Burden Bearing:

General Bioethics — By on October 31, 2005 at 3:01 am

How should Christians respond to the medical needs of the community? What paradigms are believers adopting for the delivery of healthcare? Throughout the history of the church, Christians have been actively involved in the provision and funding of healthcare. But for the past fifty years, these questions have been treated as if they were political issues reserved for the state rather than matters to be handled by the church.
Some members of the evangelical community, though, are beginning to reassert this Biblically-mandated role and are the subject of a recent Washington Post article on ‘



  • Enigma

    Whatever arrangements you feel best fit your healthcare needs, go for it. I see no reason why consenting adults should not be allowed to participate in any sort of financial transaction they wish. However, beforehand, I think it is only right that these “church plans” make very clear exactly what is and is not covered and the criteria for remaining a member.
    I personally would never participate in such a plan, but for those who think it’s their cup of tea I say: Go for it.

  • Tim

    I was very pleased with what I was reading here. Well, ok, only for the first paragraph.
    This “insurance” plan calls itself Samaritan. I am trying to remember if in the story of the good Samaritan, whether the Samaritan made sure that the injured person on the road side was injured “for innocent reasons”. Maybe the injured person stole the money and then it was later robbed from him? I am surprised that Jesus didn’t concern himself with that in this parable!
    The Biblically-mandated role is to help those in need. Give them a share of your food, the clothes off your back, a place to stay. Why liberals think that handing this responsibility to the government is “caring”, I’ll never understand. Unfortunately, too many conservatives don’t understand the call for caring no matter what their tax bracket is.
    Fortunately, there are plenty of conservatives and liberals out there giving there time, money and experience to those who can benefit from it.

  • http://TheEverWiseBoonton.blogspot.com Boonton

    It is no surprise that the political left is appalled at the idea that people could make voluntary economic arrangements that are unregulated by the government
    Well the worrisome thing about unregulated insurance is fidicuiary duty of the insurer. What, for example, would prevent the guy running this network from just taking all the $200 contributions and flying off to Mexico and ignoring the claims that come in? You say that these plans make no guarantee of a paying for claims in exchange for paying premiums so I guess ‘buyer beware’ is sufficient regulation…although I would still worry about this being marketed to people as if it was as trustworthy as insurance which must prove that it has assets on hand to pay expected claims.
    Do you want to explain to the old woman who cancelled her Blue Cross coverage and choose what she thought was ‘Christian insurance’ that despite paying the premiums on time for years she isn’t going to get any help with her illness and she has no legal case to demand any?
    But for most conservatives, even

  • http://www.evangelicaloutpost.com Joe Carter

    Tim,
    The Biblically-mandated role is to help those in need. Give them a share of your food, the clothes off your back, a place to stay.
    That is partially true, though there are certain qualifiers to that statement. But there is a difference in the way we help the needy outside of the church and those within.
    I know the concept of practicing church discipline is quite foreign to most Americans but that does not mean that we can’t set conditional standards for participation in church (or parachurch) programs.

  • http://TheEverWiseBoonton.blogspot.com Boonton

    Is this a church program or a large direct mail based program? Do the members know each other? Do they know each others problems, know their kids names etc? Could they intervene for mutual benefit (as dramatic as confronting a drug problem or simple as going on a healthy diet together)?
    As you describe it this sounds more like the impersonal health insurance plan where you don’t really know nor care about your fellow members (except to the degree that their being healthier than you lowers your premiums and being less healthy than you raises them). If that’s what you want then capitalism seems to do a better job at it. Why not get a traditional health plan which is regulated so you can be secure that the guy getting the checks isn’t going to run off with the money?

