Healthcare; Doubts about the Narrative
Udo W. Middelmann
The Francis A. Schaeffer Foundation
Chalet Mon Abri
CH - 1882 Gryon, Switzerland
Dear friends of Footnotes:
Whenever I have occasion to speak about the work of the Francis A. Schaeffer Foundation and mention the name of our publication, I add that “the title is all it claims to be -- footnotes” to events, ideas, conversations and articles or books we have come across. They strike me worthy of a conversation, not more than a footnote, but still one that hopefully makes us look and think again about a subject. I hear back from a number of people about how helpful one or the other issue has been. One person wrote how Footnotes frequently jolts her previously ingrained views and assumptions. It makes her review and then clarifies what she thinks. She noted how easy it is to repeat ideas rather than decide what to believe and do after deeper consideration.
More recently we have had a number of grateful responses to our ideas about taking care of the elderly, of the need to keep body and mind aliveand to not assume that a decline has to be accepted without resistance.
Just as children deserve our help for their developing minds, older people deserve to have their minds engaged and kept responsive.
Both stages of age depend on what we in the “Sandwich (or Squeezed) Generation” between them are willing, able and in a certain sense obligated to do out of “loving our neighbor as ourselves.”
I hope my reflections will once again be Footnotes to your own active intellectual life, as I refer you to other sources, concepts and ideas that have bearing on the subject. We need to keep each other actively on our toes!
As a work the Schaeffer Foundation depends on your help, encouragement and prayer. Our involvement with a great variety of people, old and young, through meals, lectures, conversations and sermons can only continue through hard times with your backing through gifts “from readers like you.” Thank you.
May you celebrate a Merry Christmas and continue to rejoice that God came to His own.
PER STAFFAN JOHANSSON
MARCH 13, 1949—DECEMBER 3, 2009
We grieve deeply over the death of our friend and Member of our Board Per Staffan Johansson. He is now absent from his body and rich and fruitful life, waiting for the resurrection. We express, as Jesus did at the tomb of Lazarus, our genuine anger that death takes away what God had meant to be here forever.
We are thankful for the many years of life and work together and remember even the last painful days we had together with him in June and August, when his struggle became so desperate. Staffan was our closest friend and ally in our ongoing passion for life. The days and years ahead will be bleak without his intelligence, insight and wit to appeal to.
I want to give you a footnote about the healthcare discussion on everyone’s mind.
Having benefited from health insurance since birth and having experience on both sides of the Atlantic, I am surprised at the vehemence with which the political discussion unrolls, the narrow positions taken at often extreme ends of the political spectrum and the failure to actually show a practical concern for your own and your neighbor’s health. It has taken on the format of an old-fashioned prize fight in which the referee and the managers forget that their man is bloodied.
On the factual side, the US runs way behind other developed countries in the care it provides, from pre-natal to end-of-life medical attention. It has the best knowledge and facilities, but they remain inaccessible for too many people. Infant mortality rates are abysmal for a wealthy country, as is the possibility that coverage can be terminated when it becomes too expensive and a cap is passed. With more than 35 million people not covered at all, unnecessarily crowding
emergency rooms for reasons as simple as a common flu, the situation is unacceptable in our times.
My “footnote” to the issue consists of several reflections that come to mind as I listen to the debate. They address what might be obvious misperceptions about the nature of insurance. With insurance in the classical mold the risks and contributions are shared in the community, to reduce both risk and cost. The
body of the insured pools their resources, so that no one has to pay alone for his possible, but hopefully only limited, damage. Everyone risks having to pay for no return and receives the assurance that no future cost will sink your ship or put you on the street. Insurance is not a contract between you and the company, but between you and your neighbor, organized by a company of your choice. Such insurance is mandatory when driving a motor vehicle. In some communities insurance is also required against your house and that of the neighbors’ burning down. Insurance can be voluntary or imposed, but it must be for all in a community without exception. That will lower the cost and raise benefits, but also affirm the reality of the human community.
Only short-term thinking and selfishness can create the present situation in health insurance. People take the risk of no coverage because they believe in their own lasting health. They do not want to contribute into a fund that their neighbor, whose lifestyle they want to critique, can draw on in case of need. That form of moralizing is not allowed for drivers, as even the most careful driver cannot foresee his or the other person’s driving behavior. It behooves a doctor or a judge to work against destructive lifestyle choices in these cases with counsel and the application of laws.
