ONE STRONG BODY
Chris Bell
16 January 2005.

“I am a single cell in a body of 6.4 billion cells. We are single cells in a body of 6.4 billion cells. The body is humankind.” - Norman Cousins

The image of the body is one of the most ancient and powerful ways of describing the relationship of the individual and the community. Every cell has its place and its role; yet understood as a whole, together, they are something far more powerful, more beautiful and more complex. This is an old idea. A first century author writing for a religious community in Greece described it like this: “Now the body is not made up of one part but of many. If the foot should say, “Because I am not a hand, I do not belong to the body,” it would not for that reason cease to be part of the body. … And the head cannot say to the feet, “I don't need you!” … God has combined the members of the body… so that there should be no division in the body, but that its parts should have equal concern for each other. If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.”1

From many parts, a single greater whole. It’s one of the basic rules of the universe and here’s the proof! [Refer to my body.] It’s kind of cool, isn’t it? We all happen to have brought to worship today one of the most vital religious symbols for expressing the reality of our interconnectedness: our very bodies!

Since you were all kind enough to bring your bodies to the service, it seems like a good day to talk about what it means to have a healthy body, or perhaps its better to say what it means to BE a healthy body. I’m concerned for the health of these fine but fragile physical bodies of ours – these cells – but today I need to talk more about the health of the larger body, the body politic. I want to talk about the health of the American people and the health of the American nation. If it’s not rude to say so, we don’t look so good.

A healthy body is one in which all of the parts are in balance, equally supported, equally well. If that’s the case, then friends, America needs to call the doctor. America is not in balance because Americans are not equally supported and Americans are not equally well, and to support this diagnosis one need look no farther than our unjust and inadequate health care system.

There is a boundary between the 5/6ths of our body that does have ready access to quality health care (even if they pay through the nose for it) and the 1/6th of our body that simply doesn’t (no less than 43 million people, including 11 million children). This boundary is often drawn along old and painfully familiar lines of class and race. In this way our health care system is yet another instance of America’s inability to fulfill the terms of the promissory note of justice and equality to which every American is supposed to fall heir. Those are the words of Martin Luther King, Jr. But health care is by no means “only” a race and class issue.

As Dr. King taught, the suffering caused by racial and class inequality is felt not only by those without white skin and economic privilege, it is felt by all the members of the common body, and it is the duty of all the members to redress it. “Injustice anywhere is a threat to justice everywhere.”

Well, the injustices of our health care system are everywhere. More and more Americans of all walks of life find themselves living in a state of uncertainty, of dis-ease, about their basic health, as once again our government and big business put profits above people, as once again the privileges of some are put above the needs of the many. In the case of health care, above the needs of ALL. Of everyone.

If we return to our metaphor of the body, it’s as if our leaders are the head (or perhaps a less savory body part of your choosing), saying to the feet, “I don’t need you!”

We’re all the feet. It’s time for the feet to say, “The hell you don’t!” It’s time for the feet to move. It’s time for these feet to march.

King wrote in 1968, “We have moved into an era where we are called upon to raise certain basic questions about the whole society. We are still called upon to give aid to the beggar who finds himself in misery and agony on life's highway. But one day, we must ask the question of whether an edifice which produces beggars must not be restructured and refurbished. That is where we are now.”

That is where we are now. The edifice we must restructure and refurbish is the U.S. health care system, which the World Health Organization has ranked 37th among the nations of the world for quality and 55th for fairness. Makes me feel proud… “USA! We’re 37th! We’re 55th!”

“Americans don’t actually get very much care by world standards. We don't stay in the hospital more often or longer. We don't visit the doctor more often than people in most other countries to which we compare ourselves.”2 Most of our health care problems just come to seem routine. If like the majority of folks you receive your health care through an HMO, you may have difficulty finding a doctor on the plan near your home, you wait months for an appointment, you struggle to get referrals to specialists because the decision about whether the care is necessary is being decided by a bureaucrat focused on money instead of a doctor focused on health.

