In the past several days, through the lens of my profession, I have been given a rather stark and disturbing vision of our current cultural revolution. It is, it seems, a revolution every bit as pervasive and transformational — and destructive — as China’s Cultural Revolution of the 60s — and indeed may be but a different manifestation of a global transformation which transpired in those very same decades in the West. Ideas have consequences, as they say, and we are watching them bear fruit before our very eyes in a slow-motion train wreck which seems now to be accelerating at a disturbing rate.
Exhibit 1: Phyllis Chesler’s recent piece, “Every hospital patient has a story“, at PajamasMedia. It is a piece to be read to completion, including its lengthy comment section. Therein she details a recent experience during a hospital stay for a hip replacement, with a rather remarkable litany of rudeness, neglect, indifference, and suffering sustained at the hands of her healers, at an upscale New York hospital. Her story is shocking enough, and revelatory; the comments provide even further insight, running the expected gamut of such a piece in the New Media. There are those simply shocked; those sharing similar horror stories; those relaying far better experiences in contrast; those defending doctors and nurses, those attacking them. There is the obligate wackjob who blames the AMA, and the usual finger-pointing: not enough nurses, too much paperwork, inadequate pay scales to draw quality; the evil insurance companies and the government. All mostly true, to greater or lesser degree — but all missing the core dysfunction by a wide mark. At the final period of her post, one comes away with a sense of hopeless, feeling out of control and angry, despairing that such a situation may be even a part of our reality (and not knowing how large a part it may be), yet at a loss to prevent its malignant progression through our remaining hospitals which may have been spared to date, the encroachment of such a toxic stew of callousness, indifference, and coldness. There seems, in the end, little cause for optimism.
Exhibit 2: It is late, nearly 9 P.M., seeing a final consult at the end of a punishing call day, in the ICU. The patient, chronologically young yet physiologically Methuselan, lies in his bed, oxygen mask affixed to his face by heavy straps, bleeding, as he has for months, from a tumor in his kidney. He would not survive surgery, nor even radiological intervention to stem the hemorrhage by strangling its arterial lifeline. He is, furthermore, in the parlance of modern medicine, “non-compliant”: refusing treatments and diagnostic studies; rude and abusive to nurses and physicians alike; demanding to go home though unlikely to survive there for any significant length of time.
The nurse — young, competent, smart, hard-working, the very best of the modern nursing profession — apprises me of his situation, closing with this knockout punch: “You know, we just passed that initiative — you know, the suicide one. He’d be an excellent candidate.”
She wasn’t joking.
Taken a bit off guard, I responded that it is most unwise to give physicians the power to kill you, for we will become very good at it, and impossible to stop once we are.
She continued: “No, I would love to work for a Dr. Kevorkian. Be an Angel of Death, you know?”
“I know”, I muttered under my breath, as she ran off to another bedside, competently and with great efficiency, to adjust some ventilator or fine-tune some dopamine drip. And hopefully do nothing more.
These vignettes in modern medicine are really not about medicine at all. They are in truth about a culture which has lost its compassion. Our calloused and cynical society has become a raging river fed by a thousand foul and fetid streams. We have, by turns, taught our children that ethics are situational and values neutral; taught our women that compassion and service are signs of weakness, that they must become hard and heartless like the men they hate; taught our men that success and the respect of others comes not through character and integrity but through callousness, cynicism, and greed; and taught ourselves that we are a law unto ourselves, the sole and final arbiter of what is right and what is good.
We have, in our post-modern and post-Christian culture, inexorably and irrevocably turned from our roots in Christian morality and worldview, which was the foundation and font of that which we now know — or used to know — as Western Civilization. Yes, we have preserved the tinsel and the trappings, the gilded and glittering exterior of a decaying sarcophagus, where we speak self-righteously of rights while denying their origin in the divine spark within the human spirit, made in the image of God; where we bray about liberty, but are enslaved to its bejeweled impostor, the damsel of decadence and libertinism; where compassion is naught but another government program to address the consequences of our own aberrant and irresponsible behavior, duly justified, rationalized, and denied. Others must pay so that I may play, you know.
This toxic stew of self-centered callousness has percolated into every pore of our society. In health care, the effects are universal and pernicious. Patients demand perfection, trusting the wisdom of a web browser over the experience of a physician — then running to their attorney to redress every poor outcome which their disease or their destructive lifestyles have helped bring about. Physicians, hardened and cynical from countless battles with corrupt insurance companies, lawyers, and Stalinist government regulation, forget that they exist solely to serve the patient with compassion and self-sacrifice, and that financial recompense is secondary to healing and empathy. Nurses have in large measure become administrators, made ever more remote from their patients by mountains of paperwork and impossible nurse-to-patient ratios, their patient-critical tasks delegated to underlings poorly trained and ill-treated. Hospital administrators are MBAs, with no interest or clue about what constitutes good health care, and are indifferent so long as their departments are profitable and their marketing wizards successful as they trumpet “Care with Compassion” in TV ads, radio, and muzac on hold.
The list could go on far longer, but the theme is clear: we have as a culture become utterly self-focused, trusting no one, demanding our rights while neglecting our responsibilities, seeking to be profitable rather than professional. We have abandoned the responsibility to be patient and caring of others, forgiving of human shortcomings and humble about the limits of our abilities — a responsibility not merely of those in health care but of human beings in civil society. We have, through the dubious gift of extraordinary technological advances, industrialized our profession, and replaced a sacred covenant of commitment to the patient’s best — and its corollary of the patient’s trust in the integrity and motives of physicians and nurses — with the cold legality of contract medicine. Small wonder we are treated as fungible commodities in doctors’ offices and hospital beds. Small wonder we will be euthanized when we have exhausted our compassion quotient, dispatched by highly efficient providers delivering “Death with Dignity.”
