AVERY WEST
Member Engagement Director
Read more from Avery

 

When Good Samaritan Health Centers of Gwinnett went bankrupt in 2005, they knew they’d have to make some changes to their free clinic model. 

Dr. Greg Lang, Executive Director, explains, “As a healthcare center, we have to use highly-educated, licensed providers. We can’t rely on volunteers, like many other nonprofits are able to do. Charging for services became a financial necessity.”

What began as a pragmatic decision soon became a philosophical one. “We started to believe that what we were doing was not just good business sense, but that it had Biblical underpinnings. The first book that we came across that helped us clarify our thinking was When Helping Hurts.”

Today, Dr. Lang and his team at “Good Sam,” as the center is affectionately called, know that asking customers to pay a small rate for services is the best way to affirm dignity, maintain quality, and spread the gospel. 

Pricing

“If we are the church, our doors need to be as wide open as possible,” Dr. Lang shares, “So we got rid of all the criteria, except for one: you have to be uninsured.” Unlike other clinics who have income, residency, citizenship, or wait time requirements, Good Sam provides care to any uninsured person. They use a unique model with clear cost structures, wellness incentives, opportunities for pastoral care, and of course, radical generosity when necessary.

The staff explain to customers that there’s a real value here that they get to help fund. “Sometimes they get it immediately, Dr. Greg says, “and sometimes they’ll leave and come back 6 weeks later saying, “I earn too much money, or I live in the wrong county, or they won’t see me for 6 weeks at all the other places.””

The center charges flat rates, which are about 25% of the market price, for each type of medical or dental visit. The first appointment is always the most expensive at $110, but if the patient is cooperative with their plan of care (quitting smoking, taking medicines, correctly, etc.), their fees will go down, and subsequent appointments range from $40-$85. This “incentive to wellness” plan speaks to the reality that Good Sam is interested in treating the whole person—body, mind, and spirit—not just the medical condition at hand.

Customers pay their fee at the beginning of the visit, and then the staff at Good Sam does everything they can during their appointment, even if certain procedures weren’t factored into the original cost. Every patient knows exactly what they’ll pay going in to the appointment.

“All of our front line staff are empowered to exercise generosity when necessary,” Dr. Lang explains. Employees can discount or waive it if they perceive a real reason and need. They always encourage patients to pay even a small amount, if they can, per the Good Samaritan Fund guidelines. 

Good Sam, though, doesn’t pretend that the cost simply goes away. They make clear to their patients that nothing is free. Staff are taught to offer a card, saying, “A donor has given money that we are going to use to pay your fee. We would like for you to take this postcard and write a thank you note so that we can send it to the donor. We don’t just make the fee disappear. An advocate is going to come in and pay your debt.” 

Funding

Of course, not every charitable healthcare center operates with this model. Free health clinics do exist, and most of them are only able to keep up with medical regulations and staff salaries by receiving government funding. For Dr. Lang, that was never an option. “We don’t accept any money that would tell us to shut our mouth about our religious foundations,” he shares. 

Their loyalty to their convictions has not only allowed Good Sam to continue spreading the gospel, but also to provide more services to more people. Since asking customers to contribute to their care, Dr. Lang explains, “We’ve just exploded. We went from being open two days a week with four staff, to five and a half days a week, 56 employees, and two buildings.” Unlike many other nonprofits who have grown over time, it wasn’t the donors, but the customers, who made that change possible. 

Good Sam funds more than 50% of their operational costs with patient fees. Because of these changes, Good Sam doesn’t feel like a free clinic in a basement or a commercial office park. They are able to give their customers a dignified experience with beautiful rooms and brand new equipment. “When people walk in,” Dr. Greg says, “they say, “I get to go to a place like this?””

Pastoral Care

The health center employs 56 people, including physicians,, dentists, nurse practitioners, phlebotomists , pharmacy-techs, and a pastoral care associate. They also welcome volunteers and interns from partner universities, tech schools, and medical schools. Dr. Lang sees these partnerships as an opportunity to influence the larger medical field. “We are demonstrating to them that it’s not just caring about the body or the mind, but there’s also a spiritual component. We are treating the whole person.” 

Good Sam has a full-time staff member with a degree in pastoral care. As long as patients don’t need medication, they can have a one-hour appointment with the pastoral care clinician for just $20. They provide traditional marriage and family, parent/child, and grief counseling, but also pray with patients who are have had a miscarriage, received a bad diagnosis, or are just overwhelmed. 

