Posts tagged Culture
Complex Problems Like Healthcare

In the wake of the Supreme Court's decision to uphold the healthcare legislation, I found Atul Gawande's commentary on complex or "wicked" problems very compelling:

A few days ago, while awaiting the Supreme Court ruling on the Obama health-care law, I called a few doctor friends around the country. I asked them if they could tell me about current patients whose health had been affected by a lack of insurance.

“This falls under the ‘too numerous to count’ section,” a New Jersey internist said. A vascular surgeon in Indianapolis told me about a man in his fifties who’d had a large abdominal aortic aneurysm. Doctors knew for months that it was in danger of rupturing, but, since he wasn’t insured, his local private hospital wouldn’t fix it. Finally, it indeed began to rupture. Rupture is an often fatal development, but the man—in pain, with the blood flow to his legs gone— made it to an emergency room. Then the hospital put him in an ambulance to Indiana University, arguing the patient’s condition was “too complex.” My friend got him through, but he’s very lucky to be alive.

Another friend, an oncologist in Marietta, Ohio, told me about three women in their forties and fifties he was treating for advanced cervical cancer. A pap smear would have caught their cancers far sooner. But since they didn’t have insurance, their cancers were only recognized when they caused profuse bleeding. Now they required radiation and chemotherapy if they were to have a chance of surviving.

A colleague practicing family medicine in Las Vegas told me about his clinic’s cleaning lady, who came to him in desperation about her uninsured husband. He had a painful rectal fistula—a chronically draining infection. Surgery could cure the condition, but hospitals required him to pay for the procedure in advance, and, as unskilled laborers, the couple didn’t remotely have the money. He’d lived in misery for nine months so far. The couple had nowhere to turn. Neither did the doctor.

The litany of misery was as terrible as it was routine. An internist in my Ohio home town put me on the phone with an uninsured fifty-five-year-old tanning-salon owner who’d had a heart attack. She was now unable to pay the bills either for the cardiac stent that saved her or for the medications that she needs to prevent a second heart attack. Outside Philadelphia, there was a home-care nurse who’d lost her job when she developed partial paralysis as a result of a rare autoimmune complication from the flu shot that her employers required her to get. Then she lost the insurance that paid for the medications that had been reversing the condition.

Tens of millions of Americans don’t have access to basic care for prevention and treatment of illness. For decades, there’s been wide support for universal health care. Finally, with the passage of Obamacare, two years ago, we did something about it. The law would provide coverage to people like those my friends told me about, either through its expansion of Medicaid eligibility or through subsidized private insurance. Yet the country has remained convulsed by battles over whether we should implement this plan—or any particular plan. Now that the Supreme Court has largely upheld Obamacare, it’s tempting to imagine that the battles will subside. There’s reason to think that they won’t.

In 1973, two social scientists, Horst Rittel and Melvin Webber, defined a class of problems they called “wicked problems.” Wicked problems are messy, ill-defined, more complex than we fully grasp, and open to multiple interpretations based on one’s point of view. They are problems such as poverty, obesity, where to put a new highway—or how to make sure that people have adequate health care.

They are the opposite of “tame problems,” which can be crisply defined, completely understood, and fixed through technical solutions. Tame problems are not necessarily simple—they include putting a man on the moon or devising a cure for diabetes. They are, however, solvable. Solutions to tame problems either work or they don’t.

Solutions to wicked problems, by contrast, are only better or worse. Trade-offs are unavoidable. Unanticipated complications and benefits are both common. And opportunities to learn by trial and error are limited. You can’t try a new highway over here and over there; you put it where you put it. But new issues will arise. Adjustments will be required. No solution to a wicked problem is ever permanent or wholly satisfying, which leaves every solution open to easy polemical attack.

Two decades ago, the economist Albert O. Hirschman published a historical study of the opposition to basic social advances; “the rhetoric of intransigence,” as he put it. He examined the structure of arguments—in the eighteenth century, against expansions of basic rights, such as freedom of speech, thought, and religion; in the nineteenth century, against widening the range of citizens who could vote and participate in power; and, in the twentieth century, against government-assured minimal levels of education, economic well-being, and security. In each instance, the reforms aimed to address deep, pressing, and complex societal problems—wicked problems, as we might call them. The reforms pursued straightforward goals but required inherently complicated, difficult-to-explain means of implementation. And, in each instance, Hirschman observed, reactionary argument took three basic forms: perversity, futility, and jeopardy.

