In the course of his many travels, Gulliver in Gulliver's Travels visited a country in which he heard about certain people called the struldbrugs who never died. Gulliver's first reaction upon hearing about these immortal people was to rhapsodize about how wonderful such an unending life would be. But when he actually met them, he found them to be pitiful, shrunken old skeletons who had lost their teeth, hair, and taste as well as their memory, reason, and ability to function normally. Gulliver concluded that, compared with their actual condition, "no tyrant could invent a death into which I would not run with pleasure from such a life."
Americans would do well to ponder the story of Gulliver and the struldbrugs. We continue to spend more and more every year on enhancing our health and prolonging our lives. As a result, health care costs in the U.S. are rising at about eight percent a year and health insurance premiums are becoming difficult for individuals and businesses to afford. The small business at which I am employed has recently received quotes from two different insurance companies in an attempt to find more affordable insurance. Some businesses are completely dropping insurance coverage for their employees because it is too expensive.
If we are aiming at a better understanding of our health care spending, it is important for us to look beyond the numbers to the motivations and beliefs that are responsible for it. First, I wish to probe this area of our beliefs and assumptions about health care. Second, I will suggest some principles Christians can use to evaluate these beliefs.
Understanding Our Assumptions about Health Care
Most Americans assume that expenses in pursuit of health and longevity are all important and necessary. But Gulliver's experience with the struldbrugs prompts us to ask if longevity is as desirable as we assume it is. Indeed, while everyone is talking about the rise in health care costs, not much has been said about the assumptions and beliefs that are fueling it. An article by Don Peck in the January/February 2004 edition of The Atlantic called attention to one of these assumptions in this sentence: "That we spend enormous sums of money for even tiny improvements in health-care quality reflects a social ethos to which most Americans implicitly subscribe: anything that might improve health or extend life, however marginally, should be made available to everyone, at whatever cost." The article goes on to suggest that perhaps some expensive and non-essential medical tests and treatments should be available only to those willing and able to pay extra for them.
Peck has raised an important issue in this article. Americans generally regard human life and health as a sacrosanct area that should be promoted regardless of cost. This is reflected in the saying that you can't put a price tag on good health. It is shown, too, in the rush to embrace expensive new technology even before it has produced any proven results. An example of this is California's approval of $3 billion to fund stem-cell research. While there has been a lot of debate about the ethics of using stem cells from human embryos, not much has been said about the ethics of spending so much money on a technology that is still of questionable value. The assumption is that even the possibility of effective results in the future justifies this present expense.
How should a Christian think about these issues? Is human life in this world so valuable that we should spare no expense in enhancing and extending it? Or should we impose some limits? Are there situations in which we could or should forego some tests or treatments because we believe they are too expensive or of questionable value?
In July of 2003 my 82-year-old father had triple bypass heart surgery. Dad had a difficult time recovering from this surgery. He had to have a second surgery on his urinary tract and also returned to the hospital later for other complications. Dad eventually made a good recovery, but it was a lot for an 82-year-old person to endure. Altogether, this experience cost about $75,000. Although his insurance paid for almost all of this, I sometimes still wonder if the benefits are worth the cost. How much longer and better will his life be because of his surgery?
Our family did not know ahead of time about all the complications Dad would have with his surgery. But if faced upfront with a similar situation at his age, I'm not sure what I would decide. I might conclude something like this: I have lived a good, long life and I am ready to die. I don't want $75,000 spent to prolong my life for a few months or few years. Therefore, I elect to forego surgery and continue to live as long as I can in my present condition.
Affirming Life and Health
I am not suggesting that Christians should totally reject modern medicine and all the benefits we receive from it. Human life and health and the modern medical knowledge that enhance them are gifts of God that we can and should embrace. God is the author of human life, and efforts to improve the health and quality of that life are consistent with his intentions. It would be ridiculous, for example, to discontinue vaccinations against common diseases such as polio and measles or routine surgeries such as removing an appendix or gall bladder. We can also celebrate many medications that millions of us routinely take that make a huge difference in our lives. Modern health care is in many ways a gift from God.
We can also make a distinction in many cases between improving the quality of life on the one hand and extending life on the other. I used to work with a man in his thirties who suffered from severe and chronic back pain that threatened to end his ability to keep a job and function normally. Then he had surgery to fuse together three of the vertebrae in his back. This surgery freed him from virtually all his pain and literally revolutionized his life. A case like this is obviously different than my father's open heart surgery.
Examining Our Priorities
If you are a parent who has recently stood at the grave of a beloved child, it may seem to you that the raw pain of this death is the worst experience a person could ever endure. Similarly, if you struggle everyday with a painful and debilitating disease, it may seem to you that your suffering is at times more than you can bear. And yet, if you are a believing Christian, you profess faith in a hope that transcends your present pain. This hope points beyond our present experiences to a God and a Kingdom that are much bigger than our individual pain. It enables us to believe that neither improving health nor prolonging life is one of the ultimate values we profess. Loyalty to God and his Kingdom is more important. Similarly, pain and death are not the ultimate evils. Indeed, we believe that pain and death are sometimes the means through which God brings life and healing.
