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Christian Perspectives

On Responding to the Uninsured

There are a number of occasions in the church year that lend themselves to focusing on the health care needs of people, and countless scriptural texts that speak to our responsibility to respond to the needs of those without health care. Be attentive to the opportunities that arise so that you may continue to provide leadership in urging a faithful response to the growing problem of the uninsured.

Prayers
Sermon Resources

Prayers

(Unless otherwise noted, all prayers written by Shannon Daley-Harris, M.Div.)

Greeting/Call to Worship
Hear these words of scripture: "God consoles us in all our affliction, so that we may be able to console those who are in any affliction. For just as the sufferings of Christ are abundant for us, so also our consolation is abundant through Christ." (2 Cor. 1-4ab, 5) We gather on this day in the name of that Christ who suffered for and consoles us, as we remember the nearly 44 million Americans who lack health care coverage. As God has consoled us, let us dedicate ourselves to consoling those who long for health care with our prayers, with our loving service and with our work to solve their suffering. Come, let us worship the God of our consolation with our hearts and our hands, our lips and our lives.

Prayer of Confession

Loving God, we come to you this day confessing that we have not always loved our neighbors as ourselves. We are aware of people suffering for lack of health care, and yet we pass by on the other side. We know there are children who struggle to grow and learn with untreated health problems, and yet we pass by on the other side. Families are crushed by medical bills and other financial burdens, yet we pass by on the other side. When we encounter troubling situations that we don't know how to fix, we are tempted to pass by on the other side. Stop us in our tracks, O God, and open our hearts so that we are not afraid to get involved in meeting the needs of those who are being ignored. Make our hearts bold and loving and send us in the name of your Son to go and do likewise. Amen.

Bidding Prayer
The prayer here is written as a "bidding prayer." The leader invites the congregation to pray about a particular concern. Congregation members may pray in silence or add their own brief, spoken prayer about the concern, offering either the names of individuals or categories of people. Then, the congregation as a whole concludes with the petition marked, "All."

Leader 1: Let us pray for those who do not have health care coverage. (Time during which people may offer silent or spoken prayers.)
All: We pray that those who are uninsured will receive the health care they need and that they will know your strength in their weakness, your comfort in their pain, your hope in their despair.
Leader 1: Let us pray for health care providers. (Time during which people may offer silent or spoken prayers.)
All: We pray that doctors, nurses and all health care providers will be guided and strengthened by you as they care for others as an expression of your love.
Leader 1: Let us pray for all in leadership positions. (Time during which people may offer silent or spoken prayers.)
All: We pray for elected officials, business leaders, community leaders and all in positions of power, that they will lead with justice and integrity and point the way to solutions that assure all the care they need.
Leader 1: Let us pray for the sick and injured. (Time during which people may offer silent or spoken prayers.)
All: We pray with full hearts for those who are sick and injured, especially the uninsured whose suffering is increased by lack of care or by anxiety over paying for care. We pray that in these difficult days, they will know your comforting love that enfolds each and every one, and that they will be restored to health.
Leader 1: Let us pray for ourselves. (Time during which people may offer silent or spoken prayers.)
All: We pray for ourselves…for health, for caring hands to reach out, for loving hearts to share another's pain, for the will to solve big problems. We pray these things with gratitude for the life you have given us, for your care which enfolds us and for your love made known on the cross. Amen.

God of All

God of Life, we pray this day for those whose dying is hastened by lack of access to health care.
God of Love, we pray this day for the millions of people who do not have health care coverage, that their pain and anxiety will be relieved and that our hearts will be moved to help them.
God of Justice, we pray this day that our nation will work as one to see that all people have the health care they need.
God of the Weak, we pray this day for those who are too young, too sick, too ashamed, too discouraged to speak out for themselves and call for care.
God of Power, we pray that all who are in positions of leadership will work together to solve the problem of the uninsured.
God of Mercy, we pray for those whose suffering is unrelieved by care and for ourselves that we will work with others to assure care for all.
God of All, you have made us in your image. Help us to reflect your goodness. Amen.

