Health Care Decision -- Ups and Downs

This week's Supreme Court decision on the Affordable Care Act has many rejoicing and other fuming. Chief Justice Roberts is heading off to an "impregnable island fortress" (i.e. a teaching gig in Malta), Obama and Romney are refocusing their health care ads, and Americans are still mostly ignoring some very important issues.

The Ups
Three important pluses came out of the decision.  First, people that need  health care will have a slightly easier time receiving it at a slightly lower cost to society at large.  Those are the goals of the legislation, and progress will be made toward them.

Second, the Chief Justice showed us that the Supreme Court can make an important decision based on law and not politics.  In an environment when extreme political stands are the norm (and some very political folks inhabit both wings of the court), Justice Roberts showed that we can put politics aside and do our jobs.  Without delving too deeply into legal matters beyond my competency, I can't believe the government can force any number of expensive choices concerning building codes, auto insurance or other matters paid to third parties and yet would be unable to tell us to buy health insurance so that we don't force our local emergency rooms to charge everyone else in town to cover the cost of our care.

Third, this decision showed us that as a country we can make important decisions that try to change our common life for the better.  Given the increased use of Senate filibusters, the quickening resort to litigation, and a diminished respect for the "common good", our legislators are less and less able to accomplish anything of real value. In a complex society, only the government is able to regulate, to set standards, and to protect the vulnerable in ways that have the potential to be effective and affordable.  We don't always succeed.  But we dare not fall into the cynicism that claims that open legislative processes of a free society are less trustworthy than the private decisions of individuals in any business or industry who are (rightly) concerned with their own profit and corporate future.  Businesses have a primary responsibility to their shareholders.  Good businessmen and women work with others in government to make sure the rules of the game are fair and that work is done together that no one could or would do individually.  Health care has become one of those public areas of the commonweal.  Even if the Affordable Care Act isn't perfect, the government's ability to pass and implement legislation in this arena is essential for the health of our democracy.  

The Downs
While the above are all reasons to celebrate small steps forward, I can't help but feel they are no more than baby steps.  At least three issues still remain.

The first problem is that the provision of the legislation requiring states to expand Medicaid was struck down.  If 16 million uninsured are still wandering into emergency rooms for expensive treatments to problems that could have been dealt with through a quick immunization or routine preventative care, many of the needed cost savings will probably not materialize. This leads us to the second problem.

The second problem is that the entire Affordable Care Act is an attempt to improve with the health care system we currently have, but that system is seriously broken.  Almost all the money goes through insurance companies, and inordinate amount of resources are used to pay for aspects of health care financing instead of medical care.  Instead of going to a doctor and receiving care, we go through an insurance company that has someone on staff to talk to the doctor's office, which has to hire someone just to deal with insurance companies.  (This is oversimplified, but not by much.)  Until we put almost all of our health care resources into care, we aren't going to be able to afford the health care we need.  The Affordable Care Act is a step in that direction, but until we are using some kind of modified single payer plan, our premiums will continue to go up, health care for retirees will continue to cripple public budgets, and health care costs will make American industries less competitive.

Even with all the changes that would be made in an ideal world, health care in the United States will never work until we decide to all accept the health care we need instead of the health care we want.  We want
never to die or to have our loved ones die.  American medicine can go far along those paths, if we spend tens of thousands of dollars in the last months of life to keep someone alive.  How much is one last birthday party worth to someone in their late 80's?  Good question, and I'm sure it will be worth a lot more to me in forty years.  But when someone spends weeks in the hospital getting that last birthday party while their grandchildren go without health insurance, we are not making good choices as a society and we are not providing the structure necessary to loved ones to make good choices at very difficult times in their lives.  In a similar vein, we cannot expect society to pay unlimited amounts of money to correct individual bad lifestyle choices.  Certainly we have to help people, especially people in need, but unless our health care budget it unlimited (which is what our current insurance premiums seem to imply), we need to be able to make choices as a society about what to cover, and provide the resources for people to live into those choices.

