For those on the left side of the political spectrum, single-payer health care — a system in which the government, rather than private insurers, pays for all health care costs — is one of the most popular policy proposals in America. But the recent Hobby Lobby decision is reminding some liberal technocrats that giving the government full control over health care funding also gives the government control over what medical services will be funded.
We Americans like choices. Go to any large grocery store and stand in awe at the vast array of cereals: everything from regular old oatmeal to some sort of toasted rainbow sprinkles of joy. The market economy is built upon choice: not only does the consumer have a choice in what she wants, she can stay away from things she doesn’t want, like bad service or poorly prepared food. Yes, we like choices.
Obamacare is built on fewer choices, however. The New York Times tells us that we are facing fewer choices for our health care, fewer doctors and high costs if we wish to go outside of our prescribed network. Reed Abelson:
No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans.
We were told we could keep our insurance plans, our doctors, all the stuff we liked about our old plans. Not so fast, says Ashe Schow of the Washington Examiner. Here are 5 things you CAN’T keep under Obamacare.
- Your health insurance plan, even if you really, really liked it. In theory, you were supposed to be able to keep it, but now, well…
Millions of Americans have received notices canceling their existing health plans because they did not meet the requirements of the health care law, which forced insurers to include one-size-fits-all benefit packages in all plans.
Over the past year, public discussion about the Affordable Care Act has led many Christians to question the proper roles of government and business in providing healthcare. Too often, though, the question left unexamined is what role the church should have in responding to the medical needs of the community.
Throughout the history of the church, Christians have been actively involved in the provision and funding of health and medical resources. But for the past 50 years, these functions have been treated as political problems reserved for the state rather than matters to be addressed by the church.
Some Christians though, are beginning to reassert this biblically mandated role by participating in health care sharing ministries (HCSM). HCSMs are not insurance companies, but nonprofit religious organizations that help members pay for medical treatments.
As the Alliance of Health Care Sharing Ministries explains, “A health care sharing ministry (HCSM) provides a health care cost sharing arrangement among persons of similar and sincerely held beliefs. HCSMs are not-for-profit religious organizations acting as a clearinghouse for those who have medical expenses and those who desire to share the burden of those medical expenses.”
India’s best-known heart surgeon was interrupted during surgery to make a house call. “’I don’t make home visits,’ ” said Devi Shetty, “and the caller said, ‘If you see this patient, the experience may transform your life.’ ” The request came from Mother Teresa, and the experience did change his life. Shetty’s most famous patient inspired the cardiac surgeon and healthcare entrepreneur to create a hospital to deliver care based on need, not wealth.
In 2001, Shetty – who the Wall Street Journal has given him the title of Henry Ford of heart surgery — founded Narayana Hrudayalaya (NH), which Fast Company magazine describes as “Walmart meets Mother Teresa.” Today, NH is one of India’s largest multi-specialty hospital chains and has created a record of performing nearly 15,000 surgeries on patients from 25 foreign countries. The hospital group believes it can soon cut the cost of heart surgery to a mere $800 per procedure.
If it can be done in India, why can’t it be done in the U.S.?
It could — maybe — but we’d need to learn the following lessons from India’s most innovative hospital:
In addition to internal logical inconsistencies which raise serious concerns of long term economic sustainability regarding the Affordable Care Act (ACA), recently analyzed by John MacDhubhain, Robert Pear reports in the New York Times over the weekend how confusion over certain ambiguities in the law (ironically over the meaning of the word “affordable”) would end up hurting some of the people it is precisely designed to help: working class families.
The new health care law is known as the Affordable Care Act. But Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular.
Under rules proposed by the service, some working-class families would be unable to afford family coverage offered by their employers, and yet they would not qualify for subsidies provided by the law.
Many politicians have talked of repealing the Patient Protection and Affordable Care Act (“Obamacare”). Mitt Romney has said nullifying the healthcare law would be one of his first actions if he was elected president. However, rather than just repealing the law and going back to the status-quo, with minor changes, the American people should demand true reform.
