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.
No, it’s not a Sherlock Holmes book. It’s reality: American is losing doctors.
When most of us have a medical concern, our first “line of defense” is the family physician: that person who checks our blood pressure, keeps on eye on our weight, looks in our ears and our throat for infections, and does our annual physicals. And it’s these doctors that are becoming scarce.
A new provision under Obamacare will fine tax-exempt hospitals via the Internal Revenue Service:
A new provision in Section 501 of the Internal Revenue Code, which takes effect under Obamacare, sets new standards of review and installs new financial penalties for tax-exempt charitable hospitals, which devote a minimum amount of their expenses to treat uninsured poor people. Approximately 60 percent of American hospitals are currently nonprofit.
With Obamacare (the Affordable Health Care Act) set to begin on October 1, many companies are changing their employee health care. For some, it’s a change in what benefits employees will receive; for others, employees will be losing health care all together and told to sign up under Obamacare.
The Wall Street Journal did a “round-up” of companies who’ve announced changes. Walgreens is the largest employer yet to disclose employee health care changes.
[T]he drugstore giant disclosed a plan to provide payments to eligible employees for the subsidized purchase of insurance starting in 2014. The plan will affect roughly 160,000 employees, and will require them to shop for coverage on a private health-insurance marketplace. Aside from rising health-care costs, the company cited compliance-related expenses associated with the new law as a reason for the switch.
Referring to the Affordable Care Act, chairman of the Senate Finance Committee, Max Baucus (D-Mont.) stated earlier this year, “Unless we implement this properly, it’s going to be a train wreck.”
And indeed, from looking at the Obamacare implementation timeline alone, the law seems to have gotten off to a shaky start. The implementation of the so-called employer mandate, which would require businesses with more than 50 workers to offer insurance to all full-time employees, or else pay a fine of $2,000 per worker, has been delayed until after the 2014 midterm elections. And in late June, the Obama Administration announced another delay when it pushed back the August 1, 2013 deadline of requiring religiously-affiliated non-profits to comply with the mandate to provide coverage of contraceptives, to the beginning of next year.
Time can prove valuable and as the impending “train wreck” of Obamacare gathers momentum, more and more good, free-market alternatives are beginning to take shape.
One such approach will soon be discussed in the Michigan Senate. Last week, the Senate Government Operations committee voted to send two pieces of legislation, which would create a free-market alternative to Medicaid expansion, to the full Senate for consideration by the Chamber. “Senate Bills (SB) 459 and 460, introduced by Sen. Patrick Colbeck (R-Canton) and known as the Patient-Centered Care Act, would enact a patient-centered healthcare plan that expands access to quality care without expanding government,” according to a statement released last month. (more…)
“We have to pass the bill so that you find out what is in it, away from the fog of the controversy.”
Nancy Pelosi was the House Speaker when she made those remarks about Obamacare at the 2010 Legislative Conference for the National Association of Counties. At the time, Pelosi was mocked for not understanding what was in the legislation she was supporting. But the reality is that with all legislation that is considered by Congress, we almost never really know what is in it until it has been passed.
If you took civics class in high school (or just watched Schoolhouse Rock), you likely know how a bill becomes a law. But what most people don’t understand is the process by which a law becomes policy.
We often think that the judiciary is the branch of government responsible for interpreting the law. But in reality most interpretation is done by the executive branch, through the various regulatory agencies. Regulatory agencies handle administrative law, primarily by codifying and enforcing rules and regulations. When Congress passes a new law it usually goes to a regulatory agency to determine how the law will be put in place.
The presence of one group at the Occupy Wall Street (OWS) protests might be surprising: the Distributist Review has produced this flyer for distribution at the protests. They don’t seem to have asked themselves whether G.K. Chesterton and Hillaire Belloc would have gone down to protest with the unwashed masses (the answer, of course, is never in a million years) but contemporary “neodistributists” are a more inclusive set. They go far beyond the metaphysical and aesthetic principles of Chesterton and Belloc’s economics. Since that flyer’s a little hard to read, we’ve put together a list to help you identify your inner distributist: herewith, Ten Signs You May Be a Distributist:
- You can’t wait for the Revolution: As we’ve explained before, the changes distributists want amount to revolution. That puts them squarely in line with the rest of the OWS camp, whose communications head told NPR, “My political goal is to overthrow the government.” Fortunately, the revolution will be prosecuted in accord with Catholic Social Teaching. (What’s a little property-snatching among friends?) If this idea excites you, you may be a distributist!
