A good weekend

... might look like this:

[L to R: dinner at Oggi's; home for firepits and s'mores]


[L to R: surfing at HB (Bolsa Chica) with Jeff]


[L to R: brunch with Jeff at Longboard; cycling back along the PCH]


[L to R: getting ready to go; sunset over the mountains; Vegas in the distance]


[L to R: food, food, food; all from the Wynn Buffet]


[L to R: excited to be in Vegas (finally); the Bellagio; view from our hotel room]


[L to R: outlet stores in Primm; back in Orange; sunset over Pasadena]

Human trafficking videos

Sex trafficking:

Ukraine - US


Nigeria - Italy


Nigeria - Denmark


Russia


Argentina


India


UN Office of Drugs and Crime PSA


MTV PSA, featuring the Killers - "Goodnight, Travel Well"
60-second version


Full-length version

Also: Sex trafficking in Nepal

Human trafficking in the products we buy:

MTV PSA, featuring Radiohead - "All I Need"


"Tony's Chocolonely" - human trafficking in the cocoa trade

My niece is a teenager!

Happy birthday, Aimee!

Love, Uncle Jus.

[back in 2002, when she wasn't almost as tall as me]

A little bit on human trafficking

There are an estimated 27 million people in modern day slavery around the world.

Between 600,000 and 800,000 people are trafficked across international borders each year. Approximately 80% are women and girls. Up to 50% are minors.

Around 14,500 to 17,500 people are trafficked into the US from overseas and enslaved every year.

About the same number are murdered in the US every year, but while the national success rate for solving murders is about 70% (11,000), in 2006 only 111 were charged and only 98 were convicted, which is less than 1% of all human trafficking cases nationwide.

An estimated 1.2 million children are trafficked every year.

[All info taken from the US State Department's Trafficking in Persons Report, apart from the last entry, which was from UNICEF UK Child Trafficking Information Sheet, January 2003.]

You're a star

Close your eyes, take my hand;
no need for words--I understand:
you let him in, he let you down,
and you shattered when you hit the ground.

When all you ever got from love was hurt,
won't you let me show you what you're really worth?
I can see you building up your walls again;
won't you let me hold you close, my friend?

Coz you, you're a star;
yeah, I see all that you really are.
And somehow I think we'll go far;
somehow I think we'll go far.

To turn the page and start anew,
to trust and hope again is the hardest thing to do.
To let the past fall away
and breathe in a brand new day.

When all you ever got from love was hurt,
won't you let me show you what you're really worth?
I can see you building up your walls again;
won't you let me hold you close, my friend?

Coz you, you're a star;
yeah, I see all that you really are.
And somehow I think we'll go far;
somehow I think we'll go far.

And the tears fall coz it feels like you've lost it all ...

But you, you're a star;
oh I see all that you really are.
And somehow I think we'll go far;
somehow I think we'll go far;
somehow I know we'll go far.

written on July 23, 2009

41

On July 27, 1968, my parents got married.

As one of my models of marriage, I've seen from them what it looks like to choose to love, to choose to sacrifice for the other, and above all, to choose to trust God. I know that they remain firm in the belief that everything good (including a marriage spanning for decades) is only possible by the grace of God, and the testimony of their lives together reminds me that God is good, even through the hard times.

Happy anniversary, Mom and Dad! I love you guys.

Favorite movie of the year?

It's certainly in the running. Plus, it revealed a side of LA I'd never seen but look forward to discovering a little before I head east.

Go watch it.

P.S. Zooey Deschanel may be my new fave.
P.P.S. It has a rocking soundtrack, too.

Perhaps ...

Reinhold Niebuhr:

Perhaps the church ought to be more concerned to bring the goodness of Christ as a judgment upon every fragmentary form of human goodness than to find the particular cause which might be identified with Christ. There are many good causes and just claims which turn to into evil at the precise point where absolute validity is ascribed to them. Is not religion, including the Christian religion, a fruitful source of fanaticism and bigotry precisely because men pretend that their good is the ultimate good in the name of religion; and because Christians so easily claim Christ as an ally without ever having experienced his love as a judgment upon the shoddy character of their so-called ‘values’ and upon the fragmentary of even their best causes?

We must, as Christians, constantly make significant moral and political decisions amidst and upon perplexing issues and hazardous ventures. We must even make them ‘with might’ and not halfheartedly. But the Christian faith gives us no warrant to lift ourselves above the world’s perplexities and to seek or to claim absolute validity for the stand we take. It does, however, encourage us to the charity, which is born of humility and contrition.

Essays in Applied Christianity, 91-92

Oasis 3-week update

Week Three

One of the highlights this week was the trafficking training session put on by the Coalition Against Slavery & Trafficking (CAST) LA, which took place on Wednesday. The focus of the training was ministering to survivors of human trafficking, particularly sex trafficking. As a result, many of the other attendees were workers at shelters, and much of the material that we went through that day wasn’t directly relevant to the work that Oasis is doing as an advocacy organization, and especially as a relatively young organization.

Having said that, it was very helpful to see not just all that is involved ministering to survivors of human trafficking, but also to see all the other people and organizations who are also seeking to combat human trafficking. It seems analogous to the work of the body of Christ (1 Cor. 12)—many parts are necessary to accomplish the goal, and they must be coordinated and working in tandem. In this case, non-governmental organizations and shelters must work with government agencies, police forces and health organizations.