Contracting insurance only at an advanced age to cover more likely illness defeats the arrangement. It makes insurance into an expensive private contract, not a health care effort for the community. It is no longer a sharing of risks, but an individually risked investment in an insurance company against possible future needs. It is a personal gamble with the company, not a risk-and-benefit community with the person next door. That turns insurance providers into a profit-focused instead of a mutual company.
Instead of providing coverage to the whole community no matter what, the current arrangement does not see this as their purpose and interest. Health insurance is only a chosen means to the end of making a profit, just like shoe companies make shoes for profit. Under that arrangement, thousands of insurance contracts are terminated when the company no longer makes a profit from them individually. The benefit should be insurance, not profit. That is not the case when companies must stay in the black and reward investors. Real insurance companies accumulate a reserve for worse days, but the goal is to provide what people pay for and not to serve investors. There is no reason why either voluntarily (which is unlikely) or by government requirements a multitude of competing private, not government-run, mutual health insurance companies could not offer basic health service on the free market for which all clients pay and which everyone receives. Competition among them makes companies more efficient and lean. They are in it to render a service. They pay their employees a regular and commensurate salary, not one tied to profitability. Their annual rate increases can be set within a range across the board for all without removing the competition. They would be required to offer basic health care for anyone with and without prior conditions, but could choose to accept or reject people for anything above the basic need for medical care: no plastic surgery, no private room --whatever. But the basic need for medical care would be recognized and paid for out of pooled contributions to individually and personally chosen mutual insurance companies. The cost overall would come down, because the healthy would also pay for insurance they may never have to call on. The government would only be present to restrain evil, not provide the goods. The interest and purpose of insurers would again be to insure. They would not make profits by offering insurance only to the people they can benefit from.
As it is, the whole system seems to stand on its head. It does not comply in any way with the idea that we should love our neighbor as ourselves. It illustrates the opposite: I will gamble with the company, making payments that I hope I principally will benefit from in times of need. Anything else is considered a regrettable and wasted investment. Yet that is precisely what prevents us from loving our less healthy neighbor. The voluntarily uninsured does not love his sickly neighbor, nor does the insurance company!
I am not advocating socialism. But we do live in social realities.
The Bible commands us to care for widows and orphans, and in a fallen and fundamentally unfair world love requires a first step of support for the needy, the poor, and the sick in their situation through instruction, compassion and material help. Nor do the national health systems in some countries always model a well-functioning care system. One can tell horror stories from both here and there. I do think, though, that our current way of dealing with the needs of people is third-rate. It shows up in the statistics. What many all too quickly call the best healthcare system in the world has become inaccessible except for those who can get to it in time.
There are many reasons to reject the public option. As I said above,
government is good at preventing “evil”, but it is not meant to do “good”. On the other side, people are selfish and often take risks only for their own immediate, personal benefit. They take delight in being
able to teach their neighbor through immediate punishment of alternate behavior. “I told you so” should be said down the road, but when it becomes “I don’t care,” we have stepped outside of what one should do in a community of neighbors. Insurance should be required for all without limits to prior conditions or age. It must be transferable not only between states, but also once a year between companies to keep the heat on them to deliver good and speedy services. Mandatory adherence of everyone to freely chosen, competing private mutual insurance companies, unable to refuse basic coverage to anyone from pre-natal care to death, is what we in fact already have in one of the more capitalistic countries in the world: Switzerland.
Footnotes claims to be a thoughtful encouragement or at times a provocation to the readers; I claim no last word of wisdom or great depth of insight. In that sense I only let you and others know what I observe and think. I try to do that from the perspective of what is actually there in the real world and how I integrate “whatever” with the rest of what I believe. The foundation of my belief is that there is an accessible and sensible truth to the universe that can be known. That truth resides within the lines of both fact and revelation, of reason and logical continuity. It has evidences that can be tested. It is a good playing field, wide enough to run and yet not so open that we get lost. It has lights to keep us from stumbling in the dark. Recently, I read a good review of a book on
memoirs and their often very interesting, though hardly ever fully truthful, accounts of a person’s life. In an earlier issue of Footnotes I had suggested that a memoir lets us look through a window into the life and memories of only the author. Any memoir, by definition, cuts back the actual truth by two considerations: firstly, memories are always bits and slices of reality filtered through the selecting mind of the writer. He or she decides what to tell and what to leave out. Secondly, what a person remembers is itself already filtered by the way knowledge is stored in the brain and then recalled. The former limitation is deliberate, the author’s right. The second is incidental, as events make variable impressions on us. Some we wish to suppress, others we do not recognize their importance, and still others are misunderstood to begin with.
