Once Saved, Always Saved Deconstructed

Posted: March 7th, 2011 | Author: | Filed under: Faith | Tags: , , , , , , , , , | 3 Comments »

I was quietly minding my own business the other day when the following thought abruptly popped, fully formed, into my conscious mind.

The dogma “once saved, always saved” is soteriological monothelitism.

Yes, the inside of my head is often a strange and sometimes frightening place. That’s just a small taste of what it’s like in there. However, as I turned the thought around and looked at it from various angles, I realized it seemed more true than not. There’s a lot of information packed into that short sentence. In this post, I’ll try to unpack it.

For those who are unfamiliar with it, “once saved, always saved” is a particular doctrine found among some modern Christian groups. I’m most familiar with it in a Southern Baptist context. Basically it’s a way of expressing the idea that once a person makes an authentic (and that’s a discussion in and of itself) commitment to Christ, you are sealed as a Christian and nothing you can subsequently will or do can change that status or your status as one of the saved.

In the history of Baptists in America, there are a number of strands which contributed to their development and formation over the years. Some of those strands were either outright Calvinistic or at least adopted some of the ideas of John Calvin, particularly the dogmas of total depravity and the perseverance of the saints. The latter is an intriguing, if misguided, dogma. It postulates a God who, for reasons known only to himself and which we can never know or understand, creates some human beings for salvation and others for eternal damnation. There’s nothing we can do to move from one category to the other one, but if we are in the group predestined for salvation, then we will be ultimately saved no matter what.

However, within this system there’s really no way to tell with which group you belong. Are you damned or are you saved? It’s within this context that the dogma of “once saved, always saved” seems to have developed over time. Basically, it holds that we’re all born damned. (Even so, most variations will give infants and small children a free pass from damnation. That free pass lasts until some uncertain age when the child is able to intellectually grasp the various doctrines and teachings about God.) Over the course of our lives, though, we always have the option to exercise our will and choose to commit ourselves to Jesus of Nazareth. Then, once we do so, we become a saint and cannot become anything else.

When you understand the context of this dogma’s development, it obviously is designed to address the uncertainty inherent in the somewhat older dogma of perseverance of the saints while retaining its preferred features. Since it first requires an exercise of will to become a saint, presumably one would know whether or not you’ve done so. In that way it removes the uncertainty. You can actually know whether you are in the damned or the saved group. (In practices, it doesn’t really work that way and very often those preaching or evangelizing will even deliberately try to instill doubt about your status.)

The dogma seems intended to provide assurance of a sort. You can actually know you are in the saved group and you can be certain that you’ll remain in that group as well. Until I understood that history, the way Baptists often talk about assurance and perceive a lack of assurance in other groups always seemed very odd to me. When you understand the context, it makes more sense.

Going back to my thought, soteriological is just the fancy English word we use for discussions about salvation. It’s really easy to talk right past each other if you assume that salvation automatically means the same thing to all people. It begs the question, what are you being saved from? And what are you being saved to? It even begs the question of what does it even mean that you are saved or are being saved? I’ve noticed that among Baptists, at least, salvation tends to be externalized. It’s something you possess rather than a process you are undergoing. In my mind, from the very beginning, I had an image of saving someone as an active process. That’s probably why I always felt like I understood the Fathers, who described the Church in various terms, but always as a vehicle for the ongoing process of salvation. The Church is an ark, rescuing us from destruction. The Church is a hospital for the healing of our souls and the restoration of our true humanity. Their metaphors describe a process you undergo rather than a thing you have.

And that conforms more to our normal experience of reality. Think about the times we might save or try to save others. If I save someone from drowning, it’s an action and a process. If I try to save someone from abuse, that implies a lengthy series of actions. If I try to save someone from an addiction that is destroying them, I’m committing myself to a long process with uncertain results. When you stop and think about it, salvation as a noun is really very odd. What’s the thing that it describes?