This utter self-obsession and cynical callousness is by no means limited to health care. We long for “bipartisanship” in government (by which we hope for reasoned men of principle to come together for the good of those they represent), but get instead the blood-lust of modern politics, where power trumps principle, money is king, and votes are bought and sold like chattel. Lawyers sue everything that breathes — and much that doesn’t — raking in billions while their “victimized clients” get pocket change they can believe in. Airlines pack in passengers like cattle, lose your bags, and toss you a bag of peanuts for your trouble. Road rage is rampant, rudeness rules, rip-offs too common to count. The coarseness in culture is extraordinary — in language, art, media, fashion, and behavior. It is revealing how shocked we find ourselves when encounter someone — regardless of the venue — who is actually pleasant, helpful, courteous, and kind; we have come to expect and tolerate far worse as a matter of course.
The revolution which started in the 60s with the “me” generation is bearing its bitter fruit — though its aging proponents will never admit it. And sadly, there’s no going back: the changes which have infiltrated and infected the culture, inoculated through education, media, entertainment, scientific rationalism, and a relentless and highly successful assault on reason and tradition, are permanent, and their consequences will only grow in magnitude.
So it’s time for a counter-revolution.
There is an alternative to our current cultural narcissism with its corrosive, calloused, destructive bent. It is not a new government program, nor a political movement; no demonstrations in the street, no marches on Washington. Its core ideology is over 2000 years old, and the foot soldiers of the revolution are already widely dispersed throughout the culture.
This revolutionary force is called Christianity, and it’s long past time to raise the banner and spring into action.
The true antidote to the nihilism and corruption of the age will be found, as it has always been, in the church. It has since its inception been a revolutionary force, transforming the hopeless and purposeless anarchy of the pagan world of its infancy by bringing light, hope and joy where there was none before.
It can happen again.
The church, of course, has to no small degree been co-opted by the culture it should have transformed. From TV evangelists preaching God-ordained health and wealth to liberal denominations rejecting the core truths of their foundation and worshiping instead the god of government and humanistic socialism; from pederast priests to episcopal sodomy, Christianity in the West has whored itself to a prosperous but decadent culture. Its salt has lost its saltiness, and it has, not surprisingly, been trampled underfoot by men.
It is time to return to our First Love. It is time once again to become light to an dark and stygian world. It is time for a revolution of the soul.
We must, first and foremost, be about grace and truth. We must begin with the truth of our calling: to be holy, transformed by the power of Christ and the work of the Spirit. We are, by nature of our new birth in Christ, His ambassadors: we are to be the face, the hands, the heart, the words, the compassion of Him who saved us.
The task is enormous, yet for each of us, the steps are small, easily achievable yet enormously powerful.
It must begin with a renewed commitment to obedience and submission to Christ, a willingness to fully subject ourselves to His will, rather than trying to bend His will to ours. It means getting serious about church attendance — not merely as a consumer but as an active participant. We need to renew our devotion to prayer, to Scripture reading, study, and memorization, to fellowship with other Christians. These are simple steps which ground us in truth, and give us access to that power which can first of all transform us, then radiate out to all around us.
Then we must act like the counter-culturists we claim to be. Be patient with those who are difficult; be generous in time and money; express gratitude to those around us (when was the last time you wrote a thank you note to your doctor, your contractor, your attorney, to the manager of the store employee who helped you?). Lose the profanity; guard your tongue. Repair broken relationships, as best you can. Be joyful in difficult times, knowing that God is at work in your life despite your difficulties. Be compassionate rather than judgmental to those whose life choices are destructive or misguided. The tattoos and piercings we ridicule are cries of desperation from those hungering for purpose and meaning.
These things will not come easily to many of us who claim to be Christians, as we have become complacent in our self-gratification and comfortable compromises, fearful of being viewed as extremist or weird, rejected and ridiculed.
Get over it.
You may just find that such renewed passion for Christ and love for others might, just might, transform your life.
And you might just find that it will change the world.
Got a better idea? Good, I didn’t think so.
Let’s get started.
43 comments so far ↓
Julie // Nov 18, 2008 at 9:16 AM
A good and sobering post, Doc. One thing I find that gives me hope is that there are a lot of places I’ve found (largely online, but not entirely) where people do remember grace. The seeds are there, waiting to sprout and be nurtured.
Re. saying “thank you,” I actually did send a note this fall to the clinic that treated my dog’s cancer. They took such good care of her, and I figured they probably didn’t have as many positive outcomes as they’d like; I thought it would be good for them to hear that one of their patients was doing so well.
Incidentally, if we want to see how to fix the state of our healthcare, they could do worse than look to the current state of veterinary care.
physicians foundation // Nov 18, 2008 at 9:27 AM
[...] [...]
Spoodles // Nov 18, 2008 at 2:23 PM
Good post, doc! I have nothing to add. Just good!
Shoprat // Nov 18, 2008 at 3:35 PM
Doctor
You are a badly needed breath of fresh air.
Thank You.
Jess McMahon // Nov 18, 2008 at 7:22 PM
I am in New York, on business, and I am astonished at how narcissistic and self-absorbed the people are. Not just New Yorkers, the travelers too that I observed coming here.
I think all of that 70s and 80s self-esteem stuff backfired badly only no one has the bandwidth or vision to state it for what it is, much less set a corrective course.
I feel sorry for what women are now about – they seem so shallow. I see men watching them with envy and excitement and sly eyes – and that makes me feel badly for the men too. Will any of these egocentric women make a fine match for a man, beyond lust?
Oh, I guess this has been going on for a long time – but REALLY! How much misery can a civilization take?
I agree with you, Doc, but I also fear it’s sort of spitting in the wind. Maybe I am just feeling pessimistic. Glad you posted again, I find myself looking for new insights daily! God bless, jess
Diana // Nov 18, 2008 at 9:01 PM
Thank you for your article. I have come to the same conclusions you have expressed. My problem, however, is how to find a church that is not post-Christian. No joke.