In 2001, Milton Friedman, the famed, Nobel-prize winning economist, published an article titled “How to Cure Health Care.” (Although worthy of serious consideration, Friedman’s analysis does not contain any explicit moral message, and is simply a policy analysis on healthcare. For a more in-depth look at the moral dimension of healthcare reform, visit Acton’s special section on healthcare)
In his essay, Friedman stated that, “The United States spends a mind-boggling percentage of its GDP on a health care system that virtually everyone agrees is a disaster,” and that was in 2001. Spending has only increased over the past decade. In fact, according to the Department of Health and Human Services Center for Medicare and Medicaid Services, the United States spent 17.6 percent of its GDP on healthcare in 2009, and this figure is expected to grow over time.
In addition to out of control spending, studies in the United States and Europe at the time were showing “…public dissatisfaction with the increasingly impersonal character of medical care.” Recently, a 2010 Gallup poll showed a majority of Americans are satisfied with the quality of healthcare they receive (62 percent rated quality as excellent or good), but only 39 percent rated the availability of coverage as excellent or good.
How did this happen? How has massively increased spending led to unsatisfactory coverage?
In four words: the government got over-involved.
Friedman explained, “In other technological revolutions, the initiative, financing, production, and distribution were primarily private, though government sometimes played a supporting or regulatory role.” However, in healthcare, the government decided to intervene and regulate extensively.
It all started at the onset of World War II when, due to wage and price controls enacted during the war, “firms competing to acquire labor at government-controlled wages started to offer medical care as a fringe benefit,” which was not recorded as part of their salary due to the wage-controls. As a result, employees came to expect healthcare from employers as part of their compensation.
The IRS eventually wised up to this and, wanting more revenue, started to tax the contribution. Workers raised an uproar so Congress passed a law, The Revenue Act of 1942 (Section 127 specifically), allowing, in Friedman’s words, “… medical care expenditures to be exempt from the income tax, if, and only if, medical care is provided by the employer.” This system, according to Dr. Donald P. Condit in his Acton Institute commentary “Should Business Be Responsible for Employee Health Care?”, “effectively punishes taxpaying citizens who are paying for health care benefits with after-tax dollars.”
Thus, if an employee paid directly for healthcare, this was added to their taxable income, but, if they went through their employer, it was not, setting up a large incentive to get insurance coverage from one’s employer. Condit states “medical spending has increased with this ‘tragedy of the commons’ scenario, wherein resources [health care dollars] are overconsumed with the perception that someone else [the company, the government] is paying.”
Friedman similarly demonstrated the result of this and other policies dealing with healthcare with a simple example: “In 1946, seven times as much was spent on food, beverages, and tobacco as on medical care; in 1996, more was spent on medical care than on food, beverages, and tobacco.” In 50 years, healthcare went from a minor expenditure to the major expenditure of most people, and, during this period, spending by individuals and government on healthcare approximately quadrupled.
Friedman explained, “On the evidence to date, it is hard to see that we have gotten much for quadrupling the share of the nation’s income spent on medical care other than bureaucratization and widespread dissatisfaction with the economic organization of medical care.”
What can be done?
For starters, Friedman said: “If the tax exemption were removed, employees could bargain with their employers for higher take-home pay in lieu of medical care and provide for their own medical care either by dealing directly with medical care providers or by purchasing medical insurance.” This would make families more responsible for their own healthcare and they could adjust accordingly, either spending less/more on healthcare or taking more/less in wages. (It seems that most would probably spend less on healthcare and take more income in light of this National Journal article).
This kind of reform would help by “reprivatizing medical care by eliminating most third-party payment, and restoring the role of insurance to providing protection against major medical catastrophes,” rather than using insurance to pay “for regular medical examinations and prescriptions.”
This sounds great, in theory, but how would such a drastic change actually be accomplished?
