Kids don’t listen to you,
they become you.
Kids don’t appreciate what you do,
they do what you do.

The best way to pass on anxiety is to hide it from myself
and let anxiety define my parenting.
The best way to pass on joy is to find it for myself
and let joy sustain our relationship.

The more I feel compelled to sacrifice for my child,
the more necessary my child will view sacrifice for theirs.
The more I begin to trust I am enough,
the more able my child will be to trust in their worth.

To love from a place of emptiness
is to instill expectations of scarcity.
To love from a place of fullness
is to empower a life of abundance.

The more I mask and shame my brokenness,
the more I will pass it on.
The more I admit and correct my mistakes,
the more they will end with me.

I probably don’t have Covid-19.

Since the Saharan dust blew in, I have been having some fairly minor congestion and a cough that comes and goes. It gets worse overnight, as it always does when my allergies flare up and congestion builds. I’m still taking my allergy medications everyday and the symptoms are very minor, other than a coughing fit every once in a while. I didn’t and still don’t feel much different than I almost always do when my allergies get the best of me for a few days. 

I probably don’t have Covid-19. 

I should add that I am a pastor in a local congregation. When the pandemic first hit, we immediately went to online only worship for about 3 months. We have continued that option, but have had 3 weeks of in person worship in addition to the online offering. We have pretty strict measures in place and only about 30% of our usual attendees have been present. That allows us to be socially distant. All in all, I think we have done a really good job of upholding the value of safety and doing things remotely as much as possible. 

Personally, we’ve had a few family members over for brief visits and I go to the grocery store or drive-thru line of a restaurant on occasion. I go to work, but at most two other people are in the building at the same time with me and we’re almost never in the same room. I wear my mask when going out anywhere I might be exposed to people, including in worship (other than the moments I’m actually speaking), and I haven’t had a handshake or a hug with a non family member in months. 

I therefore (probably) don’t have Covid-19. 

I still had a moment Sunday morning where I really started to wonder if I should go to worship at all. If I was not responsible for leading the service, I would have stayed home. But I was not feeling all that bad, had not had any signs of fever, I had no reason to think I had been exposed to anyone with the virus, and we’ve barely been anywhere since March. It was just a slight tickle in my throat and a tiny bit of drainage that led to the occasional cough. Plus, I can easily avoid getting anywhere near people and just keep to myself while everyone gets ready and situated. I went in and did mostly fine until halfway through the sermon. As usually happens when my allergies get the best of me, talking for long periods didn’t go well. My throat got dry and when that happens, I often break out into coughing fits. Thankfully, I didn’t completely lose control and thankfully no one was within 10-15 feet of me. But I did have to cough (into my elbow) a handful of times as I nursed my water glass and a cough drop for the remainder of the sermon.

I don’t really know what to do with that experience except to say that it is certainly making me rethink the calculus of when to call in sick and what measures to have in place in case I have to do so. I’ve been clear with my church members that we will make a solid online experience available until something significant changes. I don’t want them to feel any pressure to come in person unless they feel safe and desire the in person interaction that so many of us are missing. I’ve also offered a few links to health resources so that they can stay informed and up to date as things change. We have a predominantly older congregation, which means that a lot of folks are taking me up on that offer of staying home and staying isolated as much as possible. All that is to say, anyone who comes is doing so knowing as much as anyone about the risks and realities of what they’re getting into and with options to do otherwise if they feel at all uncomfortable. Even still, a couple of folks told me after Sunday that they couldn’t help but notice and wonder every time I coughed. The level of strangeness we feel anytime we see someone cough is a very hard to measure, yet very significant source of the discomfort and uneasiness brought about by this pandemic.

But I probably don’t have Covid-19. 

Then Monday came around. It started out like any other day – I worked alone at the office for most of the day before picking up my son from daycare on the way home. Just before dinner we got an email from the daycare. The parent of a child in our son’s class tested positive for Covid-19. That child was immediately removed from the classroom that afternoon and the rooms underwent a thorough disinfecting that night. The school already had strict protocols such that parents aren’t allowed into the building at all and there is pretty much no way the parent could have infected anyone else at the school. The parent was asymptomatic at the time, as was the child. It was only by connection with another person’s positive test that the parent even decided to get tested. We don’t know if the child had the virus, but they won’t come back before a quarantine period and being cleared by a pediatrician. 

I’m grateful for all the work the school has done to keep us apprised and ensure a safe environment. They have moved mountains to adhere to every safety protocol that has been offered, and I have no doubt they’ve done everything anyone would know to do. I’m still baffled at how much the underlying philosophy of policy and response from the national level on down seems to be to push as many decisions as possible to the lowest possible level. None of us have dealt with anything like this before and none of us has as much public health information or power to make change as the higher levels of government. Only one level of our distributed system of government has the power and resources to effectively enough support those people and businesses that have to take extreme measures either to stay open or to close for the sake of public health. That level of government doesn’t seem interested in carrying the weight of any of the most impactful, gut wrenching, and long lasting choices that are being made every day. Those decisions seem to get pushed down to the lowest possible level as often as possible.

This is probably a rant for another time where I can devote more space to it, but I feel like everyday, everyone is having to make a million decisions that we’ve never thought about before. I wouldn’t advocate for a single federal law or dictum about every conceivable choice or policy, but I remain shocked that there is not a more cohesive strategy, message, guidebook, metric, checklist, or anything else to help us work through this pandemic together, rather than as 330 million individuals making 50 choices a day about topics we’re not trained to deal with that affect our lives at levels as deep as how to make a living or how to be in relationship with friends and family. Some cohesive, clear, consistent, high level guidance would be really helpful right about now. But I digress.