Roger Drew Williams // Nov 18, 2008 at 10:21 PM
God has truly blessed you with the gift of being able to put so eloquently into words, that which many other observers cannot see without it having been called to their attention (myself frequently included). Please know that you are shining a light into people’s lives. It takes but a spark to start a fire.
Thank You
james wilson // Nov 19, 2008 at 7:03 AM
We repudiated all versions of the docrine of original sin, of their being insane and irrational springs of wickedness in most men. We were not aware that civilization was a thin and precarious crust erected by the personality and the will of a very few, and only maintained by rules and conventions skillfully put across and guilefully preserved. We had no respect for traditional wisdom or the restraints of custom. As cause and consequence of our general state of mind we completely misunderstood human nature, including our own–Lord Keynes
The Greeks possessed a knowledge of human nature we seem hardly able to attain without passing through the strengthening hibernation of a new barbarism. Perhaps in tiime the Dark
Ages will be thought of as including our own–
Georg Lichtenberg
I.H.S. // Nov 19, 2008 at 7:17 AM
Very well said Doc, and believe it is very possible for those who name the name of Christ to make a difference in our society by allowing Christ to make a difference in them first.
Blessings!
James // Nov 19, 2008 at 7:50 AM
Hi Doc,
You are fooled by one thing. The 60′s wasn’t the start of the revolution, the 60′s was the result of the revolution.
The revolution began when the progressives in the 1930′s took hold of the world of education. One generation later, and the results were there for you to see. But they were results, not causes.
You can read all of the sordid details here:
http://www.johntaylorgatto.com/
James
Gayle // Nov 19, 2008 at 8:34 AM
I came over by way of Shoprat’s link to you, and I’m glad I did. I couldn’t agree with you more.
This post is awesome! Thank you.
Anonymous // Nov 19, 2008 at 8:41 AM
Thank you for this wonderful, wonderful piece.
I needed to hear what you said. Christianity provides the hope we must have to get us through these times.
Staggering bigotry of Kathleen Parker | The Anchoress // Nov 19, 2008 at 10:35 AM
[...] The Doc is In wonders about the sharp divide between Christianity and Socialism. I’ve pondered that myself from time to time. Sister [...]
Bloviating Zeppelin // Nov 19, 2008 at 11:38 AM
Sir: I found your blog via Shoprat. I too have been encountering not just indifference but a callous behavior from the medical profession very recently.
My father, 88, has leukemia and any number of other disorders. He has survived colon cancer twice, having had 5 major operations in the past 3 1/2 years. He is a fighter and survivor. Unfortunately, I could no longer care for him and could not provide 24/7 care. I had to place him into a skilled nursing facility. Very recently, other medical issues necessitated his transfer to a local hospital for more intensive care.
That said, I recently asked for assistance for my father last night (at a local hospital existing under a religious affiliation, predominantly known for its competence) who is almost completely immobile, under the affects of morphine, weak, dazed — and he had to urinate and defecate. As there was no bedpan and no other implement present I asked the nurses for help.
Being a “civilian” so to speak and not knowing anything other than “I need help,” I rapidly became aware of the very structured “class” system extant in medical care.
I had made the extreme mistake of asking an RN for assistance and, evidently, should have examined her tag prior to the question. She replied quite coldly that she “didn’t do that” and that I should find the NA or Nurse’s Assistant. It then became MY job to examine the name tags of other persons walking by, asking them for help. About five minutes later someone was willing to assist. A moot point, however, as my father had already soiled himself and the bed. Everyone generally disappeared and I was told that “someone” would come back to clean up. A good additional 15 minutes later (this all occurred at night, around 8 PM) a female wearing brightly colored scrubs (I dare not misspeak and label a RN a NA, etc.) entered the room and with disdain told me that my father needed to hold his left arm straight out, as he was occluding the IV and causing the machine to beep, irritating her and others. Then she left.
If this is the best that medicine has to offer then I, like you, shudder to think of our future. Unfortunately I do not find this to be an isolated incident nor am I seeking sympathy per se; I simply seek to show an example.
What kind of medical treatment can I expect to encounter when I need intensive hospital care in my later years? And though you’re a doctor, I can somehow surmise that you, in the future, may be held in the same indifferent grip as the rest of us civilians.
If this is secularism, boys and girls, then all I can say is the care exemplified will some day be rained down, in spades, upon those careless.
BZ
Eric Blair // Nov 19, 2008 at 11:43 AM
I don’t want to seem to be the wet blanket, but exactly when was this culture ever that compassionate?
Patrick Rooney // Nov 19, 2008 at 12:46 PM
Thank you for this article. I particularly appreciated your recommendations as to steps to be taken by each of us. We are called to be holy, with prayer being an important part of our lives. If I may, I would like to make two related recommendations: Beginning to Pray by Anthony Bloom, a short, simple, yet profound discussion; and, if available to you, join the Nocturnal Adoration Society. I recently did at my parish and found the hour of prayer before the Blessed Sacrament to be a very powerful experience.
Honest 2 God » Time for a Cultural Revolution? // Nov 19, 2008 at 2:48 PM
[...] you ever feel despair at the state of our popular culture, then you will want to read this post: “Revolution of the Soul” at The Doctor Is In. He echoes many of my own recent thoughts, far more eloquently than I could have. Here’s an [...]
Webutante // Nov 19, 2008 at 5:00 PM
Thanks, Bob. No one says it better.
chuck aka xtnyoda // Nov 19, 2008 at 7:30 PM
God…have mercy.
came over via Brutally Honest and am going to quote you on my blog.
God…have mercy.
Connecticut Yankee // Nov 19, 2008 at 8:19 PM
I would second what Julie says about veterinary care often being more compassionate than medical care for humans. My oldest cat (13 years) developed diabetes last year, and I have been impressed by the willingness of her vet and the vet techs to teach me how to care for her at home (test her blood glucose as well as give insulin) and answer my questions as well as being gentle with her during the inevitable office exams. I took a box of chocolates to the staff last week as well as a catnip toy for the office cat– like Julie’s gesture, it was my small way of thanking them all for their kindness.
