Category: Acton Commentary

In Crisis Magazine, Acton Research Director Samuel Gregg has a new article that looks at how Catholics reflect on a wide range of financial questions ranging from the federal government’s fiscal woes to consumer debt to a fragile banking system.

Today one looks in vain for Catholic thinkers studying our debt and deficit problems from standpoints equally well-informed by economics and sound Catholic moral reflection. We don’t, for instance, hear many Catholic voices speaking publically about the moral virtues essential for the management of finances such as prudent risk-taking, thrift, promise-keeping, and assuming responsibility for our debts — private or public.

Instead, one finds broad admonitions such as “put the interests of the poor first” in an age of budget-cutting. The desire to watch out for the poor’s well being in an environment of fiscal restraint is laudable. But that’s not a reason to remain silent about the often morally-questionable choices and policies that helped create our personal and public debt dilemmas in the first place.

One Catholic who has proved willing to engage these issues is none other than Pope Benedict XVI. In his 2010 interview book Light of the World, Benedict pointed to a deeper moral disorder associated with the running-up of high levels of private and public debt. The willingness on the part of many people and governments to do so means, Benedict wrote, “we are living at the expense of future generations.”

In other words, someone has to pay for all this debt. And clearly many Western Europeans and Americans seem quite happy for their children to pick up the bill. That’s a rather flagrant violation of intergenerational solidarity.

Read “Debt, Finance, and Catholics” on the Crisis Magazine website.

In a special report, the American Spectator has published Acton Research Director Samuel Gregg’s new article on the “civilizational agenda” of Pope Benedict XVI. Special thanks also to RealClearReligion for linking the Gregg article.

Benedict XVI: In No One’s Shadow

By Samuel Gregg

It was inevitable. In the lead-up to John Paul II’s beatification, a number of publications decided it was time to opine about the direction of Benedict XVI’s pontificate. The Economist, for example, portrayed a pontificate adrift, “accident-prone,” and with a “less than stellar record” compared to Benedict’s dynamic predecessor (who, incidentally, didn’t meet with the Economist‘s approval either).

It need hardly be said that, like most British publications, the Economist‘s own record when it comes to informed commentary on Catholicism and religion more generally is itself less than stellar. And the problems remain the same as they have always been: an unwillingness to do the hard work of trying to understand a religion on its own terms, and a stubborn insistence upon shoving theological positions into secular political categories.

Have mistakes occurred under Benedict’s watch? Yes. Some sub-optimal appointments? Of course. That would be true of any leader of such a massive organization.

But the real difficulty with so much commentary on this papacy is the sheer narrowness of the perspective brought to the subject. If observers were willing to broaden their horizons, they might notice just how big are the stakes being pursued by Benedict.
This pope’s program, they may discover, goes beyond mere institutional politics. He’s pursuing a civilizational agenda.

And that program begins with the Catholic Church itself. Even its harshest critics find it difficult to deny Catholicism’s decisive influence on Western civilization’s development. It follows that a faltering in the Church’s confidence about its purpose has implications for the wider culture.

That’s one reason Benedict has been so proactive in rescuing Catholic liturgy from the banality into which it collapsed throughout much of the world (especially the English-speaking world) after Vatican II. Benedict’s objective here is not a reactionary “return to the past.” Rather, it’s about underscoring the need for liturgy to accurately reflect what the Church has always believed — lex orandi, lex credendi — rather than the predilections of an aging progressivist generation that reduced prayer to endless self-affirmation.

This attention to liturgy is, I suspect, one reason why another aspect of Benedict’s pontificate — his outreach to the Orthodox Christian churches — has been remarkably successful. As anyone who’s attended Orthodox services knows, the Orthodox truly understand liturgy. Certainly Benedict’s path here was paved by Vatican II, Paul VI, and John Paul II. Yet few doubt that Catholic-Orthodox relations have taken off since 2005.

That doesn’t mean the relationship is uncomplicated by unhappy historical memories, secular political influences, and important theological differences. Yet it’s striking how positively Orthodox churches have responded to the German pope’s overtures. They’ve also become increasingly vocal in echoing Benedict’s concerns about Western culture’s present trajectory.

But above all, Benedict has — from his pontificate’s very beginning — gone to the heart of the rot within the West, a disease which may be described as pathologies of faith and reason.