I still probably don’t have Covid-19. 

Last night I started looking into testing, just to be on the safe side. I started by looking into my insurance to see if they had recommendations or requirements for where to go. I have not seen any clear pricing information, except that some places take insurance, some places are free, some places charge something, and at least at the beginning some tests were quite expensive. I couldn’t find anything on the insurance website, and by the time I tried to call their business office, it was closed. 

My insurance has a deal with a nearby hospital, which is almost always the cheapest way to go for our healthcare needs. I decided to reach out to the hospital. I found a number to call from the Covid-19 page for the hospital system, which appeared very clearly to be the only number anyone should call for scheduling a Covid test with any hospital in the system. The appointment line attendant informed me that I needed to get a doctor’s referral in order to schedule a test. Fair enough.

 The hospital system has a virtual urgent care that offers a brief screening and can give the order for the test. I set up the appointment and within an hour or so had the recommendation that I go ahead and get tested. Between my (mild) symptoms and my son’s potential exposure, it was best to be safe and do so. I called back to see about scheduling, but the scheduling office was closed for the night.

 The next morning, I called shortly after the scheduling office opened to see about getting the test. They said they needed to have a doctor’s order, so I told them I had received one from a doctor last night through that same hospital’s urgent care system. She was very nice but ultimately didn’t have the order in the system and told me I could not send it in to them directly. They had to receive the order from the referring doctor’s office.

 I called the helpline of the urgent care arm of that hospital and they asked me where I wanted the order sent. I told them the hospital and location name and I had to look up the phone number. The person asked if I knew an email address because that was the most common way they connected with these hospitals. I did not have an email address. But I told him I was surprised that they didn’t have direct contact information since they were theoretically connected to the hospital with which I wanted to schedule the test (best I can tell now, the virtual urgent care is technically contracted out through a different provider somewhere on the back end). I found other random contact information that seemed to be the most helpful I could find online and offered that to him as well.

 After an hour or two, I called the hospital scheduling office back to see if they received any orders. They had not. It was confirmed once again that I cannot send any order that I received, they had to receive it directly from the doctor. So I asked exactly where they should send it. I was told that the hospital order receiving department has one fax line and that fax number is the only one that can receive orders for covid-19 testing. She gave me the number and we hung up.

 I called the urgent care helpline again, and gave them the updated information with the fax number. I was told I should check back with the hospital in an hour and hopefully they would have the order sent over by then.

 An hour and a half later, I called the scheduling office at the hospital again. They had still not received my order. This time I was told that a supervisor had instructed the whole team to forward patient information for anyone who had done the virtual urgent care system because they were having issues getting orders. She could not tell me anything further or when to check in again.

Two hours later, I called back. This time I was told that I had reached the central scheduling line for the Houston area. I needed to call the Sugarland specific number in order to schedule for that hospital location. So on my 5th call to the hospital scheduling office, I finally found out the number I apparently needed to call from the beginning. So I called that new number.

Surprisingly, this was the first time I was put on hold for any significant period of time. After being on hold for 25 minutes, I found out that the next available testing date at the hospital would be 13 days away. A 13 day wait just to get the test done… I was told if I wanted to try other locations within the same hospital system, I could do so, but would have to call each location individually and check their schedule. Luckily, I was at least able to confirm that the hospital had received the Dr’s order for me to get the test. Now, it was simply a matter of getting on the schedule. 

I tried calling another location. No tests available for 4 days. Better but not ideal. The second location gave me a third location’s scheduling phone number to try. That number simply went straight to voicemail. 

I decided to try and search for anything in my county. Wouldn’t you know it, the county has free testing available to all county residents. They have a screening questionnaire, but it appears anyone who wants/needs to do so can get tested for free. I submitted my information and kicked myself for not doing the obvious extra searches last night. Free and much closer. I felt like an idiot.

Then I realized on the confirmation screen from the county that I should expect a call as soon as possible, hopefully within 2-3 business days. If I miss that call, I need to resubmit the form data again in order to receive another call back to (hopefully) get on the schedule for who knows when. This was not the miracle solution that I thought I had found.

On a hunch, I tried the main phone number for that third location within the original hospital system. The main number led me to an operator who led me to the covid test scheduling line. I spoke with someone who apologized that there weren’t any tests available today. Tomorrow, however, was entirely open. So I scheduled a test first thing tomorrow morning and will hopefully know the results by…. soon????

It only took 3 intense web searches, 11ish phone calls, and (surprisingly only) one long hold time of 25 minutes, and I finally have a way to get tested soon (for free??? I guess we’ll find out someday).

I probably don’t have Covid-19. 

But I feel a lot worse about things getting better anytime soon than I did even two days ago. I know there are incredible logistical challenges to all of this and everyone is doing their best at the local and provider level. And I know everyone’s experience will be different based on where they live and what provider they are using. There are some places where it sounds like you can just drive through anytime and get a free test without an appointment or a wait at all. My experience thus far is not the experience of everyone, but that’s kind of my point.

If I were in charge of the country 4 months ago, I can’t imagine having worked toward anything other than a system in which everyone in the country can be tested free of charge under any circumstances, no questions asked. Maybe the test would be scheduled a day or two out and results probably would take a day or two no matter what, but it can’t be that hard to set up one central phone number (think 911) that anyone anywhere in the country could call and immediately be given a time and location at which to get a free test.

