By Jack Hoehn, 07/25/2017
Dick Hart, in a report on Adventist Health International, reminds us that “looking back is always easier that looking forward” and he is correct. But I’m going to try looking forward anyway, recognizing that I have no personal way of making this happen, except talking to you about it, and you talking to others, and beginning to require accountability of those we support with tithes to influence the direction of Adventist Health care in the future.
The Bible is largely a series of plans God had for us, that have failed. So I am not going to try to guess what will happen, but what should and could happen is fairly clear to me after a lifetime of involvement in various forms of Adventist health care. If boards, chairmen, executives, and health care providers could focus on basic principles and if we give freedom to innovators to try new approaches in different areas, these principles may be useful.
#1—Humility: Remember Health Reform does not belong to Adventists.
God never intended Seventh-day Adventists to have a little treasure of privileged Divine information on health and happiness that we could use as bait to get people to join our church. In the past we have spoken of “health care” or “the health care message” as “an opening wedge”. This used to mean if we are good doctors and nurses, they might listen to us about the Sabbath and the State of the Dead. If we get them to stop smoking with “The 5-day Plan” then they will join our churches. While this is perhaps true, it misses the point that we serve a God who gives the rain to the just and to the unjust. And to think that our vegetarianism is the cure to cancer, or that not smoking or drinking wine will exempt us from death and pain is bogus and unworthy of our faith.
God gave Adventists a prophetic health message, because we were sick and needy, and he wanted us to live better and share the information with the world. It was not to make Loma Linda Adventists a Blue Zone who would live 10 years longer than anyone else, it was to help everyone everywhere live better and happier. Our health message is not unique and special, the only thing unique and special about the Adventist Health message is that we believe we should do what we know, as a spiritual duty.
But we can learn, as did our Adventist Pioneers, from non-Adventists what is healthy, what is hygienic, what is rational, what is safe, pure, and effective in living our lives. Health is from God, and God is not handing out little packets of special blessing on Adventist, he is pouring out blessings on every religion, every gender, every race. While God worked for us through Ellen White, he worked for the world through Louis Pasteur, Joseph Lister, William Osler, and Bayer chemical company with knowledge of infections as causing disease, aseptic surgery, rational medical treatments, ether anesthesia and aspirin. These are all much larger and more important blessings to mankind than avoiding mustard, tea, and coffee ever will be.
Vegetarianism no longer belongs to Adventists. Not smoking is no longer a peculiar belief of Adventists. Avoiding narcotics, and addicting drugs is not an Adventist issue. We no longer need to talk about “dangerous drugs,” modern medicine has fully accepted that every chemical used for health purposes need to be pure, safe, and effective. The church needs to move from 19th century health concerns to 21st century health concerns. We need obesity prevention, diabetic prevention, cancer risk reduction, mental health promotion now, not just stop smoking clinics and harping on mustard! If the evidence shows that coffee is good for old people with memory loss, we need to encourage its use. If the evidence shows that spices actually are good for people, we need to drop those errors of our 19th century prophetess, and move on to health for today, not the reforms useful in 1863. Once it took Adventists to make breakfast cereals and peanut butter. There is no need for us to do these things today.
And we must fully embrace cooperation with all other agencies for good in our world. We will support every health initiative from every source. If the Muslim Red Crescent and the American Red Cross are improving health, we will support both equally. That’s the kind of God Adventists worship.
#2—Try to Empty Hospitals: Build Ambulatory Care Centers
Instead of building more hospitals, Adventist Health’s goals should try to keep hospitals empty. Instead of better treatments for cancers (Proton Accelerators, Robotic Surgeries, Complicated Chemotherapies) in Adventist Hospitals, the church’s goal should be to help our members and our communities to avoid cancer.
While once this world needed John Harvey Kellogg to build a huge Battle Creek hospital to treat people, what this world now needs are better ways to help keep people out of hospitals. At a local level Adventist should be building gymnasiums and safe bicycle paths, making hiking trails, swimming pools and pickle ball courts. Have you seen the new Salvation Army centers funded by McDonald heiress Joan Kroc? They are gyms and pools, they are restaurants, they are community halls, and on Sundays have services, but they are modern, up-to-date facilities meeting the communities needs for a place to practice health. They are no longer kind refuges for the down and out as they were in the 19th century.
Adventist institutions, churches, need to re-envision themselves to meet the needs of today, not the needs of previous times. Adventist professional health care institutions should be constructed for ambulatory care, as hospital care is a diminishing point of contact. We need primary care clinics and ambulatory care centers. We need places people come during the week, month after month, year after year.
