Tuesday, July 20, 2010

Right to Life of KY responds on Obamacare

Michael Janocik of Right to Life of Kentucky takes on a response to his original letter in the Louisville Courier-Journal on Obamacare:

My sympathy and prayers go out to C. Stone, who lost her young husband to cancer. In her rebuttal to my letter in the Louisville Courier-Journal, "Obamacare Leads Us Down a Dangerous Path," Stone rightly points to serious flaws in the current third-party private health insurance market. Most Americans believe we can do better and I applaud Mrs. Stone for her contribution to do so on behalf of her husband and others. The point of my CJ letter is that Obamacare will exacerbate, not alleviate, the problems with which we are all too familiar - the denial or hindrance of health care coverage by third party payers.

Notwithstanding Stone’s helpful criticisms, her rebuttal actually affirms my argument. Stone writes: "Janocik, assistant director of Right to Life Educational Foundation of Kentucky, and his ilk continue to spout these "death panel" threats and continue to obscure what health care reform is all about. Can we please quit terrifying people?” Nary a handful of keystrokes click by before she writes, “I do agree with his comment that ‘when third-party, unaccountable bureaucracies control health care decisions, rather than patients and physicians, involuntary rationing is the inevitable result, with involuntary euthanasia not too far behind’,” citing the role that private insurance played in denial of care for her husband.

To redress that denial of coverage, Stone wrote she was able to pay for care above and beyond what her insurance covered. That is true and that is precisely one of the freedoms, among others, that Obamacare will abolish - Stone’s ability to purchase health care treatment beyond the scope of her government-approved insurance policy.

It seems counter-intuitive then, that Stone would defend health care legislation that would, by her own acknowledgment, 1. ) further concentrate power to deny health care coverage within one federal bureaucracy, rather than within hundreds, if not thousands, of private insurers and, 2.) deny her the means by which to pay for additional medical care for her husband that will not be covered by “universal health care.”

Stone’s exegesis of the current health care failings seems well-informed by her personal challenge to do right by her beloved husband. Perhaps her perception of the solution, however, is clouded by same.

Michael Janocik
Assistant Director
Right to Life Educational Foundation of KY

17 comments:

Thomas said...

"Stone wrote she was able to pay for care above and beyond what her insurance covered. That is true and that is precisely one of the freedoms, among others, that Obamacare will abolish - Stone’s ability to purchase health care treatment beyond the scope of her government-approved insurance policy."

This is factually false. Obamacare does not abolish a private citizen's ability to purchase health care beyond the scope of her government-approved insurance policy.

But there's something more fundamental going on here that threatens to contradict Catholic Social Teaching. A political community is judged largely on how it cares for the poorest members. The recent popes have repeatedly stated that it is against the social teaching of the Church to advocate that such things simply be determined by the dictates of the market. Thus, John Paul II has said that social insurance programs help to alleviate the inequalities between the rich and the poor. For similar reasons John Cardinal O'Connor criticized those who claimed to be pro-life but wished to deprive mothers of public assistance. Life issues go beyond well beyond abortion. Any suggestion that a health care system does not have to be organized in such a way that it does not care for the poor is contrary to Catholic social teaching.

Anonymous said...

Thomas,

Rep. John Yarmuth, is a member of Planned Parenthood of Louisville. PP is the world’s leading abortion provider. Compassion and Choices (formerly the Hemlock Society) is the leading advocate for assisted suicide, now euphemistically called “Aid in Dying.” C&C boasts of its lead role in assuring that Obamacare include “patient consultation with their doctors about end-of-life care.” Kathleen Sebelius, head of Health and Human Services, who will set medical standards for Obamacare, invited infamous late-term abortionist George Tiller, to a party at the Kansas Governor’s mansion. Then Illinois Senator Barack Obama was the chief opponent of Illinois’ born alive infant protections act, which simply required that any baby born alive, even from a so-called botched abortion, be legally protected from being drowned in a bed pan. House Speaker Nancy Pelosi voted “NO” on the 2003 partial birth abortion ban.

It is clear that current national leadership believes that imposing death on manifest, innocent human lives is a legitimate solution to difficult societal problems. If there is one thing on which most Americans agree, it is that the rising cost of healthcare is a grave societal problem. It isn’t “scare mongering” to deduce that a categorical disregard for innocent human life at the helm, coupled with societal pressures to reduce healthcare costs as the boomer generation ages, will end in rationing and passive euthanasia. It’s called logic.

