The Health Care Debate: Fostering Civil Discussion

May 1st, 2010
This article is featured in the Global Health (May/June/July 2010) issue of Circuit Rider

In the wake of March's legislation, is it possible to discuss health care reform without being overwhelmed by incivility? The 2008 General Conference answered “yes.”

It added a clear statement to our Social Principle on health (¶161T) that “providing health care is a government responsibility.” And what is now our Resolution 3201 mandates that the General Board of Church and Society (GBCS) advocate for a single payer, “Medicare for all” health care system for the United States; if that is not achievable, GBCS is to advocate for anything else nationally that might move us in the direction of health coverage for all. If even that is not achievable, GBCS is to advocate for anything that might permit individual states to move in that direction on their own.

Both the Social Principle and Resolution invoked scriptural bases—the example of the Good Samaritan, the command to love our neighbors as ourselves, and Ezekiel's analysis of the social greed that destroyed ancient Israel, specifically the failure to heal the sick by those who governed Israel. United Methodists did not all agree, but with what now appears to have been astonishing civility, we came to a decision on what our denomination would advocate in health care reform.

The public discussion of 2009, by contrast, showed how different things can be when that commitment is lacking. One end of the political spectrum was angered by the open exclusion of single payer Medicare-for-all from the discussion, as physicians given no other opportunity to testify for it were arrested in the halls of Congress. At the other end were those who believed that government efforts were intrinsically inefficient and wasteful, a threat to both personal responsibility and individual liberty, and an assault on the economy as a whole, with enormous costs to be passed to future generations. In the middle were those who sought a means to extend health care to all without making fundamental changes to our system of privately provided for-profit health insurance.

Passions were stirred because, clearly, health care reform called into question core values of American society. Beneath the increasingly angry words, the debate was about who we Americans are in the arenas of justice for people, respect for property, affirmation of social responsibility or personal responsibility, and the nature of our responsibility to those who are sick and dying. If those topics were not sufficient cause for anger, add the hot-button issues of what beginning- or end-of-life care is offered or denied at the expense of the public. No matter what one's perspective, the debate aroused many of our passions.

During the firestorm of incivility about health care that engulfed America in the period August, 2009 to March, 2010, I helped GBCS staff respond to some of the correspondence and phone calls about the health care debate that flooded this United Methodist agency. It was not pleasant. The agency and its staff have been accused of substituting our own ideas for those of the church; of abandoning the true faith once received, of expressing the perspectives of only one political party. We have been called everything from trash to trollops, including ungodly, sinister, disgraceful, disgusting, and even “f-ing stupid.”

As the new legislation is implemented and modifications to it debated, the topic will continue to be in the news. Is this a topic you as a pastor would want to have —or express—an opinion on? Is it something you would want to help your congregants grapple with? On the surface, the gross incivility of the health care debate would seem to be an excellent reason not to touch it, not even with a ten-foot pole. Who wants that kind of abuse? But if you look at the reasons that led you into ministry—a passion for people and their lives, a love of the God who made them, a concern for the welfare of their souls, and a love for the country in which they live— aren't they the very reasons this topic has to be touched?

And lives are at stake: tens of thousands of people in the United States die each year because they lack health coverage. In September 2009 the American Journal of Public Health released a study by Dr. Andrew Wilper of the University of Washington School of Medicine, who calculated that those without health coverage had a 40% higher risk of dying each year than those who did. Applied to U.S. death statistics, that means 44,789 uninsured people die each year who would not have died had they been insured—and this is even taking into account things like education, income, smoking, drinking, and obesity. “We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease,” said Wilper, “but only if patients can get into our offices and afford their medications.”[1]

Some of those who wrote to GBCS pointed out that in an emergency, anyone can walk into a hospital emergency room and be treated, regardless of insurance. This is often true—but by the time of an emergency visit, which may cost thousands of dollars, it may be too late to save the patient, or to undo the damage of months or years when medical care was missing. Meanwhile, the cost of that emergency visit and possible admission is passed on to other patients and the tax-payer—and also sent to a collection agency which may drive the family into bankruptcy. As the legislation is implemented, observers of all opinions will be watching to see if these problems go away.

How can you address this in your congregation and actually do some good? How can you foster discussion about health care that is not only meaningful but civil, that not only strengthens your congregants' faith but also their ministry in the world?

1. You can engage your congregations with a scriptural basis.

Health is a key topic in the Bible within the even broader topic of poverty and justice. For Christ, healings were a sign of God's kingdom becoming real. For Ezekiel, the absence of healing was a sign of Israel's imminent fall. Both can help congregations understand the need to move from works of mercy to works of justice. If concern for health issues is not integrated into our overall concern for spiritual well-being and civic outreach, it is only a cut flower that will soon wither and die.

2. You can create opportunities for dialogue outside the pulpit.

Lurking somewhere in the recesses of most any pastor's fantasy life is the image of thundering from the pulpit, “Thus saith the Lord.” A key problem with this approach is that those who disagree are most likely to think, “thus saith the pastor,” and be not only unconvinced but resentful that they did not have an opportunity to talk back.

Therefore it is productive to use settings like Sunday school classes and evening events that provide an opportunity for discussion. Powerful discussions can result from addressing real people's stories in conjunction with Ezekiel 34:1-4. Visit for true stories United Methodists have submitted about their health care difficulties

A method I've found particularly useful is what I call an “old-fashioned debate,” in which participants are randomly assigned to teams to argue “for” or “against” a provocative statement. Since the statement is revealed to the participants only after teams have been assigned, it is totally clear to participants that the issue is not whether you agree with the statement, but how well your team can gather facts and marshal arguments to further its position. In a fun setting, this permits review of factual handouts, group thinking, and discussion, and competitive presentations for and against without the filter of preconceived opinions.

3. You can provide a respectful setting for outside speakers.

Organize a “Health Care Justice Sabbath” to help people understand the implications of justice in health care. This event could be a special Sunday, an entire weekend, or more. I helped plan one that included a health fair with a blood drive and booths from health agencies on a Saturday, class discussions and a sermon on Sunday, and the following Wednesday a candidates' forum in which local candidates had an opportunity to express their positions on local health concerns.

Political candidates in a church? Absolutely—if the congregation invites all candidates, treats them impartially, and endorses none. It is legitimate, without compromising separation of church and state, to present a series of health-related questions related to health and ask, “If you are elected, what will you do about this issue?” And the wrap-up at the end needs to be, simply, “Thank you.”

4. You can encourage your congregation to support stands at a level they are comfortable with.

Some congregations will be willing to take a public stand in favor of health care for all and perhaps some specific means of getting there. If a resolution is presented to the church council for adoption, with substantive advance time for discussion in the congregation, the process of considering will probably be even more useful than the congregation's stand itself.

Many congregations will not feel able or willing to take such a step but may be supportive of you or other leaders speaking on the issue as private individuals, without the congregation taking a stand one way or the other.

Whatever you do, do your research, gather your facts, and take advantage of available resources in order to lead your congregation in an informed, civil discussion of this important issue.

Jackson H. Day is an elder in the Baltimore-Washington Conference and serves as a consultant on health issues for the General Board of Church and Society. He is a candidate for the degree of Doctor of Ministry in the track “Faith and the Health of Communities” at Wesley Theological Seminary in Washington, D.C.

[1] Accessed February 28, 2010

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