23 Responses to Catholic Social Teaching And Health Care Reform

  • Blackadder says:

    If you’re going to provide statistics or make other empirical claims you ought to provide a source, at least where you can. The claim about there only being 64 preventable deaths in France in 2007, for example, smells a bit fishy (I guess they must have had a mild summer that year). But since you don’t provide a link or a cite, there’s no way to check.

    In general, I think you are far too optimistic about how a “universal” healthcare system would work in practice (I put “universal” in quotes because no healthcare system is universal in practice; every system is going to deny needed care to people, it’s just that under a government system people convince themselves that this doesn’t matter), and are underestimating some of the negative unintended consequences (e.g. in lost innovation) that would result from a government takeover.

  • karen says:

    Even if we use the 64 deaths in France as a correct figure when we compare the size of the population of France to the size of the population of the US both fall well under 1% of the total population.

    But the difference in numbers, 64 compared to 101,000, makes your case. Yes, these are not just numbers, but people we’re talking about and the fact that their deaths could have been prevented but weren’t is terrible. However, based on the size of populations I don’t think you can point to France’s healthcare system and say its better.

    For the population figures I used: (from the us census international programs center)

    http://search.msn.com/results.aspx?q=population+of+usa+2007&form=QBRE

    and

    http://search.msn.com/results.aspx?q=population+of+france+2007&form=QBRE

  • Zach says:

    There’s a lot here and I think it’s good you are making this argument. I want to make a more substantive response but right now I will have to limit myself to this:

    I think this remark, that “we have the medical care, the financial resources, but we seem to lack the moral will to acknowledge that we are our brother’s keeper.” really gets to the root of the disagreement between conservatives and liberals. A conservative would argue that it’s not that we don’t have the moral will to acknowledge that we are our brother’s keeper. On the contrary, a conservative would point to the plethora of evidence that suggests we know we are our brother’s keeper, and that we have a continual, personal call to this work. A conservative would also say that the reason for opposing a state-controlled or state-funded or state-mandated health care system is because it is inefficient and will inevitably result in the abuse of power. It is impossible to control such a large industry without having large and powerful controls – more bureaucracy and inefficiency. This will not only make the care we receive worse in the long run but the care will help less people as well.

    I also think you mischaracterize the system we have now. I do not think it’s accurate to say that our system is “every man for himself”. There are obviously great flaws in the way our health care is regulated, but this is not one of them.

  • Kathy says:

    I see that our system of health care needs serious reform, but I am convinced that a universal system controlled by government is not the prudent answer. Observation and research of such systems in other countries will confirm this. There simply must be better alternatives.

    From my Catholic perspective, I have to ask why we cannot do more for people in our own parish communities (and perhaps in adopted parish communities) who “slip through the cracks” in their efforts to locate good medical care?

  • Eric Brown says:

    Blackadder,

    http://www.medicinenet.com/script/main/art.asp?articlekey=86292

    The study was actually done in 2003, we were ranked in 19. The last one before that in 1999, we were ranked 15.

    The link you posted doesn’t reflect “preventable disease,” such as treatable cancers and bacterial diseases, essentially someone dying from something that were have the medicine to treat.

    Additionally, I’m in the process of writing a second post about a single payer system, which is essentially the only model of universal health care I support. This isn’t the model that Clinton nor Obama support, nor have they ever supported it. In fact, single payer has support from a progressive group called “Health Care for America Now!” and “Republicans for Single Payer” — http://www.republicansforsinglepayer.com/

    The latter group particularly makes the case how a single-payer system would not at all damage the free-market economy, if anything, we would be saving money. But I’ll save that for the actual post.

    But one last point I want to make: “universal health care” is not synonymous with “socialized medicine.” The common mistake is to assume that “universal health care” always means single provider, that is, the government employs all health care professionals, controls the whole system, and thus delivers the health care. This system does exist (in Britain and in Canada — and only in those two places, unless I’m mistaken), but it is not at all the only existing model of universal health coverage. In fact, such a model has never been proposed here. There won’t be a “government takeover” that totally eliminates the private sector.

