"Power tends to corrupt, and absolute power corrupts absolutely." Lord Acton

Impossible Promises on Health Care

I still haven’t quite gotten to a thorough fisking of “Exhibit B,” yet, and will have to be satisfied with arguing the following thesis in the meantime:

It is impossible to increase insurance coverage in America without increasing medical spending.

We cannot save enough on bureaucratic reform and government-induced “competition” to offset the new costs associated with an influx of 40+ million new participants. Certainly the newly mandated premiums, paid by those who have determined for themselves that it is not worth it to pay in to health insurance, will also offset some of the new costs. But how many of those 40+ million uninsured have voluntarily opted out?

If even a large minority, say 1/3 of the uninsured, is made up of those that have been denied coverage outright or cannot afford it because of various health factors (many estimates place that number far higher), then guaranteeing coverage to 15 million new patients will certainly surpass any of the potential gains seen in those other revenue sources. The very reason that so many of these folks do not have insurance coverage is because private firms have determined them to be too risky (that is, too expensive) to cover.

How can we mandate coverage of this group and not increase health care spending? It seems like an impossible promise.

The contention really cannot be that we can spend just as much as we are right now and extend the same qualitative and accessible health coverage to everyone. The honest situation is that we would have to spend more to guarantee coverage, and as a nation we need to decide whether that public good requires governmental mandates, regulations, and administration or if it doesn’t.

There will be new costs. We need to determine whether and how they ought to be borne.

Radio Free Acton - Why You Think The Way You Do

Radio Free Acton is back, this week featuring an interview with Dr. Glenn Sunshine. Dr. Sunshine is Chair of the History Department at Central Connecticut State University, and a Research Fellow at the Acton Institute. He’s also the author of a brand new book - available now at the Acton Bookshoppe - entitled Why You Think The Way You Do: The Story of Western Worldviews from Rome to Home. I had a chance recently to sit down with Dr. Sunshine and discuss his book, the importance of worldview, and some of the parallels between the declining Roman empire and modern society.

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If you aren’t subscribed to Acton’s podcast, here’s the link you’ll want to use to have podcast episodes automatically downloaded directly into your iTunes or other audio management software.

Civilizing Discourse on the Public Option

In this week’s commentary I argue that the shape of the debate over the public health care option over the next four years should focus on the critical role played by mediating institutions of civil society: charities, churches, and voluntary organizations.

While President Obama’s health care speech last week was in part intended to dispel myths about the proposed health care reforms, it perpetuated some myths of its own. Not least of these is the idea that “non-profit” must mean “governmentally-administered,” or that we do not already have non-profit competitors for profit-driven corporations in the health insurance industry.

The president ended his speech by appealing to the compassion of the American public, and I support this wholeheartedly. But compassion is apparent most obviously in those deeds we undertake voluntarily and selflessly. It’s apparent in efforts like healthcare sharing ministries (HCSMs), which would face elimination under proposals for a federal health insurance mandate.

To be sure, there is deceit, half-truth telling, and rumormongering running rampant in this health care debate. But this goes not only for the opponents of the president’s plans but also for his supporters, an accusation popularized by Joe Wilson’s shameless outburst at the president.

From the transcript: AUDIENCE MEMBER: You lie! (Boos.).

For exhibit A, see this Facebook video of Robert Reich, who says that the public option’s “scale and authority” and “bargaining leverage” do not amount to a governmental subsidy: “The public plan would not be subsidized by the government or have the government set the rules for anyone.” Of course, as I note in the commentary, relying on governmental bureaucracy and authority is most certainly a form of subsidy.

And why wouldn’t groups other than the government have this “scale and authority” or “bargaining leverage” to negotiate lower prices? Because their power doesn’t ultimately lie in the threat of coercion and they can’t arbitrarily raise taxes to increase revenue. This is of course the same reason that so many corporations and businesses go rent seeking; the government’s coercive regulatory power is the ultimate trump card. A gun is a great bargaining tool.

For a more thorough fisking of exhibit B, check back with the PowerBlog later.

Hannah And Her Sisters… and Brothers

The other day on this PowerBlog I posted “Learning To Tell The Truth” and ended the article with an observation:

It may be instructive to note that the young female reporter who took part in the videos is named Hannah. For Jews the Biblical namesake is one of the prophetesses whose prayer is remembered at Rosh Hashanah [coming soon] and the mother of Samuel. You may recall that Samuel had problems with his succession choices. They weren’t sufficiently obedient to God’s instruction in handling the errant, sinful tribes. Of course, that wasn’t Hannah’s fault. She did what God asked and was rewarded.”

I wondered in my final comment what the effect of Washington’s problems with disobedience to God might be. We’re likely to find out over the next several weeks and perhaps months because of this modern Hannah and her friends. I hope there are other Hannahs in our midst and in our counsel.