Simplifying testing wouldn’t solve everything, but if someone with as much time and know-how as me is having this much trouble just getting tested, then I can’t imagine how hard it is for people with multiple jobs; or those who can’t take half a day off to play phone tag; or people who can’t afford the risk of a surprise $100 doctor bill; or people with kids they can’t leave in order to actually go; or people who need a test so they can feel good about visiting family for the first time in months; or people who fear being fired if they play it safe and don’t go to work in the 5-10 day waiting period for test results; or any of the people in a thousand more difficult circumstances that we are.

This whole experience deeply reinforces how necessary a clear and consistent strategy is so that millions of people aren’t having to make thousands of decisions on very limited information regarding situations that may radically affect their livelihood, families, communities, and who knows what else. At the very, very least, we should all be able to get tested for the virus within a few days and without any complicated research. Without even that incredibly basic bit of knowledge, every other decision we make weighs a whole lot more than it has to and may affect our lives and loved ones more than we would ever want to consider. Unfortunately, it feels each day like we’ll have to think a lot harder about a lot more decisions for a long time. I don’t feel like I ever really know if I’m making the right decisions for myself, my family, my church, or my community. More than anything else, that makes me tired. 

And I still probably don’t have Covid-19. I suppose I’ll find out in a few days.

—————————–

*Quick update on the morning of the test

The experience to get a test scheduled was terrible. The actual testing process was about as perfectly executed as I can imagine. I showed up at my appointment time and saw signs all pointing me to an entrance specifically designated for Covid-19 testing. Someone opened the door, asked if I had an appointment for my test, and directed me to a seat. A woman asked my name, which got me checked in. I was the only person in a large hallway area and there were 5 or so seats available for those who came to be tested (all well over 6ft apart). 

A technician came out quickly and had me come back to a room that clearly had all sorts of extra equipment and air circulators to keep everyone safe. I went to the area I was told and the technician asked me a couple of quick questions. There was a contraption in the room that looked sort of like a big plastic box with two arm holes that led to something like full arm gloves. I assume that’s used for any patients who are highly symptomatic or probably infected. 

She then did the nasal swab to the back of the nose that you’ve probably heard about. It was a very weird feeling. Sort of like my brain was tickled, but more like when I really need to sneeze, but the feeling is deep down in my nostrils and won’t come out. Almost like the moment when I inhale something like pepper and desperately want to sneeze, but can’t quite do it for 5-10 seconds. It wasn’t exactly painful, but certainly not painless. To be clear, it was absolutely worth it and way less painful than the weight of constantly wondering whether I might be putting others in danger by leaving the house for any reason. 

All told, I was driving away 10 minutes after I parked. I should have results available through the online patient portal within 24hrs. And now we wait. 

—————–

Update 2

As promised, the results came back within 24hrs. I officially don’t have Covid-19!

---

Update 3

8 days later, I got the call back about scheduling a test with the county.

I’ve been thinking a lot about the intersection between 1) certain unspoken and sometimes unacknowledged theological priorities of modern American Christianity and 2) the desire I’ve heard from some (mostly white) people for Black Lives Matter organizers to offer a clear set of rules for them to follow so as not to be racist. 

Listening to a podcast conversation about anti-racism work, it was suggested that white people don’t want to know the rules about what counts as racist so that they can do the work to end racism. White people instead want to know the rules so that we can protect ourselves from being accused of doing something wrong. As long as we have a set of rules that we can point to and say “what I did isn’t on that list,” then no one can tell us that we are at fault if our actions lead to problematic outcomes despite having played within the rules.

Setting aside for a moment whether this is an accurate assessment of racism and the desire for rules, the general notion that “people want to know the rules we can’t break far more than we want to make progress toward a desired outcome” is an idea that intersects with a much deeper problem I have with a great deal of Christian thought and practice. 

We very rarely work in the church toward a constructive view of the kind of life we are hoping to make possible with our theology and practice. One of the single most significant failures of at least the mainline and evangelical branches of the American church is the radical overemphasis on defining the list of rules we cannot break rather than seeking to define and create the kind of life toward which God is guiding us. Our theology of heaven and hell has created the world in which we are so overly concerned about not doing the wrong thing and about being absolved of those moments when we do the wrong thing anyway, that we cannot help but run everything through the lens of personal responsibility and guilt. If all that matters is a ticket into heaven and avoiding hell for me, no other lens really matters. 

I’d argue that personal responsibility and guilt are not irrelevant topics for Christian faith and practice, but they only take on meaning or significance within the systems and assumptions of the world as it actually is. Starting with personal responsibility and guilt is like asking if it’s wrong to turn left. The answer depends at least on where I am and where I’m trying to go. We’d be much better served trying to assess if we’ve arrived at our actual destination than critiquing every potentially wrong turn along the way. Doing so would anchor thought and action in a constructive consideration of the kind of life and relationships we’re actually called to seek after, rather than complete focus on the rules of the road. 

Reliance on rules further creates the fiction that I can be a neutral observer – not making things worse by breaking the rules, but also not going above and beyond to advocate for positive change. In reality, we are always making imperfect decisions about which way to go based on imperfect information about the world and an imperfect representation of our own situation and motivation. If we don’t even know where we’re trying to go, we’re very unlikely to arrive simply by obeying traffic laws. 

And of course, as much as we might want an exhaustive list of rules to ensure we don’t do anything wrong, any list of rules is just as likely to instill anxiety as it is to meaningfully guide us forward. 