Thomas said...

The claim in the letter was that one won't be to use one's money to buy further medical services. That claim is flatly false. That's scare mongering.

The death panels accusation has been debunked many times, and is particularly ironic in light of the fact that the free market has produced its own death panels (HMOs and the like). And remember, it's the free market that provides the abortions.

I know some people will try to include things like euthanasia at some point, and I'm aware that the bill doesn't do enough to prevent coverage for abortions. However, the fact that many more people (though still not all) now have medical coverage is a victory for proponents of life issues, not a setback. The idea that we as a political community are taking responsibility for the medical care of the poorest and weakest among is, as imperfectly as we're doing it, is not only consistent with Catholic Social teaching, but probably mandated by it. We take the good and oppose the bad.

To not recognize our Christian duty to the poor is contrary to Catholic Social teaching. And Catholic Social teaching is not optional for Catholics, whether one is an abortion proponent or one wishes to allow poverty to exclude people from medical care. (I'm not Catholic, but I do find Catholic Social theory to be compelling.) I'm certainly not saying the letter goes that far, but it emphasizes some life issues in a way that minimizes others.

Anonymous said...

Regarding your continued assertion that Obamacare does not abolish a citizen's ability to purchase healthcare beyond the government standard, it is true that nowhere in the bill does it say "HHS shall deny citizens access to additional private healthcare." However the effect of the bill is the same.

An 18-member “Independent Payment Advisory Board” [Sec. 10320(b)] is given the duty, on January 15, 2015 and every two years thereafter, with regard to private health care, to make “recommendations to slow the growth in national health expenditures . . . that the Secretary [of Health and Human Services] or other Federal agencies can implement administratively” [Section 10320(a)(5)(o)(1)(A)]. The Board is directed to limit private health care spending so that it is below the rate of medical inflation. In turn, the Secretary of Health and Human Services is empowered to impose “quality” AND “efficiency” measures [Section 10304] on health care providers (including hospices, ambulatory surgical centers, rehabilitation facilities, home health agencies, physicians and hospitals) [Section 3014(a) adding Social Security Act Section 1890(b)(7)(B)(I)] which must report on their compliance.
This means doctors, hospitals, and other health care providers will be told by Washington just what diagnostic tests and medical care is considered to meet “quality” and “efficiency” standards – not only for federally funded health care programs like Medicare, but also for health care paid for by private citizens and their nongovernmental health insurance. And these will be “quality and efficiency” standards specifically designed to limit what ordinary Americans spend on health care. Treatment that a doctor and patient in consultation deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which the government decides is too costly – even if the patient is willing and able to pay for it – will run afoul of the imposed standards. In effect, there will be one uniform national standard of care, established by Washington bureaucrats and set with a view to limiting what private citizens are allowed to spend on saving their own lives.

Thomas said...

Controlling private health care costs is not the same thing as abolishing private health care costs. It's a bit like saying that because the FDA regulates the quality of food (and can even prohibit certain foods from coming on the market) it follows that the FDA is abolishing the private market for food.

There are already legally enforced quality and efficiency standards in medicine. You have to get a license to become a doctor; I can't just go and set up shop and start treating people for lung cancer. That's a good thing. The problem is that these standards are largely enforced through the tort system right now in medical malpractice suits, with the result that they're not consistent, and some victims get overpaid and most get underpaid. Shifting the burden of setting the standard out of the tort system and into a consistent regulatory scheme is a good idea.

This statement is simply false: "Treatment that a doctor and patient in consultation deem needed or advisable to save that patient’s life or preserve or improve the patient’s health but which the government decides is too costly – even if the patient is willing and able to pay for it – will run afoul of the imposed standards." There is absolutely nothing in the legislation to prohibit private expenditures for medical treatments. And right now we do have a system that prevents many people from getting medical care that they wish to have -- just ask those who can't afford health care insurance.

Anonymous said...

My wife has been one of the best physicians in Louisville, KY for 16 years and I am the practice manager. We are all too familiar with “quality standards” imposed through litigation. Oddly enough, that’s one area Obama didn’t touch – tort reform.