On the specifically Christian dimension of Dr. Bob’s post, one thing I find heartening is the increasing convergence of Roman Catholics, evangelical Protestants, and theologically conservative believers in the mainline churches. It is far better that we join forces in prayer and focus on our common faith in Jesus Christ as Lord than argue over differences about matters that are not essential to salvation.
z // Nov 19, 2008 at 8:48 PM
I came through shoprat, too, though I have been here before….wonderful piece, Doctor. EXCEPT, I think Diana said it right; The church is getting a little post-Christian..or SOME are..so far from the truth..”Cafeteria Christians” are thriving!, pastors saying what they have to say in order to get the offering plate filled and the pews warmed, even in normal denominations, not just ‘new age’ groups! Presbyterians are now split, Methodists, Episcopalians and even Lutherans are getting close to yet another split…it’s very sad and we need to encourage our individual churches to get back to scripture and the truth and carry on from there.
I wish I was as optimistic as Connecticut Yankee in what he says about theologically conservative believers. While I see a really fantastic, more scriptural change in the RC church, I’m not seeing as many theological conservatives as he is. I wish I were.
Brian Jackson // Nov 19, 2008 at 9:51 PM
This piece ended with hope and resurrection–something I need after reading the beginning which vividly reflects my own dark thoughts as I look around me and, worse, as I look into my heart. Since becoming an Orthodox Christian I have found deep wells of living water which both revive me and (when I let them) purify me. I am a psychiatrist with a forensic mentally ill population at a state hospital. In the moments in which I think of myself as of little account, I find myself still interacting with my patients with the fascination and tenderness that drew me to this profession. Though I fall short of any godly measure, there are nonetheless times when I can say I love my patients in my own paltry way. At other times, when the paperwork begins to mound impossibly high (which in a lesser way is a barrier between myself and my patient by virtue of the sheer time it takes to complete, but in a greater way intrudes itself between me and my patients by providing a ready-made ‘reason’ or, better, excuse which allows me to ignore those I am to serve under cover of my professionalism even when I have the time) I am tempted to see my exhaustion, my anger, my wasted time as important. Too often, I stop there and end up going home empty. On some occasions, however, when I think of the long suffering Christ, or the humility of the desert fathers, or the perseverance of the new martyrs of Russia–even if the thought and movement of my heart is slight–I find that the exhaustion and anger dissipate a little and I find myself wanting to serve. I hope for revival of the Church, but, through cooperation with my God, the struggle for repentance, prayer/fasting/almsgiving, perhaps even I can be revived.
John Ballard // Nov 20, 2008 at 6:38 AM
Wow! What a tour de force!
Doc, this essay is among your finest as the comments thread will testify. Before I get to the crux of my own comment, please know and receive my heartfelt encouragement that after the dust settles, the only way out of the “slow motion train wreck” you have pointed to is a path lit by the light of Christ Himself. The outrage of official denominational “worshiping instead the god of government and humanistic socialism; from pederast priests to episcopal sodomy” rings true with all the righteous indignation of Elijah. And I don’t mean for that to sound in any way sarcastic. I really mean it and agree. A revival in the biblical sense not only guides the way, but may already be underway as the counter-revolution to which you alluded.
Having said that, I would like to inject a couple of contrary observations into this litany of doom.
First, because you are a physician, the link inspiring this essay was sparked by a variety of medical issues and all of nearly a hundred comments from both of these pieces are voiced in the context of medical care… I gently suggest that just because the world of medicine may be hell-bound it does not logically follow that the rest of the world is in the same boat. (I realize the weakness of this argument in the face of what appears to be a global economic implosion ) The challenges of hunger, terrorism, global pollution, rising crime, drug and human trafficking, and a string of other problems which seem also to be growing worse cannot be resolved all at once, but taken individually, with respect for differing points of view and an appreciation that these problems may be connected, I think the problems described here can be made better somewhere between where we are now, and converting everyone to Christianity. (As far as I can tell, most Christians fall short of the ideals you mentioned. The Christianity you advocate cannot be nominal. It must be genuine, whatever that means.)
Second, I think it is a mistake to conclude that the picture of medicine infected with a creeping indifference to care and healing is, in fact, the whole picture. What your essay and the one by Ms. Chesler at Pajamas Media have in common is that everyone writing, reading and commenting here have a level of education, political sophistication and social standing that is not reflected in what many would call the “great unwashed,” which I prefer to call the working poor and unemployed. The big picture is in fact even worse than these essays and comments indicate.
Third, there is an elephant in the room being taken for granted: insurance. Using the Google search bar’s highlight feature I was able to count the number of times that word appeared in all this reading I just did. By copying Ms. Chesler’s essay and comments thread to a Word document I was also able to count the number of words. In over sixteen thousand words the word “insurance” appears two times in the essay and eight times more among the comments.
My guess is that everyone in these discussions has health care via an insurance company. One lonely comment down the thread said, “Maybe there is a future for universal health care in the USA..” Significantly, this was from a lady in Britain who was critical of the NHS but complimentary of ‘BUPA’ the private, but I presume regulated alternative. Unlike, Canada, which mandates everyone to be in a natiional plan, I understand the Brits allow some kind of private alternatives. This little factoid is typically not mentioned when Americans discuss the alternatives to the best system in the world.
I tire of references to socialized medicine. The term is without meaning, since we already have at least three delivery systems of health care in place in this country, one of which, the VA, is “socialistic” by anyone’s understanding. The other three are Tri-care (for military and their families), FEHBP (for federal employees) and Medicare/Medicaid, managed (more or less) by CMS. These lst three might be called “hubrids,” but are certainly not in the same camp as private health insurance outfits that spend as much money and effort denying claims as honoring them in pursuit of shareholder profits.