  • I’m not sure that anyone, free marketer or strong progressive, would argue that we currently have the best possible approach to health care, or even the best realistic approach to health care.

    However, I’m not convinced that a single payer, government run system is the best way to run things. (Though laying out an alternative would take a post in itself — which I guess I should do soon.)

    I’m a little curious about some of the figures you quote. (Do you have some links?) In particular, how is a “preventable death” identified? I do recall reading that the life expectancy of people with major diseases (heart disease, various kinds of cancer, etc.) is higher in the US than in Europe or Canada (for which I’d need to go find my own links) but on the flip side I believe that US has a lower tendency to catch things early. Some of that is probably cultural. Heck, I’ve got a great insurance coverage and I haven’t bothered to get a checkup in 5+ years.

    On administrative costs for medicare: Keep in mind that the government is able to offload most of those onto the care providers. There’s a massive industry out there (paid for by care providers) of companies that help them get all the filing right. The care providers pay for this, to a great extent, out of the higher profits they make off clients with normal insurance.

    On providing care to those who most need it: Two things that I think would probably help a lot, without the phase change of going to a government run system would be: 1) Licensing “urgent care” facilities in which people with standard ailments could see an RN or pharmacist and get prescriptions would help a lot of people who these days end up in emergency rooms, and for very little money. (A lot of other countries have this, but our doctors’ lobby has been against it.) 2) Provide tax incentives (and encourage people to support) charitable foundation hospitals whose missions is specifically to provide care to those below a certain means threshold.

    And finally, a political concern: Call me a cynic, but it worries me that although the problem expressed is always about those without insurance, the proposed solution is always universal coverage. In that sense, I can’t help wondering if the root goal of many of the politicians involved is to produce permanent dependence on a federal program (and thus a massive permanent constituency) rather than to help that small percentage of the population who are truly needy in this regard.

    UPDATE: And incidentally, thanks for providing a thorough and well thought out post on this issue. This is exactly the sort of discussion I hope we’ll be able to have substantively and politely here.

  • Eric Brown says:

    Zach,

    That statement wasn’t directed at conservatives because that would presuppose that all self-described conservatives oppose universal health care in all forms. I was referring mainly to the lagging response to a dire situation.

    I know conservatives disagree with me on method, that I understand. My disagreement stems from the fact that we spend more per capita on health care than any other country in the world only to cover a part of our citizens. With literally thousands of private insurers with a myriad of billing processes, rules, and regulations of their own, under a single payer system all that inefficiency and billions and billions of wasted dollars could be saved. Hospitals would save resources from having to do that. A single-payer makes it so that hospitals has to deal with a single entity, using one format. A single entity also allows us to negotiate costs, which cannot happen with the current format because there are too many private insurance companies, with a host of plans, with different benefits, etc. It’s too much bureacracy and to the contrary — and I’ll get to this later on — a single-payer system is actually much simpler than it sounds.

    I simply don’t see how we could control costs or give people quality healthcare, given the fact, that the interest of the insurance companies will remain upside down.

  • Eric Brown says:

    Darwin,

    I linked to the statistic about death from “preventable diseases” a few comments above. The article describes what they deemed it as. I think it’s basically something we have the medical knowledge to treat, e.g. diabetes.

    If the government were able to be the single funnel through which all monies flowed, I think the costs still even could be considerably lower. I don’t think there’s any getting around the approximately 30% of overhead costs (http://www.healthcareforall.org/basics.html) for private insurance.

    With the two points you make, while I’m not in disagreement, I have two questions. First, how would people pay for this? And what will prevent prices from spiraling out of control? How will we keep the prices affordable? The latter point, is wonderful. We need to support “charity care.”

