Message: Lets Not Dirty Ourselves

Last Monday, 2 March 2010, the Archdiocese of Washington DC announced that it will no longer be extending medical benefits to the spouses of employees. Those currently covered are grandfathered in but as of the 2nd of March, new enrollments can take place.

This move was taken in response to a new law that is going into effect in Washington that permits same sex couples to marry. The Church does not want to provide medical benefits to gay couples because they argue, it legitimized gay marriage, and the church does not want to recognize gay marriage in any form.

This situation goes to the heart of a fundamental flaw with the health system in the United States. Medical coverage is employer based. Employers at a whim can and make dramatic changes to what they will cover, the extent of the coverage, who they will cover, or even if they will provide coverage at all. Good performing employees who have given long service can suddenly find themselves forced out because the employer drops medical coverage or even worse, lays them off or finds a way to fire them to help reduce healthcare premiums the firm is paying.

Healthcare is the greatest social justice issue facing the majority of the nation. The Washington Archdiocese has demonstrated that the Roman Catholic Church is not that significant issue. It cries that it is not willing to fight for significant healthcare reform.

The Archdiocese in San Francisco took a different approach. It allows employees to pay for the medical premiums and add any adult in their home to their medical plan. Employees can add parents, adult children, grandparents, a friend as long as they reside in the home of the employee. They broadened who will be added at the employee’s cost.

As for legitimizing gay marriages by providing coverage, providing coverage does not legitimize gay marriage any more than providing treatment and care to alcoholics legitimizes alcoholism, or supporting and ministering to a sex offender legitimizes sexual abuse.

The Roman Catholic Church has the right to do what it has done but in my eyes it is contrary to the Jesus’ message of loving one’s neighbor. Like the self-righteous conservative Pharisees who criticized Jesus for visiting and sharing a meal with a publican, the Roman Catholic Church has left the banquet table rather than be “tarnished” by sharing a meal with the publican.

The Necessity of the Separation of Church and State

As a Canadian who is also an American citizen, one of the most puzzling things about American society is how the separation of church and state is understood. The concept has gone well beyond the separation Canadians understand.

In Canada the government is religious neutral. It does not promote or support one religious faith above another. It recognizes that every resident has the right to congregate for worship and worship as they so wish without governmental interference. People are free to hold any religious views a person so wishes. Likewise her residents are free to reject any and all religious believes as conscious so dictates. In return what the government and the country expects is that its faith communities to be respectful of those that hold different beliefs, to carry out religious dialogue in a civil manner and to respect the law of the land.

In return, the government protects the individual’s and group’s right to religious express if that expression is not contrary to the law of the land. Each group’s property is treated the same and allowed certain property tax exemptions and its income is tax exempt if it falls within designated bounds. Gifts to all recognized religious bodies treated the same with no group being favored above the other.

In other words, in Canada not only is government and religion not antagonistic towards one another, they frequently partner together to provide significant good for the overall welfare of the community. In the United States there is an antagonistic edge towards church and state relationships.

When the Unites States was created, it appears that the founders had similar religion neutral practices in mind. In various commentaries penned by them regarding the founding documents are references to religious neutrality and the recognition that other than Judaism other religions such as Islam may well be part of the American milieu. They also recognized that it would be left to subsequent generations to work out religious neutrality in practical terms as the country evolves and changes.

The religious neutrality has been an ongoing challenge, particularly in the last six decades. As the nation became more pluralistic court ruling and other laws were specifically designed to be religion neutral. Unfortunately some the the reaction from the conservative church became anxious that the Lord's Prayer and other Christian expressions were being removed from schools and other government locations. The intent was for neutrality but various elements in the church saw it as a threat to the church and the "dechristianization of the Christian nation." While there was some cause for concern as there was some rulings and legislation that appeared to be an effort to create a religion free environment, the bulk was an effort toward religious neutrality. As with many other conflicts the more conflicted the spirit, the further both parties pushed each other apart so that increasingly a religion free environment seemed to the goal.

Today there is a growing reluctance to see religious communities be involved in any venture that involves public funds. A religion free rather than religion neutral stance appears to have greater force. Some on the left fear that the funds will be used to proselytize while some on the left see the funds as providing an opportunity for the government to dictate religious belief, conduct and employment policies. The church does not have innocent hands.

What I find most interesting is those who are most fearful of governmental interference in her beliefs and practices are frequently the very same groups that are aggressively attempting to force government legislatures to design various laws around their religious teachings. The Roman Catholic bishops and the right to life elements of the church are demanding that government funding for abortion for any cause (including incest, rape and immediate physical health risk to the mother) be explicitly prohibited in the health reform legislation. This is an example of religious views being pushed out upon the country which on the whole does not support such an extreme position.