Naive me, I was and continue to be an enthusiastic supporter of Barack Obama, partly (but not entirely) because he was on board with the notion of universal health care. This has been a seeping wound in our country since before Hillary Clinton first failed to get Congress to do anything about it during the first Clinton administration. Since that time the number of uninsured Americans has continued to swell as insurance companies and their executives (like executives all across the economic landscape) received ever-larger golden parachutes funded by shareholder profits fed by premiums paid by employers and employees together in a never-enough effort to satisfy what might be called a national economic trend to corporate profit obesity.
Drilling into the links, I found that Ms. Chesler penned a second part to the essay you linked which says plainly in the third paragraph, “For years, politicians have been talking about universal health care–which I agree, we must have in America. According to one estimate, about 18,000 Americans may die each year because they are uninsured.” Even she is on board with the notion. (Incidentally, this essay has a few more mentions of “insurance” but still not many. My impression of Pajamas Media is that it is the Internets equivalent of Fox News. Where else does one find reference to “right-roots”?) (Sorry ’bout that. I couldn’t resist.)
There is much to be said about reforming health care and we won’t resolve the issue in a comments thread. But this is a very important conversation. I don’t recall where I heard it, but the best one-liner I have heard is “We have the best health care system in the world and the worst way imaginable to pay for it.” Or as Chruchill famously said, You can always depend on the Yanks to do the right thing after first trying everything else.
Before I end, I need to note that my post-retirement employment has been in the retirement community, five years in a facility owned by a health care system. I was shocked when I first started there after a forty-year career in the private sector (food service) scrambling for hard-earned profits). I encountered a wholesale waste of material and human resources that in the private sector I never dreamed possible. I realized soon it was because the place was “not-for-profit,” and therefore not dependent on paying shareholders over and above the operational profits that truly “private” companies must have to survive and succeed.
(There are two levels of “private.” The first is truly private, typically, but not always, family-owned. The second is what happens when a private company “goes public.” inviting stockholders into the operation. Clearly profits are easier to divide among a small number of “owners” that a large number. So the pressure to produce ever larger profits is much greater. Also, the pressure to “grow” is correspondingly greater. The price of the stock becomes more important than operational profits. See Enron. Or GM Or Goldman-Sachs. But don’t get me started…)
There is a symbiotic, incestuous relationship between health care “providers,” (both for-profit and non-profit) and the insurance industry.. This relationship is enabled by so-called “not for profit” outfits who must pick up the social pieces (uninsured people who by law and good public relations must receive at least life-saving emergency treatment) and pay for them by “writing off” unpaid expenses by overcharging insured patients enough to generate at least a little black ink for operational profits The tax accounting rules also help by allowing breaks for charitable contributions to non-profits for individuals and institutions who for business or tax purposes seek to improve their public image (tax-subsidized institutional advertising) or offset otherwise taxable gains. There are many ways to skin the tax cat.
I think I’ve said enough at the keyboard to get me through another day.
Let us go forth into the world to serve and please the Lord! Hallelujah, hallelujah!.
Bloviating Zeppelin // Nov 20, 2008 at 8:35 AM
John Ballard:
When you wrote: ‘Before I end, I need to note that my post-retirement employment has been in the retirement community, five years in a facility owned by a health care system. I was shocked when I first started there after a forty-year career in the private sector (food service) scrambling for hard-earned profits). I encountered a wholesale waste of material and human resources that in the private sector I never dreamed possible. I realized soon it was because the place was “not-for-profit,†and therefore not dependent on paying shareholders over and above the operational profits that truly “private†companies must have to survive and succeed.’
. . . you just made a massive point.
You know: Governmental Healthcare, all served up with the same considered and measured courtesy, efficiency, veracity, motivation, goodness, logic and concern of one’s local DMV.
BZ
Connecticut Yankee // Nov 20, 2008 at 10:37 AM
Reading the two preceding comments reminds me of C.S. Lewis’s description of Hell in the Screwtape Letters as a vast bureaucracy– and of St. Augustine’s remark that government is one form of punishment for original sin.
dymphna // Nov 20, 2008 at 10:54 AM
I was in Georgetown hospital in DC last year. Every one was gentle, kind and patient. I may have gotten lucky but I also was too sick to whine and complain and tick off the nurses. Treating an RN like a servant will not end in a good result.
Dr Bob // Nov 20, 2008 at 11:01 AM
It is one thing to realize that government and other large bureaucracies are wasteful, inefficient , and amoral (which they most certainly are). It is another to ask why.
1 Lack of accountability: Humans removed from the consequences of their behaviors find their behaviors rapidly devolving toward indifference, neglect, and even evil. Accountability to others is a restraining force on evil. It is, ironically, the very reason we have government: to restrain evil. But when government reaches a critical size, it increasingly becomes a force for evil rather than a restraint thereupon, as accountability to those they ostensibly serve disappears.
2. The Law of Rules: When individuals are guided by inner moral and ethical restraints (implanted by religion, conscience, social constraints, and traditions), there is relatively little need for formal law and punishment; the inner morals restrain outwardly evil and harmful behavior, at least in some measure. When inner morality atrophies and the influence of absolutes wanes, government is forced to pass an ever-proliferating set of new rules and punishments, which work poorly to restrain evil and have many unintended consequences. This ultimately ends in tyranny, as humans will happily trade freedom in exchange for an end to anarchy and chaos.
Thus, Benjamin Franklin’s wisdom: “We will be ruled by God, or by tyrants.”
Dr Bob // Nov 20, 2008 at 11:15 AM
John,
Thanks for your thoughtful comment (and those of everyone else as well).
As far as universal health care is concerned, remember the unattainable trifecta: low cost, high quality, universal access. Pick 2; you cannot have all three.