And that brings us to the last word in my thought, monothelitism. Monothelitism was the heresy that was finally resolved in the sixth ecumenical council. St. Maximos the Confessor, the one who wrote the texts of love I’ve been working through on my blog, was the great champion of that council, even though he did not survive to see it. He suffered greatly for the faith when it seemed all the powers stood against him. He had his tongue cut out so he could not speak and he had his hand cut off so he could not write. Nothing stopped him from teaching the truth about Christ, though, and his work kept the truth of Christianity alive from the ground up. Monothelitism is the teaching that Christ had only one will, the divine will. Basically, the divine will destroyed or overpowered his human will and guided him throughout his life without effort or opposition.

The problem with this view is that it makes Christ something other than fully human. If he had no human will that he had to align with the divine will, then he was not really like us. We have to struggle, and often fail, to align our will with God’s. If Christ did not share in that struggle, even though he never failed, then he cannot heal our own wills. It turns the Incarnation from something glorious and incredibly risky on God’s part into a sham.

Once saved, always saved” turns monothelitism on its head and applies it to us instead. Basically, it says that whenever we once commit to Christ, the divine will for all practical purposes obliterates our human will. Sure, we can still perform individual acts of evil, but we no longer have a will with which we can reject God. And whatever we may then be, I wouldn’t call such a creature human, much less capable of love. Moreover, if God simply wanted to turn us into subhuman creatures, what’s the point of the whole charade of history. He could have overtaken our will from the outset if such a thing were in his nature. Why would he wait until we had actually taken a step toward him to treat us so brutally?

No, I have to reject the idea that our wills mean nothing. God is truly not willing that any should perish, which means that it’s our wills that oppose his efforts. And it’s not God’s nature — it’s not the nature of love — to contravene or force the will of another, much less wipe it from existence. My struggle is to turn my will to God, who has already done everything necessary to save us all. I need to want God. It’s certain that he wants me.

But I retain always the power to turn my will away from God. It’s for that reason we pray for help, for mercy, which God offers in overflowing abundance.


Four Hundred Texts on Love (Fourth Century) 22

Posted: March 3rd, 2011 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , , , , | 2 Comments »

53. By a single infinitely powerful act of will God in His goodness will gather all together, angels and men, the good and the evil. But, although God pervades all things absolutely, not all will participate in Him equally: they will participate in Him according to what they are.

In this text, St. Maximos begins to draw the threads of his answer to the proceedings questions together. Yes, God draws all creation to himself. God fills all things. But angels and men participate in God according to what we are.

If that thought does not give you pause, I don’t know what will. It’s hard for us to be honest with ourselves, but I have some inkling of the sort of person I am. Do I love God? I don’t know that I would be so bold. Most of the time, I believe I want to love God. I’ve reached a point in my life where I am confident he loves me, for I know there is no-one he does not love.

But do I love God?

Can I even answer that question honestly and without delusion?

I see how little I love my enemies and I realize, if that is indeed a measure, then I don’t love God very much at all. To what extent can a man who does not love his enemies participate in a God who loved and forgave the men who mocked, tortured, and unjustly killed him?

I think so many of us today are reluctant to ask for mercy because we cannot see ourselves as we truly are.

Lord Jesus Christ, Son of God, have mercy on me.


Prayer, Evil, and the Nature of Things

Posted: February 22nd, 2011 | Author: | Filed under: Prayer | Tags: , , , , , , , , , , , , , , , , | 2 Comments »

A post about prayer on the blog, Permission to Live, kicked the wheels of my mind into gear and started it whirling. As my mind peeled back layer upon layer, I quickly realized I couldn’t really say anything meaningful in a comment. But in this case I also realized I did want to write something on the topic. The post in question actually touched on a number of areas, but I’ll primarily focus my thoughts on the purpose of prayer and the deeper question of why God does not prevent evil things from happening to people who do not deserve it and allows good things to happen to the wicked. Obviously, those are topics that can’t possibly be addressed in a blog post. The Library of Congress would not suffice.

When I try to express thoughts in areas like these I particularly feel the need to state up front that the things I say will of necessity be incomplete. I have to discuss God, but God is greater than me in such a way that no analogy, no description, no words could ever truly describe him. My mind and imagination are insufficient to the task, but they are the tools I have. So the reality is always far greater than anything I can understand or say. Please keep that in mind and try to work with my imagery rather than against it — at least for the short time that you are reading this post.

