KIM LAWTON, guest anchor and managing editor: Religious groups had mixed reactions to President Obama’s new plan for the war in Afghanistan. Some expressed hope that the additional 30,000 American troops will indeed bring stability by 2011, when Obama said the US will start to withdraw. But others were disappointed by the military escalation. A coalition of moderate and progressive Christians had pushed for a “humanitarian” surge, rather than a military one. In his speech to the nation, Obama said America began the war, in part, to defend what he called “the values we hold dear”:

President Obama (speaking at West Point): “America, we are passing through a time of great trial. And the message that we send in the midst of these storms must be clear: that our cause is just, our resolve unwavering. We will go forward with the confidence that right makes might.”

Joining me now is John Carlson, associate director of the Center for the Study of Religion and Conflict at Arizona State University. He’s joining us from San Diego. John, did President Obama make the moral case for his plans for the Afghanistan war?

JOHN CARLSON (Center for the Study of Religion and Conflict, Arizona State University): I think he gives us a good framework for thinking about the moral implications of that war. He started his speech by taking us back to the events of September 11th, the slaughter of innocents, and reminding us of the tremendous moral legitimacy and consensus about that legitimacy that we enjoyed at that time. He reminded us of the oppressive regime of the Taliban that supported them, and then he closed his speech, as we just saw, again reminding us of the moral source of America’s authority. So I think those are good moral bookends to a political argument for thinking about the moral implications there.

LAWTON: Well, in fact, it seems like a lot of the public discussion that we’ve been hearing has been based on the military strategy, political implications, expediency. There really hasn’t been a lot of moral discussion about the implications of this war, has there?

CARLSON: I quite agree with that. It’s been there, here and there, but not as much as it could be or should be or certainly was in—surrounding the deliberation about the initial invasion of Afghanistan.

LAWTON: But what’s not being discussed? What are some of the moral implications that you’re not hearing and you think we need to be examining?

CARLSON: Well, I think there are two in particular that need to be lifted up here. The first is to remember the plight of the Afghan people under the Taliban prior to September 11th, and also what the plight of the Afghan people would be should the Taliban return to power, and that’s particularly significant if one thinks about the treatment of women and girls, and so we really can’t afford to ignore that at all. The second is that there is a moral responsibility on the part of the United States. When you invade a country and overthrow its government and occupy it and put in a new government you incur responsibilities. We may have been there for eight years, but we have never put forward the resources needed to succeed or even to be able to say we’ve done all that we can do, we have earned the right to withdraw.

LAWTON: What about the moral responsibility to the troops, to the American people who are concerned about the cost of this and allocating those resources which people say could be used for other things as well?

CARLSON: There are clear moral implications there, and it is important to keep those in mind, and the president stressed in his speech that there’s this concept of a balancing act, so recognizing the moral implications of those features is very important as well, particularly the human cost of war, both for American lives but also for Afghan lives.

LAWTON: And I know that you are concerned about the long-term ethical implications. What do you mean by that?

CARLSON: Well, I talk about what we might consider the moral legacies of war, and that involves thinking about how the moral outcomes in many cases outweigh, in some cases outlast even, the original reasons for waging a war. So World War II was not waged to end the Holocaust, nor was the Civil War waged to end slavery, but those were important outcomes of those wars, so we need to keep those long-term moral legacies in mind, particularly if you’re thinking here about the liberation of the Afghan people from the oppressive regime of the Taliban.

LAWTON: And, very briefly, there’s been a movement stressing a humanitarian surge. Is that also something that should be incorporated into these plans?

CARLSON: I think the importance of civilian groups and building the infrastructure of society cannot be underestimated, so one has to support that, I agree. One also has to remember, of course, that those groups require security. It doesn’t help to build a school and staff it with teachers if it’s going to be bombed the next day, so security is crucial, and the military piece of  that has to be kept in mind.

LAWTON: All right. John Carlson, thank you very much for being with us today.

CARLSON: Thanks for having me on the show.

Click here to view the original June 19, 2009 story.

SAUL GONZALEZ: At the recent Worship Facilities Conference and Expo held in Long Beach, California, the business of marketing to places of worship was on full display. At this twice-a-year national convention, companies try to sell their products and services to churches and religious institutions.

UNIDENTIFIED SALES REPRESENTATIVE #1 (speaking to conference attendee): Maybe two cameras to cover the minister and the choir?

GONZALEZ: Their wares range from sophisticated video production gear to pews for churches and synagogues.