    And to your political concern, if the system fails there goes the constituency — it involves much political risk. The reason people don’t get insurance is that they can’t afford it. The goal of the private insurers is not to cover you because the profit from not doing so; therefore, when they find a technicality and can not cover you all together, one can easily be buried under medical bills (poverty and ill health often travel together). Thus, if we cannot in anyway have some sort of regulation of this or re-design, I don’t see how a free-market solution will meet human needs on the basis that this isn’t just any other consumer-based industry — these are human lives. Though, I’m sure you’re well aware of this and aren’t any less concerned.

  • blackadderiv says:

    Eric,

    I thought that was the study you were referring to. Note, first of all, that the study doesn’t say that there were only 64 preventable deaths in France in 2007 (or in any other year). What it says is that there were around 64 preventable deaths per 100,000 people in France. The 101,000 figure, on the other hand, is not per 100,000 (obviously it couldn’t be, unless you think the preventable death rate in the U.S. was more than 100%).

    Not that it really matters much, as the methodology used by the study is complete garbage. To get the rates of preventable deaths, the study simply defines deaths from certain causes (e.g. heart disease) as “preventable” and then adds up how many people died from those causes in each country. No effort is given to determining how many of the people who died in a country from one of these causes would have lived if they had received a different level of medical care. Nope. If you died of a heart attack, then your death is considered “preventable” according to the study, and goes into the statistics.

    This is important for two reasons. First, by choosing which diseases one defines as preventable, one can ensure whatever result one chooses (I guarantee that if “heat deaths” had been listed as one of the preventable diseases in the study France would not have come out on top). More importantly, though, the rate of a particular disease often depends on lifestyle factors that have nothing to do with the quality of medical care. For example, most of the difference between the U.S. and France in the study is due to the fact that the U.S. has a much higher rate of heart and circulatory disease than France. Yet the rate of these diseases is highly correlated to matters of diet and lifestyle that have nothing to do with the healthcare system. If the French were to adopt many of the eating and exercise habits of Americans and visa versa, one would very well see their respective positions in this study reverse themselves even if neither made any change to its healthcare system whatsoever (for more details and a link to the original study, see here).

  • Eric Brown says:

    Point, well taken.

    Though it remains that those people with bad lifestyles do in fact die because of it and they also go into our emergency rooms and drive our insurance premiums up.

    All things considered, I think the health care system does matter. France’s health care system covers everyone with insurance; everyone has basic access to preventative care. In America that isn’t the case.

    Medical bills have financially ruined so many people in family, unfortunately while some had finally climbed up the economic ladder. I don’t have medical insurance, if there were something wrong with me, I would be more likely to know about it if I had check ups. But with no medical insurance that hardly seems to be an option — and I think that’s a dramatic difference.

    Which goes back to the fundamental problem: the cost of health care.

    If we can’t agree on details nor on the system itself, I am curious and interested in the counter-solution that, I imagine would, find a way to reduce overall spending and help increase the number of uninsured.

  • blackadderiv says:

    If the government were able to be the single funnel through which all monies flowed, I think the costs still even could be considerably lower. I don’t think there’s any getting around the approximately 30% of overhead costs (http://www.healthcareforall.org/basics.html) for private insurance.

    Look, the U.S. today, 44% of all medical spending is paid by the government in order to provide healthcare for 27% of the population, whereas insurance companies pay 36% of the total to cover around 57% of the population (statistics courtesy of Wikepedia). And, as Darwin notes, government spending on healthcare doesn’t represent the true costs of government healthcare, as a lot of the administrative costs of those programs are borne by the private sector and billing is handled by the IRS (and thus doesn’t show up as “healthcare spending” in official statistics). The truth is that even with a profit margin, etc., private enterprise is generally able to provide a better quality service at a lower cost than is the government.

    On the question of insurance company profits being the cause of high healthcare costs in the U.S., I would recommend this article from Slate.

  • blackadderiv says:

    Though it remains that those people with bad lifestyles do in fact die because of it and they also go into our emergency rooms and drive our insurance premiums up.