Before we can move to a discussion of prayer on a topic this deep, we have to begin with the nature of things from a Christian perspective. The fundamental division of reality lies between the uncreated and the created. Only the Father, the Son, and the Spirit can be placed in the category of uncreated. Everything else that exists is a creation of God. Moreover, God created all things good. Nothing was created evil. (Elizabeth Esther actually just posted on the innate goodness of human beings.) It’s important to grasp this fundamental Christian tenet since it runs directly counter to the narrative of some religions — both ancient religions and present day ones.

When we acknowledge that truth, something should immediately stand out. There is no place in those divisions for evil. This is one of the thoughts behind my recent post on evil as mystery. Evil is not uncreated; the only uncreated is God. Moreover, all created things are created by God and are created good. Part of the mystery of evil is that it cannot be said to have the same sort of existence as created things. In fact, it almost has to said to have no existence in the sense that creation exists. Yet evil is palpably real. So what then is evil? That’s the question to which we have to turn.

One of the aspects of creation is its freedom. There is a randomness woven into the fabric of created things that seems to provide the framework within which, for example, human freedom can exist. While that provides the basis from which we can exercise our free will and creative abilities and thus have the potential of truly being in the likeness of God, it’s not limited to humanity. That element of freedom is woven into the fabric of created things by a God of overflowing love. And that freedom is, as part of creation, also an innately good thing.

Such freedom does introduce a certain wildness into creation — even absent the influence of man. I think people often particularly misread the second creation narrative in Genesis. The garden cannot represent some idyllic, perfect unfallen reality. There was already a wilderness outside the garden into which the man and the woman could be banished. I tend to think of the image of the garden in terms of a nursery. It was a place of few challenges in which the man and the woman could learn to fulfill their created function.

And what was that function? At least part of it was to order the wildness and randomness of creation. Some of that can be seen in the act of naming (though that bit also has other meanings) since names are powerful. It’s also seen in God’s command to them. A part of our natural function is also to act as priests in creation, offering it back to God in Thanksgiving. In this sense, Jesus commanding the storm, healing the sick, and feeding the many displays his true humanity at least as much as his divinity. Yet, the story of the garden illustrates that even in the safest possible nursery environment with only a single ascetic challenge, we still do nothing but turn away and hide from God. Read the story. Man accomplishes nothing in the garden but sin. From the time we were able to lift our heads above the animals, we have turned away from God.

And that provides our first clue into the nature of evil. Evil is an aberration, a distortion, of that which was created good. It flows from the freedom instilled in creation when that freedom is turned against God. (It wouldn’t be freedom if that capacity did not exist. And if it exists, it happens.) We could ask why God then created such freedom, but that strikes me as a futile question. Any such reality we could imagine would be incredibly diminished. Beauty flows from that freedom. Love flows from it. I don’t see how a God of overflowing love could have created anything less.

Yes, I’m sure God knew from the beginning that evil would flow from the fabric of such a creation. That’s why we have the apocalyptic image of the Lamb slain before the foundation of the world. God knew and was planning to rescue and complete his creation from the start. In that respect, creation is not simply something that happened in the past. Creation continues to happen every time the darkness is pushed back even a little, every time evil is transformed into good, every time love conquers. Creation is the ongoing process of renewing all things.

So what then is prayer? It seems to me that many Christians today reduce prayer to little more than intercessions. While that’s an aspect, I don’t believe it’s the central purpose of prayer at all. What is our truly human created role and responsibility in creation? Humanity was created to be the ruling, royal priesthood of our world. We were to order creation and offer it back in thanksgiving to God. (There is much that could be pursued from the Eucharist beginning as bread and wine rather than wheat and grapes, but I’ll set that aside for now.) First and foremost, prayer is our direct connection to God. And it’s in and through our communion with God that we order time and the rest of creation.We are created for communion with God and prayer is an expression of that communion.