The really great flaw in the quality of American health care would have particularly caught King’s eye: In 1999 Congress requested an Institutes of Medicine study to assess the extent of disparities in the types and quality of health services received by U.S. racial and ethnic minorities and non-minorities.

We may not receive a whole lot, and what we do receive is unfair. And, boy do we pay for it! Our health care system is by far the most expensive in terms of actual dollars and dollars per capita. Partly these costs are caused by the ready availability of high-tech and cutting edge treatments. Here’s to them! I’m no enemy of modern medicine. It has saved me and my family great pain and it definitely saved my father’s life. But. (It seems like there’s always a but when it comes to our national body, if you’ll forgive the pun.) But, as you know, my son recently broke his arm – not exactly a condition that requires particularly new or radical treatments. The bill for the overall treatment of his arm currently stands at almost $35,000!

Dr. David Himmelstein, who teaches at Harvard Medical School and is a cofounder of Physicians for a National Health Program says, “The fundamental cause of the high cost of health care in the U.S. is the deranged structure of the health care system. There's something like $50 billion a year in profit extracted from the health care system, and that's only about one-sixth as much as the bureaucratic costs of actually extracting that profit. In fact, we spend each year about $320 billion or $340 billion on useless bureaucratic work in order to apportion the right to health care according to ability to pay, to enforce inequality in care, and to enforce the collection of profit by insurance companies, for-profit hospitals, the drug industry.”

I say that’s messed up. Our body is infected with the virus of profit.

In preparing this sermon I read a lot about health care, and I tried to read voices from a variety of views. In a 2002 lecture entitled: “The Health Care Crisis: The President's Plan for High-Quality, Affordable Care” Judge Mark McClellan offered this very telling statement about how the powers-that-be view health care system. He led off his lecture with these words, “We have a very strong health care system in many respects. It's one of the largest and most vibrant sectors of our economy. It has accounted for much of the economic growth of our economy in recent years. And I think our high-tech industries are intimately connected with the health care developments that have been a hallmark of American economic growth.”

Does anything strike you as missing from McClellan’s assessment of our system’s strength? Like, say, health, bodies, children? He said “economy” or “economic” four times. He didn’t say “person” once.

Of course, what McClellan said was true, if your definition of a strong health care system is a profitable one: HMOs recorded a $1.4 billion profit in just the first quarter of 2002, then a profit of $2.3 billion profit for the first three months of 2003, a $3 billion profit for the first quarter of 2004.4 What will it be this year?

And HMOs aren’t the only businesses reaping the benefits of an unjust system. The so-called “reform” of Medicare last year attended mostly to the needs of the drug companies and the insurance industry. Drug prices continue to skyrocket, and the rights of patients to demand better care through the courts has been severely compromised. Meanwhile, half of personal bankruptcies are caused by medical bills.5

Our body is infected with the virus of profit.

To me, it seems like the most insidious thing about the profit virus, is that it affects the body, or at least the head of the body, like a drug. Privilege becomes like a narcotic, numbing us to injustice. And the fear of losing our privilege, the fear of losing health care that so many Americans live with stupefies us and makes us paranoid.

Thus I cannot hope for leadership from the privilege and profit addicts in Washington. After all, one of the nations largest HMOs is owned by the family of Bill Frist, Republican Majority Leader of the U.S. Senate. Do you think he’s going to shake up the system? He can’t make clear-headed decisions; he’s stoned on profit.

Our head may not be able to change things, but our body is. And right now 1/6th of our body is shut out. This, of the many flaws in the US health care system, is perhaps the most unjust: the lack of any access to that system outside of an emergency room. “Employer-based health insurance provides the majority of U.S. workers with access to health care and protection against devastating financial losses. Millions of workers, however, do not receive health benefits from their employers, and few sources of affordable coverage exist outside the employer-based system.”6 “We used to say that the United States shared with South Africa the distinction of being the only industrialized nation without universal health insurance. Now we don’t even have South Africa to point to.”7

Given the interconnectedness of the parts of the body to the whole, what does it mean that we as a people are willing to allow 43 million people to go without health insurance?