In this regard, Benedict’s famous 2006 Regensburg address may go down as one of the 21st century’s most important speeches, comparable to Alexander Solzhenitsyn’s 1978 Harvard Address in terms of its accuracy in identifying some of the West’s inner demons.

Most people think about the Regensburg lecture in terms of some Muslims’ reaction to Benedict’s citation of a 14th century Byzantine emperor. That, however, is to miss Regensburg’s essence. It was really about the West.

Christianity, Benedict argued at Regensburg, integrated Biblical faith, Greek philosophy, and Roman law, thereby creating the “foundation of what can rightly be called Europe.” This suggests that any weakening of this integration of faith and reason would mean the West would start losing its distinctive identity. In short, a West without a Christianity that integrates faith and reason is no longer the West.

Today, Benedict added, we see what happens when faith and reason are torn asunder. Reason is reduced to scientism and ideologies of progress, thereby rending reasoned discussion of anything beyond the empirical impossible. Faith dissolves into sentimental humanitarianism, an equally inadequate basis for rational reflection. Neither of these emaciated facsimiles of their originals can provide any coherent response to the great questions pondered by every human being: “Who am I?” “Where did I come from?”
“Where am I going?”

So what’s the way back? To Benedict’s mind, it involves affirming that what he recently called creative reason lies at the origin of everything.

As Benedict explained one week before he beatified his predecessor: “We are faced with the ultimate alternative that is at stake in the dispute between faith and unbelief: are irrationality, lack of freedom and pure chance the origin of everything, or are reason, freedom and love at the origin of being? Does the primacy belong to unreason or to reason? This is what everything hinges upon in the final analysis.”

It’s almost impossible to count the positions Benedict is politely assailing here. On the one hand, he’s taking on philosophical materialists and emotivists (i.e., most contemporary scholars). But it’s also a critique of those who diminish God to either a Divine Watchmaker or a being of Pure Will.

Of course none of this fits into sound-bites. “Pope Attacks Pathologies of Faith and Reason!” is unlikely to be a newspaper headline anytime soon. That, however, doesn’t nullify the accuracy of Benedict’s analysis. It just makes communicating it difficult in a world of diminished attention-spans and inclined to believe it has nothing to learn from history.

So while the Economist and others might gossip about the competence of various Vatican officials, they are, to their own detriment, largely missing the main game. Quietly but firmly Benedict is making his own distinct contribution to the battle of ideas upon which the fate of civilizations hang. His critics’ inability to engage his thought doesn’t just illustrate their ignorance. It also betrays a profound lack of imagination.

Today in Acton News & Commentary we brought you guest columnist Steven F. Hayward’s “Economists in the Wild,” based on his new American Enterprise Institute monograph, Mere Environmentalism: A Biblical Perspective on Humans and the Natural World. Hayward, the F.K. Weyerhaeuser Fellow at AEI, looks at how the “connection between rising material standards and environmental improvement seems a paradox, because for a long time many considered material prosperity and population growth the irreversible engines of environmental destruction.” Not so. Hayward:

The central insight of environmentalism is that humanity’s great leap in material progress has come at a high cost to nature: we tear down entire mountains for their minerals; divert rivers and streams and drain swamps to provide water for modern agriculture and urban use; clear large amounts of forests for other uses, often disrupting crucial habitat for rare animal species; and too often dump our waste byproducts thoughtlessly into the air, water, and land.

But this insight contains a paradox. Environmentalism arose precisely because we have mitigated the material harshness of human life through the Industrial Revolution; as Aldo Leopold, author of the classic environmental book A Sand County Almanac, put it: “These wild things had little human value until mechanization assured us of a good breakfast.”

I want to thank John Baden of the the Foundation for Research on Economics and the Environment in Bozeman, Mont., for bringing this to our attention. Baden’s introduction to Hayward’s commentary is worth reprinting here in full; it’s an excellent thumbnail summary of environmental economics.

Steve Hayward’s column … makes one wonder how noted environmental professionals, and even scientists, can be so, how can I say it gently, remarkably ignorant and intellectually arrogant as this: “Economics is a form of brain damage.” Economics isn’t an ideology or a mental affliction. Rather, it’s the systematic study of allocating scarce resources among contending ends.

