Samaritan Care

A study guide for churches on health care policy in America

 
** Here I offer a church “adult study” that can be completed in one after-worship program, or expanded to multiple sessions. It focuses on one of the most important issues facing voters in the upcoming midterm elections. Use as you wish! And please give me feedback on how you use it and how it is received. Jim Burklo

Before the first session:  ask parishioners to email the pastor or adult education leader with short stories answering this question:  “Tell about an experience you have had in the past ten years with the American health insurance system that has had an impact on your life and/or the lives of your family members or close friends.  In particular, if applicable, share your experience before and after the passage of the Affordable Care Act (Obamacare) and also any experiences you have had since the changes made to it under the Trump administration.”  Ask if they are willing to share these stories in the adult study, and also with candidates who are running for election.  Then send this Introduction as homework to prepare for the session:
 
Introduction:
 
The Good Samaritan invented comprehensive pre-paid health coverage:
 
Just then a lawyer stood up to test Jesus. “Teacher,” he said, “what must I do to inherit eternal life?” He said to him, “What is written in the law? What do you read there?” He answered, “You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind; and your neighbor as yourself.” 28 And he said to him, “You have given the right answer; do this, and you will live.”But wanting to justify himself, he asked Jesus, “And who is my neighbor?” Jesus replied, “A man was going down from Jerusalem to Jericho, and fell into the hands of robbers, who stripped him, beat him, and went away, leaving him half dead. Now by chance a priest was going down that road; and when he saw him, he passed by on the other side. So likewise a Levite, when he came to the place and saw him, passed by on the other side.  But a Samaritan while traveling came near him; and when he saw him, he was moved with pity.  He went to him and bandaged his wounds, having poured oil and wine on them. Then he put him on his own animal, brought him to an inn, and took care of him. The next day he took out two denarii, gave them to the innkeeper, and said, ‘Take care of him; and when I come back, I will repay you whatever more you spend.’  Which of these three, do you think, was a neighbor to the man who fell into the hands of the robbers?” He said, “The one who showed him mercy.” Jesus said to him, “Go and do likewise.  Luke 10:25-37 New Revised Standard Version (NRSV)
 
When the Good Samaritan gave two denarii to the innkeeper, and offered more to cover further expenses, he willingly taxed himself to provide health insurance coverage for a complete stranger from an un-priviliged minority group.  We could call it “Samaritan Care”!  What might this parable suggest about WWJD – “What Would Jesus Do?” – when it comes to meeting the health care needs of Americans today?
 
There is no one, simple answer to this question.  But there is a clear moral imperative embedded in Jesus’ parable, pressing us to find an answer.
 
The gospel of Jesus calls us to compassion.  And that call extends beyond the first aid that the Good Samaritan offered on the spot.  “Love your neighbor” means more than handing out band-aids, or holding an after-worship bake sale to raise money to help a family burdened with enormous medical bills, or just saying “I’m sorry”.  It means more than one-time acts of charity, more than “drive-by philanthropy”.  The Christ – divine Love manifested in human form – calls us not only to be nice, but to be effective in our compassion.  It calls us to go the distance and finish the task, as the Good Samaritan did.
 
Among the industrialized nations of the world, the United States has been a health-care outlier for a long time.  Our closest allies, Britain and Canada, provide high-quality, guaranteed, government-funded health care to all their citizens at a cost between a half or two-thirds of what the US spends per person.  And the health outcomes of their systems are on a par with America’s.  Israel, which receives over $3 billion of aid from the U.S. annually, has a health care system that, by law, guarantees coverage to all its citizens.  Israelis are among the healthiest people on earth. The United States, to this day, offers no such guarantee to its people.  Our health care system remains a patchwork, with millions lacking any form of insurance.
 
