Needlessly Inflated Medical Costs

Medical care need not be so expensive. It could well be within the affordability of most people, with true charity covering the remainder. Other things which needlessly inflate the cost of medical care:

1. Needlessly long training tracks for practitioners before they can begin to return something of value from their training to that point.

2. Hanky-panky between the pharmaceutical industry and the FDA, keeping small competitors off of the playing field.

3. Maybe some naivete in patent law.

4. Undue restrictions in licensure.

5. The classification of many human problems, sins, and foibles into the medical model. Alcoholism led the charge in this. It causes many medical problems but has never responded to application of the “medical model” of disease, which is nonetheless very expensive.

6. Tax advantages to money set aside for “medical care” in the form of insurance premiums. People will spend it rather than lose it and thus distort medical markets, ascribing value to things which are not valuable. I will pick on a small, cheap target as example. The careful and systematic teaching of breast self-examination, intuitively attractive as a prevention of breast cancer death particularly in view of the fact that most breast cancers are found that way, has been shown NOT to prevent breast cancer deaths. Prostate cancer screening by any method likewise has failed. Screening for aneurysms of the abdominal aorta, likewise. The list is in the dozens. I know this is like spitting on the Mona Lisa, but I dare you to examine it carefully and scientifically.

We are prone to go at these things according to their face validity. A real free market would help hugely in sorting the useful out from the not useful, leaving each person at liberty to make his or her selections from what is available. Medicare, Part D, joins hands with other insurance in delaying the discipline of a free market. Senator Bill Frist, Senate Majority Leader, briefly floated the idea some weeks ago of giving everyone a sum of money, I think it was $300, to offset the rise in the cost of gasoline. Notice that giving the money sustains the cost of gasoline. It tends to make people refrain from carpooling, finding more fuel-efficient cars, consolidating trips, driving more slowly, taking public transit, etc. Just so does Medicare, Part D, sustain the high cost of drugs.

7. The imposition of managerial costs into medical billing, which averages something between 18% and 25%. Direct payment by the consumer strips this almost entirely away.

8. The imposition of regulatory costs into medical care. Medicare regulations alone run over 100,000 pages, with more pages on the interpretation and no agreement on that.

With correction of these and other costs, medical care is affordable to most people, and well within the reach of Christian charity.


Excerpt from "Medicare and Insurance"

Military Thoughts

Numbers 1:2-3 “Take a census of all the congregation of the children of Israel, by their families, by their fathers’ houses, according to the number of names, every male individually, from twenty years old and above—all who are able to go to war in Israel. You and Aaron shall number them by their armies.”

The “general equity” of the law of Israel is something we should seek after to understand and apply today, even though the civil state of Israel has “expired.” Here we see an age and a gender of fitness to go to war: men and age 20. The expectation here was very likely not a military draft. Examples of draft-like events occur in the Old Testament and are presented both as exceptions and as things which go awry. The “buy-in” to war requires consent.

Further, the organization here showed clan influence. What about a military which prides itself on dismantling young men, and then reassembling them into what the ruler wants? A part of the process of disconnecting men from their roots is to mix them completely with strangers from everywhere. War accounts and war movies from the 20th century stated or implied that this melting pot approach was in some way a great strength of the American military. Aside from the benefits of avoiding a Bedford, VA, type of event* on D-Day, I doubt that it is a strength. Moreover, as our nation has become polyglot and imperial, I question the kind of cooperation you would get from such a soldiery. Would the prison guards at Abu Ghraib have indulged in such torment if they were representative of a small geographic area and kinship group, and would someday return to have to look each other in the eye and know what they had done?

* Men from Bedford, Virginia serving in the 29th Infantry were among the first to storm Omaha Beach on D-Day and therefore suffered significant losses.

Voting for Ron Paul

Today, Dr. Terrell would have voted for Dr. Ron Paul for the third time (first time in 1988 and second time just before his death in 2008). As a fellow doctor, Dr. Terrell believed that the best chance to solve the problems in medical care and the economy were not found in more bureaucratic legislation, but in more personal freedom and faithfulness to our Constitution.

On Lending

Deuteronomy 15:6 “For the LORD your God will bless you just as He promised you; you shall lend to many nations, but you shall not borrow; you shall reign over many nations, but they shall not reign over you.”

Being in a position to lend is clearly indicated as a superior position to strive to be in. A lender is one who is not here necessarily (or even likely) collecting interest, but one who can alleviate material suffering.

Inheritance

Prov. 13:22 “A good man leaves an inheritance to his children’s children, but the wealth of the sinner is stored up for the righteous.”

The use of the term “wealth” indicates that physical wealth is primarily what is in view here. Proverbs are not commandments, but rather descriptions of how God normally deals with human beings. Proverbs describes His ordinary providence. Failing to leave wealth to children is thus not a sin. A parent however who gives no heed to God’s ordinary providence is behaving questionably in this matter. Our inheritance laws today can set God’s expectation against the civil state. Inheritance taxes are wicked, implying that the wealth ultimately belongs to the state, replacing covenantal succession in the family with the state. Wise parents will invest in their offspring.