General Intercessions (Prayer of the Faithful) [Roman Catholic rubric]

Priest: My brothers and sisters, through this common prayer let us pray to our Lord Jesus Christ,not only for ourselves, but for the health and well-being of all whom God has created, saying, "Lord, make us whole."

Deacon/Cantor/Other: For the holy Church of God, that in the name of Jesus who healed the sick and welcomed the outcasts, we minister to all who suffer in mind, body and spirit and call for care that excludes none, we pray to the Lord.

Lord, make us whole.

For all the peoples of the world in which disease knows no borders, suffering is a shared language, health care is a common need and good health is a universal hope, we pray to the Lord.

Lord, make us whole.

For our nation, that we assure health care for everyone and so doing discover that true strength comes from ensuring justice and compassion for all and not just for some, we pray to the Lord.

Lord, make us whole.

For ourselves and our community, that we don’t pass by the problems of others but work together to solve the problems that afflict our neighbors, offering comfort and care, support and solidarity, advocacy and action to heal the broken places, we pray to the Lord.

Lord, make us whole.

For all who are uninsured, that they find strength and hope in you and justice and care from your people, and for the sick that they are sustained by faith and served with care by doctors and nurses acting as agents of your love, we pray to the Lord.

Lord, make us whole.

For all who have died, especially those who died for lack of care, and for the loved ones who grieve their passing, we pray to the Lord.

Lord, make us whole.

Priest: We know, O God, your desire for health and wholeness through Jesus Christ, who told the woman that reached out and touched him, "Your faith has made you well." Grant us today what we ask of you in faith, through Jesus Christ our Lord. Amen.

A Prayer for Healing [adapted from the Presbyterian Church (U.S.A.) Book of Common Worship]

Mighty and merciful God,
you sent Jesus Christ to heal broken lives.
We praise you that today
you send healing in doctors and nurses,
and bless us with technology in medicine.
May we work with justice and compassion
to assure that the blessing of this care is available
to all and not just to some.
We claim your promises of wholeness
as we pray for those who are ill in body or mind,
who long for your healing touch.
Make the weak strong,
the sick healthy,
the broken whole
and confirm those who serve them
as agents of your love.
Then all shall be renewed in vigor
to point to the risen Christ,
who conquered death that we might live eternally. Amen.

For Doctors and Nurses (adapted from the Episcopal Book of Common Prayer)
Sanctify, O Lord, those whom you have called to the study and practice of the arts of healing, and to the prevention of disease and pain. Strengthen them by your life-giving Spirit, that by their ministries the health of the community may be promoted and your creation glorified. Guide us, your people, to assure that these ministries of health are available to all and not just to some; through Jesus Christ our Lord. Amen.

Prayers of the People [Episcopal Rubric]
We know God's desire for our health and wholeness through Jesus Christ, who healed the sick in mind, body and spirit. Let us pray to the Lord, saying, "Lord, make us whole." For the Universal Church, that in the name of Jesus who healed the sick and welcomed the outcasts, we minister to all who suffer in mind, body and spirit and call for care that excludes none, we pray to the Lord.

Lord, make us whole.

For our nation and our leaders, that we assure health care for everyone and so doing discover that true strength comes from ensuring justice and compassion for all and not just for some, we pray to the Lord.

Lord, make us whole.

For people everywhere, in a world where disease knows no borders, suffering is a shared language, health care is a common need and good health is a universal hope, we pray to the Lord.

Lord, make us whole.

For ourselves and our local community, that we don't pass by the problems of others but work together to solve the problems that afflict our neighbors, offering comfort and care, support and solidarity, advocacy and action to heal the broken places, we pray to the Lord.

Lord, make us whole.

For all who are uninsured, that they find strength and hope in you and justice and care from your people, we pray to the Lord.

Lord, make us whole.

For those who suffer, especially the sick, that they are sustained by faith and served with care by doctors and nurses acting as agents of your love, we pray to the Lord.

Lord, make us whole.

