“More is Less,” the most recent radio episode of This American Life looks at the rising health care costs and asks who is to blame. Are doctors unnecessarily ordering procedures and prescribing medications? Are patients demanding costly services they don’t need? Are insurance companies doing little to keep the prices down? The short answer is yes, to all of them. It’s a fascinating listen and I recommend it highly.

All through the debate on reforming health care, something has not sit well with me and it is the fact that we as a society have arranged ourselves primarily as an economic entity. We make our choices based on our wallets and arrange our laws in such a way to reward and punish behavior financially. Many of the solutions discussed for health care reform have to do with how we address the market—tweak it, leave it alone, etc. But is health care really just a basket of goods and services that can and should be understood in purely economic terms? I don’t have a real answer for this, but I’ll give you some examples of why I see a purely economic view of health care as one that breaks down. These have to do with the fee-for-service aspect of health care.

My wife has a family friend who was a surgeon in the U.S., but due to increased insurance costs, decided to practice medicine in New Zealand, where the state pays for the vast majority of health care and patients are not allowed to sue their doctors. The growing cost of malpractice insurance created disincentives for him to continue practicing medicine in the U.S. In New Zealand, he and his staff were paid flat salaries for their work. He expressed a frustration over the fact that he was not doing nearly as many surgeries per day as he did in the U.S. Because the staff was paid a flat salary, there was no economic incentive for them to work faster and do more surgeries in a day. They were paid the same if they did three operations or seven in a day. This surgeon knew there were dozens of people in the queue waiting for these surgeries and it bothered him that his office could work faster, but people simply chose not to. If we do the math, they were actually paid more per unit of work and time if they did less procedures.

On the other hand, when we go to a fee-for-service model like one we have in the U.S., there are economic incentives for doctors and staffs to do more procedures, to see more patients. (Though the U.S. patients hava a longer wait-time to see doctors than in many countries with single-payer health care, which I don’t completely understand.) This model encourages efficiency and competition. It also exacerbates the issue that nearly 30% of health care spending in the U.S. is wasted. By paying more for more procedures and paying more for costlier and riskier procedures, we have created economic incentives for doctors to order unnecessary and expensive tests, operations, medications, etc. That is not to say all doctors do write unnecessary orders just to make money, but in our system the temptation is clearly there and the practice is clearly rewarded financially.

I’m not opposed to economics playing a role in health care. At the same time I am uncomfortable with changes in our health systems happening using purely economic tools. I don’t have real answers to the problem, this is just an aspect of the debate that has had me thinking for a while.

Any thoughts?

Yesterday, I listened again to Krista Tippet’s interview with Jaroslav Pelikan on Speaking of Faith: The Need for Creeds. Later in the day, I did some reading of Pelikan on the internet. Two quotations of his have been ringing in my ears. The first I found on numerous pages:

If Christ is risen, nothing else matters. And if Christ is not risen—nothing else matters.

The second quotation comes from the Speaking of Faith interview. As Pelikan and Tippet discussed the Maasai Creed, he refers to the important feedback loop evangelism creates. As we reach out and express the Christian story in ways that make sense to different cultures, we find that we understand new aspects and see new angles of the story.

[I]t is not enough to Christianize Africa. We have to Africanize Christianity.

Unpacking the riches in these two quotations could take a lifetime.

NPR is streaming the entirety of Radiohead’s August 28 concert at the Santa Barbara Bowl. I’ve only seen them perform live once, back in 1998, and I missed their recent Southern California shows. Thanks to NPR for providing us with the opportunity to hear these geniuses.

Today, ESPN Radio is going to air Senator George Mitchell’s press conference on steroids in Major League Baseball live (2pm EST) and hours of commentary on the Mitchell Report afterwards. I’ve had a bad taste in my mouth for years, but have held off on my indignation until they disclosed the Report’s findings. Shame on the players who cheated, the Players Association for defending the cheaters while they mocked the game, and the owners and Commissioner’s Office for allowing this crap to happen.

I’m reminded of the following interaction in F. Scott Fitzgerald’s The Great Gatsby:

“Who is he anyhow—an actor?”

“No.”

“A dentist?”

“Meyer Wolfshiem? No, he’s a gambler.” Gatsby hesitated, then added coolly: “He’s the man who fixed the World’s Series back in 1919.”

“Fixed the World’s Series?” I repeated.