Moreover, starting out at Oasis, a smaller organization (at least here in the US), working with only a few staff and a few interns, it was particularly helpful to get a sense of the movement that is rising. The coalition to combat human trafficking is a movement that is only recently gaining momentum, not just in terms of the legislation that is being enacted in the US and around the world, but also in terms of the awareness that we as anti-trafficking campaigners need to bring to the public view. There is a certain excitement that plays into being at the start of a movement, and a movement which we know is in line with what God is calling us to do: to seek justice for those who do not have it.

Week Four

I finished the first draft of the bible study resource this week (finally!). As a student, I’m used to working non-stop on something until it’s done, a tactic which I didn’t take with this internship; for this project, I worked full-time on it (when I could) Tuesday through Thursday, and then left it alone over the weekend. It’s a different way of doing things, perhaps a healthier way (since I also had plenty of other things to do apart from the internship), but the pace of work was definitely slower than I was used to and I got done later than I would have liked.

Still, it’s done; and it was an interesting exercise for me. I’ve been in higher education for nine years now, the last six of which have been in the field of theology. So I suppose I’m used to operating at a more theoretical and less basic level—I’m certainly engaging at a different level than I was before I started studying theology. The biggest challenge for me was the feeling I had that what was needed was a biblical worldview—a broader perspective—and not simply a bunch of verses that supported what I wanted to see happen. I do believe that God is a God of justice, that he is on the side of the poor and the oppressed, the orphan, the widow and the foreigner, and that if we are to be his people, we are to care for these as much as he does. I could build a case for combating human trafficking on a couple of verses if I chose, but I think that it’s important to remember the broader context, to see the person of Christ as a central figure in the story, and to highlight the consistencies and congruities in the story.

So that’s what I tried to do with this resource. I tried to establish a biblical framework for Christian involvement in human trafficking and in justice in general. In six sessions. I think it turned out okay …

Week Five

This week I went out into the Arcadia and San Gabriel area with Daniel, Oasis’ outreach worker, and Monica, who oversees the coalition of which Oasis is a part. Over about an hour and a half, we stopped by several massage parlors in order to hand out fliers advertising a community health clinic, but also to casually check the places out. It was a fascinating experience, as not one of the locations we stopped into was above reproach: one place had an inordinate number of video cameras (5) on a space which certainly didn’t seem to need it (approx. 30’ by 30’); a couple of other parlors did not advertise full body massages but said that they were available in a backroom upon request. Now, neither of these situations is a surefire sign that trafficking is taking place, but they do make one wonder.

Because of the newness of the field, which I mentioned a couple of weeks ago, there aren’t very many established protocols in terms of how to proceed in this area. While it’s definitely desirable that more people are mobilized to combat human trafficking, one of the things which people must be aware of is the uncertainty and risk involved. The trafficker(s) may well be just one person trafficking another person; or organized crime could be involved; or even larger crime syndicates may be in control. One of the central things for organizations like Oasis is safety—we are not equipped to engage in combating crime (which human trafficking is) in the way that police forces are. Indeed, if a police department is already actively involved in staking out or investigating a site, the involvement of civilians may interfere with an ongoing operation or tip off the traffickers, who will then quickly shift the victims to another location.

On the other hand, because of the newness of the field, many police departments have not yet had training in identifying and targeting human trafficking. Oasis has worked closely with the Arcadia Police Department and created a good, cohesive relationship, by which the police’s work is not interfered with or obstructed, but allows Oasis to do as much as it can. It’s hoped that this cooperation will form a template for other police departments and government agencies to work closely and effectively with non-governmental agencies, non-profits and other organizations to implement and establish a good model for combating trafficking.

What to do and conclusion [part 3]

When faced with something as vast and complex as the U.S. health care system and with the biblical challenge to do something about it, one inclination can instead be to retreat into despair and inaction; this is obviously not the answer, and the Bible’s numerous exhortations to “Fear not!” are evidence that God does not intend his people to be paralyzed by fear. Change can be effected; change must be worked for if we believe in and serve a God of justice; and change will need a collective effort, requiring the energies of:

1. Individuals. As much as we’d self-centeredly like to think that we live “in a world described and defined by the necessity of autonomous choice, freely made, most people actually live in the relational, obligatory, and interconnected world, a world far messier and heavily freighted, far more passionately loving and passionately hating than that described in philosophic texts.”[1] This being the case, we cannot simply sit on our hands, ignoring the interconnection that means that loving our neighbor may translate into reforming a health care system that denies him or her adequate health care coverage. As individuals, we can contribute by researching the issues, by paying attention to policy goings-on, by talking with friends about these topics, or by raising awareness of the direness of the health care crisis.
2. Churches. In the church, we can point beyond what is politically possible or what can be legislated, to what the Spirit can achieve through the distinctive community that is the body of Christ. Lawrence Brown suggests that institutions that mediate between policymakers and the public, such as churches, may serve to “help their members to get acquainted with the complexities of social choice and build trust in the intentions and intelligence of those who press for innovation.”[2] Churches can contribute to health care reform by contributing to the education of its members regarding the issues involved, or by organizing writing campaigns to Congressional representatives—those who are accountable to us as voters—pressing for expansion of Medicaid or more minority doctors and nurses who, studies show, are more likely to return to minority communities. In addition, churches can engage in direct health care services, running faith-based clinics, or programs to inform, enroll and translate for the poor in our neighborhoods. As Ron Sider points out, nations may choose to offer services to its citizens and not to foreigners, but “the biblical concern for the alien and stranger compels Christians and Jews to offer health care to millions of illegal immigrants.”[3] One could easily add that the biblical concern for the poor compels Christians and Jews to campaign for health care for the millions in poverty who are not, for whatever reason, covered by Medicaid.