For all who have died in the hope of the resurrection, especially those who died for lack of care, and for the loved ones who grieve their passing, we pray to the Lord.

Lord, make us whole.

Sermon Resources

Is There No Balm in Gilead?
Biblical Analysis and Sermon Notes By Shannon Daley-Harris, M.Div.

Scripture:

My joy is gone, grief is upon me, my heart is sick. Hark, the cry of my poor people from far and wide in the land: "Is the Lord not in Zion? Is her King not in her?" ("Why have they provoked me to anger with their images, with their foreign idols?") "The harvest is past, the summer is ended, and we are not saved." For the hurt of my poor people I am hurt, I mourn, and dismay has taken hold of me. Is there no balm in Gilead? Is there no physician there? Why then has the health of my poor people not been restored? (Jeremiah 8:18-22, NRSV)

Jeremiah 8:4ff resounds with words of judgment and lament that so characterize this book of the Bible. Again and again Jeremiah addresses the people's waywardness, their straying from right paths, using rhetorical questions to highlight the senselessness of it. One who falls gets up, right? One who strays turns back, right? So why not this people?! Animals show better sense than the people who have gone astray. The focus of 8:4-7 is on the people's refusal to repent, to turn in a new direction.

Verses nine through 13 turn the critique to the "wise," religious leaders—scribes, prophets and priests—whose teaching and "wisdom" conflict with the word of the Lord revealed to the prophet. The written word the religious leaders keep is not lived out in the actions God desires. The suffering that results from this judgment will affect not only the religious leaders but their families and communities. In fact, it is not only the wise who are indicted here, but the whole community, "because from the least to the greatest everyone is greedy for unjust gain; from the prophet to priest everyone deals falsely. They have treated the wound of my people carelessly, saying 'Peace, peace,' when there is no peace." (Jer. 8:10b-11)

8:14-17 describes the military threat from the North and with great irony describes the people deciding to flee to the city for shelter, only to find judgment and danger there.

Finally, to our central focus: 8:18-9:1, which begins with tears and sorrow. Patrick D. Miller, Charles T. Haley Professor of Old Testament Theology at Princeton Theological Seminary, and others suggest that the one weeping may be God, not only the prophet as many have imagined. In verse 19b and again in verse 22, the prophet asks three rhetorical questions, the third of which is accusatory. "Is there no balm in Gilead?" Of course there is. "The balm was a resin from the Styrax tree produced especially in the Transjordan region and widely used for medicinal purposes." (Oxford Annotated Bible) It was as plentiful as ever. "Is there no physician there?" Again, the rhetorical question assumes the answer is, "yes, there is a physician there." Then, the next question accuses, "Why then is there no healing for the wound of my people?" The problem is not the absence of resources for healing. The problem is the sin and injustice of the people that have resulted in such judgment and suffering. And so our passage ends with the prophet and God weeping "day and night for the slain of my people!"

Theological Themes
Patrick Miller notes the movement from sin to judgment to lament in this and other passages in Jeremiah. "The logic is that in this movement a sinful people evoke God's judgment and end up in grievous lamentation, a lament that is shared by the prophet and by God." (p. 642 The New Interpreter's Bible).

This passage also emphasizes another theme in Jeremiah: turn and return. The Hebrew word shub is used both in describing the people's turning away from the right path and their repenting, turning back to God. The active nature of "turn away" and "turn back" helps recast sin and repentance from passive states of one's heart, as they are sometimes seen, to acts and choices that we make. The indwelling of God places conditions on the heart of the believer that must be lived out in their actions.

Too, no single class or sort of person has a corner on sin in this passage. The people of Judah are held accountable, the religious leaders are held accountable, the community as a whole from the least to the greatest is said to experience sin. There can be no finger pointing among those who sin; all are judged . . . and all are invited to return to God.

Pastoral Implications
There are those who do not have health care coverage in virtually every congregation. Surely they identify with the cry, "Is there no balm in Gilead? Is there no physician there?" Too often this identification, however, is made in silence. Many people experience shame about being uninsured and feel a sense of failure. Pastors, congregation members and friends may be unaware of those who experience the stress and physical repercussions of lack of insurance.

