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Today is October 31st.  When I was a kid going to a Christian school, instead of emphasizing Halloween, we were taught that today is Reformation day – the day on which Martin Luther nailed his 95 Theses to the door of the church in Wittenberg.  They weren’t against Halloween (like the Baptists here in Georgia), but wanted to underline the importance of what Luther did 492 years ago.

Which gets me thinking about our current situation in healthcare.  The more I thought about the current state of healthcare, the more parallels I see to what Martin Luther stood up against.  Here is what I mean:

• Profiteers – Luther was most upset at the profiteering of people in the church at the expense of the poor.  People were led to believe that they needed to buy indulgences, which would somehow buy time off of their loved-ones’ time in Purgatory.  Basically, the church was abusing its position of power and influence at the expense of the poor.  Healthcare has profiteers as well (as I posted about) masquerading as people who “want to help.”  Insurance companies put themselves forth as providers of care, which they are not.  Drug companies and device manufacturers advertise directly to consumers for products they may or may not need – creating a perceived need where it may not be legitimate.
• Ignorance - One of the main things that caused the Reformation is that Luther started reading the Bible.  Up to that point it was felt that the teaching of the Church was the only thing that people needed.  One of the most controversial things Martin Luther did was to translate the Bible into German and print it using the revolutionary new communication tool: the printing press.  Ignorance abounds in healthcare – and is preferred by some parties.  Nobody knows what an episode of care costs – a benefit to those who can stand between the physician and the patient.  Doctors don’t know or control the cost of most drugs or whether a drug will be covered by insurance.  Both doctors and patients operate by the direction of the “payers” – insurance and government.
• Corruption – The corruption of the Vatican and some in the church in Luther’s day is well-documented.  He was disgusted by the claims of Johann Tetzel, a monk who aggressively marketed indulgences to the poor.  This is what actually initiated the nailing of the 95 theses.  Upon challenging the church in this way, he quickly came under attack, not just by the church, but also the governments who were under the control of the Vatican.  What saved Luther in the long-run was the fact that some leaders were embittered by this control, and saw Luther not as a reformer of doctrine, but a revolutionary against the tyrany of Rome.  In healthcare, the intermingling of the US government with the drug and insurance industries is full of opportunities for corruption.  The influence of rich corporations and interest groups on the political process is obvious – through large donations and lobbyists.  Healthcare is not public nor private, but instead an intermingled web of public and private interests, with a huge amount of money flowing in both directions.  Is there corruption in this?  One would have to be very naive to think there isn’t.
• Loss of focus on the basics – The thing that Luther discovered that was the idea of grace. Grace, he found, was a central teaching of the Bible – but not one the church was teaching at that time.  The church, instead, had gone from a religion based on the life and death of Christ, to a religion of doing good works.  Luther found this by reading Romans 1, which was revolutionary for him.  This loss of basics is also a plague in our system.  The doctor/patient relationship is confused by insurers, specialists, formularies, regulations, malpractice, and denials of service.  Rules and dogma are more important than healing the individual.  The central reason for healthcare is to benefit the patient, not the system.  This has been obfuscated by the confusion of our healthcare system.
• Confusing Rules – In the heels of the last point, Luther dealt with a system that had a complex set of rules that were nearly impossible to follow.  Pilgrimages to Rome, prayer to saints, indulgences, and other extra-biblical rules from the church were entirely obscuring the relationship of the individual with God.  With the Reformation, Luther and the other reformers stripped away these extra rules and focused again on the central relationship.  In the same way, our system has rules that are nearly impossible to follow.  Prior authorizations, pre-existing conditions, drug formularies, disability forms, FMLA, and the myriad of Medicare rules take up the majority of the physician’s time, with patient care taking a distant second.

So what now?  We need a Wittenberg door.  We need 95 theses that we can nail to the wall.  We need a reformation – tearing the care of patients away from those who have nothing to do with the patient and putting it back into the domain of doctors and patients.  We need to remove the extra hands grabbing money from the exchange between patient and caretaker, and we need to reduce rules and confusion.

We need a new Martin Luther.  He was, of course, excommunicated from the church, vilified by many, and the object assassination plots.  His life became incredibly hard once he stood up against the status quo of the day.  But he was unwavering, saying the famous words: “Here I stand, I can do no other.  God help me.  Amen”

Any volunteers?

Tagged as: Healthcare, Martin Luther