Seeking Justice in Health Care

Dr. Myron Glick - A Transcription of his speech delivered at 2012 Imprint Buffalo hosted at Westminster Presbyterian Church, Delaware Avenue, Buffalo, NY

Martin Luther King in 1966 said “Of all the forms of inequality, injustice in health care is the most shocking and inhumane” (King Jr.). In 2012 I still see this injustice every day in our work at Jericho Road.

Many of the folks in the community served by Jericho Road are uninsured, on Medicaid or are refugees. Most are poor. Almost every day we have someone call us or walk into our office with a story that breaks your heart and that is unbelievable, but true. In a city with many eye doctors I have seen a man walk in blind because he was uninsured and could not afford to pay for cataract surgery. I have diagnosed lung cancer and have watched in dismay as my patient calmly told me he had decided not to undergo treatment because he did not want to leave his family with the hospital bill to pay. I have had to listen to a middle-aged married couple of 25 years who discussed the possibility of obtaining a divorce so that they would qualify for Medicaid and would be able to afford their medications. I have examined a man with an inguinal hernia larger than a football who refused to go to a surgeon to have it repaired because he knew he could not afford to pay the bill. I have watched a 50 year old man who is suffering from liver failure and every week his belly fills up with acidic fluid and yet he refuses to stop working because he knows if he loses his job he will be unable to afford his health insurance and then will be unable to pay for his life saving medical care.

In Erie County, where Jericho Road is located, there are over 100,000 uninsured and in America over 50,000,000 people who have no health insurance. A study published in the American Journal of Public Health in December of 2009 estimated that 45,000 people die every year in the USA simply because they lacked timely access to medical care. There is little justice in our health care system. The poor who have Medicaid insurance are often discriminated against and their access to health care is limited. A study published in the New England Journal of Medicine in May of 2011 examined the availability of specialty care for children with a variety of urgent medical problems. They had trained researchers pose as mothers of these sick children and call to make an appointment with the specialist. They made two calls to the same office. First, as a mom with Medicaid insurance and then as a mom with private
medical insurance. They found that 66% of callers who had Medicaid insurance were denied an appointment as compared to 11% of callers with private insurance. Even when they found a medical office who would accept Medicaid and private insurance the Medicaid caller needed to wait 22 days longer for the first appointment to the same office with the same urgent problem. This is not justice.

Injustice in health care is also illustrated by the disparity of health outcomes between the poor and the rich. Too often people living in under-resourced communities suffer from higher rates of chronic disease such as asthma, diabetes and obesity. They die younger and suffer more chronic disabilities. In these communities the social determinants of good health are strained and so the health of the people suffer. For example, In Buffalo we see higher rates of asthma in the mostly poor community that is next to the Peace bridge. This bridge has lots of truck traffic and as the trucks idle waiting to cross the bridge the exhaust fumes cause poor air quality and higher asthma rates. We see refugee children with high lead levels because they are living in old beat up houses. Obesity is common in the community we serve but playgrounds, parks and grocery stores with fresh fruits and vegetables are rarely found. Injustice and inequity in the community is a major contributing cause of the poorer health outcomes of the most vulnerable people we see every day at Jericho Road. Poverty is not good for your health. It can kill you.

I believe that the heart of God must be profoundly grieved by the injustice in our health care system.
Justice is broadly defined as the quality of acting with “fairness”, impartiality and with equality towards others. To give each person equal protection under the law. To provide each person with basic rights. The Biblical idea of justice is closely related to that of righteousness. In fact the Greek and Hebrew word for these two concepts are essentially the same. Righteousness and justice in the scriptures demand the individual person to live a life of moral uprightness and to treat others and especially the poor in a fair manner. But this concept of personal righteousness is expanded to challenge nations to also act with justice and righteousness towards others. Biblical justice is both a personal and community responsibility. Jesus acted and spoke in ways that showed His commitment to justice. By healing the sick, feeding the hungry, casting out demons, touching the leper, befriending the prostitute, walking among the poor and calling people to be His disciples His life is a vivid example to all of us about what it means to live in a just and righteous manner.