This isn’t just an abstract question. It’s a matter of life and death.

The president and chief executive officer of The Robert Wood Johnson Foundation8, Dr. Risa Lavizzo-Mourey, tells it this way: “Those of us fortunate enough to have health insurance know what to do if we become ill or develop symptoms: We call the doctor.”

She continues, “As a physician, I have watched people grapple with choosing between the health of their child and paying their bills. I still recall a mother facing such a cruel choice some 20 years ago, when I was a young physician. The young woman brought in her 18-month-old baby boy. He had a high fever and was breathing rapidly. She was understandably concerned. I determined that the baby had pneumonia. I informed the mother that it was treatable expecting her to be relieved. Instead, she wept. She explained to me that her boy had already had one hospital admission; the family still faced debt from that stay and could not afford another hospital bill. To avoid hospitalization, she and her husband told me they would do everything they could. They would take time off from work. They would watch him around the clock. I struggled with what to do. I prescribed antibiotics and talked to her about how to care for her young child at home. Thankfully, that little boy recovered.”

Every day Americans face such hard choices…

Every day Americans make decisions about work and family guided by health care concerns that compromise our freedom, our dignity and our well-being. This issue hits close to home for me. My sister, a highly-regarded pastry chef in New York City has no health care. Since 1998 the UUA hasn’t been able to get an insurer to provide a group plan to cover all UU ministers. Over 70 ministers work in our denomination without health care.

I suspect I’m not alone. Raise your hand if you’ve taken a job or kept a job primarily because of its benefits, or have gone without health care or know someone who has. [About 1/2 to 2/3 raised their hands.]

When it comes to access and insurance racism and classism again raise their ugly heads. For example, about 35 percent of Hispanic adults with jobs are uninsured, compared to 18 percent of employed African Americans and 11 percent of working white adults.9 Across the nation higher-wage workers are more likely than their lower-paid counterparts to have health insurance and health-related benefits, such as paid sick leave, and to use preventive care services. Low-wage workers, meanwhile, are much more likely to forgo needed health care because of cost and they are more likely to report problems paying medical bills.

I say, “ENOUGH!” It is time to demand universal health coverage in America. Justice demands it, fairness demands it, our national well-being demands it.

It’s an idea whose time has long ago come. We may wonder what is holding us back. I found one possible answer online on a page titled Canadian Medical Humor. (No public speaker should be without a ready supply of Canadian Medical Humor.) The joke asks “Canadians have universal healthcare. How do they afford it when their neighbor to the south [the wealthiest in the history of humankind] is too poor to do so?

The cynic says that it’s because of Healthcare Rationing, that “nationalized health systems make people wait so long that most die before seeing a doctor.”

The savvy Canadian also ascribes cultural factors: “It is cheaper to treat a frostbitten nose than to treat a gunshot wound to the abdomen.”10

Ouch.

From a more serious angle, In the January 2003 American Journal of Public Health, Dr. Bruce Vladeck gives these reasons why America is the exception, alone among modern developed nations. Historically, Americans are anti-government and anti-authoritarian in general, and almost all Americans identify as middle-class rather than working class, which means there has been no historically successful labor party – the prerequisite for universal care throughout Europe, for example. Another reason there is no labor party? Plain old racism, I’m afraid. The inability to bring white and black people together for the cause of justice has plagued this body since its inception. Its great diversity and size makes it hard to form cohesive movement for change, while the inertia of the political middle, and its sharing in the addiction to material wealth and financial gain, makes big money even more powerful. That’s a lot to fight.

