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Merit-Based Health Care: The Shame of American Christianity

Health care has recently emerged to be one more system based on the myth of merit, joining education and business as American shibboleths of individuality. The myth of merit, in turn, creates self-perpetuating systems of disadvantage for those stuck at the bottom.
 

This point forcefully hit me while watching the Tennessee Titans football game recently. Another intelligent commercial by a local Nashville medical care provider, St. Thomas Health Services, caught my attention.

 

Titans coach Jeff Fisher extolled St. Thomas’ reputation for excellent care and service. The most interesting, as well as disturbing, quote from the football expert was: “Life. You get back what you put into it.” This same quote headlines St. Thomas’ Web site.

 

I think it is telling that an institution that deals with the absurdity of disease should make such a comment. How many doctors and nurses have treated patients who took care of their bodies and played by healthy-diet and exercise rules yet suffered from genetic illnesses or traumas?

 

Yes, individuals can remove percentages of risk by maintaining healthy bodies and minds, but doctors can never tell a patient, “Health. You get back what you put into it.” Illness does not reward and punish in that way. Just ask Phil Mickelson or millions of other athletes and citizens.

 

Yet this is the attitude many in the medical establishment curiously have adopted. They’re simply following the ethos of American business. We can’t condemn a company for putting profits first, we exclaim.

 

In a competitive marketplace of insurers and health providers, the company that can distance itself from the image of suffering, poverty, weakness and failure wins the most business. The company that most successfully identifies with the myth of merit survives.

 

The crazy thing is many American Christians who bought into this myth generations ago in matters of business and education now use it in the health-care debate. This is why health care is the real sacred cow of our society.

 

We believe we’re all in a race to the top of bodily health because that means we are financially successful. The uninsured have made their own beds in terms of health care and have squandered the American dream, we tell ourselves.

 

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Our imaginations have been hijacked by the novelist Horatio Alger’s rags-to-riches stories to the point that we believe that those who cannot afford any, or even minimal, health insurance are irresponsible failures. We believe they haven’t gotten much back from health because they haven’t put much into it.

 

American Christians are under the impression that health insurance is a moral indicator for faithfulness and righteousness. We are so convinced of these values that we are willing to distort data and policy proposals in order to demonize public health-care proposals.

 

Being without health care is a matter of shame for many American Christians who were taught that “cleanliness is next to godliness” and “the early bird gets the worm.”

 

Should we not instead pray: God have mercy on a Christian people who identify more with the chief priests and Levites of Luke 10, who walked on by the man beaten by robbers, than with the Samaritan, who helped him in his unwanted and unsolicited tragedy? Should we not plead: God have mercy on a Christian people whose first question when it comes to the poor and uninsured is, “Who sinned so that they are poor or uninsured?”

 

We’re so convinced that physical health is a moral indicator that we’re willing to ignore the fact that most of the rhetoric against public health care has been crafted by the health insurance industry. Even our politicians – Christian ones – are willing to fight for the merit myth.

 

What I find so disheartening is that statements from health-care providers like St. Thomas Health Services reinforce this attitude, despite an overwhelming percentage of doctors who understand the true relationship between health and human flourishing.

 

Finally, the most troubling thing about the strength of the merit myth in our health-care attitudes is the kind of society it creates. In education, the merit myth has created pockets of cyclical educational poverty despite affirmative action programs, like Miguel de la Torre has explained in his “Doing Christian Ethics from the Margins.” In business, the merit myth ensures that minorities and the poor are severely underrepresented in ownership and leadership positions, like the Anderson family’s Empowerment Experiment in Chicago has shown.

 

In health care, the merit myth contributes to a racist and classist society. I don’t think Barbara Ehrenreich is too far off when she writes in The New York Times, “An article on the Fox News Web site has put forth the theory that health reform is a stealth version of reparations for slavery: whites will foot the bill and, by some undisclosed mechanism, blacks will get all the care.” As in all cases, the merit myth in America favors whites.

 

Many American Christians who see the health-care issue in this way have little difficulty in tolerating the extreme disadvantages caused by lack of health care, generational poverty, subsistence wages, blighted neighborhoods poisoned by crime and pollution and a system of advancement based on privilege and access.

 

My question is “Why?” I believe it goes back to the way “having the poor with you always” makes American Christians feel about our own righteousness. It’s the same feeling the prosperity gospel gives us when we hear it: God’s will for our lives is more money, more things and more choices.

 

This means that those who “have not” are defective in our minds, even though Jesus told us over and over again that this kind of thinking is not God’s way.

 

Andy Watts is assistant professor of Christian ethics at Belmont University in Nashville, Tenn.