UNIDENTIFIED SALES REPRESENTATIVE #2: This is the Cadillac. This is our theater seat, a completely wooden theater seat.

GONZALEZ: Banks and credit unions that specialize in lending and financial consulting to houses of worship also attended.

UNIDENTIFIED BANK SALES REPRESENTATIVE (speaking to conference attendee): We don’t necessarily go by loan to value. We’re looking at cash flow.

GONZALEZ: Although there was plenty of hustle and bustle on the convention floor this year, the recession cast a pall over this expo.

STEVE KROH (Architect): In 25 years, it’s never hit us this hard before.

GONZALEZ: Steve Kroh is an architect whose firm specializes in church design. With congregations cutting back on expansion and new construction plans, Kroh is seeing his business plummet.

Mr. KROH: We’re not having to lay off a lot of people yet, but we’re cutting back on hours and just trying to hang in there right now. We are taking a lot smaller projects than we used to just to keep everybody busy.

ERIC KNOWLES (Founder and CEO, Church Brokers, San Diego, CA): The recession is hitting everybody, and it’s affecting churches just as much as it is the mom and pop homeowner.

GONZALEZ: Eric Knowles is the founder and CEO of Church Brokers, a San Diego firm that specializes in church real estate and financing.

Mr. KNOWLES: Right now, most of the churches we’ve been working with, probably the past year or least, they are all pulling the reins in. They’re not spending anything outside of the hard fast debt they have to pay. Salaries are getting cut back. People are getting let go. A lot of churches are letting their staff go or reducing their pay, going to part time. So it’s a challenging time for churches right now.

GONZALEZ: One house of worship struggling to keep its doors open in the down economy is Long Beach’s Immanuel Church, which is part of the United Church of Christ.

Reverend JANE STORMONT GALLOWAY (Pastor, Immanuel Church, Long Beach, CA): Foreclosure is a possibility and something that we are concerned about.

GONZALEZ: And to those out there who think of churches as being foreclosure-proof?

Rev. GALLOWAY: Oh, no. Forget it.

GONZALEZ: With revenues down, Reverend Jane Galloway’s church is struggling to pay off a more than $850,000 mortgage and loans used to pay for repairs of this more than 80-year-old building.

Rev. GALLOWAY (speaking at meeting): Talking with the mortgage — our mortgage broker. . .

GONZALEZ: To stay afloat the church has cut expenses, and Reverend Galloway has volunteered to slash most of her own pay. But despite the belt tightening, every bill that arrives brings a new challenge.

Rev. GALLOWAY: I mean we’re literally at a point where my husband walked in the other day and said this was on the side door, and it was a turn-off notice for the utilities. Now we are at a scary moment, and we know that each month, if we are unable to make our mortgage payment on time, we could be — the default process can be filed and a foreclosure proceeding could begin.

GONZALEZ: Although no single, hard number exists, banks and credit unions that lend to houses of worship report a steady increase in church bankruptcies and foreclosures. One of them is this 1,000-seat church north of San Diego. Built just in 2005, it closed last year after the church defaulted on loans. Even wealthy and powerful megachurches, such as southern California’s Crystal Cathedral, have had to cut staff and put millions of dollars worth of property up for sale to help pay off debts. Whether they’re big or small, many churches’ money troubles stem from s steady decline in giving. According to the Christian research company the Barna Group, American churches got between $3 and $5 billion less in donations than they expected to receive during the last quarter of 2008. That’s about a four to six percent decline.

Reverend PHIL HERRINGTON (Pastor, Pathways Community Church, Santee, CA, addressing congregation: I thank you to so many of you who have given faithfully using this envelope. It really helps us pay the bills and do what we do as a ministry — in helping people and loving God and loving people.

GONZALEZ: Phil Herrington is pastor of Pathways Community Church in Santee, California.

Rev. HARRINGTON: We have a number of people in our church right now that are unemployed, that have lost jobs. People who used to be significant donors in the church have just flat out lost their income. Maybe they can give in a smaller way, but that affects our overall income.

GONZALEZ: In response, Pathways has had to cut staff and fill more positions with volunteers. Houses of worship that face foreclosure and other financial troubles often get into their predicaments for the same reasons that homeowners and consumers do: borrowing and spending too much money when times are good and not being prepared when the economy goes from boom to bust.

