Wednesday, February 22, 2017

How the Current Health Care Market in the US Fails Liturgical Man

I attended a talk on healthcare at Star of the Sea Catholic Church in San Francisco last week, given by my colleague at Pontifex University, Dr Michel Accad. Much of the talk was devoted to consideration of the options that Catholics have for affordable healthcare.

Dr Accad spoke in detail about sharing ministries as alternatives to health insurance, and how many general practitioners are structuring their practices in a new way so that they are employed directly by patients and act as their advocate. This is in contrast to the usual arrangement by which the doctor effectively becomes an agent who sells treatments and drugs on behalf of the providers to the payer, who is not the patient, but the insurance company.

In his new model, Dr Accad is motivated to act on behalf of the patient first, and so is an advocate for him, striving to bring down the cost of treatments and drugs by negotiating with pharmaceutical companies. He is also able to devote much more time to their care. Furthermore, it enables him to offer treatment that is in accord with Catholic social teaching.

He opened up his talk by asking the question: Who here thinks healthcare in this country is going well? No hands went up. He then described how it is possible to have healthcare options that allow for the flourishing of the patient as a human person - body, soul and spirit - and a relationship between doctor and patient that is fruitful for both patient and care provider.

In the Q &A session afterwards, it became apparent from the discussion that this was of interest not only to currently disgruntled patients but also to doctors, who are frustrated that they cannot give the sort of treatment they would like to give. Several spoke of this frustration under the current system.

Dr Accad is a medical doctor (qualified both as a general practitioner and as a cardiologist) who is able to take a broad view of the crucial issues involved. He is one of those rare people who is simultaneously able to analyse the details and to synthesize them all into the big picture. A committed Catholic, he writes about medicine and is published in peer reviewed medical journals. He writes about the philosophy of nature and philosophical anthropology and has been published in The Thomist, and he has delivered papers on the economics of healthcare at the Mises Institute. He also has a popular blog on how these issues impact the medical profession, called

Of course, I was interested in the details of how one might have access to affordable health care that is aligned with Catholic social teaching and imbued with genuine consideration of the patient as a person. (If you are interested in this I suggest you contact him through his blog, here). But aside from that, what I found fascinating what his description of how so many of the problems associated with healthcare today, even before Obamacare, emanate from a dualistic understanding of the human person as a physical body occupied by a thinking soul; rather than as a single entity, a profound unity of body and soul. This is not a bad thing in itself; a deep understanding of how the physical functions of the body work has lead to great strides in medicine; however, it does place limitations on the scope of treatment through a neglect of the happiness of the person and his spiritual needs. If the underlying problem is spiritual, for example, treatments might alleviate its symptoms, which can then resurface in other forms.

And the problem runs even more deeper than that. Without a clear picture of what the human person is, the idea of a health as a goal for treatment is not clearly defined either. This has lead over the last 100 years or so to the creation of a “health market” which has been engineered to serve that idea of the human being as machine, an object to be repaired, rather than as a person who needs health in order to direct his activity towards his ultimate end, which is union with God. Consequently, the patient occupies a role in this financial model that is more like that of the car in the repair shop, in which the insurance company is the car owner and the doctor is the mechanic. While this model might work well for cars, when the doctor’s surgery becomes a glorified human “body shop”, the misalignment and conflict of interests and goals leads to secondary problems in health care.

As soon as the current system, under the guidance of the US government, began to be introduced in the early 20th century, he told us, it caused an escalation of costs, because there is no incentive for the key players to keep costs down on the patient’s behalf. The doctor seeks to serve first the specialist treatment providers, pharmaceutical companies and insurance companies, rather focusing primarily on the restoration and maintenance of the patient’health, (however that is defined).

Those who wish to know more about the connection between the structuring of the health market and anthropology might be interested in reading or listening to Dr Accad’s talk on the subject given to the Mises Institute last year, which can be accessed via his blog, here: From Reacting Machine to Acting Person.

