The Poor Will Always Be With Us. So Will Church Health.

For the last few days, I have been asked a hundred times, “How will the Trump election affect the work of Church Health?” or “What if Trump dismantles Obamacare?”

My answer is the same as it was before the election. The outcome of the election has little to do with the mission of Church Health. Our mission has always been to reclaim the Church’s biblical commitment to care for our bodies and our spirits. For nearly 30 years, we’ve cared for working uninsured people and their families. What the federal government does is of little consequence to what people of faith are called to do in order to be faithful to God.

Of course, it’s never that simple. If 20 million people who currently receive health insurance through the ACA were to suddenly lose coverage, that would be a disaster for the nation and for us in Memphis. But it’s my opinion that that will not happen any time soon. President-elect Trump’s stated goal is to repeal and replace Obamacare, but clarity on how and when that might happen has not yet been provided.

A long time ago, I gave up worrying about what the impact decisions in Washington might be for our work. Under President Bill Clinton, people worried there would be no need for the work we did once “HillaryCare” took effect. I hope you can understand my point.

What I know is that the gospels call us to care for the poor when they are sick. I feel that same call has been spoken through every world religion, and even those who don’t subscribe to a particular organized system of faith believe that everyone deserves quality healthcare.

In just over two months, Church Health is moving everything we do to Crosstown Concourse. We will dramatically increase our capacity to care for people who fall through the gaps of America’s healthcare system. Those gaps could widen in the future, but if they do, Church Health will be here to provide the same quality of care you would want your mother to receive.

On that I am certain.

Our job is to continue to talk with people of faith to help them see that caring for the health needs of the poor is a path to draw closer to God. That is our fundamental mission –  not the mission of the federal government. Therefore, whatever President-elect Trump does or doesn’t do will have little impact on the work we have undertaken for the last 30 years.

Jesus said that the poor will always be with us, and for that reason Church Heath will always stay the course we’re on and serve those who are forgotten. Make no mistake: this work is hard, and it requires intense, concerted effort. But the outcome, when successful, is truly sweet.

I will pray every day that President-elect Trump works to care for the poor during his administration. We will work with anyone who desires to stand with us on that journey.

But no matter what, our mission is unchanged and we are ready for the task ahead.

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An Open Letter to the Next President of the United States Regarding Healthcare for the Poor

Dear Mr. Trump and Sec. Clinton;

I realize that with only a few more weeks before America decides which of you will be our next leader, you are both busy talking about the things that you believe will get you elected. But for a moment, I want to tell you about some people who are often forgotten: the working uninsured. I doubt you’ll mention them in your campaign appearances or even on your social media – and I understand that – but I still have to make their case.

I will always make their case.

I have worked in Memphis, TN for 30 years as a family physician at Church Health. At our clinic, we provide healthcare for people working in low-wage jobs who do not have health insurance. We’ve cared for over 70,000 people through the years without relying on government funding. I have no desire to make the work we do political, but with all humility and kindness, I ask for whichever of you becomes our country’s next president to please consider the following points when it comes to the healthcare needs of the poor in America.

  1. We have a serious problem with issues of mental health and substance abuse. A person with a serious mental health issue will live a much shorter life than the rest of us. These issues cannot just be willed away. Behavioral heath issues disproportionately affect the poor.
  2. The number one predictor of health outcomes is education. A poor education leads to an unhealthy life.
  3. Listen to the people you are trying to help. The answers are unlikely to come just from smart people in Washington or large institutions.
  4. Do not claim the problem is solved by whatever new policy you institute. You can help with policy, but it takes all of us to change our health outcomes.
  5. Everyone in healthcare is not out to get rich. Do not be cynical about those of us who work to care for others because we feel called by God or are driven by matters of social justice. I know there is tremendous fraud in the system, but there is also tremendous good.
  6. Effective treatments must be affordable for all. That requires lowering costs and finding a means of access for all. It does not mean the government must do it all. In Memphis, we have over 1,000 physicians who volunteer their time for the uninsured and undocumented. Almost every physician I know will state that they went to medical school because they wanted to help people. If you show them a way to care for people who have no other options, physicians will do the right thing. If you assume physicians only care about the money, then they will back away. Everyone needs a pat on the back to thank them for when they are kind.
  7. We all need help to better deal with the issues around the end of life. Rich and poor are tortured because we cannot accept that death is a part of life. We waste billions of dollars and cause endless heart break by offering unacceptable hope for the future when accepting that the end of this life has come is the right thing to do. Call on our faith communities to address this issue and we will all become healthier.
  8. Health and healthcare are not simply commodities; they are necessary elements for all other aspects of our country to thrive. For all Americans – rich, poor, and every color – to thrive, our health outcomes must improve. If we are to be judged as a great country, people building our houses must be cared for when they fall off the roof no matter what their immigration status is.