This means we should task our training schools on producing more primary care providers, Family Physicians, Pediatricians, General Internists, Osteopathic generalists, than radiologists, cardiac surgeons, and orthopedic specialists. Although we need all of them, the majority should be those providers who have long term, repeated contacts with patients. Those States in the United States with the most primary care providers to specialist ratios have the best health statistics.
Adventist institutions that are schools, educational centers, need to be supported, while consideration could be given to divesting hospitals that are strictly service providers.
#3—Reforming USA Health Care Finances: A Great Mission Opportunity
If Adventist in the USA want to make a major contribution to Health Care we will try to demonstrate systems and programs that stop the hemorrhage of dollars involved in American Health Care. Although many of these decisions will need to be voted by governments, what a wonderful contribution Adventists could make by having an Adventist Health Care System that implements these reforms.
- Transparency of Charges and Fees. Require every department of an Adventist Hospital to have a printed fee schedule for every procedure they offer. No more sliding scales, no more we’ll tell you after you get your bill. Up front prices listed for everything we do.
- Transparency of Finances. Require every Adventist Hospital to report the income and finances of each hospital including salaries and benefits of all administrators and employees including physicians to be public knowledge.
- Transparency of Outcomes. We need to make known to the public of our strengths and weaknesses. Every procedure done needs to have outcomes data available. What are the results of this expensive chemotherapy, what is the average benefit from treatment?
- Bundling of charges. There must be one fee for a procedure. The fee for a chest x-ray must include both the technical and professional fees as one charge. Hospital care must include incidentals, not separate charges for linens, O2 use, every Tylenol tablet given.
- Retire any executive earning over $300,000 a year and replace them with those willing to work for modest incomes. We do not need millionaires running our health care institutions. We need well paid people with good benefits who are working for mission, not for personal profit.
#4—Adventist Health International
The health care issues facing the United States are much different in the developing nations of the world. The Adventist approach of the past in building and operating mission hospitals from the USA, has been mostly changed to local ownership and operations of hospitals. But the need for training, education, and accountability for those institutions remains a huge need. Identifying opportunities to train health care workers in their own countries and working on systems that will sustain their health care practices needs to be expanded.
Say we sold at a profit 50% of the simply service hospital presently run by Adventist Health in the USA, now before the socialist backlash (that will likely follow these Trump years) takes them from us anyway. Setting up a sustaining fund with those profits to support Adventist Health International might be the best idea you have yet read in these articles. (And sadly the one least likely to be implemented, knowing how hard it is for people to give up their positions of privilege and power.)
#5—Become an Adventist Health Care Giver Yourself.
In a sick world, there is job security in being a health care provider. Nurses can find jobs most places. Physical Therapists, Massage Therapists, Speech Therapists, Dieticians, Laboratory Technicians, all can serve God and man in a sustainable manner.
A good physician can find a practice many places. Associated professionals are always in demand in both employment and self-employment situations. From my experience, the happiest service is not solo ministry, but working with a team of likeminded individuals. I would encourage all Adventists to consider forming health care groups with people you like and agree with on basic spirituality, and then set up groups. This means in professional school, looking for friends you would like to spend your life with, and talking about spiritual and financial goals together. My advice is to work for the church in self-supporting physician managed groups. There is comfort in “letting someone else do the non-medical work” but there is a financial and a personal loss of control and a misplaced focus different than yours. I would happily work for the SDA church in a mission hospital. I would work with USA Adventist Health, but I would not choose to work for them as a health care provider in the future, unless they adopt suggestions #3 and #4.
1 Richard H. Hart, MD, DrPH, President LLU and Adventist Health International, an organization he founded and nurtures to support Adventist mission hospitals and health care schools, in developing countries outside of the USA. Dick is one of my heroes, and he like me spent time in his youth working as an Adventist mission doctor in Africa. In my opinion, he is the most important Adventist leader in keeping health care Adventist that I know, and his projects and programs deserves your prayers and financial support.
3 https://mobile.nytimes.com/2017/06/03/opinion/sunday/the-specialists-stranglehold-on-medicine.html?emc=edit_th_20170604&nl=todaysheadlines&nlid=56707872&referer= .
4 Adventist Health International can be found at http://ahiglobal.org/main/main if you have a hospital you are willing to sell for a profit and donate to a larger and more pressing concern.
Dr. John B. (Jack) Hoehn, MD(LLU), CCFP(Canada), DTM&H(London) has been an Adventist Physician for 45 years. He has worked in countries with socialized medicine, little or no medicine, and in the United States. He is a Family Physician, but has also been an obstetrician and surgeon. This article is the conclusion of a 3-part series on the Adventist church’s involvement with health care.