Posts tagged with: health care

Methodism was once the largest denomination in America. The faith grew rapidly from America’s beginning and has traditionally been characterized by aggressive evangelism and revival. It has carried a vibrant social witness, too. Methodist Church pronouncements once garnered front page headlines in The New York Times. Its high water mark undoubtedly came during prohibition, the greatest modern political cause of the denomination. Methodists even built and staffed a lobbying building next to Capitol Hill believing a dry country could remake society.

In Methodism and Politics in the 20th Century, Mark Tooley has chronicled Methodism’s denominational political pronouncements from William McKinley, America’s first Methodist president, to 9-11. Tooley has unearthed a staggering amount of official and unofficial Methodist declarations and musings on everything from economics, war, civil rights, the Cold War, abortion, marriage, and politics.

Tooley, who is also the author of Taking Back the United Methodist Church, offers very little of his own commentary on the issues in Methodism and Politics, instead allowing Methodism’s voice for over a century to speak for itself. Ultimately what emerges is a denomination that begins to recede in significance, perhaps because of the sheer saturation of their witness in the public square. But its leadership often trades in a prophetic voice for a partisan political one, and sadly at times, even a treasonous voice.

Methodists not only led on prohibition, but were out in front on issues like women’s suffrage, the New Deal, and the Civil Rights Movement. While they did not always carry a unified voice on these issues, even many Southern annual conferences and bishops broke with the popular political position of defending segregation in their home states.

While support for the New Deal and greater federal intervention in the economy was not rubber stamped by all Methodists, an emerging and often biting anti-free market voice would dominate official pronouncements. This continues to this day with declarations calling to support greater government regulations, single payer health care, and a host of measures calling for government wage and price controls. Way back in 1936, one Oklahoma Methodist pastor offered his own advice to some of his brethren:

Why do [these Methodist Reds] not get passports, emigrate to Russia where they can prostrate themselves daily before the sacred mummy of Lenin and submit themselves to the commands of Joseph Stalin?

Tooley chronicles the pacifist sentiment that begins to overtake the denomination. This amounted to the equivocating of a denomination that once was harsh in its critique of communism to one where a committee of bishops would pronounce by the 1980s, that “actions which are seen as ‘Marxist-Leninist’ by one group are seen as the core of the Christian message by others.”

Perhaps most shameful was the action of several bishops during the American hostage crisis in Tehran, Iran, from 1979 – 1981. United Methodist Bishop Dale White said of the new Islamic fundamentalist regime, “I know there are individuals in the Iranian power structure who do trust The United Methodist Church.” White offered assessments of the new regime being “democratic.” The General conference sent a message to Ayatollah Khomeni declaring that it hears the “cries of freedom from foreign domination, from cultural imperialism, from economic exploitation.” Methodist officials participated in pro-Khomeni student demonstrations in Washington D.C. and met with and offered praise for officials in the new Iranian government. One former hostage recalled:

Some of the people who came over especially the clergy were hypocrites because they came to aid and comfort the hostages but ended up giving aid and comfort to the Iranians and actually making it worse for us.

The election of President Ronald Reagan naturally sent many United Methodist Church officials into a tizzy. “People voted their self interest instead of the Social Principles of the church. It looks like United Methodists with everybody else forsook their Christian idealism at the ballot box,” said Bishop James Armstrong. Some United Methodist Bishops had already declared their denomination much more aligned with the Democratic Party. It was downhill from there for many Methodist leaders, as they coddled the Sandanistas and “Brother Ortega” in Nicaragua and dove head first into the nuclear freeze movement.

In the 1990s one General Board of Global Ministry official bewailed the Republican Congress by saying, “White, male supremacists now wear suits. They talk states rights and anti-taxes. The climate of hate and violence is a challenge to us.” General Board of Church and Society official Robert McLean declared that the GOP Contract with America effectively “cancels” the Sermon on the Mount.

Hyperventilating over partisan politics would continue in The United Methodist Church and continues to this day by American officials. Most recently many have joined forces with the “What Would Jesus Cut Campaign?” But because Methodism is a connectional denomination, the growing African influence is counter balancing what Methodist progressives and political liberals can accomplish. They have already reached the pinnacle of their power, which has been shrinking for decades. And because progressives have made so many predictable pronouncements, they no longer speak with the weighty spiritual authority they once held. It is a lesson for all churches and those that wish to bring their faith into the public square. At the 1934 Illinois Annual Conference one lay delegate offered what can be seen only as prophetic now when he declared, “It is time for churches to stop adopting resolutions and then finding out what they mean afterward.”

Just a few weeks ago, The United Methodist Church’s General Board of Church & Society heaped praise on President Obama’s HHS mandate with no mention of the measure’s threat to religious liberty, deciding to only view it as a partisan measure to defend for furthering the role of government in health care.