- You just want to grow heirloom tomatoes in a co-op: Or maybe your grandfather’s strain of prized carrot. Either way, if think the Catholic Social Teaching mandates this kind of lifestyle, you may be a distributist!
- You abominate the seedless watermelon: The seedless watermelon is an unnatural monstrosity, you say? If you oppose genetic engineering on principle and begrudge the one billion lives saved by the Green Revolution, you may be a distributist!
- You find yourself supporting environmentalist policies, but for different reasons: If you find yourself always on the side of radical environmentalists, but as with the seedless watermelon, different principles lead you to their extreme positions — well, puzzle no longer. You may be a distributist!
- You think you live in a polis: If you’d like to impose virtue on 307 million people the same way you would on 75,000; if you think that what worked on a co-op level in Spain can be scaled up 60,000 percent without distortion; and if you insist on economic self-sufficiency — in short, if you’re more attached to the form of the polis than Aristotle himself was, then you may be a distributist!
- You find yourself asking “What would Frodo do?”: Distributists often take The Shire of J.R.R. Tolkein’s The Lord of the Rings as a model society (mostly those who consider a return to the polis too fantastical). If you’re convicted that eating two breakfasts a day is more in line with Catholic Social Teaching, you may be a distributist!
- You really miss guilds: If you’ve mythologized the quaint, confraternal aspects of medieval guilds, and don’t mind overlooking how controlling they were; if you love the idea of long apprenticeships and don’t mind sweeping grants of patent and absolute trade secrecy, you may be a distributist!
- You dislike intellectual property: If you view Article I, Section 8 of the Constitution as a tool for enriching the plutocracy (except of course when monopolies are given to guilds) and identify more with the Swedish-internet-pirate school of thought, you may be a distributist!
- You bleed your patients with leeches: If you long for the simpler, more local health care system of the Middle Ages, when your barber performed appendectomies and your doctor’s first instinct in case of illness was to send for leeches, then you may just be a distributist!
- You brew your own beer: Coors is the beer of Republicans, O’Doul’s is probably the beer of the Tea Party, and the unwashed hipsters at OWS all drink Pabst Blue Ribbon, but if you brew your own beer, you may be a distributist! (No word on what Chesterton thought of bathtub gin.)
Last week the Federal Circuit Court handed down what seemed to many a funny decision: that human genes are patentable. Myriad Genetics owns patents for two tumor suppressor genes, BRCA1 and BRCA2 (mutations of these genes are correlated with increased incidence of breast cancer, making them of great interest to doctors and scientists). Myriad was sued by doctors and researchers who claim that genes fall into the category of “products of nature,” which makes them unpatentable, but the court disagreed.
Myriad’s patents allow it to charge licensing fees to doctors who wish to screen their patients for BRCA1/2 mutations, and also to researchers developing drugs that would target BRCA1/2 abnormalities in breast cancers. Myriad claims that its patents allow it to recover the costs of identifying the two genes, and so are just like the patents for Velcro, ShamWow, or the Segway. Aside from the legal dispute—i.e., the majority’s facially risible argument that “the molecules as claimed do not exist in nature,” since bits of the BRCA1 gene aren’t floating around in ponds—there are two problems with the patenting of genes: a moral one and a practical one.
In his Acton monograph The Social Mortgage of Intellectual Property, David H. Carey addresses intellectual property rights vis-à-vis the distribution of medicine. He focuses on the AIDS epidemic and infectious diseases in the Third World, and presents the Vatican’s 2001 argument that the principle of solidarity supersedes patent rights where the lives of the poor are at stake, even though the long-term consequences of a suspension of intellectual property might be severe.
Admittedly, personalized cancer treatment in the United States alters the moral calculation, but the American public has made its consideration, and by the establishment of the National Cancer Institute (part of the National Institutes of Health), has decided to fund early stage cancer research publicly. Certainly in order recoup the billions of dollars of testing required to bring a cancer drug to market, companies need the assurance of patent protection, but the sequencing of a gene comes years before any drug begins testing (Myriad filed for its patents in 1994).
As Francis S. Collins, head of the NIH, explained in a recent book,
The information contained in our shared [genome] is so fundamental, and requires so much further research to understand its utility, that patenting it at the earliest stage is like putting up a whole lot of unnecessary toll booths on the road to discovery.