Friedman advocated for medical savings accounts. He stated: “A medical savings account enables individuals to deposit tax-free funds in an account usable only for medical expense, provided they have a high-deductible insurance policy that limits the maximum out-of-pocket expense.” This way, employees, not employers, would be responsible for their own healthcare spending, hopefully eliminating the third-party problem, while allowing the wages contributed to still be tax free.
Several companies, including Forbes, Quaker Oats, and the Golden Rule Insurance Company, tried out medical savings accounts instead of employer provided insurance and found that healthcare costs were lower and both management and employees were more satisfied than under the old employer provided system.
Friedman stated, “Families would once again have an incentive to monitor the providers of medical care and to establish the kind of personal relations with them that were once customary.”
This puts responsibility back on the individual to care for his or her family and brings to mind the words of 2 Thessalonians 3:10: “If a man will not work, he shall not eat.” Modern healthcare is obviously not comparable to biblical food, but the concept of individual responsibility has largely been lost with employer provided healthcare. This reminds all that a family is better served caring for itself rather than relying on someone else to make choices, including healthcare, for them. Condit, in his essay, says as much: “Employer, or any third party, involvement in providing health care can interfere with an employee’s ability to make his or her own decisions and distort individual responsibility.”
Also, allowing families to manage their own healthcare costs would allow for greater efficiency by means of more efficient spending. For instance, instead of using insurance to pay for a doctor visit due to a cold or a small prescription, one could pay out of pocket. If most people paid out-of-pocket, the cost would likely go down because what individual would pay $80 (like my insurance company does) for a 20 minute doctor visit? By putting people in control and not insurance or government bureaucracies, one could expect people to “shop around” for quality doctors. Then, doctors’ offices would likely offer better care to compete for patients, instead of expecting an $80 to $100 payout from the insurance company or the government.
In addition, Friedman advocated for the abolishment of Medicare and Medicaid, which sounds rather radical. However, he said the government should “…replace them by providing every family in the United States with catastrophic insurance (i.e. a major medical policy with a high deductible).”
That way “the family would be relieved of one of its major concerns – the possibility of being impoverished by a major medical catastrophe – and most could readily finance the remaining medical costs.”
This should satisfy the concern that impoverished citizens would not get adequate coverage. Even if a small portion of the population is chronically ill or unable to pay their medical bills, these people would be covered by a government catastrophic care policy.
It is a citizen’s duty to care for those individuals in their communities who simply cannot help themselves. Condit states, “Christians, and others, are expected to fulfill a service obligation, with a preferential consideration for the poor and underserved.” This corresponds to the principles of subsidiarity and sacrifice seen throughout Catholic and Christian teaching.
In Luke 3:11, John the Baptist states: “The man with two tunics should share with him who has none, and the one who has food should do the same.” Jesus himself said, in Luke 14:13, “when you give a banquet, invite the poor, the crippled, the lame, and the blind.” Again, in Jesus’ and John’s teaching, the focus is on “you”, the individual, caring for ones neighbor, rather than an entity such as the government (or a corporation). The government, naturally being more impersonal and disconnected, could provide support in the severest cases, when communities and individuals could not support their own.
Rather than harming the less-fortunate and marginalized, this kind of health reform could free up time and hospital beds (many families would spend much less time and money on care) to help those chronically ill individuals who truly need the best care and doctors available. Friedman’s approach does not solve all the problems of healthcare (how do I know this doctor/hospital is reputable or provides good care since there is no rating service, what about those that refuse to or cannot pay out of pocket, etc.) and this is only a basic analysis, but it does offer a seldom discussed approach to improve care, allow for greater individual independence, and decrease costs.
Despite a promise of “complete and fair coverage of health care for everyone for free,” the Greek state-controlled system is broken and corrupt, the Athens daily ekathimerini.com reports. Predictably, Greeks have taken it upon themselves to build a private health care sector:
Despite hikes in Greece’s health spending between 2000 to 2008 being among the highest of all OECD countries, this has not been matched by growing life expectancy rates, the report added. Turning to the hospital system, corruption has grown due to poorly run operations and an improper organisation structure with about one in five Greeks admitting to having paid a bribe in order to receive medical treatment at a state hospital. These problems have contributed to growth in the private healthcare industry which provides crucial services but also enjoys the benefit of not having any competition, the report added.