Being more concerned about proving that I didn’t break a rule than I am about creating a better world is a perfectly logical outcome of a Christian faith more concerned about avoiding hell than about all God’s children experiencing and passing on the love of God. If the church hopes to have a role in dismantling problematic systems and generations long struggles, we have to stop worrying more about a mostly arbitrary list of dos and don’ts and begin to rediscover the heart of a faith that comes alive through the embrace of imperfection embodied in vulnerable relationship.

It rings deeply true to me that, within the above logic of a mainline or evangelical American Christian faith, most of our focus on naming rules is more easily understood as the product of a desire to not feel guilty rather than a desire to actually make the world a better place. If the goal is to do nothing that makes us feel guilty, then pretending everything is already OK is a far shorter path than publicly exposing our imperfections on the long path toward actual healing. However, perhaps the core assumption of the gospel message is that, before we are anything else, we are loved, we are accepted, we are enough. Attempting to live into the fullness of who we already are allows us to operate from a far different starting point than assuming we’re just one misstep away from losing salvation. Without that assumption at the core, the guilt of knowing I did something wrong too quickly devolves into the shame of feeling like I am something wrong. 

There is no finite set of rules to follow such that we can say we have done enough to be on the good side of some arbitrary line of salvation. In everything, we are either working to receive and overflow the grace of God that does change everything; or we are sometimes subtly and sometimes overtly leaning on a form of works based righteousness through which we will continue to fall short of perfection and reinforce the scars we bear and the wounds we cause. 

Which brings us back to the original comment on racism and rules. The notion that there are a finite set of rules to follow so as not to be racist is just as problematic as assuming the church could ever define a list of sins so as to not be a sinner. The assumption that creating a list of rules is even a possible, much less helpful, goal in the elimination of racism is certainly, at least in part, influenced by the American Christian manner of and focus on defining sin.

Namely, there is no finite set of rules to follow such that we can say we are ‘not racist’ enough to be on the good side of some arbitrary line. In everything, we are either working to understand and undermine racism such that powerful and entrenched systems do change for the better; or we are sometimes subtly and sometimes overtly leaning on a history of racist policy and choice through which we will continue to fall short of equality and reinforce racial disparities in opportunity and outcome. 

I don’t have any idea what every step will be toward creating a more healthy church and/or society, but I am confident that one of the first steps is giving up the assumption that progress is made by first defining the exhaustive list of rules for what not to do.

I have struggled to find the right words to say in support of all those who are hurting and grieving and angry. I keep coming back to a few things I’ve said before –

-People behave the way they feel
-Healing never happens in silence
-Voicing pain is never as bad as causing that pain
-Effect is at least as significant as intention
-Denying feelings harms people
-If I tell you “I’m not hurting you” and your response is “yes, you are,” only one of us is correct (and it’s not me)

To that list I’ll add:

– I will never conflate a broken nose with the bruised hand that broke the nose.
-It’s never constructive or helpful to tell someone how they should grieve.

If we don’t understand the source of all the hurt and anger that has sparked protests, rebellions, and demonstrations, we have to take the time to really listen before we judge the few who go too far. If we think violent force is the right or only way to put down this expression of pain and grief, we are failing to hear and escalating harm. If we think dominance is the answer to cries of pain, we are reinforcing dynamics of abuse. If we think it’s ok to rename pain as manipulation, grief as performance, or trauma as typical politics, then we will never find healing. If we expect a show of force to calm a nation’s anger over excessive force, we have completely lost our way.

As a Christian and pastor, I follow a God who would rather give up his own life than commit a single act of violence (Matthew 26:52); a God whose power is made perfect in weakness (2 Corinthians 12:9); a God whose greatest act was born in humility (Phil 2:8) and requires us to confront our deepest failures rather than pretend we have it right already (John 3:14). These are the themes and lenses that, above any other, inform my perception of how I am called to live, to lead, and to respond in moments such as this.

I mourn the death of George Floyd and the countless other black men and women who have been killed. I mourn the stark reminder of how far we have to go before we can even create the space for grief and empathy, much less heal the wounds and systems that have given birth to this moment.

I try to imagine what it would be like to tell my dad that I don’t think my life matters to him. What would it do to me if he responded by telling me to shut up, of course all lives matter? I try to imagine what it would do to my son if I said the same to him.

We have a long way to go to create a truly fair and just world. This is a moment when the very least we can do is clearly state without equivocation that the lives of our black brothers and sisters matter. There is so much more that can and ought to be said and done. But if we cannot start by uttering three simple words, everything else we say or do will be vanity, a chasing after the wind.

Black Lives Matter.

A guest post from my amazing wife, a marriage and family therapist who happens to deal with chronic pain:

Chronic pain is a funny thing. I’ve had it for years, but not many people besides my husband know about it. In the last 6-9 months I’ve finally been working with doctors on it. That seems silly since I’ve had the pain for so long. But it’s hard to know what pain is “normal” or what pain other people do or do not have. So I guess I just went about my business trying to manage my pain on my own. My back pain started when I was sixteen, so I’ve always just assumed I’ve had a “bad back.” I’ve been to the doctor and then physical therapy when the pain has become unbearable. I’ve had three bulging discs since 2012; one cervical in 2012 after being rear-ended and two lumbar in 2018 with no inciting injury. I’ll be getting imaging this week because the doctor thinks I have another bulging cervical disc. It feels different from last time so who knows. My first rheumatologist diagnosed fibromyalgia because that also explained my ongoing intestinal issues. A second rheumatologist (after we moved) said possibly that and rheumatoid arthritis because my inflammation levels are high. My hands don’t look inflamed but my rings feel tight and they hurt when they bend. I’ve cracked my knuckles since elementary school but man does it hurt now. You’d think the pain would make the habit easier to break, so far no luck there. My feet and ankles get super angry if I’m on them too long, and my shoe collection has seriously changed from cute and dainty to as fashionable as it can be while prioritizing comfort.

