Posts tagged with: subsidiarity

In the National Catholic Register, Kathryn Jean Lopez looks at the current debate on Social Security and asks: “So, is it a Ponzi scheme? Is it time to blow it up? Are these questions freaking people out — and missing the point?” Acton Research Director Samuel Gregg is extensively quoted in the article. Here he is explaining how the principle of subsidiarity plays into the debate.

“Integral human development requires us to make free choices and to be assisted in doing so to the extent that we are enabled to do so. That means, for instance, that a Social Security system that sought to provide everyone with everything is highly problematic because it destroys and undermines our ability to make free choices. It reduces us to a state of dependency. That is not integral human development.”

Therein enters subsidiarity, which has become an unnecessarily and unhelpfully loaded term in debates about Catholic social teaching and prudential political decisions.

“The way that CST reconciles everyone’s need to make free choices consistent with their vocation, ability and needs and everyone’s need for some form of assistance is through the principle of subsidiarity,” Gregg explains. “Subsidiarity comes from the Latin subsidium, which means to assist. … [It] thus combines axioms of noninterference and assistance. It follows that when a case of assistance and coordination through law or the government proves necessary, the assisting community should accord as much respect as possible to the rightful autonomy of the assisted person or community. The primary significance of this principle thus lies … in the fact that this autonomy is essential if people are to flourish as persons.”

Read “Stewarding Social Security to a Secure Future” on NCR.

Director of Research Samuel Gregg has a piece in Public Discourse today as part of a series on the 2012 presidential election. “Fix America’s Economy: Two Principles for Reform” explains why limited government is better government, and how the principle of subsidiarity can guide regulation that governments undertake. From the essay:

The economist Arthur Brooks is exactly right when he notes that the end-game of America’s free enterprise culture is not the endless acquisition of wealth. The goal is human flourishing.

In much of Europe, a contrary attitude has long been characteristic of its economic culture: that if people are to lead fulfilling lives, they need to be given things and protected from risk. In policy and institutional terms, this translates squarely into the European social model, which is presently collapsing before our very eyes throughout the Old Continent.

Ironically, however, there is a scarcity of evidence that such policies actually help make people happy. Why? Because people who are always given things know that they have not earned what they have. As evidence, Brooks points to studies that underscore correlations between unearned income and dissatisfaction with life. These illustrate, for example, that welfare recipients are generally less happy than those who earn the same income through employment.

Still, there is a need for governmental regulation of free economic activity—for exceptions to the rule of non-intervention:

But how do we prevent the exceptions from becoming the rule and thus a rationalization for endless economic intervention by the government? Part of the answer lies in a second principle: the much-misunderstood idea of subsidiarity.

Subsidiarity may be summarized in the idea that “higher” organizations (such as governments) should normally not directly intervene in the life of “lower” communities (such as families, businesses, and churches).  Intervention by higher bodies is permitted, however, when (1) a “lower” community has proved itself manifestly incapable of addressing problems that properly fall within its sphere of responsibility; and (2) other communities closer to the problem are unable to resolve the difficulty.

Subsidiarity consequently tells us that in normal circumstances, the function of child-raising is properly performed by families. It also tells us that when a family proves incapable of addressing particular problems associated with child-raising, non-governmental actors such as churches should usually be the first to render assistance.

As Gregg writes in his conclusion, because the principles of economic freedom and subsidiarity both stem from our human nature, successful government cannot ignore them.

If the economy features as the biggest single issue in the 2012 election, defenders of the market should be willing to supplement empirical economic arguments with full-bodied contentions about the nature of human happiness and how we realize it. To do so would not only be consistent with the very best of the American Founders’ vision; it would also breathe new life into America’s great and ongoing experiment of ordered liberty.

Both the religious right and left have weighed in during the heated federal budget battle as Congressman Paul Ryan’s proposed budget has seen its fair share of support and criticism from many religious leaders.

In a recent article appearing in Our Sunday Visitor Congressman Ryan explains how he used Catholic social doctrine to help draft his proposed budget opening up with his views on it should be utilized by politicians:

Catholic social doctrine is indispensable for officeholders, but there’s a right way and a wrong way to understand it. The wrong way is to treat it like a party platform or a utopian plan to solve all of society’s problems. Social teaching is not the monopoly of one political party, nor is it a moral command that confuses the preferential option for the poor with a preferential option for bigger government.

[…]

Policymakers apply timeless principles to policies that are necessarily limited by changing circumstances. The judgments of equally well-intentioned citizens may differ. Usually, there isn’t just one morally valid policy. Instead, there are better and worse ones calling for respectful dialogue and thoughtful judgment. The moral principles are dogmatic; the political responses are prudential.

