10 Augustinian Values

Questions remain about Medicaid change

Pending federal approval, all Medicaid-eligible Floridians will be required, beginning in 2014, to participate in private, managed-care programs. Lawmakers who favor this measure say that it streamlines the system and provides cost-effective healthcare for low-income Floridians.

But big questions remain.

Is this legislation in the interest of all taxpaying Floridians? Will it save money (and at what cost to patients, care systems and state revenues)? Where is the accountability? Finally, shouldn’t a change that affects millions of Floridians be based on solid evidence?

Critics of Medicaid pilot programs in Broward and Duval counties, upon which the current bill is based, say data from those programs do not reveal whether this approach has cut costs or rendered better care. Studies commissioned by the Collins Center for Public Policy from Columbia University on a two-year pediatric oral-health pilot program in Miami raised red flags as to the wisdom of providing a set fee-per-patient to one provider. With concerns such as these, why pursue a model whose economic value and efficacy remain in doubt?

One reason given for supporting the bill is the assumption that expanding Medicaid in line with the federal healthcare reform legislation will cost the state billions. However, a Georgetown University report concludes this is a flawed assumption that rests on the notion that Medicaid expansion will automatically result in 100-percent enrollment and zero savings. In its history, Medicaid has never experienced full participation in any state of the country.

In reality, if Florida were to expand Medicaid by following the federal healthcare reform law, the reduction in the cost of uncompensated care would exceed the cost of expanding the Medicaid rolls. In addition, each dollar the state invested in federal healthcare would draw 10 new federal dollars to the state. The present bill claims to slash costs, but in reality it would shift costs to the safety net and to taxpayers who bear the brunt of paying for uncompensated care for people with limited access to health services at later stages of illness.

And, what of accountability?

A recent Businessweek article quoted Sen. John Thrasher, R-St. Augustine, as saying: “This particular program is one that has cried out for the necessity of making sure those dollars are accountable.” But it seems contradictory to say that funds for the program will be accountable when the results of the pilot programs are unknown.

Augustine's Literal Adam – The Gospel Coalition Blog

Throughout his life Augustine (AD 354-430) returned repeatedly to reflect upon Genesis. In addition to commentaries and sermons on the biblical text, he often found the issue of creation at the root of a theological debate.

Augustine’s beliefs are not normative for the Christian church. No individual should usurp the final authority of Scripture. However, Augustine’s theology has shaped and set the agenda for almost every major doctrinal endeavor of the church for 1,500 years. Exploring his reflections is an excellent way to gain a fresh perspective, unencumbered by the neuroses and prejudices burdening late-modernity. A journey into the mind of one of Christendom’s most profound theologians offers fresh perspectives, stimulating us to new insights from Scripture.

Over the course of about 40 years Augustine developed his views on Genesis. His approach to reading Scripture changed. The role and importance he accorded to Adam matured. It is striking that throughout these vicissitudes, at each stage Augustine believed in the existence of a literal Adam.

We shall consider the development of Augustine’s views on Adam in four stages, summarized in the table below.

1. A literal Adam in the background of a spiritual reading

Augustine’s first commentary on Genesis was a rebuttal of the Manichees. Before becoming a Christian, Augustine had himself been a Manichee. The Manichees argued for their dualistic view of the universe using a literalistic reading of Scripture. They made God appear ludicrous by refusing the appropriateness of metaphor or anthropomorphism. So Augustine observed that “the Manichees taunt us for believing that man was made in the likeness of God. They think of the shape of our bodies and are misguided enough to ask whether God has nostrils, teeth, and a beard.”

Such overly literal reading of Genesis prompted Augustine to adopt a spiritual reading. This allowed him to teach basic Christian doctrine to the Manichees while challenging their reading of Genesis. Augustine’s spiritual reading led him to suggest the six days of creation could be read as representing stages of a Christian’s discipleship or future stages of salvation-history. The rivers in Eden represented virtues. This sort of insight has proven both profitable and problematic.

It is all the more striking—in light of this preference for a non-literal, spiritual reading of Genesis—that Augustine still maintained Adam and Eve were literal humans created by God. The spiritual, figurative reading of Scripture did not erase the existence of literal realities. So Augustine thought that the creation of a woman from Adam’s rib symbolized the sacraments. He still believed Eve was actually made in the literal manner described by Genesis. “It was surely not without reason that she was made like that—it must have been to suggest some hidden truth. Was there a shortage of mud that the Lord could have made her from?

Two compotus rolls of Saint Augustine's Abbey, Bristol, for 1491-2 and 1511-12

The value of solitude, the ethics and spirituality of aloneness in autobiography

The church history of Britain, from the birth of Jesus Christ until the year MDCXLVIII.

Politics and the order of love, an Augustinian ethic of democratic citizenship

Augustine