Health & Health Care Feed

The Exchanges

Yes, many of the ACA exchanges are failing, but multiple studies show that this result is not because of some inherent flaw in the law, but because of policy decisions of the states that didn't fully implement the law. This article in The Atlantic, for instance, details some of the study results.  If a state expanded Medicaid, didn't allow grandfathered policies, set up its own exchange, and did all the marketing and recruitment work to enroll people, then their exchanges are operating with lower risk.


Darkness Is My Only Companion

Darkness Is My Only Companion: A Christian Response to Mental IllnessDarkness Is My Only Companion: A Christian Response to Mental Illness by Kathryn Greene-McCreight
My rating: 4 of 5 stars

In 2015 our congregation became the third in our denomination to adopt a WISE (Welcoming, inclusive, supportive, and engaged) for mental health. Mental health issues had long been something we talked about, received training in, included in worship and educational forums, and advocated for. Yet we always felt we needed to do more. Then, in the summer of 2015 a young man who was a beloved member of our congregation killed himself. He lived with a schizo-affective disorder. His husband desired that we use the opportunity of Felix' death to talk more openly about mental illness, and so the Sunday following the funeral I preached on Psalm 88, from which the title of this book is derived, and shared details of Felix' illness that Felix had shared with me. That Sunday we also shared resources on mental illness. In preparing the funeral and the following Sunday, I consulted the therapists and social workers in my congregation, who provided great help. In the weeks following Felix's death, we learned that the 2015 General Synod of the United Church of Christ had called for church's to become WISE for Mental Health, and so we eagerly went through the process.

Last autumn when I saw this book in Christian Century I knew I wanted to read it in order to further my own education and understanding. The author is a priest who lives with bipolar disorder and the book is part memoir and part theological reflection. Deeply rooted in Trinitarian theology and the rich resources of scripture and the Christian tradition, here is an express of Christian identity and faith in the midst of illness.

I highly recommend the book and will use it often in my ministry.

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Faith & Pregnancy

My good friend Greg Horton has posted a response to the Hobby Lobby case that I found to be very good.  His main purpose, as Greg usually does on his blog, is to discuss the role of language.  In particular here he is discussing whether faith-talk can define medical categories like "pregnancy."  He concludes, of course, that it cannot.  Which leads him to conclude that "The Hobby Lobby decision is a hydra-headed clusterfuck."  Amen.

Two parts of this post also get to issues that I had with the majority decision, but haven't written about yet, as I also didn't want to jump into the fray before but wanted to read, listen, and mull things over.  Here is issue one, as described by Greg:

To be clear, the case rested on the Green family being allowed to define pregnancy in a way that is counter to how medical professionals define pregnancy. I have no idea why I should take the word of business owners who specialize in selling imported crap for display in middle class homes around evangelicaldom when the American Medical Association seems a far more reliable source of information about medicine, but it's America, and as my students regularly inform me with scalable—depending on their level of offense at my cultural blasphemy—levels of indignation, "Everyone has a right to their own opinion."

In reading the majority decision I was horrified by the line of Justice Alito's that the court was protecting the Green family's belief that four of these contraception methods were abortifacients.  Despite the fact that the scientific and medical communities, including the FDA, don't categorize them as such.  Justice Ginsburg was shocked that the Court now will be adjudicating religious beliefs in a way it never has before, determining if they are sincerely held in order to apply this ruling in other cases.  It is, of course, shocking that the Court is protecting a claim that is empirically false.  I'm not sure how an empirically false medical claim becomes a religious belief, but it did on Tuesday.  And that is Greg's problem, as he concludes his post:

Faith in god does not imply the ability to define non-theological terms, like pregnancy, so that they are consistent with a particular brand of theism. The object of faith is not definitions or meanings that are only tangentially related to words in a sacred text; the object of faith is god. This will necessitate that theists believe certain things are true or false, but extracting categories from the text and then insisting testable truths be understood in light of those categories is not helpful in communicating with members of various tribes who do not share those categories. Pregnant means, for all tribes, a fertilized egg is implanted in the wall of the uterus. To equate faith with the belief in definitions that are contrary to known scientific realities is to impose an anti-intellectual burden on believers that makes meaningful, intertribal communication impossible.

