The physician Paul Farmer, who teaches at Harvard Medical School and has established hospitals in Haiti for the poorest of the poor, has been known to walk for seven hours to make house calls to his Haitian patients. Recently he was here at the University of Pennsylvania, where I had the privilege to hear him speak about his work. Although he did not let on while he was at Penn, I take it from what I've read about Dr. Farmer that he is something of a religious man. He has said that he finds the charter for his work in the 25th chapter of Matthew's gospel, and is inspired by the writings of Dietrich Bonhoefer.
At Penn Dr. Farmer showed us photos of an emaciated patient suffering from both tuberculosis and AIDS. Joseph was 26 yeas old and barely more than a skin-draped skeleton. His family had already purchased a coffin for him. He, himself, told his doctors, "I'm dead already…." Indeed, to many people this self diagnosis from a poor Haitian would have seemed accurate
But Farmer does not treat his patients as though they are poor Haitians. He treated Joseph with antiretroviral and anti-tuberculous drugs. Within weeks he was up and walking. And the photo of him six months later that Dr. Farmer showed us was of a healthy young man with a child in his arms.
The medical and government establishments, Farmer told us, believe that it is not "cost effective" to treat cases like Joseph's. Perhaps borrowing from our own Ben Franklin, the establishment prefers an inexpensive ounce of prevention for the poor rather than a costly pound of treatment or cure. Prevention is cheap. Treatment is not. And the people of Haiti, by and large, are very poor.
Still, Farmer says, "I never heard a patient say, 'Hey, I'm a poor Haitian woman with HIV-AIDS and tuberculosis, but I understand it is not cost-effective to treat me.'"
Farmer thinks that the medical establishment treats cost-effectiveness "like a religion," he told us. But clearly, to him it is a very bad choice of religion, founded on what one writer called "the false belief that some people's lives matter more than other's lives."
Most of us have probably subscribed in some ways to this religion of cost-effectiveness. We do it when we shop at Sam's Club or Costco or Walmart. We do it when we drive to New Jersey to buy liquor and wine. We do it when we decide to travel off-season, or when we read the paper on line rather than buy a hard copy. We do it when we buy our cheaply made clothing and shoes. If we were in Southern California, I promise you we would hire our Mexican gardener because it is deeply cost-effective. We make decisions about our housing, our political contributions, even our dining out based on how cost-effective we expect the results to be. Perhaps we even apply some formula of cost-benefit analysis to the decision of how much to drop in the collection plate each week. We would never claim this as our religion, but we have become very good at practicing it nonetheless.
It is the practice of this religion that has left most of us able to cite within half a percentage point the available rates for mortgage refinancing this week but probably unable to name even one of the United Nations Millennium Development Goals, (like halving the number of people in the world who live on less than a dollar a day.)
The truth is that it seems somehow cost-effective to most of us to be familiar with mortgage rates, if for no other reason than to assure ourselves that it's still OK to rent rather than buy. And really, do we think it can possibly be cost effective to try to eradicate malaria or HIV-AIDS in Africa (another Millennium Development Goal)? Can we even be bothered with the math? Do we even need to try?
"Hey, I'm just a poor African woman with malaria or HIV-AIDS, but I understand that it's not cost-effective to treat me." Who are you talking to, lady? Did we even ask?
Today we are pretending to go with Jesus to the Cross. In truth, despite the expense of the musicians, and the vestments and the overhead of opening the church; despite even the cost of gas to drive here and the parking; even if you stay parked on the street and get a ticket while you go out to brunch, in truth we have chosen the most cost-effective way to go to the Cross with Jesus. I know the seats are not that comfortable, but still, you could do worse.
And the question that has been nagging me these past few weeks since I heard Paul Farmer speak is this: is the Crucifixion cost-effective? Is the relative cost of this act of God commensurate to the effect? Is the Cross cost-effective?
Another way of asking this question is to wonder whether in the shadow of the Cross some people's lives matter more (or less) than others? As in most things, the answer to this question may depend primarily on one's perspective.