Of course, even most of us who are Christian do not live in constant, unceasing prayer. I don’t think most of us regularly or ever recognize the extent of our culpability in the evil of the world. We are not isolated individuals. We were created not only for communion with God, but for communion with each other. As such, we share a common nature and bond with each other and with the created world we are intended to rule. It’s through that shared nature that the work of Jesus is efficacious. He became one of us in every way, sharing the fullness of our common nature, and by doing so he redeemed us and defeated death on our behalf. And by healing the human nature Jesus also completed all that was necessary to heal and redeem the whole created order.

But therein lies the rub. The evil we do spreads to others and to the world in ways we do not always directly perceive. As we particularly see in Romans 8, creation itself groans beneath that weight. When we turn away from God, we turn energies shared in the human nature to evil. By our own acts, we have contributed to the evil others experience and to the evil others do. I rarely hear of a crime or evil act and think to pray for the way my sin contributed to it. We deny our interconnectedness or we embrace only the positive and personally beneficial aspects of it. But to the extent we have each done evil, we have contributed to the evil of humanity and the world.

Finally, we are also instructed to pray for intercession, especially for others. And God sometimes intercedes. God miraculously heals a person. God protects an innocent in desperate need in a manner that offers no easy explanation. And yet many other people die despite many intercessions. Children suffer. Not everyone is healed. Not everyone is protected. All of this is true. And sometimes Christian attempts to explain this truth away do more harm than good, I think, especially when they try to call evil something sent by God or something that was really somehow “good.” Evil is evil and it is not of God. Our hearts look on evil and cry out, “Why?”

This is where I try to remember that God is not willing that any perish, that God is actively working for the salvation of all. I remember that God is constantly turning evil into good. I think of Joseph, who is certainly a type of Christ. Great evil was done to him again and again and God did not stop it. But Joseph did not despair. Joseph did not curse God.  And ultimately he could tell his brothers that God had taken their unquestionably evil act and turned it into a tremendous good. That’s the gospel of Christ prefigured. Jesus suffered in every way we suffer. He endured torture and execution under supremely unjust and evil conditions. Jesus absorbed the worst that evil could do and defeated evil and death on behalf of us all.

I believe God perceives all possible outcomes of every decision and every interaction. Reality is not static, so there is no single path. I tend to think of a bubbling stew, though that’s a weak analogy. It has states of being that are fluid and change. And the freedom of creation, especially our freedom, has immense value. Even in those times when God has blocked a human action, he has not blocked the intent or the effort to perform the act. God does not make human beings less than they were created to be. (Though it must be said we tend to do that ourselves.) And from all the stories I’ve read throughout Christian history, it’s rare even for God to so physically restrain someone from acting.

God is always working for our salvation — the salvation of every human being. And God is always working to transform evil into good. But he does not reach into our being and restrain our hearts from working evil. I believe God intercedes or doesn’t according to those goals and more. Other influences are the prayers of the communion of the saints. As the evil we do works its tendrils into the fabric of reality in ways we can’t perceive, so our prayers permeate creation. Either the things we do accomplish something or there is no point doing them.

It’s not an answer that explains. As one who has suffered evil and seen those I love suffer evil, I don’t think it’s something that can be explained. But I trust reality is at least somewhat like what I’ve described. We can’t avoid choosing a narrative framework and a perspective on reality. Of all the ones I’ve explored or held over my life, the Christian narrative offers the best lens through which to understand the nature of things. I’ve encountered this strange God, but even if I hadn’t I would want to believe this framework over the alternatives.

We cry, “Lord have mercy!” And he does.


Four Hundred Texts on Love (Third Century) 24

Posted: November 30th, 2010 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , | Comments Off on Four Hundred Texts on Love (Third Century) 24

68.  God is the cause of created beings and of their inherent goodness. Thus he who is puffed up with his virtue and knowledge, and whose grace-given progress in virtue is not matched by a corresponding recognition of his own weakness, falls inevitably into the sin of pride. He who seeks goodness for the sake of his own reputation prefers himself to God, for he has been pierced by the nail of self-esteem. By doing or speaking what is virtuous in order to be seen by men, he sets a much higher value on the approbation of men than on that of God. In short, he is a victim of the desire to be popular. And he who immorally makes use of morality solely to deceive by his solemn display of virtue, and hides the evil disposition of his will under the outward form of piety, barters virtue for the guile of hypocrisy. He aims at something other than the cause of all things.

