Biblical Reflections on Modern Medicine
Vol. 9, No. 6 (54)
Ignoring the Obvious to the Increase of Disease and Death
* The following is a paper that I presented at the 50th Annual Meeting of the Evangelical Theological Society in Orlando, Florida, November 20, 1998.
In 1977, Robertson McQuilkin wrote that "the functional control of Scripture over any discipline will vary in direct proportion to the overlap of that discipline with the substance of Biblical revelation."1 Concerning psychology, he wrote that "the potential area of conflict is much greater than in the case of medicine or agriculture." From that statement and others, I doubt that he would place medicine at the second level (see below) of control as he did psychology. However, medicine should be placed under that second level because of the role that health and medicine have been given in modern America.
Dr. McQuilkin suggested this paradigm.
In the highest category, Dr. McQuilkin included theology and Christian philosophy. In the second level, he included the behavioral sciences (psychology, sociology, and anthropology). In the third level were history and the arts. The fourth level included the physical sciences. At the fifth level were typing and other purely technical skills, "unrelated to Scriptural truth except in the person of the practitioner." Even in the third to the fifth levels, Dr. McQuilkin maintained that subject matter must be compatible with Scripture where they overlap and that Scriptural truths should govern the work and person of the practitioner, whatever his field of endeavor. Thus, the Christian and his vocation are never totally removed from God's authority and revealed truth.
My intent is not to debate Dr. McQuilkin's categories. Indeed, his paper was not intended to establish and debate iron-clad categories or hard definitions. His concern was about pagan ideas that were controlling too many Christians in the behavioral sciences to the detriment of individual Christians and their culture. My concern is that pagan ideas control too much of modern medicine to the detriment of the health of individuals and society.
There is a huge difference in medicine today, which I shall call "modern medicine," with that practiced only one generation ago. The purpose of medicine is to heal, care for, and comfort the diseased and injured.3 However, modern medicine both intentionally and unintentionally promotes the opposite: disease and death. Intentionally, medicine aborts more than 1 million unborn babies each year, has greased the slippery slope toward euthanasia, and endorses homosexuality. Unintentionally, modern medicine has fostered an epidemic of sexually transmitted diseases; children who are poorly educated, socially disruptive, and sometimes criminally inclined; and a cost that ex-ceeds individuals' and society's ability to pay.
Medicine has grown from an almost insignificant portion of a family's budget and social cost to a $1 trillion industry that consumes 14 percent of the United States' Gross Domestic Product. For this high cost, it has actually increased morbidity and mortality--because it has failed to be under the functional control of Scripture. Yes, it may be too much to expect "society" to embrace Biblical revelation, even for its own health. However, it is reasonable to expect Christians committed to the authority of Scripture to discern the errors of modern medicine and promote a different understanding from that of the World (Romans 12:1-2).
There is no doubt that modern medicine "has subject matter (that should be) extended by empirical research and experimentation" (second level), and even "subject matter unrelated to Scripture" (fifth level). These endeavors occupy the bulk of what modern medicine does. Positron emitters virtually take pictures of the brain. Tiny scopes can be inserted into almost any body part with startlingly clear images. Surgeries are performed with lasers and at microscopic levels with short recovery periods. People crushed in automobile accidents are kept alive and often returned to a normal life. Indeed, the capabilities of modern medicine seem to border on the miraculous.
Thus, there is a technology and science of medicine. I would not only be foolish to say otherwise, I would be extending the functional control of Scripture beyond its bounds. Some Christians have made this error. Reginald Cherry, M.D., states that "Within the Bible's holy writ are all the principles needed by each of us to find the healing of body, soul, and spirit."4 His chapters include "Bible cures" for heart disease, diabetes, ovarian cancer, stomach cancer, etc. Interestingly, Roy Maynard, who reviewed Dr. Cherry's book, observes that he is "not careful with language." For example, his "Bible cure" for breast cancer includes surgery, chemotherapy, and nutrition. These are obviously not Biblically directed treatments, but those of modern medicine.