Jesus showed compassion to the poor. Jesus told stories like the Parable of the Good Samaritan in Luke 10 with which he challenged the rich young ruler to “Love his neighbor as he loves himself”. In this story a man is beaten up and left for dead along the Jericho Road. First a priest and then a teacher walk by and see the man almost dead and hurry on leaving him to suffer alone. Then a Samaritan man, whose people are sworn enemies of the man who is lying half dead, passes by and instead of hurrying on he actually stops to help, puts him on his donkey and takes him to a hotel where he pays for all that the man needs to become healthy and whole again. This man, Jesus says, is the true neighbor and has acted in a just and righteous manner. Jesus asks us to “Go and do likewise”. In Luke 6:31, Jesus echoes the great saying that has been passed down through the ages that speaks to the heart of what justice is really all about: “Do to others what you would have them do to you”. To me that simply means that if my mother is sick and dying I would want her to have the very best health care available. In the same manner then I should treat every one who is in need of health care as if they were my own mother. These words of Jesus that call us to “love our neighbors” and “do unto others as we would have them do to us” are the foundation of Biblical justice.

What then should a follower of Jesus do? How can we make a difference? At Jericho Road we have tried to create a model of care that is welcoming to the poor, the uninsured, refugees and the people who are most vulnerable. This means accepting all insurances, including Medicaid and having an income based sliding scale fee schedule for uninsured patients. In 2011 69% of our patients had medicaid insurance and 12 % had no medical insurance. Our commitment to the under served means that we are determined to treat everyone with respect and to show mercy and compassion and  acceptance. We are determined to provide excellent quality care even with limited resources. Our goal is to provide the same care to each patient whether they happen to be the President of the United States or a refugee who just arrived in Buffalo from a refugee camp in Kenya. We become advocates for our patients to help them navigate the health care system outside of our office. So we need to find specialists who will see our patients, obtain timely tests and services as needed. This requires great persistence on the part of our team. At Jericho Road we also have developed many programs that are designed to address the social determinants of health and combat poverty. 

Programs that promote financial literacy, healthy pregnancies, preschool language development, home ownership and refugee empowerment are vitally important components of our model of care. We simply believe that this is what Jesus would do and so we are determined to do it, no matter the cost.
But what we do at Jericho Road in delivering this model of care is not enough if we are to see justice in our health care system. It is vitally important for those of us who follow Jesus to advocate for changes in this failed and unjust system. We need to figure out ways to allow the voices of the people who are suffering to be heard. Many times the people in power who make decisions, such as people in Congress, have no clue of what it is like to be sick and have nowhere to go for help, or have a painful toothache and have no access to a dentist, or see a loved one die without getting the needed care.

We must be the voice of those who cannot speak. Telling the story is a powerful way to advocate for change. We must tell the stories. It is also time to challenge the Church to care more deeply about the injustice and inequality that we see on the front lines of health care every day. Followers of Jesus meet every Sunday to worship God. Too often the leaders of the Church do not confront or even speak about the great injustices of our time. I do not imagine the Jesus Christ of the early Christian church would have been silent. Nor should we be. It is time for the Church to regain its prophetic voice and
speak out against injustice in health care. Finally, I believe it is important to advocate at a national level for systematic change. Vote for leaders who will bend the curve towards justice in health care. Advocate for policy changes that provide for health care coverage for more people, that seek to improve the communities of the poorest and most vulnerable. Speak out. You will be heard.

In the last two thousand years, followers of Jesus have courageously shown us the way to live a life that counts. The early disciples of the Christian church came from all levels of society and bravely formed a community of believers who loved each other. Basil the Great witnessed the sick being cast out of his city and left to die and so he built a refuge for the outcast and sick that society had rejected. Saint Francis of Asissi gave up great personal wealth to live among the poor. Florence Nightingale acted with great compassion as a nurse and her courage helped to found the modern hospital. William Wilberforce witnessed the atrocity of slavery and the silence of the Church and so he determined to use his influence to lead the movement to abolish slavery in England.

Dietrich Bonhoeffer was a German theologian who stood up against Nazi Germany while most of the rest of the Church was silent and it cost him his life. Martin Luther King was a pastor in the segregated south who had the courage to find his voice and in so doing led the Civil Rights movement and changed the course of our nation. Mother Theresa gave her life to the poor of Calcutta. These followers of Jesus all led lives of great courage and sacrifice and in so doing have bent the curve towards justice and righteousness. Now it is our time to confront with courage the great injustices of our time. May we as modern day followers of Jesus at Jericho Road stand with these saints of old and alongside the prophet Amos and work together for the day when “justice will roll down like waters and righteousness like a mighty stream.” For the day when justice and righteousness are restored in our nation’s health care system and all people are treated as if they are created in the very image of God. This is what we will continue to stand for as Jericho Road Community Health Center.