When applied to environmental and natural resource problems, its practitioners make a few nearly universally valid assumptions. Here are a few.

When things are free, they are counted as such and hence often over used. Common pools of fish exemplify this.

As scarcity increases, people conserve and innovate. Consider barbed wires introduction to open range, the development of particleboard, laminated beams, and plywood. Entrepreneurs developed these solutions to the increased scarcity of grass and old growth timber.

Property rights and markets peacefully coordinate development and use among people who don’t know one another and generate incentives to act as though they care about unknown others. That’s one under-appreciated function of markets.

Bureaucratic-political management replaces market prices with political favor seeking. Corn ethanol is a classic example that causes untold human misery and great environmental damage.

Wealthier is greener; poverty is the worst polluter.

And this; things that are best and most easily measured are not those that matter most.

Economics isn’t about money, it’s about confronting and helping to resolve the many problems of scarcity in a clear and logical manner. Soft hearts need not imply a mushy brain.

Read Steven F. Hayward’s “Economists in the Wild” on the Acton site. Sign up for Acton News & Commentary here.

Last summer I wrote a commentary titled “Spiritual Labor and the Big Spill.” I made the point that ultimately the kind of spiritual labor that goes on in the Gulf is invaluable. The work done by the fishermen and those working in some other industries along the Gulf is nothing short of a cultural heritage. It is the kind of work that is more than a paycheck and is a superb example of the value of work. I also highlighted the resiliency of the people who work the waters along the Gulf Coast. This from Garden & Gun magazine, taking a look back at the oil spill from one year ago:

The full impact of the spill on the fragile ecosystem of the Gulf has not been determined, but now, a year after the disaster, shrimpers are readying their fleets for another season. “Remarkably there is an optimism and resilience among the people of the Gulf Coast,” says [Jeremy] Craig. “Despite the hardships, they still have a lot of faith in their way of life. Right now, Vegas is getting his boat ready and looking forward to getting back on the water, and that is what gets him up in the morning.”

Here is a highlighted portion of my commentary from July:

Many Americans are proud of where they come from; this is no less true of the people of the Gulf Coast. Human interest stories have gripped viewers and readers following the news about the BP oil spill, which often highlights the locals’ pride in their roots. Sal Sunseri, the owner of P&J Oysters in New Orleans says it well: “The history and culture of the seafood industry in Louisiana is part of the fabric of who we are. The world should not take this lightly.”

Sunseri brings to life an important point about the spiritual and cultural aspect of work that is especially rich on the Gulf Coast. Work in a free economy is an expression of our creativity, virtue, and response to a calling. Christian authors Gerard Berghoef and Lester DeKoster note that “God so arranges work that it develops the soul.”

BP is airing a commercial in which it vows to compensate fishermen and others for the loss of income until the cleanup is completed. This is a good start. But it also serves as a reminder that earnings are secondary to fishermen whose very labor is the preservation of heritage. It is not uncommon to hear fishing crews speaking Cajun French off the coast and in the bayous and marshes of Louisiana. Cajun French, an endangered language, was at one time banned in Louisiana schools. The spill is another threat to communities and a way of life for generations of a proud and sometimes marginalized people.

My contribution to this week’s Acton News & Commentary. Earth Day is Friday. Sign up for Acton’s free weekly email newsletter here.

Humility, Prudence, and Earth Day

By John Couretas

At a World Council of Churches conference last year on the French-Swiss border, much was made of the “likelihood of mass population displacement” driven by climate change and the mass migration of people fleeing zones inundated by rising seas. While the WCC acknowledged that “there are no solid estimates” about the likely numbers of what it called climate refugees, that didn’t stop assembled experts from throwing out some guesses: 20 million, hundreds of millions, or 1 billion people.

The WCC bemoaned the fact that international bodies looking at the impending climate refugee crisis were not taking it seriously and, despite its own admission that the numbers of refugees were impossible to predict, called on these same international bodies to “put forward a credible alternative.”

The WCC did a thought experiment on the problem:

What kind of adaptation is relevant to migration? Sea walls? Cities on stilts? New canal systems? We need to start now to construct this future world. But we also need to imagine what it will mean if we fail. Indeed, it seems increasingly short-sighted to assume we will avoid sea-level rise or manage adaptive measures, given the tortuously slow progress of negotiations to date. We need to imagine that millions will, one day not too far away, be on the move, and we need to start thinking now about the appropriate way to manage this eventuality.

