Growing up, I remember my mom spending hours on the phone trying to get through in an effort to schedule an appointment. If she was lucky enough to get someone on the line, it became another feat to get a time slot inside two months. It seems like I never saw the same doctor twice, and I never had an appointment that took less than 4 hours. Most of the time, our only choice was to go to the emergency room, and wait for even longer, usually 6-10 hours, to see someone. Luckily, I was a pretty healthy. And fortunately, once we actually saw a licensed medical professional, they took their job seriously and usually provided adequate service. Yay Hippocratic Oath.
Looking back, a couple things stick out. First, I played sports growing up, and they required physicals. My parents would pay close to $100 at a local clinic for my physical, as the season would be over before I got one from the Army medical center. Knowing now how tight money was in my family, this was a HUGE sacrifice. Second, my parents still see a different doctor pretty much every time they go, and have never had a doctor that built a long-term relationship with them or took a special interest in their care. This, given their age and ailments, is sad.
So while I am very fortunate to have good health insurance at my current job, and have built good relationships with my health care providers of choice, I know there are millions of people without this benefit. So what is the solution? I don't really know, and it seems I am not alone.
I know for sure that I don't want a bunch of government-run hospitals like I experienced as a child. The private sector health care in this country is pretty darn good, just ask the rich Canadians and British who come here to escape their single-provider systems. The fundamental challenge is not of health care, but the lack of access and prohibitive costs for those not insured.
All this leads me to this article which partly through research and partly through opinion, discusses what can be learned from several European health systems:
The best healthcare system, from a conservative perspective, is that of Switzerland: it beats the U.S. system in terms of its performance, efficiency, universal coverage, and consumer empowerment. Although the Swiss system is not perfect, in empowering consumers and providing universal health insurance through market mechanisms, it merits serious consideration.
Wilhelm Röpke would be proud. I'll leave Röpke for another post, but it bears noting because his preference for solving problems with local government fostering pro-market solutions can be seen in Switzerland's approach:
Regina Herzlinger, McPherson Professor of Business Administration at Harvard and the “godmother of consumer-driven healthcare”, wrote in late 2008:
“The country of Switzerland has universal coverage, costs that are 40% lower than ours and that inflate at lower rates, and an excellent health care system in terms of outcomes and resources. The key to their success is that the Swiss system is consumer-driven: consumers buy their own health insurance from more than 90 private health insurance firms. If they cannot afford it, the cantons subsidize it. If they are sick, they pay no more for their health insurance than the well (the Swiss insurers risk-adjust each other). Consumer oversight insures value for the money better than oversight by governments and employers.”
The cantons are in control as opposed to the federal government, the consumers are empowered with choice and oversight control, and private insurance companies both compete and work together to manage costs and risks. The key is moving health insurance from an employer benefit to an individual purchasing decision, much like auto and home insurance. In order for this to work in America, there would have to be a massive overhaul to the complicated web of state regulations that make private health insurance ridiculously expensive. Less regulation would be very welcomed by me. To make the Swiss system better, the author recommends open access to doctor and hospital performance metrics. Sounds good to me.
The thing is, the Swiss approach is at least close to what Mitt Romney enacted as Governor of Massachusetts. Under current federal and state regulations, it was impossible to move away from an employer system, but he filled in the gaps through a private/public approach to getting everyone insured. I would love to have a mostly pro-market system that hinges on individual choice and responsibility, while giving everyone access to great health care.
That reminds me, doesn't Obama have an open cabinet position?
7 comments:
Don't confuse government health care with government health insurance. We already have government health care in the form of hospitals and clinics funded in large part by municipal or other governmental funds. We also have "universal" health care, in that a doctor has an obligation to treat a patient without regard for the patient's economic station (read: whether they have the cash to get that life-saving procedure). A free-market solution would dictate that the law of supply and demand sets the price for all procedures, including life-saving procedures. But the demand for life-saving procedures is somewhat, errr, inelastic, and there are significant inequities in the amount of information between the supplier/doctor and consumer/patient. Perhaps we don't want a *totally* free market for health care.
Your real concern is with Government mandated health insurance. Wait, are you one of those people that has a "gold-plated insurance policy?" I've never yet met anyone (other than a fireman or teacher) that thinks their health insurance is anything other than a shakedown.
