A Healthcare Accounting
Posted in Faith/Health - A Conversation on May 31st, 2009 by praytell – Be the first to commentSunday, May 31, 2009
Minneapolis, Minnesota
It was a quarter century ago that the thought first hit home. For whatever reason there had been a series of stories about premature children, whose months in pre-natal wards gave them a chance to live. There was a price to all those machines, all those incubaters, all those doctors and nurses who gave extraordinary care to a child who, just 50 years ago certainly would have died. It was not uncommon for the final bill to be more than half a million dollars. Few quibbled with the price. After all, what would be the price of a young life?
But then I heard the reaction of a missionary who had been working, as I remember it, in Bangladesh. “It makes me sick,” he evidently said. “The price of one premature child in the United States could save thousands of lives in Bangladesh.”
I was taken aback.
On the one hand one could say that the essence of compassion means sharing it broadly, generously, and to as many recipients as possible. On the other hand, the trade-0ff seemed stark. The numbers told the story, not the mother, the father, the child of the thousands of mothers, fathers and children for whom a supply of rice would bless them just as much as an IV would save a premature child.
“We should do both,” I said to myself. The resources to do both are available. The unjust allocation of our resources is invariably the heart of the problem. For a while the dilemma took a back seat.
But then it resurfaced.
I was at a camp for cancer patients and their families. I may exaggerate, but not one had the resources necessary to pay for their treatments. Each had to find a way to beat the system. Each had to rely on his or her intrinsic self-worth. Each had to find a way to not be swept away by the thought that their condition had made them “too expensive.”
Earlier that year, we had our own battles with insurance. It had become clear that the insurance company was doing everything it possibly could to throw us out of the system. “We need the forms in two days, or else.” “But there are no forms?” “One day. Final Notice.” “But . . . “ It did not take much to figure out that down deep the insurance company would have much preferred it if I had simply died after the first stroke. And if that didn’t do it, I should have bought the farm after the second stroke as far as they were concerned. I too had become too expensive. They wanted to cut their losses. “There are others,” an insurance company representative said to me, implying that the payments we were to receive would better be spent elsewhere.
Like many others, I then found a new level to the “costs.” Pre-existing conditions made me too risky to hire. The progress made since the strokes was admirable, but, all things considered, the numbers made me a bad bet. I am, of course, writing short-hand here. Perhaps the “cost” issue isn’t as black and white as I make it out to be. But it sure feels that way.
And, of course, it is the exact dilemma that surfaced when the missionary criticized the cost of a premature child. And it is a dilemma we struggle with as a country, as a church, as a state, as a community. It turns out that there actually is a cost and there are those whose job it is not to fish but to cut bait.
I write knowing that I am not the only one. There are millions of us. Medical expenses constitute the largest single reason for bankruptcy in the United States. Over and over again we strive to keep hope alive despite the cost. Over and again we realize that life is more than a set of numbers. It’s not that numbers don’t count . . . they do. They require us to avoid a prescription because we cannot afford it, to sell the farm when the bills on the kitchen table tell us we have no choice but to sell it. Yes, there is a place for numbers. But there is also a place for life.
Which brings me to the church.
As I posted on an earlier Faith/Health blog, we love to assume that hospital systems and the church are cut of the same cloth. History tells us that it is true, as many hospitals trace their origins to the mission and ministries of the church. But turn the stone a bit, and we find they are two almost entirely separate worlds.
I would like to join a church. “Sorry. You will cost too much.” Such a conversation is unimaginable. “I am asking the church to hold my family in prayer as we face a set of surguries that may or may not make a difference. Pastor, would you drop by?” “Sorry, but that will cost you. We charge by the elder, by the prayer, and by the visit.”
Whenever we do accounting “by the book” in the life of the church we have a sense that we’re missing something. We do not live by the offering plate, important though it may be. But if we try to increase offerings just to increase offerings, without speaking of life, without laughter, without play, without mystery, and without paradox . . . we will soon run aground. That’s the paradox. Numbers are predictable. The work of the spirit is not. As Jesus said, it goes where it wants to go. And it has never once said, “You cost too much.”
Thanks be to God.