None of that is particularly useful information. Chronic pain has an awkward place in our world. People know it exists but they expect it to be visible. They expect to see it or know about it. But they definitely don’t know how to actually respond to someone who has it. That’s a large part of why I don’t talk about it much. I hate the pity, which is perhaps my own pride issue. The suggestions get tiresome. Everyone knows someone who tried something that was a miracle cure. That holds true for migraines too, which I’ve also had since I was sixteen. Some people take my speaking about my pain as complaining and wanting them to fix it. Obviously I know they can’t, and I’m definitely not trying to complain. Why though? Why is not complaining so ingrained in us? Constant complaining is tiresome and doesn’t change anything, but should we not be able to voice our struggles? We tell people to be open about their depression. Reach out because people will listen. People have good hearts but also don’t know how to listen to pain and suffering without labeling it complaining. So we’re stuck not wanting to complain or get advice or be pitied. The resulting silence is far less than helpful. When I tell no one about my pain, how do I explain my absence at an event I was looking forward to? Saying “I’m not feeling well” doesn’t seem to cover “my pain is so high that I’m considering going to the ER but don’t want to clog the system when all they’re going to do is give me pain medicine I hesitate to take because of my family’s history with addiction.”

And how can I possibly complain? Given what is going on in our world? Another black man was murdered because of our refusal to deal with systemic racism. I would take on all the pain if it could make a difference for someone else. Let one of those innocent humans live. What right do I have to complain about chronic pain when black people literally live in fear? Fear that I desperately want to comfort and take away. How can I help? What more can I do? What more am I physically capable of doing? I’ve told my clients countless times that we should not compare traumas or pains. There is no cosmic ranking system. But I can’t get past the fact that what the black community in this country has to deal with is far worse than my chronic pain.

To give voice to my pain or not, it’s a trap either way. Then there’s the trap of feeling like our worth is defined by our abilities and contributions. My doctor told me to rest my shoulder by not picking up my 28+lb toddler… so now every diaper change and bath, etc fall on my husband’s plate. My husband who already does the literal heavy lifting and any task that could piss off my back, which isn’t always easy to predict. My angel of a husband reminds me regularly that my worth is not based on physical contribution. We joked many times before we adopted that he would handle the poop and vomit, and I would handle our child’s emotional well-being (the hard part as my husband called it.) Even with such a thoughtful and loving partner, I still fall into the trap. The worry of how my son perceives it. The feeling when I see people in public (well, before quarantine anyway) look on shocked that my husband is doing far more “parenting” than I am.

Then there’s the uncertainty. Why is my pain worse today? Did I do something differently? Did I just sleep wrong? How do I relieve the pain? Stretching helps most of the time, kinda. Heat, ice, CBD hot/cold topical stuff, medicines, delicately changing positions countless times with temporary minimal relief. If there is relief, what caused it? How do I make it happen again?

And yet, there is so much more to my life. Laughter and smiles and joy. It’s easier to show that to the world. I’m not afraid to show emotional pain. We shared our infertility journey on facebook and with our churches. People should never feel isolated in their suffering. <– I should listen to my own advice right? Right. I KNOW that, but doing it is harder. People don’t suspect my pain so it’s awkward when they’re shocked. “But you smile so much.” “You’d never know it to look at you.” Blah, blah, blah. It’s not their fault they’re shocked. It’s my own for not sharing. So why? Why don’t I share? HOW do I share without being bombarded with pity or suggestions or judgement for complaining? Man I wish I knew. Everyone who knows wants to help, but no one can help. I don’t like making my loved ones feel helpless either.

How do I do my job with chronic pain? Whew, I wish I could tell you. Somehow I manage to set it aside for the hour I’m with my clients and put my focus completely on them. Besides that, I space my clients carefully so I’m not setting my body up for failure. My office is seriously comfortable too. Comfortable seating is always more important than fashionable seating.

Wouldn’t the pain be less if I weren’t so overweight? Probably. I’ve been overweight since I was eighteen or nineteen. How much do you think chronic pain helps with that problem? The percentage is below zero. Chronic pain + poly-cystic ovarian syndrome + intestinal issues + migraines = a very complicated weight loss equation. Yoga is the only exercise in my adult life that made me feel strong and that my body responded to. I’ve never changed shape doing cardio, but yoga helped my body. Can I do yoga currently? No because of my shoulder/neck/upper back issue that hopefully we’ll figure out soon. (Isn’t that hope adorable?) The doctor told me I can only add one minute to my workout per week assuming I’ve been able to exercise without resulting pain for a few days. He wanted me to start at 5 minutes on the elliptical. I’m now up to 9 minutes. It’s infuriating. On the high pain days I have to push myself to move at all. On my good days, I’m desperate to exercise longer, but if I do my body will punish me tremendously. Last week I oh-so-foolishly “sprinted” for my last thirty seconds on the elliptical. The next day was excruciating, and to be clear, we are not talking sore muscles. Sore muscles make me feel accomplished, proud of every step when I feel the soreness. This is not that.