Even those who have health insurance may be in the midst of a health crisis of their own or that of a loved one. Surely the cry and question is upon their heart, "Why then has [my] health . . . not been restored?" To be sure, one needs to recognize that health care coverage is not a guarantee against sickness and injury, and insured people may experience their own struggles and grief over poor health.

Still others may come to this text with the familiar words of the hymn in their head, "There is a balm in Gilead, to make the wounded whole, there is a balm in Gilead to heal the sin-sick soul." In discussing health in a religious context, one always needs to be mindful of the connection many still make between sickness and sin; surely, if I (or she) had not done something wrong, had not been sinful, I (or she) would not be "punished" like this. Pastoral sensitivity is called for to ensure that the sick, or the uninsured, do not blame themselves, and that others do not blame them and assign a moral judgment to the one who is suffering.

Preaching the Lesson
"Sin-sick soul" is not a medical condition, it is a spiritual condition. And it is not only an individual complaint but the status of society.

The themes of turning away and repenting and a movement from sin to judgment to lamentation are especially fitting in the context of Cover the Uninsured Week as it is observed by congregations across the nation.

While we might like to keep the notion of sin vague and at arm's length, we are confronted by concrete examples close to home:

• How would God judge our nation's sin in allowing 8.5 million children—the same number as every first- and second-grader in our country's public schools—to lack health insurance and suffer the consequences?
• How would God judge the sin of our nation allowing nearly 44 million people to lackhealth insurance, and live sicker and die younger as a result?
• Can it be other than sin to live in a nation blessed with unparalleled health technologies, trained health care providers, state-of-the-art health care facilities, and allow one in eight persons to lack health insurance and the access to the care that he or she needs?
• How would our silence and inaction on solving the problem of the uninsured be judged, when we know that people who are uninsured live sicker and often die younger as a result?

Our scripture gives voice to the anguish that the prophet and God feel at the sin of the people, at the unrelieved suffering, at the failure of justice and compassion.

The prophet asks rhetorically, "Is there no balm in Gilead? Is there no physician there?" The answer, or course, is that there is. There is balm, as always. There are physicians as before. "Why then has the health of my poor people not been restored?" The difficult truth is that their health has not been restored because of the nation's injustice and lack of compassion, because of their stubborn refusal to live as God's beloved community. When those who are uninsured live sicker and die younger, surely we too cry, "Is there no balm in Gilead? Is there no physician there? Why then has the health of my poor people been restored?"

When uninsured women with breast cancer are twice as likely to die of it than insured women, surely we cry "Is there no balm in Gilead?"

When uninsured men are nearly twice as likely to be diagnosed at a late stage of colon cancer as men with insurance, will we ask, "Is there no balm in Gilead?"

When children without health insurance are seven times more likely to go without needed medical care than children who have health insurance, shall we not demand to know, "Is there no balm in Gilead? Is there no physician there? Why then has the health of my poor people not been restored?" Would this cry be on the lips of Rosemary? Rosemary was laid off from her job in September and cannot afford her COBRA premiums, which would have allowed her to pay to continue the coverage previously provided by her employer. As a survivor of breast and cervical cancer, premiums for individual private insurance are sky-high. Although at risk for a recurrence of her cancers, she has been unable to afford even a basic check-up with the doctors that she saw for her original treatment. Instead, she lives in fear for her health.

Would Tabitha ask with us, "Is there no balm in Gilead? Is there no physician there?" Tabitha, the mother of two small children, is self-employed as a licensed in-home child care provider. Both of Tabitha's children are covered by Medicaid. However, with a monthly income of $1,600, Tabitha earns too much to qualify for Medicaid herself and too little to pay for private insurance.

