The Problem of Unrestrained Access

The effectiveness of medical care tends to be overrated, while the hazards of medical treatment tend to be underrated. For this reason I am convinced that, in our current situation, lack of access to medical care due to lack of money is no more problematic than is lack of financial restraint in seeking medical attention. Inability to obtain wanted medical care is commonly lamented without any recognition that broadening access without restraint may also be cause for lament.


Excerpt from "Ethical Issues in Medical Insurance"

From the Bookshelf

Medical orthodoxy has for more than a century distanced itself from quackery by reference to its evidence, logic, and obeisance to professional standards, yet our actual performance has partaken of a good deal more than these, as well as sometimes less. How do physicians meld the welter of particulars in each patient’s situation into an actionable diagnosis?

The answer Dr. Jerome Groopman offers [in How Doctors Think] is that it is a very complex process with many pitfalls. He has the temerity to try to explain our variable processes, including our failures, not only to physicians, but to nonphysicians as well. He largely succeeds.

Read more of Dr. Terrell's book review here.

Psychological Theology

Although he earned a PhD in Psychology, Dr. Terrell was nevertheless an outspoken critic of psychology and the psychology that had seeped into the Church. Sigmund Freud's ideas were not, in his opinion, appropriately spurned by the Church. Echoing similar ideas, Joe Carter of The Gospel Coalition blogged recently about the connection between Freudianism and the "new deism" infiltrating the church:

Freud's enduring legacy on folk psychology is twofold. Most significant is his turn to the hidden recesses of a person's inner being, rather than the outer influences of community and environment, in order to uncover the true self and determine what is necessary for emotional health and happiness. Second is the language either invented by or colored by Freudian psychoanalysis: denial, projection, repression, sublimation, id, ego, fetish, fixation, introversion, anal-retentive, neurotic, Oedipus complex, pleasure-principle. These are the terms that Americans---a perpetually self-diagnosing people---use to communicate with and understand our neighbors, and ourselves. 

This therapeutic lingo forms the conceptual basis by which other technical jargons---such as theological terms---are interpreted. Consider the term "closure," the idea that after trauma or loss, individuals have an innate need for a firm solution rather than enduring ambiguity. Closure is a concept derived from Gestalt therapy with no parallel in Scripture, yet it is often considered a necessary precondition for forgiveness, particularly forgiveness concerning a grave injustice. The idea that God would expect us to forgive without first experiencing closure strikes the Therapeutic Deist as akin to emotional nihilism. 

These therapeutic concepts also have a way of coloring our understanding of God's self-revelation. In Isaiah 48:11, God claims to seek his own glory: "For my own sake, for my own sake, I do it, for how should my name be profaned? My glory I will not give to another." Such passages confuse the modern Deist, for they make God appear to be---to use another term coined by Freud---a "narcissist." 

More often, though, therapeutic language wholly replaces theological concepts. In his study, [sociologist Christian] Smith notes that the teenagers used the phrase "feel happy" more than 2,000 times in the interviews. None of them used the terms "justification" or "being justified," "sanctification" or "being sanctified." The "grace of God" was explicitly mentioned only three times. 

"The language, and therefore experience," Smith found, "of Trinity, holiness, sin, grace, justification, sanctification, church, Eucharist, and heaven and hell appear, among most Christian teenagers in the United States at the very least, to be supplanted by the language of happiness, niceness, and an earned heavenly reward." Smith views this not as a sign that Christianity is being secularized, but that it is either degenerating into a pathetic version of itself or being replaced by a quite different religious faith.

Read the full post at The Gospel Coalition here.

Health Is Not a Commodity

Health is not a commodity which can be purchased from “providers.” Insofar as we have control over health, it flows from our beliefs and our behaviors.

If we love God, we are to keep His commandments. “If you love Me, keep My commandments.” said Jesus, as recorded in John 14:15. Those who “forget not God's law...will have length of days, and long life, and peace.”

Proverbs 3:1-7 says, “My son, do not forget my law, but let your heart keep my commands; for length of days and long life and peace they will add to you. Let not mercy and truth forsake you; bind them around your neck; write them on the tablet of your heart, and so find favor and high esteem in the sight of God and man. Trust in the Lord with all your heart, and lean not on your own understanding; In all your ways acknowledge Him and He shall direct your paths. Do not be wise in your own eyes; Fear the Lord and depart from evil. It will be health to your flesh, and strength to your bones.”

