[ JBEM Index / Volume 8 / Number 2 ]

Clean Arteries, Clean Heart

After fifteen years in emergency medicine, Dr. Crenshaw has been for four years medical director of an HMO headquartered in Birmingham, Alabama. He earned his M.D. degree from the University of Tennessee and Master of Biblical Studies from Birmingham Theological Seminary. He, his wife, and two daughters attend Mountain Brook Community Church.

President Clinton’s Task Force on Health Care Reform has released its recommendations to an anxiously awaiting American audience. The reform package must now run the gauntlet between Congress and hundreds of special interest groups from the American Medical Association to Xerox Corporation. The potential economic shifts will make this the hottest debate since the abolition of slavery and breaking away from England.

Health care reform rose to the surface of President Clinton’s agenda because economists had predicted that, by the year 2000, America would spend 20% of its Gross Domestic Product on medical services. Expenses totaled about nine hundred billion dollars, or 13% of GDP, in 1992. Failure to control the increases will make it difficult, if not impossible, to balance the Federal budget and to make American businesses more competitive in a global marketplace. The task force chose “managed competition” as the cornerstone of its cost reducing strategy. Simply put, managed competition is the notion that doctors and hospitals will band together to compete for large blocks of patients on the basis of cost and quality measures. If the Physician-Hospital Organizations can render all the services their patients need with a fixed budget, they will profit. If not, they will presumably go broke.


Those who now have limited access to medical services will like the plan. Those currently enjoying unlimited access will probably find it too restrictive. The successful managed care plans upon which the reform package was modeled have several features in common that serve to keep costs low while maintaining high quality.

They emphasize prevention of disease by regular screening and immunizations to improve productivity during the working years and extend those years. They educate their members about disease processes, empowering them to take more responsibility for their health instead of abdicating it to professionals.

They render more services through primary care physicians, nurse practitioners, and physician’s assistants. Specialists are consulted only after the generalist has evaluated the problem and treated it to the best of his or her ability.

They rely on drug therapy and less on surgery. For example, they tend to have lower rates of such operations as coronary artery bypass, hysterectomy, and tube placement in children’s ears.

Regardless of its chances of passage through a Congress which is rapidly losing confidence in the Chief Executive, the Health Care Reform Act will not achieve its goal of making Americans healthier. It will fail because it does not recognize what leads to health or even what “health” is.

Studies have shown that higher levels of education and income are associated with better health. Better nutrition and sanitation are, too. Medical research and treatment, however, have little impact on the health of entire populations.

Empirical evidence from the United States confirms these findings. We have the most advanced medical technology of any nation on earth. Magnetic images projected onto a large screen will soon allow physicians to “walk” from chamber to chamber through the human heart. Tiny, balloon-tipped catheters remove fatty deposits from the arteries that feed the muscular pump. When all else fails, for $200,000 we can transplant a dead man’s heart into the body of the barely alive.

The social policies of the federal government have extended these technological treasures to most of our citizens. If personal medical services (the diagnosis and treatment of individuals) make people healthy, how can we explain the fact that we rank nineteenth in the world in infant mortality? Or, how do we account for the fact that our life expectancy is only seven years longer than our ancestors who were born at the turn of the century? (In 1900, if a child survived fatal infections like diphtheria, hemophilus meningitis, and polio, he could expect to live to age 65. Vaccines have drastically reduced those childhood killers. Yet, a baby born today will live, on the average, only to age 72.)

We have, I believe, greatly overestimated the benefits of modern medical technology

I also said that health reform would not make us healthier because it does not know what health is. It does not recognize that emotional and spiritual well-being are as essential to “health” as freedom from physical disorders.

The World Health Organization acknowledges as much in its definition of health. The Hebrews of Biblical times understood it as well. A word commonly used in the Old Testament for health is salom, and it carries the sense of inner peace, safety, prosperity, and satisfaction. Consider the following “report card” on the emotional and spiritual well-being of the American people.

Former Secretary of Education, William J. Bennett, has assembled eight cultural indicators that he says quantify America’s decline. During the thirty year period 1960-1990 he found that, “there has been a 560% increase in violent crime; a 419% increase in illegitimate births; a quadrupling of divorce rates; a tripling of the percentage of children living in single parent homes; more than a 200% increase in teenage suicide rate; and a drop of almost 80 points in SAT scores.”

Bill Bennett concludes that “although the Great Society and its many social programs have had some good effects, there is a vast body of evidence suggesting that these ‘remedies’ have reached the limits of their success.”

President Clinton’s social blueprint, like President Lyndon Johnson’s, will not make Americans healthier. It will, however, cost a lot more. When Medicare was enacted the U.S. was spending $41.6 billion a year on medical services – 5% of GDP. No one knows what President Clinton’s reform package will cost. At a minimum, it will cost a trillion dollars, or roughtly 15% of GDP. As stewards of the resources entrusted to us, we should ask if this is a wise use of those resources.

For those of you who prefer charts to
narratives, consider these figures from New York City.

1943 1993
Population 7,472,564 7,322,564
Welfare recipients 73,000 1,200,000
Homicides 44 1,497
Illegitimacy rate 3% 45%

The results suggest that, as a nation, we are looking in the wrong places for health, peace, and satisfaction. Someone has said that the hospital is modern America’s temple and physicians her high priests. An astounding number of us abuse alcohol or take drugs like Prozac and Xanax to make ourselves feel good. Many others have operations, like coronary bypass, that give only temporary relief of pain and do not prolong life in the vast majority of cases.


Psalm 90 says that man has seventy to eighty years on earth. There is a biological limit to life in this world. The Bible also uses the words healing and salvation synonymously. The Holy Spirit, through Isaiah the prophet declares that we are healed by Christ’s punishment for our sin. (Isaiah 53:5) In other words, an intimate relationship with the Lord Jesus Christ, based on repentance and faith, is the only sure route to health.

The peace in knowing that God forgives us for leading such self-centered lives releases us from the ever-present fear and frustration of life in a fallen world. His love is a balm for the wounds of our accumulated hurts and humiliations. We have hope because we know that one day He will come and bring things to a righteous and joyous conclusion.

This peace, this love, this hope -this is real health. And, it comes not from clean arteries but a clean heart.

God alone can provide this change the Bible calls a new heart. “I will cleanse you from all your impurities. I will give you a new heart and put a new spirit in you; I will remove from you your heart of stone and give you a heart of flesh. And I will put my Spirit in you and move you to follow my decrees and be careful to keep my laws … I will save you from all your uncleanness.” (Ezekiel 36:25-27,29 NIV)

Incidentally, scientific studies have recently shown that blockages in coronary arteries disappear with such changes in attitude, without drugs or surgery. Ph, the price? It’s free for the asking.

[ JBEM Index / Volume 8 / Number 2 ]