Obviously, these issues are thorny.  They won't be successfully discussed in sound bites or tweets. But eventually we will have to deal with them, at least for everyone except the very rich.  America is still capable of tackling such hard work when we want to.  The Supreme Court decision upheld the framework for us to do such work.  For that we can be grateful. 
  

Neighborhood Turn-Arounds

I'm chair of the Sharon Neighborhood Redevelopment Committee as part of our Community and Economic Development Commission.  Trying to make a difference in a neighborhood is neither quick nor easy.  Two articles caught my eye recently of places where something positive is happening, however. 

The first is in Erie, Pennsylvania, where a group of Benedictine Sisters are reclaiming what was one of the city's worst blocks.  The work started when Sister Mary Lou Kownacki went back to the house where she grew up to take care of her dying father.  While she was there, she began to teach neighborhood children poetry and get to know her neighbors.  After her father's death, she stayed, and brought other sisters and community members with her.  Working with the neighborhood's old Polish church and other local leaders, dilapidated housing has been renovated or demolished, a community garden planted, a Catholic Worker house started, and the "Sisters House" created where neighborhood children can come for programming or to cook a holiday dinner for the entire neighborhood.  Instead of Central European families trying to bring their families to America for a better life, now neighbors are hoping to be reunited with those still in Puerto Rico.  And, as Sister Mary Miller notes, "Beauty is important to any lasting neighborhood revitalization."  (Read more about the amazing work on Trinity block in Erie beginning on page 4 of the June issue of The Mount Magazine.)

The second article comes from the Pittsburgh Post-Gazette, and describes how chef Kevin Sousa is opening a restaurant in Braddock, which the paper describes as, "a desolate corner in one of the region's most desolate business districts."  He plans to make a go of it by pulling together a variety of resources, from Community Development Block Grant Funding, to fresh produce from a neighborhood garden, to dishes made in a pottery studio in the local library basement.  In addition to the restaurant and walk up window, he is coordinating with others to offer micro-brews made in the building and with Springboard Kitchen whose staff will use the restaurant's facilities to prepare meals-on-wheels.  Perhaps most amazing, however, is his commitment to the neighborhood is such that he plans to move there.

Revitalizing a neighborhood is tough work.  But a poet, a restaurant owner, a grandmother, or just someone who cares can make a difference. Sister Mary Lou and Kevin Sousa both love their place, love its people and offer their lives to find their community's strengths and share its struggles.  With such efforts, even the toughest places can burst forth with beautiful flowers, good food, safe streets, and thriving children.

A First Take on the PB's Budget Proposal

I was excited to see the Presiding Bishop’s budget proposal this week for a couple of reasons. While others (such as Susan Snook and Scott Gunn) are in a better position to comment on the numbers, I felt the budget made at least two huge strides forward.

First and foremost, putting $2 million at the beginning of the budget for church planting is enormous.  We are never going to reach out successfully to the unchurched if we are not willing to plant new churches to meet their needs.  In too many places where our church is dying, our unstated mission is to have Eucharist every Sunday where we once built a building.  This budget proposal puts first things first, and our first priority should be putting resources into meeting the spiritual needs of those who don’t currently have a church home.

 

Second, as a parish priest, I am most grateful for the way this budget will allow me to explain to my parishioners how the Episcopal Church is spending their money.  My parish pays our entire diocesan assessment, and our diocese (Northwestern Pennsylvania) pays its entire apportionment.  My parish, therefore, pays over $10,000 annually to the Episcopal Church.  If this proposal, or a similarly structured budget, is passed, I can go home and easily show my parishioners the positive things their money is accomplishing.  Instead of trying to go through the (Salmon) Blue Book and explain that the church is doing more than arguing about sexuality (which will likely be so helpfully misrepresented in the local paper) or forcing us into a particular expensive health care plan, I can pull out a budget document and show how two-thirds of their money is being used on important mission.  People in the pews at St. John’s know how tight our budget is and how tight their own budgets are.  But they want to see the Good News proclaimed; they want to see new believers taught, baptized and nurtured; and they want to see needs met.  If we are doing those things in dynamic, cost-effective ways, they will be proud of what the Episcopal Church is doing, and share that with their friends.  A budget like the PB’s proposal is the kind of take-away from General Convention that will make my job as a congregational leader much easier in all the right ways.  

