Thursday, January 30, 2020

I can't believe I'm planning not one but two sermon series

I don't generally think of my sermons as having titles. Certainly not beforehand. But conversation on Facebook got me praying, and that frustratingly persistent Holy Spirit started re-arranging things (as the Spirit does), and suddenly I've got a whole agenda set out from now until Trinity Sunday. The themes are somewhat externally imposed, although they look like they will connect with the lectionary for the day also. Lent will take us on a journey through the baptismal covenant and the different ways how God transforms us in the process of sanctification. I am particularly excited about how the triumphal entry passion Gospel overlaps with the final portion of the baptismal covenant. Easter Sunday will stand on its own, and the Quasimodo Sunday following will set the stage for the ways Jesus leads us out of doubt and helps us grow into salvation like newborn infants longing for the pure, spiritual milk. That sets the stage for a dose of that pure spiritual milk: as we walk through the Easter season, we will dive into the Catechism, refreshing ourselves alongside the newly baptized with the basic beliefs of our faith (that so many of us really can benefit from revisiting). All of this leads to my favorite feast day of the year, the feast of the Holy Trinity, when we celebrate that the image in which we are made is not of a solitary figure alone on a throne judging the world, but rather a loving community whose love for one another overflowed and created the heavens and the earth.

And then it's back to the lectionary, because we've only done Track 1 of the Revised Common Lectionary, and this year, we are taking on Track 2.

So my plan for sermons from now until June looks like this:


  • 2/2/20 These eyes of mine have seen the Savior, whom you have prepared for all the world to see
  • 2/9/20 What does it mean to be the Episcopal Church? (Hint: we just celebrated the ordination of a bishop yesterday)
  • 2/17/20 This teaching is difficult; who can accept it?
  • 2/23/20 From the Mount of the Transfiguration to the Hill of Calvary
  • 3/1/20 Keeping a holy Lent
  • 3/8/20 Our baptismal journey: The Apostles' teaching and fellowship, the breaking of bread and the prayers
  • 3/15/20 Our baptismal journey: Resisting evil and repenting and returning to the Lord
  • 3/22/20 Our baptismal journey: Proclaiming the Good News
  • 3/29/20 Our baptismal journey: Seeking and serving Christ in all others
  • 4/5/20 Our baptismal journey: Striving for justice and peace
  • 4/12/20 Alleluia! Christ is risen!
  • 4/19/20 Lord I believe; help me in my unbelief.
  • 4/26/20 The Catechism: Human Nature, God the Father, and The Old Covenant
  • 5/3/20 The Catechism: The Ten Commandments, Sin and Redemption, and God the Son
  • 5/10/20 The Catechism: The New Covenant, The Creeds, and The Holy Spirit
  • 5/17/20 The Catechism: The Holy Scriptures, The Church, and The Ministry
  • 5/24/20 The Catechism: Prayer and Worship, The Sacraments, and Holy Baptism
  • 5/31/20 The Holy Eucharist, Other Sacramental Rites, and The Christian Hope
  • 6/7/20 The Holy Trinity: A Community of Perfect Love


Thursday, January 23, 2020

Some thoughts on rising health care costs and the difficulty of a solution

https://www.brookings.edu/blog/up-front/2020/01/21/middle-class-income-growth-is-lagging-the-rich-and-the-poor-how-much-is-due-to-healthcare-subsidies/

Hat tip to Steve Benner who posted this link to Facebook and engaged me in a very helpful discussion on this topic.

It is no secret that health insurance policies get more expensive year after year after year. The link American system of linking health insurance to employment was designed from the beginning to reduce labor mobility and to this day is a major factor discouraging entrepreneurism and self-employment. Rising insurance costs have limited wage growth and the growth of full-time positions with benefits, encouraging firms to employ workers part-time to reduce benefit costs whilst forcing more and more workers to string together multiple part-time jobs to make a living. The labor economist in me wants me to footnote all these trends, but as this is a blog post in a blog whose title admits a lack of strong epistemological claims, I'm going to focus on getting my main thoughts down and readable, and leave the supporting research as an exercise for the reader; if any of the facts I cite turn out to be wrong, I welcome your corrections.

Whilst insurance company profiteering from market power must not be discounted, it is undeniable that health insurance policies are expensive and keep becoming more expensive in at least part because health care itself, that which the policies exist to pay for, is very expensive and becoming more so. Some of this is circular: rising health care costs raise the price of benefits in labor-intensive industries relative to industries less reliant on labor — except health care itself is labor intensive, so rising health insurance costs raises the benefit bill for the labor-intensive health-care industry. But rising health care costs are due in part to the fact that what we mean by "health care" is an ever-expanding set of possible treatments. Advancing the frontiers of medicine means an increased capacity to save lives and to improve the quality of life for people who suffer from a wide array of once-untreatable conditions. It also means that the limits of our capacity no longer shield us from the most serious moral dilemma with regard to health care: the problem of rationing.

