I’m becoming more and more convinced that the talk of health care as a ‘right’ is so vague as to border on willful and culpable obfuscation. I certainly advocate a rich and complex description of ‘rights’ talk, such that simply calling something a ‘right’ doesn’t end the ethical or political discussion. Some ‘rights’ are more fundamental and basic than others, and various ‘rights’ require things of various actors.

But when it is asserted that access to health care is a ‘right,’ what precisely is the claim? Is it analogous to the claim that access to food and water, too, are rights? Very often these rights are equated in contemporary discussions: food and water, shelter, and health care.

One the one hand, however, it’s very odd to assert that health care, at least as practiced in its modern form (with X-ray machines and flu shots) is a right, at least in the sense that it is something that the human person qua person has a claim upon. If that’s the case, then all those millions of people who lived before the advent of the CAT scan were all the while having their rights ‘denied’ them (whether by God, fate, cosmic chance, or oppressive regimes bent upon keeping us from advancing medical technologies). It would also follow that all of those living today without access to these advanced technologies, simply by basis of their geographical and cultural location, are having their rights similarly denied. (This raises the troubling implication, not to be explored in any detail here, that the debate about health care in the industrial and post-industrial West amounts to a series of tantrums by the coddled and privileged about the requisite level of health care, which by any standard already dwarfs what is available to the global poor, who do not have access to what has the best claim upon ‘rights’ talk, even the most basic health care services.)

This raises the further question, if it be granted that health care is in some sense a right (which I am not opposed to granting), “What precisely does that right entail?” Clearly we can’t mean, in the context of the history of humankind, that this is a right to arthroscopic surgery or titanium hip replacement. That would be a bit like saying my right to food means that I have a claim to eating filet mignon. Just because someone else can afford to eat filet mignon doesn’t mean that my right to not starve gives me a similar claim upon filet mignon.

Similarly, just because some people can afford the greatest medical care available in the history of humankind (whether by the providence of God, fate, or cosmic chance), it doesn’t follow that I have a right to health care in that particular form. My basic claim to health care merely on the basis of my humanity is something more like the right to ramen noodles than it is to filet mignon.

This only describes what I am due by rights. It’s the least that’s required by the standards of justice.

And what might love require? “He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him.”

I take a look at the way corn subsidies skew our eating habits — and not always for the good of our health — in this week’s Acton Commentary. Excerpt:

Government policy-makers regularly prove themselves to be unwise decision-makers by continuing to introduce arbitrary agricultural price distortions that create incentives for producing unhealthy food through farm subsidies. Perhaps the most effective national health care initiative moving forward would be allowing markets to function so that people can make better food choices.

We cannot be good stewards of our bodies or nature if we do not have accurate information. Prices help to convey that information. For example, what would happen if the market determined actual corn prices? Not subsidizing corn would cause a needed price correction. Perhaps our hamburger value-meals would adjust in price creating disincentives to eat fast-food. Without corn and other agricultural subsidies, maybe the price of meat would adjust to a point encouraging different choices benefiting us all in the long-run. Maybe, for example, eating a 72-once steak at the Big Texan restaurant in Amarillo, Texas would be too expensive to consider.

While individuals are ultimately responsible to exercise good stewardship in choosing what and how much to eat, incentives can be distorted by government meddling in the market. Dr. Barry Sears, author of Toxic Fat: When Good Fat Turns Bad, argues, “The problem lies with America’s continually subsidizing of corn and soybean production.” Government subsidies generate “an oversupply of cheap refined carbohydrates and cheap vegetable oils that when combined give rise to increased diet-induced inflammation.” This inflammation in turn “activates the genes in people who are genetically predisposed to gain weight with relative ease,” giving rise to all the health problems connected to excessive weight. Medical spending for obesity is estimated to have reached $147 billion in 2008, an 87 percent increase in the past decade.

Read “Too Much Government Makes Us Sick” on the Acton Web site and come back here for comments.

[UPDATE BELOW] I discussed the creepy side of President Obama’s “science czar” here. But there are more creepy things in the cabinet. The Wall Street Journal reports that the president’s health policy adviser, Dr. Ezekiel Emanuel, wants to implement an Orwellian-sounding “complete lives system,” which “produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated.”

The WSJ piece continues:

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”

True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care.

Now a freer healthcare market could take care of rationing much more simply, while providing increased incentives for healthcare providers to provide better value to choosey consumers. The problem is, a freer healthcare market wouldn’t route power through Washington.

And yes, it is more about power than about wanting to spread scarce healthcare services around more equally. Otherwise, the government would pursue something like healthcare tax credits for lower and middle income Americans. And they would pursue meaningful tort reform to curtail wasteful defensive medicine and the regressive transfer of wealth from consumers (who pay higher medical costs) to wealthy trial lawyers.