Should we not ask, "Why has the health of my poor people not been restored?" when we hear the experience of Robert? Robert, the father of two young children, is a self-employed seasonal general contractor who for a long time was unable to afford the costs of private health insurance for himself, his wife and their children. Although he recently managed to pay for coverage for his children and wife, he is only able to afford catastrophic coverage for himself. Because of his limited coverage, he has not sought care for a chronic condition that would improve with treatment.

We need not remain stuck in "lament." Today, as in Jeremiah's day, God invites us to turn away from the wrong path and to return to God, to fulfill God's standard of justice and compassion. Cover the Uninsured Week states the choice before us simply: We can let millions of Americans live without health care coverage, or we can do something about it.

Prayer

O God, our Comforter in sorrow, our hearts ache this day for the millions of people who suffer illness and injury, for those who lack health insurance and cannot get the care they need, for those who despair and fear they will not be saved.

You are the Balm of our souls. Restore our hearts and wills to wholeness with your healing balm, we pray, so that we will be prepared to act with justice and love to care for your people. Move our hearts to weep with their pain. Move our hands to reach out with comfort. Move our wills to work so that the resources you have blessed us with are available to all. Amen.

Raising the Roof for Health Care: Biblical Analysis and Sermon Notes
By Rev. Eileen W. Lindner, PhD, Deputy General Secretary for Research and Planning, National Council of the Churches of Christ in the U.S.A.

Scripture Selection: Mark 2: 1-5 (A parallel account can be found in Luke 5:17-21.)
This is the story of a paralyzed man who is aided by four friends who overcome obstacles to bring him to Jesus, where he is healed.

Nature, Placement and Style of the Passage: Mark places this account early in Jesus' ministry, demonstrating the importance that healing had in the life and ministry of Jesus. Set in Capernaum, this is the context in which Jesus taught in the synagogue in the preceding chapter of Mark's gospel. As such, it is a town in which the expectation already exits for Jesus to heal those who are infirm. In the Luke account, the story is not placed so early in Jesus' ministry and is a part of a series of short stories and accounts that share the theme of controversy as it begins to surround and confound Jesus. The Mark account emphasizes the press of the crowd that came to the house when "it was reported that he was at home" (RSV). The Luke account does not emphasize the size of the crowd but rather its composition. Luke notes that "Pharisees and teachers of the law from every village of Galilee and Judea and from Jerusalem" were present as Jesus began to teach. (NRSV)

Explication/Interpretation of the Passage
Especially in the Mark account, this story strikes several important themes, both with regard to understanding Jesus' ministry and related to understanding the role of believers who follow Jesus in seeking the healing and wholeness of their neighbors.

We can well imagine the scene. A famous teacher who is reputed to be in possession of healing powers is reported to be at a home in the village. Naturally people in need flock to the home. Some press in with the hope of being healed or having a child or family member healed. Others, perhaps more interested in the religious teaching, crowd in so that they may hear every word. Soon the home is filled beyond capacity, and the crowd overwhelms the house and spills out the door. Four friends who have apparently heard of this man and his healing power have determined to bring their paralyzed friend to Jesus in the hope that he will one day walk again. Carrying the man on a pallet, they approach the home, only to find it is hopelessly overcrowded and there is no chance for them to reach Jesus and seek his healing touch. The resolve of the friends is tested immediately by the seeming impossibility of the situation. Surely no one, even their infirmed friend, would blame them if they gave up trying and simply carried him back home to await his fate.

Yet, some spark of commitment, some element of determination, perhaps even some sense of justice compelled the friends onward as they sought another way to come into Jesus' presence. We don't know how many options they weighed before they decided that they must do the near impossible and transport their friend to the roof and then lower him down, unharmed, into Jesus' presence. Imagine the paralyzed man; surely he was fearful of being lifted so high above the ground where he dangled helplessly, relying on his friends not to drop him.

The problem of the roof itself was not such a small matter either. The Mark account says the friends "removed" the roof (RSV) or "dug through" it (NRSV) to obtain entry into the room where Jesus sat. The likely construction of a Palestinian peasant home in the ancient near east was likely to include not only crossbeams but mud as a binding element holding together the hay or straw that served as the roof.

