I probably shouldn’t write this up, but it seems to me to be part of our problem as a people and as the church. Because it is so “on the money” I feel compelled to think it through.
It seems that Hospitals or insurance companies or both have created a new category. The category that I heard was called observation. It is not the emergency room, or more appropriately it comes after the emergency room, but it is not true admittance either. Talking it out with the bible class they eventually accepted my description as a place for chronic (i.e. long term incurable) illness when it is bad enough that home doesn’t seem possible, but there is no immediate treatment beyond nursing care.
Now that might actually make sense as a short term nursing home. The problem comes in with money. Medicare evidently won’t pay for “observation”. If the person was admitted, then it pays. So, the bills for observation are sent to the individual, and insurance companies will often over-ride decisions about admittance relabeling them as observation. The conversation went something like this.
“So there really is no treatment for the person beyond nursing care, right?”
“So this could be taken as the insurance company’s (meaning believe medicare or medigap coverage) saying there is no treatment applicable. The place for this person is either home, home with family or a nursing home, not the hospital.”
“Yep, but the family can’t do that.”
“Ok, another way to put it might be that this is the insurance company’s ham-handed way of say you need to have end of life discussions. There is no treatment. It is not getting magically better. If you are rich enough to pay, you can delay that talk. If not, the family needs to discuss what is happening.”
“Yes, but what if there is no family?”
And I just let the conversation stop because nothing good would come from pushing it, or what I am writing here is part of working out where that conversation goes next.
There are some stated or implied expectations here. First, that the person with a chronic advanced stage illness deserves advanced care. Second, that families are incapable or should not be expected to bear the burden of care in home. Third, that someone not the family should pay. Fourth, that this would be universally available regardless of if there is anyone that feels a family compulsion. And I would include one assumption here that by advanced care the expectation is physical/material and not spiritual.
My thesis here is that list of expectations and assumptions displays a great deal of Christian compassion, but it has thrown out the most important bit. Throughout that situation there is pain. There is the pain of a person dying and suffering. There is the pain of carrying and caring for that person. There is the pain of broken relationships and fractured families. There is the pain of helplessness. And it is Christian love to alleviate pain. Treat others as you would wish to be treated. But the deeper Christian teaching is that what people need most is not physical/material but spiritual. Hospitals themselves are a Christian invention, a carrying out of a moral lesson of the Good Samaritan. (Hence all the Hospitals names Good Samaritan or St. Luke’s.) But long before we had the material ability to really do anything we had hospitals. Why? To alleviate and help carry the material pain, so that the patient and the loved ones could focus on the spiritual needs. What is the one thing excluded from hospitals today with a mixture of disdain (the white-coat emphasis on technology and surgery vs. Spiritual) and law (Hippa laws)? Ask yourself what would your reaction be if the prescription at the hospital was for a heavy dose of morphine, a visiting nurse service and a chaplain?
Our assumptions are all material. We fear pain and suffering so we seek to banish it or hide it. But these apparent calamities and illnesses are given to direct us to the great truth. “I tell you my friends, do not fear those who kill the body, and after that have nothing more that they can do. But I will warn you whom to fear: fear him who after he has killed, has authority to cast into hell. Yes, I tell you fear him! Are not five sparrows sold for two pennies? And not one of them is forgotten before God. Why even the hairs of your head are all numbered. Fear not; you are of more value than many sparrows. (Luke 12:4-6).” St. Paul states his purpose in this life, “that I may know Christ and the power of his resurrection, and may share in his sufferings, becoming like him in his death, that by any means possible I may attain the resurrection of the dead (Philippians 3:10-11).” The Christian’s suffering is a sharing the sufferings of Christ. If our assumptions were Christian, if they included the spiritual realm, instead of fearing death we would take it as our last great chance to witness to the hope that we have in us.
Now that is one part of the problem – Christians who are not acting like Christians. The lamp of Christian witness in the face of suffering has been place under the bed (Luke 8:16). The second part, the cultural part, is the problem with the law. We as a people are attempting to carry out Gospel ends – caring for everyone – though the means of the law. The deep problem here is twofold. First the law is not a means to actually accomplish anything. Make a law and it is never really done. The law was given to show us just how far short and how limited we are as creatures. If you take it upon yourself to honor your father and mother by ensuring their material comfort and well-being in the face of chronic illness and death, you will soon find out how onerous that burden is. And so we seek to pull in others to help us, also by law. Tax the young to pay. Move mom to the nursing home as soon as Medicaid is available. And that is what the law demands. But what the law does is show us how inadequate we are. With all the powers of the US government we are not able to carry this burden. The second problem with the law is that we are natural law-breakers. For every person who is attempting to take care of dad through the law there are many more who have ditched the responsibility. The second we make a law is the second that we find out all the ways it can be abused and evaded and made to favor us. The only place you have to look is medicare fraud to find that proof. But that is far from complete. The question of “what about those who don’t have family?” highlights the trouble. Everybody has family. We were not created ex nihilo. But the lives that we have lived might have alienated our family. Our family might be running from responsibility. We might have aborted our family. We might have raised them with our material longings only. It is not a lack of family, it is the result of sin. The way to address that is through repentance and acknowledgement of our state. Addressing the problem of sin with more law doesn’t work. The law was given to multiply the sin (Rom 5:20), not to alleviate it.
Observation, as far as I can tell, is a gross tool of the law. Either cough up the money to fulfill the burden, or dodge it. But neither of those paths leads to a good outcome. What they should do is point us toward what is truly necessary – the gospel. There is someone much greater who observes us and has felt all that we are going through, Jesus Christ. We are all in observation and someone else has already paid the price with his blood. When every earthly prop gives way, He then is all my hope and stay.
The more we deny this and run from it, the worse our rebellion and problem will get. Repent, and believe the good news. The Lord is merciful and may yet stay his righteous judgment.