Too Many Doctors in the Room

I don’t like doctors. I always feel uncomfortable around them. When I am a patient I find myself second guessing everything the doctor says, wondering if he is getting it right. When one of my patients is a doctor I second guess everything I say, wondering if I am getting it right. It is extremely stressful.

As stressful as it is doctors are people and people need to go to the doctor, which is why I occasionally find myself seeing physicians in the office. One came in recently for an annual exam. I don’t know if he was nervous, but I was.

I did my best to treat him as I would any other patient in my practice. I asked about his health history and I asked about his family. He started to share some of the issues he was facing, at one point pausing to say “You don’t need to hear all this.”

I told them I did want to hear it, that it was important to know all of the issues in his life. We spoke for quite a while about his work, his wife and his children. We talked about the challenges of balancing family life and medical practice as well as the work required to maintain a healthy marriage.

I did my best to encourage him but found myself wondering if I had succeeded. It is one thing to give guidance about a medical issue. Encouragement about personal issues is different. There is a significant risk of offense or coming across as condescending, especially with a colleague.

A few weeks later I received an email from the doctor. In it he thanked me for the personal advice, telling me that one thing I shared had truly impacted him. He wanted me to know that my personal touch had made a difference and that he hoped I continued to encourage others in the same way.

His note accomplished its intended purpose. I was encouraged. He reminded me that I need never be afraid to love and encourage the patients that God brings to my office. In the midst of the making diagnoses and developingtreatment plans I must never forget that sometimes caring is the most important part of medical care.

-          Bart

Young and Without a Voice in Church

When Lisa and I were newly married we became a part of an adult group at church dedicated to our demographic. Each Sunday we gathered together with other couples under the age of thirty for conversation and fellowship. It was a remarkable group. It seemed almost everyone there had a passion for the Bible and knew it well. Several had degrees from Bible colleges and many had attended seminary. In this group my knowledge was unimpressive. I did not stand out at all.

In spite of the wealth of Bible knowledge and spiritual commitment there was something we lacked compared to young people today. None of us felt entitled to a voice in church leadership. No one talked about being an elder or leading a ministry and all of us accepted the fact that it was not yet our time. We knew we needed to grow and learn, that leadership positions were in our future, not our present. We were willingly taught each week by older men in their fifties and sixties, confident that they possessed wisdom and experience we lacked.

This is in stark contrast to the current young generation, many of whose members are quite antagonistic to mature church leadership. A friend of mine recently shared a post on why it is that Millenials are not going to church. Written by a Millenial, it unintentionally clarifies the arrogance of the current generation.

Here are some of the reasons given for young people turning away from the church-

-  Millennials value voice and receptivity above all else. When a church forges ahead without ever asking for our input we get the message loud and clear: Nobody cares what we think.

-  Millennials are told by this world from the second we wake up to the second we take a sleeping pill that we aren’t good enough. We desperately need the church to tell us we are enough, exactly the way we are. No conditions or expectations.

Throughout the post runs the theme that the current millennial generation has something special to offer, a special insight into the church and the culture that is being missed by the older generations. The author is confident in his assertions that older believers are driving younger believers away and believes himself to be offering effective solutions. He appears to be sadly blinded to the arrogance of his assertions.

When I was 24 the church didn’t care what I thought either. No one sought my input on anything. I didn’t mind because I recognized the truth- At the age of 24 my opinion wasn’t worth much. I lacked the experience and wisdom that comes with age. I understood that as a young person in church it was a time for me to hear and learn. The time for being heard and teaching would come later, if I was faithful. If I wanted a voice I could earn it through a life of service and godliness. Even though I was a bright young man at the time 30 years later I look back and see the foolishness of many of my young thoughts and opinions. Passion and commitment were not substitutes for wisdom and experience.

Millennials have grown up being taught that they are important and deserving of attention and praise. Parents and teachers have celebrated modest accomplishments. Christian youth have grown up in an "everyone gets a trophy" world that teaches them their youthful opinions matter, that they have something to say and deserve to be heard, and that they are enough "just the way they are." They have embraced this worldview without realizing that these are the teachings of the world and not the teachings of Scripture. Passages such as 1 Peter 5:5-6, “Young men, in the same way be submissive to those who are older. All of you, clothe yourselves with humility toward one another, because, "God opposes the proud but gives grace to the humble. Humble yourselves, therefore, under God's mighty hand, that he may lift you up in due time", are a clear reminder of how God moves within the church.

Just as Millennials are struggling with where they fit into the church so is the church at large struggling with how to respond to them. To the church at large I offer this warning- Do not try to appeal to or appease wrong thinking. The brilliant Christian author Michael Horton, in his book Ordinary, says it well-

“It is nothing new when young people want churches to pander to them. What is new is the extent to which churches have obliged. In previous generations elders- both officers and simply older and wiser members- wouldn’t let that happen. They took young people under their wing and taught them by word and example what it meant to begin to accept the privileges and responsibilities of membership in Christ’s body.”