However, individuals and organizations alone will not be able to effect this change. According to Kaiser State Health Facts, Medicaid alone cost a total of $303.9 billion in 2006.[4] The fiscal force of employers and governments will also need to be brought to bear in order to effectively face the challenge of insufficient health care, and individuals and organizations may play a part in pushing for such employer and government action. After all, “What is politically possible, of course, changes quickly when enough people demand action.”[5]

****

4. Concluding Thoughts

The issue of the U.S. health care system is an imposing malady, imposing enough that it has never been successfully addressed despite significant deterioration in the last few decades. As President Obama pointed out recently, “When times were good, we didn't get it done. When we had mild recessions, we didn't get it done. When we were in peacetime, we did not get it done. When we were at war, we did not get it done. There is always a reason not to do it. And it strikes me that now is exactly the time for us to deal with this problem.”[6] Framed in biblical terms, the call to image God in love, justice, mercy and concern for the poor and oppressed is too important to not do anything about the health care crisis.

Superficial change will not be sufficient. I would join the chorus of voices seeking change that takes root at a deeper level as well, advocating for a more foundational reform, such as Rebecca Todd Peters’ appeal to a new economic model “that is rooted in a moral framework of compassion and the elimination of poverty … that does not focus on growth and trade as its primary indicators of success,” but focuses on biblical priorities such as justice and the affirmation of human dignity.[7] Or Laurie Zoloth-Dorfman’s challenge for “a change in the ideological paradigm of health care itself, along with a change in the process and language of the discourse of public policy. There must be a change in how Americans perceive health and illness, cure and death.”[8] As Christians, our calling is to consider these issues—as well as those of justice and poverty and treatment of the alien—from a biblical perspective and to speak them into society and into being, seeking to see the kingdom of God come on earth. The challenges we face will be great in addressing the reform of the U.S. health care system. But the need is too great to ignore. And we may take heart from the reminder that the God we serve—the God of justice, the God of the poor, the God of healing—is a mighty God, and he can do anything.

---

[1] Zoloth-Dorfman, “First,” 24.

[2] Lawrence D. Brown, “Health Reform in America: The Mystery of the Missing Moral Momentum,” Conservative Judaism, 51 no. 4 (Summer 1999), 111.

[3] Sider, Generosity, 188.

[4] Kaiser State Health Facts, “Total Medicaid Spending, FY2006”; accessed from http://www.statehealthfacts.org/comparemaptable.jsp?ind=177&cat=4 (March 14, 2009).

[5] Sider, Generosity, 181.

[6] Barack Obama, “Closing Remarks by the President at White House Forum on Health Reform, followed by Q&A, 3/5/09,” The White House; accessed from http://www.whitehouse.gov/the_press_office/Closing-Remarks-by-the-President-at-White-House-Forum-on-Health-Reform/ (March 14, 2009).

[7] Peters, “Economic Justice,” 106-107. She goes on to say, “This new economic model need not eschew profit, or growth, or efficiency, but it should recognize the ways in which it values these goals. And it will balance them with other moral considerations, such as sustainability, justice, and the social well-being of people and communities.”

[8] Zoloth-Dorfman, “First,” 26.

Thinking Christianly about Health Care Reform [part 2]

In considering the importance of a Christian voice in our culture, and particularly in the field of bioethics, Allen Verhey writes, “To raise a theologically articulate voice in protest or in hope may be a sign of life in the culture, and it may preserve a memory or stir an image that will make a difference to the culture.”[1] The church is intended to be a distinctive community, living out the values of the kingdom of God and proclaiming the gospel with words and actions. The following section is intended to build the framework for a biblical understanding of some of the main issues which may impact on one’s consideration of health care and health care reform in the United States. The gospel is all-encompassing good news, which means that it has something to say about this issue. I will survey one overarching theme which is particularly pertinent—that of justice, recognizing that there is a multiplicity of approaches that can be taken and a long list of such themes that can be investigated.[2]

a. A biblical framework[3]

In Genesis 1:27, we read that humanity is made “in the image of God … male and female he created them.” Most scholars have concluded that “the image of God reflected in human persons is after the manner of a king who establishes statues of himself to assert his sovereign rule where the king himself cannot be present. … The image of God in the human person is a mandate of power and responsibility. But it is power exercised as God exercises power.”[4] And as John Goldingay notes, being made in the image of God means that “humanity not only represents God but also resembles God.”[5] Thus, it is important to understand the character of God in order that we might best represent him, resemble him, and exercise the power he has given us in the way that he exercises power. In considering the theme of this paper, I will focus on justice as central to God’s character: Yahweh is a God of justice. But what does this mean? For this, we turn to the biblical narrative.[6]