John Ballard // Nov 20, 2008 at 12:06 PM
Thanks for your indulgence, anyway.
And about that “unattainable trifecta,” that first item, low cost, is driven by no less than four additional variables: operational profits for the institutional providers, additional profits for individual providers (physicians, clinics and ancillary services), more operational profits for non-medical administrative infrastructures where ever they are, and finally, enough additional profits to satisfy stockholders in insurance companies.
Somewhere in that ecosystem it’s time for some “mergers and acquisitions” to reduce replicated administrative costs and profit demands.
I have always known from the food business that size is the enemy of service. The larger the operation, the less likely it is to deliver a decent level of care and individual attention to the customer. Fortunately this is not a prindiple cast in stone. The healthcare system for which I worked is a community-based non-profit which includes five hospitals and a raft of other interests. In a determined effort to change the corporate culture to one of top-quality service and image, the leadership began a comprehensive program that started about two years ago using some Baptist hospital system in Florida famous for high marks on patient care, outcomes and patient/family satisfaction scores. Progress has been slow but solid and I have watched this system move slowly but surely from the nightmare images of these two essays to a level of caring stewardship that will soon match the best systems in the country.
It is possible to improve and be big at the same time. I have seen it up close and personal.
I am now employed by a senior care agency as a sitter and non-medical personal care provider. My client is an older man who broke an ankle and must be attended round the clock until he can manage to toilet himself without assistance. (He is fortunate to have laid by enough money to pay for my assistance. One sentence that jumped off the page at me from one of Ms. Chesler’s articles was “Pity the person who cannot pay for private assistance.”) I was present for his surgery and follow-up visits and can tell you that the level of care and professional excellence I saw was top notch.
And about that “universal” part, all I can say is that some measure of universal is not optional. Rationing is inevitable, to be sure. Not everyone will be able to have the organ transplants, expensive drugs and end-of-life heroic measures that are now available only for the well-heeled and well-insured. But those people and those measures will always be available for those who can afford them. But for those who cannot afford even a baseline of care there has to be a better safety net than “get sick and die.” Tens of millions of uninsured people is not an acceptable state of affairs in today’s world.
Gary Mohr M D // Nov 20, 2008 at 3:26 PM
I have practiced family medicine for 26 years, and the drop in quality of care has been precipitous. The best people used to go into medicine; now they go into engineering and they will live longer and healthier lives as a result of less stress. It’s sad and it’s accelerating. Life has become cheap, expendable, almost disposable. If your physician doesn’t respect and value your life, who will?
Grumpy Old Man // Nov 20, 2008 at 8:58 PM
Two thoughts:
All the horror stories are true. But I recently had a prostatectomy at the City of Hope in So. California. Everyone was extremely kind, thoughtful, and compassionate. So it ain’t all bad.
I believe true Christianity can be found in the Orthodox Church, because I have experienced it. It’s a “hospital for sinners.” Your sensibility and thoughts are very close to the Orthodox way, which has continuity going back to the Apostles.
VisitorA // Nov 20, 2008 at 11:49 PM
I noted this comment: “This relationship is enabled by so-called “not for profit†outfits who must pick up the social pieces (uninsured people who by law and good public relations must receive at least life-saving emergency treatment) and pay for them by “writing off†unpaid expenses by overcharging insured patients enough to generate at least a little black ink for operational profits.”
Questions and Comments in response:
On what do you base your supposition that Government, the ultimate “not for profit” agency, would “pick up the pieces” or behave any better? Under a nationalized healthcare system, how will all this “free” care be funded?
When something we want appears to be “free,” the human tendency is to use too much of it. This is abuse. Government has never, and will never, be able to legislate morality or stewardship; those are individual decisions. Is it valuable to consider that sometimes, the greatest freedom is the freedom NOT to consume something even though we can? Taking better care of our individual health (using our freedom NOT to consume too much of the wrong foods, NOT to consume too much couch time when we could be moving around, etc.), could translate into *better* use of the healthcare system. Might such self-stewardship also allow physicians – and nurses- to practice the kind of medicine that matters, rather than having their professions drain their passion? Can individual accountability function properly in a socialized framework?
Free enterprise is what leads to innovation. Take that incentive away, and we wind up like other nations with three-plus year wait times for cancer treatments, a death sentence in many cases. There’s a reason American “medical tourism” exists: we still reward innovation that results in amazing technology. Compare our technologies with theirs and consider the implications. How can it all be evil?
Insurance companies provide a financial service: spreading risk. If there was no demand for that service, there would be no supply. Why would you expect these businesses not to consider their bottom line? If they don’t watch the dollars and cents, the lights go dark and the doors close. I’m not saying there’s no greed. I am asking, do *you* work for free? If not, why should they?
Who exactly are the 46 million uninsured? Some are the genuinely American poor of various ages. Others are working Americans, but choose not to part with the income to cover the premiums. Others have entered our country illegally and using our system anyway. Should all of them receive equal treatment?
Is healthcare a right or a privilege? And for whom? Socialized medicine would say it’s a “right for all” with no rationing mechanism to limit it (except that each day has only 24 hours in it and our docs need to sleep sometime).
I don’t know the right answers – people far more brilliant than I continue to grapple with these issues. I can say, though, that I’ve seen the best answers offered on smaller scales by a free enterprise system that promotes human compassion. While such examples are not common, they cast their lights beautifully in the dark. And I thank God.
John Ballard // Nov 21, 2008 at 3:53 AM
I want to answer that storm of questions but time and space do not allow. I’m starting to wish I had never left my comment. I’m having flashbacks to forty-five years ago when I was trying paitently but mostly in vain to convince Southern-born and reared family, peers and neighbors that segregation was a poisonous problem that had to be resolved. And soon.