At the conclusion of the book, after reading through 100 years of political pronouncements, Tooley finally offers just a hint of his own assessment,

American Methodism in 1900 was growing, confident, largely unified, and politically formidable. One hundred years later, it had already endured several decades of steep membership decline and accompanying political marginalization as church officials were no longer presumed to speak for most church members.

Tooley, through the myriad of voices that he has chronicled over such a lengthy period, understands those voices only need to speak for themselves to make his point.

In the 1920s Calvin Coolidge once said of Francis Asbury, one of the first two Methodist Bishops in early America, that “he did not come [to America] for political motives,” but came to bear “the testimony of truth.” One wishes Methodist denominational officials would not only follow more of Asbury’s doctrine, but his praxis as well.

At the most recent GOP presidential debate, there was a famous exchange between CNN’s Wolf Blitzer, Rep. Ron Paul, and the partisan crowd. Blitzer asked Paul about a hypothetical 30-year-old man who refused to purchase health insurance, got sick, and needed extensive medical treatment. Blitzer asked “Who pays?”

Paul replied, “That’s what freedom is all about, taking your own risks…”

Blitzer interrupted him by asking “Are you saying the society should just let him die?”

A few people in the crowd shouted “Yeah”. But Paul said no—and then explained that society should and would take care of him.

Paul continued: “We’ve given up on this whole concept that we might take care of ourselves, assume responsibility for ourselves. Our neighbors, our friends, our churches would do it. This whole idea—that’s the reason the cost is so high!…We dump it on the government; it becomes a bureaucracy; it becomes special interests; it kowtows to the insurance companies and the drug companies…”

Paul made a number of interesting and important points. But aside from his astute analysis, it’s clear that his reply runs counter to conventional ethics. In contrast, many (most?) people believe that we should not rely on freedom and markets. Instead, they want the government to take a lot of money from a lot of people—to support others who make bad decisions and/or face circumstances beyond their control.

When I heard the debate over “let ‘em die”, I immediately thought of students in a classroom. If a student decides not to study appropriately, should I “let ‘em fail”? I’ve always thought so, but maybe I should reconsider. Should I lower the grades of the successful and increase the grades of those who don’t study or just aren’t very smart. (I could transfer grade points explicitly—for example, from “wealthy” A-students. Or I could arbitrarily increase the grades of D&F students, devaluing the grades of A-C students.)

It turns out that the analogy is limited in two important ways. First, health care can be much more important than grades. Of course, grades are important too. If you don’t graduate from high school or college—or you graduate with a weaker major or a lower GPA—then this will have a dramatic impact on your standard of living. And much health care is not vitally important. So, the analogy only falls short when referring to catastrophic or highly-significant health considerations.

Second, I don’t do anything to get in the way of my students earning a good grade. In fact, I do a lot to help them learn and succeed. In contrast, the government is quite busy making it much more expensive to obtain health insurance and more difficult to obtain care. The federal government subsidizes the purchase of health insurance through businesses, causing it to move away from the normal role of insurance in covering rare, catastrophic events. Vastly broadening the scope of health “insurance” causes a dramatic increase in the cost of health care and especially, health insurance. (Imagine the cost and accessibility of auto “insurance” if it covered door dings, oil changes, etc.) This makes Wolf Blitzer’s scenario far more likely. As the government vastly inflates the cost of health insurance, it tempts people to take their chances.

In addition, state and federal governments have all sorts of mandates and regulations on health insurance—that increase costs and decrease competition in the market for insurance. In fact, government has all sorts of other regulations—on everything from prescription drugs to labor markets—that cause all sorts of trouble, but this would require a far longer essay! (If you’re interested, check out my paper in the Winter 2011 edition of Cato Journal.)

Rep. Paul’s answer was to rely on markets and freedom to take care of people. The flip side of that coin is to reduce government intervention—not only taking money from A to care for B, but also government policies that dramatically and artificially increase the cost of health insurance. Blitzer’s question will always be with us. But why do we ignore the many government policies that make his question so much more relevant?

Even though Ron Paul clarified himself at the Tea Party debate, and explained that he doesn’t think those who can’t afford medical care should be laid out on the curb to die, the Left went about painting his answer as morally abominable. Before we deal with their abuse of Christian doctrine, let’s see what Paul said:

I practiced medicine before we had Medicaid, in the early 1960s, when I got out of medical school. I practiced at Santa Rosa Hospital in San Antonio, and the churches took care of them. We never turned anybody away from the hospitals. And we’ve given up on this whole concept that we might take care of ourselves and assume responsibility for ourselves, our neighbors, our friends, our churches—would do it.

A great answer, it seems to me, and thoroughly Christian, unless you take the United Nations as an instantiation of the Gospel command to “love thy neighbor as thyself.” Liberals latch onto the Good Samaritan aspect of the commandment and think, if my neighbor, then why not the fellow two counties over, two states over, or two countries over?

Newsflash: prudence is a part of moral calculations.