And here we are in a pandemic when so many of our coping skills have been put out of our reach. So many of our self care strategies changed abruptly. I would be foolish to assume the stress of social distancing hasn’t made my pain worse. I miss my family and friends. I miss going to restaurants and wandering the grocery store aisles looking for inspiration. We find joy where we can, and we try to cut each other some slack because pretty much everyone is struggling.

So what is the point of all this? Maybe someone will understand a little more what it’s like to live with chronic pain. My dad joked today that my husband should have married a younger woman instead of an old lady like me. We laughed (I really did find it funny and not offensive). Then I hoped elderly people don’t have this much pain. Then I feared what my pain will be like when I’m elderly. Maybe you’ll remember that just because someone seems ok when doing their job or pushing through the pain it doesn’t mean they are. Maybe you’ll remember when someone shares their pain with you to show empathy and ask how you can be supportive. Sometimes I just need to be heard. Sometimes I need a distraction and/or laughter. Sometimes I need grace when I cancel last minute or when I stop answering my calls/texts. It’s not you. It’s me. It’s the pain.

Anyway, things like this are what keep me going on the hard days…

I wrote the post below a while back and was just about ready to publish it when COVID-19 changed the world . The present crisis brings into focus an aspect of the more theoretical point – there are no players in the field of insurable healthcare who are incentivized and therefore aligned to value and invest in healthy people as a whole. Insurable healthcare is seen primarily as individual responsibility and choice OR as a human right and worthwhile public service. In this system, sick people are a problem that needs to be solved. The only difference in options, to admittedly oversimplify things, is that the right argues the burden ought to be carried by the private sector of individual decisions and market forces, while the left argues that the burden is a worthwhile one to be carried by government obligation, ensuring something like the right to life for all people. 

Plenty of individual actors and institutions within the overall system are certainly interested in and greatly value the idea of healthy people. Countless stories have emerged of the heroic efforts doctors, nurses, and others have made to stay ahead of the virus. My point is not to diminish their effectiveness and Herculean efforts but in fact to highlight the extent to which their dedication and sacrifice actually work against or are at least foreign to the outcomes toward which the system of insurable healthcare is aligned. There is no individual, entity, or institution positioned in the current system with the incentive, authority, and desire to even aim at creating a truly healthy populace. In a moment like this, it is only the collective response and health of a nation that are sufficient to overcome such a widespread crisis. But there is no incentive toward collective action within the insurable healthcare system as it currently functions. 

On the more practical side of the argument below – especially in the early days of COVID-19, there were stories of people debating whether to get tested or treated because of astronomical costs, even with insurance. To rely on hundreds, if not thousands of individual insurance companies to decide their policies, clearly communicate them to the public, all while the government may or may not impose requirements upon insurers for a financial burden they may or may not be able to handle radically slows response time and leads to much greater costs in terms of life and money. In a crisis like this, it doesn’t actually even matter whether the stories are true at all. People are used to having no idea what anything health related will cost till long after the fact. People will at least hesitate based on those kinds of stories because it is very rational, especially in the beginning of a crisis moment, to assume the odds of any individual being infected are much lower than the odds that they’ll be hit with hundreds or even thousands of dollars in hospital bills they can’t afford. 

Without a central player with clear authority to set (or zero out) costs and copays in the midst of a crisis, plenty of people will rationally move much slower toward testing or treatment for fear that their particular insurer may not play by the rules, if any are even set. The government (and essentially the US economy) as that player, is far more highly incentivized, as should be quite evident from recent stock performances, to act quickly than an insurance company that stands only to lose money by making everything free and more widely available to all its customers even if it is the right thing to do. I don’t say that to imply callousness on behalf of insurance companies who are aware of the bottom line even in the midst of a crisis – I say that to highlight the extent to which alignment and incentives define outcomes much more than any individual or even heroic decision made along the way. Especially when every day counts, we need a system that has zero ambiguity as to the financial implications of going to the doctor. 

As long as sick people are a problem rather than healthy people being the point, we will never be able to align the power of free market forces in such a way that would prioritize fast response or long term progress toward public health. Single payer insurance at least puts the right pressure on the right player with the right incentives and powers such that the whole system can actually work toward health.

——————————–

Health care in the United States and the corresponding health insurance system are filled with contradictions, problems, and imperfect outcomes despite being one of the most expensive and cutting edge producers of medications and doctors galore. There are far more nuances and problems than I could possibly address here, but I want to offer two reasons that a single payer health insurance plan might cut through some of the stickiest problems of our current system.

More often than not, I see the single payer debate couched in terms like private industry vs socialism or health as individual responsibility vs health as a basic human right. I have no intention of wading into those waters at all. I find the talking points all around to be quite unhelpful or, more to the point, meaningless and undefined. Instead I offer one practical and one theoretical reason why I believe single payer health insurance is at least worth serious consideration.

To express the practical side of the argument I first want to share 5 things I’ve experienced in the process of dealing with health care providers and insurance. 

1. At least four or five times, I’ve received bills that look something like this: 

The “Submitted amount” column is theoretically the cost of the lab work that was done. “plan savings” represents the discount offered merely because of the deal our insurance company has worked out on our behalf. Two charges show discounts of $132.37 from $142.85. If you can discount your services by more than 90% before anyone pays anything, you are clearly just making up numbers out of thin air. 