A reader made the following comment:

Interesting thoughts. I liked the Hannah reference…I hadn’t thought about that.”

I was happy that he got it and let me know.

Tuesday afternoon I listened to the 20 year old reporter Hannah Giles being interviewed on a radio program. The host shared my admiration for her spunk. Her explanation in reply to his compliments was something on the order of “a lot of people tell us we have courage but we never thought that we couldn’t do it.”

In an article early in the string of indicting ACORN videos and document postings at www.biggovernment.com, Hannah Giles wrote the following:

“Most people come up with ridiculous ideas, things that graze against societal norms. However, not all are capable of action because not all are comfortable with action. Many lack the desire for truth and justice, most don’t even know to want it.  But on occasion, the previous join forces. The right people with the appropriate calling unite against a common enemy, then the sky is the limit and hell is the target. There will be no compromises, only adaptation and infiltration.”

To some who think about having an effect on life’s ills, that statement may seem a little strong. I prefer to focus positively on her phrase “then the sky is the limit and hell is the targetl” To which others might say, “Oh, to be young again!”

Anyone who believes in truth and invests themselves in the search for it should be inspired by this young woman and her friends. And remember that it’s not to be young again, but to put your trust in Him and see where He leads you.

Give Temperance a Chance

Just about every state has dealt with the issue over the last few years, it seems. But here in Ohio, the legal status of gambling is the issue that won’t go away. It’s on the ballot again in November, this time as a constitutional amendment to permit casinos in four cities.

The issue is something of a dilemma for Christians with limited-government inclinations. In general we don’t want prohibitions on legitimate business activity or entertainment, and most Christians don’t consider games of chance to be inherently immoral. Yet the societal repercussions of Big Gaming don’t appear very attractive from any angle. For one, as Acton’s Jordan Ballor pointed out in his treatment of the subject a few years back, revenue from lotteries and other gambling represents an all-too-easy source of funds for expansive state governments. Even more serious, as a recent analysis by Fr. John Flynn on Zenit underlines, gambling often amounts to a regressive tax on the poor, who tend to throw away a much higher proportion of their incomes in this fashion than do the better off.

In any case, it appears that widespread legalized gambling is here to stay. So what now? Fr. Flynn has one important answer: a return to the classic virtue of temperance, “the moral virtue that moderates the attraction of pleasures and provides balance in the use of created goods.” (It was given sort of a bad name in the US in the early twentieth century when the “temperance movement” became the “Prohibition movement” and enacted the ill-fated 18th amendment, but there’s nothing puritanical about temperance.)

I’ve noted in other contexts the importance of temperance: for example, the implications to health care of moderation in food, drink, physical activity, etc. Its relevance for gambling is self-evident. And of course there’s consumerism, the mortgage crisis, and financial speculation. So, pastors, writers, teachers: we’re long overdue for some sermons, commentaries, and lessons on the contemporary indispensability of that ancient virtue, temperance.

Learning To Tell The Truth

Last week when the videos were aired showing ACORN employees in their Baltimore and Washington DC offices consulting “a couple” pretending to be a pimp and prostitute I watched with amazement. On Saturday my wife sat at the computer to see for herself. Busy in another room I could hear the rumbling of the adult’s conversation but what stood out was the unmistakable sound of little kids and the high pitched chatter and muffled squealing that characterizes children at play.

That’s right: while mom or auntie or grandma was unemotionally advising the two actors on matters of tax fraud, abuse of the federal guidelines for subsidized home ownership, and with stoic and neutral non-reaction listening to the “couple’s” plans to house up to 13 Central American girls — aged 13 or less — in the HUD financed brothel — little children were within earshot.

In the long history of the “heredity versus environment” argument, I’ve pretty consistently come down on the environment side. And there’s plenty of evidence to substantiate my leaning that way. But when the basic principles of Western Civilization are abrogated to the extent they are today, it’s hard to get kids on the straight and narrow, let alone keep them there. And groups like ACORN are decidedly not doing us any favors.

In a piece in The Wall Street Journal Scott Harrington, a professor at Wharton School of Business illuminates three statements President Obama made last week in his speech to Congress on health care. Each of Harrington’s “fact checks” clarifies what the president had asserted on air and show that Obama plays fast and loose with the facts. Professor Harrington’s most basic point is that applications for insurance contracts require our telling the truth and nothing but the truth and when it is determined that an applicant has lied the recourse for the insurance company is to cancel the liar. That cancellation protects all the rest of us who tell the truth.

Although ACORN now has the attention of federal bureaucracies that will hopefully work toward disassociating themselves from a system of “spoils” that has fed ACORN millions if not billions of taxpayer’s dollars, we need to make sure that Congress acts swiftly and without compassion to get any advanced funds that are still in bank accounts returned, and begin sober investigations of ACORN executives.