The idea staggered me. I remembered of course that the World’s Series had been fixed in 1919 but if I had thought of it at all I would have thought of it as a thing that merely happened, the end of some inevitable chain. It never occurred to me that one man could start to play with the faith of fifty million people—with the single-mindedness of a burglar blowing a safe.

“How did he happen to do that?” I asked after a minute.

“He just saw the opportunity.”

For those who don’t know, Sufjan Stevens is streaming his five Christmas albums over on the Asthmatic Kitty website. Take a listen to awesome renditions of classics, often with interesting twists on their titles. (I’ve put the title of the album on which the songs appear for easy reference.) “Away in a Manger” (Vol. 4, Joy) with a banjo? Fantastic! “Holy, Holy, etc.” (Vol. 1, Noel)? Splendid! “O Come O Come Emmanuel” (Vol. 3, Ding! Dong!)? It’ll make you cry. He busts out nearly obsolete carols and hymns like, “I Saw Three Ships” (Vol. 2, Hark!) and “Lo! How A Rose E’er Blooming” (Vol. 5, Peace) with such gentle craft that you wonder why they ever went away. And then there are his original compositions. I recommend “Put the Lights On the Tree” (Vol. 2, Hark!), “Come on! Let’s Boogey to the Elf Dance!” (Vol. 3, Ding! Dong!), “Did I Make You Cry On Christmas Day? (Well, You Deserved It!)” (Vol. 4, Joy), and “Get Behind Me, Santa!” (Vol. 5, Peace).

Listening to these songs gets me in the right Christmas spirit, i.e., a worshipful and awed posture in considering Jesus’ incarnation. I think Stevens has created some of the best Christmas music of the past few decades. Actually, one could argue it’s the only good original Christmas music from a major artist for decades—admittedly, some good covers of classic songs do exist. If you want to argue that Paul McCartney’s “Wonderful Christmastime” should be considered as a good original Christmas tune, you’re going to get a knuckle sandwich from me. To employ a phrase from Anne Lamott, that song makes “Jesus want to drink gin straight out of the cat dish.”

The second installment of internet listening comes from the awesome public radio show, This American Life. The show takes a subject and tries to look at it from different angles using stories, interviews, and works from artists. In the episode I recommend for this post, This American Life explores the topic of superpowers. The funniest story comes from act one: Hawkman vs. Invisible Man. John Hodgman narrates this act. Hodgman is the PC from those “I’m a Mac, and I’m a PC” commercials, and more importantly, the Resident Expert over at The Daily Show. He says that when he meets people, instead of asking them what they do for a living, he asks them what they would choose: the power of flight or the power to turn invisible. In the thirteen minute vignette, we hear answers, questions, inner debates, and explanations from several different people. So many people ask such similar questions that Hodgman has had to make up ground rules for these powers—you can only fly within the Earth’s atmosphere at a maximum speed of 1,000 mph, anything you’re wearing also turns invisible but you cannot turn other things invisible just by touching them, etc. You can find the link to the audio on this page.

So, what would you choose, invisibility or flight?

It’s flight without hesitation for me. Never mind how cool it would be, imagine the savings in transportation costs. Also, as one of the interviewees put it, “Flying is for people who want to let it all hang out. Invisibility is for fearful, crouching…” Well I won’t ruin that statement and will let you enjoy it in its fullness.

This post is the first of a new series. A huge perk of my job is that I get to listen to a lot of different podcasts. I want to start sharing some of my favorites. My first offering comes from the wonderful Public Radio show, Speaking of Faith. In this episode, host Krista Tippett interviews Armenian theologian Vigen Guroian on Eastern Orthodox Easter and liturgy and how the Eastern Church traditions offer a more sensory worship experience, that is both “more mystical and more earthy than the Christianity dominant in Western culture.” Guroian wants us to “restore our senses” and draws from his experience in his garden. His description of gardening is almost enough to make me want to dig my hands into some soil.

Click the link to find streams or downloads of the podcast: “Restoring the Senses: Life, Gardening, and an Orthodox Easter.”

Speaking of Faith is one of the most consistently interesting and engaging shows on the radio. Tippett proves to be an outstanding host in that she shows that she has clearly done her homework and treats each guest with an appreciative interview style. Tippett is able to both bring in newcomers to the conversation as well as let the guests develop their statements beyond a cursory introduction. (Vigen Guroian also offers us a vision of what Eddy Ekmekji might look like in the future.)