Saturday, January 14, 2017

On Keeping Healthcare Stable

Some of you may wonder why I haven't said too much about the threats to adequate healthcare for all Americans. Some of you may wonder why I have said "keep healthcare stable," instead of just defending the Affordable Care Act. I have done that because I actually work in healthcare, and want to be clear, including by when and where I'm logged in, that these are my opinions and not a reflection of or a reflection on my employer.
That said (and I can't imagine anyone will be surprised), I do have opinions. First and foremost, I think we have sold the Act incorrectly. The name of the act that is labeled Obamacare is "The Patient Protection and Affordable Care Act." We've spent so much time letting folks complain about what "affordable" might mean, and for whom, that we are now at risk for letting the "protection" get washed away. Pay close attention: it is the protections that are truly popular - no exclusions for pre-existing conditions; equity on preventive care for both men and women; equity for mental health with physical health; subsidies to allow the most vulnerable to afford insurance; insurability for folks whose employment and lack of income had left them out; coverage for children on a parent's policy until age 26; a set of minimum standards for what a policy should provide. It is also the protections that make this less "affordable;" and so it is the protections that are at risk. So, not just "Defend the ACA;" "Defend the Patient Protection Act."
So, I speak about "keep healthcare stable" because I can imagine improvements to the Patient Protection and Affordable Care Act; and even a replacement that might be better. At that point, I heard Paul Simon singing about "the myth of fingerprints:" I don't care much whose name is on the bill as long as the bill does the right things. Call it Romneycare instead. Call it the German Model, because this is basically how the Germans meet everyone's needs. Call it Trumpcare or Ryancare - I don't care, as long as it's a real replacement - you know, one that does at least what the old one did (EVERYTHING the old one did), and perhaps more, and perhaps more economically. One of our major auto insurance companies has this ad out, with a focus on their full replacement policy. The hook, proclaimed by the actor complaining about another company is, "Do they expect you to drive 3/4 of a car?" So, I am interested in stability more than the myth of fingerprints. I don't care whose name is one it; but 3/4 of a replacement for the Patient Protection and Affordable Care Act is not a true replacement.
I am also concerned about stability because healthcare is one of the largest employers, as a sector of the economy. These are good jobs, professional jobs, that can't be outsourced overseas. In my years in the business one of its hallmarks has been the many people who have started at the bottom and used employer-supported resources to have better jobs and better pay. One of the patient protections at risk if things aren't stable is an adequate workforce to care for them. Note that at this point I'm not talking about chaplains. We are so small a part of the industry already that we can't sway much. I'm talking about nurses, therapists, lab scientists, and pharmacists. To have them when we need them means we need to keep healthcare stable.
So, there I am: I'm willing to hear that there's a better way; but those who claim that need to actually offer something better. They need to offer it clearly, and they need to offer it before dismantling what is in place. For patient protection, affordability, and a stable economy - things that have actually been helped by the Patient Protection and Affordable Care Act - we need to keep healthcare stable.

Friday, December 23, 2016

Once Again, Amahl - Once Again


I posted this for Christmas eight years ago. As I look back at it, somehow the tenor of the times call it back to me, make it seem particularly apt. I offer it again. Once again this Christmas there will be Amahl; and once again I will cry.

This morning I am once again practicing my last Advent (or first Christmas) ritual: I am listening to “Amahl and the Night Visitors.” As “Jesus Christ Superstar” has long been my Holy Week ritual, I can’t be quite ready for Christmas until I’ve heard Amahl.

If you haven’t heard it before, I commend it to you. Gian Carlo Menotti composed it for the first broadcast of the Hallmark Hall of Fame on NBC. It was first broadcast on Christmas Eve, 1951, and every Christmas Eve after until 1966. It is a memory from my childhood, before we had joined the Episcopal Church and I had discovered Midnight Mass. Wikipedia has a good synopsis, with the history of the production, here. I have written some earlier reflections on the opera here.

As I listened this morning, I was particularly struck at how timely the setting is for this opera. Amahl’s mother is in her own survival mode. She can see no value beyond the economic, whether in her son’s poetry or in her guests’ possessions. It isn’t because she’s unfeeling. She loves her son powerfully, and wants, with what little she has – another “widow’s mite” – she wants to show hospitality. She is enough of a known person in her community that those around her will turn out in the middle of the night to extend their hospitality with hers.

At the same time, she is defeated, or so nearly so as not to matter. She is ashamed to consider begging, however exciting it might seem to her son; but she sees no other option for his survival, much less her own.