Certainly there are other positives with this proposal.  Reorganizing the budget based on mission priorities helps link the budget and mission.  The reorganization is also a powerful example to dioceses and congregations who are stuck in the staff/buildings/programs/outreach budgeting process made up primarily of last year’s numbers.  Our Presiding Bishop is stretching our imaginations a bit, and that challenge is healthy, especially for those who want to budget this way but haven’t yet found a way to do so.

Thank you, Bishop Jefferts Schori, for proposing a budget that can make the people back home proud.

Entering Heaven Through Liturgy or Through Accepting Jesus Christ as Personal Lord and Savior

Anyone who has grown up in a strongly liturgical church has probably been taken aback at some point by an eager evangelical asking if they have accepted Jesus Christ as their personal Lord and Savior.  In most cases, they have accepted him, although they would never describe it as such and probably couldn't explain it in a way that would be acceptable to their interlocutor.  Learning one another's languages for faith is important for us if we ever hope to be one, as Jesus and the Father are one.  But that is a topic for another time.

A number of real differences do exist, however, and we hit upon one in our staff meeting today.  We discussed an excellent resource by Christian Schwartz called The 3 Colors of Spirituality, which looks at a variety of approaches to God taken by people from widely varied Christian churches.  Specifically, we were talking about the huge emphasis on sacramental spirituality in the Episcopal Church, compared with emphases that may be more balanced in other churches.

Once clear difference struck me between those who are grounded in liturgical and sacramental traditions that makes us talk past many of our evangelical brothers and sisters.  The emphasis on evangelical churches is to win people for Christ, which usually means having them accept Jesus Christ as their Lord and Savior in some formal fashion.  Speaking broadly for them, when that has happened, an individual has been saved, is assured of heaven and begins the process of sanctification which can occur in a number of ways.

For high liturgical Christians, participating in liturgy is already providing access to heaven.  The most ardent of that spiritual stream understand a Divine Liturgy in heaven, as described in Isaiah 6 and Revelation, to be eternally occurring, with Jesus Christ now presiding.  When we gather to pray as a church, especially in the Eucharistic liturgy, we believe that we are taken in a mystical but real way into the heavenly throne room to join with the angels and saints in their praise.  When we sing, "Holy, Holy, Holy" on earth, we are truly harmonizing with the heavenly chorus.

Participating in worship with diverse people who range from good church people to mature disciples to seekers to unbelievers to Christmas and Easter church-goers can make it hard to think about finding a specific time and place an individual might be saved, since all of us experienced something of heaven together.  We know that we have been present to God and he has drawn us to him, so we are invited in.  Yet we also know that we are not yet spiritually ready to live in the house of the Lord all the days of our life.  We hope we are always growing in faith, drawing nearer to God and more full of the fruits of the Spirit, growing from strength to strength in this life into the next.

For that reason, the model of the church from more liturgical streams is a hospital, curing sick souls.  God and his ministers help us go from our deathbeds to sitting up to walking to a full life in the Kingdom of God.  A different model is more prevalent among evangelical churches.  For them the courtroom model is more central, where when the judge finds you innocent, you are free to go.  If you are wearing the blood of Jesus, you will be judged innocent.  Both models have their strengths, and neither is likely to be a fully accurate picture of how we are brought into the Kingdom of God through Jesus Christ.

We need to understand and value the strengths of each others' traditions better, however.  We do have important individual relationships with Jesus that are crucial to our salvation.  We also can't really be saved as individuals, but only as part of the full Body of Christ where Jesus is the head.  We certainly want to go to heaven when we die, but we can also begin to experience heaven today.

1Q84 by Haruki Murakami

I picked up 1Q84 at the Community Library of the Shenango Valley on a whim.  The reviews looked good and I haven't read much Japanese Literature.  The 900+ page work by Haruki Murakami is a magical realism story, somewhat along the lines of Bulgakov or  Gabriel García Márquez, about two troubled young people who find each other after 20 years and one change of reality.  The book is definitely for adult readers.