Mr. KNOWLES: You know, churches are no different than, literally, business owners or homeowners. We all believed that everything was going continue to appreciate, that there was no turning of the curve, and so everybody was overleveraging, and churches are no different. They were not exempt.

GONZALEZ: Real estate broker Eric Knowles, a devout evangelical Christian, says churches’ financial problems are sometimes made worse by leaders who are unable to face harsh economic realities.

Mr. KNOWLES: There’s that faith, you know, that often we think that the Lord is directing us to go do something. Well, how do you refute that when I deal with a pastor that says that the Lord is calling me to buy this building? And I have many situations where it will not pencil. We run our analysis and we get real involved and detailed. But then the pastors continue to say, well, I believe God is directing me for this. Goodness. So what do you do? What do you do? We give the best counsel we can. We give it to them pragmatically, you know, documented in writing that this is where you are going to be, and often time the pastor will look me in the face and say, well, you know what? I understand what you are saying. I understand by earthly standards this will not work, but God has called me to do it. And that’s the trump card. What do you do? You’re just kind of like, okay.

GONZALEZ: In both good economic times and bad, some churches are supplementing what goes into collection baskets by finding new and creative ways to raise income. For instance, with assistance from investors Pathways Community Church purchased this once dilapidated shopping mall. The church occupies the space that was once a supermarket but rents out the rest of the center to other businesses. The revenue earned helps the church pay operating expenses and mortgage payments that total over $21,000 a month.

Rev. HARRINGTON: Right now it’s helping us survive. If we didn’t have that right now we would have to massively downsize staff and personnel and do a lot less ministry out in the community than we are doing right now. So it has opened up a lot of doors for us.

Rev. GALLOWAY (speaking at meeting): I think it could be shared space, perhaps like a collective office space . . .

GONZALEZ: But as they try to guide their churches through turbulent economic times, the strain is taking a visible toll on some religious leaders such as Reverend Galloway.

Rev. GALLOWAY: I really want this to work, and I feel a sense of responsibility. I’ll let myself be this vulnerable because you are asking me this. I feel a sense of responsibility to the people I am here for. People come here with broken hearts. People come here looking for food — looking for spiritual food, and I hear the kind of despair they are in, and I realize that it’s crazy for me to be this preoccupied with the finances of some place, when I’m here to create a place where people can come and find solace. So I feel a sense of responsibility to the people who come here for that kind of nurturance.

UNIDENTIFIED SALES REPRESENTATIVE #3: We’ve developed what we call our McDonald’s approach to church design. It’s our “church in a box.”

GONZALEZ: At the expo, those attending hoped the recession would soon end, allowing houses of worship to focus not on their money problems, but on their ministries.

For RELIGION & ETHICS NEWSWEEKLY, I’m Saul Gonzalez in Long Beach, California.

Click here to view the original December 19, 2008 story.

KIM LAWTON: It’s the season of Santa Claus, and it seems he’s everywhere. Children anxiously await the arrival of Santa who is, of course, bearing gifts. But some Christians are worried that most of those children, and their parents as well, don’t know who “jolly old Saint Nicholas” really was.

Canon JIM ROSENTHAL (Founder, UK/USA St. Nicholas Society): St. Nicholas was a real person — not a fairy, not someone who’s flying through the sky with reindeer, but an actual person who lived and worked and died and had a full life. He had a Christian life because he was actually a bishop, a pastor.

“If we don’t recover this tradition…we are going to eventually lose Christmas”

LAWTON: As director of communications for the worldwide Anglican Communion, Canon Jim Rosenthal was always on the lookout for images of bishops. He says he was captivated by a fourth-century bishop named Nicholas. Now Rosenthal helps lead an international movement urging churches to reclaim Saint Nicholas.

Canon ROSENTHAL: I believe that Saint Nicholas and his tradition is something that needs to be recovered and now.

LAWTON: Rosenthal is founder of the UK/USA Saint Nicholas Society.

Canon ROSENTHAL: The children are getting these that say “I met the real and true Santa Claus and Father Christmas.”

LAWTON: Every year, he dresses up like Saint Nicholas, complete with the bishop’s staff called a crozier and his distinctive hat called a miter.

Canon ROSENTHAL: I have to decide if I wear one of those miters or this miter. This is the most pretty one.

LAWTON: He visits churches to help spread the Saint Nicholas message.

Canon ROSENTHAL: If we don’t recover this tradition, I believe that we are going to eventually lose Christmas, any semblance of a religious Christmas.

