Torrent

I was supposed to be in India two weeks ago to participate in the Christian Medical College of Vellore’s strategic conclave and to attend the astonishing Sikh Sathya Sai Grama in Bangalore. Instead my visa got caught in the US government’s sabotage of international relations. You can imagine how badly I felt to not be in these sacred places at this time so pregnant with possibility and, yes, danger.

The Sikh One World One Family Foundation supports the Sri Madhusudan Sai Global Humanitarian Mission that provides essential services in 5 world regions, to over 100 countries, and maintains 12 Centers for Human Development (one is coming up in Los Gatos, CA). One of our Leading Causes of Life Fellows, Dr. Sunny Anand is deeply involved.

CMC asked me to speak about the theological clues from the Leading Causes of Life relevant to strategic planning. They take theology more seriously than any Christian hospital in the world—at least that I know about. So I leaned in and spoke frankly. (find the full text here)

CMC expected my remarks to be framed by the new book that came from the Leading Causes of Initiative, Taking Responsibility for the Life of Complex Human Ecosystems—Deep Accountability. And also in the context of my 18 years in hospital leadership roles. That title sounds preposterous but that’s exactly what CMC is trying to do in India in the most complex human ecosystem imaginable. The challenge is especially, dangerously, vexingly hard for a massive academic medical center trying to be Christian in a wildly interfaith context. Especially at a time in India when the god of the medical market is rising in power every week. CMC is among the most eminent medical schools and clinical systems in a nation with more middle class and wealthy people than in the United States.

I based my theological comments on the passage from Ezekiel 47 that Larry Pray told me about one day. “Gary, grab the Bible on your desk and turn to Ezekiel 47! I asked my secretary to go find one, then quickly read about the trickle of living water escaping the temple, running down the street, growing into a torrent downstream over his head. “Man do you not see it?”   “See what?” I asked with the man in the water. “That you are being carried by a torrent of life, surrounded by even more life on the banks.” That is what we must build strategy on–that torrent.

Our new book addresses this in the chapter called “Storm” which is inspired by Ivan Illich’s 1970 book, Medical Nemesis. It was audacious to jam Illich in a chapter, even worse in a blog but even a teaspoon makes for hot and uncomfortable reading. Every faith-based hospital and academic medical center I know about long ago became comfortable with the ugly complicities and intellectual capitulations he predicted a half century ago.

In the USA Mr Kennedy may finish off the last remaining scraps of thoughtful mission as the trillion-dollar array of organizations betray their founders, patients, staff and communities by joining in the whitewashing of their complex human ecology. Illich is sadly prescient, but not just sad. Nemesis is the Greek God who brings justice to those enjoying privileges they do not deserve because they betrayed their gifts. Illich focused on the medical science—obvious even a half century ago—as these institutions tuned their financial logic to the most profitable sciences, mostly cardiology, cancer and, as the public aged, orthopedics. That’s what drives the financial engine, builds the massive buildings and pays the ridiculous salaries. And that’s part of what calls forth the certain storm Illich predicted.

These organizations also betray the moral intentions of the thousands of people who give their lives to these organizations. Illich didn’t address that, but I was one of them and I know many more hugely decent people involved. So our book not only grieves for the waste of moral intention but asks us all to focus on being deeply accountable – from wherever we are in the span of our lives.

It is never a convenient time to face the complexity of the human ecology, especially when one is making vast sums patching up the damage that comes from ignoring it. Hospital executives and Board members have nearly unanimously decided to take giant steps backward as quietly as they can terrified that the MAGA or MAHA people will notice the estimated trillion dollars in financial reserves held by non-profit healthcare organizations. So the earlier chest thumping commitments to a diverse community—what we call complex human ecosystems—evaporated as quietly and totally as morning dew in a southern summer day. Shameless; but what attracts Nemesis is their pride in these business decisions that betray both faith and science.

The most obvious action of Nemesis is likely be the taking away these organizations’ non-profit tax benefits. MAHA cares as little about their mission as do their Boards, viewing them realistically as just part of the corporate healthcare industry which they believe should be in the hands of the most efficient capitalists—Google, Microsoft, Amazon, whoever. Without well-funded Medicaid, Medicare and public health these organizations are forced toward the high-margin services and they  will supplicate before these deep wells of capital. Of course, the health-tech firms know that Artificial Intelligence will decimate physician-driven hospitals and allow for precision cherry-picking of paying patients. They will let somebody else feed medical scraps to the poorly insured middle class and the poor. Faith-based hospitals could have invested this past half century arguing for policies building deep accountability to the science of prevention, chronic condition management and truly effective care. Instead they invested in self-serving revenue-oriented policies. This eroded any possibility that the public they were supposed to serve would now protect them when Nemesis comes to call with all its profoundly bad news.

The good news is clarity that it didn’t have to be this way; and it doesn’t need to be this way in the future.

Every part of this book is about deep accountability, and only one chapter deals with healthcare. Those of us who do care about the health organizations – public, private and faith-based – will need the other chapters to think with, to break the deadly intellectual dead-end the health sciences have trapped themselves in. We need clarity about how much capacity we have to act, invent, choose and imagine. We need to join economist Mariana Mazzucato’s fundamental new thinking about what and who produces value in our current world, unmasking, like Illich, those who are satisfied with mere cost and acritical profit-taking. We need mycologist Merlin Sheldrake’s whole new way of seeing how we humans move toward each other to make new social and political possibilities real. And we need the dramatic insights about social meshworks that are so much smarter than the dumb computer networks we’ve long tried to emulate with such meager swill.

It is Spring time. It is always Spring time. Even in the dark and cold of January life is finding its way all day and night, never resting, always emerging, never quitting. Joy! Life works.

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