Whether the Supreme Court reverses the Federal Circuit’s decision, or Congress passes a law making clear the proper extent of patent protections, this intellectual property mess must be untangled.
I’m not sure I have ever really encountered the term intergenerational justice before this discussion over “A Call for Intergenerational Justice,” at least in any substantive way. This unfamiliarity is what lay behind my initial caveat regarding the term, my concern that it not be understood as “code for something else.”
The Call itself provides a decent definition of the concept, or at least of its implications: “…that one generation must not benefit or suffer unfairly at the cost of another.”
One of the commenters here at the PowerBlog is Peter Vander Meulen, who runs the Office of Social Justice at the Christian Reformed Church (the denomination to which I belong). Vander Meulen rightly reiterates that much of the disagreement has to do with our differing views of the primary responsibilities of government.
Much of my concern with the Call is that is does not display enough in terms of substantive commitment to principles. I think our debates about the budget crisis need to lead us back to consider from first principles what the role of government in society ought to be relative to other social institutions. (I hope to provide more on that positively later this week.)
It is on this point that my concern about the invocation of intergenerational justice in this context, and social justice more broadly, is not being construed in a vigorous enough manner.
To put it bluntly: How can a call for intergenerational justice in particular, or social justice more broadly, have any plausibility without addressing the fundamental social problem of abortion? If intergenerational justice is about the duties and responsibilities from one generation to another, it seems obvious that the starting point of the discussion, from a particularly evangelical and even more broadly Christian perspective, should be on the question of whether that next generation has a right to come into existence in the first place.
It is an unfortunate reality that social justice and abortion are oftentimes not viewed as related in this way. Acton Institute research fellow Anthony Bradley wrote last week at WORLD’s site about how abortion is often not considered a priority justice issue. In the context of the abortion rate in New York City, he writes,
I’ve been browsing the mercy and justice websites of several of New York’s well-known churches and Christian non-profit groups for discussion of New York’s abortion crisis. Outside of the crisis pregnancy centers themselves, I have not found much of anything. What one will find are very good discussions on subjects like fighting homelessness, improving inner-city education, opening women’s shelters, and dealing with sex trafficking and juvenile delinquency. I raise this issue because I am concerned that perhaps the missional pendulum has swung too far in one direction.
Closer to the context of this discussion, Mr. Vander Meulen’s agency, the Office of Social Justice (OSJ), was instructed by the denominational synod last year to “boldly advocate for the church’s position against abortion.” This instruction was deemed necessary because the OSJ did “not currently offer many resources to advocate for the unborn,” despite the fact that there is an official denominational position on the question of abortion (while there is not one on so many of the issues that the OSJ does “boldly advocate” for). You can judge for yourself whether that situation has changed substantively in the intervening time (e.g. “Advocacy…Coming Soon!”).
One of the signers of the Call, Jim Wallis, perhaps illustrates this illegitimate dichotomy between social justice and abortion in his judgments about the moral status of the abortion question. In a 2008 interview with Christianity Today. When pressed on this point, Wallis spoke candidly:
“I don’t think that abortion is the moral equivalent issue to slavery that Wilberforce dealt with. I think that poverty is the new slavery. Poverty and global inequality are the fundamental moral issues of our time. That’s my judgment.”
By contrast I do think the “Guideline on Human Life” offered by CPJ is rather more helpful and substantive than the current efforts of the OSJ to “boldly advocate” against abortion.
But shouldn’t consideration of abortion be a critical consideration in any discussion of “intergenerational justice”? The Call itself invokes the context of “generations yet unborn” and the relationship between “grandparents” and “grandchildren.”
If the connection of abortion to the budget debate remains unclear to some in the context of intergenerational justice, we might raise the following considerations:
Does the Call adequately address government provision for funding of abortions, whether through entitlement coverage or through funding for organizations that provide abortion services, such as Planned Parenthood? There are clauses advocating that “Effective programs that prevent hunger and suffering and empower poorer members of society must continue and be adequately funded,” and that “We must control healthcare expenses.”
Is funding for Planned Parenthood support for “an effective program” that prevents suffering or something that should be cut?
And there are also clear demographic and population implications for questions of future funding of entitlements, including Social Security. As I noted above, I hope to make the link more clear later this week when I talk about the need to get back to basics in the budget crisis.
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.”