In the Exodus story, God had to shape a people who had spent years oppressed in slavery, by the Egyptians, into a people who more ably represented—imaged—their God. Moses reminds the Israelites:

Yahweh your God is God of gods and Lord of lords, the great God, mighty and awesome, who is not partial and takes no bribe, who executes justice for the orphan and the widow, and who loves the strangers, providing them food and clothing. You shall also love the stranger, for you were strangers in the land of Egypt. (Deut. 10:17-19)

God’s justice is revealed in tangible acts; his characteristic qualities are proven only when his saving actions attest to them. And it was God’s justice that became the reason for the Israelites to do justice: “I am Yahweh your God.” This meant:

• having honest balances, honest measures, honest practices, because Yahweh their God is an honest God (Lev. 19:36; Deut. 25:15; Ezek. 45:10);
• practicing the year of Jubilee, a year of emancipation and restoration, because Yahweh their God had emancipated them from slavery in Egypt and restored them to the land he had promised their ancestors (Lev. 25);
• loving their neighbors as themselves because love was central to Yahweh their God’s being (Lev. 19:18);
• loving the alien and the stranger among them because Yahweh their God had brought them from a place where they themselves had been aliens and strangers (Lev. 19:33-34).

Similarly in the Psalms, God’s righteousness and justice (two concepts which are virtually interchangeable from an Old Testament perspective) are not intangible characteristics. Instead, they are revealed most often in God’s saving, righteous and just actions (Ps. 71:1-2, 15-19, 21-24a). The psalmists were especially vocal in their affirmation of God’s justice, singing, “Yahweh loves justice; he will not forsake his faithful ones” (Ps. 37:28) and “Yahweh works vindication and justice for all who are oppressed” (Ps. 103:6). He is worshiped as the God:

• who helps the victim and the fatherless (Ps. 10:14);
• whose throne is built upon righteousness and justice (Ps. 89:14);
• who executes justice for the oppressed, sets the prisoners free, opens the eyes of the blind, lifts up those who are bowed down, watches over the strangers, and upholds the orphan and the widow (Ps. 146:5-9).

Yahweh is the God who commands his people, “Give justice to the weak and the orphan; maintain the right of the lowly and the destitute. Rescue the weak and the needy; deliver them from the hand of the wicked” (Ps. 82:3-4).

When his people failed to discharge their responsibilities as representatives of God and ambassadors for his justice, he raised up prophets to point this out to them:

• Jeremiah pleaded with King Shallum, “Did not your father eat and drink and do justice and righteousness? Then it was well with him. He judged the cause of the poor and needy; then it was well. Is not this to know me? says Yahweh” (22:16);
• Ezekiel spoke out against corruption, where “the alien residing within you suffers extortion; the orphan and the widow are wronged in you … you have forgotten me, says the Lord God” (22:7, 12);
• Through Amos, God denounced worship devoid of justice: “Take away from me the noise of your songs; I will not listen to the melody of your harps. But let justice roll down like waters, and righteousness like an everflowing stream” (5:23-24);
• Micah reminded the people, “He has told you, O mortal, what is good; and what does Yahweh require of you but to do justice, and to love kindness, and to walk humbly with your God?” (6:8);
• Through Isaiah, God’s words to his people are most revealing:

Is not this the fast that I choose: to loose the bonds of injustice, to undo the thongs of the yoke, to let the oppressed go free, and to break every yoke? Is it not to share your bread with the hungry, and bring the homeless poor into your house; when you see the naked, to cover them, and not to hide yourself from your own kin?

Then your light shall break forth like the dawn, and your healing shall spring up quickly; your vindicator shall go before you, the glory of the LORD shall be your rear guard. Then you shall call, and the LORD will answer; you shall cry for help, and he will say, Here I am.

If you remove the yoke from among you, the pointing of the finger, the speaking of evil, if you offer your food to the hungry and satisfy the needs of the afflicted, then your light shall rise in the darkness and your gloom be like the noonday. (58:6-10)

It is in Jesus, though, that we find the fullest expression of God’s image, and consequently, the truest paradigm for us to follow. In Jesus, we find the fullness of God and his justice embodied in a human being (Col. 2:9). Jesus took upon himself the mantle of the Servant about whom Isaiah prophesied, anointed “to bring good news to the poor, to proclaim release to the captives and recovery of sight to the blind, to let the oppressed go free, to proclaim the year of the Lord’s favor” (Luke 4:18-19; cf. Is. 61:8). Yet Jesus was also characterized by love. He commanded his followers:

• to love one another as he loved them (John 13:34, 15:12);
• to love not only their neighbors but also their enemies (Matt. 5:43);
• to feed the hungry, to give drink to the thirsty, to welcome the stranger, to clothe the naked, to take care of the sick, to visit those in prison, for “just as you did it to one of the least of these who are members of my family, you did it to me” (Matt. 25:31-46).