The perversity thesis is that the change will not just fail but make the problem worse. The futility thesis is that the change can’t make a meaningful difference, and therefore won’t be worth the effort. We hear both of these lines of argument against the health-reform law. By providing coverage for everyone, it will drive up the system’s costs and make health care unaffordable for even more people. And, some say, people can get care in emergency rooms and through charity, so the law won’t do any real good. In fact, a slew of evidence indicates otherwise—from the many countries that have both universal coverage (whether through government or private insurers) and lower per-capita costs; from the major improvements in health that uninsured Americans experience when they qualify for Medicare or Medicaid. The reality is unavoidable for anyone who notices what it’s like to be a person who develops illness without insurance.

The jeopardy thesis is that the change will impose unacceptable costs upon society—that what we lose will be far more precious than what we gain. This is the sharpest line of attack in the health-care debate. Obamacare’s critics argue that the law will destroy our economy, undermine health care for the elderly, dampen innovation, and infringe on our liberty. Hence their efforts to persuade governors not to coöperate with the program, Congress not to provide the funds authorized under the law, and the courts to throw it out all together.

The rhetoric of intransigence favors extreme predictions, which are seldom borne out. Troubles do arise, but the reforms evolve, as they must. Adjustments are made. And when people are determined to succeed, progress generally happens. The reality of trying to solve a wicked problem is that action of any kind presents risks and uncertainties. Yet so does inaction. All that leaders can do is weigh the possibilities as best they can and find a way forward.

They must want to make the effort, however. That’s a key factor. The major social advances of the past three centuries have required widening our sphere of moral inclusion. During the nineteenth century, for instance, most American leaders believed in a right to vote—but not in extending it to women and black people. Likewise, most American leaders, regardless of their politics, believe people’s health-care needs should be met; they’ve sought to insure that soldiers, the elderly, the disabled, and children, not to mention themselves, have access to good care. But many draw their circle of concern narrowly; they continue to resist the idea that people without adequate insurance are anything like these deserving others.

And so the fate of the uninsured remains embattled—vulnerable, in particular, to the maneuvering for political control. The partisan desire to deny the President success remains powerful. Many levers of obstruction remain; many hands will be reaching for them.

For all that, the Court’s ruling keeps alive the prospect that our society will expand its circle of moral concern to include the millions who now lack insurance. Beneath the intricacies of the Affordable Care Act lies a simple truth. We are all born frail and mortal—and, over the course of our lives, we all need health care. Americans are on our way to recognizing this. If we actually do—now, that would be wicked.

The article can be found at this link: http://www.newyorker.com/online/blogs/comment/2012/06/something-wicked-this-way-comes.html

Dana HicksCulture, Life
Last Chance for a Win-Win on Same Sex Marriage?

In the wake of a lot of conversation without a lot of substance, I have a deep appreciation for the following blog posted by Bob Hyatt. I don't agree with all of his premises but I have a deep respect for the civility and thoughtufulness of this response:

 

"This week, two important things happened. First, the voters of North Carolina passed a State constitutional amendment banning same-sex marriage. And then shortly after, President Obama reversed his long-held position against same-sex marriage and said, “It ought to be legal.” In addition, the polls now show that the country is almost precisely divided in half for and against changing our laws on this issue.

 

All of which lead me to believe that we will soon reach or have already reached the last chance for both sides of this issue to lay down the all-or-nothing mentality they possess, and find a win-win scenario where each side gets the essentials of what they want.
Is it possible to have a win-win on same-sex marriage (SSM)? I think it’s not only possible- it’s imperative.

 

Because, at least at this point, neither side seems willing to try and see the issue from the perspective of the other and look for something other than a binary, up or down, yes or no kind of solution. And where will that lead us? Certainly no place good. Look for more protests of churches, more of those who speak out in favor of the biblical understanding of marriage to be labeled as “haters”… and fewer and fewer gay men and women even giving the Gospel a hearing because in their mind, the Church simply doesn’t care about them as people.

 

In order to avoid an exacerbation of this cultural war, some common sense compromise is going to be necessary- each side is going to have to give up something for the sake of the other.

On one side, the Church is going to have to realize that gay men and women, in wanting what everyone else has, are asking for something reasonable. Rights of inheritance and property, custody and visitation- all of the rights granted currently by the state in marriage are good things, things we can affirm, even in relationships that we wouldn’t necessarily endorse. After all, even if we hold a more conservative view on divorce, I don’t see many churches advocating for divorced couples to lose the right to have custody over their step-children should something happen to their spouse. We may not endorse the relationship, but we can certainly try to understand the desire of those in it to have the same legal rights as other couples. And more than understand it- I think we can advocate for it, and practically demonstrate that we do in fact “love everyone.”

