Posts tagged with: health care

A recent New York Times story reports that the new British government plans to “decentralize” the National Health Care system as part of its new austerity measures.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

[N.B. Note that the plan applies only to England; the other constituent countries of the UK will have to make their own policies]

Though I’m not by any means an expert on British politics, the move strikes me as bold for two reasons: (1) The Conservatives have reversed their original position on not touching the National Health Service, instead opting for a plan that seeks to make unprecedented changes to the system; and (2) according to the NYT”s reporting, the plan is predictably facing intense opposition from government employees that stand to lose their jobs, as $30 billion are saved and 45% of administrative costs are phased out by 2014. In fact, some union members are trying to derail the plan by portraying it as a stepping stone towards privatization.

But what is most pleasant about this whole affair is the precise appeal made to an idea very similar to the Catholic understanding of subsidiarity:

“One of the great attractions of this is that it will be able to focus on what local people need,” said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. “This is about clinicians taking responsibility for making these decisions.”

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between G.P.’s and consultants in hospitals has become fragmented and distant,” he said.

Here we once again have the understanding that society should deal with problems on the lowest possible level.

But the winning side in this plan is not just that of the proponents of subsidiarity. Economic theory also suggests that policies guided by sentiments similar to subsidiarity tend to increase prosperity: the $30 billion that the government plans to cut from the budget will now exist in the private sector, where it can be put to more productive uses, in accordance with consumer demand. The civil employees released from their positions in the government do not have to mire in unemployment; instead the money from their state salaries will be used by the private sector to create positions which they can fill.

On the other side of the ocean, the United States moves in the other direction: away from subsidiarity, and towards a “one-size-fits-all” solution to fixing our health care system. The office of Congressman Kevin Brady recently released a diagram prepared by the minority of the Joint Economic Committee. It’s a fully detailed diagram of what the new health care system in the United States will look like once all provisions of the legislation are in effect. Take a look:

America's New Health Care System

The current health care system already raises enough questions about whether the principle of subsidiarity is respected. But this newest remake makes the question all the more serious.

In fact, over 37 states have begun to take some form of legal action against the health care legislation on the constitutional grounds that regulations such as the individual mandate overstep the federal government’s legal bounds. As I’ve argued before, the federalism of the Constitution is a rather good embodiment of the principle of subsidiarity, since it recognizes that many issues (even urgent and pressing ones like health care) should be dealt with at the state level.

And some partial victories for advocates of subsidiarity are already making the news: Missouri voters overwhelmingly approved of a ballot initiative opposing the individual mandate (by a landslide ratio of 3 to 1), and a federal judge refused to dismiss a suit by Virginia that challenges the constitutionality of the health care law.

In addition to a national campaign to repeal the legislation at a Congressional level, supporters of subsidiarity would do well to also pay attention to the battles at the state level. I suspect this is where we will see the greatest impact.

Thomas Jefferson’s long-forgotten theory of state nullification may have  found an ideal time for a resurgence, as the Tea Party and other groups advocate limited government as a solution to many of our current problems in health care, the economic crisis, our broken educational system, and the relentless expansion of government. The concept of nullification is simple, yet powerful: That individual states can and should refuse to enforce unconstitutional federal laws; and that the states, not the federal government, should have the final word on constitutional interpretation. The return of this “forbidden idea” (as its contemporary advocates sometimes describe it) represents not only an opportunity for small-government groups like the Tea Party to enact substantial change, but it also provides a unique opportunity those who are serious about a Christian social witness in public life to implement the principle of subsidiarity.

It is in this spirit that Dr. Thomas E. Woods, Jr. writes his newest book, Nullification: How to Resist Federal Tyranny in the 21st Century. Dr. Woods, who has authored two publications for the Acton Institute (the award-winning The Church and the Market and the monograph Beyond Distributism), as well as two New York Times bestsellers, now brings back the tradition of nullification into the public eye.

The seemingly radical idea of nullification flies in the face of nearly everything we have learned about the federal government and the Constitution: that federal authority always supersedes that of the states, that the Supreme Court has the final say on interpreting the Constitution, and that the only way to get rid of undesirable federal laws is to either have Congress repeal them or the Supreme Court overturn them.