Throughout the article Congressman Ryan defends his proposed budget by articulating how the poor and vulnerable will benefit, how it preserves human dignity, that it creates budgetary discipline (which according to the Congressman is a moral imperative), and abides by the principle of subsidiarity.

Furthermore, Congressman Ryan argues the U.S. government cannot keep the principles promoted by Catholic social doctrine if the country defaults stating: “Preferences for the poor, solidarity, subsidiarity, the common good and human dignity are disregarded when governments default and bankrupt economies stop producing. Economic well-being is a foundation stone of an enduring ‘civilization of love.’”

Here at the Acton Institute we also understand the importance of passing a federal budget that is morally sound. We wrote our Principles for Budget Reform where readers can find articles, videos, and blog posts in support of four vital principles.

To read the full article click here.

Click here to read the Acton Institute’s Principles for Budget Reform.

Blog author: jmeszaros
posted by on Wednesday, July 6, 2011

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.

 

In a new article on Public Discourse, Samuel Gregg explores social contract theory and how that may apply to the current budget battles:

In very broad terms, social contract theory is a way of understanding the relationship between governments and the people. It holds that, having agreed upon the need for a government, individuals create a state on the basis of mutual promises. This permits the state to claim that its authority is based on a delegation of people’s rights to pursue their particular interests in their own way.

Our present economic disputes are, at a deeper level, about the precise content of those mutual promises. One influential interpretation may be found in John Rawls’ Theory of Justice.

On the basis of what reasonable people in an imaginary “original position” and blinded by a “veil of ignorance” about their future abilities, social status, etc., would want, Rawls argued that each person had “an equal right to the most extensive total system of equal basic liberties with a similar system of liberty for all.”

As part of this calculation, Rawls maintained that no one in the original position would risk being abandoned at the bottom of the social heap. Rawlsian social contract theory has thus, economically speaking, usually been interpreted as translating into extensive entitlement programs and large welfare states.

At the other end of the social contract spectrum is an older concept. This was given prominent expression in John Locke’s Second Treatise of Government.

In Locke’s view, what he called “the Law of Nature” meant that individuals were morally bound not to damage other people’s lives or property. The only way to ensure that this was given effect was through a government that defended everyone against anyone else’s attempts to damage their lives or property. The citizens thus agreed to set up a state that would protect the life, liberty, and property of everyone living under its sovereignty.

In economic terms, this position broadly equates to a state that focuses upon protection of property rights and adjudication of contractual disputes. Issues of distribution according to criteria such as need are deemed beyond the state’s competence.

The significance of these understandings of the social contract is difficult to overstate. The Lockean conception profoundly shaped the Declaration of Independence and much of today’s movement for limited government. By contrast, the Rawlsian interpretation represents the most contemporary philosophical underpinnings of modern American progressivism.

Not only does Gregg explain the problems with different ideas of social contracts, but he articulates what is needed for people to flourish in a society. Gregg states that many times it is the principle of subsidiarity that allows people to be successful:

Subsidiarity’s genius is the manner in which it uses this attention to free choice, human flourishing, and the need for support to provide guidance concerning how we apply subsidiarity’s two axioms of non-interference and assistance. It helps us determine (1) what economic roles can only be performed by the state (such as the provision of courts to adjudicate contractual disputes); (2) when the state should allow other communities to provide assistance (private banks should normally be the first place of call for loans); (3) when the state should intervene outside its normal economic responsibilities (when those communities that would normally assist are clearly unable to do so); and (4) when such interventions should cease (when they start impeding human flourishing or when the communities that normally provide assistance are now able to do so).

Click here to read the full article.

A dispute has arisen in Illinois between Catholic Charities and the state government. As the National Catholic Register explains it, “Catholic Charities branches of three Illinois dioceses have filed a lawsuit against the state of Illinois in order to continue operating according to Catholic principles — by providing foster care and adoption services only to married couples or non-cohabitating singles.” In an interview, with the newspaper, Rev. Robert A. Sirico defends Catholic Charities in light of the principle of subsidiarity while arguing for the right of the Catholic Charities to exist and conduct its own business without the influence of the state:

“What is it about foster care that necessitates a state-run system? Why can’t it be done on local levels?” he said. “Why can’t a city, municipality or affiliation of organizations do it and merely abide by standards set by the state? But when you have it monopolized, in effect, by the state [which uses organizations such as Catholic Charities as contractors to provide services], then you have the political-interest groups in control.”