However, you failed to mention that there are a number of other quality standards a physician must meet to remain viable in the healthcare market. Let’s start with medical school. In order to be accepted into legitimate medical schools, you have to fare pretty well as an undergraduate, don’t ya think? Then there is that pesky little Board certification by the National Board of Internal Medicine. That requires minimum standards in continuing medical education and that you pass an exam every 10 years as established by the legitimate authority in her area of medical expertise. Then there is the Kentucky Board of Medical Licensure, which has its own authority and disciplinary activities for inept doctors. But wait, there’s more. In order to be a participant in Medicare or any private insurance carrier, a physician must be credentialed there as well. Then of course she has to keep her patients happy by keeping them, more or less, healthy. Obviously time catches up with everyone, but over the years, she’s established a good reputation which keeps patients coming back. Finally, in order to gain hospital privileges, physicians have to meet quality standards with those hospitals as well.

Believe it or not, Thomas, most physicians WANT to do right by their patients and provide the highest level of medical care possible. That’s one reason they invest so much time and money in education and give long hours in the wee small hours to helping old ladies who fall and break their hips.

I know all about quality standards. But you completely ignore the "efficiency" requirement. The Independent Payment Advisory Board is charged with limiting private healthcare spending to below medical inflation levels. Again, coupling the momentum of cutting or limiting total healthcare costs with a total disregard for human life, it is not a stretch to conclude that Obamacare won’t be good for anyone.

You also need to look up the record of Donald Berwick who will be directing this whole behemoth. You’ll find some interesting quotes from him about healthcare rationing and equalizing everyone’s medical care. You should also take some time to read about a concept called “Comparative Effectiveness” which seeks to quantify and stratify “quality of life” of patient populations and then funnel funds to those who have the highest CE rations - the healthy.

Obamacare turns Catholic social teaching on its head by expanding abortion coverage, rationing healthcare away from those who need it most, and violating the principle of subsidiarity.

MJ

Anonymous said...

My wife has been one of the best physicians in Louisville, KY for 16 years and I am the practice manager. We are all too familiar with “quality standards” imposed through litigation. Oddly enough, that’s one area Obama didn’t touch – tort reform.

However, you failed to mention that there are a number of other quality standards a physician must meet to remain viable in the healthcare market. Let’s start with medical school. In order to be accepted into legitimate medical schools, you have to fare pretty well as an undergraduate, don’t ya think? Then there is that pesky little Board certification by the National Board of Internal Medicine. That requires minimum standards in continuing medical education and that you pass an exam every 10 years as established by the legitimate authority in her area of medical expertise. Then there is the Kentucky Board of Medical Licensure, which has its own authority and disciplinary activities for inept doctors. But wait, there’s more. In order to be a participant in Medicare or any private insurance carrier, a physician must be credentialed there as well. Then of course she has to keep her patients happy by keeping them, more or less, healthy. Obviously time catches up with everyone, but over the years, she’s established a good reputation which keeps patients coming back. Finally, in order to gain hospital privileges, physicians have to meet quality standards with those hospitals as well.

Believe it or not, Thomas, most physicians WANT to do right by their patients and provide the highest level of medical care possible. That’s one reason they invest so much time and money in education and give long hours in the wee small hours to helping old ladies who fall and break their hips.

I know all about quality standards. But you completely ignore the "efficiency" requirement. The Independent Payment Advisory Board is charged with limiting private healthcare spending to below medical inflation levels. Again, coupling the momentum of cutting or limiting total healthcare costs with a total disregard for human life, it is not a stretch to conclude that Obamacare won’t be good for anyone.

You also need to look up the record of Donald Berwick who will be directing this whole behemoth. You’ll find some interesting quotes from him about healthcare rationing and equalizing everyone’s medical care. You should also take some time to read about a concept called “Comparative Effectiveness” which seeks to quantify and stratify “quality of life” of patient populations and then funnel funds to those who have the highest CE rations - the healthy.

Obamacare turns Catholic social teaching on its head by expanding abortion coverage, rationing healthcare away from those who need it most, and violating the principle of subsidiarity.

MJ

Anonymous said...