Pride has many ways of ruling us. Humility, by contrast, is the most difficult of virtues. For when we set our eye on our humility, it immediately becomes pride. We can only truly be humble when we do not much think of ourselves at all.


Four Hundred Texts on Love (Third Century) 19

Posted: November 9th, 2010 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , | Comments Off on Four Hundred Texts on Love (Third Century) 19

60. The origin and consummation of every man’s salvation is wisdom, which initially produces fear but when perfected gives rise to loving desire. Or, rather, initially and providentially wisdom  manifests itself for our sake as fear, so as to make us who aspire to wisdom desist from evil; but ultimately it exists in its natural state for its own sake as loving desire, so as to fill with spiritual mirth those who have abandoned all existing things in order to dwell with it.

The fear of the Lord is the beginning of wisdom. I run across too many Christian teachers today who seem to feel that fear is also the culmination of wisdom. It’s not. When we begin to understand this God and the breadth and depth of his love, and we see how we have turned from our only source of life to things which have no life, it is wise to be afraid, for fear can motivate us to turn toward life instead. But if we continue to live in fear, we remain stunted and cannot know God. Perfect love drives out fear.


Four Hundred Texts on Theology (Third Century) 16

Posted: October 28th, 2010 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , | 3 Comments »

41.  The first good which actively affects us, namely fear, is reckoned by Scripture as the most remote from God, for it is called ‘the beginning of wisdom’ (Ps. 111:10; Prov. 1:7; 9:10). Setting out from this towards our ultimate goal, wisdom, we come to understanding, and this enables us to draw close to God Himself, for we have only wisdom lying between us and our union with Him. Yet it is impossible for a man to attain wisdom unless first, through fear and through the remaining intermediary gifts, he frees himself completely from the mist of ignorance and the dust of sin. That is why, in the order established by Scripture, wisdom is placed close to God and fear close to us. In this way we can learn the rule and law of good order.

I was reminded, when I read the above, of a recent two-part sermon series by Shane Hipps at Mars Hill in Grand Rapids, MI. The first one, Touching the Stove, explores precisely that positive aspect of fear in a way I had never before considered it. (The second part, Outside the Boat, is pretty good too.) Fear and any resulting abstention from evil is not wisdom, but it is the first baby step toward wisdom. That’s an important distinction. It strikes me that there are too many today who preach fear and treat fear as though it were the destination rather than that which is sometimes our first immature step toward union with Christ.


Four Hundred Texts on Theology (Third Century) 15

Posted: October 26th, 2010 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , , | Comments Off on Four Hundred Texts on Theology (Third Century) 15

39.  The spirit of the fear of God is abstention from evil deeds. The spirit of strength is an impulse and disposition prompt to fulfill the commandments. The spirit of counsel is the habit of discrimination according to which we fulfill the divine commandments intelligently and distinguish what is good from what is bad. The spirit of cognitive insight is an unerring perception of the ways in which virtue is to be practiced; if we act in accordance with this perception we will not deviate at all from the true judgment of our intelligence. The spirit of spiritual knowledge is a grasping of the commandments and the principles inherent in them, according to which the qualities of the virtues are constituted. The spirit of understanding is acceptance of the qualities and principles of the virtues or, to put it more aptly, it is a transmutation by which one’s natural powers commingle with the qualities and principles of the commandments. The spirit of wisdom is ascension towards the Cause of the higher spiritual principles inherent in the commandments, and union with it. Through this ascension and union we are initiated, in so far as this is possible for human beings, simply and through unknowing into those inner divine principles of created beings, and in different ways we present to men, as if from a spring welling up in our heart, the truth which resides in all things.