And no, I’m not proposing that these power-hungry politicians are monsters. Most are probably sincerely convinced that their increased power will help them pursue the greater good down the road. It’s just that others have been down this road before, and it isn’t pretty.

UPDATE: Longtime medical ethicist Wesley J. Smith has a nuanced look at Dr. Emanuel here. The post concludes:

[H]e explicitly advocates rationing based on what appears to be a quality of life measurement. From the piece [in the Hastings Center Report]:

This civic republican or deliberative democratic conception of the good provides both procedural and substantive insights for developing a just allocation of health care resources. Procedurally, it suggests the need for public forums to deliberate about which health services should be considered basic and should be socially guaranteed. Substantively, it suggests services that promote the continuation of the polity-those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations-are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.

A lot of people are frightened that someone who thinks like Emanuel is at the center of an administration seeking to remake the entire health care system. Having read these two articles, I think there is very real cause for concern.

Blog author: jballor
Tuesday, September 1, 2009
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Ron Sider: “If American Christians simply gave a tithe rather than the current one-quarter of a tithe, there would be enough private Christian dollars to provide basic health care and education to all the poor of the earth. And we would still have an extra $60-70 billion left over for evangelism around the world.”

Jim Wallis: “I often point out that the church can’t rebuild levees and provide health insurance for 47 million people who don’t have it.”

Saleem H. Ali, a ‘pro-consumption environmentalist’ at the University of Vermont “argues that sometimes a nation has to extract a nonrenewable resource like oil, or tricky-to-recycle metals and gems, in order to leapfrog from dire poverty to a more diversified economy.”

“Money from oil wealth can be used to invest in other sectors. And that in turn can yield sustainable development,” Ali says.

Awhile back I sketched very briefly a view of the theological purpose of fossil fuels. On this view, “fossil fuels would thus have the created purpose of providing relatively cheap and pervasive sources of energy. These limited and finite resources help raise the standard of living and economic situation of societies to the point where technological research is capable of finding even cheaper, more efficient, renewable, and cleaner sources of energy.”

This meshes nicely with the Cornwall Declaration’s statement that “A clean environment is a costly good; consequently, growing affluence, technological innovation, and the application of human and material capital are integral to environmental improvement. The tendency among some to oppose economic progress in the name of environmental stewardship is often sadly self-defeating.”

ABC is refusing to air a national ad by The League of American Voters, featuring a neurosurgeon asking the question, “How can Obama’s plan cover over 50 million new patients without any new doctors?”

ABC justified the decision by pointing to a long-standing policy against running partisan commercials. Dick Morris, a onetime advisor to former President Bill Clinton and chief strategist for the League of American Voters, called the ABC decision “the ultimate act of chutzpah.” As he explains:

“ABC is the network that turned itself over completely to Obama for a daylong propaganda fest about health care reform,” he said. “For them to be pious and say they will not accept advertising on health care shuts their viewers out from any possible understanding of both sides of this issue.”

Fox News reports that NBC may also choose not to run the ad.

I suggest we respond to this abuse of the public airwaves by creating a little homegrown balance. Forward the commercial to friends and family, and while you’re at it, steer them to Acton’s health care page, which includes this piece on “The Problem with Socialized Government Healthcare.”

Blog author: ken.larson
Thursday, August 27, 2009
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As the fall school term approaches there were a lot of announcements this past week relating to education — both K-12 and college — including the annual publication of U.S. News and World Report’s America’s Best Colleges, a Wall Street Journal story about the SAT score results, ACTA’s College Report Card and ISI’s latest edition of “Choosing the Right College.” Then The Los Angeles Unified School District [LAUSD] decided to off load over 200 schools bought and paid for with tax dollars to applicants to operate as Charters. This is most disturbing although many will be shouting hooray.

Let’s recap the situation.

Nationwide, the public K-12 schools will continue to fail miserably despite an increased budget in 2009-10 that will include Obama stimulus money and total over $667 Billion spread over 50 million students — $13,000 plus per child. At colleges, freshmen with GPA’s of 4.7 and a slew of AP courses on their high school transcript will be guided to remedial writing labs so they can get up to speed and write a coherent essay by mid term. Many will not get better at it.

At the same time this is happening we as a nation are having town hall meetings and shouting matches with arrogant politicians and their minions over our distrust with the thought of having government run the health care delivery industry in this country.

Do you sense the disconnect? Why does the idea of public instruction or as my title suggests National Ed Care not bring about the same questioning and emotion and distrust inspired by the prospect of public health management? With education we have years of failure in the U.S. to use as evidence to argue for another path. A path devoid of public finance. But we’re not going there. Why?

Some things need to be laid on the table.

