The news today, May 4, 2017, is filled with President Trump and the House Republicans celebrating Trump’s legislative victory of passing the “Trump Care” bill though the House of Representatives by 217 votes, all Republican.  This does not take into account the 193 Democratic representatives and 20 Republicans who opposed.  Nor does this account for the passage through the Senate which is required for this “repeal of Obamacare” to become law.  I predict the “shame, shame, shame” of the protesters on the Capitol steps after the vote will be heard in an increasingly louder measure in the coming days.

The Congressional Budget Office has not yet reviewed the implications of the bill, which should occur before the bill is presented to the Senate for debate.  We know that the first and failed version of Trump Care was predicted to eliminate 24 million patriotic Americans from the possibility of obtaining health insurance.  We do not yet know the numbers excluded from health care by this bill, but it will be in the millions as well.  The Alt-Right and the Koch brother’s Republicans (‘in their pocket Freedom Caucus’) is actively opposed to the US government being involved at all in health care.  This is despite the fact that 55.3 million persons currently are beneficiaries under Medicare, including about 9 million disabled persons. (US Government Website, ncpssm.org, also see kff.org)

Medicaid and the CHIP program cover approximately 70 million persons, about 1 in 5 persons in our country. (from www.usnews.co>2015/02/24)

70million + 55 million is a total of some 125 million persons (although some are covered by both programs in certain circumstances).  It can truly be said that is about 1/3^rd of the population of the United States is covered under a government mandated insurance program.  As physicians, we can often say some of our most reliable patients are those covered by one of these programs.

When President Obama presented the Affordable Health Care Act to balance the cost of covering all persons regardless of preexisting and current health conditions, this act had a mandate requiring healthy persons to buy insurance or pay a penalty.  This was intended from the beginning to help insurance companies balance the cost of the more expensive and more ill patients with those who are “more healthy.”  This means essentially that for the Affordable Health Care plan to work the healthy population helps subsidize the poorer or more ill Americans.  When the Republican congress removed the mandate which they considered onerous, it essentially made the coverage of the sickest Americans unaffordable.  We also saw some 18 or more states refuse to participate which sabotaged the program from the beginning, so now later Republicans can crow about “the tremendous rise in premiums on healthy Americans.”  This would not have occurred had the program been adopted by all states, with less reliance on what is called the “government exchange,” so more insurance companies could afford to stay in it.  By this time, the program may have covered most Americans not covered by their employer’s insurance plans.  The Affordable Care Act could have provided a basis, along with other insurance plans and Medicare, Medicaid, CHIP for a national health care insurance program providing at least a basic coverage package for all Americans.  It is truly a shame that one of the wealthiest nations on earth has such poorly managed health care.  It does not have to be this way.  We can and could do better.

Health care is big business in the USA.  The need to make profit has corrupted our whole system, which could be viewed as a right of all Americans.  Corporate greed has prevented this from occurring and ideological fractures in how health care is viewed across the political spectrum have led to this current confusing and frustrating picture of health care in America.  Except for the healthy twenty somethings, who do not see the value of a safety net for all Americans and do not want to help contribute to the global coverage, most reasonable Americans I know see the value of having some kind of health insurance when a person is injured either at home, or when driving their car, or when illness strikes the family without warning.  Even the most conservative Republicans sees value in immunizing our children from multiple diseases and have not tried to strike down the mandate that children must be immunized in order to go to elementary school and beyond.  Most colleges require some type of health form, showing vaccinations and insurance to be completed for students to be enrolled, particularly those who live in campus dormitories.  Our military sees the value of immunizations and good health care for our soldiers, both men and women.  Our Veterans have come to expect good health care when they come home after serving our country.

As a physician, I am continually amazed at the schizophrenic thinking regarding health care among our politicians.  On the one hand most everyone views having health insurance as being valuable to their life and the well-being of their families.  Yet for the House of Representatives to have an excellent health care plan for themselves and their family, yet deny the same for those persons who voted to place them in their job and position is disturbing and “schizophrenic thinking”, in my opinion.

The problem as in so many things in life is money.  If health insurance is made available for everyone, how will it be paid for?  The expansion of Medicaid under the Affordable Health Care Act was onerous to many because of the cost to the Federal budget.  With the deficit now into the trillions of dollars for the US government economy and with entitlement programs as Medicare, Medicaid, CHIP and the expansion of Medicaid under the Affordable Care Act, for many Republicans this became untenable, due to the cost.  This brought about the opposition from many very conservative Republicans to eliminate the US government from any involvement in health care.  Their goal is not only to cut the government budget but eliminate its participation in at least some of the entitlement programs which now make up more than 26% of the total expenditures of government.  If Medicare, Medicaid, Chip and the Affordable Care Act were eliminated from the Federal budget, then only Social Security and Social Security Disability would remain to be reformed or eliminated and the government would have a leaner budget, devoted mostly to defense spending (now 16%) and public works projects, with a little for the National Parks and other items.  There would be money for greater salaries for government employees, representatives of government, national disasters, and funding the Hadrian (sorry) Trump wall on the border with Mexico.  Hell, we would have enough left over to build a wall on the Canadian border too and stop all the bad influences coming in from other nations.