My wife has been one of the best physicians in Louisville, KY for 16 years and I am the practice manager. We are all too familiar with “quality standards” imposed through litigation. Oddly enough, that’s one area Obama didn’t touch – tort reform.

However, you failed to mention that there are a number of other quality standards a physician must meet to remain viable in the healthcare market. Let’s start with medical school. In order to be accepted into legitimate medical schools, you have to fare pretty well as an undergraduate, don’t ya think? Then there is that pesky little Board certification by the National Board of Internal Medicine. That requires minimum standards in continuing medical education and that you pass an exam every 10 years as established by the legitimate authority in her area of medical expertise. Then there is the Kentucky Board of Medical Licensure, which has its own authority and disciplinary activities for inept doctors. But wait, there’s more. In order to be a participant in Medicare or any private insurance carrier, a physician must be credentialed there as well. Then of course she has to keep her patients happy by keeping them, more or less, healthy. Obviously time catches up with everyone, but over the years, she’s established a good reputation which keeps patients coming back. Finally, in order to gain hospital privileges, physicians have to meet quality standards with those hospitals as well.

Believe it or not, Thomas, most physicians WANT to do right by their patients and provide the highest level of medical care possible. That’s one reason they invest so much time and money in education and give long hours in the wee small hours to helping old ladies who fall and break their hips.

I know all about quality standards. But you completely ignore the "efficiency" requirement. The Independent Payment Advisory Board is charged with limiting private healthcare spending to below medical inflation levels. Again, coupling the momentum of cutting or limiting total healthcare costs with a total disregard for human life, it is not a stretch to conclude that Obamacare won’t be good for anyone.

You also need to look up the record of Donald Berwick who will be directing this whole behemoth. You’ll find some interesting quotes from him about healthcare rationing and equalizing everyone’s medical care. You should also take some time to read about a concept called “Comparative Effectiveness” which seeks to quantify and stratify “quality of life” of patient populations and then funnel funds to those who have the highest CE rations - the healthy.

Obamacare turns Catholic social teaching on its head by expanding abortion coverage, rationing healthcare away from those who need it most, and violating the principle of subsidiarity.

MJ

Thomas said...

The efficiency requirement is one of the more crucial parts of the bill. Insurers can't effectively regulate cost controls (see the HMO problem) because of the systemic incentives (for example, the fact that the more expensive the care a patient receives, the more doctors usually get paid). Private insurance is just a generally bad scheme for paying for medical care, since the insurer and the insured's interests are opposed: insurers benefit by not insuring sick people and dropping the healthy people once they get too sick.

If you're concerned about rationing, I have no idea why you think this is going to happen without political intervention. The market already rations health care, that's how a market works -- it allocates scarce resources. The question is whether it's allocating those resources justly, and that's where political controls come in.

"Obamacare turns Catholic social teaching on its head by expanding abortion coverage, rationing healthcare away from those who need it most, and violating the principle of subsidiarity."

I agree on the abortion coverage, but the second statement is, again, simply false. The new regulatory scheme gives more people access to medical care, not less. The third statement presumes that this kind of regulatory overhaul can be done at the local level, which it simply cannot. That's why the Constitution gives Congress carte blanche to regulate commerce: if you have a national (or really an international) industry, it's almost impossible for the states to regulate it effectively, especially since they're limited by the dormant commerce clause.

Anyway, I'm not so concerned with the slippery slope argument. Any time there's a regulatory overhaul people predict the end of the world, and I disagree with much of the bill. It seems as though you're emphasizing some life issues (abortion) in a way that minimizes others (access to affordable health care for the poor). It's a false dichotomy: one can and should be opposed to any funding for abortion or euthanasia on the one hand, while wanting to further those covered under the bill on the other.

In other words, one can both agree that there ought to be a ban on abortion funding and agree with John XXIII when he said "Systems of social insurance and social security can make a most effective contribution to the overall distribution of national income in accordance with the principles of justice and equity. They can therefore be instrumental in reducing imbalances between the different classes of citizens."

Anonymous said...

I am not a Libertarian. I believe in limited government for the same reason I believe in the free market. In a free market it is often, though not always, the case that large, inefficient, powerful, and corrupt businesses work against the best interest of the people and then the allocation of scarce resources becomes distorted, which, by the way, is the case we have today in much of the private health insurance market.