  • http://www.anotherthink.com Charlie

    So glad you posted this, Joe. There is a general thread here that is very important, and that is that the Christian church ceded many of its social responsibilities to government after the Depression, but it has recently begun to reconsider. And it should. Feeding the hungry, clothing the poor, caring for the sick can’t be effective if they only involve a transfer of goods, services and payments. That’s all that government and health management orgs can offer, but the church can offer more: community, spiritual intercession and comfort, prayer, sympathy and compassion.
    I have several friends who participate in the sort of self-funded faith-based “insurance” program you describe. Yes, these plans could be seriously hurt by a well-placed, unethical manager. But they work well because they are seen as a ministry to the hurting rather than a contract with a faceless mega-corporation, and they give people with very limited means access to health care as needed. The people using these plans are very frugal about their requests for help (and their use of the healthcare system generally), and as a result, costs are very low.
    It becomes an extension of the church in the best sense of the word — a community of believers who all look out for each other. So, it works.
    One final note. My father died when I was 9, my mother had no work skills and little education, but we began to collect Social Security. The payments were quite pitiful, and we were poor. In retrospect, knowing James 1:27 and 1 Tim 5:3-7, I am surprised that our church failed to help. But it never did.
    Like other churches, it had decided that those passages were for a different time, because government had created the safety net of Social Security to care for people like us. I think in this oversight, the church missed out on a very important opportunity to practice (and benefit from the practice of) charity in its own flock. That sort of charity produces in those who practice it some of the self-denying heart of Christ, and it forever changes us in a way that mailing a check to Blue Cross never will.

  • http://www.sufficientscruples.com Kevin T. Keith

    It is no surprise that the political left is appalled at the idea that people could make voluntary economic arrangements that are unregulated by the government.
    The left is appalled that people could be inveigled into economic arrangments that threaten to destroy their lives, without any safety guarantees or legal recourse.
    You note that the plans are not guaranteed, but it goes far beyond that: they’re not funded. One of the pesky little slavery-inducing regulations that the legitimate health insurance industry groans under is the requirement that they actually be able to pay the bills they contract to pay – by maintaining reserve funds equal to some percentage of their contracted liabilities, so that they will always have money on hand to meet claims. The article you quote notes that none of these church plans has any reserve funds whatsoever – the plans exist in name only. (As you also note, some of the plans actually operate by having the members pay each other, rather than the plan handling the money.) The article goes on to note that members are issued a card that looks like an insurance card, and that many of them present it to hospitals and doctors while saying things like “This is my medical provider” – not using the word “insurance” but not explaining that the plan does not actually pay bills. They are then instructed to negotiate a monthly payment plan with the hospital – just as if they were medically indigent, which they more or less are – and pay off the charges over a long term as “shares” dribble in from the plan or its members. One plan administrator notes that many of its members would otherwise qualify for Medicaid, and claims they are doing a public service by keeping them off the rolls. He does not note that they are also subjecting the members to extremely high deductibles, limiting their access to care, and threatening that limited access by delaying payment. Many of these members would obviously get more and better care if they were on Medicaid, but these plans have sold themselves as “the Christian thing to do”.
    In other words, aside from being intrusive and limited, and expensive in the long run (some of the plans have deductibles of $300 per illness, meaning that they essentially never pay for routine care, only for emergencies), the plans also leave their members in significant financial jeopardy: they do not have financial resources to pay their claims, they do not guarantee that they will pay all or any claims in the first place, and what payments they do make are strung out over months as they collect premiums from members, or in some cases actually have some members pay other members directly. The plans are essentially insolvent – they are virtually Ponzi schemes, and like Ponzi schemes they will go bankrupt when short-term liabilities exceed incoming premiums. Members must pay monthly premiums steadily to qualify for assistance when they need it, but there is no guarantee that it will be available at that time. A sudden flu epidemic or an economic downturn among the membership, and those members with outstanding claims would simply not get paid even though they had been paying their own premiums. The members have no legal protection in such a case. These are precisely the sort of problems insurance regulations are supposed to addresss. And, given especially that the plans are actively recruiting members away from alternative coverage like Medicaid, they are not just offering a voluntary service, they are putting people in danger.
    There are other problems. The plans do not submit to those pesky, intrusive, non-Christian audit and oversight regulations that pagan insurance companies do, which may explain why the oldest one got into some trouble after “its founder, Rev. Bruce Hawthorn, and other former officials defrauded the ministry and [were ordered] to repay nearly $15 million they spent on luxury houses, motorcycles, expensive cars and high salaries, including one for a stripper whom Hawthorn said in an interview he was ‘trying to help.'” They also practice quack medicine. Not only do they limit the conditions they treat according to what they regard as Biblically approved and “innocent” diseases, they subject claims to medical review by “Christian physicians” (apparently medicine is different if you’re a Christian); the largest plan relies on an unlicensed doctor who makes surgical diagnoses over the telephone and in once case prescribed a two-week fruit-and-water-only diet for a woman with high cholesterol. Luckily, he escapes review by those pesky, annoying medical licensing boards, and there are no limits on what decisions he can make without meeting the patients or reviewing their charts like real insurance companies are subject to, as if anyone would want such a thing. The plans also stifle complaints by threatening to expel members who “‘choose to ignore the finality of the three Christian doctor appeal’ and who pursue arbitration or ‘use the secular courts’ to settle disputes.”
    In short, they’re crappy healthcare plans providing crappy service to people who need, and in some cases have been encouraged to reject, better options. They are also judgmental, intrusive, and coercive. This is not to say they should be prohibited, but it’s hard to see much good in them. They strike me as another example of Christians not understanding why Christianity often looks like a bad thing. At any rate, as far as regulation goes, there’s a reason for regulating healthcare and health insurance providers. The regulations provide protection for the people who really matter – the patients who are subject to their care.
    The difference between regulated and unregulated health insurance – between a fiscally healthy plan that has reserves to cover its liabilities, that does not impose moral judgments or practice quack medicine, that undertakes a clear contractual relationship with its members and is obligated to provide the services listed in the contract, and whose members have legal protections guaranteeing the services and benefits they have been provided, and one that has no financial assets, pays bills hand-to-mouth, violates confidentiality, imposes intrusive and idiosyncratic limitations on its members, leaves much of the obligation of actually working out the payments to its members themselves (while collecting 20% or more for administrative expenses while not actually paying its members’ medical bills), and engages in intimidation to discourage members from exercising their legal rights, should be obvious. These plans are certainly making it so.