It will not go without notice that only a few years ago, Barack Obama was one of those executives in ACORN’s Chicago office. Stanley Kurtz told the story long before last fall’s election here; and here.

ACORN’s immediate reaction was to cry out that Fox News was racist because they showed the videos. Hmmmm.

So as to connect some dots and clarify my purpose in writing this essay, let’s finish up by noting a column that originally appeared in The St Louis Post Dispatch in August titled “The Britney Spears Syndrome“. Focusing on Gigi Durham’s 2008 book The Lolita Effect Colleen Campbell outlines the ways in which the popular culture has regarded any “breaking of sexual taboos as a form of progress.” No wonder the ACORN folks didn’t blink at the plan to hustle 13 girls into prostitution. My gosh, do you suppose ACORN’s defense attorney will plead their case as victims of the culture as some with law degrees are prone to do? Ms Campbell writes:

Durham worries that today we are “reverting to a time when childhood was indistinct from adulthood, when the concept of ‘child abuse’ was unknown.” That reversion has helped fuel the growth of the multi-billion dollar child porn and child sex-trafficking industries, as well as alarming rates of eating disorders and sexually transmitted diseases among girls and the rise of such trends as “sexting,” in which girls send out nude photos of themselves via cell phone or Internet to attract the male sexual attention they have learned to seek at all costs.

It may be instructive to note that the young female reporter who took part in the videos is named Hannah. For Jews the Biblical namesake is one of the prophetesses whose prayer is remembered at Rosh Hashanah [coming soon] and the mother of Samuel. You may recall that Samuel had problems with his succession choices. They weren’t sufficiently obedient to God’s instruction in handling the errant, sinful tribes. Of course, that wasn’t Hannah’s fault. She did what God asked and was rewarded.

But Washington, and the bureaucracy: How will they do?

President Obama Praises/Opposes Health Insurance Competition

Our latest health care video short is up: “Why Consumer-Driven Healthcare Beats Socialized Healthcare.” And John Hinderaker of Powerline has an incisive analysis of the president’s speech last night to a joint session of Congress. The passage that stood out to me was this one about competition:

This seems to me to be the most critical moment in Obama’s speech:

My guiding principle is, and always has been, that consumers do better when there is choice and competition. Unfortunately, in 34 states, 75% of the insurance market is controlled by five or fewer companies. In Alabama, almost 90% is controlled by just one company. Without competition, the price of insurance goes up and the quality goes down.

In fact, Obama and Congressional Democrats have zero interest in increasing choice and competition. If they did, there is an easy solution. There are over 1,000 health insurance companies in the United States; why do you think it is that in Alabama, one company has 90 percent of the business? It is because there are major legal obstacles to insurance companies operating across state lines. State legislatures, and lots of the companies, like it this way. Competition is hard. But if Obama really wanted to expand “choice and competition” in health care, all he would have to do is go along with the Republican proposal to allow health insurance companies to sell on a national basis. Like, say, computer companies, beer companies, automobile companies, law firms, and pretty much everyone else.

The video and transcript of President Obama’s speech is available here. And more Acton analysis of healthcare policy is available here.

Stewardship, Soulcraft, Work, and Eternity

In what deserves to be considered a modern classic, Lester DeKoster writes on the relationship between work and stewardship. These reflections from God’s Yardstick ought to be remembered this Labor Day:

The basic form of stewardship is daily work. No matter what that work may be. No matter if you have never before looked upon your job as other than a drudge, a bore, a fearful trial. Know that the harder it is for you to face each working day, the more you will to persevere schools the soul.

Here is a sense of work as soul-forming that anticipates the contemporary Shop Class as Soulcraft discussion.

But beyond the formation of the individual worker’s soul, the order of work has consequences for the larger society.

Work knits the fabric of civilization. We take for granted all the possibilities which work alone provides. And we become aware of how work sustains the order which makes life possible when that order is rent by lightning flashes of riot or war, and the necessities which work normally provides become difficult to come by.

Those record numbers of people who are unemployed on this Labor Day in 2009 certainly need no reminders about the blessings that work offer.

DeKoster also provides needed perspective about what we can and cannot accomplish in this life, and how what we do has eternal consequences.

While the object of work is destined to perish, the soul formed by daily decision to do work carries over into eternity…. This perspective on work, as a maturing of the soul, liberates the believer from undue concern over the monotony of the assembly line, the threat of technology, or the reduction of the worker to but an easily replaceable cog in the industrial machine. One’s job may be done by another. But each doer is himself unique, and what carries over beyond life and time is not the work but the worker. What doing the job does for each of us is not repeated in anyone else. What the exercise of will, of tenacity, of courage, of foresight, of triumph over temptations to get by, does for you is uniquely your own. One worker may replace another on the assembly line, but what each worker carries away from meeting the challenge of doing the day’s shift will ever be his own. The lasting and creative consequence of daily work happens to be the worker. God so arranges that civilization grows out of the same effort that develops the soul.