In many ways, big business cooperates with big-government (recent financial collapse comes to mind) to keep smaller, smarter, more efficient businesses from competing with better, more just, more efficient solutions to societal problems that can be both profitable and demonstrably uplifting to the dignity of human life.

If we look at the private health insurance market that exists today, we see that it persists in its unjust practices because its lobbyists have colluded with government largess to make it almost impossible for others to enter the market and provide less expensive and superior alternatives.

Again, you are committing a logical fallacy by deducing that criticism of Obamacare is an endorsement of the current system that is only quasi free market. I have long been critical of the current healthcare market. But what sustains that market is powerful corporations who control much of the regulatory environment with quid pro quo deals in Washington, D.C. Small businesses don’t have that luxury, so they are squeezed out of the market.

The old adage and empirical history demonstrates over and over again that the fallen nature of man dictates that absolute power corrupts absolutely.

So I am being asked to believe that by transmitting healthcare decisions away from hundreds of powerful corporations into the hands of a few extremely powerful people in Washington, D.C. will end the rationing we see in private insurance.

Worse, I’m being asked to believe that transferring healthcare decision making power away from a few hundred corporations into the bloody hands of Barack Obama, Nancy Pelosi, Kathleen Sebelius, and Donald Berwick, who all believe strongly that killing innocent unborn babies is “at the heart of healthcare reform” in Obama’s words, will somehow usher in a system in which all are treated with justice and equality.

There is no greater fan of JPII than I. He has said that any claim to other rights without first protecting the first right – the right to life is illusory and futile. Perfect quote for this healthcare system. Having said that, the quote you provided in no way demonstrates that Pope JPII was talking about government-run healthcare. Even if he were, he would be outside the bounds of faith and morals. He has no legitimate competency on the best delivery of healthcare to which I must assent.

It is not a false dichotomy to hold that people who think killing innocent babies is healthcare should not be entrusted with delivering “universal healthcare” when they are willing to bar an entire generation of human persons from their first breath, and, again, not to put too fine a point on it, all of it under the guise of healthcare.

So why should I expect Obamacare policies to respect he inalienable right to life at the end of life if they reject it at its beginning - nay, they even reject it 9 months after its beginning because they all support partial birth abortion and Obama supports born alive abortions.

Or, from JP2: “…the common outcry, which is justly made on behalf of human rights — for example, the right to health, to home, to work, to family, to culture — is false and illusory if the right to life…is not defended with maximum determination…

MJ

Thomas said...

"Having said that, the quote you provided in no way demonstrates that Pope JPII was talking about government-run healthcare. Even if he were, he would be outside the bounds of faith and morals. He has no legitimate competency on the best delivery of healthcare to which I must assent."

Social insurance is government sponsored by definition.

There's a common line among libertarians that you're following here. People like Thomas Woods like to argue that the Pope does not have authority to pronounce on economic matters. Unfortunately, libertarian types (among whom I'm not including you) want to keep their politics separate from the Gospel. Pope Pius XI disagree:

"We lay down the principle long since clearly established by Leo XIII that it is Our right and Our duty to deal authoritatively with social and economic problems. It is not of course for the Church to lead men to transient and perishable happiness only, but to that which is eternal. Indeed “the Church believes that it would be wrong for her to interfere without just cause in such earthly concerns”; but she never can relinquish her God-given task of interposing her authority, not indeed in technical matters, for which she has neither the equipment nor the mission, but in all those that have a bearing on moral conduct. For the deposit of truth entrusted to Us by God, and Our weighty office of propagating, interpreting and urging in season and out of season the entire moral law, demand that both social and economic questions be brought within Our supreme jurisdiction, in so far as they refer to moral issues."

There's a Chronicles article here that goes a bit deeper into it: http://www.chroniclesmagazine.org/index.php/2004/06/17/economic-science-and-catholic-social-teaching/

Anonymous said...

Thomas,

I get that and totally expect the Church to pronounce on economic matters and appreciate it doing so as it is important to lay down the moral principles for a just society. That's not the point. The Church teaches, and of course I agree, that universal healthcare is a great good. That all should receive basic healthcare regardless of ability to pay is a princple that 95 to 99 percent of conservatives and others agree with. HOW we achieve that goal is an area that the Church has little competence.