Rev. Sirico also offers a solution for guaranteeing the independence of Catholic Charities:

“I think we need to separate the giving from the mechanism of the state,” Father Sirico continued. “I think there are ways to incentivize people to give that aren’t channeled through political and bureaucratic agencies. For instance, what if we had a tax credit to corporations or individuals that allowed their money to be used in a way that isn’t run through the state, but for services that they’re already obligated to pay the state to perform? For example, you have a tax obligation; but let’s say you’re allowed to take the portion going to social services and designate it to a specific charity you wanted to support. You don’t pay the state. The state reduces its involvement in that sphere. What you do is present the state with a documented receipt that you paid money to that charity.”

Click here to read the full article

In today’s edition of Capital Commentary, HBU assistant professor of literature Micah Mattix explores the question, “How Might the Arts Be Funded?” He ably and briefly surveys the recent history of politics surrounding the NEA.

And he concludes by noting that art is inherently “relational” and that “the problem with large, centralized organizations like the Endowment is that they are often unable to take such relational elements into account.”

He muses:

However the arts are to be funded, this relational element of art must be taken into account. Instead of encouraging artists to write against their audience out of spite or merely play it safe, funding should help artists to flourish while encouraging them to communicate the truth (of which speaking “prophetically” is part) in love. I wonder if funding the arts at the local level might help to do exactly this.

We can think of it in another helpful way as the concept of subsidiarity (which is a principle of society, not just politics) applied to the arts, specifically artists and their communities and audiences. In some ways this question about funding and the arts is a subset of the broader cultural critique of the market economy, that is, that markets do not support authentic cultural expression. This also has to do with whether you think work, leisure, or some third thing is the basis of culture.

In an argument analogous to that which Abraham Kuyper makes in his treatise, Common Grace in Science and Art, it may be at one time that the arts were necessarily dependent on institutional support from the church and the state in order to exist and grow. But we are certainly at the point, at least in the developed West, where it is not strictly necessary from a purely financial point of view that the government serve as the sole, or even primary, patron. The ideal in this vein is that the arts flourish and mature, come into their own and stand in their own independent space, related to other spheres yet distinct from them in terms of their general sustenance. (This is not to say that civic and sacred art projects are out of bounds, but that they do not exhaust the limits of art as a cultural phenomenon. They are, rather, projects that are intended to illustrate the grandeur of the empire, whether temporal or eternal, respectively.)

Mattix draws on a recent controversy over the Christian stewardship of art published in the Journal of Markets & Morality between Calvin Seerveld and Nathan Jacobs. You can find the text of their dialogue in issue 12.2, and you can also listen to a subsequent podcast moderated by David Michael Phelps (in two parts: Part 1 and Part 2).

John Boehner

On National Review Online, Acton’s Rev. Robert A. Sirico has a new commentary on the letter sent by a group of Catholic academics to Speaker of the House John Boehner. The occasion for the letter is Boehner’s commencement address at Catholic University of America in Washington this weekend. The letter accuses the Ohio Republican of having “among the worst” record in Congress for supporting legislation that addresses the “desperate needs of the poor.”

Rev. Sirico:

It appears then that these Catholic academicians who have written to Speaker Boehner do not understand the distinctions the Church herself makes between fundamental, non-negotiable dogmas and doctrines, and the prudential and debatable give and take when it comes to applying the principles of Catholic social teaching. Here Speaker Boehner need only consult the text of the Compendium of Catholic Social Teaching, which the authors of the letter say they have delivered to him, wherein he will read: “The Church’s Magisterium does not wish to exercise political power or eliminate the freedom of opinion of Catholics regarding contingent questions.” (no. 571)

The specifics of the 2012 Budget proposed by the Speaker and his colleagues are, the letter’s authors contend, the result of either ignorance or “dissent.” I think they are neither; they simply reflect a different, and in many people’s estimation, more accurate and economically-informed way, of proposing how we achieve worthy goals. Indeed, it could be said that what these Catholic academicians are proposing is not a “preferential option for the poor,” but rather a preferential option for the State. They make the unfortunately common error of assuming that concern for the economically weak and marginalized must somehow translate into (yet another) government program.

That assumption is wrong, and flies in the face of another principle of Catholic social teaching — the principle of subsidarity. With good reason, this is something the Catholic Left — or whatever remains of it these days — rarely mentions or grapples with, because they know that it would raise many questions about the prudence of any number of welfare programs they support.

Indeed, what strikes me about this letter to Speaker Boehner is how reactionary it is.

Read “Boehner’s Catholic Critics Rush to Protect Welfare State” on NRO.

The Detroit News published Dr. Don Condit’s Acton commentary on Accountable Care Organizations (ACOs) in today’s paper. The ACOs are designed to manage costs under the Patient Protection and Affordable Care Act, better known as Obamacare.

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 that 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. Doctors will face agency conflicts between the time honored primary duty to patient. 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.

Read “Obamacare rules belie compassion, care” on the Detroit News website.

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.