Evangelicals and health care for the poor

Evangelicals and health care for the poor June 20, 2012

During the 1990s, I worked for a parachurch nonprofit called Evangelicals for Social Action. We tried to get American evangelicals to share with and to advocate for the poor and the powerless.

As you may guess, that wasn’t easy. Our message was often met with suspicion or even with outright hostility. Some people and some churches could almost grasp the value of “social action” to meet the needs of the needy, but only if it were explicitly a tool for subsequent evangelism — “Soap, Soup and Salvation” or “rice-bowl” Christianity. Others just objected to the idea entirely as a worldly distraction from the calling to evangelize.

I had what I thought then was a terrific response to such suspicions and objections. “Your church is already doing all this,” I would say. “You’re just doing it overseas, but not here at home.”

This was true. Most evangelical churches are committed to supporting missionaries. That support is less zealously consuming than it was 150 years ago at the height of the missionary movement, but it remains a core aspect of evangelical identity. Many evangelical churches have a bulletin board in the lobby or in a Sunday school classroom featuring a big map of the world with pushpins, string and prayer-card family photos of all the missionaries supported by the donations and prayers of the congregation. It’s a big deal.

Some of those missionaries are pastors or full-time evangelists in the Billy Graham/Bill Bright mode. But a great many of them are also doctors, nurses, teachers and agricultural scientists. They run schools, hospitals, clinics and co-ops. And while they may not emphasize this in their fundraising visits to supporting churches, most evangelical mission agencies have refined their missiology over the years and view this work of teaching, healing and feeding as an end in itself and not just a manipulative means or tool to some other purpose.

So I could point to that big map on the bulletin board and say, “Look, you see Dr. Fountain there in Zaire? You love Dr. Fountain — and you should, he’s awesome. You know what he does every day? He treats sick people — poor people who have nowhere else to turn for health care. That’s Christian ministry. You already think of that as legitimate and valuable Christian ministry when it happens in Vanga, so why don’t you see it as legitimate and valuable Christian ministry here in America?”

I thought that was a killer argument, but it rarely worked. In some cases I worried that argument may even have undermined those churches’ support for medical missionaries.

It’s a very odd thing, the way that American evangelicals’ social concern stops at the water’s edge — or, I guess, starts at the water’s edge.

For more than a century, evangelical churches in America have been giving generously, sometimes sacrificially, to support medical missionaries in other countries. Health care for poor people is something they’ve prayed for and donated to for generations — but only overseas.

Somehow that commitment has never really translated into support for health care for the poor here in America. Not in any form. Here in America, evangelicals do not pray, give or vote for health care for the poor. Here in America, health care for the poor is something that evangelicals pray, give and vote against.

That’s immoral and generally horrifying. But given those same evangelicals’ support for medical missions, it’s also just deeply weird.

If you want a general idea of what life is like for many medical missionaries overseas, read Alec MacGillis’ account of a recent Remote Area Medical clinic in southeastern Tennessee.

To be clear, Remote Area Medical is not a religious mission agency. Like Doctors Without Borders, it’s a secular nongovernmental organization committed to providing health care to those in need wherever they may be.

But RAM’s origins are remarkably similar to the stories of many medical missionaries, with details that call to mind many a missionary slide-show presentation at a Sunday evening service in an evangelical church: remote tribes in the Amazon, bush pilots, etc. RAM’s website describes it’s history:

The vision for Remote Area Medical developed in the Amazon rain forest where founder Stan Brock spent 15 years with the Wapishana Indians. He lived with the pain and suffering created by isolation from medical care. He witnessed the near devastation of whole tribes by what would have been simple or minor illnesses to more advanced cultures. When he left South America to co-star in the television series, Wild Kingdom, he vowed to find a way to deliver basic medical aid to people in the world’s inaccessible regions.

The organization was founded in 1985 and years of research and planning yielded a vast, carefully developed network of men and women who have come together to make RAM a highly mobile, remarkably efficient relief force. Volunteers are doctors, nurses, technicians, and veterinarians who go on expeditions at their own expense and treat hundreds of patients a day under some of the worst conditions.

Brock — who’s a pretty amazing persondescribes that history himself:

A half century or more ago, I was living in a part of the upper Amazon basin where health care was a 26-day march away on foot. I survived malaria, dengue fever, numerous wild animal attacks and various encounters with Longhorns and mustangs without the help of a doctor. Others were not so lucky and I buried a number of them. It occurred to me that designing an all-volunteer health and veterinary care program for such desolate places might make life easier for a whole lot of people. It took a few years to work out the concept, but in 1985, Remote Area Medical was born. We have been called RAM ever since and in quite a few parts of the world, the appearance of a RAM Team means an opportunity for poor folks to get some real treatment free of charge from real doctors and veterinarians.

In recent years, the inspiring work that RAM’s volunteer network performs has gotten even more interesting, because they’ve expanded that work beyond the “remote areas” of “the world’s most inaccessible regions.” They’ve started working here, in America, the richest country in the world.

Americans may not live “a 26-day march away” from access to health care, but many are in just as “desolate” a location financially. For many Americans, access to affordable health care is as remote as the distant jungles of the Amazon.

That’s why 600 people camped out for a chance to see a doctor at RAM’s recent clinic in Sewanee, Tenn. About 15 percent of Tennesseeans lack health insurance, MacGillis writes in The New Republic:

Tennessee’s uninsured includes middle class people who can’t afford insurance or are turned down for health reasons, but the need is particularly acute among the poor and near poor who don’t qualify for Medicaid. In Tennessee, the program covers poor children, pregnant women and the disabled, as well as many parents below a set income threshold, about $28,000 for a family of four, but adults without children in their care are ineligible.

That’s set to change in 2014 thanks to the Affordable Care Act, or “Obamacare.” If five Republican justices on the Supreme Court don’t contrive some pretext for striking down the law, then it will greatly expand access to health care for those Tennesseans:

Under the law, Medicaid will expand in 2014 to cover anyone earning up to 138 percent of the poverty level, or about $31,000 for a family of four. Many people above that income who lack employer-provided coverage will receive subsidies to help them purchase private insurance.

Jesse Curtis summarizes the partisan divide over the health care law and the prospect of it being dismantled by the Republican Court:

This is purely cultural and partisan. The poor and working classes in this country will be much better off under this law. I don’t know if anyone has the audacity to claim otherwise. Poor minorities don’t necessarily know anything more about the law than poor white people, but they’re likely to assume it will help them. Obama passed it, after all, and they support him. But poor whites find it hard to believe that President Obama, for whom they harbor a deep cultural and partisan opposition, would do anything to really improve their lives.

Because this law will make life better for poor and working class Americans and bring health insurance to over 30 million people, Republicans have difficulty arguing against it on the merits. …

Most white evangelicals in America reflexively dislike the Affordable Care Act. They don’t know why, and can’t tell you why other than “SOCIALISM!!1!” or fear of contraceptive religious persecution or death panels or some other myth. They may concede that the law will, in fact, “make life easier for a whole lot of” poor and working-class people in America, but somehow that doesn’t make them any less reflexively opposed to it.

White American evangelicals support health care for poor people overseas. And White American evangelicals adamantly oppose health care for poor people here in America.

Again, this opposition is immoral and generally horrifying. And, again, given their historic support for medical missions abroad, it’s just deeply, deeply weird.

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