The second big issue I had with the ruling, is also something Greg addresses tangentially.

That the SCOTUS majority opinion specifically said the decision could not be used for precedential purposes related to blood transfusions and other medical realities about which different faith traditions have differing beliefs is a strong indication that they know this was a perilously bad decision. Either the principle applies or it doesn't, and in this case, they treated a comprehensive application of principle as an ad hoc application of principle, but the box is still open and the five justices in the majority will be living with their decision in the form of litigation for years to come.

First, as a practical matter, you cannot claim that the ruling is not a precedent, for clearly lower court judges will be compelled to use it as a precedent when adjudicating similar cases.

Second, the ruling defies the laws of logic that most people learn as an undergraduate in college.  According to those laws it is the basic form of the argument that is valid, regardless of what the particulars are.  The particulars in this case had to do with contraception coverage under the Affordable Care Act.  But if the argument itself is valid, then you can change that particulars and get the same conclusion.  That the Court in point of fact says that the form of argument is not valid when applied to other particulars entails that it is not valid when applied to this particular.  This part of ruling must be making every logicians head spin.

So, we'll be living with this "hydra-headed clusterfuck" for some time.


An different perspective on the birth control case

A rabbi writes that in Judaism the use of birth control is often required by religious faith, such that the ruling on Tuesday may make it more difficult for some Jewish women to fulfill their religious obligations, thus harming their religious liberty.

If other closely held corporations follow suit, we may have hundreds of thousands if not millions of people who will not have access to basic health coverage that helps them to uphold the religious and ethical principles that guide them in building their families.


More on the contraception mandate and religious liberty

This essay in the Atlantic voices important points in the debate over the contraception mandate.  The article discusses the two cases of Hobby Lobby and the Little Sisters of the Poor.  It points out, "The nature of that claim offers a glimpse of some toxic ideas floating around in American law."

Here is the powerful core of the essay, and I wholeheartedly agree:

Taken together, these two cases aren’t claims for religious exemption. They are more like an ordinance of secession—a statement that religious bodies, and people, and even commercial businesses, no longer belong to society if they decide they’d rather not. The idea depends on an assumption that government itself is sinful, and presumptively illegitimate. If courts follow this notion, they risk making it impossible to have an effective government at all. 

Religion should not exempt one from generally applicable laws, as even Justice Scalia noted in the peyote case in the early 1990's.  The essays makes a similar point:

The assumption seems to be that religion releases you from any obligation of any kind to the state. And that’s apparently even true if you are a giant for-profit corporation. 

I do not question that the nuns, and the Green family, are sincere. But why are they the only ones whose interest matter? These cases involve the government and the employees covered by the Act. Their interests should count, too.

In the nuns case, the government has an interest in knowing to whom an exemption should apply -- the nuns are suing to avoid filing a form that they are exempt.  In the Hobby Lobby case the court should consider the health concerns of the employees, which the dissent in the 10th circuit (written by the only woman on the Court) upbraided the majority for not considering at all.

And the comparison to Civil Rights law is important, as this same religious exemption idea is being argued for by religious conservatives when it comes to laws that protect the LGBT from discrimination.

In 1964, many people had sincere religious beliefs that African Americans and whites should not mix in restaurants, stores, and hotels—that this violated the words of Acts 17:26 that God had fixed boundaries for the nations of man and expected them to remain within them.  (There are sincere believers of this idea even today within the so-called “British Israel” and “Christian Identity” sects.)

The Civil Rights Act did not demand that these people change their beliefs. It did not demand that they desegregate their churches, or open their homes. But it did embody a judgment by society that, in order to engage in business, they had open their businesses to all. 

The same kind of governmental interest is present in the contraceptive-mandate cases: If you want to engage in interstate commerce, cover your employees. The peoples’ representatives have determined that both public health and the economy will function better if you do.

The essay concludes with a clarion call:

And beyond the health question, for heaven’s sake, think for a moment about “liberty”: A country where employees have both jobs and religious freedom will be freer than one where they must choose between the two.