In all of these instructions, Jesus was seeking actions that demonstrated characteristics. Justice, I would suggest, is the effective action that makes the characteristic quality of love tangible. As the Apostle John asked, “How does God’s love abide in anyone who has the world’s goods and sees a brother or sister in need and yet refuses help? Little children, let us love, not in word or speech, but in truth and action” (1 John 3:16-18).

Catholic theologian Walter Burghardt summarizes New Testament justice:

Love as Jesus loved. The kind of love that impelled God’s unique Son to wear our flesh; to be born of a woman as we are born; to thirst and tire as we do; to respond with compassion to a hungry crowd, the bereavement of a mother, the sorrow of a sinful woman; to weep over a dead friend and a hostile city; to spend himself especially for the bedeviled and the bewildered, the poverty-stricken and the marginalized; to die in exquisite agony so that others might come to life.[7]

Jesus is God incarnate, and in him, we see the personification of the justice, compelled by love, that is evidenced throughout Scripture as a central characteristic of God. Consequently, as human beings created in the image of God—created to image and represent God—we are called to be just people and to do justice, motivated by love and by the example of Christ. Just how this works itself out with regard to health care and health care reform, we will see a little later on.

b. A Catholic perspective

The Catholic Church has been a consistent and outspoken voice on matters of justice, particularly in addressing biblical implications for culture with a constancy that the Protestant Church has been sorely lacking. For this reason, it is instructive to look at some of the texts in which the Catholic Church has addressed the issue of health care, applying biblical teaching to a contemporary cultural issue:

• Pope Leo XIII in Rerum Novarum, published in 1891, highlighted the importance of social justice to the individual and to a peaceful society by emphasizing the importance of themes such as the centrality of the common good and its promotion.[8]
• In 1981, the U.S. Bishops issued a letter addressing the health care problem, which restated the Catholic Church’s position and is worth quoting at length:

Every person has a basic right to adequate health care. This right flows from the sanctity of human life and the dignity that belongs to all human persons, who are made in the image of God. It implies that access to health care which is necessary and suitable for the proper development and maintenance of life must be provided for all people regardless of income, social or legal status. Special attention should be given to meeting the basic health needs of the poor. With increasingly limited resources in the economy, it is the basic rights of the poor that are frequently threatened first. …

The benefits provided in a national health care policy should be sufficient to maintain and promote good health as well as to treat disease and disability. Emphasis should be placed on the promotion of health, the prevention of disease and the protection against environmental and other hazards to physical and mental health. …

Health planning is an essential element in the development of an effective and coordinated health system. Public policy should ensure that uniform standards are part of the health care delivery system. …

Following these principles and on our belief in health care as a basic human right, we call for the development of a national health insurance program.[9]

• In 1993, the U.S. Bishops issued a resolution on health care, restating the basic right of every human being “to adequate health care. This right flows from the sanctity of human life and the dignity that belongs to all human persons, who are made in the image of God.” This right is rooted in the sanctity of human life, and “the biblical call to heal the sick and to serve ‘the least of these,’ the priorities of social justice and the common good,” the “virtue of solidarity,” and “the option for the poor and vulnerable.”[10]
• In the same resolution, they also laid out the criteria for reform, consistent with the principles the Catholic Church has always sought to champion:[11]

Respect for Life. Whether it preserves and enhances the sanctity and dignity of human life from conception to natural death.

Priority Concern for the Poor. Whether it gives special priority to meeting the most pressing health care needs of the poor and undeserved, ensuring that they receive quality health services.

Universal Access. Whether it provides ready universal access to comprehensive health care for every person living in the United States.

Comprehensive Benefits. Whether it provides comprehensive benefits sufficient to maintain and promote good health, to provide preventive care, to treat disease, injury, and disability appropriately and to care for persons who are chronically ill or dying.

Pluralism. Whether it allows and encourages the involvement of the public and private sectors, including the voluntary, religious, and non-profit sectors, in the delivery of care and services; and whether it ensures respect for religious and ethical values in the delivery of health care for consumers and for individual and institutional providers.

Quality. Whether it promotes the development of processes and standards that will help to achieve quality and equity in health services, in the training of providers, and in the informed participation of consumers in decision making on health care.

Cost Containment and Controls. Whether it creates effective cost containment measures that reduce waste, inefficiency, and unnecessary care; measures that control rising costs of competition, commercialism, and administration; and measures that provide incentives to individuals and providers for effective and economical use of limited resources.

Equitable Financing. Whether it ensures society’s obligation to finance universal access to comprehensive health care in an equitable fashion, based on ability to pay; and whether proposed cost-sharing arrangements are designed to avoid creating barriers to effective care for the poor and vulnerable.