And so she is driven to theft. She considers differences in class: “I wonder if rich people know what to do with their gold,” thinking not of great luxury, but of the simple pleasures now beyond her reach, beyond her hope. She considers a greater good to be done: “Oh, what I could do for my child with that gold!” She considers even whatever incipient relationship, even obligation, she might have with her guests: “Why should it all go to a child they don’t even know?” Finally, she gives in, not for herself but for her child; not for it all, but for just what she might need: “If I take some they’ll never miss it.”

Perhaps; but she is caught in the act. And when caught, her humiliation, and that of her son, are complete. She is seized, and her only defender is her crippled son, too weak to do more than appeal plaintively to the kings themselves.

It is then that she discovers mercy: for the kings know she and her son are more important than the gold itself:


Oh, woman, you can keep the gold.
The Child we seek doesn’t need our gold.
On love, on love alone
He will build His kingdom.
His pierced hand will hold no scepter.
His haloed head will wear no crown.
His might will not be built on your toil.
Swifter than lightning
He will soon walk among us.
He will bring us new life
and receive our death,
and the keys to His city
belong to the poor.

And in that moment, there is a miracle – indeed, there are two. We will all celebrate with the second, when Amahl can walk, blessed with healing in the moment of his own greatest generosity. But, neither do we want to miss the first: for it is indeed miraculous when his mother’s eyes are opened, her imagination expanded, and her hope renewed. Indeed, her miracle is not so different from his; for as his body his healed, so is her spirit. She can see possibilities again, possibilities that take her beyond herself, even beyond her son: “For such a king I’ve waited all my life. And if I weren’t so poor, I would send a gift of my own to such a child.”

We are surrounded these days with the same desperation Amahl’s mother felt. We see it of course in any Christmas, and will until we see the Kingdom in fullness: those who, beat down by their circumstances, unable to imagine alternatives, will steal. Some will be simply and solely greedy; but many, like Amahl’s mother, will be unable to bear the shame of what they cannot do for another, for children or spouse or those otherwise family. But this year I fear there will be so many more. The economic devastation around us, wrought in no small part by our own inability to see value beyond the economic, our own poverty of spirit, leaves many, and more than usual, literally with “nothing to eat, not a stick of wood for the fire, not a drop of oil in the jug.”

Give thanks for those who can say, to whatever extent and in whatever way, “Oh, woman, you can keep the gold [because] the Child we seek doesn’t need our gold.” Give thanks and praise when you can and I can say that, for when we do we open up possibilities for miracles. Cry aloud, “On love, on love alone will he build his kingdom… and the keys to his city belong to the poor.”

And pray, pray now and always, for those miracles, whether as visible as a dancing child, or as profound as a healed and opened heart. Pray that as our hearts are opened, so might theirs be; so that all of our eyes might be opened to the miracles wrought in the name of the Child.

Blessings for Christmas, and for all in this season of Light, from the Episcopal Chaplain.

Monday, December 19, 2016

Opportunity for Fun for Wonks and Geeks Like Me

This morning I received a link to a page that ought to be exciting - if you think knowing about published research is exciting. Take a look at the Top 100 Articles of 2016 as compiled by Altmetric. Altmetric is new to me, too. They say of themselves, "Altmetric is a Digital Science company based in London, UK. Our mission is to track and analyse the online activity around scholarly research outputs."

At any rate, their list of the most reviewed articles is interesting. They include at least one unexpected author. And, at least some of the articles are available for anyone to read (and, yes, for some you'll need to get the journal in which it was published).

So, take a quick look to see at least which was number 1. Take a quick scan, and you'll discover a number that are not only of broad interest, but also accessible to a broad audience. (And thanks to Becker's Hospital Review for the link.)
 

Monday, December 05, 2016

Up at the Cafe: On Healthcare for All

I have a new piece up at Episcopal Cafe - my first in quite a while. The topic is to continue commenting on where the Episcopal Church is on health care. Specifically, General Convention has repeatedly called us to work for universal access to affordable, quality healthcare. (I've written about that before, including here and here.) 

Go over, take a look, and let me know what you think, whether there or here.

Thursday, September 01, 2016

A Political Thought for September 1

I have been mulling over again and again this concern I have heard often expressed, "I don't like the feeling of voting for the lesser of two evils." I can appreciate the sense of dissatisfaction in that. However, I have come to a different concern. If we accept that "All it takes for evil to triumph is for good [persons] to do nothing," (attributed, or more likely misattributed, to Edmund Burke; but thoughtful, whatever the source), then I think we are offered a different perspective. That is, we may feel some disappointment at the thought of voting for the lesser of two evils. However, we should feel a sense of duty to vote against the greater of two evils. That applies whether we identify the "evil" with a person or a platform; and whether the "evils" are two or more. (It applies whether you agree with me or disagree on where the "evil" is seen.) If we are called to act in this world for the love neighbor as self, we who are citizens have a positive moral duty, when we see "evil" to act against it. Vote!