Again, there is a technology and science of medicine outside of Scripture. Here, modern medicine has Biblical legitimacy. Its research and applications bring comfort, and sometimes cure, to many patients with various diseases. I want to state this clearly and unequivocally because it will occupy only a small place in my efforts here.
Why do I say "small" place? Because this legitimate area of medicine in the large scheme of health, disease, and injury occupies only a small place. In cost and public attention, this area is gigantic, spending most of the $1 trillion each year. But, its effects on the overall health of individual patients and society are small.
First, modern medicine has received a credibility that it does not deserve. Modern medicine claims to have eliminated the infectious disease killers of the past, such as measles, tuberculosis, whooping cough, and diphtheria. Yet, charted declines of these diseases indicate that they were mostly eliminated before there were effective vaccines or treatments.5 These disappearances were due to better sanitation, housing, and personal maturity,6 not public health or medical measures. Yet, modern medicine is credited with conquering such infectious diseases to cause the marked increase in life expectancy of about 25 years that has occurred since 1900.
Second, the efficacy of modern medicine is vastly overrated. By efficacy, I mean the ability of medicine to impact the morbidity and mortality of individuals. Of the patients seen in a generalist's office, 80-90 percent have problems which are self-limited. That is, they will get better without treatment or can be treated as well with non-prescription drugs. Or, as we physicians say among ourselves, "Patients will get better in spite of what we as physicians do to them"!
A plethora of coronary care units has had little, if any, impact on the survival of patients with heart disease, far and away the leading cause of death. In fact, the causes of the 40 percent decline in coronary artery disease mortality since 1960 are unclear, but are almost certainly not due to medical intervention. Changes in lifestyle give a mixed message. While some people have cut their saturated fat intake, our population in general has become more obese and sedentary. More likely, this decline is due to the observed phenomenon of a natural ebb and flow of diseases over time.
With a few exceptions in childhood cancers, the war on cancer has been lost. For 30 years, billions have been spent on research for better treatments and early detection, but this great effort has, at best, produced a slight gain when all cancers as taken as a whole. Almost all of this gain has occurred with childhood blood diseases. Among all age groups, cancer remains the second leading cause of death. Strokes (cerebrovascular diseases) continue to be the third leading cause of death, but nothing has ever really been found to treat this severely crippling disease, including recent attempts to bring stroke patients in very early and rapidly treat them.
Third, the science of medicine is difficult and usually is not the basis for what physicians do. The "gold standard" of medical research is the double-blind, randomly controlled study. However, such studies probably account for less than five percent of what physicians actually do every day. Their actions are not necessarily invalidated by this lack, but it certainly undermines the notion that modern medicine is "scientific" and research based. When these controlled studies are actually performed, "orthodox" treatments may be found to be beneficial, have no net improvement in a patient's condition, or actually be found to be harmful. Further, patients rarely take medication according to directions, which decreases the likelihood of benefit.
Fourth, medical treatments are sometimes harmful. There are medication errors in hospitals, complications of surgery and anesthesia, complications of investigative procedures, and untoward effects of drugs--to name a few. Indeed, it seems that the increasing complexity of medicine and newer, stronger drugs has increased these harmful effects. This "iatrogenic" harm must be considered in any overall evaluation of modern medicine.
I could go on, but my purpose is not to invalidate medicine. My purpose with this brief review is to remove modern medicine from its god-like pedestal apart from the immorality that exists outside the functional control of Scripture.
Were medicine as effective as we pretend, giving us a good return on our
What are the evidences for modern medicine's being outside the control of Scripture, and what are the effects of this position?