The Catholic approach to applying biblical values to contemporary issues like the one of health care is enormously helpful and instructive, particularly for an introduction such as this project.

c. Health care and the Bible: other things to consider

Building upon the Catholic perspective and drawing upon the biblical framework of justice, we may also consider the following points:

• When we consider that all of humankind is created in the image of God, what does it mean that tens of millions people in the United States are uninsured? Ron Sider concludes bluntly, “By tolerating a situation in which over 45 million people lack health insurance, this society stands in blatant defiance of God’s will.”[12]
• When we consider that Jesus loved, welcomed, and commended children (Mark 10:13-16; Luke 18:16), what does it mean that 13.3 million American children under 18 live in poverty?
• When we consider that God shows favor to the poor, if not holding a preferential option for them, what does it mean that the poverty rate stands at 12.5% of the population, an estimated 37.3 million people, and that most of these are uninsured?
• When we consider that “those who oppress the poor insult their Maker” (Prov. 14:31; 17:5), what does it mean that the Medicaid budget, which covers hospitalization, doctors and drugs (in some states) for the poor, and provided for about 52 million people in 2004, was cut significantly by Congress in 2006?
• When we consider that Christians defend the family, what does it mean that poor families suffer doubly from being in poverty and being uninsured? When we consider that Christians value life as a gift from God, what does it mean that millions of babies born into poverty lack decent health care? “How can any Christian read what the Bible says about the poor and what Jesus says about the sick without hearing a divine call to demand that every person in this nation, starting with the poor, have access to health insurance?”[13]

In considering our Christian role in addressing health care and health care reform in the U.S., we must be realistic, recognizing that we live in a broken and sin-marred world with broken and sin-marred people and broken and sin-marred systems. But this should not deter is from doing what we must in living up to our calling as images, ambassadors and representatives, of God. As Laurie Zoloth-Dorfman puts it:

Our discussion of health care has a prophetic responsibility. It must move beyond that which is and point to that which ought to be. …

The outcome of the national debate over health care reform will represent a compromise, the result of victories and defeats along the road to justice. But the plan itself must clearly reflect the prophetic “ought,” and it must provide a mechanism for truly democratic participation of all of us in the process of determining its final makeup. It will fail if it does not frame the issues in terms that remind us that we are part of a larger moral community, and that to do justice means to pay careful and sustained attention to the fact that people live among, are responsible for, and are obligated to others.[14]

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[1] Allen Verhey, Reading the Bible in the Strange World of Medicine, Grand Rapids, MI: William B. Eerdmans Publishing Company (2003), 28.

[2] Not least of these might be a study of sickness and healing in the Bible, considering verses such as Matt. 10:1-8; Acts 3:1-10; 5:15; Rom. 5:12-14, 1 Cor. 15:26; James 5:14-15.

[3] Adapted from Justin Fung, “Social Justice and Human Rights,” MD524 Advocating for Social Justice final paper, Pasadena: CA (Summer 2008), 4-7.

[4] Walter Brueggemann, Genesis, Louisville, KY: Westminster John Knox Press (1982), 32.

[5] John Goldingay, Old Testament Theology, Vol. 1: Israel’s Gospel, Downers Grove, IL: InterVarsity Press (2003), 98.

[6] For further examination of this topic, see also Enrique Nardoni, Rise Up, O Judge: A Study of Justice in the Biblical World, Peabody, MA: Hendrickson Publishers, Inc. (2004); translated by Seán Charles Martin from Enrique Nardoni, Los que buscan la justicia: Un studio de al justicia en el mundo biblico, Estella (Navarra), Spain: Editorial Verbo Divino (1997).

[7] Walter J. Burghardt, Justice: A Global Adventure, Maryknoll, NY: Orbis Books (2004), 19.

[8] Leo XIII, Rerum Novarum: Encyclical of Pope Leo XIII on Capital and Labor, Vatican City: Libreria Editrice Vaticana; accessed from http://www.vatican.va/holy_father/leo_xiii/encyclicals/documents/hf_l-xiii_enc_15051891_rerum-novarum_en.html (March 16, 2009).

[9] Excerpted from U.S. Bishops, Health and Health Care: A Pastoral Letter of the U.S. Catholic Bishops, Washington, DC: United States Catholic Conference (November 19, 1981).

[10] U.S. Bishops, “Resolution on Health Care Reform,” Origins 23 no. 7 (1993), 99-100.

[11] U.S. Bishops, “Resolution on Health Care Reform,” Origins 23 no. 7 (1993), 99-100.

[12] Sider, Generosity, 178.

[13] Sider, Generosity, 189.

[14] Zoloth-Dorfman, “First,” 25, 89.

So You Think You Can Dance

I only started watching SYTYCD last season, largely because many of my friends did. I'm not a dancer ... which is perhaps why it's one of the few reality shows that I watch, and while I feel like last season had more characters (Twitch, Joshua, Chelsie, etc.), this season has certainly had its share of amazing dances.

Jason and Jeanine

Ade and Melissa

And from last season:

Mark and Chelsie

Twitch and Katee

Chelsie and Joshua

P.S. For an entertaining and informative write-up of every week's episode, check out Liz's blog.

The state of US health care [part 1]

[The following is excerpted from the first part of a project I did for my Ethics of Life & Death class in Winter 2009. The project is entitled "Initiating a Christian Conversation About Health Care Reform."]