2. A second issue with the same bill should also be readily apparent. This bill is for 5 tests all ordered at the same time by the same doctor and performed in the same lab on the same visit. Yet two are covered without question and three are not. Those three tests received a code of KU. I fought for a year to figure out what that meant and get it corrected and still have no idea exactly what it means or why it happened. I called both the lab and my insurance no less than 5 times, one time even getting both reps on a conference call together so they could get their act together and make whatever coding changes were needed. I again received a bill asking me to pay the balance with no explanation for what is wrong or what can be done to fix it. My insurance said it wouldn’t pay, the lab said I owed the balance, and I didn’t get any discount on those tests. After the year of fighting, the lab just closed the bill and I didn’t owe anything anymore, no explanation or change ever came.  

3. A third issue highlighted by the same bill is the absolute unpredictability of the cost of receiving medical help. After over a year of wrestling over this lab work I still have no idea what I was actually supposed to owe. The idea of knowing cost ahead of time and thereby being able to make informed decisions about where to go or what I can afford is far beyond impossible. On a separate occasion, a medical provider contacted my insurance company to verify coverage and how much my out of pocket cost would be for a particular medical necessity. It was around $200. The provider charged me based on the quote, provided the service, and then officially submitted the claim with my insurance. Over a month after I’d already received the services, I got the final bill. I owed an additional $900 or so. The provider said the initial bill was only an estimate and no guarantee. Insurance said they don’t quote figures ahead of time. Even when health costs are supposedly confirmed beforehand, they can be completely arbitrary numbers with zero relationship to reality. 

4. A final problem with this specific bill is the three categories to the right that indicate how much I owe – deductible, copay, and coinsurance. These are 3 different types of payments my insurance company expects me to make. I have no problem with the theory that these types of breakdowns would exist. The problem is that it is never entirely clear which categories will be affected for which types of services and visits. These categories unnecessarily obfuscate the amount that will be paid for any particular health service, even assuming the bottom line cost is in any way reflective of reality.

5. Separately from all that, I previously dealt with another absurd consequence of our insurance and billing weirdness. I was billed for a dozen or so of the same type of visits to the same doctor for the same health concern over the course of a few months. Every bill required a copay of $30 or so. But two of the visits also came with a $300 or so ‘hospital room use’ fee. There was no explanation as to why these fees applied to only these 2 visits, but my insurance company denied the charges because they said there were coding issues and the hospital sent me numerous bills. The doctor said they couldn’t change the code, the insurance said they couldn’t accept the code, and the hospital said I owed the money. After more than a year of asking questions, I finally spoke with a hospital higher up who is in charge of customer relations. I explained the situation yet again and he came back a while later and offered to give me a 90% reduction and we’d call it even. I’d owe something like $60 and we’d all walk away happy. I said I’d gladly pay the $600 if someone could just tell me why I was being charged for these 2 visits and no others, but I would not pay a penny until someone had answers. A couple of weeks later, he called back and the bills had been closed – again with no explanation and no change in the stance of my doctor or insurance company.

Each of these anecdotes is only possible within a system that both complicates the relationship between providers, customers, and insurers and obfuscates every cost involved to the point that no one can make a rational decision about anything in the process. To whittle insurance down to a single payer for everyone in the system does not solve every problem, but it at least makes it possible to know and understand the game that we are all playing. At most, any test or procedure or appointment would only have 2 possible costs – full price and insured price. There would not be 1000 different contracts with 1000 different companies that allow providers to make up numbers that have no relationship to reality. With only a provider, one consistent insurer, and the patient involved, it would take infinitely less effort to lay out clear and consistent expectations for who charges/pays what and who may be at fault when problems arise. 

———————————————–

To express the theoretical side of the argument, I need to offer a brief word on the power of alignment. In companies, different markets and business models lend themselves to different ways of structuring employees, setting up incentives, and a variety of other core decisions necessary to run a successful business. 

A common and fairly simple way to illustrate the importance of alignment is in the difference between a company like Google and one like Apple. Google makes almost all of its profits on advertising, whereas Apple makes its profits from products (most from the iPhone). That difference incentivizes Google to ensure that everyone, everywhere is using Google’s services. More users means more eyeballs, which means more advertising dollars. Apple, on the other hand, makes money from high end computer products with high profit margins. Thus, Apple necessarily limits its addressable market and allows lower cost phones and computers to cannibalize each other. Apple also artificially limits services to its own hardware to increase customer lock in (such as iMessage).

Google’s entire business alignment lends itself to pushing products out the door and iterating quickly through software, which helps explain why they have struggled to make a dent in the hardware space in which a company must sell a mostly final product and can only do so much through software updates. Apple is better than almost any other company at pushing out great hardware, which helps explain why they have struggled to create necessarily iterative and unfinished services like maps or Siri that can match the capabilities of Google or Amazon. Everything down to the decision to have only one profit and loss statement as a company aligns every aspect of the business toward selling specific hardware.

Neither business model or market approach is better or worse as should be evident by the presence of both companies at or near the top of the stock market for quite some time now. They are, however, aligned to run based on very different goals and incentives. 

Which brings us back to healthcare. 

In our current system, insurers are aligned to extract the most money from patients while paying the least to healthcare providers. Insurers, on one hand, must keep patients from getting so much more unhealthy than the patients of their competitors that someone with the power to do something might act. Add in the fact that employers often choose insurance companies rather than direct consumers and there is usually almost no correlation between patient experience and pressure on insurance companies to change. No insurer has any reason other than a vague sense of good will to do more than triaging the worst health conditions (as opposed to offering proactive and sustainable health initiatives beyond a handful of highly cost effective preventative measures like free flu shots). On the other hand, the more likely someone is to be ill, the more likely they are to purchase insurance and vice versa. Profitability for insurance relies on having a great enough number of people involved such that overall risk and costs are predictable even though any particular individual may require nothing and another may require millions of dollars in care. Pushed to the logical extreme, if insurance made people completely healthy, the insurance market would put itself out of business. These two realities are not meant to imply that insurance companies do anything nefarious or wrong in the choices they make – they instead point out that the business model of insurance is deeply incentivized to maintain sick, but not critically ill people. Alignment is not around making healthy people but around profiting off of every individual’s rational concern that one illness could lead to bankruptcy without insurance. Insurance companies do a lot of good, but doing more than the absolute minimum is often actually against the business interests of the companies. 