The main problem with this sort of thinking from religious groups on climate issues is not the lack of scientific credibility, which is bad enough, but their own credulousness. They have been all too willing to embrace any and all dire forecasts of environmental destruction, so long as it fits into their apocalyptic narrative. Maybe it’s their taste for catastrophe of biblical proportions.

Put her on stilts?

Remember when, in 2005, the United Nations Environment Programme (UNEP) declared that 50 million people could become environmental refugees by 2010, as they fled the effects of climate change? They’d rather you didn’t. It turns out that the climate refugee problem is only the latest disaster-movie myth to be shattered. AsianCorrespondent.com reported earlier this month that “a very cursory look at the first available evidence seems to show that the places identified by the UNEP as most at risk of having climate refugees are not only not losing people, they are actually among the fastest growing regions in the world.”

The fraudulent scare based on nonexistent climate refugees has no bearing whatsoever on the question of whether the Earth’s atmosphere is warming, what may cause the warming, or what we should do about it. It speaks rather to too many religious groups’ gullibility for theories that line up with their anti-market economics, which undergird their blind faith in environmental doom. This is the “eco-justice” school of thought, which sees the market as “asserting the supremacy of economy over nature.” When people are factored in to this ideology, they are always helpless victims, not creators of economic wealth that has the potential of wide benefits.

Because of these shrill and unfounded warnings of ecological collapse, religious leaders and those who look to them for guidance are increasingly tuning out on the climate change scare. A new survey of Protestant pastors shows that 60 percent disagree with the statement that global warming is real and man-made, up from 48 percent two years ago. These results are in line with an October 2010 Pew Research Center poll which showed that belief in human-caused global warming had declined to 59 percent, down from 79 percent in 2006.  Cry wolf often enough and you’ll find yourself alone at the next climate refugee conference.

Religious leaders should celebrate Earth Day 2011 by showing more humility in the face of the exceedingly complex scientific, public policy, and political questions bound up in environmental stewardship. A good start would be to drop any attempt at interpreting deep climatological data, which like complex policy or economic questions, is outside the usual competency of seminary training. Instead, religious leaders should focus on advancing an understanding of environmental stewardship that has a place both for productive economic activity and the beauty of God’s creation — without the Manichean split.

The virtue of prudence should lead us all to do more to reduce destructive man-made effects on the environment, with an eye toward improving the overall health of the air, water, and land that sustains us. De-carbonizing the economy, over time and in an orderly fashion, without wrecking economic life that likewise sustains us, is the reasonable way to do that. A strong market economy that creates the sort of wealth that can lead to practicable and affordable energy alternatives, free of the waste, abuse and cronyism that accompany government subsidies, will get us to a cleaner future faster than more “expert” management from Washington, the UN, or the WCC.

So let’s drop the nonsense about building cities on stilts to house a billion climate refugees. No more scare tactics, please. Environmental stewardship is too important to leave it to those who would drive more of the faithful into apathy and disinterest with their rash and incredible predictions of ecological doom.

The Detroit News published Dr. Don Condit’s Acton commentary on Accountable Care Organizations (ACOs) in today’s paper. The ACOs are designed to manage costs under the Patient Protection and Affordable Care Act, better known as Obamacare.

Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money.

The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words that emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.

Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs. Doctors will face agency conflicts between the time honored primary duty to patient. Medical care providers will receive incentives for controlling spending, and penalties if they do not. “No one can serve two masters” (Matthew 6:24); not even physicians.

Read “Obamacare rules belie compassion, care” on the Detroit News website.

The American Spectator published a new commentary by Acton Research Director Samuel Gregg. The commentary was also picked up by RealClearReligion.

Christians in a Post-Welfare State World

By Samuel Gregg

As the debt-crisis continues to shake America’s and Europe’s
economies, Christians of all confessions find themselves in the
unaccustomed position of debating the morality and economics of
deficits and how to overcome them.

At present, these are important discussions. But frankly
they’re nothing compared to the debate that has yet to come. And
the question is this: How should Christians realize their
obligations to the poor in a post-welfare state
world?

