Life is generous, although most humans don’t notice.
I offer evidence, if you failed to notice the azaleas, not to mention the rising sun. I’ll point to a full bloom of creative generosity where you might not expect it—in a complicated partnership between government, healthcare and hundreds of small community-based organizations in California.
This week Stakeholder Health released some careful research into a radical innovation in how the state of California is providing health care for the poor.
Here is the link to the webinar.
Here is a link to a two-page summary of the research.
Here is a link to the full report.
In most places government and healthcare are built proudly with nonchalant acceptance of the fact that the poor live demeaning lives and then die in humiliating pain. Sorry, there’s just not enough to go around, says the hard-hearted god of the castles. Even when the poor can slither through the doors into the emergency rooms, they have little access to 21st century preventive medicine. For decades it has been clear that most of the drivers of disease and suffering are not medical and need relatively inexpensive preventative care. Most conditions that look medical are best managed by something social, mental or spiritual before leaping to the expensive pill or carving up a body part.
This is technically called the social determinants of health (SDOH) which is unhelpful language because they go way beyond social work. Everything that happens in human life has biological-psychological-social-and Spirit drivers and implications. Duh. Humans are complex and wonderfully made (Psalm 89). Even straightforward medical problems—say a broken leg, which my kid is still recovering from— has a four-fold a healing path. It works the other way, too: childhood trauma shows up as wickedly complex biological issues decades later.
The healthcare industry is not organized this way. Governmental programs usually take the head off the body and put it over in the mental health agency, then detach body parts in thousands of reimbursable codes. Everything outside one’s skin goes under a totally different set of social services agencies leaving a scrap for public health to inspect the food, chase rats and get ready for the next pandemic.
BUT now California launched the first really large-scale trial (CalAIM) using Medicaid to treat humans as they actually are—complex and wonderfully made and living in communities that are complex human systems that can care for each other. The technicians in government (usually called bureaucrats) leaned into all that complexity and got the federal government to grant a “waiver” to spend Medicaid money on a wide range of SDOH drivers. North Carolina had been lauded for talking about this. California has done it in a state five times larger following science to embrace 10 times the range of SDOH factors. Bold.
AND they are spending that money through the extraordinary array of community-based organizations. In reality, these groups have only had scraps of money from bake sales or philanthropic largess (social justice one chardonnay at a time, says Dr. Suzanne Henderson). CalAIM has put $4 billion in motion, which, even in California, is a lot of chardonnay.
AND the innovations continued by investing millions in helping community organizations strengthen their capacities to interface with governmental funding procedures. This would be impossible except for the last innovation—the government folks listen, adapt in real time and change their way of doing things, too. Note the research was paid for by CommonSpirit Health, one of the largest healthcare systems in the nation. It is rare for such systems to even be curious about the reality of community organizations, much less partner in learning. It is head-breakingly difficult to blend institutional cultures and ancient practices. Easier to shame, blame and whine. Not here.
The initiative has released creative energy and imagination through changing the work of many hundreds of organizations. Many of the groups were built from faith, which is supposed to believe in generosity and even resurrection, but settle for much less. The Stakeholder Health panel included Lutheran Services, which has been doing this kind of work for many decades, now accelerated with the partnerships. And it includes “Pneumacare” (spirit—get it?)—a collaborative that grew out of a ministerial association, now managing millions of dollars to provide care that that cares in partnership with CalAIM. And yes, the healing is for everybody of every kind of faith and no-faith, skin and language. It’s California.
You have to watch the video to hear the story of real resurrection going on and be amazed at the technical skill making it work. (Here’s the link.)
This is smart generosity, not dumb give away. It is obviously smarter to invest in what people actually need when they need it will prove less expensive than the obviously dumb current idea of waiting for their life to blow up so completely, that they then end up in an emergency room. This kind of work is hard with many technical challenges. You have to do the right things right. It breaks every day and is fixed in real time. The research reveals a bold effort still underway.
The only unforgivable sin is to accuse God of creating a world broken from the beginning without enough for everyone. All the disciples of every religion can’t work around that because it assumes that inequity is inevitable; God’s fault, really. That sin is the root of every angry political movement. If they would open it, even You-Know-Who’s $60 Bible tells of a God who did a good job for everyone and expects us to do so, too. Turn on the lights to the most the most obvious thing in the world– there is enough for everyone. Everything works—politics, faith, family, health, food systems, housing, education—if you begin with that most obvious fact. Witness California.