Customers from every faith are welcome at Good Sam, and if they would prefer not to pray or talk about God, the staff respects their wishes. “We’ll just pray for them later!” Dr. Lang says.

Sharing the Vision

In order to maintain this holistic vision of helping, the Good Sam staff begins every morning with a 15 minute staff devotion. They pray together and talk about why they do things this particular way. 

Additionally, new employees are assigned a mentor, a staff member who has been around for a while. The conversations between mentors and mentees helps maintain the culture of the organization.

Unity is key. For those interested in making a similar change to their ministry, Dr. Lang emphasizes that every board member must be supportive of the empowering model. Otherwise, there will be conflict every step of the way.

Care Coordination

Good Sam knows they can’t meet every need for every customer. They have a full time employee that maintains cordial relationships with hospitals, surgery centers, private practices, and the public health department. The Good Sam staff doesn’t just make a referral— they make the introduction, help the customer fill out the paperwork, help them navigate financial need processes, and do a follow up appointment.

“The Good Samaritan didn’t just point to a hotel down the street. He went all the way. We want to do the same thing,” Dr. Lang explains.

Consultation

“We know we can’t multiply everywhere. Other people need to be in this space. If we can make that path any shorter for them, we want to help,” Dr. Lang says. The Good Samaritan staff generously share their expertise and experience with anyone who is interested in learning more. 

“We will give you everything we have except for the names and addresses of our donors,” Dr. Lang jokes. The Good Sam staff will give tours, documents, and personal consultation to other organizations who are interested in the model. They have seen great impact in the Atlanta area, and with the model spreading, they hope to see more around the country.  

Conclusion

A couple of years after making the switch to welcoming customers into ownership, Dr. Lang remembers, a conversation with one of his employees confirmed that this was undoubtedly the right decision. 

Dr. Lang had given a raise to one of his staff members—a single mom with four children who received no child support. He was surprised when she came into his office, asking him to take it back. With the extra money, she no longer qualified for food stamps. 

“When that happened,” Dr. Lang says, “I realized, we do not want to oppress our patients. We do not want to have a policy that requires people to minimize their earning capacity. We want them to earn as much as they can so they can feed and clothe their children.” 

Good Sam does just the opposite. They help unleash the capacity of people in need, and empower them with the confidence, knowledge, and love of Christ that they need to flourish. 

 

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It is foundational to our faith that we care for those who are hurting and in need. Isaiah 58:11 is clear that when we shelter the homeless and feed the hungry, we are like a “watered garden.”

We are called to help, and we are blessed when we do.

So often, though, our help can cross an invisible boundary that was established by God. With the best of intentions, we can seek to help someone but end up taking responsibility for them.

We are responsibleーthere is no questioning thatーbut how we are responsible to help must be considered.

Galatians 6:2-5 sheds some light on this:

 

‘Carry one another’s burdens; in this way you will fulfill the law of Christ. For if anyone considers himself to be something when he is nothing, he deceives himself. Let each person examine his own work, and then he can take pride in himself alone, and not compare himself with someone else. For each person will have to carry his own load.‘ 

 

Paul in this passage exhorts believers to be responsible. He uses two interesting phrases to describe the two sides of the responsibility coin: “carry one another’s burdens” and “each person will have to carry his own load.”

The use of two different words to describe how we are responsible is important. First, Paul says we must “carry one another’s burdens.” The word translated as “burden” indicates something too big for one person to carryーthe idea is that Christians help one another with the things in life that are weighing them down beyond their ability. These are the big events of life where we cannot and indeed are not meant to go it alone. This could be helping a family after their house burns down. It could be walking with someone through a challenging season of his life by being a good listener and offering biblical wisdom. And it certainly can mean helping someone get out of an addictive cycle. It means being an advocate for those not listened to. It means creating pathways to meaningful employment for those being released from prison. The list goes on.

Now, contrast that with Paul’s use of the word “load” as the other thing we are supposed to carry. The word translated as “load” refers to the normal responsibilities of our lives. This indicates the things in our life that are accepted as normal parts of a functioning adult, like getting a job and earning a wage in order to pay for living expenses, keeping ourselves in good health, and even brushing our teeth.