"Social insurance," I expect the liberal to interpret as government run. But to the conservative, "social insurance" should mean a widely accepted and therefore moral imperative that charity demands we extend basic healthcare to every human being and that private stuctures operate to deliver it. For those who fall through the cracks, few of us have a problem with a government safety net to help those, who, for whatever reason, cannot secure that right through the societal structures set in place. But the safety net, unfortunately, has become a hammock and now the government seeks to expand its reach into the areas that should be left to the individual working in charity with his family and local community to "insure" access to those rights.

So it is perfectly right and good that the Church articulates the moral principle that each human person has a right to basic healthcare and that societies should work to insure that right is not revoked by unjust powers, sometimes of the marktet, but often times also the federal government.

But if Pope John Paul 2 or Pope B16write an encyclical that the faithful must ascent to government run healthcare or exchange markets or private markets to secure that right, they have stepped outside the gospel and into the temporal world of public policy, in which they enjoy no charism of authority or competence.

A more direct example might be this. Each human being comes into the world with a right to life and therefore a natural and attendent right to the basic sustenance of human existance such as food and water. The Church is very clear on this. But if Pope Benedict wrote an encyclical that said that every household should have municipal water piped into its home and enough land to grow corn and cattle, I would have absolutely no obligation to ascent to that teaching.

If, however Pope B16 wrote that societies should strive to insure that each person have access to food and water, I would necessarily have to ascent to that moral principle rooted in the nature of the human person.

There is no natural right to have access to government sponsored insurance as established by Kathleen Sebelius and Berwick and that the allocation of healthcare resources be based on "comparative effectiveness" criteria as defined by a secular philospher who believes killing born alive babies is a legitimate medical procedure.

MJ

Thomas said...

I have never heard anyone refer to social insurance as anything other than government sponsored insurance, conservative or otherwise. The term "social insurance" is used in contradistinction with "private insurance" - that's what makes it social. If conservatives use the term that way, they're using it incorrectly. Every single dictionary I can find defines it this way.

This:

"Pope John Paul 2 or Pope B16write an encyclical that the faithful must ascent to government run healthcare or exchange markets or private markets to secure that right, they have stepped outside the gospel and into the temporal world of public policy, in which they enjoy no charism of authority or competence."

Is incompatible with this:

"We lay down the principle long since clearly established by Leo XIII that it is Our right and Our duty to deal authoritatively with social and economic problems..." - Pius XI

Pius is speaking to precisely the claim that the Church should butt out of temporal affairs, saying that the Catholic Church has the right and the duty to pronounce authoritatively on temporal social and economic matters. The other social encyclicals clearly demonstrate the same conviction.

Though it's not the case that Catholic Social Theory necessarily involves social insurance (though it strongly encourages it and may well in the future), things such as a living wage have been spoken on authoritatively. To argue that the popes, when they have repeatedly said they have the authority to speak on such issues, don't really have such authority makes the whole thing rather pointless. It's similar thinking that leads those like Nancy Pelosi to compartmentalize her faith and politics. Abortion is, after all, a social, economic, and moral issue. The morality element cannot be separated out. But the same goes for a society's duty to care for the poor.

Society has a social responsibility to the poor. To say that private charity can cover the medical costs of the poor is unrealistic. There's simply not enough money (just take a look at the numbers, which are inflated anyway due to our tax system), and even if there were it would be an administrative nightmare to try to get universal coverage that way. Through our democratic political process we have chosen to care for the poor in an organized way as a social body. That's how a democracy works; we chose, as a nation, to pay for health care coverage. To the extent that we succeed in caring for the poor through social insurance, we will be fulfilling, in part, the demands of Catholic Social theory. To the extent that abortions and euthanasia receive funding, we will have failed. Being pro-life -- not just pro-biological existence but advocates of life in its fullness -- involves both.

Anonymous said...

Thomas,

Again you miss the point. I flatly stated that the Church should get involved with economic matters, including healthcare. But what I said, and this is what the Church teaches, is that its involvment and legitimate competency limit its scope to articulating the moral principles that serve as the standard by which we just any temporal system put in place to achieve goals in meeting the must moral requirements for any social system, be it economic or heatlhcare.