Abortion. The worst offense is abortion, with its destruction of 1.5 million unborn lives each year. The American Medical Association, the American Association of Obstetricians and Gynecologists (AACOG), and the nurses division of AACOG once legally defended abortion as "sound medical practice." The Bible is clear that individual human life begins at conception (Genesis 4:1, Psalm 51:5, Luke 1:31) and that it is a special work of God's design (Psalm 139:13-15). God even plans the creation of individuals and their life's work before they are born (Psalm 139:16-18, Jeremiah 1:5).*
Modern medicine has had to juggle its own science to justify abortion. Conception was re-defined to mean implantation of the embryo in the uterus. The rationale to define when the embryo and fetus become "human" or a "person" would be laughable were it not so morbid. Simply and "scientifically," individual human life begins with the unique cellular complement that is formed by the union of a sperm and an egg.
Under this same failure to defend fully human life, medical organizations and governmental agencies have failed to take a stand against infanticide, so-called assisted suicide, and euthanasia. We are on the brink of another holocaust.
Marriage. Modern medicine has failed to uphold and endorse sexual relationships within marriage. This failure has a widespread fallout in ways that may not be readily apparent. First, sexually transmitted diseases are epidemic. Not only are syphilis and gonorrhea prevalent, but there are literally new epidemics of sexually transmitted diseases, such as hepatitis B, cervical cancer, herpes type II, and HIV/AIDS. Nearly one in four Americans has or has had one or more sexually transmitted disease.
Second, this failure to endorse marriage has destroyed the secure environment of homes for children. There are hundreds of studies that show that children of single and divorced parents have a far more difficult time than children of two-parent homes. They perform more poorly in school, are more likely to drop out of school, and are more commonly involved in crime.
Third, even apart from sexually transmitted diseases, unmarried adults (never married, divorced, and widowed) have more disease and difficulties than the married. In 1977, James Lynch, M.D., wrote The Broken Heart: The Medical Consequences of Loneliness.7 In that book, Dr. Lynch cites a plethora of statistics in which married people have less mortality from virtually every kind of disease, including heart disease, hypertension, stroke, cancer, diabetes, and kidney disease. They have fewer deaths from automobile accidents, homicide, suicide, and even accidental falls.
Homosexuality. While failing to endorse traditional (Biblical) marriage, modern medicine has endorsed homosexuality. The homosexual lobby bullied the American Psychiatric Association in the early 1970s until 1973 when its board removed homosexuality as a pathological diagnosis and made it an "alternative lifestyle" (that is, a legitimate sexual relationship).8 This endorsement has progressed to the extent that one psychiatrist has threatened that "clinicians" who continue to call homosexuality a "disorder" and attempt to change homosexuals to heterosexuals "may soon find themselves confronted with malpractice litigation."9 Thus, the medical profession has called evil "good" and good "evil."
The homosexual lifestyle is unhealthy and deadly. Even apart from AIDS, the life expectancy of homosexuals is only 42 years.10 No doubt this shortened life is caused by the fact that homosexuals have a far greater frequency of sexually transmitted diseases than heterosexuals, have other diseases that are endemic to their group, and have a higher incidence of crime and other socially destructive behavior.11
Parental authority. Modern medicine has failed to stand for the parental authority necessary to the health and welfare of families. Single or married women of any age can be treated for sexually transmitted diseases, receive birth control of any kind, and even have an abortion without parental or spouse's consent anywhere in the United States! It is even argued that teenagers and individual spouses should be able to present any problem to a physician without their "fearing" that their parents or spouse will be told. The American Academy of Pediatrics has taken an official stand against spanking, God's own design for disciplining children (Proverbs 19:18, 22:15, 23:13).
Godless psychiatry. Since Sigmund Freud, psychiatry and its practitioners have usually viewed Christian beliefs as pathological and destructive to the individual and families. Indeed, one could argue that psychiatrists (and psychologists) have become the priests of modern medicine (and society). Certainly, psychiatry has facilitated, if not endorsed and caused, many of the other problems discussed here.
