KC Bishops don’t like “socialized” medicine
John Allen has the latest from the bishops of Kansas City, Naumann and Finn, from a pastoral statement that seems to make a prophet out of the NYT’s David Kirkpatrick, as posted earlier. The two bishops, who have earned some headlines for various statements on abortion and crusading and communion, seem to strike out on a path against current health care reform that is decidedly different from that set out by the Pope or even the rest of the American bishops.
From John’s article, which quotes the joint pastoral statement:
“In evaluating health care reform proposals, perhaps we ought to ask ourselves whether the poor would have access to the kind and quality of health care that you and I would deem necessary for our families,” they write. The bishops include legal immigrants among groups which merit improved care.
Nonetheless, Naumann and Finn also warn that “change for change’s sake, change which expands the reach of government beyond its competence, would do more harm than good.”
The bishops assert that “our country, in some ways, is the envy of people from countries with socialized systems of medical care.” Grounding their critique in the principle of subsidiarity, which holds that higher levels of authority should not usurp what can be done better or more efficiently at lower levels, the bishops write that a “centralized government bureaucracy” poses three risks:
- “A loss of personal responsibility”
- “Reduction in personalized care for the sick”
- “Higher costs”
Although Catholic teaching asserts a right to health care, Naumann and Finn say that this right “does not necessarily suppose an obligation on the part of the government to fund it.”
“In our American culture, Catholic teaching about the ‘right’ to healthcare is sometimes confused with structures of entitlement,” the bishops write. “The teaching of the universal church has never been to suggest a government socialization of medical services.”
A hasty expansion of government programs, the bishops warn, could create “a future tax burden which is both unjust and unsustainable” as well as fostering “permanent dependency for individuals or families upon the state.”
I’m not sure who they expect would fund health care for those unable to afford it. And I think the rest of their analysis is deeply suspect. But above all it seems counter to everything the church has been teaching on this score. More Acton Institute than Caritas in Veritate, ya know.
What gives? Apart from the political influences that may be at play, I have been viewing this intra-ecclesial debate over health care as a kind of tug-of-war between the principles of subsidiarity (as emphasized by Naumann and Finn) and solidarity. Thoughts?
I suspect that these boyos would scream like hades if THEIR “socialized medicins”, provided by the earnings of their pew potatoes, suddently disappeared and they had to find coverage on their own.
Ordination is no guarantee against ignorance.
Still another US hierachical disgrace!
it’s hard for me to see how our Bishops can maintain credibility when some just shoot from the lip so ignorantly.
These bishops are bringing Catholic teaching to bear on a complex topic that touches on many different aspects of modern life.
These may or may not be good arguments, but they can’t just be brushed aside as so much partisan posturing. If their argument is lacking, someone should explain why.
David G., if you find their reasoning “deeply suspect”, shouldn’t you say why that’s so?
Have carefully read their statement at least three times during different parts of the day to try to understand where they are coming from.
I have worked in the managed care business and with insurance carriers (all the major carriers) for 20+ years. The three bullet points: “A loss of personal responsibility”
“Reduction in personalized care for the sick” “Higher costs” are exactly what insurance does and what employers who purchase 80% of insurance yell the loudest about.
We have spent an inordinate amount of time over the last 3-5 years to shift and change the current employer delivered insurance so that members take responsibility for their own health – via high deductibles, HSA accounts, wellness rebates, onsite biometric screenings, etc. The fact – most folks get insurance as part of their status as employed folks. It is so easy and already set up (premiums automatically deducted from their paychecks) that they do not even think about much less connect their health responsibility to their employer paid insurance. That is the issue – what happens when you lose your job through no fault of your own?
Reduction in personalized care – this happens every day because the current employer system is designed to purchase insurance plans that limit, restrict, do not cover pre-existing, etc. It is a form of rationing but since 80% of us are employed with insurance, no one squacks.
Higher costs – geez, for the last 4 years medical costs and premiums have, on average, risen from 12-16%. Projections are that by 2020, 40% of the cost of a US made product will go to insurance.
These guys do not have a clue.
It is hard to see giant for-profit insurance companies and the pharmaceutical and health-care industries as representing the principle of subsidiarity in any meaningful way. At least big government administrations can be voted out.
David Gibson:
You wrote:
Is that really the best way to formulate it? True, you qualify it a bit by saying it’s subsidiarity as emphasized by Naumann and Finn. But are you being too generous to them? Might it really be a question of subsidiarity as defined by them? That is, mis-defined by them?
I’m no expert on this, but I find myself saying, “It’s wrong, it’s an abuse for them to try to win points for their position by slapping the label ‘subsidiarity’ on it. What they’re talking about, and what the church is talking about when it speaks of subsidiarity, are two very different things.”
If I’m mistaken on this, I invite any of you to set me straight.
Hi, Gene and all,
Regarding subsidiarity: here are four paragraphs from the CCC that give a rather concise context for understanding what it is. FWIW, I don’t think the bishops are out of line in raising the question of subsidiarity. Among the possibilities discussed for health care reform are single-payer and public option, and it shouldn’t be objectionable to weigh whether or not either possibility corresponds to the principle of subsidiarity.