One: The Federal Department of Education and state departments of education are tools of statists. I defer here to Proverbs 22. You know the passages about “the parent is the primary educator of the child.” The educating of a child is a very personal thing. And despite many parent’s lack of confidence it’s something they have traditionally done and can do. Don’t believe me? Read some of the letters sent home during the Civil War and WWI by primarily home educated soldiers. Their expressions of wit, solemnity and grace are far more eloguent than the stuff that lands today’s college freshmen in that writing lab described above. Have doubts? read your kid’s emails. With its continued reach into our education, the government is increasingly pushing to mold curriculum in a fashion that ignores tradition, reason and faith.

Two: The benefit of an educated public is an informed electorate. That’s what Thomas Jefferson believed and it remains an absolute necessity for sustaining a free people. Sadly, our knowledge of American History and Civics is lacking. We left it to the public schools and they have predictably dropped the ball. Don’t believe me? What about earlier this year when Congress almost unanimously voted to tax after the fact employees of a private company who had been paid bonus money. That’s called an “ex post facto” law and is forbid by the U.S. Constitution [Article I, Section 10], the law those legislators swore to support and defend. But the question of doing something explicitly against the law since the country’s founding didn’t raise a stir among the public. Very likely because they never learned about it in their public schools.

Three: Not all students should be pushed toward college. The ease with which credit became available to finance college costs increased the “opportunity” and cost for students who in other times might have chosen a trade or career path that didn’t require four years of college. Now, everyone is considered eligible for that trophy. Most High Schools no longer offer non-college prep tracts so many kids are either overwhelmed or drop out instead of being guided into skills and job training that would fill the nation’s need for tasks which go wanting these days. Stuff like plumbers, electricians, food service, office staffing. I don’t know what it’s like in your neighborhood but in mine a plumber with a good attitude and some cheap cologne can make a valuable contribution and more money than many college graduates.

Charter Schools are public schools under different management. That’s likely to make some of my friends in this debate unhappy but it’s true and I have to tell you that if the LAUSD charter plan goes through, you will see a rush by progressive, leftist activists groups in the Los Angeles area to file applications and start charter schools of their own design, to push their own agenda. The review of charter curriculums after initial approval will not take place for three or more years and since it will be done by the same bureaucrats who have dropped the ball for the past 50 years, we cannot count on the public’s money being put to use in a way that satisfies my point “Two” above: to educate an informed public. Don’t kid yourselves, the charter will not look for operating savings, they’ll use up the $13,000. per child the state’s accustomed to spending. That’s what is happening now.

Anecdotal proof of a need for concern is the furor that took place in 2008 in the San Francisco Bay area of California when elementary school children were taken to the same sex union of their lesbian teacher without parental notification. The teacher thought it would be an enriching experience. The school was a charter.

“But we can’t home school our kids,” cries a mother. “I’ve got to work. We both have to. We don’t have a choice.”

The alternative to chartering is a voucher. Parochial K-8 schools like those run by the Catholic Church and other denominations charge an average of $5,000 for annual tuition in many areas of the U.S.. The number is significantly less than the state spends and the results are superior and the surroundings more in line with a family’s beliefs. As a parent a voucher would allow you to be free to choose.

In my novel about a family’s decision to home school, the mother cries out in doubt, “What if I screw up. What if he can’t get into college.” She is persuaded by an older neighbor and former professor that there will be “lots of help.” And there is. But it’s help that is there to guide them to the truth; not what the state whispers in our ears — a persuasion that there can be a heaven on earth.

National Health Care is a bad idea. State run education has been a failure. Both need to be rejected.

Blog author: rsirico
Thursday, August 27, 2009
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Published today on National Review Online:

I only met Edward Kennedy once.

I had been invited to visit then-senator Phil Gramm, who was contemplating a run for the Republican presidential nomination in 1996. Having read some of my musings on the topic, Senator Gramm wanted to brainstorm about some innovative welfare-reform policies that would simultaneously make economic sense and really help the poor.

After we had chatted for some time in his office, a bell rang and Senator Gramm rose. “I need to take a vote. Walk with me and let’s continue this conversation,” he said.

As we walked down the corridor, I could spy familiar names on the various Senate office doors. We came to an elevator that would take us down to an underground subway connecting the Senate offices to the Senate chamber. It was a small elevator, no more than a large closet. Senator Gramm, an aide, and I tucked ourselves in and the door began to slide shut.

Just before closing, an arm came through to stop the door’s close. As it reopened, I found myself standing face-to-face with the Lion of the Senate, arguably the most prominent Catholic layman in the country, scion of the most prominent Catholic family, perhaps, in U.S. history. Kennedy immediately looked me up and down, and then quizzically glanced over to Senator Gramm trying to figure out why his colleague was hanging out with a priest.

