The Cost of Compassion

Remember when Obamacare was the greatest scourge that could be brought upon the earth?  Remember the cries of oppression fueled by the insurance lobby?  Remember?  Remember the person holding the sign, get government out of my Medicare?  Remember?  Seems like a world ago. 

The political frenzy has moved on.  Now, voting, voting rights, January 6th, stop the steal, abortion, climate: those are our battles now.  Who cares about healthcare?   

We have moved on. But the need for reform hasn’t.  Healthcare, or more directly how we finance healthcare, is just as much in need of reform as it once was.  Even more so I would say.  But how can you discuss the reform of healthcare during a pandemic?  

Seems a bit tone deaf.  Yet, I don’t want to miss this moment.  Maybe it won’t make a difference, but our reading today, the healings at Gennesaret, this little throw away story is the key to health care reform.  Might not be the best time to bring it up, but here it is.  The healings at Gennesaret are a light to shine on our broken system.  And healthcare in America has been broken by greed. 

Serving on a hospital board for 12 years I learned a lot.  It really was a kind of accidental MBA.  Things are complex with 2000 employees and an annual budget of a quarter of a billion.  And your decisions count when it is real lives.  And this was just a small, rural hospital; I can’t even fathom how complex Robert Woods Johnson is.   

No matter the size and scale, the personnel and the policy review, the audit and compliance, no matter if it was clinical issues or union disputes, the battles in a hospital boardroom, all of them, are always the same.  All things come down to a fight between compassion and greed. 

No matter how if it’s how many doctors or how to keep nurses or where a clinic should go, even the type of food in the cafeteria: it will at some point, on some level, become a contest, a battle between compassion and greed.   

And the battle is not a one and done, once and for all, winner take all.  The battle is for leadership.  Will greed guide your decisions or will compassion guide your decisions? Sometimes compassion wins.  This is true.  But for the most part greed too often prevails. 

This battle is really something to see.  I want to say one of the most fascinating moments where I saw this play out was the design of a new hospital wing, a patient pavilion.      

I was on a committee to select the design for a new hospital wing.  Each architect who presented made clear how their design reflected the needs of the community, how it was a unique vision.  And then, each architect went out of their way to explain how they are all trying to do the same thing.   

Each firm spoke to the shift in design for hospitals in general.  Medical facilities shifted from designs based upon economic utility to welcoming space.   

In the sixties and seventies hospital design was to maximize space (most people in the least space) where efficiency was achieved by eliminating privacy (soft walls/curtains with shared floor space).  Think dormitory, prison, storage. 

If you have been in a new hospital, you know the markers of welcoming space: privacy, sofas and large chairs that recline, and soft colors with artificial plants and coffee stations.  Think day spa, hotel.   

The basic parts of the patient room, though, were still the same.  Bed, chair, bathroom, curtain, window, utility sink, closet, and lots of outlets.  The parts were the same but the direction or scheme or intention of how the parts were put together was radically different.   

At first glance, you might think compassion was winning the day here.  Greed is easy to see in storage model, but day spa?  

There is compassion here for sure.  Again, it’s not one or the other.  The change to welcoming space looks like compassion, but in the end, it was really a new way of maximizing profits.  Softer colors and coffee stations, couches and chairs that allow family to stay for a long time, even privacy, all meant to increase the bottom line.   

This may sound cynical, but it is not meant to be.  You can’t eliminate greed.  But you need to be mindful if it is winning the day.  Does greed guide you? 

You need a hospital to turn a profit, to be financially healthy.  And to that end, you increase the likelihood of customer satisfaction through hospitality.  Comfortable people write better reviews and raise your brand.  Privacy, private rooms, reduces the likelihood of hospital borne infection and thus allows for quicker discharge, which is a complicated set of regulations all meant to lower costs to the state government.   

The real cost potential, though, is introducing family into care.  In the past hospitals maintained a hard line between the professional caregiver and the family.  Think back to visiting hours and the expectant father kept at bay.  Now, the family is not out there, they are everywhere, encouraged to stay, shown where extra blankets can be found.  The hard line softened when studies showed how much cost saving was possible with family involved.  Family is free labor.  Greed likes free labor. 

Even though compassion may not be leading here, it is not lost altogether.  Family is really the key to improving hospital stays.  Family knows you; they can advocate and care and encourage.  Families are not always helpful, true.  But for the most part, they are the game changer of care. And so, design the hospital room with family care as the goal.  Make the room big enough that three daughters can sit with a dying mother, parents can sleep in a recliner with a sick kid, put in a couch so a husband can ask his wife, “four letter word for good soil, starts with L.” This improves care and the bottom line. 