LAWTON: Nicholas was born in Asia Minor when the new Christian faith was beginning to spread across the Roman Empire.

Canon Jim Rosenthal visits churches to help spread the Saint Nicholas message.

Canon ROSENTHAL: He came from a very wealthy family. His parents died at an early age. His uncle was a priest. That was the undivided church in those days. There was no Roman Catholic Church or other kinds of churches — one church. And he became a priest like his uncle.

LAWTON: Nicholas rose to leadership in the early church and was named Bishop of Myra, a city on the southern coast of what is now Turkey. During a time of persecution by Roman Emperor Diocletian, Nicholas was imprisoned for his outspoken faith. He was eventually released and continued his ministry until his death on December 6 in the year 343.

Canon ROSENTHAL: He was known for his generosity and his good will because he was very rich. He literally, by the end of his life, gave away all of his fortune. Many stories talk about the fact that he was so generous that he became known as the Gift Giver.

LAWTON: More and more churches in the US and the UK are finding ways to keep the Saint Nicholas stories alive. For example, the Episcopal Cathedral of Chicago hosted a special Saint Nicholas exhibit.

Reverend JOY ROGERS (St. James Cathedral, Chicago, IL): The stories of Saint Nicholas are wonderful stories of a bishop who cared about his people, who cared very much about the poor.

LAWTON: There are numerous tales of Nicholas doing good deeds: performing miracles, calming the seas, stopping famine and rescuing children. Separating truth from myth can be difficult.

Rev. Joy Rogers

Rev. ROGERS: My guess is that some of the fanciful stories that have moved into the realm of legend and miracle had their roots in very concrete acts of very real kindness and generosity.

LAWTON: One of the most famous stories involves a poor family who couldn’t afford marriage dowries for their three daughters.

Rev. ROGERS: The parents were going to have to sell them off into slavery or into prostitution or whatever, and Saint Nicolas came by the house at night and dropped off three bags of gold coins.

LAWTON: Some legends say he secretly tossed the bags of gold through an open window, and one landed in stockings or shoes that were drying by the fire, thus launching the tradition of the Christmas stocking. Pawnbrokers have especially embraced that story.

Canon ROSENTHAL: If you go to a pawnbroker shop you’ll see three gold balls. Those represent the three bags of gold, which we now turn into chocolate coins that Saint Nicholas threw through the window to save three girls from slavery or prostitution.

LAWTON: Nicholas has been adopted by many groups beyond pawnbrokers.

Canon ROSENTHAL: So many people love him, and so many people wanted him as

theirs that he’s the patron saint of almost everything: unwed women, children, which of course is the most prominent; pawn brokers; sailors and merchants and cookie makers, apothecaries. You just name it, and he’s got something to do with it.

LAWTON: Many European countries have a long tradition of celebrating the Feast Day of Saint Nicholas on December 6. Then Saint Nicholas evolved into Santa Claus and got all tied up with Christmas.

“He’s the patron saint of almost everything”

Canon ROSENTHAL: If you look at the name Santa Claus, you will see its “Santa” means saint, and “Claus” is simply an abbreviation from the “Nicholas.” But the reality is he became a secular image.

SANTA (reading to children): Not a creature was stirring, not even a mouse. The stockings were hung by the chimney with care, in hopes that Saint Nicholas soon would be there.

LAWTON: American writers and advertisers helped disseminate a new myth that made no mention of the jolly old saint’s religious connections.

Canon ROSENTHAL: We always talk about roots and being politically correct. Let’s be politically correct about Santa Claus and give him his proper title.

LAWTON: Church leaders emphasize that Saint Nicholas’s generosity was motivated by his Christian faith. The saint was following Jesus’ commands to love others, help those who are suffering, give sacrificially, and to do one’s good deeds in secret. They say Nicholas is a reminder that Christmas is really about the coming of Jesus.

Canon ROSENTHAL: The problem with Santa Claus as it stands now is that it’s a substitute for Christmas — Santa Claus instead of the creche, instead of the manger, instead of the nativity scene. This man we would find kneeling at the nativity scene saying, “This is what I’m here to celebrate as well.”

LAWTON: Nicholas may have been called the Gift Giver, but Christians teach that on Christmas God gave the world the ultimate gift — Jesus .

Canon ROSENTHAL: Symbolically, as a Christian leader St. Nicholas is pointing, like other Advent stories, pointing towards this event called Christmas, which as Christians we believe is the most wonderful night of the year.