1Q84 is takes an interesting look at Japanese culture, religious cults, and how two broken people can make each other whole.  A variety of spiritual themes are also present, all the more interesting because they take place in an Asian culture without the same religious background as America.  Two in particular are worth noting.  


In the alternative reality of 1Q84, two opposing spiritual forces claim to be held in tension.  They are talked about as pre-dating good and evil, but are dangerous and often harmful to human beings.  This understanding is similar to that of many pagan and pre-Christian religions.  The main characters get pulled into the battle to balance the world's spiritual forces.  Part of the wholeness longed for by the protagonists is not only their reuniting, but an escape out of this dangerous world.  For the reader, questions are inevitably raised about whether our reality is like 1Q84, or if we are governed by a different set of spiritual forces.  Whether Murakami has an answer in his own mind or is just raising questions, I don't know.  I know that the answer for Christians is that Jesus' victory over death has put all other spiritual forces under his feet.  We are no longer pawns hanging in the balance, but the creation of an all-loving, all-power God who has saved us and brought us to wholeness, as the main characters here long for.


Another spiritual theme is a prayer that the heroine continually recites in critical moments.  Her parents were part of a cult which required her to recite this prayer out loud multiple times a day, even when it isolated her from her classmates.  While not found in the Book of Common Prayer, the prayer would not be out of place in a Christian liturgy.  Amazingly, even thought she rejects the religion of her parents and often recites the words with no sense of their meaning, the prayer aids her and in some cases even seems to save her.  She locates a significant portion of her identity in these few lines at a time when she is in danger of losing herself.  When everything else around her is crumbling, the true spiritual heritage given to her is an anchor.  The falsehoods and hypocrisies have fallen away and there is no repair to the loveless relationships.  What is real, however, remains.  A good reminder of the power of what we pass on to our little ones and of the blessings and the burdens that result depending on what we are able to give them.


O Lord in Heaven, may Thy name be praised in utmost purity for ever and ever, and may Thy kingdom come to us.  Please forgive our many sins, and bestow Thy blessings upon our humble pathways. Amen. 
-- From 1Q84 by Haruki Murakami
 

All-By-Itself Growth

In Mark 4, Jesus tells the parable of the seed that grows all by itself.  The farmer scatters the seed, then goes about his business.  The seed grows all-by-itself in ways that baffle the farmer.  When the grain is ripe, the farmer can harvest.

This strikes me as the opposite of how we normally act as individuals and as churches. We don't like to scatter the seeds we have.  We like to hold onto them, just in case. (Sometimes we even put a bronze plaque on them.)  Then we look for places where shoots are beginning to sprout and do our best to make them grow faster into plants that look just like us.  Never mind that we don't really know how that growth works -- the earth produces all-by-itself.  We would be wise to take off our shoes and recognize the holy ground where God at work, but we can't help but tinker with the watering can, the fertilizer shovel and the weed spray.  How much fruit have we lost because we can't trust God to give the growth?

Of course, this parable doesn't provide an entirely accurate picture, horticulturally speaking.  But it does say something about our work as Christians.  If we focus more on scattering seed, we can trust God to grow fruit at the appropriate time.  But scattering seed can be challenging.  We have to let go of things that we might not get back, including pieces of ourselves.

For example, scattering seed might mean:

• Talking to someone about how God has changed my life.
• Singing a hymn or praise anthem walking down the street.
• Offering a room in my house or my church to someone who needs it.
• Sitting down and just listening to someone.
• Sharing where I see God at work in someone's life.

All of us can think of other ways we might scatter seeds based on our own gifts.  The more we focus on scattering seed at all times and in all circumstances, the more we are going to see fruit being borne around us.  Not all of it will be what we would have planned to plant, but all of it will be a blessing at God's heavenly banquet.

Note: Some of the best discussion of the all-by-itself growth described in this parable is found in the congregational development resources of Natural Church Development.   You can find them at http://www.ncd-international.org/public/essence.html or order resources in the United States from www.ChurchSmart.com