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Issues of health care

By , 21 August 2009 6:00 pm

There has been a certain bemusement in the UK recently over the sudden American preoccupation with the British National Health Service. I followed the debate with some interest: these are important issues. I also have some familiarity with the private system: when we were in Lebanon the system was totally private. The result was that at the entrance of the American University Hospital casualty department two sombre signs were posted . The first read something on the lines of ‘No guns allowed beyond this point!’; the second, ‘Medical Insurance Essential’. Immediately beyond the signs was an armed guard and a cashier’s office to ensure that both these entry criteria were met.

Anyway, I have to say that most Brits I know were pretty indignant about the NHS being trashed on US television by those opposed to Obama’s health care reform package. Passing over the ridiculous assertion that Professor Stephen Hawking would not have been kept alive by the British system, when that is exactly what it has done, our indignation was aroused on a couple of counts.

The first is that on the whole the British system works very well, and when it comes to accidents and emergencies, extremely well. We get the odd horror story but in general the system is really very good at what we call A and E. One of its big plus points is that when you do get ill or injured the only thing that matters is the medical process. If you hear someone in the UK say ‘I can’t afford to get ill’, 99 times out of 100 what they mean is ‘I can’t afford to take time off work’, ‘I’ve a wedding to attend’ or ‘It’s the big match coming up’. It is also very good for long-term care. As some of you know, our first grandson (now a thriving one-year-old) has a major hormonal deficiency that will require him to be on replacement steroids and to have regular health checks for the rest of his life. The total financial cost to him and his parents of this condition is zero. Well given that all three of them have enough to deal with anyway, there seems a degree of justice in the state shouldering some of the burden. I don’t mind my tax money going to that.

The second point of indignation centred on our perception of the existing US health system. Not having much experience of this, I do not wish to comment too much but it is a generally accepted truism that whenever you go to the States you make sure you have good health insurance. There is much that Americans may legitimately take pride in but I have never heard any American boast of their health system.

There is also much muttering in the UK over the perception (note, I choose my words carefully) that the protest against health care reform was being funded by the vested interests of the healthcare industries. Maybe I’m getting unusually cynical, but I too tend to take the old policeman’s rule that when faced with a crime, you ask ‘who benefits?’.

However the venerable NHS is not perfect. There are two problems, which relate to the general Christian theme of these blogs, to which I have no easy answer. The first one is that the NHS was created after the Second World War for a population that was still largely speaking, Christian. They felt that life was inevitably tough (the war and rationing had reminded them of that) and they had little expectation of making it much beyond the biblical 70 years. They had, if you like, limited expectations of a Health Service: it was not expected to reverse the Fall. (It should also be said that in those days there was not a lot the health service could do anyway; I have read somewhere that in the first years of the National Health Service, there were only 27 drugs available to doctors.) The problem now is that people expect to live to 90 or more, with all their organs working perfectly, their looks preserved and preferably sexually active, all at the state’s expense. (I hate to think of the number of drugs now available to the NHS, or their cost.)

My second concern, and I know it is shared by many people, is the extent to which we should bail out those who have effectively brought upon themselves self-inflicted injuries. I knew someone who courtesy of illegal steroid use during weight training destroyed his knees and put him and his family at the mercy of the state forever. A very large number of injuries received in our excellent accident and emergency wards over the weekend come about as a result of excessive alcohol abuse. And do I need to mention sexually transmitted diseases in unhealthy life styles? I do wonder if we had a private medical system, as we do with car insurance, such people would lose their ‘no claims bonus’ or its equivalent. But a totally free system is inevitably open to abuse.

Anyway I have no easy answers; the eternal Christian dilemma of balancing generosity and justice, fairness and forgiveness, persist. But I would cautiously suggest that, in both the UK and the US, we really need to do some careful and compassionate thinking about the way ahead.

Talking to God

By , 14 August 2009 7:17 pm

There’s a lot that I could blog on this week, from family matters to healthcare policies, but I want to continue the theme that was picked up last week: that of language. One of the fun things of struggling with another language (and I never do more than struggle) is that, like looking in a mirror, you see familiar things very differently.

Anyway, let’s begin with some grammar. For those of you that don’t know French, French verbs take a tu form for family, children and close friends and a much more respect-laden vous form for everybody else, particularly those who are above you socially. Vous is also used when you are addressing more than one person. Most tourists tend to use the vous form in France because it’s less likely to give offence. English residents and others living in France apparently go through nervous agonies knowing when to shift from the vous to tu form. (I’m told that there are similar patterns in German, Spanish and other European languages: it is called the T-V distinction and you can read all about it on Wikipedia.)

Now God doesn’t play a major part in French culture. Voltaire and others had good go at ejecting him around the time of the French Revolution and he never really seems to have made much of a comeback. You get the impression that, in popular French Catholicism, the ‘Blessed Virgin’ and the ‘Saints’ tend to occupy what we might call the spiritual ecological niche that Father, Son and Holy Spirit fills in Protestantism. Certainly all the evidence is that if God is at all considered in the French mindset he is as a very remote and distant character. So with that all in mind, it comes as something of a surprise when, reading a French Bible you see that God is addressed in the intimate tu form.