Let me be clear. There is a place for medical treatment of problems that are caused by organic brain diseases. However, far too many besetting sins have been excused as "diseases" or beyond the control of the "patient."12 These include alcoholism, gambling, sexual promiscuity, theft, and both legal and illegal drug abuse. Indeed, "addiction" has become a shibboleth to excuse almost any harmful habitual behavior (although most who use the word "addiction" never bother to define it).
Psychiatry has entered the world of individual, marriage, and family counseling for everyday problems, a realm that is definitively moral rather than medical. Also, psychiatry (and psychology) have penetrated the Church of Jesus Christ to the extent that pastoral counseling is commonly taught by these "professionals" in many seminaries. This movement into the moral and spiritual arenas of society is evidence of the prevalent authority that has been granted to psychiatry (and psychology).
The place of modern medicine under the authority of Scripture is no less than that determined by Dr. McQuilkin, that is, "in direct proportion to the overlap of that discipline with Biblical revelation." I contend that that overlap is far greater than that envisioned by most Christians and never even grasped by non-Christians.
The overlap lies at the heart of the Biblical message, salvation. The Greek roots, sozo and diasozo are translated "save" or "salvation," most commonly referring to salvation from personal sins in this life and hell in the afterlife. However, they are also translated for salvation of the physical self (Matthew 8:25, 14:30) and healing of the body, as the woman with the flow of blood (Matthew 9:21), blind Bartimaeus (Mark 10:52), the lepers (Luke 17:19), and the man lame from his mother's womb (Acts 4:9).
Iomai may refer to both physical and spiritual healing. For example, there is the healing of paralysis (Matthew 8:8), leprosy (Luke 17:15), a severed ear (Luke 22:51), fever (John 4:47), and dysentery (Acts 28:8). The noun form, iatros, designates physician. Relative to spiritual healing (i.e., salvation) are Matthew 13:15, Luke 4:18, Hebrews 12:13, and I Peter 2:24.
Hugies (hygiene or health) is similar. References to physical healing from this root include that of a withered hand (Matthew 12:13), bleeding (Mark 5:34), and lameness (Acts 4:10). Texts that designate spiritual healing are Luke 5:31 and 15:27. Indeed, several contexts may be recognized to use derivatives of sozo, iomai, and hugies interchangeably.
This clear association of healing, health, and salvation of both body and soul (spirit) leads to my first principle of functional authority of Scripture over medicine. No fullness of health is possible without belief in Jesus Christ as Savior and Lord. As medicine mends broken bodies, the Gospel mends broken spirits. The word "fullness" is used rather than complete health, because neither complete health of the body nor of the soul can be experienced in this life.
I am not advocating that every physician devote most or all of his time and energy to evangelism. I am advocating that the health of the soul be recognized as an absolute prerequisite to fullness of health for every person. The frequency with which Christians in medicine, particularly psychiatrists and psychologists, ignore this foundational principle is appalling.
The second principle of functional authority for modern medicine is that human responsibility, not disease, is the cause of problems to which the Bible speaks clearly. The following are not "diseases" but sins: alcoholism (drunkenness, Proverbs 20:1, 31:4-6, Ephesians 5:18), homosexuality (Leviticus 18:22, 20:13; Romans 1:26-32; I Corinthians 6:9-11, I Timothy 1:10), lying (Exodus 20:16, Ephesians 4:25), theft (Exodus 20:15, Ephesian 4:28) and heterosexual immorality (Exodus 20:14).
Addictions are better understood as "besetting sins."13 That is not to say that there is not a physical craving, even a physical biochemical proclivity (which is certainly not proven) toward some addictions, such as drugs and alcohol. However, that proclivity is not primary. Many alcoholics and drug addicts have broken the stranglehold of their problems, thereby proving that alcoholism is not entirely physical. If the physical element were primary, none could ever quit. Even the substitution of another chemical in the place of the harmful drug would remain an addiction.