From our own perspective, the Passion of Jesus Christ is exceptionally cost-effective. After all what has it cost us to come and hear that Jesus died for us? What has it cost us to sit for an hour or so under the shadow of his Cross? What has it cost us to hear the promise of his love, his assurance - if offered to the penitent thief, then surely offered to you and me - that today we will be with him in Paradise! Well done! Nicely sung! Always look on the bright side of life and all that!
It is enough for us to hear it now and then - that Jesus died for us. It is enough for us to commemorate the moment in wood and stone and paint and glass and music. It is enough for us to shed a sentimental tear at this love unknown, to reach out our hands for this bread, to dampen our lips with this wine. It is enough. An hour and a half, after all - and yes, Jesus loves me! What a remarkably cost-effective Cross this is that has so easily bought us our freedom, our forgiveness, our lives and still leaves us time to get to brunch! I never heard a person say, "Hey, I'm a poor sinner who has done pretty much what I like in the world, but I understand that it is not cost-effective for God to save me."
But as a matter of perspective, I wonder how this looks to Jesus.
He has been betrayed by one of his own followers. He has been handed over to an unsympathetic and foreign authority. He has been interrogated, accused, unjustly sentenced. He has been jeered by a mob, deserted, now, by the rest of his disciples. He has been stripped, mocked, spat upon. He has stumbled his way up this hillside, he has carried the heavy wood, the sweat pouring from his face. He has been sentenced to die as a joke: Jesus of Nazareth, King of the Jews. He has now felt the pain of the nails - pain I pray I will never know. He has prayed his last prayer and then, it seems, given up on prayer. He has felt the heavy agony of his own breath slowly evacuating. And finally he has breathed his last.
And all this, we are told, for you and for me? Can the cost of this act ever be even roughly commensurate with the effect? Look at us?! Can it?!
The truth of the matter is that, like that Haitian patient Joseph, we would have done well to purchase our coffins. Like him, we might have said, we are dead already. Because we should have long ago drowned in our greed, our abuse of one another, of this planet, our lust for blood and war, our regular assumption that some people's lives matter more (or less) than others, and our inexhaustible willingness to flirt with the cynical religion of cost-effectiveness.
The Good News of the Passion of Jesus Christ is that his Cross is not cost-effective at all. We have never managed to show the effects of this great cost God bore to save us from ourselves. Here and there, perhaps, when we ditch the religion of cost-effectiveness and care for the poor, the price tag be damned. But has God done well in this deal? Has his Passion been matched by our promise?
The mystery of God's love for us is that it is so deeply un-cost-effective. There the Son of God suffers and dies - not because he knows that it will make us good, but with the promise that it can. The passion and death of Christ are flagrantly and extravagantly not cost-effective: all this and even his own followers don't get it, run away scared, and deny they ever knew him.
But even now, all these years later, there is a Harvard professor who will walk seven miles in Haiti to make house calls; and if there are still those, like him, who refuse to believe that some people's lives matter more than others, then maybe we begin to see in them the wisdom of God's Cross. Maybe we begin to believe that it could be possible to halve the number of people who live on less than a dollar a day. Maybe we could find a way to eradicate malaria and AIDS, and even treat poor people who suffer with these diseases.
Maybe we could think this way and make these choices because we learned from the Cross of Christ something about that love unknown before the Cross: a love that has made the math of cost-effectiveness look somehow unfair. Because how could a cost-effective God ever love us? How could a cost-effective Christ ever suffer and die for us? And how could a cost-effective Cross ever save us?
You and I are sinners: selfish, greedy, stupid and weak - magnificent, it's true - but all the more tragically so because we know in our hearts that left to our own devices, like that patient Joseph we are already dead. We might as well have bought the coffins; some of us already have.
But at the Cross, God will listen no one say "I'm just a poor sinner and I realize it is not cost-effective to save me."
At the Cross, God shows us the mystery of a love unknown to us before: a love that promises that no one's life matters more or less than another's. The long walk to that Cross has somehow visited every soul; the hands that are nailed there somehow touched every head; the arms stretched out there somehow reaching every life - waiting only for us to stretch out our own arms and return the embrace.
Palm Sunday, 2007
Saint Mark's Church, Philadelphia