“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?

40 years ago today, Apollo 11 launched from the Kennedy Space Center to make its journey to the Moon. It marked the beginning of a journey that was the culmination of hundreds of thousands of peoples’ work and passion. I wish I was alive to see the launch and landing. It’s amazing to me that the missions to the Moon still evoke awe and wonder in us. It seems we could use a worldwide jolt of awe and wonder now. Check out this site: We Choose the Moon. It recreates the Apollo 11 mission in real time. Very cool.

This past Sunday, the Christian calendar marked the Ascension of the Lord (I know, it was really on May 21, but I’m a part of a protestant church that doesn’t go to worship services throughout the week, so we celebrated it on the Sunday). This weekend was also Memorial Day weekend in which people in the US remember those soldiers and sailors who died while in military service. I wonder how many congregations in the US made some mention or had some special moment in the service for Memorial Day this past Sunday, but did not mention or did not observe the Ascension?

From the essay, “Seminarians,” by Martin Marty in the most recent Sightings:

We historians are not given the gift of foreseeing, but as for seeing – as in Sightings – I learned long ago to look at trends and signs that don’t fit headlines or on cable. Thus, decades ago, while many chroniclers thought that “death of God” theology was a cosmic challenge, it occurred to some of us that “high-rise apartments and the long weekend” would do more to assault the world of Sunday Schools, church attendance, and the parish as a center of communal life. Today those trends continue, and the higher-rising of apartments and the longer-yet weekend keep playing their part. Forget the current “new atheism,” so readily reported on as an assault. Notice instead patterns of leisure like Sunday marathons and soccer, patterns of work in which 24/7 job demands increase, and now, of course, “the economic crash” that colors all prospects.

A couple of friends have posted this story on Facebook. CNN reports:

The more often Americans go to church, the more likely they are to support the torture of suspected terrorists, according to a new survey.

More than half of people who attend services at least once a week—54 percent—said the use of torture against suspected terrorists is “often” or “sometimes” justified. Only 42 percent of people who “seldom or never” go to services agreed, according to the analysis released Wednesday by the Pew Forum on Religion & Public Life.

White evangelical Protestants were the religious group most likely to say torture is often or sometimes justified—more than six in 10 supported it. People unaffiliated with any religious organization were least likely to back it. Only four in 10 of them did.

I find these results disheartening. Is it really true that the more people are supposedly exposed to the story of an incarnated and crucified God, the more likely they are to support torturing others? (The outliers seem to be the mainline denominations who do not support torture as much as their evangelical and Catholic family.) I cannot think of any real Christian justification for torture. Over on First Things—a journal no one would consider a bastion of liberal Christianity—Russell E. Saltzman roots his rejection of torture in a human being bearing God’s image:

I’ve been trying, like many Americas, to think this thing through. There is the altogether practical question: Did torture help us? Did it make America safer? Was the information really good, helpful, in thwarting terrorists? Did it actually in fact spoil pending plots? Frankly, the evidence is mixed.

But I really don’t care. Whether torture “worked” or not as an interrogative tactic is far from the main question. I’m a pastor. I think as a pastor, which is to say as a parish theologian. I don’t care if these guys shrieked like little girls on the playground and blubbered out plots for everything from the St. Valentine’s Day Massacre to knocking over Bagdad candy stores as juvenile delinquents. Torture is morally wrong. It is morally wrong, theologically speaking, because it is an attack upon the imago Dei, upon the image of God inherent to every human life.

One could just as easily rooted a rejection of torture in the words and actions of Jesus. “Love your enemies, do good to those who hate you.” (Lk 6.27) How in the world can we worship a savior who endured the torture of lashings, a crown of thorns, nails in his hands, and crucifixion and think that it is morally acceptable to torture someone else? For those who have ever asked, “What would Jesus do?” can you really imagine that Jesus would strap a person to a board and subject him or her to “controlled drowning”? In mounting a Christian defense against torture, one could have used Paul and Peter as well: “Do not repay anyone evil for evil, but take thought for what is noble in the sight of all.” (Rom 12.17) “Do not repay evil for evil or abuse for abuse; but, on the contrary, repay with a blessing. It is for this that you were called—that you might inherit a blessing.” (1 Peter 3.9) I am outraged. I am outraged that my country would torture others and I am outraged that my sisters and brothers in the faith are more likely to support torture than the general public.

My Christian family’s support of torture is a terrible witness to the watching world.

Did people watch Jon Stewart eviscerate Jim Cramer on The Daily Show? I enjoyed his reporting and mocking of the spat all week, but his interview with Cramer displayed the serious intelligence behind The Daily Show. Forget what Keith Olbermann may say about himself—Stewart is our best version of Edward R. Murrow, except in a jester’s costume. Stewart’s interview with Cramer is decidedly, intentionally, and appropriately unfunny. I’m curious to see what happens to Cramer’s career after this interview. Many people think that Stewart’s serious lambasting of Crossfire led to that show’s demise.

President Obama’s recently signed an order lifting the ban on government money funding embryonic stem cell research. USA Today reported,

The audience burst into applause at several points when Obama implicitly rebuked former president George W. Bush for what opponents have characterized as making decisions based on ideology rather than sound science.

