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Posted by Dr. Lachlan Forrow September 18, 2013 06:14 AM
Almost every story these days about health care reform gives the impression that Americans are deeply, if not hopelessly, divided -- steps toward implementing the Affordable Care Act fight daily with calls to "Repeal Obamacare!", even if that means threatening to shut down the whole government.
And when the issue touches on approaches to "cost containment", rational conversation seems almost impossible.
But last night a diverse group of Boston-area faith leaders, supported by a standing-room-only crowd of members of their diverse congregations, proved that faith communities have the potential to help us chart a united path forward that our elected political leaders too often seem incapable of finding.
An article about the planned gathering in The Boston Globe, titled "Clergy Push to Curb Health Costs", observed that "The next big movement in Massachusetts health care may come not from the state’s world-famous hospitals or its cutting-edge research labs, but from houses of worship."
When many of us think about diverse religious perspectives on controversial issues, words that often come to mind are "dogmatic" and "divisive". "Rational conversation" usually does not.
But last night, the Greater Boston Interfaith Organization (GBIO) convened a remarkable, and remarkably honest and rational, discussion at Temple Israel titled Health Care Cost Containment "Interim Accountability" Action. Participants included health system CEO's from Partners (Gary Gottlieb), Steward (Ralph de la Torre), Boston Medical Center (Kate Walsh), and Beth Israel Deaconess Medical Center (Kevin Tabb); insurance leaders from Blue Cross Blue Shield of Massachusetts (Andrew Dreyfus), Tufts Health Plan (James Roosevelt), Neighborhood Health Plan (Deborah Enos), and CeltiCare (Jay Gonzalez); leaders of the state's Health Policy Commission (Executive Director David Seltz and Commission member Paul Hattis), and the state's Center for Health Information and Analysis (Executive Director Aron Boros).
A core theme for GBIO leaders is "We are not just consumers" of health care -- this is our health care system, including at the most hard-nosed level of money. And they are right.
Every dollar in our health care system comes from the people it is (or should be!) designed to serve -- whether through directly-paid insurance premiums, or through taxes paid that provide every penny of Medicare, Medicaid, or other publicly-funded programs, or through employer-based health insurance that ultimately comes out of our paychecks. Because it is our lives and health that are at stake, and because it is our money, GBIO leaders insist that decision-makers need to understand that they are ultimately accountable to us.
GBIO President Reverend Burns Stanfield began his introductory remarks by expressing deep gratitude for the superb care that a family member has been receiving at a Boston hospital for a serious illness. But he then held up a thick -- a very thick -- stack of papers, which he explained were the bills for that care. He expressed gratitude that the bills had been paid by the health insurance he has as a church employee, but admitted that he and his wife had not even tried to understand all the details.
As Reverend Stanfield then said, "the temptation with something as complicated as health care costs is to leave it to someone else to figure out. But we can't afford to do that." Why has GBIO engaged so passionately on this issue? He gave three reasons:
1. Because it matters.
This complicated issue of health care costs matters a lot, he said, to all of us: "40% of the state budget goes to health care costs, and if we do not control health care costs, we lose our ability to support education, transportation, public safety, and all of the other things we care about."
2. Because we can do something about it.
Yes, these issues are complicated, he said, and it takes people who are "wicked smart" to understand them. But, he said, "we are fortunate -- we are blessed -- because in our pews we have amazing leaders who are wicked smart", and building from our faith perspectives, "we have a distinct capacity, and a distinct calling, to do something."
3. Because success requires accountability
This gathering, he said, was only the first in an ongoing process through which GBIO and other organizational partners will continue to insist on open, explicit accountability for health care cost control -- accountability to the people of the Commonwealth, whose money it is that is being spent.
During the evening, the energy from the overflowing, standing-room GBIO audience was at times almost electric. On several occasions, whether in response to a Jewish rabbi, or a Christian pastor, or an Islamic imam, the united voices of the diverse interfaith attendees called out in a loud "Amen" to express their agreement and solidarity. It reminded me of Albert Schweitzer's comment on religion: "Spirit Unites; Dogma Divides".
As I listened, it struck me that all three of Reverend Stanfield's reasons why GBIO is so passionately engaged about health care cost containment apply at least as powerfully to the challenges of ensuring excellence in the care of patients near the end of life. So I was delighted that my own hospital's leader, BIDMC CEO Dr. Kevin Tabb, explicitly appealed in his prepared remarks to GBIO to help in this area, given the vast sums of money currently spent on caring for people in the last months of life. He said it would be invaluable if faith communities could take a leadership role in statewide discussions of how we can do better in end-of-life care, including but not at all limited to helping ensure that we are spending our money in this area as wisely as possible.
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About the authorLachlan Forrow, MD is Director of Ethics Programs and Director of Palliative Care Programs at Boston's Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School. More »
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