On and off this week I have been trying to find out through the Internet and a French teacher friend something of the origins of this peculiarity. What transpires is that the Protestants seem from fairly early days to have used tu to address God while the Catholics didn’t. This caused some animosity and heightened the religious divide between them. The Protestants were held to be overly familiar; they seem to have retaliated by saying that the Catholic use of vous could mean that they believed that God was not one. Given that Bible reading was not actually approved of in Catholicism until 45 years ago, the debate was probably quite academic. However at the Second Vatican Council (1962-65) papal approval was given firstly, to reading the Bible and secondly, to using the informal manner of address. So things are changing: nevertheless, some French Catholics have never adjusted and still resolutely use the vous form of God. After all, the argument goes, isn’t it inconsistent to address the Virgin Mary as vous but to address her Boss (so to speak) as tu?

This leads back to the fact that we used to have a similar problem in English with thee, thou and thine. Thee took the place of the French tu and was used for close friends and social equals and inferiors. You/ye and yours were reserved for those of higher social status. (There is a very good Wikipedia article on it). Apparently it had largely fallen out of use by around 1650 in southern Britain so all those historical novels set in the Civil War with them thee-ing and thou-ing are probably incorrect. As an aside, it has persisted in North English dialect until the present. Growing up in Lancashire it was very common to often hear people addressed as thee: as in “I’ll get thee a cuppa’ tea” and “where has tha’ been?” Being totally lacking in linguistic skill (grammar of any sort was starting to die out in the 1960s) I only now realise that it was restricted to use between friends and in the singular form only. The curious irony is, of course, that many people assume that the use by the Authorised Version (KJV) Bible of thee and thou is to indicate a respectful distance between us and God. That was not the meaning: far from it.

In fact, the issues here are not entirely linguistic; it’s the old dilemma of familiarity and respect. Because neither Hebrew nor Greek uses this T-V distinction we don’t have a pattern to go from. In this respect English Bible translators have much less of a problem: they don’t have to choose. I suppose using the tu form in prayer is something one would learn. How suitable you would feel it was, would probably depend on how you felt you stood in respect to God. If you see God as your Heavenly Father then the family tu form would no doubt seem utterly sensible. But if you see him as Lord then I presume vous would seem more appropriate.

A final comment here. In the Lamb among The Stars the Assembly worlds speak the artificial Communal. In case anyone asks I have no real answer as to whether that language would have preserved the T-V distinction. The issues of familiarity and respect, of God being Father, Friend and Lord are, this side of glory, not easily resolved.

Have a good week


New Labour and a warning to evangelicals

By , 1 May 2009 7:00 pm

At the start, let me say that this blog is not really about British politics; it is about something else far deeper. I actually wonder if it doesn’t touch on something of fundamental and rather worrying importance for the evangelical church. But let’s start with the politics.

One thing that has become apparent in Britain over the last week or so – although it has been looming for some time – is that what has long been called ‘New Labour’ is finished. The financial debacle, the massive rises in unemployment and various other scandals have so doomed the present administration that wherever you look on the storm-tossed ship that is the Labour government you can see people desperately running around looking for seaworthy lifeboats. Indeed so catastrophic is the pending electoral disaster that most of them seem reconciled never to play a part in politics again. A generation in the wilderness looms.

The background is worth repeating. As the Wikipedia article helpfully puts it, the traditional Labour Party ‘was in favour of socialist policies such as public ownership of key industries, government intervention in the economy, redistribution of wealth, increased rights for workers and trade unions and a belief in the welfare state as well as publicly funded healthcare and education’. After 20 years in which good old-fashioned Labour was so out of sympathy with the contemporary world that it was unelectable, Tony Blair and his colleagues (one is tempted these days to use word cronies) created a rebranded and updated version of the Labour Party: New Labour.

New Labour was a subtle creation. On the one hand it claimed complete continuity with the past. Traditional supporters were reassured that it was still Labour: at party conferences, the followers of Blair sung the same old songs, cheered the same slogans and assented to many of the old aspirations. Despite considerable misgivings, long-term Labour supporters were reassured that all that they had held dear was still present. Yet on the other hand New Labour now presented a friendlier face to the public. It was smoother, sleeker, more contemporary and, above all, more acceptable. Much of the old confrontational language about class struggle and social justice was no longer heard: the party was utterly remarketed. The floating voter was charmed and under the chameleon-like Tony, New Labour achieved a massive 179-seat majority in the 1997 general election . It has retained power until the present.

Yet now, as the wheels spectacularly spin off the wagon of the New Labour enterprise, the old Labour supporters are saying that they knew all along that this would happen. All their misgivings as to whether New Labour was actually Labour in any real sense have returned with a triumphant vengeance. It certainly now seems that, beneath all the words and new slogans, whatever the Blairite project was, it wasn’t really Labour at all. It was a charade, the survivors of old Labour say, and the fact that it has come to such a sticky end is utterly predictable.