LAWTON: And that, they say, is the true meaning of Saint Nicholas. I’m Kim Lawton reporting.

KIM LAWTON, anchor: The Obama Administration launched a new initiative this week encouraging Americans to help fight hunger in their communities. The campaign is called  “United We Serve: Feed a Neighbor.” It urges people to donate money to local soup kitchens and food banks and also to volunteer their time and talents. The effort comes amid new government reports that hunger is on the rise in the US. Forty-nine million Americans struggled to put food on the table this past year—that’s an increase of 13 million—and a record number of Americans, 36 million, now receive food stamp assistance.

Joining me with more on all of this is Candy Hill, a senior vice president at Catholic Charities USA. Candy, it seems like this time of year, every year, we hear appeals from groups saying “Oh people are hungry, you need to give.” What makes this year different?

CANDY HILL, Catholic Charities: Well, we certainly are seeing such an increase, and new people that have never come to Catholic Charities for services before. Some of them are even our donors, and some of them are our former board members, so we see a real crisis in the number of people coming and who need assistance this year over the other years that we’ve been in business.

LAWTON: And there’s been some talk of food insecurity, I mean we’re not talking about starving in the streets, but we’re talking about people who are just having a harder time feeding their families?

Candy Hill, Catholic Charities USA

HILL: Yes, and I think when we talk about food insecurity we’re really talking about people not having food for three meals a day, so we find parents who are scrimping or not having a meal themselves in order to feed their children, and seniors who are making choices between whether they buy medicine or feed themselves, and in a country as great as this country we shouldn’t have people doing that.

LAWTON: And this is a function of the economy and all of the repercussions of that?

HILL: I think this is a perfect storm. We see the economy, and the people that we serve certainly were struggling before the collapse of Wall Street, but they were struggling first and will be the last to recover in this recovery.

LAWTON: And to what extent is it difficult in these tough economic times to make appeals for groups like yours, to say to people, give money to hungry people when individuals might be thinking, you know, I don’t know how I’m going to feed my own family?

HILL: Exactly. Well, what I would say as Americans we’ve always risen to the occasion, and this is one of these occasions. Our neighbors are suffering and we need to dig deep into our own pockets. The government has a role to play, all of us have a role to play, and we need to reach out and help each other during this really tough time.

LAWTON: Well, speaking of the government’s role, the U.S. government is urging people to give more in this new initiative, but is that enough? I mean, is it enough for individuals to give $20, a $100 or whatever, or do we need systematic changes in policy?

HILL: Well, I think long term we need systematic changes, but you know that’s a long term strategy and right now we have a short term problem, and so we need people to give and we also need the government to step up and do its part as well.

LAWTON: Are you pleased that the administration is having this initiative?

HILL: Absolutely, because I think it brings, it highlights always when the administration speaks on something and gives information, it helps connect to the things that we’re doing on the ground, and so this initiative, certainly, I think will highlight the need, but also the really creative things that are happening across America to try and meet the needs of individual people.

LAWTON: Yours is a faith-based organization. A lot of groups are trying to help the hungry. What is the specific role for religious groups and those from the faith community?

HILL: Well certainly we have a 2,000-year tradition that we’re supposed to feed the hungry and we take that very seriously and so we’ve been doing this for decades across the country and we see it as a moral issue, that people shouldn’t have to go hungry in a country as rich as ours, and we’re going to continue to try and meet the needs of people in local communities across this nation.

LAWTON: Again, we hear all the time people are hungry, people are hungry, the poor are always with us. Are there solutions? Is it possible to end hunger?

HILL: I absolutely believe it, and certainly the government is calling on that and Congress is as well. We have to think creatively. We have to think about 21st century solutions to 21st century problems, and the safety net in this country is badly torn and weakened, and we need to not just fix it. A repair is not sufficient. We really need to think about how do we eliminate the need for programs like food stamps, and like donations to feed the hungry through a food bank or a soup kitchen, and if we have the political will to do it in this country we can change this. You know, Bobby Kennedy forty years ago called attention in the Mississippi Delta to children being hungry, and yet today you and I are sitting here having the same conversation four decades later. We just need to rise to the occasion and have the political will to change it.

LAWTON: All right, Candy Hill, thank you very much.

HILL: Thank you as well.

Click here to view the original July 24, 2009 story.

JANE STROM: Happy Birthday.

AL (Jane Strom’s father): Thank you.