However, Thomas Jefferson was convinced that if the federal government had a monopoly on interpreting the meaning of the Constitution, then there would be no certain way to constrain an unconstitutional expansion of its power. What if the constitutional system of checks and balances were to fail? What if, counter to the wishes of James Madison, ambition fails to counteract ambition, and the different branches of the federal government are able to cooperate in increasing the central government’s reach? Rather than wait two, four, or six years until the next election cycle, Jefferson thought, a more “rightful remedy” would be for states to simply declare that the laws in question violated the Constitution, and would not be enforced in said states.

He was not alone in this belief, as one can find the practice of nullification in the earliest years of the Republic. Kentucky and Virginia famously nullified the Alien and Sedition Acts of 1798. During Jefferson’s own presidency, northern states employed nullification against the total trade embargo imposed by the federal government. During the War of 1812, northern states once more passed resolutions nullifying any potential federal conscription acts. South Carolina passed resolutions nullifying the 1832 “tariff of abominations.” And in the 1850’s, free states frequently invoked nullification in an effort to combat unconstitutional aspects of the fugitive slave laws. Also interesting to note is that southern states did not invoke nullification to defend slavery.

To some extent, this practice continues today. As the Tenth Amendment Center thoroughly documents, dozens of states seek to propose legislation that would prohibit the federal government from enacting health insurance mandates, enforcing some federal gun laws, abusing the interstate commerce clause, and imposing cap-and-trade regulations, among other things. And though these efforts are still underway, supporters of nullification can already point to one success story: over two dozen states openly defied the Real ID Act of 2005, which imposed federal standards on state drivers’ licenses. Though the law is still “on the books,” so to speak, the federal government has given up on enforcement, due to the widespread and extremely overt opposition.

But what does all of this have to do with subsidiarity? At their core, the ideas of nullification and federalism that Dr. Woods invokes echo many of the same concerns that the Church raises in speaking of subsidiarity and the role of the state in society: that there needs to be a just division of responsibilities between different social orders. Social problems should be addressed at their lowest possible level. An unnecessary usurpation of power by, for example, the federal government, undermines the role that state governments should play in resolving some of their own domestic problems.

This principle is often invoked in religious discussion of public policy. The Catholic Church places such great emphasis on the principle of subsidiarity that the Compendium of the Social Doctrine of the Church lists subsidiarity as one of the four foundational principles of social teaching. The Church not only exhorts us to respect human dignity, respect the common good, and have solidarity with the poor, but also teaches that we should pursue these social goals in the proper context of subsidiarity:

It is impossible to promote the dignity of the person without showing concern for the family, groups, associations, local territorial realities; in short, for that aggregate of economic, social, cultural, sports-oriented, recreational, professional, and political expressions to which people spontaneously give life and which make it possible for them to achieve effective social growth [....]

On the basis of this principle, all societies of a superior order must adopt attitudes of help (“subsidium”) – therefore of support, promotion, development – with respect to lower-order societies. In this way, intermediate social entities can properly perform the functions that fall to them without being required to hand them over unjustly to other social entities of a higher level, by which they would end up being absorbed and substituted, in the end seeing themselves denied their dignity and essential place. (185-186)

One can certainly see a similar spirit in the intentions of the framers of the Constitution: the purpose of this founding document was not to provide a new kind of all-powerful entity lording over the states; rather, the states created the federal government in order to serve them as an instrument for promoting the common good – as the Compendium says, to provide “support, promotion, and development.” To discover this, one need look no further than the preamble of the Constitution:

“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

In the same way, subsidiarity dictates that higher orders (e.g. the federal government) exist to promote and assist lower orders (e.g. states) in developing and protecting the common good. But a political system in keeping with the principle of subsidiarity should have appropriate mechanisms to ensure that the abuse and usurpation of power does not take place. This makes the need for a revival of nullification all the more urgent.

Today’s Tea Party-ers eye with skepticism the intrusions of the federal government into all sorts of matters: guns, education, charity, health care, business regulation, etc. They clamor for change, and will certainly have a substantial impact on the coming electoral cycle. But advocates of limited government should also reflect on which strategies are most effective at introducing real and substantial change. Both Thomas Woods and Thomas Jefferson contend that waiting for a benevolent Supreme Court, President, or Congress is not the right way. States cannot trust the federal government to police itself. They must take a direct role in reeling back federal power. Nullification is the best way to concretely implement the principle of subsidiarity, restore true federalism, and strengthen a truly Constitutional rule of law.