For a liberal, that might mean that government-controlled healtchare assuring that everyone has equal access to a waiting line for basic care but extraordinary care like MRIs and heart surguery after 65 is "discouraged" through a "shared decision making" center because bureacrats deem the qualiy of life after 65 based on comparative effectiveness ratings, not worth the expense.
That would be the liberal way of achievieng social insurance for basic healthcare.

To the conservative, achieving social insurance for basic healthcare might include expansion of insurance providers through wiping out regulatory burdens that hinder or prevent smaller insurance companies from entering the market, tort reform so that physicians can stop practicing uselss defensive medicine, medical savings accounts, and instilling in everyone that their bodies are the temple of the holy spirit and that it is first their responsibility to excercise, eat right, and moderate their indulgences. For those who, again, for legitimate reasons, fall through the cracks, Catholic Medical Associations should develope a program in which every Catholic doctor volunteer one day a week or at least a few hours a week where they see truly needy people gratis. Then there can be local secular centers, run by local people who are close to the situation to provide charitable means by which to help the downtrodden. After that, the city can establish free health centers to catch those who can't be helped in the other mechanisms. For the really tough cases out in the state where access to metropolitan areas would preclude a sufficient network of free health clinics, the state could estabish regional clinics to relieve. Finally, for the really, really rare situation wherein the down trodden can't find help close to home provided by their neighbors, churches, local free clinics, etc. the Federal government can step in, as a last resort, and provide tax credits - not government control - to physicians and hospitals who treat people who are unable to pay.

The conservative idea achieves the social insurance while also garnering the effectiveness and efficiencies which flow from the principle of subsidiarity - that is, solutions are best handled at the lowest level possible and only resort to expanding as the need arises - a bottom up approach.

The HOW of acheiving a just society based on the moral principles articulated by the Church, is a prudential judgment questions, not one of faith and morals.

But again, if Pope Benedict releases (he won't because the Church doesn't do it) a "how to" encyclical with a detailed actionable healthcare policies, he would have stepped outside his competent and religious authority to become something far less noble - a policy wonk.

BTW, we now have social insurance vis a vis automobile and homeowners insurance. As a society we've figured out a great way to share risk by paying a fee each month to allow insurance companies to shift resources to pay when my house burns down.

But again, the liberal sees the word social and that immediately translates to government.

Oh, and we didn't vote for Obamacare. We are a representative REpublic and we voted for people to represent us. AS you will recall, there was no point in which a majority of people supported any form of Obamacare and now by upwards of 65 - 35 people want to repeal it. It was rammed through congress with unjust, immoral, and down right unconstitutional procedures.

MJ

Thomas said...

"The HOW of acheiving a just society based on the moral principles articulated by the Church, is a prudential judgment questions, not one of faith and morals."

It depends on how far you take it. Let's use the example of the living wage. The Pope has used his authority to say that there ought to be a legally cognizable right to a living wage. The authority of this statement is clearly not limited to the general statement: people ought to be paid a living wage, but the government doesn't have to recognize this since the private sector will take care of it. That is to say, it is part of Catholic social doctrine that the government ought to require that a living wage be paid. However, if the Vatican were crunching numbers for each area to determine precisely what that wage would be, that would be going beyond their competency.

In any case, the Vatican has not yet gone so far to declare a right to social insurance, at least that I am aware of. But it has endorsed social insurance as a good way to implement the Christian duty that a political body has to its poor. So while a Catholic (or one who is not Catholic but subscribes to their social theory, like me) is not obligated to advocate social insurance, they may not say that social insurance is wrong because its social insurance. If the object is that the current regulatory scheme could work better, that's one thing. I actually agree with that, I think the insurance companies should be pushed out of the picture entirely and we should just go to a single payer system. Or if the argument is that social insurance might be abused, I agree that is also possible. But though one can argue that there are better ways of implementing a social insurance system, one cannot object to social insurance simply because it's social insurance.

As to whether car insurance and homeowner's insurance is social insurance, it's not really true that car insurance is social insurance. It is required by the government, and the government (mostly the state governments) regulate how it works. However there are other elements to social insurance (wikipedia has a pretty helpful page), one of which that it be funded, at least in part, out of taxes. I believe the no-fault systems meet this criteria in most states, but these are hardly ever used, at least in Kentucky. I don't think homeowner's insurance meets the criteria prima facie.