In 2010, the United States Congress passed the Affordable Care Act, which dramatically changed our health care system.  Before the ACA – nicknamed as Obamacare – people could lose their insurance if they incurred medical bills beyond certain levels.  They could be denied coverage if they had “pre-existing conditions”.  There was no way to compare private health insurance plans, because each consisted of many pages of fine print with differing levels and extents of coverage.  Tens of millions of people had no insurance at all.  Many millions more had plans that were inadequate.  Hundreds of thousands of people each year declared bankruptcy because they could not pay their medical bills, due to insufficient or unavailable insurance – a situation unimaginable in most other developed nations.
 
Obamacare addressed these problems.  It required private health insurance companies to meet minimum standards for all policies.  It created a health insurance marketplace where different levels of coverage and costs could be easily compared.  It provided government subsidies for moderate income people to access private insurance, and it greatly expanded government Medicaid coverage for very low income people who had not had access to it before.  It required private insurance companies to cover all applicants regardless of their health status, and in exchange, to protect the solvency of the insurance companies, it required all citizens to secure health insurance – a “mandate” enforced with fines for non-compliance.  It created regulations and incentives intended to drive down the escalating costs of health care.  It imposed new taxes to cover costs for these changes.
 
The ACA – Obamacare – succeeded in greatly increasing the number of people with health insurance, by about 20 million citizens.  It gave many millions more Americans a much higher level of health care security and higher-quality insurance.  But it did not stop the trend toward higher health care costs and higher insurance premiums – a trend that long predated the ACA.  Many people saw their premiums get cheaper, due to subsidies or to access to Medicaid.  Many others continued to experience the “pre-existing condition” of annual insurance premium increases. This article from the New York Times gives a “scorecard” on the effectiveness of the Affordable Care Act prior to the election of President Trump.
 
Obamacare has been a political hot potato from the start.  Conservatives objected, on ideological grounds, to its “mandate” that everyone buy insurance.  They objected to the increased role of government in health care, in subsidizing premiums and in expanding Medicaid at taxpayer expense.  Efforts by conservatives to eliminate it have failed so far, but the Republican administration has weakened the law in a number of ways.  In terms of the popularity of Obamacare, Republican attacks seem to have backfired, according to this article by the Kaiser Family Foundation, which is an excellent nonpartisan source of information about health care issues.  The Republicans have proposed a number of “repeal and replace” plans, outlined in this Kaiser report.  All these proposals would result in millions of people losing insurance entirely, millions more being left with inadequate insurance, and millions continuing to face annual increases in health insurance premiums.  The Republicans have passed legislation to eliminate the mandate for all citizens to secure health insurance.  This could threaten the solvency of insurance companies which are still required to offer insurance to those with pre-existing conditions.  The Trump administration has also legalized the sale of cheap insurance policies that do not meet the minimum requirements of the ACA for quality and scope of coverage.  This also could destabilize the health insurance market and increase the number of people who declare bankruptcy due to unpayable medical bills.  This NBC piece describes the current condition of the ACA since changes made to it under the Trump administration.
 
Today, in addition to the “repeal and replace” proposals that Republicans have failed to pass through Congress, there are other voices in the public square on the  subject of health care.  Many Democrats argue that Obamacare did not go nearly far enough in assuring health care access for all.  They argue for Canadian-style single-payer insurance for the U.S., in which the government would become the insurance provider for all citizens, funded by taxpayer dollars.  “Medicare for all” would supplant private insurance and cover the services of private doctors and hospitals.  There is a strong movement for establishing this system just in the state of California.  Many other Democrats are leery of the enormous complexity of shifting from a largely private to a fully public insurance system, opting for preserving Obamacare and incrementally improving it at the federal and state levels.
 
For us as Christians, while there may be no one tidy answer to the question of how to provide “Samaritan Care” for ourselves and all our neighbors, we do have inspiration from scripture to guide us.   The prophets exhort us away from greed and inspire us toward social justice.  And Jesus put healing the sick as a priority right next to spreading the gospel.  As Christian citizens and voters, we’re clearly called to take a stand.
 