However the debt-crisis unfolds, the Social
Democratic/progressive dream of a welfare state that would
substantially resolve questions of poverty has clearly run its
course. It will end in a fiscal Armageddon when the bills can’t be
paid, or (and miracles have been known to happen) when political
leaders begin dismantling the Leviathans of state-welfare to avert
financial disaster.

Either way, the welfare state’s impending demise is going
to force Christians to seriously rethink how they help the least
among us.

Why? Because for the past 80 years, many Christians have
simply assumed they should support large welfare states. In Europe,
Christian Democrats played a significant role in designing the
social security systems that have helped bankrupt countries like
Portugal and Greece. Some Christians have also proved remarkably
unwilling to acknowledge welfarism’s well-documented social and
economic dysfunctionalities.

As America’s welfare programs are slowly wound back, those
Christian charities who have been heavily reliant upon government
contracts will need to look more to the generosity of churchgoers
— many of whom are disturbed by the very secular character assumed
by many religious charities so as to enhance their chances of
landing government contracts.
(more…)

My commentary this week focuses on the how the rise in prices at the pump is impacting the poor. Currently, in many areas of the country a gallon of gas is now priced over $4. I also argue that we need a more coherent energy policy coming from leaders in Washington. Part of the argument against drilling in ANWR (Arctic Refuge) over a decade ago was that the oil wouldn’t hit the market for 10 years. That’s a very shortsighted way of thinking about meeting our energy needs. We need leaders in Washington to work for us not against us.

Perhaps now a forgotten event, former Senator Jesse Helms in 1982 waged a dramatic battle against a federal gasoline tax hike of five cents. The tax hike had bipartisan support, including the support of President Ronald Reagan. However, Helms fought virtually alone with only a small cadre of tax opponents. He eventually lost on the measure but as he was traveling back to North Carolina he stopped at a rural Hardees restaurant. Truckers recognized Helms and he was greeted with thunderous applause for his efforts. Helms stood up not just for business interests like the trucking industry, but the rural poor, who are hit hardest by increases in gas prices. The current federal tax on a gallon of unleaded gasoline is 18.4 cents per gallon and the mean state tax on a gallon is 26.6 cents. My commentary is printed below:

High Gas Prices Devastating to Poor

by Ray Nothstine

Religious leaders staging a fast over budget cuts on social spending have not offered to fast over higher gas prices, even though the impact on the poor is devastating. In fact, there is very little focus on the rise in energy costs, with political and religious leaders remaining largely silent. Yet, when they speak on the issue, they often do not have your best interests in mind.

At a recent visit to a wind turbine plant, President Obama responded to one questioner’s concern about rising prices by laughing and saying, “If you’re complaining about the price of gas and you’re only getting 8 miles per gallon, you might want to think about a trade-in.” The president didn’t say which vehicle he was talking about. But a 2003 Hummer H2, rated among the worst for gas mileage, scores 10-14 miles per gallon.

But for most people a truck that is getting 8 miles per gallon is the one that delivers their food. This is true too for charitable food banks as delivery costs cut into the number of people they can feed. Food banks also depend on volunteer drivers to deliver meals to shut-ins.

Many individuals and families are already curtailing discretionary spending to save for gas. In turn, more money and jobs exit the U.S. economy for oil exporting countries.

The national average for a gallon of gas is currently $3.79. Some American cities are well over $4 per gallon. The price, up almost a $1 since last year at this time, has some experts forecasting $5 for Memorial Day.

While oil markets can be complex, free market alternatives offer better relief than heavily subsidized “green energies” propped up by government. A new study in the United Kingdom by Stuart Young Consulting and the John Muir Trust again pointed out what previous studies have found: Wind output is often less than anticipated and is an unreliable source of energy.

Likewise, electric cars are rejected by consumers shopping for fuel economy—even though they are subsidized with tax credits. Rachel Slobodien of the Heritage Foundation points out that people are instead buying more affordable super fuel economy cars with traditional engines that get upwards of 50 miles per gallon.

Some lawmakers from both parties in oil producing states are asking for more domestic drilling, more refineries, and uniform state standards on gasoline mixture requirements. All of these proposals will help lower prices and could add hundreds of thousands of American jobs.