The Good Samaritan was passing by the man who had been beaten and robbed, and was in a position to help him. But while residents of Alaska and Florida are each others’ neighbors in one sense, they cannot be of service to each other in the same way that they can those on their own streets. Moral considerations involve not only intention but also acts themselves, and whether they are likely to succeed (cf. Catholic just war principles).

Furthermore, the federal government might be practically able to assume some of the responsibilities of the Good Samaritan, but no one on the Christian Left has provided an argument why it should—why it would be better for two neighbors to love each other through the government, in some sort of progressive trinity. Otherwise, isn’t it best to let people practice love of neighbor themselves, so that they can store up treasure in Heaven?

Finally, most of the people making these arguments don’t think Congress should pass some sort of Obamacare law for the entire world, but that’s exactly where their thinking leads. Really why not preemptively cover any Martians without access to dental care and free contraception? Well because that would cost too much.

Director of Research Samuel Gregg is among those reacting to last night’s CNN/Tea Party Debate on National Review Online. His first point is that “when CNN hosts a Tea Party–sponsored debate, you know we’re not in 2008 anymore.” Gregg’s take is that the debate was a lot more mainstream than the network wanted us to think, and that the economic questions raised and debated are going to be the central issues of the 2012 election:

Almost all of the candidates demonstrated their ability to raise sharp questions about the present administration’s specific policies but also about the basic philosophy informing those positions. The question running through my mind was how the president was going to provide convincing (let alone coherent) responses to the critiques I heard of policies ranging from Obamacare, to his administration’s not-so-subtle association with some of America’s worst examples of crony capitalism, to the ramping up of deficit spending that has produced so few tangible results in terms of employment and growth.

Gregg doesn’t see the Tea Party’s influence declining anytime soon:

It was also revealing that the economic questions asked at this forum closely mirrored many of the issues raised at the previous debates. This suggests that all the talk about the Tea Party’s running out of steam since 2010 seems less convincing than ever. Whether the Republican party likes it or not, the Tea Party is still galvanizing American conservatives and also, perhaps more importantly, independents. And that spells deep trouble for the Left in 2012.

Justin Constantine has written an excellent piece on the high cost of war in the Atlantic titled “Wounded in Iraq: A Marine’s Story.”

Constantine, who was shot in the head in Iraq, notes in his essay,

Blood and treasure are the costs of war. However, many news articles today only address the treasure — the ballooning defense budget and high-priced weapons systems. The blood is simply an afterthought. Forgotten is the price paid by our wounded warriors. Forgotten are the families torn apart by lengthy and multiple deployments. Forgotten are the relatives of those who make the ultimate sacrifice in defense of our country. As we look back on 9/11, we should also remember all those who deployed to Iraq and Afghanistan. Fewer than 1 percent of Americans have fought in these wars, and it is important for the public to understand their effects on our fighters and those close to them.

Constantine also touches on his own frustration with the U.S. Department of Veterans Affairs in the piece. I wrote a commentary in 2009 on the need for the federal government to fulfill its obligations to our veterans before expanding its scope and reach on health care. The fact that Congress rushed through a comprehensive health care law in 2010 without major reform of care for veterans speaks to the failure of the political leadership in this nation.

We should remember the high cost of war this weekend and every day. Constantine evokes the 44,000 wounded warriors from Afghanistan and Iraq and the more than 6,000 families who have had to bury a loved one. Last Memorial Day, I wrote a post on a few of the men whose names adorn the Vietnam Veterans Memorial in Washington D.C. One of the names is Roy Mitchell Wheat, a Medal of Honor recepient from Moselle, Miss. Trying to hold back tears, his brother recently offered these haunting but wise words about the cost of war,

When you see a man there that’s 19 years old, and you can look in the casket and his shoes are at the end of it. And his pants legs is neatly rolled up. It’s, that’s when you realize what war is.

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.

With health care moving back to center stage in Washington, we’re publishing Dr. Donald Condit’s Acton monograph A Prescription for Health Care Reform as a free eBook readable in a variety of formats. This excellent work continues to be available for $6 (paperback) in the Acton Bookshoppe.

For your free eBook, visit Acton’s Smashwords page. The Condit book will soon be available in the Kindle store (no charge for that, either) and in other eBook retail sites. We’ll keep you updated when they become available.

Via Smashwords, you can download digital versions of the 81-page health care monograph for eBook readers, smart phones and computer screens.

The monograph was released before the passage of the Patient Protection Act in March. Dr. Condit has recently authored an update in the November 2010 issue of the Linacre Quarterly, published by the Catholic Medical Association. The medical association has graciously offered readers of the Acton PowerBlog an open link to Dr. Condit’s new article, “Health-Care Counter-Reform.”

The Jan. 5 Acton commentary was based on the Linacre article. Read “Obamacare and the Threat to Human Dignity” by Dr. Donald Condit.