I wanted to share this text since it expands on the text I posted last Thursday and I find the progression it describes compelling. Of course, we don’t move smoothly from one spirit to another. Rather, we move forward only to fall back. We get “stuck” for long periods of time. Sometimes, through the grace of God, we leap forward for brief periods only to return to our former position. But always we seek to become so one with God that a life abiding in him truly becomes a spring welling up in our heart.


Four Hundred Texts on Theology (Third Century) 14

Posted: October 21st, 2010 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , , , , , , | Comments Off on Four Hundred Texts on Theology (Third Century) 14

38. Scripture says that seven spirits will rest upon the Lord: the spirit of wisdom, the spirit of understanding, the spirit of spiritual knowledge, the spirit of cognitive insight, the spirit of counsel, the spirit of strength, and the spirit of the fear of God (cf. Isa. 11:2). The effects produced by these spiritual gifts are as follows: by fear, abstention from evil; by strength, the practice of goodness; by counsel, discrimination with respect to the demons; by cognitive insight, a clear perception of what one has to do; by spiritual knowledge, the active grasping of the divine principles inherent in the virtues; by understanding, the soul’s total empathy with the things that it has come to know; and by wisdom, an indivisible union with God, whereby the saints attain the actual enjoyment of the things for which they long. He who shares in wisdom becomes god by participation and, immersed in the ever-flowing, secret outpouring of God’s mysteries, he imparts to those who long for it a knowledge of divine blessedness.

The only true wisdom lies in union and communion with God. That strikes me personally as the most important point of all. There is, however, a clear progression toward that true wisdom and the first step is to begin to choose to abstain from evil. Unfortunately, it seems to me that many modern Christian groups get stuck in that first step (perhaps with brief forays into the second — the practice of goodness). To grow in union with God it is important to learn to stop doing evil and start doing good. Moreover, we have to learn to desire what is good over what is evil. But that’s just the starting point, not the destination or goal. It’s important not to lose sight of that point.


Four Hundred Texts on Theology (Third Century) 13

Posted: October 19th, 2010 | Author: | Filed under: St. Maximos the Confessor | Tags: , , , , , , , , | Comments Off on Four Hundred Texts on Theology (Third Century) 13

36.  He who aspires to divine realities willingly allows providence to lead him by principles of wisdom towards the grace of deification. He who does not so aspire is drawn, by the just judgment of God and against his will, away from evil by various forms of discipline. The first, as a lover of God, is deified by providence; the second, although a lover of matter, is held back from perdition by God’s judgment. For since God is goodness itself, He heals those who desire it through the principles of wisdom, and through various forms of discipline cures those who are sluggish in virtue.

St. Maximos here describes a God who is truly “not willing that any should perish.” So many modern descriptions of God do not. This is a God who meets everyone where they are. If we desire communion, he gives us grace, that is himself, to give us the strength to move forward. And if we do not desire God, he uses loving discipline (not the borderline or outright abusive treatment many modern Christian parenting gurus recommend) to heal us.

Often God allows us to experience the natural consequences of our choices. Sometimes he might rescue us from them. Always God is drawing us to communion — with Him and with other human beings.


Health Care in the US

Posted: September 20th, 2010 | Author: | Filed under: Celiac, Personal | Tags: , , , , , , , , , , | 10 Comments »

As a rule, I don’t tend to post on political issues, mostly because I don’t tend to write about or otherwise wrestle with such matters at any significant level. I do stay generally informed, and I also find that much of what passes for political discourse in our country is pretty abysmal.

Health care, however, is one issue which does concern me a great deal, especially since at least two of my children have inherited celiac disease from me. Personally, my wife and I are somewhat insulated and secure from the worst of what has happened to health care in the US over the past decades. I’m a federal employee and as such we are covered under the FEHB. Twenty years ago, the FEHB offered pretty average employer insurance plan with low to average benefits and costs. Over the past couple of decades, I have watched our health care coverage become better and less expensive than that of almost everyone else I know.

And my health care plan has not significantly changed.

Let me say that again. Over the past twenty years, I’ve seen my health care plan go from, at best, a middle of the road plan, to one that seems to be better than that of most of the people I know without changing. I have watched the overall level of health care access and coverage dramatically decline for almost everyone else around me.