On the lakeshore in ancient Galilee, we may not see the battle as clearly as in the design of a patient room in a hospital.  But there was a battle going on.  A battle much like the one in healthcare finance reform today.   

On the lakeshore the people came to Jesus.  And not just some people, or a select few.  This was not the healing of God’s chosen people.  All came to him, and he had compassion and healed them. And with this the battle lines were drawn.  

This little story, the healing at Gennesaret, is the moment in the life of Jesus where everything starts to change.  He is turning over the apple carts, undoing tradition, how things are supposed to be.  He healed them all.  He didn’t discriminate. Jesus cared for, had compassion for all of them. 

In being so compassionate Jesus is dismantling the system of segregation, of election, he is fighting with the idea that some are chosen, and some are discarded.  And what is very important is that this radical departure is the way of the Kingdom of God. This open door, unrestricted, compassion for everyone: he is saying follow me.  This is the model of living life Jesus is putting forward for us to follow. 

This didn’t go over well.  Again and again in the coming days Jesus will renew this radical idea of compassion for all.  He will feed the four thousand, heal the Syrophoenician women’s daughter, heal the Roman transplants outside of Tiberius.  This open-door policy will rankle the pharisees and Sadducees.  Well, rankle is a bit understated.  They will become enraged and seek to kill him.   

Ultimately, this posture of extravagant mercy will lead Judas to say, “enough.  This has to stop.”  And he will betray Jesus.  The compassion for all Jesus started in Gennesaret, this new way of following God, cost Jesus his life.  There was a cost to his compassion. 

Yet, I don’t want to rush to the cross.  The death of Jesus on the cross, where he died for many or died for all or died for those who believe in him, this death is not the conclusion of our reading today.  What starts here in this little town and the healing of the crowds will lead to Calvary.  The Pharisees will seek to regain control, put Jesus down, and all the chaos he started. 

Yet if we rush to the end, though, we miss the other cost he paid.  Jesus cared for the people; he healed them; he had compassion in Gennesaret, and this cost him a great deal. 

If you were to ask ICU nurses and doctors and physician assistants and aides, if you were to ask the folks in our hospitals right now is there a cost to healing, is there a cost to compassion, does caring for the broken cost you, the answer would not come right away.  You would need to wait for the tears to stop, for breathing to resume, before you heard: yes.  There is a cost to compassion.   

When Obamacare was in full political frenzy, there was a specter raised of death panels.  Remember that?  If Obama gets his way, there will be death panels!  I wrote an article for the local paper that said, I sure hope so.  We need death panels.  

A radio station asked me to come on air and be interviewed about the article.  The co-hosts kept peppering me with questions meant to expose my blatant communist leanings.  About half the way through the gauntlet, I asked them this. Let’s say your parent has a terminal illness and there is no cure, but there needs to be care.  How your parent is cared for, what he or she receives, could be determined by an insurance company or a state health department, or the care your parent receives could be defined by a panel of people in your community: doctors, nurses, pastors, neighbors, a local attorney, a professor at the college all having a conversation, considering what is best for him, for her.  Who would you choose to define the care of your mom, your dad?   

The conversation shifted at this point.  From this point on compassion had more power than greed.  I want, you want, we all want compassion to have the victory, to guide us.  We don’t want greed to define us.  But when we monetize compassion, when we say some are welcome and some are not, some are offered grace and others are not, we may feel responsible, feel we are doing the hard work of real life, but we are not following Jesus. 

What Jesus did in Gennesaret is not a religious doctrine like atonement or election or God as sovereign.  What Jesus did was shine a light on our day, a light that still shines today.  The light: let compassion be your guide.   

Does this make it easy?  No.  Does this magically whisk away all challenges?  No.  A life of faith is a costly life.  Compassion costs a lot.   

In the end so does greed.  We know this too.  The thing is if you give your life away in compassion, your life comes back to you in beauty.  The life you forfeit in greed, well, that life comes back too.  It comes back to haunt us. 

It turns out state agencies and insurance companies are not the best way to design care.  They are not because we don’t do a good of caring when we monetize compassion.  Love and money are not a good combination.   

Jesus lived this in Gennesaret.  His life showed the way.  Heal everyone.  Don’t count the cost.  Bring hope to all.  Open the doors; don’t try to control the future.  This was the image of God he offered, the hope he gave.  This scared folks.  Still does.  I have seen this fear in many a boardroom debate.  

There is a cost to compassion.  It takes our very life. In Gennesaret there is a great challenge.  You care for them all.  You give your life away again and again.  No control, but a promise: if you give your life away, you will find it in beauty.  Amen.