Rationing is how society determines who gets to use scare goods and services. If there's more interest in something than that which is available, everyone can't get everything they want, and somehow society has to determine who should get the thing and who should not. In the case of concert tickets or artwork, being on the "not getting it" side might be disappointing, but when it comes to health care, this is a life-or-death question: the question of rationing health care is literally a question of who lives and who dies.

The present system is an odd hybrid, but a lot of it comes down to price rationing, which is the way our society rations the bulk of scarce goods and services. When there is a shortage of a good, the price rises, both motivating producers to supply more of the item in question, while making fewer consumers able to afford it, until the number of willing buyers match the number of willing sellers at the market price. Under the best of circumstances, it means that the people who value a good most are the ones who get it. Under less noble circumstances, it means that when something is scarce, the rich get it and the poor go without, regardless of relative need.

It may at some point have been a reasonable stance to say that "health care should be a right" – that is, everyone should have access to health care up to the point where “the doctors have done all they can do.” Limits to the capabilities of medicine in the past might have made the provision of literally "all the health care we can provide" to everyone a goal within the universe of possibilities, making a clear moral position affirming the sacredness of life: we should do what doctors say is necessary and possible for whomever needs it, and to worry about the resources would be to value money over life.

If this were ever the case, it is not now. The theoretical capabilities of medicine are expanding to the point where if everyone was entitled to “the doctors doing ALL that they can do,” providing such care could approach using the entirety of resources at society’s disposal. Technological limits no longer shield us from the difficult moral choices about how much health care we should provide to whom. But wow that’s a loaded and difficult moral question. The current system is a terrible approach, but the question of how we ration health care is becoming unavoidable, and there are few comfortable answers.

 I worry that we don’t have a shared moral framework as a society to tackle the problem of how to ration health care. The current system sucks. But any proposal to change necessarily involves changing who decides literally who lives and who dies. The cries about “death panels” with regard to "Obamacare" were misplaced, but the underlying fear is very real and, I would argue, unavoidable. If technological limits mean there’s not much health care we can really provide, we can say "do all we can for everyone." I believe we’re past that point. Currently, price rationing determines who lives and who dies. That’s a terrible system. But any change would necessarily mean putting someone besides the market in a position to make these determinations, and people privileged in the current system will use their power to fight it tooth and nail because a different decision-making process might, literally, kill them. Reforming the health care system is so essential, and yet even if it saves many lives, it will also cause people who live longer under the current system to die sooner. It is in no small way a version of the infamous trolley problem.

This is just about the perfect intersection between my two jobs or economist and priest, and it’s a terrifying question. If not via market pricing, how should society ration who has access to what health care? We literally can’t do everything medically possible for every sick person. So how do we decide who gets what treatment? Which steps are considered ordinary and which extraordinary? Who should have access to what care? The current system is terrible. Any different system will make some people who are winners in the current system losers in the new system, which will kill them. This has to happen, but wow this will NOT be easy. And all the harder in a culture that is terrified or in denial of death.

(The dismal science has spoken. The Christian answer, I suspect, lies in 1 Cor 15:55, and focusing on medicine to help people thrive whilst they are alive rather than maximal delay of death, but that won’t fly with many people today unless we can pull off massive conversion.)

Sorry to unload on you all here (well, that's assuming anyone is reading this blog, probably a big assumption), but I’ve put a lot of thought into this over the years. The “death panels” scare latched on to the wrong particulars, but the underlying fear is real. There ARE currently death panels and there will be under most systems we can generate. But no one seems to want the debate to be “who should properly be on the death panels and what standards should they use” or “what would a society look like in which death panels weren’t a necessary component of a health care system.”

Health care has been, is being, and will continue to be rationed for the foreseeable future, the possibility of a post-scarcity economy notwithstanding (the subject of another post). Our current rationing system is a bad one, but changing it requires replacing it with something. It is one thing to say that the standards for determining who should have access to what health care should be "not what we're doing now," but another thing entirely to come to any sort of public consensus who should be making such decisions and on what basis.

Tuesday, January 21, 2020

Is the Episcopal Church still really following the 1928 Book of Common Prayer?

Dean McGowan's essay in the amazing new Earth and Altar magazine "ON ADOPTING THE OLD NEW PRAYER BOOK" (https://earthandaltarmag.com/posts/on-adopting-the-old-new-prayer-book) inquires whether liturgical practices in the present Episcopal Church suggest that the church is "still" following the ritual actions prescribed by the 1928 Prayer Book and while it uses the texts from the contemporary prayer book, by not conforming to its rubrics, the Church has not truly adopted the 1979 Book of Common Prayer. My experience suggests that this is not the case.

The "new" Prayer Book was written before I was born. I came to the Episcopal Church in my early 20s, decades after the adoption of the current Book of Common Prayer, and was received in a parish where Enriching Our Worship was the norm. The 1928 Prayer Book is something I have seen once or twice, but it holds no particular place of sentiment or nostalgia for me; indeed, if I were to think of anything as the "old prayer book," my thoughts would go to the 1662 book still official in many other parts of the Anglican Communion. But for the most part, in my heart, the 1979 Book of Common Prayer is THE Book of Common Prayer: the thing cried out to me from the pew rack the first time I set foot in an Episcopal Church, and what drew me to this Church.