Give a Defense

Our calling in work is not normally just to provide ourselves and our families with the necessities of life so that we can use the balance of our time as junior pastors. It is not that there is necessarily something amiss in teaching, lay ministry, lay evangelism, and the like. It is that we are not to neglect our calling in order to invade that of someone else.

1 Peter 3:15 says, “But sanctify the Lord God in your hearts, and always be ready to give a defense to everyone who asks you a reason for the hope that is in you, with meekness and fear;”

A defense is a reaction, not a proaction. But the spirit of our times in the Church is that we are to be proactive in the propagation of the gospel. We are rather inculcated in the idea that we are a massive sales force for the gospel, plotting out what we call “witnessing opportunities,” somehow as if our whole life is not a witnessing opportunity.


Excerpts from "Realizing Our Vocational Calling"

Individualizing Medical Care

The insatiable demands of the production line for monitoring, feedback, control, and payment distract the physician from the ill person. Industries want uniformity of method and product. Medical care is embedded in individuality.

There is only one way to return control of the patient-doctor relationship to the axis that runs between the two. It is to recover a free market in medicine.

Patients who can vote with their feet and their wallets will regulate their care. Others can only pretend to do so.


Excerpts from "Medical Information and Bureaucracy: F. A. Hayek and the Use of Medical Knowledge"

The Prison of Entitlement

The attitude of entitlement is like a wall around the person who has it, walling out love. What is sent to the person in the name of love is received as merely partial payment of a debt. The sender cannot be perceived as having acted in love because the recipient believes that the sender had to do it. It was his job. He owed it, and the debt cannot ever be fully paid. Entitlement is a miserable prison, constructed by the prisoner around himself. What he needs most, he seals outside. He cannot articulate, "I need love." He instead demands, "You owe me."

Though patients build their own entitlement walls, the material is sometimes supplied by well-meaning Christians who support entitlement programs. The usual pleas for the financial involvement of civil government in the delivery of individual health care are "compassion" or "love." Yet compassion and love are precisely not what Medicaid and other entitlement programs express. Compassion is expressed when we reach into our wallet and voluntarily produce something to give another. It is not love when we vote to use the strong arm of the state to pry open the wallets of other persons to make them give. This is coercion. God sometimes coerces, but even He does not coerce love of others (Acts 5:4a). If we would recognize that the effect upon the recipient of such coerced giving is sometimes materially beneficial but ultimately spiritually deadening, as in the entitlement syndrome, we would resist it. We can do this by political, economic or educational means.

As a nation we are walling out the love of God by looking for government entitlement to benefits only God truly provides. God has purposes for governments, but love demonstrated in compassionate individual medical care is not one of them.

Excerpts from "Breaching Walls Against Love"

The Faith of Science

Science claims to be not merely the observation of things and events in nature, but a logical arrangement of these observations so that conclusions can be drawn. The work of science is inductive. You see event a, and event b, and event c, and event d and from these you reason out that the relationship between these events you have seen must also extend to other relationships you have not seen. I check the throats of 100 people who have scarlet fever, and 100 times I find evidence that they have, or have just had, a streptococcal infection. Yet, there are literally millions of cases of scarlet fever in a year’s time (over the world). I have assumed that my sample is true for the huge majority which were not checked. It might be so. It also might not be so. I am reasoning from the partial observations to the whole situation. This is induction.

Theology, unlike natural science, is a deductive enterprise. We take the Word of God as true premises and reason through to a derived conclusion. We reason from the greater (revelation) to the lesser (derived conclusions). When you use logic to arrive at a conclusion, it is like geometry. You have to have axioms. You have to presuppose certain things to be true, things which you did not, or cannot, prove. You may call them presuppositions. I presuppose that the millions of people with scarlet fever whom I have not checked, would have had evidence of active or recent streptococcal infection in their throats. It is reasonable, but it is at bottom an assumption. Quite regularly, science turns up things which disprove the axioms (presuppositions). So, scientists have to have faith in their presuppositions. Without these assumptions, taken on faith, they can prove nothing. Scientists have faith, just like theologians do. It is a level playing field. You can point this out in some conversations.

As Christians, we have axioms. Ours are the Scripture. We take it as true by faith. We do not look to archaeology to prove that the Scriptures are true. Scientists also have axioms. Their axioms are of uncertain parentage, picked up here and there. They are often unstated until someone makes them state them. They take them by faith. Faith is a level playing field. We have ours, unsaved scientists have theirs. I promise you that they squirm when you press this upon them. They do not like it. I have yet, however, been unable to fail to wring this admission from them, if they will stay with a conversation.

Excerpts from "What Is Truth?"

Contentment

Contentment looks to God and sees Him as the One who provides. The old word for this is “Providence.” What happens to us is what God has provided for. To recognize that our situation is from God is to recall that He is sovereign. It doesn’t mean that when our situation is unpleasant, when we are under some kind of affliction, that we don’t feel afflicted. He is not requiring us to be insensitive to afflictions. The grace of contentment is that we do not rail and chafe at the trouble.