Health Care and ‘Rights’ Talk

I’m becoming more and more convinced that the talk of health care as a ‘right’ is so vague as to border on willful and culpable obfuscation. I certainly advocate a rich and complex description of ‘rights’ talk, such that simply calling something a ‘right’ doesn’t end the ethical or political discussion. Some ‘rights’ are more fundamental and basic than others, and various ‘rights’ require things of various actors.

But when it is asserted that access to health care is a ‘right,’ what precisely is the claim? Is it analogous to the claim that access to food and water, too, are rights? Very often these rights are equated in contemporary discussions: food and water, shelter, and health care.

One the one hand, however, it’s very odd to assert that health care, at least as practiced in its modern form (with X-ray machines and flu shots) is a right, at least in the sense that it is something that the human person qua person has a claim upon. If that’s the case, then all those millions of people who lived before the advent of the CAT scan were all the while having their rights ‘denied’ them (whether by God, fate, cosmic chance, or oppressive regimes bent upon keeping us from advancing medical technologies). It would also follow that all of those living today without access to these advanced technologies, simply by basis of their geographical and cultural location, are having their rights similarly denied. (This raises the troubling implication, not to be explored in any detail here, that the debate about health care in the industrial and post-industrial West amounts to a series of tantrums by the coddled and privileged about the requisite level of health care, which by any standard already dwarfs what is available to the global poor, who do not have access to what has the best claim upon ‘rights’ talk, even the most basic health care services.)

This raises the further question, if it be granted that health care is in some sense a right (which I am not opposed to granting), “What precisely does that right entail?” Clearly we can’t mean, in the context of the history of humankind, that this is a right to arthroscopic surgery or titanium hip replacement. That would be a bit like saying my right to food means that I have a claim to eating filet mignon. Just because someone else can afford to eat filet mignon doesn’t mean that my right to not starve gives me a similar claim upon filet mignon.

Similarly, just because some people can afford the greatest medical care available in the history of humankind (whether by the providence of God, fate, or cosmic chance), it doesn’t follow that I have a right to health care in that particular form. My basic claim to health care merely on the basis of my humanity is something more like the right to ramen noodles than it is to filet mignon.

This only describes what I am due by rights. It’s the least that’s required by the standards of justice.

And what might love require? “He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him.”

Patients and Doctors

In an Acton Commentary this week, I argue that a critical piece of any comprehensive and meaningful reform of the health care system must include malpractice litigation (tort) reform. Part of what makes this so urgent is that the litigious climate in which we live has eroded the doctor-patient relationship. In “Patients and Doctors: Partners not Adversaries,” I write that “patients are less inclined to trust doctors whom they believe are ordering tests and procedures out of a desire to protect their own economic interests. Patients in turn are much more apt to turn to legal remedies when they feel that doctors have not been forthcoming and trustworthy.”

Last week President Barack Obama spoke on a conference call to thousands of faith leaders from around the country to try and enlist them in his fight for health care reform. Highlights of the president’s remarks, as well as full audio of the proceedings, are available here.

I should note that I was not (at least intentionally) channeling Sarah Palin when composing this piece. But last week Shane Vander Hart (at the ever-worthy Caffeinated Thoughts) pointed out that the former Alaska governor wrote in a recent Facebook memo that “we cannot have health care reform without tort reform.” Of course my (and Gov. Palin’s) argument is not novel with either of us.

But what is novel is the particular concrete approach that I highlight in the commentary. The University of Michigan Health System has implemented policies that encourage doctors to be upfront and honest about the regret for procedures gone awry and admit when mistakes might have been made.

As David N. Goodman of the AP reports, “The willingness to admit mistakes goes well beyond decency and has proven a shrewd business strategy,” citing an article in the Journal of Health & Life Sciences Law, “A Better Approach to Medical Malpractice Claims? The University of Michigan Experience,” by Richard C. Boothman, Amy C. Blackwell, Darrell A. Campbell, Jr., Elaine Commiskey, and Susan Anderson (PDF). The article cites a case that “illustrates how an honest, principle-driven approach to claims is better for all those involved—the patient, the healthcare providers, the institution, future patients, and even the lawyers.”

For some basic facts on health care, visit the Health Insurance Costs page at the National Coalition on Health Care. And for more information about the widespread practice of defensive medicine, see the PDF report from the November 2008 study, “Investigation of Defensive Medicine in Massachusetts” by the Massachusetts Medical Society. For more Acton resources, check out the institute’s Health Care media page.