That’s not to say they aren’t constantly tweaking and adjusting my health care plan each year. Some years we pay a bit more in deductibles and other copayments. Some years we pay a bit less. Premium costs have pretty much risen every year, but at a less dramatic pace than that of many people I know. They did add a PPO network in the nineties, and reduced coverage for care received by non-participating medical practitioners and facilities. But the plan’s PPO network is so large, that’s been a non-issue. I don’t think there’s ever been a doctor or facility we wanted to use that was not a preferred provider on our plan.

As a result, my wife and I have been somewhat insulated from the abuses in health care coverage in this country and it’s less likely to ever be a critical issue for us personally. However, at least two of our children inherited celiac disease from me — that is they’ve been tested and positively diagnosed with active celiac disease. Thus, they already have one strike for a pre-existing condition and it’s a condition which can manifest in a huge variety of ways. They also have a family history for a variety of other conditions they could develop over the course of their lives. So from a personal perspective, the issue of health care does strike close to home.

However, that statement is true for every single one of us. The odds that we or someone we love will face some sort of serious, life-threatening, and individually unaffordable (unless you happen to be a Bill Gates or Warren Buffet) health crisis at some point in our lives approach certainty. And within the context of the privatized, for-profit system we allowed to balloon over the course of the past two decades, the odds were unacceptably high that during that almost inevitable health crisis, we would not have access to the level of care we might expect and our family would be crippled by debt for the care we did manage to receive. This is clearly the sort of problem that can only be mitigated by sharing the risk, responsibility, and cost as a society. It’s for reasons like this that we group together as a society and a country. There are many things we can do together that we simply can’t do alone.

Of course, it’s a scientifically demonstrated fact that the way our minds function leaves us remarkably poor at evaluating and acting on those sorts of risks. Even when we know the odds, we tend to have irrational optimism that we can beat the odds in some situations. (That’s one reason why, in every flood here, there are usually people who get in trouble and even die from driving around barriers and into flooded low water crossings.) Conversely, we tend to inflate threats that seem riskier, but which actually have a comparatively lower and often even minimal chance of impacting us. The biggest risk many of us personally encounter on any given day is the risk of simply driving to work, school, or the grocery store. But if you ask people to list or rank risky activities, that rarely makes the list at all.

In this instance, managing health care at the societal level in some way is the common sense thing to do from a self-oriented, pragmatic perspective. Ironically, it’s also the only thing you can do if you claim to love your neighbor. In this country, we have organized ourselves as a form of representative democracy. One of the things that means is that we all share in the responsibility of ruling our country. As Christians, that has particular implications. It means we face, though perhaps on a more distributed scale, exactly the same sort of dilemmas that Christian emperors and other rulers have faced throughout history. We are the powers and authorities who will be held accountable by Jesus for the way we have exercised that power. We cannot escape that responsibility and we cannot abdicate it. There are no easy answers to the proper use of that power. There never have been.

Unfortunately, there is no easy button.

So what are our options? I’ve studied what other countries do to some extent and it seems to me that most employ variations of one of three different general approaches. (Yes, I know there are a lot of ideas out there, but most countries seem to actually end up doing one of three things.) It also seems to me that part of our problem is that we are trying to use them all in a disorganized and hodge-podge manner rather than selecting one approach for everyone in our country. If we are going to truly share the risk, responsibility, and cost, it doesn’t seem effective to me to take that approach, especially if, as you’ll see, we segregate pools of those with higher risks and costs from those with lower risks and costs.

So what are these options?

  1. Government run health care. In this system, the government owns the hospitals. Most doctors and other health care practitioners work for the government in those institutions. And basically, health care is delivered directly by the government. England is one example of a system like this. There are many variations and permutations.
  2. Single payer health care. In this system, the doctors and other practitioners largely do not work for the government, nor does the government own or directly operate most of the hospitals and other facilities. Instead, the government is the single payer for health care services. They negotiate payments and they usually distribute the costs to some degree across the populations based on your ability to pay. Canada is one example of a system like this. Again, there are a lot of different ways to do it, but they do share the same common characteristics.
  3. Government regulated health care insurance exchange. Here, the government does not directly pay most health care costs. Instead, it establishes and regulates an insurance exchange and mandates the participation of all citizens in order to spread the risk across the population. Such a system typically must include subsidies for groups like the poor. Switzerland’s system is generally the model for a system like this.