Remember when Nancy Pelosi said that the House needed to pass the health care reform legislation so we could find out what was in it? Well, it turns out that she might have done Congress a big favor by slowing things down and allowing her House members to figure out what was in the bill before passing it. I mean, I’m only saying that because it seems that in the process of passing the bill Congress may have accidentally left itself without health care coverage. No biggie, though. I’m sure this sort of thing happens all the time in DC. From the New York Times:

In a new report, the Congressional Research Service says the law may have significant unintended consequences for the “personal health insurance coverage” of senators, representatives and their staff members.

For example, it says, the law may “remove members of Congress and Congressional staff” from their current coverage, in the Federal Employees Health Benefits Program, before any alternatives are available.

The confusion raises the inevitable question: If they did not know exactly what they were doing to themselves, did lawmakers who wrote and passed the bill fully grasp the details of how it would influence the lives of other Americans?

If even the Times is starting to ask that sort of question, perhaps there is hope for America after all.

Via Hot Air, where Allahpundit brings the requisite snark:

Turns out that fantastically long, mind-bogglingly complex bills which no one has actually read may create unintended consequences.

Couldn’t happen to a nicer bunch, though.

My new column on health care was published in the Detroit News today. Full text follows:

As the health care debate moves to the U.S. Senate, much of the focus has been on how the Catholic bishops’ support of the amendment by U.S. Rep. Bart Stupak, the Menominee Democrat, to prohibit the use of tax dollars to fund abortion was a major victory for the pro-life side. The bishops urged the House of Representatives, through local parishes and in a Nov. 6 letter, to ensure that “needed health care reform legislation truly protects the life, dignity, health and consciences of all.”

All people of good will, all those who value human life and dignity, should cheer this development.

But there’s more to this health care juggernaut that should give us reason to oppose it in its current form. We should first be concerned with the vast expansion of government reach into the private lives of millions of Americans.

This “reform” will create a system that will put bureaucrats in charge of personal health care decisions — not doctors. It will give the federal government an avenue to nationalize more than 15 percent of the U.S. economy, putting bureaucrats and elected officials in the role of manager and regulator — much as we’ve seen in banking and automobiles.

Amazingly, with the push for a $1 trillion-plus health care package and the attendant debt, we may soon see Canada with lower government spending (as a percent of gross domestic product) on heath care than the United States. All this, too, is a threat to human dignity.

What will this heavy burden of government spending and regulation have on U.S. health care innovation and competitiveness, which has to date pioneered so many advances? How many medical research and development firms would leave our shores under threat of higher taxes and regulation?

All the assurances from President Barack Obama that health care reform will not add “even one dime to our deficit over the next decade” seem more fantastic with every passing day.

A new report shows that projected Medicaid cuts, on which rests much of the financial funding for health care reform, would prove to be so onerous to hospitals and nursing homes that they would simply stop taking such patients. The report, by the chief actuary for Medicare and Medicaid, also questions how doctors and hospitals would cope with an additional 30 million people to the ranks of the insured, many of them into public health programs.

As it’s been said, if you think health care is expensive, wait until it’s free.

I also worry about the crowding out effect that this vast expansion of the government into health care will have on voluntary charitable action. Somewhere along the line, we have lost sight of the fact that charity and health care was not an invention of Washington bureaucrats.

How did the more than 600 Catholic hospitals and clinics, and many more hospitals bearing the names Jewish, Presbyterian, Methodist, Adventist and Baptist, get built in this country? It wasn’t through the sufferance of government.

Faith is the source of these works, not policy initiatives. Faith, because it involves the entire scope of the human person, body and soul, has not only a larger claim on our allegiance but a deeper commitment to our well-being. Our faith communities know us as persons, not as welfare case numbers or voting blocs.

The effect of the proposed massive expansion of government and vast increase in federal debt is unknown, but if the experience of other countries is any guide, it will lay a crushing burden on the lives of future generations.

The Senate health care reform package should be scrapped. The ill-conceived plan will break the budget, provide fewer opportunities for market-driven health care solutions and limit those who want to practice real charity.

Black leaders constantly remind Americans of our racism. Should not these same leaders protest the expansion of government control contained in the health-care reform bill currently working its way through Congress?

Here’s why. Notwithstanding their rhetoric of freedom and empowerment, many prominent black leaders appear content to send blacks back to the government plantation—where a small number of Washington elites make decisions for blacks who aren’t in the room. Why do minority leaders not favor alternatives that demonstrate faith in the intelligence and dignity of people to manage their own lives?