But the real question is this: Who Would Jesus Treat? And then a follow up: how does your response impact and inform your position on health care? Sorry if I sound too high school essay-question-ish...
In health care "system" I include providers, patients, and insurance or some other form of payment. You are correct, there are public and private providers. I am focusing on the insurance portion of the equation because very fiew can pay for their healthcare fully out of pocket, so insurance (or lack thereof) affects the health care choices made by patients and providers. See:
http://query.nytimes.com/gst/fullpage.html?res=9C0CE2DD1138F933A05756C0A964948260&sec=health&spon=&pagewanted=1
and
http://www.toledofreepress.com/2009/02/13/obama%E2%80%99s-sinking-schip/
I would answer your first question the way you expect. Jesus would treat everyone. However, I find no proof that he would tax everyone else around to pay for the costs incurred. He acted out of love and charity, and instructed his disciples to act likewise.
Ron Paul is a great example - Paul did not accept Medicare and Medicaid payments as a physician; instead, he worked for free or arranged discounted or custom-payment plans for needy patients; he says of these patients, "I just took care of them."
Christ left the decision to each of us to decide whether we would follow him and do the right thing. My (humble) opinion is that taxes take that choice away.
So I view forced collectivism and socialism as working against the free will God gave us, and voluntary collection and social communities as part of the deal if we are to be servants to God.
If not, Jesus could have gotten 12 Matthews and taught them how to be better tax collectors and work with the authority structure to do good.
How would you answer the same two questions? And if I may add a third - If government were able to do everything Jesus would have us do, how much relevance would that leave the church?
The 12 Matthews bit was intended as a joke, by the way ;-)
There has been an experiment where the government attempted to do all that Jesus would have us do - it was called socialism. Socialism gets a bad rap, and rightly so because it was horrible in practice, especially since the people in the most powerful positions were capitalists at heart and frequently gamed the system to their own advantage. Socialism, or at least communist socialism, failed in practice, but if you compare the tenets of socialism with Jesus' own teachings, there are far more similarities than there are with capitalism. There's nothing more collective than telling someone to sell all they have and give the proceeds to the poor. I'm just sayin'.
Now to your question as to who would Jesus treat, its pretty clear that Jesus would treat everyone, but he would treat those in most need (especially those without insurance) first. In fact, the wealthy or those who could afford to pay for treatment likely wouldn't receive assistance... at least not directly from Jesus. Jesus came for those who needed him most - the outcast, the poor, the sick, the untouchable. Often he waked past the devout and righteous in order to focus his attention on the lowly.
And how does this inform my understanding of health care? Any public form of assistance should be reserved for those who can't afford treatment otherwise. If you have your own insurance, you receive no supplement from governmental programs such as medicaid. But that's not fair - you're punishing the rich you say. Sorry kids, you're rich. You don't need government assistance. Just as Jesus ignored the pharisees and focused on the untouchables, so also the public assistance ignores those who already have insurance and "saves" those in most need.
To your aside: "who would Jesus tax" I say - Jesus wouldn't tax you. He's pretty clear about that in his instructions to return to Caesar what belongs to Caesar. Whew - we're off the hook. But that's only half of the story: Jesus is far more demanding than Caesar ever could be. Jesus asks us to give up everything - and he doesn't mince words (just ask the Rich Young Ruler). He calls us deny ourselves, our friends, our family and forsake all to follow him. Think about that call - turn your back on your family, your wife, your job your money even your church and follow. Surely Jesus doesn't mean what he says because I fear I'm too similar to the rich young ruler. And when you think of it that way, the repressive tax regimes in Continental European countries don't require all that much from theircitizens.
Finally, if Government did everything Jesus would do, things would look a whole lot like the Kingdom of God, don't you think? And in such a place, the church would be redundant. That's the nice Sunday School answer. But I think you're getting at what Hauerwas and Willamon were getting at in Resident Aliens - and that's a question about the role of the church in society (secular or otherwise).