Horton then identifies the core reason young people are abandoning church-

“For the first time in the history of the church it is now possible to go from the nursery to children’s church to Sunday school to the youth group and college ministry without ever actually having experienced church membership. Shocking surveys abound reporting that many of our children are dropping out of church by their college years. But maybe it shouldn’t be so shocking if they were never actually involved in church to begin with.”

The generation that has been taught it is all about them desperately needs to be confronted with that lie. It is not about them. It is about God. It is about what God says, what God proclaims and what God commands. God’s commands, while never burdensome, challenge our comfort and disrupt our lives. 

Bart

Thanks for reading and sharing. I can be followed on Twitter @bartbarrettmd, and many of my sermons can be watched on my vimeo page, www.vimeo.com/bartbarrett. In addition I am available as a guest speaker and can be reached through this website via the contact page.

The complexity of the Pre-Existing Condition Problem

I have several pre-existing conditions which are not covered by my insurance. I am signed up with Medi-Share, a health coverage co-op which is allowed to impose such restrictions. When I applied for the coverage I was told that my knees were not covered due my history of injuries and potential need for surgeries in the future. My anxiety disorder was also excluded. I signed up anyway.

I signed up because my private work-based "cover everything" Blue Shield plan cost $1800 a month for full family coverage. It also had a deductible of $3000 a month, which meant I would spend over $24,000 a year before I had any true health benefit. The Medi-share plan, in part because it restricts pre-existing conditions, cost $480 a month for a $5000 deductible. I decided that the $16,000 of premium savings a year was worth the risk of paying cash for future treatment on my knees.

I confidently made this bet because my pre-existing conditions do not require ongoing care. Unlike diabetics, cancer patients and patients with congenital conditions, I can go years without paying anything for my knees. In the event I do need such care it will not be urgent and I can re-enroll in another plan to get better coverage. If I need a knee replacement I can game the system and enroll in an ObamaCare plan in November, have the surgery in January, and disenroll in February. 

I am not the only person who has figured out that delayed enrollment may be the best financial option. Many healthy Americans are choosing to forego insurance completely. Because they know that they can wait until they get sick to buy insurance, or in the case of emergency know that emergency care will be given regardless of their ability to pay, they roll the dice and do not sign up for coverage. They pay cash for the occasional sick visit and save thousands of dollars a year. 

While this no-insurance decision is beneficial for these individual families it is devastating to the insurance industry and the health care system. All insurance industry profits come from healthy patients. As more and more of these patients drop out of the insurance pool insurers are increasingly struggling to cover expenses. The only option they have is to further raise their premiums, which causes more healthy patients to opt out. Patients with pre-exiting conditions, especially chronic diseases, do not have such a choice. They have to pay the higher premiums.

(I have heard many people say that the solution is to eliminate insurance company profits. As appealing as this option may seem, it will do nothing to solve the problem. The insurance industry’s profit margin is about 3%. Cutting this to zero would take only $30 a month off of a family’s $1000 premium. This is not the answer.)

The current system is designed to fail. Millions of Americans have health coverage through their employer. This is incentivized by a tax policy that makes this type of coverage a deduction to the employer and tax free to the employee. Individuals purchasing insurance on the individual market get no such benefit. When people with chronic illnesses leave their jobs they take their pre-existing conditions with them. When they try to buy insurance on the individual market they find insurance difficult to get and expensive.

ObamaCare attempted to address this by forcing insurers to cover pre-existing conditions. While this seemed nice, lawmakers ignored the reality that the money has to come from somewhere and that somewhere is from healthy patients. This has caused sky rocketing premiums in the individual market. Faced with such high premiums many healthy patients opt out of the system, resulting in even higher premiums.

The reason this failure is predictable is that this system results in the financial burden falling on healthy people regardless of income. Younger people are on average the healthiest people but they are not the wealthiest. The current law limits the ability of insurance companies to charge higher premiums based on age so the young and healthy are effectively subsidizing the health costs of older, sicker and oftentimes wealthier people.

ObamaCare attempted to address this by trying to force all people to buy insurance. Uninsured Americans are faced with penalties if they do not purchase coverage. Since the cost of the penalty is far less than the cost of insurance and is essentially uncollectable, this part of the law has been ineffective. Too many healthy individuals do the math and opt out.

Left out of all of the current laws and proposals is an important reality. All of the proposals I have read expect all healthy people to pay the same, regardless of income. This seems fair on its face, but is no longer feasible. Health care costs have reached the point where many families simply cannot afford the premiums. I am reluctantly left with the conclusion that we need a system in which contributions to health care costs are based more on income than they are on health. As people are not likely to do this on their own, I expect the ultimate solution will come as a result of a government program or tax.

As unpalatable as this is, if the remaining option is to limit insurance to only those who can afford it, it is a pill we will all need to swallow.

Bart

thanks for reading and sharing! comments are welcome!