One bishop has gone as ask a Roman Catholic Congressman not take communion because he is willing to allow for federal funding of abortion. Communion within the Roman Catholic Church is one of the primary sacraments of grace, and the Church is withdrawing that primary vehicle from the Congressman because he will not agree with the Church on this one point. There is no separation of church and state.

Another example of a branch of the church that is attempting to force its views upon the community as a whole is the ballot and other initiatives regarding gay rights and gay marriage. While the initiatives are carefully crafted in their wording, and positioned to be defending “the traditions marriage”, what underlies it all is inflexible religious teachings and homophobia. As an aside, any cursory understanding of western and world history through the course of history shows us that the “traditional marriage” is anything but traditional, but is for the most part a modern North American creation.

Interestingly these groups do not see their political lobbying as being wrong or as entrenching a particular set of views upon the country at large. If the Jehovah Witnesses had greater political clout and were pushing for blood transfusions not be permitted or paid from public funds, would these same groups not take issue with the JWs for imposing their religious views upon the country as a whole? I doubt that they would remain silent.

It is such political activities of the religious right that pushes for people to have a stronger demarcation between church and state within the United States. In the last year I have come to see that the more dogmatic views of the separation of church and state is necessary in the United States whereas it is not in Canada. The separation is necessary to protect the state and the citizens of the country at large from a highly active and forceful religious group from having undo sway and having that brand of religion receiving preferential treatment, or worse tyranny of one religious viewpoint dominating society and how the country is governed.

A Tragic Story

As it is my 500th post I have elected to tell a story from T. R. Reid’s Healing of America. This story of Ms. White eloquently captures the problems of the American healthcare system. Functionally, America does not have a healthcare system, it has a healthcare marketplace that is driven to produce as large a profit as possible.

According to studies arising from Harvard, one of the conservative bastions of capitalism, each year 40,000 to 44,000 Americans die every year with a medical condition that could have been readily addressed if the person received adequate medical attention but died because they lacked adequate medical insurance. The Harvard figures do not include the number that do not die but who become prematurely disabled or miss work at a high rate due to untreated medical ailments. While horror stories can be told about any system in the world, Ms. White’s story is more common than Americans wish to admit, and some will heatedly claim the Harvard figures and Ms. White’s story are lies.

In blue print is Ms. White’s story as found in two sections of the Reid's book. It is rather long for a blog but deleting sections would do the story a disservice.


RESIDENT OF ANY OTHER rich country, she would be alive today. Around the time she graduated from college, Monique A. “Nikki” White contracted systemic lupus erythematosus; that’s a serious disease, but one that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in, say, Japan—the world’s second-richest nation—or Germany (third richest), or Britain, France, Italy, Spain, Canada, Sweden, etc., the health care systems there would have given her the standard treatment for lupus, and she could have lived a normal life span. But Nikki White was a citizen of the world’s richest country, the United States of America.

Once she was sick, she couldn’t get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms, pleading for help.

When she died, Nikki White was thirty-two years old. “Nikki didn’t die from lupus,” Dr. Amylyn Crawford told me.“Nikki died from complications of the failing American health care system. It was a lack of access to health care that killed Nikki White.” Dr. Crawford is a family physician at a no-frills community health center in an old strip mall in a downscale section of Kingsport, Tennessee.


Who was Nikki and what is behind her story? T.R. Reid goes at the end of his book returns to her.


The late Monique “Nikki” White, the bright, vivacious young woman…Tall, slender, athletic, she grew up in a middle-class family in Bristol,Tennessee; her parents were both middle managers in corporate America, and she was covered by a family health insurance plan until she finished college in 1999.

She earned a degree in psychology at the University of Texas and went to work after college for a bookstore near the campus in Austin. It was a perfect job for her. But Nikki, beginning to feel ill, felt obliged to look for a job with health benefits—the bookstore didn’t provide them, and her parents’ plan wouldn’t cover her after she finished school. She found work at a hospital in Austin, where she was eligible for the employee health insurance plan. Some days, Nikki was too sick to go to work; she developed severe stomach pains, extreme fatigue, and skin lesions on various parts of her body.

A doctor confirmed that Nikki had contracted systemic lupus erythematosus, a chronic inflammatory disease that mainly strikes women. This was not good news, but it was hardly a death sentence; about 80 percent of Americans with lupus live a normal life span. “For the vast majority of people with lupus,” says the Lupus Foundation of America, “effective treatment can minimize symptoms, reduce inflammation, and maintain normal bodily functions.” But effective treatment requires health insurance.

In 2001, Nikki was so ill that she had to leave work. That’s when the long, frustrating, and eventually fatal struggle with America’s health care system began for Nikki White. Like most working Americans, she lost her health insurance when she lost her job. “The timing was just tragic,” said her family physician, Dr. Amylyn Crawford. “The insurance system dropped her at the point when she needed it most.”

