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Affordable health care – about saving lives, or money?

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Affordable health care – about saving lives, or money?


By Martin Elfert

I was naked and you gave me clothing, I was sick and you took care of me, I was in prison and you visited me.

­            – Matthew 25:36

A little over a month ago, as the debate over the repeal and replacement of the Affordable Care Act thundered on, the surgeon and author Atul Gawande asked a question of congress and of our wider society:

What is the human goal of this bill?

In so doing, Gawande invited us to zoom out the camera, to examine more broadly what is going on in our health care debate. In many ways, his question was an elongated version of that old question which is beloved of small children and theologians alike: Why? Absolutely, Gawande’s question suggests, let’s name the goals of creating jobs and of reducing the deficit and of granting individual citizens more discretion and decision-making authority. But once we’ve identify these goals, let’s make sure that we don’t skip the next and bigger and more important question, the human question, the question of why, the question that we might paraphrase as:

How will this make life better?

Or if we are the sort of people who are inclined to use theological language:

How will this build up the Kingdom of God?

I thought of Gawande last week as the House of Representatives passed a bill that, should it become law, will radically alter how health care in America works. In particular, the bill will alter and limit the availability of health care to the most vulnerable.

Now, there is considerable confusion and debate about how the bill would affect the poor, the aged, and those with pre-existing conditions. But there does appear to be broad agreement that the bill will make health insurance function more like car insurance, so that health care will be predominantly available to those with the financial resources to pay for it and that premiums will increase markedly for folks who are sick or injured, much as they increase for people who get too many speeding tickets or get into too many accidents.

Why? What is the human goal of such a law? How will it make life better? How will it build up the Kingdom of God?

Part of the role of the church – a big part – is to act as a catalyst for moral questions such as these, to provide a forum within which to ask them. Our job is to nurture the kind of questions that Gawande posed a month ago, to join those who are reminding society that life has a moral dimension. Our job – to risk using unpopular or old-fashioned language – is to proclaim that we will be judged for what we do and for what we leave undone in this life.

When you read the Gospels, you find that Jesus doesn’t talk a whole lot about sexual morality (that’s a bit of Biblical trivia that you wouldn’t always guess when listening to his followers). What Jesus does talk about all the time is taking care of those in need, of extending mercy to those in need. Indeed, Jesus doesn’t just talk: his ministry is comprised of one healing story after another.

Through his words and his actions, Jesus has left a command for us. The command is to ask big questions of ourselves and of our culture, questions about how we treat the least of these, our siblings, questions that lead us into action. Right now, that command means asking whether or not the bill that has just taken a step closer to being law would to add to the sum of justice and compassion and mercy and love and healing in the world, especially as these things apply to the most vulnerable of our neighbors.

Asking such a question is not a case of the church forgetting its job and becoming a political institution. Asking such a question is a case of the church remembering its job as a moral institution.

And should we discover that the answer to our question is “no” – should we discover that this bill is more about saving money than it is about saving lives – then Jesus’ command means that we need to be part of demanding something better, demanding something fairer, demanding something more like the Kingdom of God.

Martin Elfert

About Martin Elfert

The Rev. Martin Elfert is an immigrant to the Christian faith. After the birth of his first child, he began to wonder about the ways in which God was at work in his life and in the world. In response to this wondering, he joined Christ Church Cathedral in Vancouver, British Columbia, where he and his new son were baptized at the Easter Vigil in 2005 and where the community encouraged him to seek ordination. Martin served on the staff of the Episcopal Cathedral of St. John the Evangelist in Spokane, Wash. from 2011-2015. He is now the rector of Grace Memorial Episcopal Church in Portland, Oreg.

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