Providers operate with the same lack of incentive to make people completely healthy because profitability comes through addressing specific illnesses, not sustaining health. Additionally, providers are incentivized to extract as much money from patients and insurers as possible. Providers have every reason to push costs as high as possible knowing the bulk of payment won’t come from the patient who is making acute decisions, the patient can’t know much about the level of necessity for treatment much less it’s cost when making decisions, many patients are told where to go by their insurers anyway, and the billing process is so opaque and complicated that only the most diligent and intelligent patients can even figure out what they should have truly paid. 

Patients are incentivized at least to not die and perhaps to attain some level of health while spending as little as possible. Any patient with an expensive health concern, most commonly diabetes, is often forced to choose between potentially bankrupting themselves or taking the medicine they need to remain stable. Individuals may or may not take necessary steps towards health but staying well for any individual is always a matter of luck as much as it is a matter of personal choices. Individuals also lack the robust information necessary to make the best possible choices.

To align health insurance around a single payer government model makes it possible to align incentives toward insurance as an investment in a nation’s greatest asset – the health of its people. Having more healthy people who are able to focus on anything other than their health and its financial impact on their lives frees up an enormous amount of potential for the growth of all other economic sectors. Knowing the bulk of the healthcare cost rests in the government finally gives someone with a financial stake in the outcome an incentive to understand what causes negative health outcomes and what policies can be adopted for long term financial and physical health. It also places much of the cost of un-health on the only player (the government) that has the broad reaching powers to structure policies, laws, and other incentives toward a healthier society.

With a system set up to invest in people, providers would then be able to offer specific rates for service ahead of time and know with much greater certainty what will be covered and how. The government could (as it already does to some extent) determine what aspects of covered healthcare are essential for creating healthier people and allow providers to build ancillary benefits around which to differentiate their services and costs. The provider market would finally have some semblance of direct market forces guiding its decisions, the government as insurer would be capable of incorporating healthy people as an essential principle rather than accidental outcome of profit, and patients would be able to make real and meaningful decisions about their health and wealth. 

Properly aligned incentives don’t solve nearly every problem with the healthcare system in the US. But alignment is a primary factor defining culture and decision making over time. Alignment and the interrelated incentives and cultures that flow from alignment do more to determine outcomes than anything else in a system. The structure of our current system is a muddled mess in which no one besides an individual patient has any incentive to work towards actual health. Aligning the system around a single payer would at least make it possible for that system to be directed toward healthy people rather than simply fighting illness.

I find myself increasingly dissatisfied with the nature and consequences of the church’s debates around sin and righteousness in a changing world, especially within the UMC. What often happens is a dispute around where the line is drawn between sin and righteousness. Often more conservative voices draw that line closer to a strict reading of biblical practices and traditional values. More liberal voices are often eager to factor in cultural shifts and societal forces that require a more broad interpretation of scripture to find coherence between biblical principles and human flourishing. 

The process results in something like a spectrum of potential positions upon which anyone’s respective view is placed. No person is truly conservative or liberal on any and/or every topic and there may be a multitude of ways to assess the relative position of any particular view. But so often in debate, a thousand factors and choices are flattened into a spectrum pitting something like “tradition” against something like “progress” and then further flattened by the arbitrarily binary choice of ‘sin or not’ as though doing so could possibly clarify what godly action is.

What rarely happens is a conversation regarding the shape and direction of the love and community toward which our actions and ideas ought to be guiding us. Thus, we get moments like General Conference 2019. After 40 years of arguing about what the church ought to define as acceptable, we did not even attempt to offer a positive view of Christian community, action, holiness, or relationship that could potentially bring our respective views under a coherent umbrella. We only expected that our place on the spectrum of sin and righteousness were different and that we would ultimately draw our lines in different places. 

I greatly respect the desire for a biblical, traditional, Christ centered life. I have at least as much respect for those who, out of a desire to honor their present reality and avoid doing harm, choose to engage in a more generous orthopraxy. For this reason, I often find myself in agreement with the logic of one side and the conclusions of the other. I find the distinctions and lines in the sand between these sides to be false choices more often than not. 

Every option fails to relegate sin to a secondary existence after the community sin breaks. Treating sin as the more fundamental reality fails to account for the core good news that it is love and community by and for which we are created.

To constructively engage in conversations of how Christians are to live, we must first ask what love and community are and then seek to define sin as that which breaks love and community. If we can’t first define love and community, sin means nothing. If we can’t define how a potential sin breaks love and community, we should hold loosely our conviction that this particular action is worth calling sin, much less policing. That we so often hold fast to our traditional lists of sin without any positive conception of what Christian community is leads us into our most intractable, harmful, and pointless debates.

A positive constructive engagement would necessarily evaluate word and action through our expectations of relationship qualities like consent, intimacy, vulnerability, trust, empowerment, teamwork, attachment, mutuality, authenticity, commitment, public accountability, personal growth, sacrificiality, and respect.