  • Tim

    Joe,
    Church discipline is fine. It’s just what should be disciplined? The Bible is clear (especially in the NT) in its concern the sins of not giving, for greed, arrogance, self-righteousness, etc. The Bible (especially the NT), is little concerned about sexual and other behaviors. (The Bible is concerned but it is concerned about what is in your heart, not the outward behavior showing what is in your heart).
    I am not mocking or foreign to church discipline, my disagreement is with what they regard as important. Maybe I should start a insurance program with the disciplines of fasting, praying and giving at least 10% of your income to church and charity? Why not have that as primary concerns?

  • Tim

    Joe,
    “That statement is so completely unbiblical that I don

  • beloml

    Will gluttony go back to being a sin, then?

  • http://www.evangelicaloutpost.com Joe Carter

    Kevin The left is appalled that people could be inveigled into economic arrangments that threaten to destroy their lives, without any safety guarantees or legal recourse.
    Exhibit A of what I was talking about. ; )
    You note that the plans are not guaranteed, but it goes far beyond that: they’re not funded.
    Um, yeah, that

  • Mike O

    Tim,
    “(The Bible is concerned but it is concerned about what is in your heart, not the outward behavior showing what is in your heart).”
    For the writers of the Bible the heart was the seat of action, the place where actions originate.
    Mt 15:19 For out of the heart proceed evil thoughts, murders, adulteries, fornications, thefts, false witness, blasphemies:
    Mr 7:21 For from within, out of the heart of men, proceed evil thoughts, adulteries, fornications, murders,
    Actions show what is in your heart and cannot be seperated. Paul, James and John all make this clear and both passages above are in red if you have a red letter Bible.

  • Tim

    Two small but significant examples
    1 Samuel 16:7
    …the Lord does not see as mortals see; they look on the outward appearance, but the Lord looks on the heart.
    Proverbs 4:23
    Guard your heart, for out of it flows the springs of life.

  • Tim

    Mike O,
    That is exactly what I am saying.

  • http://www.gryphmon.com Patrick

    Tobacco use, immoderate drinking, homosexuality and extramarital sex are strictly forbidden, and anyone caught violating these proscriptions can be expelled. The plans don’t pay for abortion, or treatment of sexually transmitted diseases or HIV that was not, as Samaritan puts it, “contracted innocently.”