In my thirty years of caring for the people who work to make our communities great, I’ve been amazed at the resiliency of people who have so little. The joy they are able to maintain even when they have little money and work harder physically than I ever dreamed of doing inspires me every day. It makes me proud to be an American.

Surely, in the years to come, we can work hard together to assure them that we as a country will give them the benefits of the best health care system in the world. Indeed, doing so is truly part of what makes America great.

With hope for healing,

Scott

Let’s Talk About the C Word

The C-Word postI have just returned from the Democratic National Convention in Philadelphia.

No, I did not meet Bernie or Hillary. In fact, my agenda had absolutely nothing to do with politics. (Thank God).

But I did have an agenda: to promote the idea that it’s time to rethink cancer.

I was in Philadelphia earlier this week to speak on a panel after a screening of a new documentary film called “The C Word“. The Church Health Center is featured prominently in the movie, which will be in theaters this fall and on Netflix in the spring. It is narrated by Morgan Freeman and produced and directed by the Academy Award-nominated director Meghan O’Hara.

You can watch the trailer here:

The movie is about how cancer can be prevented through improved eating habits, exercise, and stress reduction. Does that sound familiar? It should; the Church Health Center has been preaching prevention for nearly 30 years. The movie centers around a French physician, Dr. David Servan-Schreiber, who developed brain cancer then aggressively began treating himself with the basics of good nutrition, exercise and stress reduction. He then wrote a popular book titled Anticancer: A New Way of Life. He doesn’t advocate a fad diet or his own special treatment plan.

The movie also uncovers ways our lifestyles contribute to the cancer epidemic in the US. But what’s disturbing is that even if we vigilantly do everything we can to avoid cancer, the deck is often stacked against us. Did you know that tobacco companies now own all the major food distributors in America? Or that when a food label uses the term “fragrance” as an ingredient, there is a list of carcinogens that can be included in that term? The movie reveals a great deal of similar information and is extremely thought-provoking.

A portion of the documentary includes several interviews with me, but I am proudest of the Jones family that the movie tracks over a year. Several members of the family lost significant weight by attending our Wellness center and working with our health coaches. They are the real stars of the film.

My hotel in Philadelphia was located downtown near Independence Hall. Staying there reminded me of Benjamin Franklin’s famous quote, “An ounce of prevention is worth a pound of cure.” Franklin wrote that after returning to Philadelphia from Boston in 1735. Impressed with Boston’s fire prevention programs, he sent an anonymous letter to the Philadelphia Gazette with suggestions for how fire prevention could be enhanced in the city. It included avoiding “carrying live coals in a full shovel out of one room to another.” His commonsense suggestions led to licensing chimney sweeps and requiring homeowners to have leather buckets in which to carry coal.

Of course, common sense only seems so in hindsight. It takes an incredible amount of work to make real headway in the way we rethink health and then push for effective implementation of that new way of thinking.

Franklin’s suggestions about fire prevention have parallels in today’s healthcare landscape where we’re constantly talking about prevention of chronic health issues like cancer. It’s my hope that the lessons of The C Word will be heeded.

Top 10 Church Health Center Myths

After doing the work of the Church Health Center for almost 28 years, it is easy for me to come to work every day and think nothing has changed. After all, my office is in the same room it has always been, and in my head I am still 33 years old. (Please don’t laugh.)

There have, however, been enormous changes to our ministry in those past 28 years, and even more are on the horizon with the move to Crosstown Concourse well on the way. As a result, many people misunderstand the extent of the work we are doing. Here are the 10 most common misconceptions people have of the Church Health Center.

Top 10 Myths about the Church Health Center

1. We are a small clinic on the corner.

Actually, we are the largest privately-funded, faith-based clinic in the country, caring for over 70,000 working but uninsured patients. We help faith communities all over Memphis establish health ministries in their congregations. Our Wellness facility boasts an affordable gym and a demonstration kitchen where everyone in our community is welcome. We have a preschool because we believe that education is a health issue.

We are a clinic, but we are so much more. We’re moving the needle on health disparities and helping people live their healthiest, happiest lives.

2. Because of the Affordable Care Act, the Church Health Center is no longer needed.

There were 26 million uninsured Americans when we opened our doors in 1987. Fast forward to 2010 when the ACA began, and that number had risen to between 50-60 million plus the immigrant population. The ACA has helped 11 million people get health insurance, but that means there are millions more uninsured people now than when we began. The ACA has too many gaps to count, and the Church Health Center fills those gaps.