A larger area to which this principle speaks is that of psychiatrists dealing with "everyday" problems of family disruption, career decisions, and personal disputes. Such problems are the province of Scripture. "'Be angry, and do not sin,' do not let the sun go down on your wrath, nor give place to the devil" (Ephesians 4:26). "Therefore do not worry about tomorrow, for tomorrow will worry about its own things. Sufficient for the day is its own trouble" (Matthew 6:34). "Husbands, love your wives, just as Christ loved the church and gave Himself up for it" (Ephesians 5:25). And so on. Virtually every problem faced in life has a Scriptural solution, either directly or derived.
A third principle for Scriptural control is the sanctity and structure of the family. The father is the loving head (Ephesians 5:23-33), the wife is his help-meet (Genesis 2:18, Ephesians 5:22), and both are responsible for their children (Ephesians 6:1-4). How can children be brought up in the "nurture and admonition of the Lord" if there is a place (the physician's office, school-based clinics, abortuaries, etc.) where they can receive treatment and advice on some of life's most crucial issues? Husband and wife are "one flesh," with nothing happening to one that the other should not know about (Gen. 2:23-24, Eph. 5:22-33).
A fourth principle is the sanctity of sexual expression within marriage. One can escape all sexually transmitted diseases, the most serious epidemics of modern times, by following this admonition. Is this principle, then, not a health message? Interestingly, if fullness of sexual expression is a concern, studies have shown that married men and women have better sex lives than the unmarried. Also, religious men and women who are married have better sex lives than the married who are not religious!14
There are other principles that could be derived, but these four address major intrusions of modern medicine into Scriptural authority. Medical science's own studies show the health that is possible by following these prescriptions and proscriptions. Would we not expect that only healthy instructions would come from the Maker of mankind Himself?
When C. Everett Koop was Surgeon General, he said that the Surgeon General's office is not a bully pulpit. That is, it is a place from which to dispense health, not morality. Many without and within the Church have agreed with him.
Not so! Allowing 1.5 million babies to be born each year instead of being aborted, avoiding all sexually transmitted diseases, prolonging health and life in marriage, raising children to be better achievers and more healthy, and solving problems before they lead to destruction and death are indeed messages of health.
The World Health Organization has stated that "health is a complete physical, mental, and social well-being and not merely the absence of disease or infirmity." While this definition is overly broad, it does link bodily health to social and spiritual concepts. "Well-being" concerns what is "good," and good is necessarily determined by right and wrong. The Bible is the only true Source of right and wrong.
The functional control of modern medicine by Scripture has more to offer toward the prevention of morbidity and mortality and health promotion than all of modern medicine's skills and knowledge. The Bible is indeed about health. The science of medicine and sociology have hundreds of studies that demonstrate the healthy admonitions of the Bible. There is indeed an empirical realm of knowledge and expertise for medicine that is its primary function. However, modern medicine has overstepped this primary function with resulting disease and death in the millions.
Is the functional control of modern medicine by Scripture important? It is--only if the hubris of modern medicine is willing to bow its knee to Godly wisdom. It is--only if the American people truly desire maximal health and longevity over their own sins. Neither seems to be forthcoming any time soon.
* Note: In supplying Bible texts that support my contentions, I have made no effort to be thorough. I have found that those who would differ are neither persuaded by one text or every relevant text in the Bible. For the same, I have made no effort to document a plethora of medical-scientific resources that support my positions.
All Scriptural quotes are from the NKJV.
1. J. Robertson McQuilkin, "The Behavioral Sciences Under the Authority of Scripture," 1/20 The Journal of the Evangelical Theological Society (March 1977), 31-43.
2. Ibid, 32.
3. The purpose of medicine is more complicated that this simple statement, but it will suffice for this paper. A more detailed analysis may be found in my book: Franklin E. Payne, Biblical Healing for Modern Medicine, (Augusta, GA: Covenant Books, 1993).
4. Roy Maynard, "Taking the Bible Cure" (book review), 13/32 World (August 22, 1998, 22. Reginald Cherry, The Bible Cure (Creation House, 1998).