1. The Current State of U.S. Health Care
We start with an introduction to the current condition of the U.S. health care system, which offers the worst return for highest cost in the developed world. I hesitate to begin with statistics because they tend to be remarkably impersonal, thereby contributing to an already-malignant bent toward depersonalization and distance; additionally, a statistics bombardment can leave one shell-shocked and overwhelmed. However, they also serve a purpose in setting the stage onto which the gospel must make its impression.

a. Overview of the health care system
First, though, an overview: insurance in the U.S. is provided through a “five-part patchwork system that covers most serious problems for most people most of the time, but still allows many people to fall through the cracks.”[1] The five parts are:

1. Employment-based coverage and private medical plans;
2. Medicare, which covers 80% of medical expenses for Americans over 65, and also people with disabilities under 65;
3. Medicaid, which provides coverage for the poor, including people on public assistance, children of poor parents, poor seniors, people with disabilities, and adults with mental illness;
4. CHAMPUS (Civilian Health and Medical Program of the Uniformed Services), TRICARE (the U.S. government-sponsored health insurance plan for active military members, their families and retirees) and the Veterans Administration Hospital System, provide health care for military personnel, their families and for veterans;
5. Health care in emergency rooms: the Emergency Medical Treatment and Active Labor Act 1986 forbids emergency rooms from turning away anyone who is medically unstable. As a result, emergency rooms serve as a national safety net for all kinds of medical problems of the uninsured and for illegal immigrants.

Those who fall into this fifth category (or those who obtain health care through private service organizations, including faith-based clinics) are not generally considered to have reliable access to health care since emergency rooms and private service organizations are not designed to function as a safety net and therefore not equipped to deal with the vast amounts of people who turn up for treatment. These include undocumented immigrants; homeless people (who have no fixed address and thus are ineligible for state-based Medicaid); and people with problems including substance addiction which are not recognized as disabilities. As Sondra Ely Wheeler notes, the health care that is provided through overburdened emergency rooms and private service organizations is often “both more costly and less effective than prompt primary care would have been; sometimes, it comes altogether too late. These people suffer and die of treatable or preventable illnesses at a much higher rate than those with stable access to care.”[2]

Clearly, such a patchwork health care system is not conducive to promoting preventive medical services and better control of chronic illnesses such as hypertension and diabetes. Such chronic illnesses, if left unchecked, and even minor problems, if not treated, will deteriorate, leading to bigger health issues and higher costs of treatment, perpetuating a vicious cycle that is seeing health care spending as a percentage of the U.S. budget rise at a much faster rate than all other spending.

b. Health care spending

Nobel Prize-winning economist Paul Krugman writes, “the opposition to universal health care depends on the claim that doing the morally right thing isn’t possible, or at least that the cost—in taxpayer dollars, in reduced quality of care for those doing okay under our current system would be too high.”[3] The facts tell a different story.[4]

On the whole, Americans spend more on health care in order to get the same or worse treatment than the rest of the developed world. Of course this is not to suggest we ought to simply transfer the health care systems of other advanced nations onto the American framework; there are advantages that Americans benefit from over the rest of the world, such as more cancer screening or quicker access to specialists and elective surgery, and these other systems have their own drawbacks. But as things stand, the wealthiest nation in the world has the highest population of uninsured in the developed world.

According to the U.S. Census Bureau, in 2007, forty-six million people were without health insurance in the wealthiest nation in the world, in the nation that spends the most per person on health care; and this number has undoubtedly risen in the last two years of economic recession. (There is the additional issue of the underinsured, who may spend their own income on out-of-pocket health care but will be unprepared and unable to face health catastrophes. Karen Tumulty estimates this number at around 25 million, and these too ought to be factored into what one considers the health care crisis.)[5]

Returning to uninsurance, we can also see that there are glaring disparities when we look at its distribution, both in terms of race and in terms of economic status: the percentages given are percentages of that particular ethnic population and that particular economic bracket. For example, we can see that while only 10% of all non-Hispanic Whites are uninsured, a staggering 32% of Hispanics are uninsured.

From the McKinsey publication alluded to previously, we also learn that 11% of children are uninsured, and this number increases to 17.6% when we consider children living below the federal poverty line. Here too, uninsurance is unevenly distributed across racial and ethnic categories:

Ron Sider summarized the American health care situation thus:

1. the uninsured are four times as likely as the insured to report that they needed medical care but did not get it;
   
2. they are three times more likely to report problems in paying medical bills;
   
3. and the uninsured get substantially poorer medical care even when they do see a doctor. Studies show that the uninsured enter hospitals sicker than the insured, receive fewer tests, and leave the hospital sooner. Hospitals receive the greatest number of uninsured patients, and incurred 60 percent of the $40.7 billion uncompensated care costs in 2004.[6]

Bioethicist Laurie Zoloth-Dorfman frames our current condition in stark practical terms:

To travel on the freeway across Los Angeles … is to share in the risk that an accident could bring you to the doors of the nearest emergency rooms, the ones that serve as outpatient clinics to the poorest and the uninsured. They might well be closed, full beyond capacity, or inadequately staffed, no matter how exquisite your car, or provident your health care coverage.[7]

Because emergency rooms are not being used in the capacity for which they were meant—that is, as emergency rooms—they are overtaxed and understaffed and therefore unable to properly treat emergencies.