3. We only treat colds and minor illnesses.

Not even close. We care for the full gamut of healthcare needs because the uninsured get sick with the same things that the insured do. From broken bones to life-threatening cancer, our 1,000 physician volunteers allow us to achieve our goal of providing the same quality of care you would want your mother to receive. We offer dentistry and optometry. We offer counseling services and physical therapy. We’re here to care for your whole body, mind, and spirit.

4. We are just a doctor’s office.

In fact, our goal is that for every dollar we spend on treatment we spend a dollar on prevention. Our wellness programs are extensive, ranging from nutrition, to fitness, to spiritual care.

5. Our Wellness Center is just for our patients.

It is actually open to everyone in our community, uninsured and insured alike. There are no income requirements to become a member. Anyone can join and pay on a sliding scale according to their income.

FM berries6. Our Wellness Center is just a gym.

It is actually a Certified Medical Fitness Center. That means we have staff trained to help you return to your highest level of wellness after you have had a stroke, knee surgery, or heart attack. Church Health Center Wellness also houses Child Life, which is far more than daycare for your kids while you run on the treadmill. Church Health Center Child Life offers engaging staff and curricula that prepare our youngest members to be healthy for life.

Need more proof that Church Health Center Wellness is more than a gym? We host a farmers market during the summer. When was the last time you bought a locally-grown tomato at the chain gym up the street?

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7. We are only touching lives in Memphis.

Actually, we are a national, even international organization. Our magazine Church Health Reader is read all over the world and we are the home of the International Parish Nurse Resource Center, which has trained over 15,000 nurses worldwide to work in faith communities.

8. Health is only about what the doctor does.

That actually has very little with being healthy; 10%, to be precise. For that reason, we run a preschool called Perea. We have a wide array of health programs that have nothing to do with the doctor. We believe that change in healthcare starts with you. Healthcare we can live with starts with growing a new culture that features dignity, community, giving, and prevention.

9. We are a government-funded health clinic.

Nope. We keep our doors open because of the generosity of the wonderful people in our community, congregations, businesses, and foundations. We must raise almost $14 million a year to keep our doors open.

10. I am about to retire.

Sorry, that’s a myth too. I will retire only when I cannot physically come to work. Antony Sheehan has joined the Center as the President and is helping to lead us to our new home at Crosstown, but he and I are working side-by-side and will be doing that for years to come.

The most important point I am making is that the Church Health Center will and needs to exist in perpetuity. Jesus said that the poor will always be among us, so we will, too.

Ready to join us? Click here. 

The ACA Lives, but Healthcare Gaps Remain

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A couple weeks ago, the Supreme Court upheld the Affordable Care Act. The vote was 6-3, which makes me think that even the conservative judges realized that eliminating the current way the Exchange works would create chaos for millions of people and our healthcare system in general.

Don’t get me wrong; I believe that the Supreme Court’s decision is good and wise. The truth, however, is that nothing has really changed. The flaws in the healthcare system are still there whether or not the Supreme Court gives it its stamp of approval. I know this firsthand because at the Church Health Center, more than 90% of our patients are ineligible for a subsidy from the Exchange.

Our patients – all of whom are employed – will continue coming to us when they are sick.

Many of our patients and countless others all over the United States continue to struggle in this post-ACA landscape. If they go to the ACA website and enter their income information, they will be referred to their state’s Medicaid program for help. But in Tennessee and every state in the South except Arkansas, the state legislatures have refused to expand Medicaid. That means that anyone whose income is below 138% of the poverty level receives no benefit from the ACA.

Yes, that is right: the poorest people get nothing.

If a single person makes less than $16,000 or a family of four makes less than $32,000, they receive no help with purchasing health insurance. They are on their own. Even those who are eligible for subsidies through the Exchange sometimes face difficult decisions. If a single mother works three jobs and has three children and makes $33,000, she will be able to buy a policy for $150 a month for herself, but that is $150 she might not have budgeted. The policy will have a $5,000 deductible. Not a day goes by that one of my female patients doesn’t ask me what I would do if I were in her position. I cannot honestly say that I would purchase the policy, but she knows that if she does not, she is breaking the law.

It is hard to believe, but these are the facts.

The gaps are real.

The system is broken.

People are dying.

It is clear that the Supreme Court did not solve our healthcare issues. Our system is not designed to provide affordable care to our most vulnerable populations, but I am confident that America can do better than that.