JANE STROM: Do you know how old you are?

AL: Yeah.

JANE STROM: How old are you?

AL: I don’t know.

JANE STROM: How old are you? You are 90, 90 years old…

LUCKY SEVERSON (Contributing Correspondent): Not long ago, Dr. Joel Strom and his wife, Jane, were so convinced that Jane’s father was close to death, notwithstanding the attention he was receiving from ten specialists, they put him in a hospice, and then he got better.

DR. JOEL STROM (Cardiologist and Professor, University of South Florida Medical School): Part of it was that he had one person who took care of him. They cut out all the referrals because they didn’t expect him to live long, and they cut out all the medicines.

SEVERSON: Dr. Strom is a cardiologist and a professor at the University of South Florida Medical School. Like every doctor we spoke with, Strom is fed up with the health care system.

DR. STROM: It’s not a broken system. There is no system. Medical care is haphazard. Medical care is disorganized. There are pockets of superb care. There are pockets of very mediocre care.

SEVERSON: If Medicare costs are any measure, Miami-Dade County should have the best senior care in the country. The federal health program spends over $16,000 a year per patient. That’s about double the 2006 national average. Brian Keeley is the CEO of Baptist Health South Florida, the largest nonprofit health care system in that part of the state. He says huge Medicare costs do not translate to better health care.

BRIAN KEELEY (CEO, Baptist Health South Florida): We know that more can be injurious to people, and more health care services, more aggressively providing those services, can result in lower levels of care.

SEVERSON: He says there are several factors that bloat health care costs in the Miami area.

KEELEY: There’s a huge imbalance between the number of specialists and primary care physicians, and we have such a high percentage of specialists down over here, they utilize resources more, technology more.

SEVERSON: Dr. Strom, a specialist himself, says one reason there is such a shortage of primary care physicians is that Medicare doesn’t reimburse them enough for patient visits.

DR. STROM: If you spend a lot of time with a patient you will starve to death as a physician because you will only get paid for a certain amount of time. In fact, a lot of physicians will actually steer patients to their offices to have tests performed, because they collect both the professional component, and if they own the equipment, the technical component.

SEVERSON: Dr. Gloria Weinberg is a geriatrician and chair of the department of medicine at Mount Sinai Hospital in Miami Beach. She says when young doctors, fresh out of medical school and burdened with school loans, discover how much less a primary physician earns, they choose a specialty where they can make more money.

DR. GLORIA WEINBERG (Geriatrician and Chair, Department of Medicine, Mount Sinai Medical Center): If you look at the reimbursement, you are going to come away after paying expenses, if you are lucky, with $40 or $50 an hour. That’s not going to help the youngsters go into a field of medicine and pay off loans and do everything else that needs to be done.

SEVERSON: Here in Miami, a typical senior citizen will see a doctor 106 times during the last 2 years of their lives. Not just one doctor, several—specialists who will then prescribe a battery of expensive tests and procedures: MRIs, ultrasounds, CAT scans, and an astonishing assortment of drugs. It’s because that’s the kind of care patients around here often demand. Dr. Weinberg:

DR. WEINBERG: Patients are very sophisticated. They come, and they say, “I have a headache.” You take a headache history. They are not satisfied if you say, “You don’t need a scan.” They want a scan. If you are pushed, and you are suspicious enough, and perhaps you suggest a CT, which is less expensive than an MR, some of them will come to you and say, “I want an MR. I hear it’s more sensitive.” We have had patients in our center tell us, “If you don’t do what I’m asking I’m going to sue you.”

SEVERSON: The threat of lawsuits forces many doctors to practice defensive medicine, ordering more tests and procedures to protect themselves from being sued. Health care professionals here cited malpractice suits as another factor behind spiraling costs, and Medicare fraud in South Florida, particularly in the home health care industry, has been described as rampant.

KEELEY: The Miami Herald reported about a month ago that the FBI and CMS [Centers for Medicare & Medicaid Services] indicated that fraud was about $2.5 billion per year in Miami-Dade County. That, in and of itself, is a huge, huge difference, comparing our cost structure to the rest of the country.

SEVERSON: About 50 million Americans are uninsured, and that includes 30 percent of the population around Miami. Many of that number are undocumented and in the US illegally. Whatever their status, most who need care end up in a hospital emergency room where, by law, they cannot be refused treatment.