    Well, here’s another failed opportunity for Christians to put their money where their mouth is. Apparently today’s Sunday school isn’t quite the same as when I attended. Remember a concept called “Christian Charity”? You should take care of the sick. No matter how they became sick. Even if they continue to sin. If you are going to help your neighbor, you should do so whether they are sinner or saint. You don’t help people because you think they deserve it. You do it out of respect for God’s creation and in devotion and gratitude to God for his gift of redemption to you.
    Really, this sounds like the health care plan from Hitler. Help only those that deserve it or of the “right sort” or who are “innocent”. Sheesh. Thanks for tarnishing one of the things I actually respected and admired about Christianity.
    You know, at the gay and lesbian community center here in Los Angeles, they help people whether they are gay, straight, Christian, non-Christian, innocent or guilty. Whether or not we approve of them or their “lifestyles”. And whether or not they can pay for it.
    And as far as America’s “rugged individualsim” goes: Horse-Hockey. Try surving in Colonial America without giving and recieving plenty of help from your neighbors. The real “original” spirit of America is more profoundly expressed by the old Christian hymn, the Promise of Giving. Apparently thats another one they don’t sing in Sunday School anymore. Maybe they should.

  • Mike O

    Tim
    What I am saying is that God is as concerned with the outward behavior as with the condition of the heart because they are all part of the same thing. In your original comment you seem to think actions and heart can be separated but they can’t.
    If, however, what you are saying is that God intends to take care of your outward actions by changing your heart, I can certainly agree with that.

  • http://TheEverWiseBoonton.blogspot.com Boonton

    Remember when insurance was intended to cover emergencies. You appear to believe, Kevin, that health insurance is intended for routine care.
    Health insurance is intended to cover whatever it is contracted to cover. Regardless Joe you just stated:
    Um, yeah, that

  • http://jollyblogger.typepad.com David Wayne

    I used to be in one of these programs and I gotta tell you that I am on the leery side of them now. I got out when my church offered to pay for a group plan for all of us. I never had any problems but I also never had any major claims to make. However, my sister in law was in the Brotherhood program, the one that Kevin mentions. She had some major surgery and got stuck with over $20k in bills.
    I don’t have a problem with these folks having their “lifestyle requirements” – if an individual doesn’t want to join because of the lifestyle requirements they don’t have to. If people of similar conviction and lifestyle want to band together for something like this I say great – go ahead.
    My concern does get back to the fact that there is no regulation for these things. Providers have no guarantee of payment other than the promises of the members of the group to pay. But there is nothing other than Christian charity to compel the members to pay and unfortunately, as in the case of the Brotherhood program, Christian charity doesn’t win out.
    I am not saying I like government regulation. In principle I am all for taking stuff like this out of the hands of the government. If these things are “Christian” programs then they ought to be administered under the oversight of a church body or some other group that could compel payment and I don’t see how that could happen.
    Fortunately, most of these programs are administered by honorable people, but total depravity still applies to Christians and there ought to be stronger checks and balances if these things are to fly.

  • http://TheEverWiseBoonton.blogspot.com Boonton

    “Fortunately, most of these programs are administered by honorable people, but total depravity still applies to Christians and there ought to be stronger checks and balances if these things are to fly”
    Yes total depravity still applies but what can be avoided is idiocy. Running an insurance business is much more complicated than simply collecting premiums and paying out claims. It takes a lot of collective skill to set both the premiums and payout rules just so the system is solvent.
    Why a Church should have any special skill at doing this when mainstream insurance companies benefit from the expertise of hundreds of actuaries, huge banks of historical data and highly trained analysts is beyond me. We are left then with charity…but as we have seen this isn’t a particularly charitable program. It’s primary appeal is that it can function as health insurance on the cheap. I wouldn’t be very sympathetic with someone who opened up a food store or pizzera ‘on the cheap’ by finding some loophole to avoid public health laws. I wouldn’t be very impressed with the claim that eating there cheaply was ‘sharing the burden’ of hunger in America or the world.

  • Soup

    The church-based-welfare debacle as described herein is (in my estimation) but a pitiful variation of the old “Ponzi scheme”.