In the wake of Independence Day, surely we will remember that a great country is judged on how it treats those whom the Bible calls “the least among us.”

Mental Health Stigma Has No Place in the Exam Room

Bethany struck me as being very sad from the moment I walked into the exam room.

At 27, she had a number of small physical complaints, but nothing I could put my finger on. I came to the conclusion that the problem was depression, but over the years I have never been very good at telling young women that I think we need to be treating the cause of their depression rather than their physical symptoms.

Often, patients become defensive when they come to see me with physical complaints and I ask them questions about their mental health. This is understandable: if a patient sees a doctor about their chronic stomach pains and they’re asked if something in their life has been causing them turmoil, they may think that the doctor is implying that their symptoms are “all in their head”. We all want to be taken seriously, especially when we’re experiencing pain of some sort. Unfortunately, on more than one occasion, patients have left before we finish the appointment because they are insulted by the thought that their physical pains are rooted in anxiety or depression.

As a society, even though we’ve come a long way in accepting, loving, and successfully treating those around us who struggle with mental health issues, the stigma surrounding mental health is still very real. Whether it’s a social stigma that perpetuates the myth that mental health sufferers are broken, lost causes or a patient’s self-stigma, the topic of mental health remains taboo, even in the exam room. A patient will openly admit that their hip hurts, but they’re less forthcoming in admitting that they can’t remember the last time they felt joy. The fear of admitting “weakness” prevents them from receiving the very treatment that can help them get better.

I hoped that Bethany was open to seeing our counselor, but I was still afraid that an abrupt this-appointment-is-over response might be coming. I just couldn’t justify performing a number of expensive tests or giving her medicine for “feeling bad,” which would in effect be a placebo.

At first, Bethany declared that all was well and that her life was going fine. But near the end of the appointment, long after I had brought up the possibility of seeing the counselor, she asked, “Is the counselor on the premises here?”

“Yes, she is. Would you like to see her?”

“It couldn’t hurt.”

Mental Health Stigma

 

Putting the “Care” Back in End-of-Life Healthcare

There was a recent segment on the PBS news that featured the daughter of my good friend and former Church Health Center board chair, Dr. Kenneth Robinson. His daughter, Dr. Maisha Robinson, is a physician at UCLA who is working with African-American clergy in Los Angeles to encourage their congregations to embrace the idea of palliative care at the end of life.

It is startling that only 8% of all African-Americans have a living will or are even open to discuss a plan that centers around how they will die. This compares to 45% of Caucasians. It is startling, but it’s also problematic.

The problem stems from our country’s poor track record of providing quality medical care to African-Americans. Historically, blacks were not offered the best medical care possible. The residual of “experiments” like the Tuskegee Syphilis Study is still prominent in many minds. The consequence is that many African-Americans want the doctor to “do all they can” to prolong life, no matter the consequences.

This desire for the “best” medical care, unfortunately, means that we are prolonging the dying process for many African-Americans and, ironically, not offering a nurturing experience in a patient’s last days. In fact, we’re doing just the opposite. By dying in a hospital, perhaps tethered to a ventilator, patients are kept from being nurtured by the people who love them most. Rather than receive care that eases suffering, patients often continue down a long road of treatments in a fruitless quest to provide a cure to a disease that has dictated that the end is inevitable. The result is that everyone can say “we did all we could.”

In my mind, this declaration is an illusion. There was never anything we could do to save the person’s life and provide true quality of life. We kept the person’s heart beating, but the essence of the person who was loved had long since died.

Putting the Care Back in End-of-Life Healthcare

The younger Dr. Robinson is working with pastors in LA to get them to preach that death is not the enemy, that offering comfort care at the need of life is a better way to help people die.

I have learned over the years that the easiest thing for the doctor to do is do “more.”

There is always one more thing that we can try.

There’s always one more drug we can add.

We can always call one more consultant.

But what is never asked is this: To what end? A person who is 85 years old with metastatic cancer is unlikely to live much longer no matter what the situation. Do we really want Grandmother to die around people she doesn’t know, in a place where they never turn the lights off, surrounded by people who do not know her well enough to love her?

I am proud of Maisha for taking on this daunting task. Unfortunately, as a white male doctor, it is hard for me to effectively champion this cause and have people listen. It is people who look like me who made Maisha’s work necessary. But I do believe that people of faith can play a large role in helping her work and others like her succeed. While I am certain that it is not possible to die with dignity – death takes away your dignity – I believe that we can die well. It is the role of the Church to help people die in a way where God’s will that we have lived with joy can be fully realized.