The picture does not improve when one considers the fact that, foundationally, the system upon which the health care system is built is not a value-free system but “one laden with values that favor profit and economic gain over other priorities—such as sustainability and economic justice.”[8] As such, the system which contributes to almost half of personal bankruptcies, according to a 2005 Harvard study, is allowed and encouraged to perpetuate:[9]

• Medical costs are going up rapidly as medical technology improves and doctors are able to treat more (though at higher prices); thus employer-based insurance is in decline as employers seek to maximize profits and cut benefits or declare more employees ineligible for health care coverage or the cost is shifted onto employees through high-deductible health plans.
• This has knock-on effects galore, including eventual lack of health care coverage for many workers, particularly low-wage workers, leaving them to seek unaffordable health care treatment or to go without insurance.

It might be interesting to note that the government subsidizes employer-provided health insurance at about $130b for 2006 in tax breaks, which far exceeds the benefits the poor receive through TANF and food stamps combined ($57b); most of these tax breaks end up going to those who make more than $75,000.

c. An insurance-driven system

The United States is perhaps the only developed nation whose health care system is driven by the insurance industry. Paul Krugman explains the process of insurance:

1. Insurers screen applicants for any indications that they might need expensive care—family history, nature of employment, and, above all, preexisting conditions. Any indication that an applicant is more likely than average to have high medical costs, and any chance of affordable insurance goes out the window.
2. If someone who makes it through this first process nonetheless needs care, insurers will look for ways not to pay, picking through the patient’s medical history to see if they can claim an undisclosed preexisting condition; this would invalidate the insurance. More important in most cases, they challenge the claims submitted by doctors and hospitals, trying to find reasons why the treatment offered wasn’t their responsibility.[10]

Naturally, all of this lends itself to much bureaucracy and administrative costs. Krugman notes that Medicare, the government-run health care, which does not (need to) haggle, spends only about 2% of its funds on administration, a figure which stands at about 15% for private insurers.[11]

d. Conclusion

Considering the situation now with the economy in recession:

• if the economy is struggling, more people are losing jobs;
• more people are losing health insurance;
• more people are unable to afford to be healthy, and wait until problems become critical before being treated;
• more people pay higher prices for treatment, which they cannot afford;
• and the vicious cycle continues …

Princeton economist Uwe Reinhardt predicts that if nothing change:

1. Health-spending per capita in the United States will continue to rise 2 to 2.5 percentage points faster than the rest of per-capita gross domestic product, as it has done for the last four decades. Health care then will absorb about 40 percent of G.D.P. by 2040.
2. More and more middle- and lower-income American families will find themselves priced out of needed health care, as the cost outpaces the growth in the wage base that supports the families. They will experience harsh rationing of health care, not by government, but by price and their ability to pay.
3. The waste most experts impute to our health system would continue unabated, as it thrives on the opaqueness of a heavily paper-based, fragmented health system that shuns comparative effectiveness analysis.[12]

The current state of the U.S. health care system is decidedly unhealthy, and it's about time something was done about it.

[Part 2 to follow]

---

[1] Gregory E. Pence, Classic Cases in Medical Ethics: Accounts of the Cases and Issues that Define Medical Ethics, New York, NY: McGraw-Hill (2008, 5^th ed.), 348.

[2] Sondry Ely Wheeler, Stewards of Life: Bioethics and Pastoral Care, Nashville, TN: Abingdon Press (1996), 63.

[3] Paul R. Krugman, The Conscience of a Liberal, New York, NY: W.W. Norton & Company (2007), 215.

[4] McKinsey Global Institute, “Accounting for the cost of U.S. health care: A new look at why Americans spend more,” (November 2008), accessed from http://www.mckinsey.com/mgi/publications/US_healthcare/ (March 14, 2009); and Organisation for Economic Co-operation and Development, “OECD Health Data 2008, 26 June 2008,” Organisation for Economic Co-operation and Development; accessed from http://www.oecd.org/document/27/0,3343,en_2649_34631_40902299_1_1_1_1,00.html (March 16, 2009).

[5] Karen Tumulty, “The Health-Care Crisis Hits Home,” Time Magazine (March 5, 2009); accessed from http://www.time.com/time/nation/article/0,8599,1883149,00.html (March 14, 2009).

[6] Ronald J. Sider, Just Generosity: A New Vision for Overcoming Poverty in America, Grand Rapids, MI: 2007 (2^nd ed.), 175.

[7] Laurie Zoloth-Dorfman, “First, Make Meaning: An Ethics of Encounter for Health Care Reform,” Tikkun, 8 (July-August 1993), 23.

[8] Rebecca Todd Peters, “Economic Justice Requires More than the Kindness of Strangers,” in Douglas A. Hicks & Mark Valeri (eds.), Global Neighbors: Christian Faith and Moral Obligation in Today’s Economy, Grand Rapids, MI: William B. Eerdmans Publishing Company (2008), 106-107.

[9] David U. Himmelstein, et al, “MarketWatch: Illness and Injury As Contributors to Bankruptcy,” Health Affairs (February 2, 2005); accessed from http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1 (March 14, 2009).

[10] Krugman, Conscience, 220-221.

[11] Krugman, Conscience, 223-224.

[12] Uwe E. Reinhardt, “Economic Trends in U.S. Health Care: Implications for Investors,” presented to An Investors’ Health Care Conference (January 2009); accessed from http://blogs.ft.com/maverecon/2009/02/uwe-reinhardt-on-the-health-of-the-economy-and-the-economics-of-health/ (March 14, 2009).