DR. WEINBERG: It’s our ethical responsibility to treat that patient as we would any other. That patient can go down the path of having a cardiac catheterization, ultimately having a pacemaker, a defibrillator at $30,000, ongoing medical care, and then we face the problem, when we discharge the patient, where does the patient get the follow-up care, and the hospital doesn’t get reimbursed for it.

SEVERSON: Perhaps the biggest chunk of Medicare expenditures, something like 30 percent, goes to end-of-life care for aging Americans. Professor Anita Cava directs the University of Miami business ethics program. She says Americans need to rethink the way we look at end-of-life medical care.

PROFESSOR ANITA CAVA (Director, University of Miami Business Ethics Program): I think we in the United States really need to reconsider our relationship with end of life and to realize it’s a natural process and that perhaps ending life in a more humane and comfortable way at home with family, rather than trying to prolong it for another day or week or month, is perhaps the best way to go.

SEVERSON: Joe Gasperovich would take exception to the ethical argument for withholding expensive medical treatment for aging, failing Americans. He was born in 1919 and would prefer to prolong his life as long as possible.

SEVERSON (speaking to Joe Gasperovich): If they say we need to go do a $1,000 CAT scan, is there a point, an age you reach where you should say no, I’ve lived 90 years?

MR. GASPEROVICH: No, I want more.

SEVERSON: You want more years?

MR. GASPEROVICH: Everybody—nobody want to die.

SEVERSON: Dr. Weinberg says the decisions about the ethics of distributive justice for society as a whole are often much more difficult when the doctor is meeting with a patient one-on-one.

DR. WEINBERG: The health care dollars, an inordinate amount, go to taking care of people in the last 6 months of their lives. But how do you know when those last 6 months are? You have a person who has worked all their life, paid taxes, done very well, and now they are 80, and they have a heart attack. That may be the person who lives 10 or 15 more years. Are we going to say no just because of age? That’s a very, very slippery slope.

SEVERSON: There is a huge ethical discussion about who should make these end-of-life decisions—the patient, the family, doctors, the government? Brian Keeley says some decisions are easier to make. For instance, Medicare should only reimburse for treatments and drugs that are known to work.

KEELEY: It ought to be evidence-based. If something is proven not to work, I don’t think the federal government ought to be paying for it. I don’t think anybody ought to be paying for it, except for the private patient.

SEVERSON: Dr. Weinberg says too many patients receive expensive treatments and surgery in their final years that very likely won’t prolong their life.

DR. WEINBERG: So if you have an Alzheimer patient who, your own belief may be, it’s time to let this person go naturally, and the family is telling you, “I’m the surrogate, and I’m insisting that a feeding tube be put in,” you cannot make the decision not to put the feeding tube on your own, even though you think it’s futile care, at least in the state of Florida.

SEVERSON: Dr. Weinberg says her 95- year-old mother has a living will that stipulates she will not be kept alive on a ventilator. Brian Keeley says preparing for end of life is not something that’s culturally accepted in South Florida.

KEELEY: Other parts of the country where people plan for end-of-life care, with the use of hospices and palliative care and what have you—down here there’s less usage for that, so people go to die in the hospitals.

SEVERSON: Everyone seems to agree that health care reform is urgently needed and that health care should be a right and not a privilege and that it should extend to everyone. They also agree that South Florida is a good place to start.

For Religion & Ethics NewsWeekly I’m Lucky Severson in Miami.

Note: Since this story first aired in July 2009, Dr. Joel Stroms’ father-in-law, Al Godin, passed away.

Click here to view the original April 10, 2009 story and additional Wintley Phipps videos.

Pastor WINTLEY PHIPPS (singing at National Prayer Service, Washington National Cathedral):  “Amazing Grace, how sweet the sound . . .”

KIM LAWTON:  Grammy-nominated Gospel singer Wintley Phipps is a familiar voice at big national events. At President Barack Obama’s National Prayer Service following his Inauguration, Phipps’s rendition of “Amazing Grace” brought the entire National Cathedral audience, including the new president and first lady, to their feet. But he says it’s just as meaningful to him when he sings in places like prisons.

Pastor  PHIPPS: There is a sense that you’re giving hope to people who really need it.

LAWTON:  For Phipps, who is also a Seventh-day Adventist pastor, music is a ministry and, he says, one of the deepest expressions of his Christian faith.

Pastor PHIPPS: Music is almost to me an echo of the sounds of the divine world, and when you hear these sounds, it stirs something deeply spiritual within you.  Music also is the most powerful way of impressing the human mind with hope.