First session: 
 
1)  Sharing stories, 20 minutes:  The pastor or leader chooses three or four people, who have sent in their stories about their experiences with the health insurance system, to share them briefly with the whole group – or the stories are read aloud by others. If you cannot get enough stories, use a balanced sampling of these from a CNN story.
 
2)  Conversation in small groups, 20 minutes: 
 
How do you interpret these passages from the Bible, applying them to these stories?

“For scoundrels are found among my people; they take over the goods of others.  Like fowlers they set a trap:  they catch human beings.  Like a cage full of birds, their houses are full of treachery; therefore they have become great and rich, they have grown fat and sleek.  They know no limits in deeds of wickedness; they do not judge with justice the cause of the orphan, to make it prosper, and they do not defend the rights of the needy. Shall I not punish them for these things?  says the Lord, and shall I not bring retribution on a nation such as this?” 
Jeremiah 5:26-29 

“But let justice roll down like waters, and righteousness like an ever-flowing stream.”  Amos 5:24
 
Many Christian denominations have issued statements very similar to this one:

“Because the scriptural test of a just nation is how it treats its weakest members, we will be clear and consistent advocates to policy-makers on behalf of public health matters and access to healthcare for everyone. We join other faith-based communities in urging our government to establish policy for a system of healthcare in which everyone, everywhere in the United States has access to basic, affordable healthcare, and where the risks and expenses are shared by all.” — Mennonite Church USA, 2006
 
How would you translate this statement into specific public policy for health care?
 
3)  Reports from groups, whole group discussion, 20 minutes.
 
If you are doing just one session, send the material below to participants for further engagement and learning.  Include the websites and contact information for local candidates for Congress in the 2018 primary and general election.
 
Second session: 
 
Questions to Ask About Any Health Coverage Proposal  (p 39, “Being the Good Samaritan” by California Council of Churches, 2008)
 
Apply these questions to the original Affordable Care Act and to one or more of the various Republican “repeal and replace” proposals, as described in the Kaiser report as well as to current proposals for federal “Medicare for all” and in California for a state-based universal, single-payer system.  Assign the small groups to address these questions to the different proposals, and report back to the larger group:
 

1) Is the proposed system truly universal? Will it cover everyone, regardless of income, employment, social status, or pre-existing conditions?

2) Is anyone excluded? Does it include immigrants as a whole, and undocumented immigrants in particular?

3) Is it comprehensive? Does it include the following:
• Doctor visits • Nursing home and long-term care
• Hospitalization • Preventive and rehabilitation services
• Access to specialists • Prescription drugs
• Mental health treatment • Dental and vision care
• Occupational health services • Medical supplies and equipment?

4) Is there a single standard of care, or will there be inferior care for the poor, and superior care for the wealthy?

5) Is it cost-effective? Will it cost the average person more or less than what he or she pays now?

6) Is its financing fair, consistent with the social justice principles of our churches?

7) Does it address health care primarily as a human right or as a commodity? Does it enhance, restrict, or eliminate the role of private, profit-motivated insurance companies?

8) Does it have an effective cost control system?

9) Does it provide relief for workers who may be displaced by the elimination of private health insurance companies?

10) Is the health care coverage affordable to all people?

11) Is it accessible so that all people, without geographic restrictions, ethnicity and language differences, and with cultural differences may get care?

12) Is the coverage portable so that if you leave a job or change your life conditions through moving, loss of a spouse, etc., you still have coverage?
 
Further resources:
 
As homework, use passages from Being the Good Samaritan:  Health Care Access for All Californians, produced in 2008 by the California Council of Churches:  pp 15-17, 22-23, 37-38.  Another source of material on the subject:  Faithful Reform —
 
 About the Author
 
JIM BURKLO
Website: MINDFULCHRISTIANITY.ORG   Weblog: MUSINGS    Follow me on twitter: @jtburklo
See the GUIDE to my articles and books
Associate Dean of Religious Life, University of Southern California

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