    Well, okay. But it’s not like if they were dying in government hospitals instead it magically wouldn’t cost us anything. The irony is that emergency room care is one of the areas where we already have something close to a “universal” system. If one isn’t impressed with the results, I’m not sure how it makes sense to make the rest of the healthcare system just like it.

    All things considered, I think the health care system does matter.

    I agree. If I thought it didn’t matter, I would be indifferent as to whether we adopted a European-style system.

    France’s health care system covers everyone with insurance; everyone has basic access to preventative care. In America that isn’t the case.

    I disagree that people in America don’t have basic access to preventative care, though it may just be a question of semantics. Is there something specific you have in mind?

    It’s true that in France everyone has insurance (though the employment based insurance required by the government doesn’t cover a lot of things, which is why 85% of French people also pay for additional insurance beyond what they get through the government mandated employer based insurance).

    If we can’t agree on details nor on the system itself, I am curious and interested in the counter-solution that, I imagine would, find a way to reduce overall spending and help increase the number of uninsured.

    I offer my thoughts on some proposed alternatives here.

  • Zach says:

    Eric,

    It seems then we agree on the basics. Of course I think we should make health care affordable for all and so that it covers as many people as is humanly possible.

    I think a bad way to do this is to let the government do it. The government is practically by definition inefficient. Remember the mess after Katrina? That wasn’t a function of George Bush’s leadership alone.

    I think you have too much faith in the “single entity”. That entity you are talking about is the federal government of the United States which is defined and limited by our Constitution. It serves a nation of 300 million people.

  • Eric Brown says:

    Zach,

    Perhaps, you’re right. Maybe I do have too much faith in the government, which hinders my judgments. I respect your position, but in good honest charity, I disagree. I think I rather don’t have enough faith in the private sectors’ ethics.

    First, I don’t support the government by itself running the health care system — in fact, the government wouldn’t run the system at all; universal health care really is “universal health insurance.” Health care professionals and hospitals would be as free as they are now to make decisions. A single-payer system doesn’t eliminate insurance companies nor the insurance insured people currently have; businesses would be able to buy into either private or public insurance for their employees and/or people could buy it separately — health insurance would not be dependent on one’s job. It all just in the end comes through one source (a non-profit, public trust), which saves billions of dollars — which allows us to at last, negotiate costs with health care providers. This simply cannot be done with thousands of insurance companies using just as many different standards — it simply is a complex, bureaucratic administrative mess.

    We do agree on basics (providing affordable and quality health care to all Americans). It is the means we disagree on. I just don’t see how we can have a solely private market solution when the clear incentive for the markets is profit and not public welfare. The strategy ultimately reaffirms the notion that economics and ethics don’t cross paths, that is, what ever is most cost efficient is the best strategy, even if it leads to some sort of injustice. There is nothing more worth our investment than human life.

    In turn, I think people have too much faith in the free market. I hardly see any reason as to why I should believe profit-oriented markets are concerned about ethics and human dignity. Fundamentally, we are presupposing good moral judgment (in terms of the natural law) by the private sector. Enron comes to mind. One reason why drug companies and health care insurance companies oppose a health care overhaul is that it would cut the millions and millions of dollars they make.

    Do I have all the answers? No, of course not. But it isn’t acceptable (and on this we agree) that we’re spend approximately 15% of our GDP to insure only a portion of our population. I think that a universal health care system, particularly a single-payer would be cheaper in the long run with the administrative costs being lower. It estimated by the Physicians For a National Health Program (http://www.pnhp.org/) that a single-payer system will save more than a $150 billion dollars in reduced paperwork (not having to deal with hundreds and hundreds of different billing and coding systems), people will remain insured (insurance will be portable job-to-job), and another $50 billion or so can be saved from bulk-purchasing of medications just in the first year of such a system.

