Posts tagged with: subsidiarity

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.

 

To provide water for people, communities have usually turned to  two different options: public or private utilities. However, if Bolivian President Evo Morales, leader of the Movement Towards Socialism Party, gets his way, the United Nations will pass a resolution blocking the sale of public water utilities to private companies. If adopted, this resolution will cause problems for many nations, especially the undeveloped countries receiving support from the U.N. that will be forced to abide by one option—public supply of water—instead of being permitted to consider privatization which may be more efficient and cost effective.  The makes the global water crisis much worse.

It will not help any country to limit its options when searching for the most efficient and cost effective solutions for providing a clean, sanitary, and abundant source of water.

Theories and examples in support and against both private and public water utility systems are numerous. A study conducted by the University of Michigan showed that water prices, in general, are too low. The study explains that direct and indirect subsidies, in both developed and undeveloped countries, have caused low prices, resulting in water waste. Furthermore, the study argues that if the subsidies are removed, the price of water will increase and provide an incentive for those utilizing water to not waste it. This, in turn,  will result in the investments that are needed to develop more efficient technologies. If subsidies are removed, then a lighter burden is placed on public funds.

Lending support to the findings of the University of Michigan study, a survey conducted in 2004 by Global Water Intelligence found that the under-pricing of water is widespread. The study analyzed the prices charged by water utilities in 132 major cities worldwide and found that 39 percent of water utilities had average tariffs that are set too low to cover basic operation and maintenance costs. Some 30 percent had tariffs that are set below the level required to make any contribution toward the recovery of capital costs.

Changing the price system may be a solution. Some argue for a metering that charges water users based on consumption. However, while subsidies are proving to be largely inefficient the question must be asked: Can those in undeveloped countries, who are already living in a state of grave poverty, afford increased prices on water?

The International Development Association and the World Bank are quick to point out the success of private water utilities. Examples can be found in Rwanda and Mozambique where the private sector helped provide, improve, and/or expand the water supply. The U.N. has acknowledged five reasons to pursue private sector partnerships.

A private sector supply of water can be more efficient and cost effective. According to the World Bank, it is estimated that in the United States each dollar of public funds raised for utilities has an opportunity cost of $1.30 of private consumption, and the average opportunity cost for each dollar of tax revenue raised is $1.17 for 38 African countries.

Critics of the privatization of water argue that while it is more efficient and cheaper, the private systems fall short of social equity in supplying water and charge higher prices. While there have been unsuccessful stories of privatization, the aforementioned examples in Rwanda and Mozambique are a just a few of the many success stories, and, as The Economist notes, when private utilities charge higher prices, that often corresponds to higher rehabilitation investments, better water quality, and better service.

Privatization will also promote the decentralization of  government, and in the case of many developing nations, remove the control of water out of the hands of corrupt bureaucrats. A large overarching centralized government is not needed. Instead, the principle of subsidiarity should be applied.

Private entities are able to supply an efficient and cost effective supply of water. Privatization is an effective solution, and its ability to meet the needs of consumers has improved. As a result, water supply can follow the principle of subsidiarity by utilizing other alternatives to supply water instead of through a system brought forth by a centralized government.

It is important to note that just as public utilities are open to corruption, inefficiencies, and poor management, so is privatization. Privatization can fall subject to a corrupt government. The example of Detroit is instructive here. For example, when a government decides to contract a private utility to supply water, instead of having an open bidding process, the government accepts no outside bids and picks a company that is owed a political favor. If privatization is to succeed government must take the appropriate actions to allow it to succeed and also nurture an environment that is open to decentralization, promoting business without unnecessary government interference.

Budget battles have heated up recently throughout the United States, and President Obama’s budget proposal has not been exempted from the intense discussion.

The current proposal by the President pushes our national debt to $15.476 trillion or 102.6 percent of our GDP.  Furthermore, there are no cuts to entitlement spending which consist of 57 percent of the spending in the budget, or approximately $2.14 trillion.