5. Leonard A. Sagan, The Health of Nations: True Causes of Sickness and Well-being (New York: Basic Books, 1987), 67-70.
6. Ibid., pp. 187-188. "Personal maturity" is my phrase not Sagan's. His "psychological characteristics of the healthy person" included being "confident of (his) ability to make competent decisions," "having a high regard for themselves," having "a high value (for) health and survival," being "future-oriented," "forming strong and persistent affectionate bonds (in) social networks" (especially marriage), "relishing companionship," and "pursuing knowledge of themselves and the world around them."
7. James Lynch, The Broken Heart: The Medical Consequences of Loneliness (New York: Basic Books, 1977).
8. The removal of homosexuality as a pathological diagnosis was correct (Biblical). Making homosexuality legitimate was incorrect (unbiblical).
9. Stanley E. Harris, "Aversion Therapy for Homosexuality" (letter), 259/22 The Journal of the American Medical Association (June 10, 1988), 3271.
10. Paul Cameron, William L. Playfair, and Stephen Wellum, "The Longevity of Homosexuals: Before and After the AIDS Epidemic," 29/3 Omega (1994), 249-272.
11. Paul Cameron, Kirk Cameron, and Kay Proctor, "Effect of Homosexuality Upon Public Health and Social Order," 64 Psychological Reports (1989), 1167-1179.
12. Franklin E. Payne, "Addiction as Besetting Sin," 7/4 Journal of Biblical Ethics in Medicine (Fall 1993), 96-99.
14. Robert J. Levin, "The Redbook Report: A Study of Female Sexuality," Redbook (special report, 1975); Philip and Lorna Sarrel, "The Redbook Report on Sexual Relationships," Redbook (October 1980), 73-80; "The Janus Report," Redbook (March 1993), 69-71, 114, report based upon Samuel S. Janus and Cynthia L. Janus, The Janus Report on Sexual Behavior (New York: John Wiley and Sons, 1993).
In the September 1998 issue of Reflections, I quoted an interview with Eric Harrah that described the callous disregard that man men had for women and their unborn children relative to abortion. The interview continued in the next issue of Life Issues Connector, and the picture of women and families is equally callous.
Commentary: There are great evils within the abortion industry other than the killing of unborn babies. Abortuaries provide no followup, yet they sometimes injure women severely and fatally. The Centers for Disease Control and Prevention carelessly processes these statistics in order to give the best possible "safety" label to the abortion industry.* Cities and states require lesser health standards and record-reporting of abortuaries than almost any other health-related industry. Women are sexually abused in abortion clinics because the personnel there know that the women want to keep their abortion quiet.
And families. Oh, what our laws have allowed to happen within families! Men using and abandoning women. Women aborting their husbands' and boy-friends' babies. Teenagers killing the grandchildren of their parents. Parents forcing their daughters to kill their children to protect the parents' "reputation." Future families prevented because women are unable to have children from the complications of abortion.
I am not so naive to think that these families and relationships would be happy and wholesome. There are indeed severe problems that legal abortion itself does not create. However, abortion introduces homicide into what are otherwise strained and distorted relationships. Abortion deepens, darkens, and broadens these personal struggles. Situations that are difficult become tragic and catastrophic.
And, our culture, esteemed medical profession, and legal system does almost everything in their considerable power to maintain and expand this culture of evil and death.
Brothers and sisters, make no mistake about our situation. Our "civilization" has no thin veneer over its barbarism. Its depth and depravity is as bad, if not worse, than any before it. Apart from a powerful intervention from God, change for the better will be slow and long in coming, if ever. Judgment from God must occur either naturally (from violation of His moral laws) or supernaturally (from His superseding of His natural laws).
I encourage you to write for the full interview in the September and October issues of Life Issues Connector for this description of the broader effects of abortion in our culture.
* Mark Crutcher, Lime5, (Denton, Texas: Life Dynamics, Inc., 1996), pp. 135-170.