  • Soup

    Ooops! I see that someone else has already observed the Ponzi scheme at work.
    Yes, these plans are funded

  • http://jimgilbertatlarge.blogspot.com/ Jim Gilbert

    Joe, this post and subsequent comments illustrate, perhaps most clearly of any EO posts that I’ve read, how utterly out of touch some of your debaters are. There are many churches who participate in medical fund cooperatives, and while I regret David Wayne’s experience, I’ve known of them working just like they should. In fact one friend, from Tyler, Texas, contracted malaria in India and promptly received the more than $200,000 he needed when his hospital bill arrived. He’s continued paying in faithfully since then, and the fund still works.
    I’m amazed at how your non-church detractors will give you their reasons as to why this won’t work, when it’s working for so many people already. The reason: They are indeed faithful and trustworthy WITHOUT being policed by Uncle Sam, which is apparently incomprehensible to several commenters here.
    The comments on adulterous hearts, excusing physical follow-through, are perhaps the most bizarre I’ve ever read here. How appropriate that they appeared on October 31.
    Wow.

  • Soup

    Some people like to gamble and actually win the lottery from time to time, too! Using your logic I wonder why the church doesn’t simply advocate congregants pooling their money for the weekly Powerball? Free healthcare for everyone!
    It’s unimpressive to solemnly point at anecdotal evidence and then universally proclaim “SEE, IT WORKS!”.
    I know a guy who claims that God speaks audibly to him from his car radio…
    “Wow” indeed…

  • Larry Lord

    http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/10/31/MNG2LFGJFT1.DTL#story
    Washington — A new vaccine that protects against cervical cancer has set up a clash between health advocates who want to use the shots aggressively to prevent thousands of malignancies and social conservatives who say immunizing teen-agers could encourage sexual activity.
    Ah yes, those “social conservatives” are once again insisting that keeping Jack Chick’s demons alive and well is the KEY to transforming our society.
    Eliminate the fear of cervical cancer, these “social conservatives” say, and our young girls will get a few degrees sluttier — it’s only natural!
    Perhaps they will also be more willing to get raped by men who are carriers for venereal disease. Surely that must be a concern of these “social conservatives” as well … right?
    Is rallying against anti-cancer vaccines another sort of Bible-based health care?

  • http://www.twoorthree.net/2005/10/christian_healt.html two or three . net

    Christian Healthcare Alternatives?

    Solving the healthcare problem won’t be easy, for a couple of reasons. First, we don’t have a model that allows us to properly contain costs while providing adequate care. Secondly, and more importantly, there is shared resonsibility between the spheres

  • windbag

    Hello readers, a reality check. Kevin T. Keith wiped the slate clean here. What exactly is left to say in defense of these plans? Elvis has left the building. If you’re in doubt, re-read his post and respond– substantively, point by searing point– and try to do a little better than Joe did.
    Come ON…. you can’t pretend to not understand, and thus ignore, the implications of what he just laid out in that post about some of those plans.
    Unless, of course, you’d prefer to.

  • http://TheEverWiseBoonton.blogspot.com Boonton

    I agree Keith did an unbeatable number on these plans. Soup was dead on as well. If this is charitable ‘burden sharing’ then people should simply put $200 a month against someone else’s medical bills. It isn’t charity if you expect to be able to cash in at some point later. Then it is either gambling or investing (or both) and I simply because it is being organized by a so-called Church doesn’t magically exempt it from economics.

  • http://jeffthebaptist.blogspot.com/2005/11/christian-healthcare.html Jeff the Baptist

    Christian Healthcare

    Joe Carter is discussing taking “social justice” issues back for the Church starting with Healthcare. This seems like a bad idea to me…

  • Soup

    It’s a little OT, but since it has been incorrectly addressed by several “fruit watchers” here let it be noted that while works are sometimes linked to heart motivation, the heart motivation itself is completely misguided apart from the leading of the Holy Spirit.
    The point is, don’t believe that works = faith. Countless multitudes of self-proclaimed “Christians” are going to bust the gates of hell wide open because they believed that works = faith or worse works = salvation.
    It just ain’t so.
    Beware the “fruit watchers”.
    Matthew 23:27
    Woe unto you, scribes and Pharisees, hypocrites! for ye are like unto whited sepulchres, which indeed appear beautiful outward, but are within full of dead men’s bones, and of all uncleanness.
    Matthew 7:22-24
    22 Many will say to me in that day, Lord, Lord, have we not prophesied in thy name? and in thy name have cast out devils? and in thy name done many wonderful works? 23 And then will I profess unto them, I never knew you: depart from me, ye that work iniquity.
    Tim’s position is absolutely scripturally correct: The heart is the key and good works flow from a redeemed heart and a pure desire to advance the kingdom.
    While the unredeemed may certainly live seemingly moral lives and even do commendable, meritorious works they are as all works; filthy rags before the righteousness of The Lord.