And things like car insurance are actually extremely inefficient. Government run systems are capable of being administered with much lower risk, are capable of better pooling of resources, yield more consistent judgments, and are much quicker. If I remember right, in Kentucky, only about 12% of premiums go to paying out damages. Hence the need for an effective no-fault system.

Finally, though we are not a direct democracy, we are responsible for the laws that are passed, and we are obliged to obey them so long as they are not manifestly unjust. We the people act through our representatives, that is the means by which we express our political will. This idea that the government simply imposes these things on the people violates the theory of democracy. I don't know where you're getting the idea that the procedures that were used to get it through Congress were any more unjust and immoral than the typical way legislation gets passed, but the bill is certainly not unconstitutional.

Anonymous said...

Thomas,
You’ve been a fair interlocutor who has argued with charity and good will. I have enjoyed the exchange very much. But this will have to be my last post on this topic because I have other responsibilities that demand my attention.
First, it is a moral principle based on the nature and dignity of the human person who lives and thrives within a community that laws be enacted and enforced that protect individuals or groups from being abused by the powerful. That is not a prudential judgment question.
On the issue of the living wage, it is impossible to codify a living wage law in any statute because a.) A living wage for a husband and father of 7 is entirely different than a living wage for a 60 year old man whose 2 children have moved out of the house and whose wife has passed. One who lives modestly in a 900 square foot home with windows and a small ice box doesn’t require the same wage as a family who lives in a 2,000 square foot home with a disabled child. A 17 year old boy living with his parents, yet who wants some extra spending money for his car insurance doesn’t require much. Then there is the aspect of how a living wage would enhance or, more likely, be at odds with a sustainable business model wherein a $25 per hour salary would run the business into the ground and thus infringe on the business owner’s rights to make a living for his family. I could write another thousand pages of such variables. This means that the moral principle of a living wage cannot be put into practice with a law. The law could say that each business owner is required to pay a minimum wage, but could never specify what that is and therefore could never enforce such a law. That is why we now have a minimum wage which, in our relatively developed economy, absolutely works against the best interest of employees because it provides a collusion point on which businesses settle to pay low skilled workers.
So having said all this, I think we are in agreement that the Catholic Church’s teaching on healthcare does not mean that we must ascent to government-run or, as you say, single payer system.
As to your theory that states are more efficient than private insurance, that’s simply happy talk. Have you been to the DMV or post office lately?

Finally, I do hope that your admiration for the Catholic Church’s social and moral teaching is the beginning of a beautiful conversion story.
Another brilliant Catholic mind, G.K. Chesterton once wrote, “The problem with capitalism is that there are too few capitalists.” He was referring to the natural accumulation of power which leads to huge corporations, some of which end of being abusive of the marketplace, the workers, etc. That is true. How much truer that has proven to be with big government where accountability is hard to administer.
So I do believe the solution to expanding healthcare to all is fewer regulations, more marketplace competition, and yes, even a government law that would establish a high-risk pool to which all of the major insurance carriers would fund on an equitable basis to help those with pre-existing conditions.
The reason healthcare insurance companies don’t cover those PEC now is that the first one who does will quickly go out of business if the others don’t. But if all were required, I think you’d get very little complaint from insurance industry and we could expand healthcare to many more people.
Finally, I don’t think the procedures that pushed through Obamacare were any more unjust than the typical way legislation is passed. Two or a billion wrongs don’t make a right and that’s exactly why I have more faith in the free-market with the free flow of capital, ideas, and creativity where unjust and immoral procedures, for the most part, are ultimately weeded out. You can’t take on city hall!
Thanks again for the great dialogue, but I have to move on.
MJ

Thomas said...

Thanks, Mike. I think we're in agreement that there is a societal duty to care for the needs of the poor, and that's more important than resolving precisely how to go about doing this. Further, I think we're in complete agreement that the health care system should be vigilantly scrutinized so that it is not abused in a way that harms anyone, but especially the elderly and the unborn. And the most pressing life issue in America right now is abortion, and you've done much to fight that fight. So in total, I think our points of dispute are fairly minor in comparison with the points on which we agree.

I've enjoyed the conversation very much. Keep up the good work.