For as long as I can remember, my father (veterinary surgeon) and my brother (medical doctor) bewailed the state of the National Health Service (NHS) in England. This subject comes up a lot these days because of the American mess surrounding Obamacare and the astronomical cost of health insurance and medical treatment.

I had two hernia operations in 2011 and 2012, and they each cost a couple of thousand Euros to my caisse d’assurance maladie here in France. What we pay for our health care and pension schemes is quite a lot, but we get an excellent service here in France with very little waiting. How long will it last? Macron’s government is planning changes from 1st January 2018 for self-employed workers and the liberal professions, and we are all nervous about what will come out of it.

I have always been deterred from emigrating to the USA by this problem. Need hospital treatment over there and you find yourself in very big debt or left to die because you don’t have the means to pay the full whack. At one time, medical treatment was less expensive, but it was also quackery much of the time. The strain is felt by the NHS in the UK and the various organisations in other countries. Either the sheer weight breaks these state organisations or it has to be shared by taxpayers. The charges are high because we are paying for an increasingly ageing population. The alternative is some kind of Nazi-style extermination / euthanasia programme (!) – or returning to the life expectancy of former eras (which century?).

It is difficult to understand many of the issues hidden under layers of bureaucracy and politics, and we wonder if there is a Christian response. I often wonder where the limit of saving and prolonging life is situated. Would I like to linger on for years with Alzheimer’s or terminal cancer? Could I take the rigours of chemotherapy knowing that it would only give me another six months of life? What is life? What is death? If we believe in the survival of the spirit after death, does it matter? If we are atheistic nihilists, does it matter either? I’m thinking of these things as applied to myself, not to others! On the other hand, who would leave sick children to die if they can be saved and given real hope?

One big problem is that like housing and utilities like water and electricity, they are market commodities and are subject to speculation and the maximisation of profit. Health care is a part of the system. To what extent is it moral for drug companies to multiply the prices of their products for the sole reason of supply and demand? Can it be compared with the housing market in England, which is really unaffordable?

One big difference is the essentially Socialist notion of healthcare in Europe we take for granted against the Liberal notion of things in America where health care is not a right. Americans are expected to have their own savings for health care and retirement pensions. A good question would be one of decentralising health care schemes and regulating the pharmaceutical companies and the medical profession. Could it be done without making the contributions ever more expensive?

Ideas on a level of ethics and morality would be welcome if they don’t concern the American situation exclusively. What are the limits of human life?

* * *

I found two related themes as I begin to feel the autumn close in. The leaves are still on the trees, though starting to change colour, and the weather is still fair enough on the whole for some last outings of the season in the boat. November will be worse, and the world will seem pretty dead as Advent begins, leading to what is usually a feast of hypocrisy, and we Christians try to remember what Christmas is really about.

The first that struck me is Bernard Brandt’s More Notes from the First Circle of Hell. It strikes me that human life has become very cheap. I can’t imagine what Japanese society and culture are like, but I gather that they are cruel people with no notion of the person. The human being is only of value in relation to society and the corporate. Life can get lonely, especially as winter is just round the corner. This is one reason why I have decided to convert the smaller of my two boats into something suited for inland sailing and rowing, so that I can get out for a daysail without depending on the whims of the sea. It is important to get outside, even when we are professional writers fettered to an office stool and a computer. I also have a bicycle, but have to admit to my laziness in regard to physical effort. If I can row a boat, then I can make the effort on a bicycle and get daylight and fresh air.

Bernard Brandt writes quite a harrowing picture on the plight of the homeless in America, vagrancy being treated as a criminal offence rather than for a situation of people who need help. Like medicine and life itself, the poor Lazarus has no rights in America. In Europe, it isn’t perfect, but there is always a possibility of a place to sleep at night and some food, however unpleasant and demeaning that might be. My old friend Patrick Sheridan wrote something quite striking in his new blog The Lady in the Van…, admitting the possibility that he could become homeless and live this life of a living death.

I had a little experience in London in 1978-79, when I had a room at Toynbee Hall, with a soup kitchen in the crypt of St Botolph’s church in Aldgate. We gave them food and clothes, but each enclosed his secret within himself. Some were clearly mentally ill, many with physical problems. A few went to get free treatment at the London Hospital in Whitechapel. There is no less misery today than in the Victorian era. Is such misery a choice? I think that in most cases, it is the result of a sequences of events, a downward spiral – a consequence of bad decisions. My father used to say when I was a child, The world doesn’t owe you a living. You have to go out and earn it. It is reminiscent of the old Victorian work ethic, which is essentially at the bottom of the way things are done in America, but it is true. We either have to struggle and compete in society, or find some way of getting by.

Patrick makes mention of eccentricity, which can mean anything if one doesn’t have a taste for psychiatric labels like Aspergers or some personality disorder. “I may one day end up a vagrant”. I hope he doesn’t, but that he manages to set up a little self-employed business in doing something he does well. I wondered how I would make it once I was out of seminary and the RC system. Beyond one’s mid 30’s, one is not very employable – especially if you have “quirks” and don’t fit into the corporate mould. Orwell also wrote Keep the Aspidistra Flying, which is a portrait of the middle class keep-up-with-the-Joneses mentality of the 1930’s depression era. Patrick encouraged me to see films about Quentin Crisp, above all the Naked Civil Servant. The camp manner exasperates me, but he was being himself, and there was something Christlike in that soul. Crisp also knew when his time was up and flew to America despite his doctor’s orders not to take a plane. I am surprised that Patrick, now a Russian Orthodox, didn’t mention that poignant film The Island – or for that matter The Way of a Pilgrim, St Benedict Joseph Labre or St Seraphim of Zarov. He did mention the fictitious Sebastian Flyte created by Evelyn Waugh, whose particular demon was the bottle!

It helps enormously to keep ourselves free from addictions, including the computer and the smartphone. Some of us are not good with mainstream society, which is not good for a priest! We need to come to terms with ourselves and take life day by day. It is useless to worry about the future, especially when things seem pretty hopeless in many ways. Do not fear death! It will come and in the way we least expect. Most of us will leave this world and become totally forgotten, leaving nothing for others. It is important to engage in writing and art, not to be remembered, but to leave some good in the place of other people’s evil and sin. There is a chance we will be remembered for something good, but the importance of that is relative. How are we with God?