Contentment means trusting God to work things out even when we have no idea how He is doing it.

Excerpt from "Contentment"

Our God Our Help In Ages Past

Isaac Watts wrote this hymn in the early 1700’s. He had become a bit weary of strict adherence to the psalms. He wrote many hymns which are still familiar to us. He was a pastor in London, but hymn writing was his strong suit. He was much beloved of his congregation and indeed lived in the home of one of his members, Sir Thomas Abney, for 36 years! He was a short man, only about 5 feet tall.

This hymn is modeled on Psalm 90, especially the first part of the psalm. The flood of Noah is alluded to clearly. Our identification with those who drowned in the flood is indicated in Psalm 90 (verse 7 ff) in that we, too, are sinners as were they. Our security from the same fate is only by His good pleasure. Our life is short, and we should respect His anger.

Our God, our help in ages past

Note the identification of the singer with the Church through the ages.

We today are a bit too prone to think only of God’s provision for us in our own brief and narrow experience. Think of how David wrote psalms about events that were centuries old by the time he wrote them.

shadow of Thy throne, still may we dwell secure

Think of how our security comes from God. Stormy blasts, trials in this life, we can expect.

Before the hills

God’s eternity looking backward in time is extolled. Some of our hymns major in how we feel and what is on our mind, and on our response. This hymn focuses on God, returning His thoughts to Him from Psalm 90.

A thousand ages 


God’s eternity looking forward in time is extolled. He stands above time.

Preparation and Deliverance

Proverbs 21:31 “The horse is prepared for the day of battle, But deliverance is of the Lord.”

The battle is always the Lord’s. If there is a victory, it is the Lord’s. If there is deliverance, it is the Lord’s. Yet, the verse says that the horse is prepared for the day of battle. We are to make preparations for conflicts, testing, trials.

We are accountable to attend to our horses. That is, we are accountable to make preparations. The verse is not a teaching against foresight or preparation. However, the verse cautions us against a reliance in ourselves, in our machinations, in our intelligence, our foresight. We are not clever enough, we are not strong enough, we are not rich enough to deliver ourselves.

Psalm 147:10-11 says, “He does not delight in the strength of the horse; He takes no pleasure in the legs of a man. The Lord takes pleasure in those who fear Him, In those who hope in His mercy.” Let us fear Him and hope in His mercy.


Excerpts from "Preparation and Deliverance"

Meditation

“Oh, how love I Your law! It is my meditation all the day. You, through Your commandments, make me wiser than my enemies; For they are ever with me. I have more understanding than all my teachers, For Your testimonies are my meditation.” Psalm 119:97

What is biblical meditation?

It is not getting into a yoga position, chanting meaningless syllables until your mind is emptied of all sensibility and you mystically become one with the universe, absorbed into god and become a god yourself.

It is not problem-solving, such as how you are going to route a holiday trip to cover all the relatives, or how you are going to make the checking account last until the end of the month.

I submit that one form of biblical meditation is taking a matter, a concept, and turning it over and over in your mind, bringing biblical passages to bear, searching for meaning and connections which are not immediately present.


Read more on "Meditation".

Practical Preaching, Please

The church needs to dare to engage its preaching with the material world as it is connected to the spiritual world. It needs to cease exclusive fixation with our inner spiritual/psychic states and gaze outward from time to time at the creation and the links of causation that emerge into our view as more or less proximate to actions. We need robust teaching on matters of practice wherein second causes are not despised, but established. Liberals so-called want to make sin into mere system error; we are basically okay, but our environments are the problem, especially the social environment. We make an opposite error; we want the heart to be changed but make no development of its interaction with the material and social world.

There is a world of homiletically undeveloped ethics here. The Spirit of the world has made off with these ethical opportunities while we have been reviewing our basic historic doctrines for the umpteenth time, lest we make those dreadful errors of the fifteenth century church. We may need a second Reformation to redress our neglect in these matters. We can rebuke Johannes Tetzel’s errors while tolerating those of Charles Darwin in our very pulpits. We acknowledge the Puritan iconoclasts in our history while tolerating the worship of nature in environmentalism. Aaron’s calf today would not be golden, but green. We recognize the reprehensible militancy of the late medieval Church but not the military hubris of our own present empire. In economics we know that Scripture says our silver has become dross; we understand that in an abstract way, but not one Christian in a hundred could connect that ultimate revelation with the proximate statement of Gresham’s law and its illustration in 1965 when silver coins disappeared from circulation as dross coins were introduced. We can recite, “Render unto Caesar ... and render unto God,” but have surrendered nearly everything to Caesar since we have had no explicit instruction in discerning the difference in the claims. We have a catechism which tells us to preserve life by all lawful means, but leave Christians on their own when faced with feeding tubes and desperate surgical options at the tail end of the life span. Christians sit on juries deciding the fate of a parent charged with the crime of spanking his child. Their uneasiness has no focus. They have never been taught about jury nullification or the relevant history of William Penn in this regard.

Excerpt from "On Proximate Causes: A Neglected Aspect of Modern Reformed Preaching"