Everyone, except President Trump and a few others knows a wall will never stop drugs, guns or criminals from entering this country.  It will not reduce domestic violence or terrorism of determined individuals from abroad or more concerning, those from within our borders.  It will, however give a psychological boost to the idea of American exclusiveness and identity, so central to Trump’s view of the world and that of many of his supporters.  Just as the Hadrian wall did for the Roman Empire and the Great Wall of China did for China, the identity of the empire is involved in these expensive symbols.  It can also become a good place for graffiti and artistic expression (as the Berlin wall) and serve as a canvas for many opinions and voices of many people on either side.  If it were possible to isolate ourselves from all persons with disease, from all terrorists, criminals, people of other color and races, persons who speak funny English or no English at all, and for religious persons to finally exclude all non-religious persons, and straights to separate from gays and lesbians and transgender types, (shall I continue?) would we really be better off in this society or would we be happier within ourselves?

The whole idea of a democratic society trying to seal itself off from the world is utterly ridiculous!  If we took the time to think about what we are trying to do, we could find a better use for our time, our energies and our money.

Unless we welcome we exclude.  If we refuse to embrace others, we isolate ourselves.  Anyone who has ever tried to escape from their own life by moving to another country soon finds they brought the problem of their life with them to the new place.  The problem is ourselves!    We cannot run far enough away or build a high enough wall to escape from the problem of me.

Once we define where the real problem lies, within ourselves, we can then begin to make progress on the welcoming of others and the embracing of those unlike ourselves.

According to the holy scriptures of every major religion, we all carry within ourselves the image of God our Creator.  Whether we define this image as our “human consciousness”, or “our mind”, or our “soul” or our “spirit”, or the fact we are born knowing shame and right from wrong is really irrelevant.  The fact is we are more alike one another than we are different.  There may be only a few genes separating us from the chimpanzees and the great apes, but it is enough for God to call us “human beings” (See Genesis 1-2:4).

I wonder why we so easily forget this basic understanding of the human family.  We are all made by God, made in God’s image and exist for the pleasure and by the desire of our Creator-Redeemer-Savior-Friend.

Human community, human diversity is a gift to us.  The spectrum of white light bent by a prism into a rainbow of colors of different frequencies still originates from one white light.  If we can embrace differences rather than excluding these from ourselves by ourselves to ourselves, we might find that human community is that for which we all have been made!

When the gospel of John says in chapter thirteen, in the words of Jesus:  “In my Father’s house are many rooms.  I go there to prepare a place for you.  If it were not true, I would have told you.  I will come again and receive you unto myself that where I am there you may also be,” Jesus is trying to tell us something important about the human family.

I grew up in a large family which has a house of six primary rooms, but had within it ten persons.  We had to learn to accommodate one another.  At times, particularly when needing a bathroom, the house seemed to be too small.  But we made do.  We learned how to accommodate one another, not simply because we had to, but because we are family.  We took our turns.  We helped do the chores together.  We all did our part.  We all lived in this one home together from more than 20 years, until we all were grown and left to develop families of our own.

So if God has only one house for us that has many rooms, does each person get one room or do we share?  If we share, do we get to pick whom we will room with or does God choose?  If God chooses to put me in a room with someone unlike myself, who is of another color and speaks another language will I be upset?  Will I spend my time in heaven complaining about the unfairness of it all?  Heaven is supposed to be a place of harmony, happiness and bliss.  Will I be the only person there who is dissatisfied?

If I cannot live with my neighbor now, will God see to it that I am placed in the same room with him or her on that great day, so I can finally learn what I should have already learned while I was here on this earth for chapter one of my life?  If heaven is chapter two, what if there are later chapters three, four, five and six?  Perhaps going from chapter one into chapter two requires that I learn something in chapter one before I get to live in chapter two!  If that is so, will God recycle me through here again until I learn enough to go further?

Now these questions are all speculations of an old man thinking about the meaning of life here on this earth late at night, when all the house is quiet and even the little creatures are asleep.  I am the only one still awake at this hour.  Perhaps I am still awake because questions like these trouble me in this time when our President tries so hard to make American great.  But is our greatness simply to do this alone?  If we exclude our Hispanic brothers and sisters, those from Somalia and Ethiopia, and the Chinese, the Russians, the Syrians, the Vietnamese will we have anyone to be our neighbors?  If as a Christian I refuse to acknowledge a Moslem as a worshipper of the Living God, have I somehow diminished my own worship of God?  If God made all persons, most of whom are not like me, am I the one who is special, or are they the special ones?  We assume a whole lot when we presume to say God loves me more than he loves you.  Suppose God loves you more?

If God loves us all the same, does this not mean that your worth in God’s sight is as great as my own?  So if we are loved by God all the same, who am I to exclude you from my love?  If God loves you, does that not also mean that I am called to love you, too!

Am I the only one on the face of this good earth who is haunted by questions such as these? I suspect not.  But I will continue to speak these things until I awaken the consciences of others to be as troubled by these matters as I am troubled by my God over our treatment of one another.   So the question of Cain to God:  “Am I my brother’s keeper?” which occurred to him to ask after he had murdered his brother Abel may be our question too.  It is enough for me simply to repeat the question.  You wrestle tonight as I will wrestle what you will say when you stand before your God.  Save yourself, my friend!  I am trying to save myself!  What about you?  Will you join me in this endeavor?

A Voice of one crying in this wilderness, “Make straight in this desert a highway for our God!”

“Amen and Amen!”