There is then a fragile relationship between what we know and what actually happened. A more careful person hesitates before claiming that a memory is true to fact. This distinguishes a biography from a memoir.
A biography requires at least some research by an outsider into a variety of sources. A memoir does not. That carefulness about the truth has been part of our Western Jewish and Christian tradition in the past. It arose out of the need to know facts, not stories, to be aware of real history instead of myths. It ties us to the text of the Bible, written accounts of people and events which preceded and now surround us. Without the text, or the law carved in stone we would be left with a “lite” Christianity of stories. The Biblical insistence on two witnesses for what is truth, and the 9th Commandment, which forbids bearing false witness, show the importance of factual accuracy. Jesus puts it into a brief, solid reminder that your “yes” should always be “yes”!
This insistence on truth, facts and history, on reality rather than pretence, on accounts rather than stories, is a marked distinction between religion and the Bible, between what is and what merely seems to be, between revelation and shrouds of mysterious meaning. I have increasingly wondered whether these distinctions have not been weakened and even lost when we apply the term “narrative” to Christianity. “Narrative” is now widely in use as a term for a story. It came to greater prominence when post-modern writers correctly suggested that individuals, starting from themselves alone, have only a finite, specific and narrow view of a slice of reality. They rightly opposed the assumption that a person had an objective insight into anything. We are creatures, not Creator. Our view is always partial and finite, waiting to expand. Indeed, everyone sees the real world from a limited angle. No one can see two sides of a coin at once. We often see things according to what we expect to see or according to our individual priorities, tastes, professional interests and emotional states. In that sense we tell our story, the content of what we see at the intersection of time, events and our personality in the moments we are looking. A personal story does not stand alone by itself. The Bible requires not less than two reliable and corroborating witnesses to make an accusation. Luke consulted with eyewitnesses and checked other written sources. Our confidence rests on the interlocking bits of information, both external in history and internal in our mind and experiences.
My concern stems from the observation that some Christians call what they believe a “narrative”. I am troubled, because the term “narrative” refers to something more personal than what the Bible presents in its propositions, and less trustworthy than what we need in order to explain life, history and the real world. “Narrative” is a term widely applied to many areas. It puts the central focus on the teller of that narrative. It is subjective, relating a personal outlook to integrate events and ideas into a story that refers to what “I” did, do or experience. Consequently there are as many personal “narratives” as people. Each person lives and tells his or her story. Whether I experience people on a common field or only in my own game, “narrative” ties all I see together into “my story.” Not only does it leave out most of what happens elsewhere, but it also takes away the obligation to see where any number of individual threads, or stories, become a solid rope to support one’s need to know. Only when the many threads are woven together and each one gets bent to fit in with the others can the rope have the strength of truth.
A personal “narrative”, chosen from what I have been told or have gradually constructed to please myself, is singular and does not necessarily relate to a world wider than my own perspective. It gives a
lot of information about me, but may withhold much about the world as we should see it. It is therapeutic to my ego, but not helpful to the human family in our struggle to understand life and its meaning. It is a form of self-affirmation, but we all know how easily we can over-or underestimate our place in history. History is older and wider and encompasses more than what one person has in mind. Someone’s narrative declares what he or she wants to tell, where they are in their own story. It does not tell anyone else what we all should find out. It speaks of his or her vision, not their view. It takes you inside the person, not into the real world in front of us. It gives freedom from exposure to critical questions to each and every one of us. Curiosity and admiration are acceptable, but are not challenging requests for evidence or facts. The proof of the pudding is no longer in the eating, but in the pleasure it gives to the eye. Yet, if there is a real world prior to my ability to notice it (as there is for any child aware of its parents!), there must be a narrative about the real world already “happening”, in which fact and interpretation come together into a convincing argument...for truth.