Both words indicate responsibility, but not the same kind of responsibility. Perhaps the way to distinguish the main idea in this passage is to say we are responsible to one another but not responsible for one another.

So what does this look like in real life? In my role with Watered Gardens, a rescue mission in Joplin, Missouri, I wrestle with this every day as I minister to the homeless and impoverished. There is a real tension in determining how to help someone carry a burden but not carry their load for them.

This passage in Galatians teaches us that good discernment starts with humility. As Paul writes, “For if anyone considers himself to be something when he is nothing, he deceives himself.” It takes humility to realize you don’t have all the answers. It takes humility to accept that you don’t know what’s best for someone else’s life in all the particulars. Yes, you may have some wisdom and good counsel. Yes, you may have some experience to share. Yes, you may even have a proven program, but their lives are their own.

I think this is why Paul says “Let each person examine his own work, and then he can take pride in himself alone, and not compare himself with someone else.” Our life is unique to us. We cannot compare our life to someone else’s and think we know what is best in a prideful way for someone else. Some call this type of attitude a “god-complex”ーin effect, playing God in someone else’s life.

Paul is telling us to consider our motivation. Our motives for helping someone can be a mixed bag of self-sacrifice and a filling of a kind of prideful desire to be needed or have someone follow “our” way. A good test of our motives is our willingness to say no to someone when saying yes is not in his best interest. A refusal to take responsibility for someone reveals that we are practicing good discernment. Sometimes there’s more love in saying “no” than saying “yes.”

None of this happens, though, if we don’t do what Paul wrote in the verse preceding this passage.

 

If we live by the Spirit, let us also keep in step with the Spirit. Galatians 5:25

 

We must wholeheartedly depend on the Holy Spirit to guide us. If we listen, the Spirit will guide us to discern how we should help. Nothing has stood out to me more in working with people in desperate situations than the need to be led by the Spirit. Only He can guide us in ways that will really help. Only He can help us be responsible to but not take responsibility for someone else.

 

FROM THE TRUE CHARITY TEAM: We appreciate the perspective of our knowledgeable guest contributors. However, their opinions are their own, and do not necessarily represent positions of True Charity in all respects.

 

 

 

“You don’t know what you don’t know.” Although I have years of experience serving people in poverty, this perennial saying describes my recent effective charity awakening. My old view of charity grew out of my experience working in government-based programs, including mental health and in-home-based care. The majority of the clients I “helped” in my former roles were either at or below the poverty level. I unknowingly did some unhelpful things. 

Let’s take a look at a few of my uncovered blind spots and you can be on the lookout for them in your own work.

 

Confession #1 – I often asked disempowering questions.

The questions asked of individuals living in poverty often point toward problems, deficits, and flaws, unintentionally ignoring both the inherent worth of every human created in God’s image and the capacity they have to be a part of their own solutions. I routinely asked what people’s problems were, which can be fine, but I failed to ask what capabilities they had. Notice the disempowering dynamic in my typical communication: 

• You don’t have health insurance? OK, let’s see if your income is low enough for Medicaid. 
• You are short on food? OK, let’s get you signed up for SNAP or send you to get free food at the food pantry.
• You don’t have a place to live? OK, let’s see if you qualify for HUD. 
• You don’t have a job? OK, let’s see if you qualify for unemployment benefits. 
• You aren’t able to work? OK, let’s see if you qualify for disability income. 
• You can’t clean your own home? OK, let’s see if you qualify for state-based in-home care.

These types of “What’s-wrong-with-you” questions and “how-can-I-fix-it” answers are harmful both to the person in poverty and those attempting to help alleviate it.

 

Confession #2 – I assumed that all needs required emergency relief.

Most people have the capacity to meet their own material needs by using their own abilities and relationships. When people are in poverty, it could be a result of a short-term crisis, which requires emergency relief, or it could be that their capacity to provide for themselves is impaired. In that case, they need development of their capacity, not mere temporary provision. On other occasions, people have the capacity to provide for themselves, but request emergency relief anyway. A system that assumes everyone needs relief all the time is ripe for abuse and poor results. Here are a few examples of assumptions and the results I have experienced:

• A man reported needing help cleaning his bathroom and kitchen due to his disabilities. Caseworkers worked to get these services authorized through a government-funded program. Once authorized for the program, the caregiver noted that he was always in a hurry for her to finish the work so he could leave to tend to his extensive vegetable garden and work as a roofer for cash “under the table.” A developmental solution would address the root cause, be it lack of self discipline or skills training. Partnering with him (addressing chronicity) rather than doing for him (addressing crisis) to address the immediate need would encourage self-sufficiency over dependency.
• A woman reported that she needed food, so workers assumed that her need was dire rather than attempting to determine the exact extent. After signing up for several programs, she had so much government-subsidized and donated food that she had to buy an additional freezer and pantry. Even then, she had so much food that there was no way she could consume it before it spoiled. Because her need was addressed as if it was a crisis, workers missed the opportunity to help her develop by addressing her underlying fear of running out of food.  
• A man lost his ability to work and stayed on disability and other government assistance for several years. Caseworkers assumed that he was forever unable to work, when in fact he had delayed scheduling his surgery. After someone finally dug a little deeper and encouraged him to get his surgeries scheduled and complete physical therapy, he was able to get back to the work he loved.
• Soup kitchen workers assumed a man who came daily for lunch did not have any other way to get a meal. The soup kitchen changed policy due to the pandemic and instead of hot meals they gave sandwich sack-lunches out the door. When asked why the man stopped coming for food, he said he was, “sick and tired of sandwiches,” and would rather eat his own food at home.
• A woman put her name on the list in need of yard work at each bi-annual community clean-up day. Volunteers showed up to complete the work while her capable adult son sat inside playing video games. Volunteers stepping in when the son was capable took away the opportunity to strengthen the bond between mother and son. A developmental approach would have been for volunteers to work alongside the son, teaching him skills so that he would be able to do future maintenance himself.

Had workers dropped their assumption that all needs are relief needs and investigated further, they could have found much better solutions. If the need is determined to not be relief (i.e., crisis) but is instead developmental (i.e., chronic), throwing money or other material goods at the problem is not the answer. Developmental needs can only be met by opportunities that expand capacity such as relationship building, budget counseling, work readiness training, goal setting, and spiritual growth.

 

Confession #3 – I focused on our activity, not our results.

Most nonprofits and churches will agree that looking at the statistics related to our services is important to determine success. In many churches and nonprofits, success is defined in terms of the number of individuals in our programs, how many meals served, and other similar outputs. While there is nothing wrong with tracking these outputs, I was rarely attending to outcomes – long-run results.

The importance of HOW we define success and WHAT we measure cannot be overstated. I measured:

• The number of budgeting classes offered and how many attended them. 
• The number of completed home visits.
• The number of support groups offered and how many participated.
• The number of job skills classes offered and how many attended.
• The dollars billed and received from Medicaid.

Better measurements would be:

• The number of people able to complete a personal budget and amount of debt paid off as a result of budgeting classes.
• Measurements of improved health among those who no longer need home visits.
• Changes in social capital among those who participated in a support group.
• The number of people who developed a resume and got a job as a result of job skills classes.
• The number of people who no longer rely on Medicaid after gaining employment with health insurance benefits.

 

While we liked to tell ourselves our goal was to “work ourselves out of a job,” our actions did not reflect that aspiration. A more honest message was “we need to get more people on the program so we can bill more Medicaid dollars to be able to continue to pay our staff.” Private donors tend to reward nonprofits who can prove the program is changing lives. Thus, privately funded organizations have at least some pressure to show that people are graduating from their programs if at all possible. Government reimbursement structures compensate for the number of people remaining in the program. It made us feel good to say we wanted to work ourselves out of a job, but when our compensation grew with the quantity of the disabled who receive Medicaid and stayed in poverty, there was an underlying demand for people to remain in these conditions.

I didn’t know what I didn’t know. 

Thanks in large part to a True Charity Foundations Workshop in my community, I started to see what I had missed before. Once I saw the problem with disempowering questions, assuming that all needs were relief needs, and defining success inaccurately, I found myself asking, “Where do I go from here?” 

The good news is that there are effective alternatives. If you’re a part of a church or nonprofit that wants to move past these blind spots, our membership network offers tools and training to amplify your impact. If you’re already a member, check out our member’s portal to keep up to date with all of the tools we offer. And if you’d like us to bring a True Charity Foundations Workshop to your city, please reach out to me. There may be a leader in your community like me who doesn’t know what she doesn’t know.