In the UK, the National Health Service has been using hospital beds as housing for senior care, to the detriment of people who actually need hospital beds. From the Telegraph:
If current trends continue, almost 100,000 of 170,000 NHS beds will end up being filled by elderly people who are well enough to be in residential care. This will cost the health service millions of pounds and throw its day-to-day operations into chaos, says the report by Bupa, the health insurance and care provider. It blames the looming crisis on a “17-year legacy of under-funding in the care home sector”. The next few years will see the problem getting progressively worse, the report’s authors predict, despite a Coalition pledge that local authorities will have an extra £2 billion to spend on adult social care over the next four years.
For more on this issue, see Acton’s Health Care resource page.
From the Jan. 5 Acton News & Commentary. This is an edited excerpt of “Health-Care Counter-Reform,” a longer piece Dr. Condit wrote for the November 2010 issue of the Linacre Quarterly, published by the Catholic Medical Association. For more on this important issue, see the Acton special report on Christians and Health Care. Dr. Condit is also the author of the 2009 Acton monograph, A Prescription for Health Care Reform, available in the Book Shoppe.
Obamacare and the Threat to Human Dignity
By Dr. Donald P. Condit
Since President Obama signed the Patient Protection Act into law in March 2010, the acrimonious debate on this far-reaching legislation has persisted. For many, the concerns over the Obama administration’s health care reform effort are based on both moral and fiscal grounds. Now, with House Republicans scheduling a vote to repeal “Obamacare” in the days ahead, the debate is once again ratcheting up.
Perceived threats to the sanctity of life have been at the heart of moral objections to the new law. Despite a March 2010 executive order elaborating the Patient Protection Act’s “Consistency with Longstanding Restrictions on the Use of Federal Funds for Abortion,” many pro-life advocates fear a judicial order could reverse long-standing Hyde amendment restrictions on the use of federal tax dollars for abortion. Impending Medicare insolvency and the Patient Protection Act’s establishment of an “independent payment advisory board” to address treatment effectiveness and cost suggest bureaucratic restrictions on the horizon for medical care of the elderly and disabled.
The objections made on fiscal grounds are serious. Prior to the 2008 presidential election, Barack Obama voiced concern for 47 million Americans without health insurance. More recently, supporters of this legislation focused on 32 million Americans, with 15 million immigrants and others left out of the equation, yet still requiring care in United States emergency rooms. The Patient Protection Act increases eligibility for Medicaid recipients, yet state budgets are severely strained with their current underfunded medical obligations. Moreover, doctors struggle to provide health-care access to Medicaid patients when reimbursed below the overhead costs of delivering care.
Who Should Pay?
The perception among consumers of third-party responsibility for health, including payment for health-care resource consumption, is the major factor for unsustainable escalation of medical spending in the United States. Yet the Patient Protection Act augments third-party authority and threatens doctor-patient relationship autonomy, by increasing responsibility of government and employers for health care. Patients and physicians will face increasing involvement of third parties in decision making in exam rooms and at the bedside. (more…)
Dr. Donald Condit joined host Drew Mariani on the Relevant Radio Network to discuss the positives aspects of end-of-life planning as well as the troubling issues surrounding end-of-life care under government health care systems. Dr. Condit is an orthopedic surgeon and the author of Acton’s monograph on health care reform, entitled A Prescription for Health Care Reform and available in the Acton Bookshoppe; he has also authored a number of commentaries on health care for Acton and other organizations; his most recent commentary can be read right here. And don’t forget to check out Acton.org’s special section on Christians and Health Care for a wealth of related information.
To listen to Dr. Condit’s 20 minute interview with Drew Mariani, use the audio player below.