My wonderful, delightful, extraordinarily intense “whatever” story boosts my experience of my existence! But not necessarily anything else! For by the time reality is concentrated into my experienced perception of it, contact with anything outside of myself is weakened and eventually fades into insignificance. Such a person wants to live in the world of his own making according to the narrative he chooses. This is not just theoretical or philosophical.
For through this notion of “personal narrative” slip at least two perspectives with dangerous results. First, a personal narrative allows a person to believe anything, no matter what. Any worldview can emerge out
of such personal views. It nurtures existential anthropology, since theology depends on God speaking to, not through one. When the right to an opinion is then extended to the right of living it in reality, problems arise. Belief is internal, but it will always have external, visible manifestations. The second result of “narrative” thinking is the freedom it creates for people to hide behind their own way of seeing things without having to expose their views to broader critique in the marketplace of ideas. Neither another person nor the real world gets to argue with a person’s private narrative. It is a wonderful way to escape into subjectivism. In a very thoughtful opinion piece by David Brooks (NY Times November 9, 2009), we read of such a “narrative”, one personal to Maj. Nidal Malik Hassan, but with horrendous public consequences at Fort Hood in Texas. It demonstrates the problems that arise when concerns about truth are satisfied by a personal narrative, regardless of its validity in fact. You can read the editorial of the NY Times at:
Turning a proposition about reality into a personal narrative disconnects it from general or universal criteria. When no one’s view of things is exposed to the demands of reality, we are free to believe before we know enough to evaluate. We never get to that point, if faith in one’s narrative is the point. We
“rent a sort of storage space” for our personal views, claim title to it and give it a name. The valid and necessary acknowledgement of finiteness and subjectivity no longer obligates us toward further inquiry. Instead we lock up and relish the safety of our stored views. This is a relatively new direction. Since all we have is finite understanding, every bit of insight was previously seen to be part of a larger whole we need to pursue. Everything should be exposed to a multitude of people with diverse interests and sensitivities in order to formulate a view of the real world. Sadly, we often present a personal view too soon, not paying attention to our limitations. When that still occurs in the thinking of many religious and secular totalitarian viewpoints, a concern for truth is replaced by ideology, a mere image or an idea of truth. The Protestant Reformation paved the way to increasingly free us from a variety of such ideological dictatorships over our minds. It gave rise to intellectual, scientific and social inquiry beyond what we already knew.
But when we replace the “common cause” with a personal “narrative”, we revert to a totalitarian mindset. It becomes “totalitarian” (i.e. without the need for review) to each person in their personal political or religious faith. The willing acceptance of and frequent fascination with people’s “narrative” has several sources. In an open society we are surrounded by a multitude of people, backgrounds, religious convictions, sexual definitions and ways of facing, or not facing, the tasks at hand. At close quarters this requires a measure of acceptance, tolerance and even neglect. “Narrative” in that setting has the quality of folklore. It grants stability in self-confidence, not in an educated conscience. Self-confidence means holding to what I believe (fideo) about myself, while conscience means that I want to gather knowledge, facts and truth (scientia) together. An open society admits doubts after experiencing many historical situations when authoritative statements could not always stand up under scrutiny as true, just or wise. Educated people with access to multiple resources are not easily persuaded by the loudest voice alone. But parallel to the decline of a common view, new associations around particular views, preferences and narratives are formed. The family may be in decline, but substitute associations readily take its place and create their own personal narrative base. Furthermore, we treasure our freedom to stake out our own intellectual, spiritual and aesthetic territory. We do not want to be told what to see, believe or do in any area of life. The catalogue of rights, granted and assumed, has expanded. We even ask who has the right to give us rights or to limit the ones we give ourselves. The right to privacy is a bottomless pool with many fish to catch. Parallel to all this, for over 120 years artists have studied perception of colors. They showed us how and what we see. Neuroscientists tell us how we see things that we expect to find. Travel reveals that people in different parts of the world see the same thing differently. Literary critics tell us that language is a grid through which we see, invent and control powerful domains. In fact, we learn, reality is a mere construct of words.
