I have within me the great Pope, Self.” – Martin Luther
Roy Smythe–(Forbes)–An edifice in the distance diverted my gaze – it towered dark and massive above the modest homes surrounding it. Smoke bellowed from a chimney and the dim winter light reflected off of the massive, ornate windows. As I drew closer, I recognized the traditional symbol and knew it for what it was – the seat of power and authority for this community, and all like it across this continent. Here dwelled the powerful and all-knowing priests through whom we must all work to seek salvation.
Is my vignette describing a medieval church? No – a hospital I passed on a Saturday night a few weeks ago on my way to the airport in Chicago.
The parallels between the medieval Catholic Church of Europe and American health care, including the impressive towering structures in which they both have characteristically performed their miracles, are striking.
The medieval church was the most powerful social, political and economic force on the European subcontinent, and in many areas, the largest employer, if one considers the “affiliated” friars and monks as well as the priests and their church and cathedral support staff.
There were constant skirmishes with parochial governments, in large part over taxation rights vs. the collection of tithes and indulgences by the church. Indulgences themselves were a unique business model – sold as guarantees by the Church against time in Purgatory. The general public was encouraged to believe that the only pathway to heaven, or to even have prayer acknowledged, was through direct intercession of the priest.
The modern American health care delivery system is among the most powerful economic engines, and in many areas of the country, the largest employer. As an enterprise there have been countless skirmishes with the federal government – particularly on the issues of payment for services rendered, and the structure of payment. If we are fortunate, all Americans, instead of most, will be paying “indulgences” to various insurers, with a “guarantee” of health, or at least rescue from disease – one that can never actually be realized.
Finally, we have been conditioned over the past one hundred years, just as were all the inhabitants of Europe during the twelfth through the mid-sixteenth century, to believe that the only way that we can seek “salvation” (i.e., health) is via the direct intercession of a doctor, and his or her “monks and friars.”
It is not my intention to criticize any religious group, past or present. However, it is historical fact that there grew a great deal of resistance to the power and perceived excesses of the medieval Catholic Church, and an uprising resulted. John Wycliffe – a mid-14th century Oxford Don – formally initiated the Reformation movement. He translated portions of the Bible from Latin into “common” English, and preached in favor of secularization, or de-institutionalization of religious activities. He was followed by the more strident accusations of church corruption by John Hus, a Czech Priest at Charles University at Prague. In a Middle Ages bait-and-switch maneuver, Hus was invited to the Catholic ecumenical Council of Constance in 1414 to air his arguments, but once there was burned at the stake as a heretic. Wycliffe died of natural causes, but his evidently heretical remains were exhumed in 1428 and burned as well.
Eventually, the movement expressed itself definitively in the person of Martin Luther. He was a complex historical figure – a Catholic priest that had a “fit in the church” – perhaps a psychological event, after which he became dedicated to the cause that would define his life and the world forever. That cause, the Reformation, suggested divine intervention could not be purchased and that direct, personal access to salvation was possible, with no need for priestly or papal intercession. Luther nailed his “Ninety-Five Theses” – arguments against various excesses and corruptions – to the door of the Castle Church of Wittenberg.
There have been no actual auto-da-fe (a medieval term for burning at the stake) in the American healthcare system, but some executives actually have crashed and burned – consider Dr. Don Berwick’s modern Council of Constance experience at CMS. However, there is significant dissatisfaction outside the sanctuary in the form of concern about the revenue-driven excesses of health care and a growing desire to move the locus of control for the promotion of “health” from the priests to the parishioners, using new technology and better access to information.
Perhaps what we need is “Reformation”, in American health care, and not just “Reform”?
Who will nail these “Ninety-Five Theses” to the hospital door?
Roy Smythe is a Forbes contributor and the the Chief Medical Officer for Valence Health, a Chicago-based health care consulting, services and operating company that seeks to facilitate the ability of providers of care to manage medical and financial risk.