOR PARDON
In the name of Jesus who healed the sick and cared for the suffering, receive forgiveness and healing for yourself. Amen.
AFFIRMATION (Read in unison)
God wills our health and the health of all people. Jesus ministered to the sick and the suffering in body and mind. The Holy Spirit is a present power calling us to be the continuing healing ministry of Jesus. The church is a community reaching out to us and all peoples of the world to bring wholeness and health. Prayer is a means of working with God to care for the sick and suffering. Loving words and actions are used of God in healing. Education, research and understanding of the body and mind is a holy calling for those whose vocation is in health care.
Thanks be to God.
HYMNS
"O Christ the Healer"
"Dear God, for All in Pain"
"There Is a Balm in Gilead"
OTHER SELECTIONS
"Awesome God" (words and music by Rich Mullins)
"Someone's Crying, Lord" (stanza from Kum Ba Ya)
"Healer of Our Every Ill" (words and music by Marty Haugen)
PRAYER OF BLESSING
(Invite physicians, nurses and other health care workers to stand or come forward)
Healing God, we thank you for these who care for the health needs of persons. Bless them in their labor and their leisure. Keep them aware that your work of healing is being done through them. Give them insight in every situation, and grant that the blessing of love and faith shine in and through them. Amen.
OTHER SUGGESTIONS
Many congregations also sponsor blood pressure check ups. Arrange to have volunteer nurses or others qualified to check blood pressure on hand to do the check up following the service.
Many of the doctors and local health agencies also have interesting handouts that can be distributed or included as bulletin inserts.
Plan a health fair either in one congregation or in a coalition of congregations that serve a neighborhood.
There is a program sponsored by the Rotary Club which you could introduce in the worship service. Every year, through Rotary International, South American and Central American countries send delegates to propose projects. These projects are as inexpensive as $1000 up to the establishment of clinics. But most of the programs involve the sending of old medical equipment to villages in countries where almost nothing exists. Beds, wheel chairs, lab equipment, etc. that otherwise would be pitched is collected and sent through the cooperation of transportation companies to responsible private citizens and Rotary clubs in these countries where it is put to use. Through these kind of programs Rotary has eliminated the threat of polio in the western hemisphere and is presently working in Asia. By 2005 polio will be eradicated in the world.
The Evangelical Lutheran Church of America's Occasional Services lists a number of Sundays for which the gospel reading make it appropriate to have a service of healing. This is done with the Lutheran Book of Worship but it would be easy to make connections with Revised Common Lectionary. The calendar of the Lutheran Book of Worship includes a commemoration of the nurses Florence Nightingale and Clara Maass on August 13.
A Related Children Sermon
Scripture: Matthew 22:34-46
Text: "He said to him, 'You shall love the Lord your God with all your heart, and with all your soul, and with all your mind'...And a second is like it: 'You shall love your neighbor as yourself.'" (vv. 37-39)
Object: Hands folded in prayer and arms in the form of hugs.
Good morning boys and girls. Today we are going to try something a little different. Instead of me bringing you something to look at as an object for our sermon, we are going to use something that all of you brought along with you. Do you have any idea what you brought to our children's sermon that we can use? (let them answer) Well, let's get right to it.
Jesus told some lawyers who were questioning him that the most important commandment was this, "Love the Lord your God with all your heart, and with all of your soul, and with all of your mind." How many of you have a heart? (let them answer) Everyone does! How many of you have a soul? (let them answer) Good, everyone has a soul; we were born with it. How many of you have a mind? (let them answer) Just like the other two, we all have minds. And the way we use our heart, soul and mind to love God is to worship him. I want you to fold your hands like you were going to pray, bow your heads and close your eyes and thank God for his love. When you fold your hands in prayer you are doing as Jesus asked and following the first and great commandment.
But Jesus said there was a second commandment that was also very important. Do you know what that commandment is? (let them answer) Jesus said we should love our neighbor as much as we love ourselves. How many of love yourself? (let them answer) Everyone who loves himself or herself, give yourself a big hug? (show them how to wrap their arms around themselves) That is a very funny hug? When you want to hug, you hug someone else, don't you? (let them answer)
Give somebody a hug! (begin by giving hugs to the kids) Hugging others is wonderful, isn't it? It gives you a good feeling. It shows other people that you care about them. Jesus wants us to care about other people. He wants us to care about babies and old people. He wants us to care for people who are rich and people who are poor. He wants us to care for people when they are healthy and when they are sick. There are lots of ways to show people how much you care.
Suppose you knew someone who was really hungry. How would you show them that you cared? (let them answer) Right, you would give them food. You might also give them a hug after you gave them the food. How would you show someone who was very tired that you cared? (let them answer) Great, you would give them a place to rest, like a chair or a couch or a bed. You could give them a hug after you helped them rest. How can you show someone who is sick how much you care? (let them answer) Very good, you can visit them, help them take their medicine, call a doctor or nurse or just sit with them until they get better. Sick people like hugs also.
So the next time you hear about Jesus telling us to love God with heart, soul and mind and also loving our neighbor like ourselves, you can think about folded hands and big hugs. I love you boys and girls. I really do love you.
The Immediate Word, October 27, 2002, issue.
Copyright 2002 by CSS Publishing Company, Inc., Lima, Ohio.
All rights reserved. Subscribers to The Immediate Word service may print and use this material as it was intended in sermons and in worship and classroom settings only. No additional permission is required from the publisher for such use by subscribers only. Inquiries should be addressed to permissions@csspub.com or to Permissions, CSS Publishing Company, Inc., P.O. Box 4503, Lima, Ohio 45802-4503.