Vol. 12, No. 6 (79) November 1998
World AIDS Day
December 1 was established as World AIDS Day eleven years ago. Locally, there is a formal ceremony in the lobby of a major state hospital with candles, speeches, and other laments about all the people who have or have died from HIV and AIDS.
Every year I get a different lament--AIDS victims can be celebrated in the lobby of this hospital, but God cannot. Manger scenes in public places, other than on the lawns of churches or private homes, were once common to the celebration of Christmas (not "Winter Holidays"). No more. But, there is a celebration of HIV/AIDS.
Just what is that celebration? It is a ceremony to homosexuals. I reason in this way. What is unique about HIV/AIDS? It is not the prevalence of disease and death. Far more people die of cancer, heart disease, and stroke than AIDS each year. It is not the horror of the disease. To most, cancer, strokes, and the complications that follow are as severe as AIDS.
Perhaps, IV drug abusers make HIV/AIDS unique, since they comprise the other large category of victims. If so, why choose HIV/AIDS alone? IV drug abusers die of other severe diseases: malnutrition, hepatitis B and C, blood infections (sepsis), and abscesses in almost any part of the body, including the brain.
No, the unique aspect of HIV/AIDS is its association with homosexuals. There is nothing else distinctive about the disease over other diseases.
So, homosexuals are celebrated and remembered in public, and God is banished. Perhaps, there is no other contrast that clearly represents the spiritual depravity of modern medicine and America. "And even as they did not like to retain God in their knowledge, God gave them over to a debased mind... (they) also approve of those who practice them (many evils, including homosexuality)" (Romans 1:28, 32).
Some 242 HIV-positive gay men from "various community venues (such as AIDS service organizations, gay bars, and public sex environments)" participated in a study of their own perceptions for their own responsibility to prevent HIV spread to others.
Commentary: Methinks that there is a huge gap between perception and action here! Homosexuals still account for the largest proportion of new AIDS cases each year (35% in 1997). If 82 percent of gay men acted on their perceptions, then there would be far fewer cases of HIV infection and AIDS each year. Evidently, their moral oughts do not translate into moral deeds.
Commentary: The likelihood that the Gospel of Jesus Christ will be presented in this "non-judgmental" and "sensitive cultural and psychosocial issues" program is virtually zero. Yet, is there a more important "psychosocial" issue?
While this particular program is Roman Catholic, many Protestant churches participate in similar HIV/AIDS programs. Thus, I am not directing my comments at them alone.
These "churches" have sold their birthright for a one-time meal. That is, they have sold eternal for temporal consequences. They have sold the spiritual for the physical. They are no longer churches.
But, then, this situation is not new. Since the Enlightenment, this exchange has been occurring as "churches" become "enlightened." Only the ministry to HIV/AIDS victims and potential victims is new. I ask the question that so many of my forebears in the faith have asked, "Why retain "Christian" and "church" if you offer only what the godless offer?
Perhaps, the answer is that to remove these labels would force them into the reality of what they have actually done: abandoned the rock of Jesus Christ for sinking sand.
"On July 1, 1997, the Federal Portability and Accountability Act of 1996 (HIPAA) became effective in all states.... HIPAA makes most health coverage renewable at the option of the insured, and removes or limits the use of exclusions for pre-existing medical conditions by insurers and employers in most situations. HIPAA requires insurers and employers to accept persons into group health plans without regard to their health status. Most employees are now able to change jobs without their medical conditions being a problem or barrier to eligibility for coverage under their new employer's group health plan. HIPAA portability rules apply whether the plan is an insured health plan of an employer self-funded uninsured plan." (Fax-Wire, Office of Insurance and Safety Fire Commissioner, State of Georgia, October 1998)
Commentary: What the Clinton Health Care Plan could not do by direct assault, it is doing by stealth. The above law is potentially catastrophic to both businesses and health insurance. The effectiveness of insurance depends upon actuarial tables to predict insurable events in population groups. This law destroys actuarial tables.