With grim determination, Nikki applied to every individual insurance plan she could find—in vain. No for-profit insurance company in the United States was willing to cover a person who had chronic lupus. Unemployed and uninsured, she moved home and set up an apartment over her mother’s garage in the green, rolling Appalachian country where Tennessee, North Carolina, and Virginia meet. This not only provided free housing, but the return to Tennessee also meant she could enroll in TennCare, the local version of Medicaid, the government program that provides health insurance for the poorest Americans.

Nikki had trouble finding a specialist who would treat her condition at Medicaid’s payment rates—Medicaid pays doctors less than Medicare, the U.S. government program for the elderly—but eventually she found a rheumatologist who agreed to take her on. The doctor prescribed azathiopine, a drug that would control the inflammation that was causing painful lesions on Nikki’s chest and hands. He warned her clearly that this powerful medication could have dangerous side effects. To avoid them, she needed regular blood tests, CT scans, and office checkups. Neither Nikki nor her mother could pay for such expensive care.

Fortunately, they had TennCare to help. In the summer of 2005, though, Tennessee cut back sharply on its TennCare insurance program. Under the new rules, Nikki White had too much money to qualify for Medicaid. Once again, she was uninsured. She kept trying to get health coverage, but all her appeals were denied. By now, her hands were so painful from the lesions that she had to wear thick gloves just to fill out an application. “She fought and she fought and she fought,”

Dr. Crawford recalled later. For months at a time, as Nikki dealt with a bewildering onslaught of cold bureaucratic form letters, it was unclear whether she was insured or not. “If your TennCare has ended, you should not have gotten this letter,” one missive said. That was followed by another, equally mysterious: “If this box is checked, the person listed in line 3 has at least 18 months creditable coverage. IMPORTANT! This does not mean you have coverage now.” The state Department of Human Services sent TennCare Form Letter 207.5, explaining the extent of her legal right to get insurance: “You can still apply for individual health insurance coverage. Some companies may let you buy a different kind of insurance (not a HIPAA plan). But, they don’t have to. AND, they don’t have to cover preexisting conditions.”

Nikki White was a college graduate and had worked in medical care. She knew how to research health insurance regulations. Eventually, she figured out that Medicaid would have to give her coverage if she was legally determined to be “disabled.” She began filing applications with yet another government department, the Social Security Administration, the agency that determines whether or not an American is disabled. Denied.

By the summer of 2005, Nikki White began to fear that she would never get the medical care she needed. “I don’t want to die,” she said on her thirty-second birthday. “Please don’t let me die.”

In her last weeks of life, Nikki began to receive medical care. In November of 2005, she suffered a seizure—due to kidney failure and perforated intestine—and was admitted to the emergency ward at Bristol Regional Medical Center. From that point on, her insurance problems didn’t matter; under federal law, the hospital had to treat her until her condition was “stable.”

Over ten weeks, she had more than twenty-five operations, all provided gratis. By then, though, the patient was too sick for any hospital to save. In the spring of 2006, at the age of thirty-two, Nikki White died.

Officially, the cause of death was listed as “complications of lupus.” In fact, as her doctor said, the proximate cause of death was a health care system that failed to provide the treatment that would have saved her life. Monique White was an American citizen, guaranteed equal access, along with every other American, to certain basic rights. But she didn’t have equal access to health care. If Nikki had received the standard treatment regimen for lupus readily available to any American with health insurance, she could have lived a normal life span. If she had been a resident of any other developed nation, she could have lived a normal life span. No other rich country would have tolerated the inequality that left Nikki White dead.

An Alarming Argument Against Healthcare Reform

The healthcare debate in America has become increasingly heated. It is wrapped up in a host of misinformation, obfuscation, red herrings and illogical statements. Fear of illness and worry about not receiving care are powerful spectacles that color what one hears. Whether those concerns are grounded in facts or not is not as powerful as the emotions attached to the issue. These are the similar to the emotions that stand in the background that cause young couples and families to spend tens of thousands more than they can afford on weddings. These feelings are similar to what has led families to pay ten thousand or more for a casket for a loved one, and for costly options to funeral services.

Well educated who often are logical people can readily act irrationally when emotions are raging. Today I heard a statement on FOX News against healthcare reform that stunned me. The statement was that if the middle class was concerned about waiting an hour or more in a doctor’s office or in an emergency room, if healthcare is passed just think how much more the wait will be when all those who are uninsured have health insurance.

I was stunned, I thought I misheard him but he said something a few seconds later that confirmed I had heard correctly. He was implying that people should resist healthcare reform because it will mean that those who currently have insurance will have more people demanding the attention of their doctor and hospital which means that they will get less. In other words, I should keep others out of the system, leave them on the sidelines of receiving care so that I can receive care more swiftly.

This argument reminds me of the kid’s game king of the mountain of pushing others down so I can remain on top. I do not accept this self centered perspective and it is most unbecoming for it to be on the lips of Mike Huckabee, a minister of the Gospel.