 

At a bare minimum, those who claim the stance “Welcoming but not affirming” must come to grips with the very practical question of what that looks like not just on Sunday morning, but it the public/civic arena too.

 

On the other side, those pushing for SSM need to understand the depth of feeling involved in and around the word marriage- what is for many Christians a sacrament and for all Christians sacred. To have the State legislate an understanding of what is essentially a religious term, and to legislate it in a way contrary to the faith and practice of so many is profoundly offensive. This goes beyond legalization into the realm of endorsement and definition, and as such, is qualitatively different than many other culture war issues.

 

As long as we’re talking about “marriage” we’re going to continue to see a stalemate on this issue as those who believe in a traditional, biblical view of sexuality and those who want the basic rights afforded to others all around them each refuse to give an inch.

So what’s the solution?

 

The State needs to get out of the “marriage” business. It should recognize that as long as it uses that term, and continues to privilege certain types of relationships over others this issue is going to divide us as a nation, and is only going to become more and more contentious. We need to move towards the system used in many European countries where the State issues nothing but civil unions to anyone who wants them, and then those who desire it may seek a marriage from the Church. When I pastored in the Netherlands, this was the system- you got a civil union certificate at the courthouse and then a Marriage ceremony at the church. This division largely negated the culture war aspect, and allowed those churches who objected to same sex marriage on biblical grounds to not only opt out, but to be able to continue to teach their biblical view of marriage, uncontradicted by the State.

But more even than changing our system, we need to change our hearts. I don’t know how many proponents of gay marriage will be reading this, so I won’t make much of a plea to them beyond this: please stop labeling the other side of the argument as “hate speech” and bigotry. It’s not. It is a working out of deep convictions and a particular understanding of sexuality as a good gift from a good Creator, to be used within certain boundaries. Personal animosity doesn’t enter into the argument- and when it does, it deserves just as much sanction and rebuke from the Church as anything else.

 

And that means that in addition to rethinking how we talk about LGBTQ issues in the church, and what it looks like to actively welcome them in the name of Jesus, the Church needs to rethink its political strategies. We ought to stop worrying about ballot measures and propositions which declare same sex marriage illegal, and ought to start focusing on the new realities of this Post-Christendom world in which we find ourselves. Our efforts would better be spent on trying to get the government OUT of marrying anyone. Will this mean giving up one more piece of privilege and power in the public sphere? Sure- the Pastor’s signing of the “Marriage License,” a document issued by the State is exactly that. But if it gets us towards a place of peacemaking with a community we are not doing very well at sharing the Gospel with, isn’t laying that down worth it?

 

Ultimately, we in the Church need to change our hearts as well. It is our primary goal that the Gospel of Jesus be heard and understood and that the person of Jesus be esteemed. As we often say in marriage counseling, “perception is reality,” and the sad truth is that right now, the gay community in America doesn’t think much of us or our Jesus, not based on the offensiveness of our Gospel, but on the offensiveness of our fighting what they see as fundamental human rights. My fear is that we may (for a while longer at least) continue to win battles like The recent one in North Carolina… but ultimately lose the war in the hearts of a portion of our population who become convinced that the Gospel couldn’t possibly be Good News to them, based on what they do (or don’t) see in us."

 

You can find Bob Hyatt's blog at: http://BobHyatt.me

U2 in Seattle

“One day you will look back and you'll see -
You were held by this love.
You could stand there or you could move on this moment -
Follow this feeling”

(Mysterious Ways)

Last Saturday marked the third time I’ve seen U2 in concert and every time I see them I take something different away. Yes, it is a rock and roll show with world class production like nothing else on the planet. Yes, the catalog of songs they have to draw on is stunning. And I doubt there has ever been a band that could make a crowd of 60,000 feel like a small club show the way U2 can. But this time around, I was struck by the spiritual dimension of the band. I grew up in a Christian subculture that assumed that the only legitimate art forms are the ones that beat you over the head with “biblical principles”. But yet – as I looked around Qwest Stadium on Saturday night, if I didn’t know better, I would have thought I was at some kind of Pentecostal rally -- hands raised, dancing, surrender, and talk of justice, grace, compassion, and love. Bono told the fans gathered in Seattle, “…if this band has stood for anything, it is the idea that there are second chances.” My friend Tom who was at the concert posted on his Facebook page the next morning, “I went to a praise and worship service last night and a U2 concert broke out.”

