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Volume 8, Issue 1: Medicus

Coercive Disabilities

John Grauke

For the word of God is living and powerful, and sharper than any two-edged sword, piercing even to the division of soul and spirit, and of joints and marrow, and is a discerner of the thoughts and intents of the heart" (Hebrews 4:12).

This week my piercing came as I writhed at the point of the American Disabilities Act (ADA). This product of rampant statist machinations has brought us such extravagancies as wheel-chair accessible toilets at Camp Muir and a proportion of handicapped to regular parking that makes you want to buy stock in wheel chairs.
Many within the medical community have rationalized our care of those on the public dole as a break-even proposition. The government remits approximately one-half usual and customary charges, and overhead runs somewhere in the fifty percent range. So, assuming a medical practice is not too heavily skewed to public assistance, one can chalk it up to charity.
Of course, this is a precarious complacency. "Since 1950, the number of persons receiving public and social welfare payments has increased from six million to 18 million [in 1974] to more than 30 million [in 1984]. Aid to Families with Dependent Children (AFDC payments) soared from 3.5 billion dollars in 1960 to 16.1 billion in 1984. The amount spent on food stamps increased from 550 million to 10.7 billion dollars. In 1983 . . . all governments spent 455.8 billion dollars for public assistance and social welfare; that represented 39 percent of all government spending and 15 percent of the GNP. In 1984, welfare expenditures accounted for some 64 percent of the Federal Budget."1 Add to this that: "Federal social spending rose by nearly 10 percent in real terms during the Reagan years, and another 20 percent during the first three Bush years. Throughout the 1980's these programs accounted for more than half of all government spending." 2 And on Paul Harvey just this morning, I heard "in just seventeen short years, it will require the entire Federal Budget to cover health and social welfare." However, ignoring the fact that it is wrong-headed from the beginning -- representing a misplacement of responsibility for health care -- and that it is an abysmal failure by any measure, I still felt the nail driving into the coffin when faced with the ADA.
The precipitating event involved two long-time deaf patients calling through the relay to schedule appointments, and in keeping with their newly acquired rights, demanding an interpreter be present -- at my expense, of course. I found it interesting that these patients had been receiving care at my clinic for well over a decade using the now out-of-date method of writing messages back and forth using a pen and pad. I suppose there is probably no limit to the number and variety of goods and services we find we cannot live without.
I wandered off into the sins of self pity, whining and grumbling as I tried to find a way to face my patients without allowing my negative feelings to affect their medical care. I have practiced in a variety of settings, including prepaid, free, fee-for-service, cooperative, and university. I have advised my sons, as well as others interested in medicine, that as long as the physician-patient relationship is preserved, the practice of medicine is potentially rewarding.
As I writhed like the newest addition to someone's insect collection, it occurred to me that I was a slave. Actually, my status was worse than a slave because I had to pay money to perform uncompensated labor. It should be noted that I could not just refuse to see these patients because that would place me in violation of the ADA and subject me to very large fines. An assumption I know and was reminded of by my minister was that God is sovereign. He is not up in Heaven wringing His hands at my newly recognized status of slave.
Dabney concludes his chapter on the New Testament arguments on slavery: "Slavery is, indeed, one form of the institution, government. Government is control. Some control over all is necessary, righteous, and beneficent: the degree of it depends on the character of those to be controlled. As that character rises in the scale of true virtue, and self-command, the degree of outward control may be properly made lighter. If the lack of those properties in any class is so great as to demand, for the good and safety of the whole, that extensive control which amounts to slavery, then slavery is righteous, righteous by precisely the same reason that other government is righteous. And this is the Scriptural account of the origin of slavery, as justly incurred by the sin and depravity of man." 3 Certainly many would argue that western medicine has lacked properties of self-control and that extensive control is necessary.
Nonetheless, my writhing continued as I joined Abraham's descendants thinking I had never been in bondage to anyone. "How can you say, you will be made free?" Jesus answered them. "Most assuredly, I say to you, whoever commits sin is a slave of sin. And a slave does not abide in the house forever, but a son abides forever. Therefore, if the Son makes you free, you shall be free indeed" (John 8:33-36). And, from Paul: "Therefore, you are no longer a slave but a son, and if a son, then an heir of God through Christ" (Galatians 4:7).
The day for my patients' appointment came, and, coordinated with an interpreter, by God's grace I saw them. And by God's grace, I was healed.

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