 

The Stupidity of American Healthcare

I have watched in fascination this week as our broken political system has churned out yet another foolish creation, the passage by the House of Representatives of a useless healthcare bill that has no chance of becoming law. Dysfunction is bipartisan, as Republicans gathered at the White House to celebrate their lack of accomplishments and Democrats gleefully hung on to the sinking Titanic of Obamacare. Neither side offers a viable solution and the American people suffer.

How did we end up with such a mess? The answer is simple. We voted for it.

Conservatives crow about getting the government out of Medicine, stupidly ignoring the reality that 132 million Americans are covered under government insurance already (58 million Medicare and 74 million Medicaid). That amounts to 40% of Americans. I hate to be the bearer of bad news Republicans, but we will never get the government out of medicine. That ship has sailed.

Democrats ignore the failures of Government medicine, which is expensive, inefficient and for the 74 million Americans on MediCaid, of remarkably low quality. A large majority of the 180 million Americans who are not covered by the government rightfully fear the quality of their health care will decrease if they lose their private insurance.

Both parties seem to be angling for a solution that caters to enough people to keep them in power instead of a solution that addresses the fundamental problems that plague our healthcare system.

Republicans need to address the reality that health insurance is increasingly out of the reach of the typical American family. It is not uncommon for health costs to consume a massive portion of a family’s income. In Huntington Beach a family of four making $80,000 a year will pay $13,000 a year for health insurance. Rent is $30,000 a year and state and federal income taxes are $10,000. Basic math says that after taxes and rent, one-third of the family’s remaining income is health insurance! The average American family simply cannot afford coverage.

Conservative “solutions” such as allowing insurance to be purchased across state lines are farcical. The savings achieved will be so small as to be irrelevant. They hate to hear it, but the only way to lower costs is by lowering coverage in the form of higher deductibles and limited benefits. Wealthy families can afford to take such risks in a way that lower income families cannot.

Democrats need to address the poor quality care and service rendered under many government programs. Medicaid pays hospitals and physicians so poorly that access to care is severely limited. This limited access increases the use of emergency rooms for routine care, driving up costs. In many parts of the country, ObamaCare is failing. Iowa is down to one insurance provider and it is threatening to leave the state. Doing nothing is not an option.

Both parties stay on their side of the aisle and holler at the other, accusing them of abandoning the American people, ignorant that they are all to blame. Their refusal to work together to accomplish things for the people they were elected to serve is the reason we have an orange president.

Bart

Medical Advice from Vin Scully

Her life was at a crossroads. At the age of 27 she was barely making ends meet. She was working two jobs, at Disneyland and at an office, making just enough to pay her portion of the rent for the 2 bedroom apartment she shared with a roommate. With only a high school education she did not think she would be able to afford Orange County living much longer. She was debating moving back to her family home in New England. She did not have a job there, but she had family and a lower cost of living.

I asked her if she was going to school or had considered it. Her reply surprised and saddened me.

“I don’t have much self confidence,” she said, “I am afraid that I will not do well in school.”

It wasn’t just the reality of her low self worth that bothered me, it was the fact that her sense of worth was tied more to academic achievements and professional accomplishments than it was to who she was as a person. This attitude, when combined with her anxiety disorder, was paralyzing her. She felt badly about herself and she wasn't sure her fragile sense of self could withstand the threat of failure she associated with college.

I thought of how I could encourage her. I gained inspiration from an unexpected source. What came to mind were words I had heard Vin Scully, the great announcer for the Dodgers, say during a baseball game many years ago. The Dodgers had fallen behind after a fielder had dropped a ball. After commenting how the game would have been different if the ball had been caught, he said, “The saddest words of tongue or pen are those that read, ‘What might have been.’”

I shared the story with her, that regret at previous mistakes need not consume her, and that fear of future failings not lead to lifetime of regret, how sad it would be if later in life she found herself wondering how her life would have been different if she had only tried going to school. I encouraged her to consider counseling to help her overcome here low self-esteem, anxiety and fear.

I shared with her that I had similar self doubt when I started college. I thought I was smart enough for college but I was certain that I was no where near intelligent enough to pursue a career in medicine. I was interested in health care and, thinking I could be a registered nurse, signed up for a course in anatomy and physiology. The class included two weekly physiology lectures and a Wednesday evening anatomy lab course.

Each week in the lab included a quiz on the previous week’s instruction. To my surprise, I went 11 weeks in a row without missing a question. The professor recognized my potential and each week asked me, “Are you going to go to medical school?”

Each week I answered, “I can’t go to medical school.”

Each time he answered back, “You should go to medical school.”

His words stuck. A year later, after Lisa and I had been married for about 6 months, I found myself wondering, “Could I go to medical school?” The words of Vin Scully gave me motivation. I did not want my future self to look back wondering what might I been. I decided that I had to try. I feared failure, but I faced those fears.

I encouraged her to think about trying. It seems to me that failing to try is worse than trying and failing.

Bart