In recent years, I have come to recognize the powerful effect that U2 has had on shaping in a positive way Christian spirituality in our culture. I am constantly amazed at the number of people who refer to their U2 concert going experience as “inspired” or “divine” or even “the high point of their spiritual journey.” In Rob Bell’s most recent book, he poses a question about both the necessity and the difficulty of responding to Jesus. He writes,

…It is about how you respond to Jesus.But it raises another important question: Which Jesus? ... When one woman in our church invited her friend to come to one of our services, he asked her it if was a Christian church.She said yes, it was. He then told her about Christians in his village in eastern Europe who rounded up the Muslims in town and herded them into a building, where they opened fire on them with their machine guns and killed them all. He explained to her that he was a Muslim and had no interest in going to her Christian church. That Jesus? Or think about the many who know about Christians only from what they’ve seen on television and so assume that Jesus is antiscience, antigay, standing out on the sidewalk with his bullhorn, telling people that they’re going to burn forever? That Jesus? (“Love Wins”)

In this regard, it may be that U2 may be the best advocate for way of Jesus in our culture today. U2’s Jesus looks a lot like the Jesus of the gospels – a dangerous outsider calling out the greed and corruption of the rich and powerful. The draw to this kind of Jesus is powerful. For people like myself who are church insiders, it is humbling to recognize that it is not usually the preaching that I am used to doing that changes the world.In the biblical narrative, it is the artists and poets, like U2, who are the ones imagining a new world, a new reign of the Kingdom of God, Shalom. I love the way Walter Brueggemann describes it:

The poets of the Bible use a shattering, evocative speech, the kind of speech that breaks fixed
conclusions and presses us always toward new, dangerous, imaginative possibilities…These poets not only discerned the new actions of God that others did not discern, but they wrought the new actions of God by the power of their imagination, their tongues, their words. New poetic imagination evoked new realities in the community
. (“Finally Comes the Poet")

Yeah, it rocked. And yeah, there were several times (like when Bono cried out, “uno, dos, tres, catorce”) that I thought 60,000 people were going to jump out of their skin in unison. But I also think there is something deeper going on. Something pretty significant.

Dana HicksCulture, Faith
Dangerous Eschatology

I don’t know many people who took seriously Harold Camping and his doomsday prediction for May 21st.And I’m confident that every late-night comedian is delighted that he has revised his prediction to five
months from now
.(As a side note – Camping’s revision of May 21st being a “spiritual thing” happening rather than a physical event is eerily similar to the Seventh Day Adventists dealing with “The Great Disappointment” of Jesus not coming back in 1844. It’s uncanny how history has a way of repeating itself.)

The whole episode would be quite funny to me as well except that I am pastor.Consequently, I have
to deal with the human carnage that is inherent in this kind of bad eschatology.This weekend I had a conversation with a young woman who was convinced by her Pentecostal church that it was a waste of time for her to attend college because Jesus was coming back so soon. Eight years later she is understandably very hurt with the path that she chose after trusting her spiritual leaders.

I also don’t think the whole episode is very funny to those who gave their life savings to Camping’s organization to put up billboards.

All of the biblical and theological shortcomings of this kind of thinking can’t be addressed in a short blog like this.But what is clear from a pastoral perspective is that Camping is a true “wolf in sheep’s clothing” (Matthew 7:15). Any belief that makes us less engaged with the suffering of this world runs
contrary to the life and teachings of Jesus. Jesus taught us to pray, “Your kingdom come, your will be done on Earth as it is in Heaven” NOT, “Get us out of here to Heaven so that we don’t have to
deal with this Earth.”

What is most ironic to me is that those outside of the Christian Beltway seem to intuitively get Jesus’ message more than some insiders do.On May 22nd, one of my high school friends posted on Facebook, “To the ‘A’ hole who spent millions of dollars on billboards across America about the so called rapture that was going to happen yesterday. I hope you feel good about your money spent, personally I would have spent that money on someone who needs help, just sayin.....”

A couple years ago Bill Mahr produced a film that was exceptionally anti-religious.While I thought many of his arguments were straw men, the final scene the movie put in to some perspective for me the tension that many outside of organized religion feel with all the dangerous eschatology that is floating around religious circles these days: http://www.youtube.com/watch?v=XeRcHZqPqW8

For those of us who are insiders – can we agree to corporately repent of all the times that we distracted people from REAL issues with speculation and trivia?Can we repent of ways that we have been so heavenly minded that we are of no earthly good?