By forcing insurers and businesses to accept pre-existing conditions, their expenses are unpredictable and potentially costly, especially for smaller insurers and self-funded uninsured plans.
This law creates a catch-22 in a time when the hue and cry is for less expensive health care which is supposed to be provided by managed care plans. However, such laws cripple these plans' ability to keep costs down for their "subscribers." Before long, the federal government will once again say that the "free market" has failed and only it can provide low cost, high quality health care for the American people. The feds will not say, and most of the American people will not realize, that there has not been a free market in health care since state licensure and state-regulated insurance were implemented!
But, dear brothers and sisters, state and federal governments are not the only problem here. Greed is rampant at every level of the "system." Almost everyone in the system pretends to have the "patient's best interest at heart, while trying to increase their own share of the medical pie. The American Medical Association is profiting greatly from its cooperation with the federal government through its coding system and other benefits. The managed care industry is structuring its plans to insure (bad pun!) maximum profits for the corporation and obscene salaries for its executives, all the while pretending to have patients' best interests in mind. Government bureaucrats fight to defend and increase their jobs and budgets.
Physicians are not without blame in this scenario. They have reaped three decades of an opulent lifestyle from Medicare and third-party payers. But, their run (with a few exceptions) is about over. Their administrative costs and decreased income from the "provider portion" of their contracts with third-party payers is markedly reducing their bottom line and take-home income.
Perhaps, hospitals are the biggest losers in this scenario. In the past they have been able to care for indigent patients by shifting income from private pay patients and other sources of income. However, their "provider portion" of insurance and managed care contracts has been severely cut. This cost-shifting has become almost impossible. They will either have to cut out indigent care, or cities and states will have to increase this portion of their budgets (at a time of tight budgets for them also). Further, hospitals have been forced into bankruptcy virtually overnight by a large managed care company shifting its contract to another hospital.
With laws like HIPAA, the health-care industry is rapidly reaching a critical mass. Either the system will begin to break down and there will be a return to direct responsibility between physician and patient. (This change is occurring in many places among individuals and groups.)
Or, national health care will become a reality that will be a nightmare for patients and health-care workers alike. The current system is too complex to be run centrally. There will be long lines and endless paperwork like nothing seen before.
There is nothing to indicate that more than a few Americans understand what would be required for a free market in medical care. So, the situation is only going to become worse for a long, long time.
In a way, this article and the one above are complementary. While managed care plans are inherently immoral, removing decisions for patient care away from the patient-physician relationship, they have brought some needed light to some areas of medicine. I cover a few here as they come to mind.
1) Managed care has exposed much of the inflated costs of medical care. Less expensive drugs and supplies, such as syringes and bandages, are found. Length of hospital stays are looked at critically, not always a bad criterion, in spite of publicity to the contrary, usually contrived by the news sources themselves.
A large portion of surgeries have moved from hospital stays to "day surgery" and even free-standing units. This move both reduces costs and allows the patient to return home, almost always a more healthy environment.
2) Managed care requires its physicians to practice more in accord with the prevailing medical literature. While this requirement can be detrimental, it is also beneficial. Physicians are directed toward, if not forced, to use those treatments which are sometimes better supported by the medical literature. You have heard many times on these pages that a great deal of what physicians practice is not reflected by the best science available.
3) Managed care is providing data that heretofore has not been available in office settings. Diseases and treatments can be reviewed and studied simply by typing in the requested demographic data. Of course, much of this data was coming available simply because of computers, but managed care has added more of a detailed structure to such records.
4) Managed care often saves on billing costs. Fee for service medicine wastes vast sums running relatively small bills through "third parties." Managed care greatly reduces this cost. (Direct payment from patients would reduce it further.)
Again, I do not want to be understood as an advocate of managed care. However, it has brought some positive influences to medical care. If and when the system crashes and a freer system (they are never entirely free) exists, these lessons can be applied for the benefit of all.
Copyright © 2003 BMEI, Inc.