Post-modernism warms up and enlarges upon Immanuel Kant’s philosophical statement that reality is only what you see, that the real thing (Das Ding–an–sich) always escapes our minds, which are limited by the categories of time and space and causation.
We are finite. As subjects we do see things subjectively. Our expectations color our perceptions. We are not neutral. We always interpret information, which is mediated to us by means of experiments we selected and built. But is there not at the end of the road still something more definite than a personal vision, an interpretation, a “narrative”? If we are in fact reducing knowledge to personal fairy tales, we remove them from the context of reality. Yet there is more. Reality bears down on us in daily experiences of imposed shapes, substances and dependencies. Within these we must recover an earlier distinction between “narrative” and truth. The right to religious liberty did not contain the right of religious practice. The former is in the mind and heart, where it must have free reign and need not be practical. The public is less tolerant. Where the rubber hits the road a person’s belief or narrative is tried with the fire of reality. A personal narrative may remain personal. The real world demands more than a tale, an image or wishful thinking for us to survive with integrity.
When religion is considered a “personal narrative”, it does not have to obey the facts on the ground nor the reality of flesh-and-blood neighbors. In religion one believes what one wishes and becomes obedient to the views inside one’s head as mental constructs. That can be called a “narrative”, a tale of another world with promises for another time, a personal view of things. But whatever relates to things as they are outside one’s head, as they happen and how they are found does not come together as a story, a tale or a “narrative”. They become part of a report when they are transported to our minds in the form of rational language or concepts, anchored in external historic facts, to receive an explanation. Men and women in their equal humanness become part of a “narrative” only after they are first part of reality, of everything relating to the facts on the ground, to biology and psychology. Anyone who lives only within their personal “narrative” cannot make general assertions. “Jesus rose bodily from the dead” is either history or nothing. If one sees that as a story or part of one’s “narrative” (“The way I see what gives me hope”) it may be interesting, cute or odd, but it is not true.
The Bible is not a narrative; Christian faith is not a person’s narrative, a personal way of lining up imagined ducks. It is either a report of events or it consists of symbols of wishful thinking. The references to Creation and Fall, to the Flood and the Exodus, to the giving of the Law on Sinai and the Captivity in Babylon, to good and terrible kings, true and false prophets and recognizable human beings in their greatness and corruption do not constitute a “narrative”. They constitute history, not my story or anyone else’s. For that reason I regret that Christians increasingly also see their faith as a personal “narrative”. What could be told about the real world before has instead become a private witness. Theological proclamations have been reduced to personal testimonies. Bible texts are no longer studied with sufficient attention to the language, context or relationship to other passages. They are more often quarried for personal meanings. Paul did not address the Athenians, or any of the people he is recorded to have spoken to, with his privately preferred personal narrative. Instead he related the history of God’s work with people across the Near East. Events, the Scriptures and logical arguments were the stuff that relieved and constrained him to love, speak and exhort. A personal “narrative” explains preferences for Lutheran, Presbyterian or Baptist, agnostic or Muslim, Buddhist or secular particulars, to mention a few, but does not touch on the central affirmations of the Bible, the character of God, the nature of the human being or the way of salvation.
The central affirmations that support the Bible, such as the rational study of Creation, the flow of history, etc, are not a narrative. Such items are specific facts that contribute to our understanding of reality around the world. We respond to them with faith; they are not initiated by our faith. We believe in facts and conclude after sufficient review that we have not been deceived by a narrative we individually like and prefer. Neither is anyone else deceived. The Biblical affirmations relate to a common human experience, not a separate cultural one of the real world. The Biblical account takes each person into a unifying view of Mankind, reality, history and rationality. “Narratives” have a personal focus, while the Bible has a focus on all human beings.
When we change our view of truth, and our need to find it, into a “narrative”, we make it virtually impossible to talk about the same thing. It gives generous space to personal views, but eventually makes common rationality, law and life together that much more complicated, if not impossible.
“Narrative” becomes a screen behind which a person can hide from exposure to questions of common experience. A good and proper way to respond to this private view of reality is to require a demonstration of how it explains the real world. The facts of human existence have not changed. What has changed is the obligation to seek truth and to challenge each other in that important task. We are responsible for seeking truth rather than for being happily satisfied with our private storyline.
Gloria in excelsis Deum!
Udo and Deborah Middelmann
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