So it is with some bewilderment that I read Dean McGowan's inventory. While he may be correct about old habits regarding the offertory, most of the practices described in the article do not strike me as inspired by some unresolved allegiance to a defunct set of rubrics.

The lectionary indeed prescribes three readings for every Eucharist with the sole exception of Monday through Saturday of Easter Week. The rubric on page 325 and 357 prescribes that "One or two Lessons, as appointed, are read"; who it is that does this appointing is not specified, and the lectionary psalm is allowed by a "may" rubric but not prescribed (interestingly, if one used two lessons and the psalm option, what second psalm ought to be used is not suggested). In churches that regularly use a single lesson before the Gospel, I have seen far wider use of the lesson from Hebrew Scripture being included and the Epistle being omitted, which hardly seems to be lingering 1928-ism.
With regard to the Prayers of the People, the rubric on page 328 first suggests the use of "the following form" (the prayer for the whole state of Christ's Church and the world) and secondarily suggests the directions on page 383. The rubric on page 359 invites the reader to "See the forms beginning on page 383." The directions on page 383 explicitly say "Any of the forms which follow may be used." While permission to adapt is explicitly granted, and permission to use freely-composed prayers that conform to the categories of prayer prescribed are implied, there is nothing unfaithful to the 1979 Book of Common Prayer about using the forms provided with minor substituions. In fact, following such forms seems to be the primary suggestion of the text. I have participated in communities that composed Prayers of the People from scratch each season, and I have participated in communities that use the forms in the book with adaptations or insertions suitable to the occasion. While the former can be done well, I have also seen it done badly, and would generally recommend the latter.

With regard to the Offertory, the rubric states "Representatives of the congregation bring the people’s offerings of bread and wine, and money or other gifts, to the deacon or celebrant. The people stand while the offerings are presented and placed on the Altar." I agree with Dean McGowan that the widespread practice in many congregations does not conform to this rubric. Mostly I see the people sit when bread and wine are brought forward, followed by a collection, then the people stand when the money is brought forward. Having no experience with the 1928 Prayer Book, I cannot say whether this pattern comes from there, or from the practices of other denominations from which people came to our pews, or from something else, but I have rarely seen the offertory bring bread, wine, and money together to the altar, the people standing. This is indeed a place where we can grow into the practice and theology prescribed by the "old new prayer book."

The posture prescribed for the Sursum Corda, preface, and Sanctus (and Benedictus, which is required in Rite II and optional in Rite I), is clearly standing. Following the Sanctus, the rubric clearly invites the people to "kneel or stand" on page 334 and "stand or kneel" on 362. While I far prefer the posture of standing for the entire Eucharistic Prayer, it is wholly consistent with the invitation of the rubrics of the Prayer Book to kneel.

For communion, the rubrics prescribe that "The ministers receive the Sacrament in both kinds, and then immediately deliver it to the people." While "immediately" might be stretched, the delays that I have seen have universally been logistical and not devotional. I recoil with horror at the notion of anyone on the altar receiving communion before the prayers and invitations to communion are concluded, and I have never anywhere see any devotional, pietistic, or liturgical actions cause delay between the communion of the ministers and the communion of the people other than delays introduced by individuals at the altar rail before taking communion. I have certainly not seen any ministers receiving before they are supposed to. If such a practice happens, Dean McGowan is right to condemn it.

With regard to the closing procession, I believe the Church has struggled to understand how to best be faithful to the instructions of the current book. If the dismissal comes from the altar and then the congregation stays in their pews while a retiring procession transports the ministers from the altar, the criticism is that the dismissal was not real, because people are not really free to "Go in peace to love and serve the Lord"; they are invited to "stay and watch while all the people in fancy vestments walk out." But if the retiring procession happens and then the dismissal comes from the back of the church, Dean McGowan accuses the sanctuary (and choir?) party of leaving before they are dismissed. While sometimes that does seem to happen, far more often I have seen the movement take place from front to back or sides, then the dismissal, at which point everyone (except those who stay to listen to the postlude) are indeed immediately dismissed. I agree with the dean that the rubrics do not seem to envision a retiring hymn or procession, and I don't believe the Church has truly determined the best way to uphold the integrity of all three of 1) letting the dismissal truly be a dismissal, 2) treating the sanctuary and choir parties as truly part of the laos, and 3) preserving the "jollity of singing on the way out of church" and our Anglican heritage of loving a good procession.

Finally, as a footnote, I would note that the rubrics indeed require a blessing and allow a dismissal in Rite I, and allow a blessing and require a dismissal in Rite II. Throughout the article, the good dean seems to conflate "The 1979 Book of Common Prayer" with Rite II. Rite I is not a vestige of the old book nor identical to 1928; it is thoroughly part of the 1979 Book of Common Prayer. The rubrics of Rite I are more like those of Rite II than those of 1928, and the following of them should not be construed as not embracing the 1979 Book of Common Prayer.