Yet Americans worship good health and they fear pain, suffering, and death. This is part of a secular view of life that sees human life in this world as the highest possible good. If this life is all there is, then we have to do everything possible to enhance and prolong it. Death is the ultimate evil because it brings this good life to an end.
The Christian view of life is profoundly different. Our human life in this world is part of a divine plan that transcends the mundane concerns of health and life expectancy. This present existence is a prelude to life in a new heaven and earth that will make our present sufferings look insignificant in comparison. As Paul says in 2 Corinthians 4:17-18: "For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen. For what is seen is temporary, but what is unseen is eternal." This does not mean that we should be totally focused on our eternal glory to the exclusion of concern for life in this world. But it does mean that life in this world should not be our final or ultimate concern.
At times it may be difficult for us to believe that our present difficulties are only "light and momentary." Can I justify spending thousands of dollars on my own health when I know that same amount of money could save the lives of many children in a Third World country? My own experience has included repeated job failure, career frustration, and a consequent battle with depression that at times seemed it would never end. But we should also remember the experience of the Apostle Paul who wrote these words: "Five times I received from the Jews the forty lashes minus one. Three times I was beaten with rods, once I was stoned, three times I was shipwrecked, I spent a night and a day in the open sea, I have been constantly on the move"(2 Corinthians 11:24-26a). Yet he could consider all these difficulties "light and momentary" compared to the eternal glory that awaited him.
This reminds us that the Christian God is a God who specializes in bringing about good things by means of difficulty and suffering. As Philip Yancey shows in Where Is God When It Hurts?, pain is an important and necessary part of human life. Pain is designed to protect us from needless injury and even greater suffering, and individuals such as Joni Eareckson Tada are living testimonies to how Christians can transform experiences of pain and suffering into productive and meaningful living.
I see a great conflict here between the prevailing American ethos and a Christian view of life. It seems definitely wrong to me for a Christian to cling desperately to anything and everything that might improve his health or extend his life. We should be able to face suffering and death with a confidence and equanimity that Americans in general can only envy. This reminds me of the behavior of some of the Western hostages in Iraq who begged and pleaded for their lives, hoping that the leaders of their countries would negotiate with their captors for their release. Not wishing to belittle their plight, at the same time I could hope that a strong Christian in the same situation would have behaved quite differently. It is precisely because Westerners are so preoccupied with what they regard as the sacred value of their own individual lives that the hostage takers can manipulate them so effectively for their own evil purposes.
The Universal Value of Life
Another point to consider is that our affirmation of life and health should be universal. That means the value of a life in Haiti or Sudan or India is the same as it is in Chicago or Houston. When we look at the subsistence living of millions of people in other countries, it calls into question the vast sums of money we spend on our own health care. For many years my wife and I have supported a child through World Vision for just sixteen dollars a month. There are millions of people in the U.S. who are spending more than sixteen dollars every day in prescriptions that control their symptoms and prolong their life. Yet even here in the U.S. we have difficulty funding such basic nutritional programs as that for Women, Infants and Children (WIC) and school lunches for needy children.
The disparity in all of this is astounding. Can I justify spending thousands of dollars on my own health when I know that same amount of money could literally save the lives of many children in a Third World country? If we are conscientious, we will try to balance our own expenditures between personal needs and contributions to the needs of others. We will also advocate for government policies that fight hunger, malnutrition, and disease in our own country and around the world.
Reaching a Conclusion
So where should a responsible Christian stand on health care spending? First, we need to examine our own presuppositions to make sure that we are operating with Christian values and not mindlessly going along with the rush to spend more and more on our own health and longevity. Second, we should also do our part to hold down costs by questioning our doctors and other medical providers about the necessity and propriety of the tests and treatments they recommend. Sometimes older Christian people with a terminal illness will forego any dramatic or heroic efforts to save them. This points the way to a sensible approach towards health care spending. The latest and greatest may not always be necessary.
Third, we should also examine the relationship between what we spend on our own health and what we invest into the Kingdom of God and the well-being of other people. A preoccupation with our own existence in this world is selfish and un- Christian. Only our investments into the Kingdom of God will have lasting results.
There are many people--my Dad included--in their seventies and eighties today whose lives are still worthwhile and meaningful. But Gulliver's struldbrugs remind us that an indefinite tenure in this world is not the greatest good we can imagine. I, for one, would much rather be standing before the throne of God with the great white-robed multitude of Revelation 7. That text tells us that this multitude will never again hunger or thirst, and that God will wipe away every tear from their eyes. I don't think we are stretching this text too far if we conclude that this also means we will be forever free from all the blood tests and surgeries and pill bottles of our earthly existence. That certainly sounds like heaven to me!
Daniel Boerman is a graduate of Calvin Theological Seminary in Grand Rapids, Michigan, and the author of numerous articles. He currently works in retail sales for a Grand Rapids business.