President Obama has responded by saying an increase in domestic drilling “will help some.” He also signaled he may be willing to tap more of the Canadian oil sands, but at the same time, he wants to cut oil imports by one-third.

High prices at the pump can offer a moment to pause too and remember a spiritual truth. The price of gas not only draws attention to the Middle East, but it draws our attention back to the Garden of Eden that tradition places in that oil-rich region.

Oil itself is decayed vegetation and plankton that has seeped into the ground, forming over millions of years. At one time wildlife was abundant and forests were especially lush in the garden. In the creation story we are reminded that after the fall of man, we have to toil for resources (Genesis 3:19).

While we are bound to labor, 17th century Bible commentator and Presbyterian minister Matthew Henry reminds us, “Let not us, by inordinate care and labor, make our punishment heavier than God has made it; but rather study to lighten our burden.”

Similarly, John Paul II declared, “Besides the earth, man’s principal resource is man himself. His intelligence enables him to discover the earth’s productive potential and the many different ways in which human needs can be satisfied.”

This is good advice. The free market helps to sort out those effective alternatives, encouraging us to drill for oil responsibly at home, and protecting us from costly utopian schemes that drive up energy prices. The market is also our best hope for developing renewable energy technologies that are economically feasible.

We know too well that leaders in Washington reflect the fall of man, but they are not working to lighten our burden right now. As the price of gas approaches $5 per gallon, perhaps its rise may help us to refocus on new ways to meet the needs of those who have the most to lose from rising fuel costs.

In this week’s Acton Commentary, “Do Less with Less: What the History of Federal Debt and Tax Leverage Teaches,” I reflect on how the federal government has lived beyond its means for decades. This reality is especially important to recognize as we approach Tax Day this year as well as in the context of debates about how to address the public debt crisis.

There are many who think we need to raise taxes in order to close the historic levels of deficit spending. In theory I would consider raising taxes as a viable option, or at least preferable to continued deficit spending, since it would at least make the real cost of government more visible. Roughly 40% of what the government spent last year was beyond what it took in.

But without structural connections between increased taxes and balancing the budget, there’s nothing at all to give us hope that the government wouldn’t simply continue to leverage the greater revenue into greater deficit spending. In this vein I note the conclusions recently updated by Richard Vedder and Stephen Moore, that “over the entire post World War II era through 2009 each dollar of new tax revenue was associated with $1.17 of new spending. Politicians spend the money as fast as it comes in—and a little bit more.”

Calvin College philosophy professor James K. A. Smith doesn’t take this reality into account, I don’t think, when he recently argued that the current situation calls for raising taxes, both on the rich and the middle-class. Thus, he writes,

But only a lazy, unimaginative take on this would assume that “low taxes” is a given. So sure, one strategy to reduce debt would be to slash spending, which inevitably happens on the backs of the poor and vulnerable, particularly women and children.

The alternative to such an unattractive option as Smith sees it is to raise taxes, particularly on the rich. Smith thus points to the idea that America needs to adopt a “graduated tax like most other North American countries.”

The fact is, though, that the US already has a progressive tax system, and indeed places a much higher relative burden on the top decile of household incomes than other developed nations.

One of the next big fights will be over raising the debt ceiling, as Smith points out. Perhaps we can link balanced budgets with increases on the debt ceiling (something more feasible than passing a balanced budget amendment). The idea would be that we only increase the debt ceiling on the condition balancing the annual budget, and that we only think about raising taxes to balance that budget if we actually commit to balancing it.

Simply raising taxes won’t do anything but give the federal government more money to leverage into higher levels of deficit spending.

It has been over a year since the passing of the Affordable Care Act, and we are still discovering problems with it. Supporters claimed passing the bill will help everyone, especially the vulnerable. However, the Affordable Care Act ironically does just the opposite by placing the elderly in a very dangerous position. Dr. Don Condit, author of the Acton monograph a Prescription for Health Care Reform, explains how the Affordable Care Act negatively impacts the elderly and its violation of subsidiarity in this week’s Acton Commentary. Get Acton News & Commentary in you email inbox every Wednesday. Sign up here.

A Sugar Coating for the Bitter Pill of ObamaCare

By Dr. Don Condit

Remember Mary Poppins singing, “A spoonful of sugar helps the medicine go down in the most delightful way”?

