Cost-Effective Community

We live in a time where Herod is in control...If you stand up and do as John the Baptist did, say a few simple words- such as That is not right; this is not how it should be done; this is not how we should treat one another; this is not how we should life-you are risking death. Sometimes we forget that the Christian life is a risky life, a life that might cost you your own life. This is the context of the text, and also the context of the miracle....This is the Gospel. This is where it is preached, in dangerous times.

From Pathologies of Power:

These are indeed dangerous times. In the name of "cost-effectiveness," we cut back health benefits to the poor, who are more likely to be sick than the nonpoor. We miss our chance to heal. In the setting, we're told, of "scarce recources," we imperil the health care safety net. In the name of expendience, we miss our chance to be humane and compassionate. Herod remains in control, but this is also the context of the miracle: it is precisely such contexts that we have the privilege of reasserting our humanity. Against a tide of utilitarian opionion and worse, we are offered the chance to insist, This is not how it should be done. Indeed, this is always what healers were called upon to say, but now the stakes are even higher. The world is a very different place now than when the prophets roamed the land. Medical technology has changed. We have great laboratories, diagnostic capabilities, and effective medications for a host of diseases.

Certainly, distributing these developments equitably would be expensive. Certainly, excess costs must be curbed. But how can we glibly use trms like "cost-effective" when we see how they are perverted in contemporary parlance? You want to help hte poor? Then your projects must be "self-sustaining" or "cost-effective," You want to erase the poor? Hey, knock yourself out. The sky's the limit.

Similar chicanery is used with a host of other terms, ranging from "appropriate technology" to "community." Through analytic legerdemain- the world is composed of discretely bounded nation-states, some rich, some poor, and each with its unique destiny- we're asked to swallow what is, ultimately, a story of growing inequality.

Is this the best we can do? Attempting to provide a "basic minimum package" for the poor is something that should be done apologetically, not proudly. Even the WHO, which has invested heavily in promoting cost-effectiveness as a means of assessing health care services, recognizes the sharp limitations of this method in improving the health of the poor and thus addressing inequalities of outcome:

"Cost-effectiveness by itself is relevent for achieving the best overall health, but not necessarily for hte second health goal, that of reducing inequality. Populations with worse than average health may respond less well on an intervention, or cost more to reach or to treat, so that a concern for distribution implies a willingness to sacrifice some overall health gains for other criteria."
-Pathologies of Power. by Dr. Paul Farmer.

if you liked this snip-it, read this book! I started years ago and am finally finishing it. Paul Farmer is a strong believer in health care as a basic human right. Many medical professionals currently strongly disagree with this statement. I think the difference in opinion, and the vast array of opinions between Farmer's and medical professionals,' hinges on how 'health' is defined, and therefore what it means to care for the 'health' of a person or a people.

There is one thing Paul Farmer is absolutely right about: everyday we miss chances to heal, and those chances should be viewed as priviledges.