Well, I have my reservations about both Old and New Labour and Old and New Conservatism too. In fact, I am increasingly thinking that the roots of our national problems lie too deep for politics to change. Nevertheless I think the account of New Labour – so clearly now in its final chapter – is worth us evangelicals thinking about.

Why? The answer is this. Those of us who are contemporary evangelicals claim that we are part of a great and honourable lineage going back through the Victorians as far as the Puritan reformers. We count men such as Bunyan, Wesley, Whitfield, Spurgeon and Lord Shaftesbury as our spiritual ancestors. We sing the same songs (well a few of them, at least). We pronounce the same mantras. We read the same Bible. We have the same creeds and we hate the same sins.

Yet just occasionally when I read some of the older literature, listen to some of the older songs or read biographies about some of those who we are proud to call our forefathers, I look around the contemporary evangelical scene and I do not find their like. Particularly in the areas of godly living and zeal for witness I find something of a mismatch between them and us. Is it possible, I wonder darkly, that while we wear their clothes and use their names, we are not indeed either them or of their party? When I point out such differences of language, outlook and emphasis I am speedily reassured that these are but minor changes of externals done in order for us to relate to a new clientele. The chorus of soothing voices says ‘Relax! Nothing fundamental has changed! The New Evangelicalism is just the Old Evangelicalism reclothed.’

And as I wonder whether that is indeed so I look at the tattered and beaten remnants of New Labour. And somehow, I am strangely afraid.

On bureaucracy and evil

By , 27 March 2009 7:43 pm

First of all, thank you all for writing in; the messages still keep coming and I value them. A good friend in church made the point that this is a biased sample of people who have read and enjoyed my books. He is, of course, right but frankly I don’t know how to poll those who haven’t read and enjoyed the books. Secondly, nothing much has happened at work to do with jobs and reorganisation. But I’m sure there will be news in the week before we break up for Easter.

So let me tell you about something that happened to me this week which I’m afraid is symptomatic of the New Britain. A week ago I had a letter from the local doctor’s surgery which included what was claimed to be the form for my annual test for fasting glycaemia. Very nice of them, you say; yes, but the problem is I have never had such a test. I politely wrote back pointing out that 20 years ago I had been diagnosed with blood sugar problems for a matter of a week before a thyroid issue was diagnosed but that had been 20 years ago and that I have had no such problem since despite a fairly regular battery of blood tests.

On Monday I had a phone call from the surgery. The insistent and unapologetic woman said that the reason for the letter was that they had noticed I had had a marginal result in 1991 and felt a retest was in order. I’m afraid to say I was very cynical about this; anyone who knows the British Health Service will realise that the idea of people sitting around saying ‘We’ve got nothing to do this afternoon so let’s look at 18-year-old test results’ is ludicrous. I mentioned this to a surgeon in our Bible study the following day and was told with that thin, weary smile that our healthcare professionals now bear, that doctors are now being paid for every screening they carry out. So they trawl through the records looking for likely candidates and once found, send them to be tested for no other purpose than financial. So, in the pursuit of spurious statistics and dubious gain, genuine issues of patient health are completely overlooked. I was not terribly surprised; we generate all sorts of figures in order for fundraising and quite a lot have nothing to do with our prime purpose which is (I still believe against all the odds) educating people.

This has led me onto a further meditation about the nature of evil. I always thought when I looked at those 20th-century mass killings of Stalin’s Russia and Hitler’s Germany that their awesome administration (all those names, those interminable lists, the sheer organisation) was merely an incidental feature. My logic had been something like the following: you decide to eliminate people so you are forced to create a bureaucracy which enables such a killing to take place. The murderous hatred comes first, the paperwork is second. I am now beginning to revise my opinion. I wonder if there isn’t something about the very nature of administrative systems that actually facilitates evil. All these forms, targets and goals actually create a fertile soil in which other evils, including mass murder, can grow. I am a long way from fully understanding how this works but I suspect that first of all it is to do with the dehumanisation of individuals. The very nature of bureaucracy is to render us faceless ciphers and turn us into impersonal and distant objects that can easily be moved around. In such a virtual world we have no more permanence than this sentence I am writing on the computer screen. A few keystrokes and we are changed; a few more and we are gone.

A secondary feature of this bureaucratisation is the substitution of human good (which ought to be the goal of all our efforts) by statistical achievement. In the beginning, no doubt statistical achievements represent no more than the necessary quantification of human good but all too soon they become not the means to the end but the end itself. It is all analogous to how the idol starts off as an aid to worship but soon becomes the worshipped object itself. So, slowly and insidiously, administration replaces humanity. On this view the tyrant does not so much create a bureaucracy of evil as divert an existing bureaucracy into flowing along an evil path. But I fear that such a diversion is easier than we may imagine. While bureaucracy may not be evil, it clearly lends itself to evil.

I have no idea what the solution is. The anarchist remedy of smashing all machines and systems is beyond credibility. Perhaps, at the very least, we need constantly to be reminded that human beings are in the image of God and that – however disguised by numbers and ciphers – we remain beings of extraordinary value.

Have a good week.

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