In a sermon at Howard University, the Rev. Jeremiah Wright reminded university students that, “Racism is alive and well. Racism is how this country was founded and how this country is still run.” During the presidential campaign, Wright explained to his parishioners that America is “a country and culture controlled by rich white people.” But if racists and “rich white people” control America, why do those sympathetic to Wright assume that those same people will look out for the health of blacks?

If Princeton religion professor Cornel West was right in his 2008 book, Hope on a Tight Rope, that “the very discovery that black people are human beings is a new one,” then shouldn’t blacks raise questions about centralizing health care decisions in a bureaucracy peopled by officials who are only recently cognizant of minorities’ humanity? “White brothers and sisters have been shaped by 244 years of white supremacist slavery, 87 years of white supremacist Jim and Jane Crow, and then another 40 years in which progress has been made” but “the stereotypes still cut deep,” West wrote. He admits “relative progress for a significant number of black people,” but warns that there has not been “some kind of fundamental transformation” in America. Dr. West asserts that “white supremacy is married to capitalism.” If that is true, then why would we want to set up a health-care system that strengthens the government sanction of health-care provision by businesses?

If Georgetown University sociology professor Michael Eric Dyson is correct about the current racial and structural injustice impeding poor blacks, then there is cause for concern. In response to Bill Cosby’s “conservative” reflections on black America in 2006, the Rev. Dr. Dyson wrote, “Cosby is hell bent on denying that race and structural forces play any role in the lives of the poor.” He continued by saying, “The plane of black progress lifts on the wings of personal responsibility and social justice.” If race and structural forces are at work against blacks, why not promote personal responsibility and justice by liberating them from dependence on those structures and putting them in a position to call their own shots?

If CNN analyst Roland Martin was right on February 18, 2009, when he said, “while everyone seems to be caught up in the delusion of a post-racial America, we cannot forget the reality of the racial America, where African-Americans were treated and portrayed as inferior and less than others,” then shouldn’t blacks be concerned about centralized health care, which will tether them ever more securely to a fundamentally corrupt political system? We cannot hope for change, after all: Martin insists that “the realities of race” are “being played out in our communities each day,” and had earlier reminded us that when it comes to white racism blacks should “accept the fact that some people will not change” (September 10, 2008).

Many black leaders seem confused on this point. If America has a race problem, then it will manifest itself in both public and private sectors. Expanding Medicare and Medicaid only subjects poor blacks to more government control. Economic empowerment and returning health decisions to black people are the only way to eradicate concerns about structural injustice. When health-care providers compete for their patronage, blacks are empowered and control their own destinies. Economic freedom in health care is a moral and civil-rights issue because for too long blacks have suffered the indignity of having political structures make surrogate decisions about their bodies.

Black leaders should encourage policymakers to make health more affordable by giving individuals absolute control over their earnings with concomitant power to choose their own health plan. Instead, they are conspiring with Congress to lead us back to the plantation.

This week’s Acton Commentary:

Healthcare reform – it’s one of those causes almost everyone favors, but which almost automatically produces sharp arguments when we ask what it means and how it might be realized. You would have had to be living in a cave for the past eight months to be unaware that Americans are deeply divided on this matter, and that the division runs clean through the middle of many communities. That includes Catholic America.

Of course, there are a small number of non-negotiables for Catholics, whatever their politics, when it comes to healthcare reform. These principally concern any provisions that facilitate or encourage the intentional termination of innocent human life, or which diminish existing conscience exemptions.

Without question, these are the primary issues for Catholics who take their Church’s teaching seriously when it comes to healthcare legislation. They dwarf everything else.

No matter how good the rest of the legislation might be in, for example, widening access to affordable healthcare, it is a stable principle of Catholic faith – and natural law – that you cannot do evil in order that good may come from it. St Paul insisted upon this almost 2000 years ago (Romans 3:8), and it is constantly affirmed by Scripture, Tradition, and centuries of magisterial teaching. Try as they may, no amount of rationalization by the usual suspects can get around this point.

For this reason, much of the Catholic contribution to the healthcare debate, especially that of Catholic bishops, has focused on these issues. We’ve yet to see what impact this might have on whatever eventually arrives on the floor of Congress.