  • http://auspiciousdragon.com/ holmegm

    Many of these members would obviously get more and better care if they were on Medicaid, but these plans have sold themselves as “the Christian thing to do”.
    I’m not quite sure what your point is here. That seeking “more and better” at the forced expense of others is “the Christian thing to do”?

  • Nick

    most exclude coverage of preexisting conditions, as well as treatment related to cancer recurrence, serious heart disease, obesity, psychiatric disorders or vision problems
    Can someone explain these limitations and exclusions? The exclusion of pre-existing conditions makes it smell an awful lot like an insurance plan. I’m not sure that Christians bearing one another’s burdens should make that distinction.
    How about the exclusion of psychiatric problems? Why? Are mental illnesses somehow different than diseases that affect other organ systems?

  • http://www.evangelicaloutpost.com Joe Carter

    Nick,
    Can someone explain these limitations and exclusions? The exclusion of pre-existing conditions makes it smell an awful lot like an insurance plan. I’m not sure that Christians bearing one another’s burdens should make that distinction.
    It is an unfortunate requirement for such plans to survive. Without such exclusion, most people would simply wait until they have an illness and then take advantage of the low cost of entry. Unfortunately, just because the programs are Christian they still suffer from the

  • http://TheEverWiseBoonton.blogspot.com Boonton

    It is an unfortunate requirement for such plans to survive. Without such exclusion, most people would simply wait until they have an illness and then take advantage of the low cost of entry. Unfortunately, just because the programs are Christian they still suffer from the

  • http://intheouter.net/2005/11/01/the-idea-sounds-great/ …in the outer…

    The idea sounds great

    According to this Washington Post article, there are now healthcare plans that people of faith can join in order to provide healthcare for their families. Apparently, in order to join and benefit from these plans, you need to commit to a lifestyle tha…

  • http://blogotional.blogspot.com/2005/11/being-christian-in-real-world.html Blogotional

    Being A Christian In The Real World

    I agree with Joe’s overriding premise that the church is called not just to redeem individuals, but to redeem the world, but I think it is called to redeem the world by redeeming individuals.

  • Phillip

    I see that comments stopped a few days ago, but I feel compelled to add (tho perhaps someone mentioned this already).
    Regarding exclusions, both pre-existing and “non-innocent”, how do any of these plans dare use the description of bearing one another’s burdens? Call it “alternative insurance”, call it “christian business”, call it “we hate those secular plans”, but don’t call it “bearing one another’s burdens”! I see much more guidance to err on the side of mercy in scripture (ex. 1 John 3:16-18, 1 Peter 4:8) rather than prevent misbehavior (thus the heart vs. action argument you’ve gotten wrapped up in).
    If one of these plans wanted to adopt NT disciplinary policy, then that would be somewhat better, but ultimately I find that God teaches(not through the radio) that it’s okay if I am taken advantage of when I give and that’s it’s GOOD to give to the broken and sinful. HE is the provider and the avenger according to HIS will. i am the follower.
    These plans have no business (pun intended)trying to hide behind Acts and other NT writings, unless they are willing to tell members sell all their crap, live in a commune, and share everything, burdens and blessings.
    The thing that strikes me about all this is that no one seems to address that this argument is about two sad alternatives. On the secular side, we have the provision of plans that mostly operate based on rules seemingly bent on prevention of coverage/payment, i.e., no heart, no mercy. On the Christian side, we have plans that put on the guise of having heart and mercy, then operate not only poorly but also exclude. This sort of separatist parallelism sickens me! Will we forever show the world that we suck at doing this sort of thing? For years it was true with things more benign, like pop music, but now we misguidedly head into areas that have real consequences. Why can’t we hold ourselves to the higher standard? If we do something, it should be demonstrably better, otherwise work within what the world has to offer and be salt and light. (of course, if we set up the better alternative, we are also salt and light). To me, when we offer clearly inferior alternatives, we are salt that has lost its flavor. Can’t we strive to measure all we do by how close we come to excellence in love and action? A cheapened, watered-down effort dishonors our God.

  • tommythecat

    sounds like socialism to me. time to bring back the mccarthy hearings.