Our health is not something that can be passed on to a cadre of health priests who, for a fee, will keep us healthy no matter what we think or how we live.


Excerpt from "Pharmacy and Medical Interventions"

Health At Any Cost?

Suppose research showed that a completely government-controlled comprehensive health plan improved a population's physical health significantly over a 10 year period. A government-mandated vigorous exercise plan for youth, government policies on agriculture to limit the supply of excessive amounts of red meats, government-subsidized vacation, etc., could probably do this. Who would doubt that the population's health would improve? Such government action has already occurred – in Nazi Germany. A population willing to be enslaved can, at least for a time, be healthier under some regimes. Though we do not have formal research into the effects on German health, an eyewitness has testified to the contrast he noted between vigorous German youth and scrawny British youth at the outbreak of World War II.* What would have been his assessment at the end of the war? The youth of Germany were decimated by Nazism. Similarly, abortion is sometimes justified because it leads to a healthier population. Neither health nor longevity should be set up as the ultimate values, but rather God's revealed will. Freedom comes at a cost; part of that cost is recognizing that some people will abuse their health or ignore their illness to their own detriment.

* Shirer, William, The Nightmare Years, Little, Brown & Co., Boston 1984.


Excerpt from "Ethical Issues in Medical Insurance"

More Insurance is Not the Answer

Medical insurance is not an answer to the problem of medical costs. It is one of the principal reasons for the high costs. We need not more insurance, covering more people for more things; we need far less insurance, covering far fewer things, and for fewer people. Biblically consistent provisions in insurance were stated well centuries ago. See how they conform to a Biblical understanding of fallen human nature.

Basic medical care is an uninsurable risk. To be an insurable risk a risk must be:

1) Unable to be faked. Can you fake a bellyache? The very word "hypochondriac" derives from the fake bellyache. Fallen humans bear false witness sometimes.

2) Substantially outside of the control of the insured. Is my heart attack unrelated to decisions that I make? They insure a farmer's crops against hail, but not against weeds. The former cannot control. The latter he can. With basic medical insurance, we encourage people to allow health weeds to grow up in their lives, then use the insurance to remove them. Fallen human beings can be poor stewards of things God has put under our control. Therefore, we need systems that encourage good stewardship, not ones that reward poor stewardship.

3) Significant in size, not economically trivial. Does anyone sell dry cleaning insurance? Big surgical bills might be insurable, but not visits for ankle sprains or sore throats. Again, the principle here is stewardship. A surgeon's bill for $3000 for brain surgery may incur $50 in costs to handle the billing. That is about 1.5%. The physician's bill for an office visit for otitis media may be $45. The billing costs will be about the same, making the billing cost 110% of the cost of the service. That is the system we have in place now in some insurance plans.

4) Objective, not covert. How objective is a backache? Human beings cannot see into the spirit of another and therefore cannot make and enforce contracts which pretend that we can do so.

5) Unlikely to occur to many in the insured group. What proportion of the population does not become ill? The Bible assures us that trouble comes to us as surely as sparks fly upward, and that it is appointed unto man once to die. Insurance makes sense for unlikely losses with a high cost, such as your house burning down. For nearly certain expenses, it amounts only to a redistribution over time of the expenses you are likely to occur, overseen by third parties at a charge by them of about 20%.

Basic medical care fails to satisfy any of these fundamental requirements. Therefore, all public or private schemes to create an insurance payment system will fail. It is as certain as gravity, which cannot be repealed by law. Neither government nor the insurance industry has the power to overturn human nature. They have to accede to it just the way everyone accedes to gravity or breaks something.

The present craziness in medical and pharmacy payments defies basic fallen human nature. When I can live a hellion's life and send the bills for my misdeeds to other people – insurance companies, employers, the government, or my mother – my fallen nature pulls me, urges me, implores me to do just that. We have a health care economic structure that is substantially structured like that.

For commonplace medical and pharmaceutical bills, patients need to pay themselves.


Excerpts from "Pharmacy and Medical Interventions"