Those are the basic, widely used options. And here’s where the arguments of those who seem to oppose almost anything that is proposed turn irrational. Why? Because we employ all of the above approaches in our country and have for a very long time. Yes, I know there has been widespread demagoguery over government taking over health care or socialized medicine, but though it has been noisy, it’s had no basis in reality. I don’t personally have any strong preference for one system over another. But my life has been such that I prefer to maintain some connection to the world as it actually is rather than my fantasy about it.

Let’s start at the top of my list. Because we are so large as a country, we actually have a government run health care system that rivals that of some smaller countries. It’s called the Veteran’s Administration. While the VA operates many programs on behalf of veterans, one of the largest is certainly the network of doctors, hospitals, and clinics it runs. We hear about it in the news when there is a problem with a VA hospital, but they mostly do pretty amazing work — especially when you consider that we usually choose to underfund them. If a government-run health care system is good enough for those who have served us in our military, tell me again why it wouldn’t be good enough for all of us? Be careful how you answer that question. Though I’m not eligible for care through the VA, I am a veteran.

Or let’s move to the next item on my list. Our government-operated single payer system is the largest single health care system in our country and is much larger, I believe, than Canada’s entire health care system. Our single payer system, of course, is called Medicare. In the debates over health care, both Republicans and Democrats publicly defended Medicare. I remember some of my older relatives, especially the ones with serious illnesses and inadequate coverage, anxiously waiting to reach the Medicare enrollment age. It has problems, of course, because of the way we’ve chosen to structure and fund it over the years, but as a system it works well enough that threats to take it away seems to raise the ire of those who have it.

Finally, even before the recent Act, we had government-regulated insurance exchange option available. It’s the one that has covered my family and me for most of my life, the Federal Employee Health Benefit (FEHB) program. OPM has regulated the program pretty well over the years and overall it’s worked pretty effectively.

The recently passed health care reform act requires that similar exchanges be established at the state level (or the state can opt into a national exchange), but the only population of those exchanges will be those who do not have health care coverage through their employer and who do not participate in any of the above health care systems. (And yes, I know I left Medicaid off my list, but it’s similar to Medicare in the way it functions.) That’s certainly an improvement over our current situation, but it means the pool will be a lot smaller which isn’t very good for sharing the cost and risk across the population.

Personally, I believe we need to move toward some single system. As I said, I don’t have any strong feelings about any particular system. Since I’ve participated in the FEHB for twenty-five years, I probably have a slight preference for expanding it to be the single exchange for all United States citizens. That’s not necessarily easy. In order to fund it and make it affordable, we would probably have to mandate that large businesses pay at least the same portion of the premium for their employees that the Federal Government does for its employees. And then we would need to develop appropriate subsidies for individuals and people in various categories such as the poor and the elderly. And it would obviously require a larger regulatory body than OPM currently has in place. But it could work if we had the will to make it work. Switzerland has proven that it’s possible.

In the interim, the health care act has some excellent features. The changes to prohibit denial of coverage of preexisting conditions and the end of the evil practice of rescission alone are very worthwhile. The extension of coverage under parental plans until the age of twenty-six means I will be able to keep my younger two children (both with celiac disease) on my insurance for as long as should be necessary. The insurance reform requiring that a minimum of 85% of premiums be used to cover medical loss is a great first step. I still remember when the typical medical loss by our mostly non-profit insurance companies was 95%, so I’m not impressed by the 85% number. Still, it’s better than the current 70%-80% medical loss. 85% is at least less egregious than the current situation. There are others, but those were the ones that I found particularly relevant.

Nevertheless, it’s a patchwork law that really doesn’t do enough. That doesn’t upset me terribly. That’s how things usually work with us. The health care reform act was a good start. Now we just have to keep making it better while trying not to take any steps backwards.