As Senator Kennedy stepped into the elevator, Senator Gramm welcomed him with his Southern tones, “Come on in, Teddy. We’ve called you here to pray for you.”

Without missing a beat, Senator Kennedy tossed a mischievous wink in my direction, nudging me with his elbow in Catholic camaraderie and replied in his Bostonian accent, “Uhh [there was that familiar pause of his], uhh, no Phil, Father and I have called you here to pray for you.”

There was laughter as the elevator door slid closed. It was my turn to speak so I decided to enter the spirit of the moment.

I stood erect, place my hand on Senator Kennedy’s broad shoulder and said, “Actually, senator, this is an exorcism.”

The laughter in that elevator, which spilled out onto the train platform, was electric, causing the by-standing senators to look in our direction and wonder what in the world would have Senators Kennedy and Gramm in such uproarious laughter with a Catholic priest.

And so, I had mixed feelings on the news of Ted Kennedy’s passing. A memory of a pleasant encounter, but knowledge that despite our common baptism, Senator Kennedy and I differed in some very radical ways on issues of public policy, economics, heath care, marriage, and, most fundamentally, on matters related to life. (more…)

Blog author: jballor
Wednesday, August 26, 2009
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In an Acton Commentary this week, I argue that a critical piece of any comprehensive and meaningful reform of the health care system must include malpractice litigation (tort) reform. Part of what makes this so urgent is that the litigious climate in which we live has eroded the doctor-patient relationship. In “Patients and Doctors: Partners not Adversaries,” I write that “patients are less inclined to trust doctors whom they believe are ordering tests and procedures out of a desire to protect their own economic interests. Patients in turn are much more apt to turn to legal remedies when they feel that doctors have not been forthcoming and trustworthy.”

Last week President Barack Obama spoke on a conference call to thousands of faith leaders from around the country to try and enlist them in his fight for health care reform. Highlights of the president’s remarks, as well as full audio of the proceedings, are available here.

I should note that I was not (at least intentionally) channeling Sarah Palin when composing this piece. But last week Shane Vander Hart (at the ever-worthy Caffeinated Thoughts) pointed out that the former Alaska governor wrote in a recent Facebook memo that “we cannot have health care reform without tort reform.” Of course my (and Gov. Palin’s) argument is not novel with either of us.

But what is novel is the particular concrete approach that I highlight in the commentary. The University of Michigan Health System has implemented policies that encourage doctors to be upfront and honest about the regret for procedures gone awry and admit when mistakes might have been made.

As David N. Goodman of the AP reports, “The willingness to admit mistakes goes well beyond decency and has proven a shrewd business strategy,” citing an article in the Journal of Health & Life Sciences Law, “A Better Approach to Medical Malpractice Claims? The University of Michigan Experience,” by Richard C. Boothman, Amy C. Blackwell, Darrell A. Campbell, Jr., Elaine Commiskey, and Susan Anderson (PDF). The article cites a case that “illustrates how an honest, principle-driven approach to claims is better for all those involved—the patient, the healthcare providers, the institution, future patients, and even the lawyers.”

For some basic facts on health care, visit the Health Insurance Costs page at the National Coalition on Health Care. And for more information about the widespread practice of defensive medicine, see the PDF report from the November 2008 study, “Investigation of Defensive Medicine in Massachusetts” by the Massachusetts Medical Society. For more Acton resources, check out the institute’s Health Care media page.

Blog author: jballor
Tuesday, August 25, 2009
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Amity Shlaes, a senior fellow in economic history at the Council on Foreign Relations, has an excellent primer on public choice in the August 3 edition of Forbes, “The New PC.” Shlaes is also the author of the 2007 book, The Forgotten Man: A New History of the Great Depression.

Shlaes, who will be featured in the upcoming issue of Religion & Liberty, writes, “Government reformers view themselves as morally superior, but that is an illusion. They are just like private-sector operators, who do things that are in their own interest, not society’s. Those things include taking advantage of an economic crisis to aggregate power for themselves and their offices.” She goes on to point out five specific instances of recent government action that fits the public choice paradigm.

I have no doubt that many enter politics with good intentions. Some even follow through on those intentions and work for their constituencies. But a precious few remain uncontaminated and uncorrupted by the temptations that political power offers.

This reality is a strong argument in favor of term limits. Even though the individual constiuencies might lose out by replacing older, more senior representatives, who have garnered the most powerful appointments and consolidated the most influence, it has the happy consequence of putting caps on political clout. Every so often the slate is rubbed clean and alliances, power partnerships, and appointments need to be rebuilt.

Anything that puts an absolute ceiling on an individual politician’s power seems like a step in the right direction. Of course, an unintended consequence is that with the sundown of their political career always in view, an individual politician will be just that much more focused on greasing the skids to a comfy private sector job after the term limits come into effect.