Our imaginations can easily replay this account. The four friends, not to be denied by the crowd at the door, somehow scramble to the roof even while carrying their friend on a stretcher. Once there they either remove roof tiles, or worse, dig through dried mud and straw opening the ceiling on the people below. Finally into the midst of the densely-packed crowd do the friends lower the stretcher literally on top of Jesus. The story concludes with Jesus rapidly and thoroughly healing the man to such an extent that he picks up his pallet (verse 12) and walks out the door by which he could not enter. (No mention is made either of the fate of the four friends or of the status of roof repairs to the home!)

Sermonic Application
While several lessons present themselves immediately in this short account, most central is the example of these four friends with their determination and ingenuity. They clearly know what it means to be good neighbors and friends, and they have dedicated themselves on this day to seeing to it that their friend obtains access to the care he needs. No obstacle, it seems, is too discouraging. First, they need to find or make a pallet on which to carry him. When they find the house where Jesus is healing and teaching, all looks hopeless. They can't get in the house, certainly not with a stretcher in their arms. They then hit upon a new idea. They will climb to the roof and drop their friend through the roof to the feet of Jesus! Clearly the friends' determination did not falter, yet we are startled to find that the courage of the paralyzed man persisted in the face of an adventure he surely could not have imagined. These faithful believers and followers of Jesus make it their mission to secure care for one who is need in their community.

It hardly needs to be said that this story teaches a lesson about the nature of healing as well. Some people do not, for whatever reason, have the resources to get themselves to the source of healing and wholeness unless they are assisted by others. Access to the source of healing is a matter of life and death. A matter of social justice and a matter of community equity requires some parity of opportunity.

At last we come to Jesus, who heals and makes whole one who is in need and hopeless. Jesus confidently restores and heals to wholeness the paralyzed man, instructing him to "take up your pallet and walk." Jesus still calls his followers into action on behalf of those in need.

Sermon in Context
We are challenged to hear this healing story of Jesus in the context of an America in which nearly 44 million persons lack health care coverage. In our society there are many that are unable to reach the source of healing and who are shut out from the restoring care of life. Children who live in uninsured families often lack routine check-ups and preventive care and even lack needed medications for chronic conditions. Eight out of 10 people who are uninsured are in working families.

The uninsured in America need a group of determined and dedicated friends to commit themselves to raising the roof or doing whatever else is necessary to bring the uninsured to the source of healing care.

Meeting Uninsured Americans
The uninsured in America are all ages and races, and come from all regions of the country and life circumstances. To live in the kind of community where equality is celebrated and opportunity is a birthright, we all will need to work for health care coverage for all. Some of the uninsured include:

• Christina: Christina is a breast cancer survivor who, at age 62, finds herself ineligible for Medicare. The American Cancer Society is able to help her with the cost of her medication, covering all but $40 of the monthly fee. However, the subsidized community clinic that she regularly visits is unable to provide her with the specialized care that she needs, and this, in addition to the required $10 up-front fee, prohibits her from seeing a doctor regularly. Christina also needs regular treatment for high blood pressure, but cannot afford it. With a combined monthly income of just $920, Christina and her husband cannot afford insurance for their house, car or health.
• Joel: Joel is employed in roofing and home construction, earning $12 an hour. His employer is a small business that cannot afford to provide coverage to its workers. Several months ago, Joel suffered a leg injury that required emergency room care and left him with a bill for hundreds of dollars. Recently, Joel contracted a severe virus that resulted in an additional bill for $800. Joel is trying hard to pay these bills on his modest income.
• Marcie: Marcie has had to delay care for her thyroid condition because she is uninsured. Until recently, Marcie was covered through her husband's employer-based health coverage. In the midst of a divorce, Marcie has been removed from her husband's health insurance. She has been an at-home parent, raising her daughter and volunteering with AIDS patients. Now she faces the predicament that many women do when going through divorce: she must find both employment and health insurance while continuing to meet her daughter's needs.

For Christina, Joel, Marcie and all God's children, let us raise the roof for health care coverage!