The long and short of it is that Government can't do all that Jesus would have us to do because governments are collections of people, and, therefore, have the same flaws and the same fallen nature as men. All governments start with an ideal - a Utopian ideal, and all governments fail miserably the harder they try to reach that ideal. But that's not an indictment of the ideal, its an indictment of us - why else would theocracies fail the say way secular governments do? I'll submit that it has more to do with the theocrats than the theology. This brings me to my mantra about businesses. Governments and businesses are the same in one respect:they both have only two possible ultimate outcomes: (1) dissolution (failure) or (2) acquisition (or domination) by another business/government that has the same to options as possible ultimate outcomes. Thus, no human institution lasts for ever no matter how powerful. GM is learning this lesson as we speak. The same will one day be said about the United States just as it was about the Egyptians, the Minghs, the Greeks, the Romans and the list goes on. Incidentally, this informs my beliefs on Israel as nation-state v. Israel as the people of God. But that's for another time.
For a great discussion of why governments are doomed to fail and the role the Christian must play in fighting against government domination, read Walt Wink's Engaging the Powers. It will turn your mind inside out...
And you're talking about 12 Levis. I think Matty was a nickname given to Levi by J.C., but I need to check that. I knew what you were talking about though...
And excellent work liking to Orson Swindel on your Blog. Everyone needs a (liberal) dose of the irreverent from time to time, and EDSBS does that while covering my favorite earthly pursuit: college football. Good thing Jesus doesn't call us to give up college football...
It's reassuring to know that in a round about way we mostly agree.
-Socialism is a horrible practice (at least by secular force or on a large scale)
-The teachings of Jesus and the practice of early Christians as recorded in Acts stresses strong communal groups and sharing of resources
-The ministry of Christ was and remains to help the lowly
-A government that could perform the ministry of Christ would make the church redundant.
-Government can't accomplish the ministry of Christ because it is (and should be) secular, and composed of fallen humans.
-Theocracies fail just like secular governments, with the bonus that God gets blamed in the process.
Also, if you are a fan of Engaging the Powers, I would have to assume you are a fan of a non-interventionist foreign policy, which I certainly am.
How we come to radically different conclusions with this shared set of beliefs, I am still not clear.
Speaking for myself, I would say that the larger governments (and business for that matter) become, the harder they fall. The best hope for long-term success and stability is a completely secular government with severely limited power and scope, much like the US for its first 150 years. On the whole, combining the above theological/philosophical beliefs along with observation on human action and economics (we are all capitalists at heart), and the best government response in most cases is to do very little, and allow society to innovate and self-correct. My fundamental premise is that without the illusion or reality of government intervention, people are much more incentivized to form communities of self-interest that are mutually beneficial. Some of those can be Christian communities doing the work of Christ, others can work for good in the name of Science, Gaia, Darwin, Spock, or whatever Utopian messenger they choose. Taking the idea of states rights and making it even more local, allow more resources to go to smaller local communities that compete, rise and fall as part of a larger federation that stays in tact.
I don't want to put words in your mouth, so tell me where the shared set of beliefs leads you. You don't seem like the kind of guy that enjoys the futility of aiding a system doomed to failure of catastrophic proportion, no? ;-)
How we reach different conclusions may be attributable to the fact that despite my fierce independence and dedication to personal liberty, all of those things are secondary to my desire for a society that is compassionate. I want my church, my social circles, my government (although I want my government secular to the highest degree) and my friends (I include myself in all of those groups) to be guided primarily by compassion at all times. Accordingly, compassion is the driving force behind my political, philosophical and religious views. That said, I don't accept that compassion should be reserved for the Church or benevolent societies only. Christ himself certainly didn't reserve his ministry for synagogues and benevolent societies - instead, he took on the theocrats of Herodian Palestine as well as the Roman Empire with. But he did so compassionately - by empowering the outcasts of a rigid and dominating societal system, thus undermining (in a very literal sense) the power of the established order. This grass-roots approach was what ultimately lead to his conviction crucifiction
Sadly, my ideal of a compassionate society is impossible in this world. But again, I'm not concerned about impossibilities because this is MY ideal.
The rub in all this is that sometimes the compassionate thing to do is not the economically advisable thing. Sometimes the compassionate thing is at odds with personal liberties and even democratic principles. Sometimes the compassionate thing doesn't square with human notions of justice. There again, is where I come up short in arguments. But again, as I said, I'm completely comfortable with whatever dissonance others may perceive in my ideals. I'm comfortable with the fact that I don't have all the answers or that my own thoughts may not be fully cooked just yet...
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