Friday, February 05, 2010
As much as I respect +Anis, I cannot join him in this call. I think we spend way too much time worrying about leadership in the Church. We need to concentrate, instead, on discipleship.
We need new discipleship for our Church. As I've remarked in the past, TEC (and I would bet CofE and ACoC and other western, Christendom models) does a very poor job of making disciples out of members. We then take our members and look for leadership qualities in them and send them off to seminary without first making sure that they are gounded disciples. We look for people who can organize and inspire, but we don't seem to care what they inspire to.
We, particularly the clergy, need to be better disciples before we can be better leaders. We need to make sure that our leaders are disciples first.
A disciple is not just a "student" but closer to an "apprentice." The apprentice hears the voice of his master (the Holy Spirit) and does what the Holy Spirit says. in TEC, we have substituted the voice of the spirit of the age for the Holy Spirit. If you doubt that, look at how we discuss and debate issues. We form advocacy groups and put out press releases. We fight in courtrooms and use the canons of our Church like cudgels to beat each other with. We fight with political will and not with enlightened debate on the teaching of the Church.
And we wonder why we are declining in membership.
I call for a renewed focus on discipleship within the Church. Before you send someone to the Commission on Ministry, ask them what being a disciple of Jesus Christ means. Before electing a bishop or a person to the vestry, ask them how discipleship is evidenced in their lives.
We need to be more focused on being disciples first and leaders second.
Tuesday, February 02, 2010
Philosphers have measured mountains,
Fatholmed the depths of seas, of states, and kings,
Walked with a staff to heaveN, and traced fountains:
But there are two vast, spacious things,
The which to measure it does more behoove:
Yet few there are that sounds them, Sin and Love.
Whoever would know Sin, let him repair:
Unto mount olivet; there he shall see
A man so wrung with pains, that all his hair,
His skin, his garments bloody be.
Sin is that press and vice which forces pain
To hunt his cruel food through every vein.
Whoever does not know Love,
let him assayAnd taste that juice, which on the cross a pike
Did set again abroach; then let him say
If ever he did taste the like.
Love is that liquor sweet and most divine
Which my God feels as blood, but I as wine,
Lord, how I am all with fever, when I seek
What I have treasured in my memory!
Since, if my soul makes even with the week,
Every seventh note by right is due to thee.
I find there quarries of piled vanities,
But shreds of holiness, that dare not venture
to show their face, since cross to thy decrees:
There to circumference earth is, heaven center.
In so much dregs he quintessence is small.
The spirit and good extract of my heart
Comes to about the many hundreth part.
Yet, Lord, restore thine image, hear my call.
And though my hart heart scarcely can to the groan
Remember that thou once didst write in stone.
Monday, February 01, 2010
- Primary Care - normal doctor stuff.
- Catastrophic care - ER Stuff, Major Illness, accidents, etc.
- Chronic Care - long term illnesses such as asthma, diabetes, and some mental illnesses.
There are several problems with how health care is delivered in America today. I would like to address what I think are the two biggest.
- Using insurance the wrong way - we have divorced the reception of services from the payment for services. There is little incentive for the patient to be fiscally involved in his or her health care
- Overuse of some types of health care. This is primarily "defensive medicine" where a doctor orders test as a precaution, not against the adverse health, but against a malpractice lawsuit. This also comes when a doctor orders a battery of lab results from a lab in which the doctor is a partner or orders rehab in a clinic where the doctor is a partner. There is a tendency to over-order in such cases.
First, let's talk "insurance." The purpose of insurance is to provide relief in the event of an unforseen and catastrophic loss. We have home owner's insurance to cover costs associated with major and unpredictable damage such as fire, flood (a separate policy), lightening, major theft, or other damage. We don't ask home owner's insurance to cover light bulbs going out or the replacement of air filters or routine maintenance on the grounds. Most financial analysts will tell you to take as high a deductible as you can reasonably afford because it will save you in the long run.
But, when it comes to health insurance, we ask that it cover every single visit to the doctor. At the beginning of the year, I had a visit with my doctor to get blood work on my diabetes. (The blood work came back good with a glucose level of 100 and an A1C of 6.2.) I suggested that I pay the doctor for the visit right then because I had started a new deductible year. However, the office couldn't do that. They had to file the insurance, wait for it to deny, then bill me and wait for me to pay. All the filing and tracking requires a person to handle. So, the costs of delivering routine medical care have gone up because of the friction involved due to the instrusion of health insurance into a type of care that is not a good candidate for insurance - routine, primary care. To reduce the cost of insurance (and the cost of delivering health care), we should return to a high deductible plan that covers only chronic or catastrophic care. Currently, most employees are allowed to have a set amount taken from their paycheck, pre-tax, to cover health care costs. But, the amounts are lost if they are not used. So, may people either have too little take out or they spend wildly at the end of the year so as not to lose the money they've already spent.
We should change this to a health care savings account that can be carried over year to year and will grow tax free. The money in this account can be used for later costs such as rehab or even long term care. If a person dies with money in this account, the money should be taxed at capital gains rates before it becomes part of the person's estate. This would return primary care back to a transaction between the patient and the doctor and it could reduce the cost of delivering care because it reduces the friction of paying for the service.
My next post on health care will dicuss "defensive and offensive medicine."