I’m not arguing a case for “nationalized health care” or “Government as the ultimate provider. I am pointing out that the messy collection of well-meaning, individually well-run overlays of enterprises to which you alluded are the medical equivalent of the banking and credit mess now crippling the global economy. Securitized debt (an oxymoron if ver ther was one), massive insurance schemes that cannot insure (can you say “credit default swap”), and hedge funds that no longer “hedge” are recent illustrations of private enterprise in pursuit of innovation. Individually they all made sense, but the effect altogether was something like a chain letter. The delivery of good health care should not have a multi-level marketing business plan. Two or three levels will do just as well.
In another comment above someone quoted my remarks about the waste of material and human resources I saw in the not-for-profit health care operation where I worked for five years. My point was not that we had “the same considered and measured courtesy, efficiency, veracity, motivation, goodness, logic and concern of one’s local DMV” but that the place was swimming in revenue, so much that working conditions and benefits were way out of synch with comparable for-profit enterprises in the same line of work. In fact, it was that swollen but well-managed revenue stream that enabled the place to become one of the finest systems of its kind in the country. My point was precisely the opposite: health care should be provided, NOT sold for profit.
The reason that non-profits are often able to take in so much money is that many of them are gaming the system by sucking up to both well-insured and Medicare/Madicaid patients while minimizing service to those who do not fall into either of those two revenue-producing groups. Why else do you suppose charity hospitals all over the country are in danger of shutting down? I don’t know about the rest of the country but I can assure you that when Grady Hospital here in Atlanta was threatened every other hospital in the area was praying that a way could be found to save it so they would not have to absorb the results if the place closed. I’m still waiting for someone to point out the importance of geography to the delivery of health care.
Insurance companies are critical to the economy. We all need to insure against property damage, liability and loss of income. A good case can be made for life insurance (although I did read a book years ago promoting the notiion of “buy term and invest the difference”). But insurance companies do not provide health care. Their mission is to ration health care. Physicians and nurses, hospitals, clinics and laboratories are the providers. Insurance companies, however, are administrative, not medical. And their real mission is only partly to manage the delivery of health care. The other part is to provide dividends to shareholders and good benefit packages to their employees. And the only way to do that is to do a good job finding the right population of “customers” who need just enough health care to make those profits. As you correctly pointed insurance companies provide a financial service (not a medical service) by managing risk.
The reference to “medical tourism” is interesting. I can’t tell from the context, but it seems you are referring to people from other countries who come to America for treatment because health care in their home countries is not as good. I can tell you that in the health care world (I think Dr. Bob can verify this) the term “medical tourism” refers instead to Americans going to other countries, notably Thailand or India, to get organ transplants, expensive cardiac care or other high-end treatments because they can get the same care at those destinations, including round-trip air fare and family accommodations, for as much or less than the same procedures would cost in America. Correct me if I’m wrong, but when I heard reference to “medical touorism” where I worked, that was the meaning.
As I said before, I’m tired of references to socialized medicine and Government health care. That’s never going to happen in America. But what is happening, if I may correct and repeat what I said in my first post, is that we now have five different delivery systems, one of which, the VA, is “socialistic†by anyone’s understanding. Three others are Tri-care (for military and their families), FEHBP (for federal employees) and Medicare/Medicaid, managed (more or less) by CMS. The fifth “delivery system” if it can be called such, is the snatch-and-grab, messy, totally ineffective byproduct of the best health care system in the world by which the uninsured (read unemployed, not old enough for Medicare and those with chronic expensive and/or pre-existing conditions) receive whatever they are fortunate enough to get at the bottom of the system.
I’m all for operational profits.But I’m NOT in favor of making money by rationing health care, and that is the mission of insurance companies. It’s called by many names: PPO, HMO, managed care. More recently a Medicare spin-off called “Medicare Advanage” is a for-profit hybrid which costs more than Medicare.
The system we have is not working as it should. It’s not necessary to destroy it. It’s time to fix it and make it better.
james wilson // Nov 21, 2008 at 6:29 AM
Mr. Ballard, it is well that you have raised the issue your moral and ethical superiority so evident by your actions of forty-five years ago or I should have less confidence in your prophecy that socialized medicine will never happen here.
I would have thought there is not one thing you believe to be true that is not false. But in my world progress is formed by a simpler prevailing discipline, that of constant failure. You have all the formulas for avoiding them. That is precisely why we approach disaster.
Dr Bob // Nov 21, 2008 at 7:19 AM
Keep it civil, folks — no personal attacks over differences of opinion.
If you want a flame war over health care coverage, find another blog to vent.
Misses the whole point of the post, doesn’t it?
I.H.S. // Nov 21, 2008 at 7:34 AM
Thank you Dr. Bob. I was wondering when you were going to say that. I was wondering though is it that people really do find it uncomfortable to identify with Christ and choose rather to deflect what is truly needed in our society, by ranting on such topics as health care, and the never ending arguement of how to solve it, when it is but the results of what is truly missing in the lives of people which is a real relationship with the Son of God, Jesus.
james wilson // Nov 21, 2008 at 9:25 AM
The welfare of the people has always been the alibi of tyrants, and it provides the further advantage of giving the servants of tyranny a good conscience.
When this tyranny comes attached with manners, or is protected by them, it is no less a tyranny.
Our affectations are subtle persuaders, and take the deepest root. Especially then, man cannnot be degraded by humiliation, rather, he is often capable of coming to dignity only thorough indignities.
No one can hear something he does not alreadybelieve or suspect in some small part of himself. You will not reach such men, and do them no favors through grace and kindness.
It would seem even Jesus reached this conclusion at least once. The Founders expressed it continually.
But it is your blog, and it is exceptional for the reason that it is yours. So I will not argue with that.
Joe // Nov 21, 2008 at 6:30 PM
Chalk up another one for the shoprat, as I, too, found you through him.
And I am glad I did.
Thank you for a thoughtful and very meaningful post.