More "McLovin" for McCrackin: A Response to the CT Article on "Hipster Christianity"

This is part 2 of responses to the new Brett McCracken book. My first post I wrote almost entirely for the class I’m teaching on ministry and culture and I thought that was the end of the conversation. However, Mr. McCracken was the cover story in this month’s Christianity Today. AND my boss loved the article so much he emailed it to all the pastors on my district. So, I feel like I’ve been drug in to a battle I didn’t want to fight.

So, let me start with all the ways in which I AGREE with McCracken’s article in Christianity Today:

*Evangelicalism’s love affair with what is “trendy” is nothing new.

*There is a difference between an organic contextualization of Christianity in to culture in order to serve a community and a desire to be “cool.”

*Evangelical culture in the 1990’s was, “…schlocky kitsch. And it was begging to be rebelled against.”

*A critical critique of one’s culture is necessary for every generation of Christ Followers.

But, as you might imagine, there are few issues I struggled with:

*I don’t know if McCracken is aware of this or not but the word “hipster” is a derogatory term, not a term of endearment. His use of the term sets a tone in the article that is paternalistic and condescending.

* I don’t believe in the (Greek) dualistic separation between “Christian” and “secular” that McCracken uses. I prefer to subscribe to the Hebrew view of life that believes that God is present everywhere. And being Wesleyan in my theological orientation means that I believe in God’s prevenient grace that shows up in places that I least expect it.

McCracken admits that, “Hipster Christianity isn’t a monolithic subculture than can be easily categorized…” but then he buys back what he says by inundating his readers with generalization after generalization. Stereotypes are the lazy person’s shortcut to understanding people. As such, stereotypes are almost always an inaccurate representation of individuals. In McCracken’s case, I personally know Erwin McManus, Mark Driscoll, and others that he has mentioned in his article and they don’t fit neatly in to the description that McCracken is giving. As near as I can tell, McCracken has done no real research on emerging churches like Ryan Bolger and Eddie Gibb’s book, Emerging Churches (Grand Rapids: Baker Academic, 2005) his conclusions are mere generalizations drawn from anecdotal observations. As such, most of what McCracken has to say is only good for firing up older Evangelicals but lacks any definitive substance or academic credibility.

McCracken's so called "hipsters" are motivated by rebellion. It may be self-evident to say, but rebellion is not always bad. Its value depends on what the person is rebelling against. To be rebellious is to be in the good company of people like Martin Luther King, Phineas Bresee, John Wesley, and Bishop Desmond Tutu. McCracken seems to assume that those in his cross hairs are rebelling for the sake of rebellion. Yet, from my observation it seems to be a rebellion against arbitrary legalism that became an idol and imprisoned their parents and a rebellion against a faith that is so individualistic that it makes the world we are living in worse and not better. In short, it seems like something worthy to rebel against.

McCracken’s own immersion in this older Evangelical subculture is obvious. He laments, “When…Christian hipsters begin to look and act just like their secular hipster counterparts, drinking and smoking all the same things, shouldn’t we raise a red flag?” It is sad that McCracken doesn’t get the irony of this own words – does he really believe that a defining characteristic of those that follow Jesus from those who do not is in their legalistic lack of drinking and smoking? Many emerging Jesus followers would reply by saying – “Yes, that is the point of our ‘rebellion’! For many years that legalism WAS the only difference between many people who claimed the name of Jesus and the rest of the world.” (By the way, if one’s personal piety exceeds Jesus’ piety, THAT might be a red flag that something has gone askew.)

As a result, many people in Evangelical (specifically Nazarene) churches live with this cognitive dissonance – they drink but come to church and pretend like they don’t. People are not stupid. Let’s at least be honest about it. Most people in the churches that I have pastored drink and I don’t think my church is that much different than the others. But for most it is “don’t ask, don’t tell” on Sunday. Could I be so bold as to suggest that Jesus’ defining criteria for his disciples might a better one – love for each other?

Given that McCracken’s stereotypes are accurate (which I don’t think they are), what takes my breath away is in the next paragraph of the article. McCracken argues with a straight face that drinking and smoking are “…not…much better” than the greed, raping of the environment, idolatry of nationalism, disdain for the foreigner, and apathy toward the marginalized of previous generations of Evangelicals. [For those who have ever read the Bible, I will pause to let the weight of that sink in. Wow.]

In the end, I really don’t care what McCracken thinks. What saddens me is that many will read his article and minimize the really important theological shifts that are taking place in some churches as just one more fad akin to skinny jeans or hula hoops.

Dana HicksChurch, Culture