I won’t comment on the order signed by Obama. I want to use this matter as an illustration of a fallacy in our thinking. Those who have criticized President Bush for “making decisions based on ideology rather than sound science” are not without an ideology themselves. Their beliefs of what constitutes “sound science” and how science should shape how the government funds research follow an ideology. Everyone holds ideologies, especially when it comes to areas of morality and politics. Ideology is a neutral term. An ideology comprises a set of beliefs, values, and doctrines that guide a person or group and I can think of no one who is void of ideology. I am fond of saying everyone has a theology because everyone has some beliefs about divinity. The person who does not believe in a divine being, or the person who says there is no way we can truly know if there is a divine being, hold as much a theological position as the Christian who recites the Nicene Creed. Ideology works the same way. The most pragmatic utilitarian position that seeks to do the least amount of harm for the least amount of people adheres to an ideology. To criticize someone for letting ideology guide their decision-making is a rather weak argument. The question is not will we let ideology shape our public policy, but what ideologies do we let shape our public policies?

We may disagree vehemently with another person’s ideology, but it gets us nowhere to criticize the person for being ideological. Each ideology has non-negotiable points and we can debate whether those non-negotiables do more harm than good. Even a total laissez-faire attitude comes from an ideology with strong non-negotiables. The amount of non-negotiables in an ideology, the positions of an ideology, how stridently that ideology requires adherence, all these matters are open to critique. So is the way in which a person chooses to conform to the ideology. In other words, to criticize someone or some position for being “ideological” does not get to the heart of the matter because there is no such thing as a non-ideological person or a non-ideological position. When people criticize others for being ideological, they are really criticizing the ideology’s non-negotiables for being wrong, or they are criticizing others for being unwilling to listen to different information. We should not strive for an ideology-free society—as if there ever could be one—but a society that values and adheres to good ideologies.

Steven Thomma, in a March 5, 2009 article for McClatchy Newspapers, writes a needed story in the midst of all debate regarding government spending: “It only looks different: Both parties love big government.”

Republicans say they’re outraged that Obama would “borrow and spend” his way to a new behemoth government. But they borrowed and spent their way through the ‘80s and the current decade. And they love big government — when it’s at the Pentagon.

Democrats from Obama on down insist that they don’t like big government, that they’re just forced into a temporary spending spree by the recession. But Democrats love big government as well, when it’s for social programs such as universal health care.

“The basic difference between Democrats and Republicans in recent decades is which aspect of government spending they prefer,” said Steven Schier, a political scientist at Carleton College in Northfield, Minn. “With the Republicans, it’s defense. With the Democrats, it’s education, environment, health care etc. That’s been the major difference between the two parties going back to Reagan.”

The numbers tell the tale.

In his eight years, Republican Ronald Reagan increased government spending by 69 percent, led by a 92 percent increase in defense spending as he built up the military to confront the Soviet Union. (These numbers aren’t adjusted for inflation.)

With the economy growing by the time he left office in 1989, the size of the government as a share of total economic production had shrunk slightly, from 22.2 percent to 21.2 percent.

Democrat Bill Clinton increased government spending by 32 percent from 1993 to 2001, brought down largely by the rapid slowdown in defense spending after the Cold War ended. Defense spending grew by just 4 percent during the Clinton years.

The combination of restrained growth in government and a booming economy meant that government’s size as a percentage of the economy dropped from 21.4 percent to 18.5 percent in the Clinton years.

George W. Bush boosted government spending by 68 percent in his eight-year presidency, spearheaded by a 126 percent increase for defense as he waged wars in Afghanistan and Iraq. Bush’s spending totals don’t include the $700 billion bank bailout added last fall to his final fiscal year, or the $787 billion stimulus package added early this year.

By the time he left office, Bush’s government had grown as a share of the economy from 18.5 percent to 22 percent.

While he relies on optimistic assumptions about the economy, Obama forecasts that he’ll raise spending this year and next, then ratchet it back until it again represents 22 percent of the economy at the end of his first term.

In the January 19th edition of Sightings, Martin Marty takes the opportunity of the transition of power to reflect on who we as Americans want to be.

The text for our meditation is something the late columnist Mike Royko wrote when he bade good-bye to the presidency of Lyndon B. Johnson. My Royko books are in storage and what he said was not lifted up by Google and other search engines, but it was etched in my mind, and I hope that my reproduction is faithful. It went something like this: “Farewell, President Johnson. You weren’t the best president a people ever had, but we were not the best people a president ever had.”

This season people are still debating whether President Bush, who, I think, is being mentioned in this column for the first time on his last day in office, is “the worst president a people ever had,” and I don’t think we are “the worst people a president ever had.” But Inauguration Day is a good time to reflect on “what kind of people we have been” and “what kind of people might we wish to be and might become.”...

What kind of people do we want to be with a new president who has such lofty ideas about what he wants to be? A sermon: We might do better if we aspire to be good rather than claim to be good; if we become a self-claimed godly people who serve God more than we boast about our goodness; if we spend less time fighting over who prays when and where and how, and let the intrinsic value of praying speak for itself….

What kind of people do we want to be? A people not paralyzed by fear and insecurity in the face of fearful threats; a people more dedicated than before to the education of all and health care for all; a people concerned with the environment given – many of us say – by a generous Creator; a people concerned for the rights of others. In four or eight years we hope to bid our now-new president farewell upon his retirement: “Farewell. Your and our record is mixed, but there is good in it. And you and we and the people we affect can live with that.”