Friday Links | The Doctor Is In // Nov 21, 2008 at 6:51 PM
[...] RSS A true opium of the people is a belief in nothingness after death — the huge solace of thinking that for our betrayals, greed, cowardice, murders, we are not going to be judged. –Czeslaw Milosz– ← Revolution of the Soul [...]
VisitorA // Nov 22, 2008 at 12:46 PM
Mr. Ballard, I believe I did indeed misuse the term “medical tourism.” Good point. I’m not at all offended by anything said, and am actually pleased someone felt my post worth a thoughtful response (the “rationing healthcare” is a great note too). Thank you. I must, however, apologize for widening the healthcare “rabbit trail.” Dr. Bob is right to call us back to the proper focus (though the lens here does render the healthcare discussion somewhat unavoidable, and not entirely without value, though, since it is our reality). Compassion is the key, and we can only pursue it individually. I pray that we do.
And therein lies the rub. It scares me to confront my own inadequacies and the truth that I am powerless to impact any sphere larger than my own circle of influence (and the bald truth is that even this small circle is beyond any genuine control on my part). Then I recall that God is the one who spoke the world into existence, and is powerful enough to extract good effects from evil causes. He can take our puny faith and not only enlarge it, but use it to impact the world in ways we can’t imagine this side of eternity. That is what comforts me as I confront this desperate and ongoing need in my own soul – and in the world – for the previously-mentined revolution. Phil 1:6 – I am a work in progress He will nurture for as long as I have breath.
Parents have the greatest challenge: raising the next generation with values that transform a culture (and therefore, one hopes, a healthcare system!). As one discussion above traced, past legacies have provided the medium for the current toxic stew. We can’t change the past; but we can allow God to renew *our* minds so that we redeem the time and love our neighbors where we live now. Trust the Lord and do good. Please take heart that the darkness, while profound and powerful, cannot and will not conquer all.
ELC // Nov 30, 2008 at 7:44 PM
I am a bibliophile, and I order (when I have a little spare money) from bookstores over the Internet. I try to remember to thank booksellers for good service. When I do, they sometimes reply that it’s very unusual to receive any comments from customers other than complaints.
K. // Dec 21, 2008 at 2:57 AM
Interesting read…
Unfortunately, I think that one of the biggest proponents of this type of behavior that he talks about IS the church to begin with.
Not only the health and wealth (or name it and claim it as Brad and I like to call it) “theology†(I use that term VERY loosely) that he mentions is to blame.
Many…if not most of the churches in our country have totally watered down their teaching trying to make it “seeker sensitiveâ€. In the process they have focused on trying not to scare people away with the Truth and in turn have stopped preaching the Truth.
“5 ways to a happier you†should NEVER be a sermon topic. Even if the point is that Jesus is what you need to be truly happy, the focus is still on US and not on the gospel. We shouldn’t be taught how to use Christ or the Word or Prayer or anything to our own advantage. Blessings for us are merely a side affect to following Christ…not the point of following Him.
Too many churches have so many programs and things going on that the people begin to live in the church and take themselves out of the world…even though we are told to be IN the world…but not of it.
The church’s role should be to equip it’s congregants to fulfill the “but not of it†part of that verse.
Paul’s verse about not forsaking the gathering together of yourselves was put there because at the time the church was so busy making disciples that they didn’t meet together often enough for iron to sharpen iron…so they weren’t being built up and exhorted and they weren’t being kept accountable in their personal lives.
That’s what church is for. It’s not for us to make a Jesus club and only let people in who learn the secret handshake. For anyone can play the part of a Christian…anyone can learn the handshake.
Like salt without flavor we roll around this shaker of a world not adding anything that anyone else couldn’t add…selfishness, greed, broken marriages…no different than world…in it AND of it.
Church should be about learning to put on the hip waders of the Spirit over our boots so we can slog through this crappy world without being tainted by the crap we’re walking in. It should NOT be about (not matter how cleverly disguised) keeping away from the muck in an attempt to keep clean.
New believers need DISCIPLESHIP…one on one mentoring by a more experienced believer who can teach them with RELATIONSHIP and by EXAMPLE what it means to love Christ.
Experienced believers need RELATIONSHIPS with other experienced believers that are REAL and RAW and DEEP. They need a couple people in their lives, besides their spouses (if they have one) who can call them on their crap. Friends who can call sin, sin, who can say “Look, what you’re doing is wrong and you need to stop and I want to help you.†From repeated bad attitudes to addictions and beyond, if we don’t have people in our lives who KNOW us then we have no accountability in our walks. Lack of this type of NECESSARY relationships are how “Christian†men get addicted to porn and how “Christian†women get into bed with someone other than their husbands. It’s not full-proof, and if we don’t have relationship with Christ first these friendships will be useless, but if we are building one another up like we should…well…things could be very different.
I don’t think we need a revolution involving politics or summer camps or tent revivals.
I think we need to step back and make sure we are fulfilling the Biblical models for relationships, church, discipleship, womanhood, manhood, parenting and what our focus in all of this should be.
Glorifying God…in all things.
Church today makes it way too complicated.
But I think that the guy who wrote that piece makes it much too simple. This can stem from a legalistic mindset…if you just obey then you will be accepted and things will get better. Yet the Bible says “While we were yet SINNERS, Christ died for us…†Like the song says…â€If you tarry…till you’re better…you will never…come at all…†Christ accepts us, the Holy Spirit changes us, we love him and so we try to obey…and we are blessed. Not with health or wealth necessarily, but with Love, Joy, Peace, Patience, Kindness, Goodness, Faithfulness, Gentleness and Self-Control.
And I also don’t agree with this blanket statement about tattoos and piercings.
AttheHeartoftheMatter // Jan 10, 2009 at 1:08 PM
You,of course,are calling upon those who, though describing themselves as Christian, do not necessarily pay close attention to living the way Christ encouraged….and are not saying that the only way our society will become a kinder and gentler one is through belief in Christ?
Thought so. Thank you.
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