But let’s hypothesize. Imagine the healthcare legislation submitted to Congress involved a massive expansion of government involvement in healthcare. Let’s also suppose that the same legislation was stripped of any provisions that violated non-negotiables for Catholics. Would Catholics be obliged to support passage of such legislation? (more…)

The Detroit News published my commentary on Catholics and health care reform in today’s newspaper. A slightly longer version of the article will appear in tomorrow’s Acton News & Commentary:

Catholic America is about as divided about health care reform as the rest of the country. But there are a small number of non-negotiables for Catholics that principally concern any provisions that facilitate or encourage the intentional termination of innocent human life or diminish existing conscience exemptions.

These issues dwarf everything else for Catholics who take their church’s teaching seriously when applied to the health care legislation. No matter how good the rest of the legislation might be in widening access to affordable health care, it is a principle of Catholic faith and natural law that you cannot do evil so good may come from it. St. Paul insisted upon this almost 2,000 years ago (Romans 3:8), and it is constantly affirmed by Scripture, tradition and centuries of magisterial teaching.

For this reason, much of the Catholic contribution to the health care debate, especially that of Catholic bishops, has focused on these issues. But imagine the health care legislation involved a massive expansion of government involvement that didn’t promote abortion or other non-negotiables. Would Catholics be obliged to support passage of such legislation?

The answer is no. Catholic moral teaching has held that the realization of good ends (such as making health care more affordable and accessible) mostly falls into the realm of prudential judgment. The church has always recognized that faithful Catholics can disagree about such matters.

Read the entire article here.

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.

In a column in this past Saturday’s religion section, Charles Honey reflects on the second great love commandment in the context of the national health care debate.

Honey’s piece starts out on a very strong note, detailing the perspective of Dr. John Vander Kolk, director of a local non-profit initiative focused on the uninsured:

“Where would we see Jesus in our culture?” asks the member of Ada Bible Church. “He would be down there with his sleeves rolled up, helping the people that don’t have any access (to health care). That’s what we’re being called to do.”

An editorial published this month by George Barna takes a similar point of departure.

In short, Jesus Christ showed us that anyone who follows Him is expected to address the most pressing needs of others. You can describe Jesus’ health care strategy in four words: whoever, whatever, whenever, wherever. Whoever needed to be healed received His healing touch. Whatever affliction they suffered from, He addressed it. Whenever the opportunity to heal arose, He seized it. Wherever they happened to be, He took care of it.

But it is after this shared perspective that the respective pieces on health care and the Christian faith part ways.

Honey’s piece continues to argue, in the vein of the Forty Days for Health Reform, that the gospel imperative is best met through government action. “For many, it’s about treating others as you would want to be treated — seeing to it that they get the decent medical care you and I would expect. It’s just not that complicated.”

Barna, however, ends on a note of personal challenge. He writes,

Government clearly has a role in people’s lives; the Bible supports its existence and circumscribed functions. It is unfortunate that when God’s people, collectively known as the Church, fail to exhibit the compassion and service that He has called us to provide, we are comfortable with the government acting as a national safety net. In a society that has become increasingly self-centered and self-indulgent, we simply expand our reliance upon the government to provide solutions and services that are the responsibility of Christ followers. Some Christians have heeded the call, as evidenced by the medical clinics, pregnancy centers and even hospitals across the nation that were initiated and funded by small numbers of dedicated believers who grasped this responsibility. Imagine what an impact the Church would have on society if it truly reflected the model Jesus gave us of how to care for one another!

This echoes the words of Abraham Kuyper, who in an address on the social question of poverty, wrote, “The holy art of ‘giving for Jesus’ sake’ ought to be much more strongly developed among us Christians. Never forget that all state relief for the poor is a blot on the honour of your Saviour.”

If it doesn’t faze you that

1. Uncle Sam badly mishandled the stimulus porkanaza
2. Congress would have directed bazillions to a surreally corrupt Acorn but for these two young heroes
3. Michael Moore’s Sicko is Wacko
4. Canadians will no longer have a free market healthcare system to flee to
5. Government-run health care will look and smell and feel like the Department of Motor Vehicles … with sharp needles and bedpans
6. If none of this has convinced you that a government-run healthcare system is a bad idea, then spend some time perusing Jay Richards’ thoughtful blogging work on health care here at The Enterprise Blog.

And have a blessed weekend.