If so, be concerned, because you or your parents are probably on Medicare – or will be soon — and last week the Department of Health and Human Services (HHS) proposed regulations for Accountable Care Organizations (ACOs).

The sugar-coated rhetoric in this announcement from HHS cannot disguise the bad medicine in this part of this part of the Affordable Care Act, which intends to bureaucratically cut as much as $960 million in Medicare spending over three years. This ObamaCare prescription  threatens patients, the physicians who care for them, and the common good. The only clear winners are the consultants and lawyers busy trying to decipher this 429-page tome of acronyms and encrypted methodology that will compromise the doctor-patient relationship and is contrary to the principle of subsidiarity.

Medicare beneficiaries will be “assigned” to 5,000 patient-minimum organizations to coordinate their care. While HHS Secretary Kathleen Sebelius talks about improvement in care, the politically poisonous truth is that Medicare is going broke and ACOs are designed to save money. The words “rationing” or “treatment denial” or “withholding care” are not part of her press release, but reading the regulations reveals intentions to “share savings” with those who fulfill, or “penalize” others who fall short of, the administration’s objectives. The administration’s talking points include politically palatable words which emphasize quality improvement and care enhancement when the real objective is cost control by a utilitarian calculus.

Physicians and other health care providers will find themselves in conflict with the traditional ethos of duty to patient within ACOs. Ever increasing numbers of doctors are leaving private practice and becoming employed by hospitals, due to a variety of challenges inherent in these uncertain times. The hospitals are the most likely recipient of bundled payments for caring for Medicare patients. Doctors will face agency conflicts between the time honored primary duty to patient, which may conflict with hospital administration, and ACO goals of fiscal savings. Medical care providers will receive incentives for controlling spending, and penalties if they do not. “No one can serve two masters” (Matthew 6:24). Not even physicians.

The physician’s ACO conundrum is illustrated in the language where these regulations proclaim that, “Providers should be accountable for the cost of care, and be rewarded for reducing unnecessary expenditures and be responsible for excess expenditures.” Yet the very next sentence stipulates that, “In reducing excess expenditures, providers should continually improve the quality of care they deliver and must honor their commitment to do no harm to beneficiaries.” (page 14)

The principle of subsidiarity guides policy makers to empower decision making and scarce health care resource allocation at the doctor-patient level. However, the Affordable Care Act moves in the opposite direction. It increases bureaucratic power and responsibility. This is not the antidote needed to reform health care in the United States. The complexity, cost, and confusion of implementing these ACO regulations defy comprehension. We can only hope ACOs will follow “just say no” HMOs into the historical ash heap of misguided health policy.

There is no question that significant – and scarce — health care resources are consumed in the Medicare population toward the end of life. ACOs intend to limit this spending — the government way. The Ethical and Religious Directives by the United States Conference of Catholic Bishops suggest a better path forward:

While every person is obliged to use ordinary means to preserve his or her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive risks and burdens on the patient or excessive expense to family or community. (32)”

The patient must be the focal point of concern. They, or their surrogate, with the help of their physician, need to become informed. They must also participate in the expense of their care, which will better allocate resources for the community than would more distant bureaucratic panels or regulation.

Furthermore:

A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (57).

Enabling all patients, with and without means, to “proportionally” participate in the cost of their care will better allocate scarce health care resources than further sugar-coated, and non-delightful, misguided administrative policies.

By the way, if you didn’t recognize the Mary Poppins song, that’s OK. Worry instead about your grandparents for now, and consider how your generation will counter-reform ObamaCare in the future.

Dr. Donald P. Condit, MD, MBA is an orthopaedic surgeon specializing in hand surgery in Grand Rapids, Michigan. After graduating with a BS in Preprofessional studies at the University of Notre Dame he attended the University of Michigan Medical School. At the Seidman School of Business of Grand Valley State University his emphasis of study was economics and the ethical allocation of scarce health care resources. With his family, he serves annually with Helping Hands Medical Missions in El Salvador. He also volunteers at Clinica Santa Maria and for Project Access, for the uninsured, in Kent County. He is the author of A Prescription for Health Care Reform and is a Clinical Professor of Surgery at Michigan State University.