LAWTON: Hope has been a hallmark not only of Phipps’s musical career, but in his charitable efforts as well.  In 1998, Phipps founded the Dream Academy, a national nonprofit for at-risk kids. Born in Trinidad, he says hope was crucial in overcoming his own at-risk childhood.

Pastor PHIPPS: I was born to a troubled home, and I used to get away from my parents’ troubles — I had a little red tricycle, and I’d go in the back yard of my house, and I would turn the tricycle on its side and use one of the backside wheels as a steering wheel, and I would sit there for hours, and I would dream that I was flying to faraway places in the world and meeting important people when I was six, seven years old, and then I wanted to be like Tom Jones.  I’d go around the house singing, “It’s not unusual to be loved.”  I just wanted to be Tom. But something was missing to me.

LAWTON: Despite a difficult family life, Phipps says his mother always prayed for him and told him that God had a special plan for his life.  As a teenager, Phipps embraced her faith as his own.

Pastor PHIPPS:  t the age of 16, God walked into my life and said, “I’ve seen your dreams. Give me your dreams, and I’ll let you see what I’ve been dreaming for you.”

Singing at National Prayer Service

LAWTON:  He attended an historically black Seventh-day Adventist college in Alabama, where he met Linda, now his wife of 32 years.  Then, Phipps says, God began providing opportunities for him to sing in national venues such as a 1984 appearance on “Saturday Night Live” with Jesse Jackson.  He came to the attention of Billy Graham’s team and became a frequent performer at the evangelist’s crusades.

Pastor PHIPPS (singing in Washington): “Talk about a child that do love Jesus.”

LAWTON: Phipps also became a favorite in Washington. He’s sung for every president since Ronald Reagan.

Pastor PHIPPS: I’ve never had a manager or never had an agent, and yet some of the most wonderful moments that a singer could ever dream of have happened to me, and I believe it’s providential.

LAWTON: The idea for the Dream Academy came after he got involved with a prison ministry.

Pastor PHIPPS: I did not know that so many young men in prison looked like my sons. , and when I saw it I was shaken. One of every three young black men in America between the ages of 18 and 30 are in prison today or supervised by the court system either on probation or parole.

LAWTON: Phipps then learned that 60 percent of the young people who end up in prison are the children of prisoners. He wanted to break the cycle of intergenerational incarceration. The Dream Academy offers after-school mentoring and interactive academic tutoring to children of prisoners and kids falling behind at school.

Pastor PHIPPS: One of the most exciting things that can ever happen in a child’s life is to know that , “You mean God thinks about me?  Or God dreams about me?”  And he’s got a dream for my life?”  And when you catch a little glimpse of what that dream is, wow, it changes everything.

LAWTON:  Phipps has enlisted the support of some of his famous connections for the project.  One of his biggest benefactors is his longtime friend Oprah Winfrey.  The lesson of faith, he says, is that things aren’t always as they seem and that hardship can be overcome.  In these uncertain economic times, he’s released a new music DVD called “No Need to Fear.”

LAWTON:  It’s a theme he finds throughout the old spirituals that he often performs.

Pastor PHIPPS (singing): “Swing low sweet chariot, coming for to carry me home . . .”

The Negro spiritual teaches us that you’re going come up rough sides of mountains, and you’re going to have difficulties.  But faith gives you that ability to weather any storm.

(singing): “I looked over Jordan and what did I see?”

LAWTON:  It’s the core theme as well for the song that has become his signature, “Amazing Grace.”  He finds great spiritual lessons in the history of the song.

Pastor PHIPPS:  A lot of people don’t realize that just about all Negro spirituals are written on the black notes of the piano, and they just keep recurring.  Probably the most famous white spiritual that’s built on this slave scale was written by a man by the name of John Newton who, before he became a Christian, used to be the captain of a slave ship and many believe heard this melody that sounds very much like a West African sorrow chant (hums “Amazing Grace”).  And it has a haunting, haunting, plaintive quality to it that reaches past your arrogance, past your pride, and it speaks to that part of you that’s in bondage, and we feel it. We feel it. It’s just one of the most amazing melodies in all of human history.

(performing “Amazing Grace” on stage): “To sing God’s praise than when we’ve  first begun. Hallelujah, hallelujah. Amen.”

LAWTON: Another lesson, he says, on how hope always triumphs. I’m Kim Lawton in Vero Beach, Florida.