On top of those reasons Dr. Vladeck says, “James Madison was a really smart guy, and the constitution he designed largely accomplishes what he wanted: that is, within the confines of a basically democratic nation, policies that would redistribute significant resources from the wealthy to the more numerous poor and middle-income citizens are almost impossible to effect.”

Friends, these are some of the same reasons that might have been given to Martin Luther King, Jr. and the other civil rights leaders for why their cause would fail. But that didn’t stop them.

The struggle for universal health coverage IS a civil rights struggle, and not only because of race-based inequalities. This is a civil rights issue because it affects the well-being of us all, of the whole civic body. Health care should be provided out of duty and responsibility, not lust for wealth. Health care should not be yet another commodity like a toaster oven, it should be a right. And it is: as Article 25 of the United Nations’ Universal Declaration of Human Rights, says: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” It’s worth remembering that the United States played a major role in drafting and ratifying that language. Not that we’re all that could at respecting global treaties these days…

Still, change is not going to happen until we are willing to put our bodies into action. We need to feel the injustice right here. [Touching chest] These feet need to move, to march! We have to march into health care offices, to march into HMOs, to march on Washington if we have to. We need to raise the issue to a fever pitch, and pray that that heat – the fire of righteousness that razes whenever a body refuses to tolerate disease any longer – pray that that heat will burn away a system that is fundamentally unhealthy and incomplete and replace it with one that will respect and give dignity to all the members of this body.

It’s not going to be easy. As Dr. King said, “We know through painful experience that freedom is never voluntarily given up by the oppressor; it must be demanded by the oppressed.”

I don’t know what the precise solution is. The system is wildly complex and any replacement would be too. But I know that what we’ve got now is wrong. That “there are some things in our social system to which all of us ought to be maladjusted.” I know we’re sick and hurting, and I know that solving our health care problem is vital if we hope to retain what little moral authority we have in the world. We need to practice what we preach. The world isn’t going to be inclined to take advice about how to live from a doctor who refuses to take care of himself.

I believe a fight for universal health care is just what we need to bring liberal people together. We need a unifying issue, a moral issue that affects all people, all classes and races. A civil rights issue.

King illuminated our shared culpability for injustice, and made the fulfillment of the American Dream a responsibility of all her people, working together. “We are caught in an inescapable network of mutuality, tied in a single garment of destiny.” We have a moral and ethical duty to care for all members of our body. As such, we must pursue universal health coverage for all Americans.

So with apologies to Dr. King, that is the dream of this poor idealistic socialist. A dream of a national body made whole. A dream of health over wealth. And – why not? – a dream of universal health care for all, of a day when our commitment to our common well-being might be so complete that “all of God's children, black…and white…, Jews and Gentiles, Protestants and Catholics, will be able to join hands and sing [about our health care], in the [slightly modified words] of the old spiritual: Free at last, free at last/Thank God Almighty, it’s free at last."

May it be so.

1 Corinthians 12.
2 “The Health Care Crisis in America”, An Interview Dr. David Himmelstein, by Nancy Welch. Available at http://www.counterpunch.org/welch10302004.html
3 Update on the Health Disparities Literature; Long JA, Chang VW, Ibrahim SA and Asch DA; Annals of Internal Medicine, 141(10): 805-812, November 2004.
4 According to Weiss Ratings Inc., a respected business survey company.
5 According to the California public interest group “Health Care for All”
6 “Wages, Health Benefits, and Workers' Health”; Sara R. Collins, Ph.D., Karen Davis, Ph.D., Michelle M. Doty, Ph.D., and Alice Ho; The Commonwealth Fund Issue Brief, October 2004.
7 Dr. Bruce Vladeck, writing in the January 2003 American Journal of Public Health.
8 Whose stated mission is “to improve the health and health care of all Americans”
9 The report was prepared by researchers at the State Health Access Data Assistance Center, located at the University of Minnesota, for The Robert Wood Johnson Foundation.
10 I found this joke at the Northern County Psychiatric Associates website in a section called “Canadian Medical Humor.”