Dr Accad is currently preparing material for his first course for Pontifex University on the Philosophy of Nature and Philosophical Anthropology. He is a wonderful addition to the faculty precisely because of his ability to draw themes from one area of expertise and apply them in another. The development of this ability to think synthetically is part of what a good Catholic education ought to aim for, and it is why a formation in beauty is so important as part of that education. When one apprehends the beauty of something, one is able to see not only how it’s parts are in right relation to each others in due proportion, but also how the whole is in accord with its purpose and in right relationship with all that surrounds it (integritas). In short, one is able to look at the details (analysis) and place them in the bigger picture (synthesis). This is why beauty and culture, which touch every aspect of human life, including economics and health provision, are so intimately related.

As Catholics, we must strive always to take that mental step away from whatever field of study we are engaged in and ask ourselves the big question: How does this relate to man’s goal of union with God through worship of Him in the earthly liturgy in this life, and in the heavenly liturgy in the next?

As an inspiration for this in the field of health care, I look to the Spanish saint, John of God, here portrayed by the 17th century Spanish artist Bartolomé Murillo.

St John of God (1495 – 1550) was a Portuguese-born soldier who founded a hospital in Granada, Spain, and whose followers later formed the Brothers Hospitallers of Saint John of God, dedicated to the care of the poor, sick, and those suffering from mental disorders.

How many doctors today are taught of the need for God’s grace in their work for the benefit of both patient and doctor? One only has to look at the design of hospital buildings past and present to see how differently the provision of care was considered. Below are photographs of the exterior and interior of the Hospital de Tavera in Toledo, Spain, built in the 16th century. (Today it is a museum housing many El Greco paintings.)

And here is a standard National Health Service hospital building, in Darlington County, Durham in England:

The standard criticism of the modern building is that it is only designed for utility, hence its depressing appearance. I would argue something different: in my opinion, beauty does have a utility, which is to raise hearts and minds to God. When a hospital building is beautiful, its beauty helps serve the spiritual needs of all the people in its care, and the good of all concerned. Furthermore, just as the person is a profound unity of body and soul, the hospital should be a profound unity of design that aids its function of restoring health to all aspects of the human person. Such a hospital will be beautiful and optimize its purpose of providing both spiritual care and physical care. It is no accident that the Spanish hospital shown above, like the educational institutions built at the same time, has the look of a monastery. Both institutions have aims that cannot be separated from the supernatural end of the human person, and both aim to create a community in which all work toward this end for themselves and others.

Here’s another example, Broadmoor Hospitalin Berkshire, England, built as a prison for the criminally insane, which houses some of Britain’s most violent and notorious criminals.

Those who are committed to its care are almost certainly going to live the rest of their natural lives behind its walls. The original building was completed in the mid-19th century. It does not have the cloisters and prayerful feel of the 16th century Spanish hospital, but nevertheless it is a listed building. The prison/hospital is currently being redeveloped, and there has been discussion as to what use the original building will be put to; newspaper reports suggest that one idea is to turn it into a luxury hotel. While I am sure that it was not pleasant to be an inmate there, it seems that in some ways our Victorian forebears had greater insight than we moderns do into the need to care for the souls of the most reviled members of society, how to do it.

The Darlington hospital no doubt has dedicated staff, and patients there surely receive the best that the National Health Service in the UK has to offer. (The NHS has its problems too, for similar reasons, although manifested in different ways; it is interesting to note that while the quality of care in many measures is not a good as that offered by the American system, patients’ satisfaction with it is anecdotally reported to be higher). Regardless, the design of the building tells us something about how the human person who is to be treated therein is viewed. I would argue that it is not even the optimal design if the provision of physical care, for the physical and spiritual cannot be separated. The building of beautiful hospitals is not an extravagance, but ought be considered a necessity that will give us the most highly functional hospitals by any measure. As we can see through Dr Accad’s discussion of the provision of healthcare, care of body and soul cannot be separated, just as body and soul cannot, in reality, be separated in the person being cared for.

Neglecting the spiritual aspects of man will almost certainly affect detrimentally the care of even man-as-machine in ways that cannot always be anticipated. Let us be clear: wrong anthropology does not suddenly invalidate all that is good about modern medicine  and its methods or even its method of delivery. Even allowing for problems that exist, there is much that is good. Rather, it allows us to locate the source of the problems that remain with the recognition there is more to be done. Once we recognize that man is a single entity that is both physical and spiritual who is made to worship God in the sacred liturgy, and that this is the activity to which all others are ordered in this life, then we have the greatest chance of restoring all aspects of human health, and having beautiful hospitals once again!

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