    Now, sure, a universal health care system will not be a “utopian” system, but I think it will be much cheaper and more efficient than the current system — a system which I don’t see much efficiency in. If the private sector was really concerned about public health, I think they would be collectively advocating change and reforming the health care system. A universal health care system doesn’t entail all-government nor all private sector; it’s an both/and approach — the cooperation of the two, if you will.

    I’m looking into other suggestions in earlier posts (from others as well). Thank you for your comments.

  • Zach says:

    Hi Eric,

    A most reasonable comment. It is possible I don’t understand the system you are describing. Perhaps I will have to look at it more critically.

    I would like to clarify a few things, though. First, I don’t have faith in the “private sector”. I have some faith in people.

    I also think you are wrong about what private companies need to be concerned with. I work in the private sector and one reason private companies are concerned with ethics is exactly because of the Enron disaster. That was a bad thing and companies don’t want that to happen to them. In fact, my company makes me take ethics classes so that I’m aware of the consequences of my actions. Further, companies are obligated to play fair because we have a solid system of laws that penalizes them heavily for playing unfair.

    In short, profit is not the only incentive that controls markets. There is also the incentives of stability, ingenuity, respectability and reputation. And more I can’t think of at the moment.

  • Eric Brown says:

    I thought I should have made that clarification. Sure, the private sector takes into account ethics, but more often than not it is consequentialist ethics and not natural law ethics — there is a profound difference. One takes into account the weakest and most vulnerable among us, more so than profit; the other side sees the ends justifying the means.

    I’m sure there are tough decisions and I don’t support the government regulating the free market into a collapse. But I do think a lack of governmental oversight (in some areas) can lead to natural injustice. You mentioned that you trust people, well our politicians are just as much people as those who work in the private sector and the private sector deliver money to our politicians often enough for their own ends and our politicians fall. Basically what I’m trying to get at here is that there is corruption due to our fallen nature: the government and the private sector alike. This is why I like the both/and approach.

    Now, I tend to like safeguards — some sort of minimal regulation that can ensure that the individual dignity of the few isn’t neglected. So while I will continue to support universal health care, I will be looking into other possible solutions, at least in the short term. If Senator Obama wins this thing (and hopefully he doesn’t), universal health care debated in Congress would be wonderful and hopefully some abortionless (wishful thinking) package would be welcomed. Though Obama supports mandate universal insurance, which I think actually proves to be a disaster — so hopefully they go in a different direction.

  • Eric Brown says:

    blackadderiv,

    I looked at your post on alternatives to universal health care and I think those are meaningful solutions that are good short-term goals. Though, I’m saying this in recognition of the fact you weren’t going for comprehensive and attempting to exhaust all that we can do.

  • Micha Elyi says:

    Eric made the “observation that a private sector dominated healthcare system is bad business without some sort of minimal regulation.”* If only there were “minimal regulation” of America’s health care providers instead of the heavy left foot of the government pressing down upon them and their customers. Make that the two left feet of government, the state foot and the federal foot.

    As for the principle of subsidiarity, how that is reconciled with a “single payer” scheme is puzzling. “Single payer” is a catch phrase that sounds sweet to folks with a collectivist impulse but when one thinks twice about it one must realize that all such schemes really boil down to establishing a “single denier” of health care. Think about what that means in today’s American culture of death.

    * To refer to a “healthcare system” is to indulge in a fallacy of reification.

  • Eric Brown says:

    Perhaps you’re mistaken. I don’t support regulating health care providers.

    Second, I made the point that the principle of subsidiarity applies if the task can be done efficiently at that level. Whether or not you agree with my assessment is another matter.

    Third, there is nothing inherently wrong with a collectivist approach (in this case, a participation of both the public and private sector) on some matters. It doesn’t have to be applied to everything, just on what it can do efficiently. This calls for the virtue of prudence and not so much adherence to a rigid ideological principle of no-government involvement, period. I’m more interested in what works and not the principle of a political theory. I also just happen to think a single-payer system would be more efficient than what we have now.

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