While it is imperative to our economic recovery to have a budget that is fiscally sound, it is also crucial to have a budget that is morally sound.  There are critics to cutting entitlement programs, however, a fiscally sound budget which may require a look at entitlement cuts and reforms, will help the poor and vulnerable.  If we continue the spending trend the United States has been fostering under previous budgets than economic recovery will be hampered which means less job opportunities.  The poor and vulnerable will be dependent on entitlement programs, violating the principle of subsidarity.

A fiscally responsible budget also abides by stewardship principles.  To be good stewards we must look long term and create a strong and stable prospering economy not just now, but for our children and grandchildren.  Monsignor Ignacio Barreiro-Carámbula addresses this issue in his blog post:

…we are leaving our debts to future generations. We are asking them to pay the principal and the interest on our debt with their labors. This is akin to forcing them into a form of indentured servitude to us, and it will last long after we have gone to meet our Maker. By law, one can reject an inheritance if has more liabilities than assets, but a citizen cannot reject public debt if he wants to remain a citizen…

Rev. Sirico also articulates the necessity of morality in the Federal Budget during his recent interview with Raymond Arroyo on EWTN’s World Over.

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.

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…)

Last Thursday at Rome’s (but technically part of Vatican City) Pontifical Lateran University, Istituto Acton held a day-long conference on “Ethics, Aging and the Coming Healthcare Challenge.”

It was a successful event, if a bit unusual compared to some of our other Roman gatherings. It’s not often that an Acton conference is so focused on the finality of death, after all; we often stick to the other “inevitability” of life, i.e. taxes. Yet in both spiritual and economic terms, there’s no sense in denying it.

The conference covered many different aspects of the changing demographics affecting health care, ranging from declining fertility rates to pharmaceutical research to pensions to hospice care. One of the main objectives of the conference was to help participants understand how both ethics and economics can work together to help us confront the challenge of aging populations.

The conference was co-sponsored by the Pontifical Council for the Family, the John Paul II Institute for the Study of Marriage and Family, the Centro di Orientamento Politicio, Associazione Famiglia Domani, Human Life International, and Health Care Italia. As you can tell from the nature of these organizations, we sought to place health care issues in the context of the family, following Catholic social teaching’s emphases on this fundamental institution and the principle of subsidiarity.

Here are audio clips from three of our speakers who appeared on Vatican Radio’s English World News service:

Bishop Jean Laffitte, secretary of the Pontifical Council for the Family, click here

Dr. Daniel Sulmasy of the University of Chicago, click here

Dr. Michael Hodin, executive director of the Global Coalition on Aging, click here

For the first time, we live-streamed a conference on the Acton website, and we’ll soon post the conference papers and presentations as well as related media on the Istituto Acton webpage.

Kevin J. Jones of the Catholic News Agency interviewed Acton’s Rev. Robert A. Sirico and Dr. Steven Schneck, Director of the Institute for Policy Research & Catholic Studies at the Catholic University of America, to find out how the Tea Party lines up with Catholic Social Teaching. Here’s a snip:

Fr. Sirico described the Tea Party as “an amorphous thing” with a lot of variety and as a “populist, spontaneous movement.” He thought its common themes include a desire for less government and a desire “to limit the power that politicians have over peoples’ lives.”

Participants find motivation in a variety of philosophies. Some have “well-developed Catholic sensibilities” while others’ sensibilities are “almost anarchistic.” He thought it was “remarkable” that the Tea Party could bring so many non-political people into the political process. The Church’s teaching on subsidiarity can meet these people and “augment what they’re doing,” he said, while also guarding against “the more fanatical edges of the tea party.”

Fr. Sirico explained subsidiarity as being the principle that higher levels of society should not intervene in lower levels without “manifest and real necessity,” and such intervention should only be temporary. “Needs are best met at the local level,” he said, calling government “the resource of last resort.”

Read the entire article at “Catholic thinkers examine Tea Party movement and Church teaching” on Catholic Online.