[Begin quote]
1882 Certain societies, such as the family and the state, correspond more directly to the nature of man; they are necessary to him. To promote the participation of the greatest number in the life of a society, the creation of voluntary associations and institutions must be encouraged “on both national and international levels, which relate to economic and social goals, to cultural and recreational activities, to sport, to various professions, and to political affairs.”5 This “socialization” also expresses the natural tendency for human beings to associate with one another for the sake of attaining objectives that exceed individual capacities. It develops the qualities of the person, especially the sense of initiative and responsibility, and helps guarantee his rights.6
1883 Socialization also presents dangers. Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good.”7
1884 God has not willed to reserve to himself all exercise of power. He entrusts to every creature the functions it is capable of performing, according to the capacities of its own nature. This mode of governance ought to be followed in social life. The way God acts in governing the world, which bears witness to such great regard for human freedom, should inspire the wisdom of those who govern human communities. They should behave as ministers of divine providence.
1885 The principle of subsidiarity is opposed to all forms of collectivism. It sets limits for state intervention. It aims at harmonizing the relationships between individuals and societies. It tends toward the establishment of true international order.
[End quote]
Gene – see my comments. Would agree that their use of subsidiarity does not apply to profit driven insurance/pharmacy companies. To suggest or even imply this reveals their bias and/or lack of knowledge about how employer purchased insurance works; the amount of profit that insurance makes/pharma makes, etc.
There is also something called the Common Good and excessive profits. They seem to completely miss the need for reform of the health care delivery system – we spend more than any other country but do more poorly in any number of disease conditions.
Jim P: My main intent wasn’t to get into the details of health care economics, but you are right that I should back up what I say. Some points have likely been made in Grant’s thread above.
In any case, my main objections to their statements would be, for one, the notion that our health care is the envy of other nations. That seems to reprise a meme that we have a great health care system, or that others envy us. Neither is the case, but that talking point seems to stick.
Another is that we can’t afford health care, and it would saddle future generations with debt. I don’t know the track record of these bishops on pastoral statements/letters, but I wonder if they’ve said anything about fiscal responsibility in the previous eight years when the GOP was racking up this huge debt we’re saddle with.
In any case, once again, universal health care as done in many other industrialized Western nations is much better and much cheaper. If nothing is done to our system, the costs will break our banks–so to speak.
Complaining of “socialized” medicine also seems to pick up an opposition talking point–it’s weird, in that we have Medicaid and veterans health care, and a “socialized” postal system and a “socialized” military and Social Security, and the bishops aren’t complaining about those. The public option, if it even happens, is a small part of the reform. Citing that as producing a threat of “socialization” of health care is akin to the death panel canard.
Anyway, that’s just a start. None of their technical arguments hold water, but Grant’s thread deals with that above. I wonder why they’ve broken with or reinterpreted Catholic teaching on this regard. Interesting that they engage in a kind of cost-benefit analysis of this life issue of health care when they have been among the most outspoken bishops as regards pro-choice pols who they accuse of making the same moral calculus.
“a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good.”
This definition of solidarity seems like the epitome of health care reform. It is being done to support “communities of a lower order” in case need arises, as when illness impoverishes a family, or communities are subjected to monopolistic control of health decisions by insurance companies/HMOs. (apparently the bishops point out the problems of HMOs rationing services, as if that is not a current problem? I cannot follow how that is a warning against health care reform)
These activities are being done to coordinate “with the rest of society”, which again is the main purpose of reform, so that smaller communities have equal access to the care available to the “higher order” communities. This should suffice to demonstrate its motivation “for the common good”.
So how does this definition of solidarity in any way validate opposition to this reform? We cannot have government rationing because that is an HMO responsibility? We should allow insurance company profits to determine care, not the common good? We should allow uninsured individuals to suffer and die, instead of supporting them in their need?
Gene Palumbo and David Gibson have it right in my opinion. These bishops have misapplied the principle of subsidiarity in this matter. There is absolutely no evidence that “lower levels” are providing health care more efficiently than higher levels can. The facts seem to point in the opposite direction. I know people here in DC who have the government plan and they fare much better than I do regarding premiums and deductibles. Their coverage is also more comprehensive than mine. My health plan is the most profitable in the nation and its CEO gets extraordinary compensation, for which I pay dearly. And yet I consider myself fortunate to have the coverage I have. What do less fortunate people do?
“There is absolutely no evidence that “lower levels” are providing health care more efficiently than higher levels can. The facts seem to point in the opposite direction. ”
I do not think that is correct. I think 2006 Mass. Acts Chp. 58 and its results is evidence of the States providing health care more efficiently than higher levels can. If what you were implying is the Majority Party argument that the Federal Government can print fiat money and therefore price everyone else out of the market, then I withdraw my comment as obviously the several States cannot print money.
David Bernstein of the Volokh Conspiracy offers a simple proposal that would take advantage of the subsidiary units in our federal system, namely the states, as ideally suited, in Brandeis’s words, to act as laboratories of democracy and social experiments:
“Let the Democrats put forward three different health care reform proposals. Let the Republicans put forward two different proposals. Find five states to volunteer. Each state adopts one of the proposals. Wait several years. See if any of these proposals worked out well, and if so, which one seems best, and why. Learn from this trial and error, and then pass a national health bill, instead of trying an untested, one-size fits all solution for 20% of the American economy.”
http://volokh.com/posts/1248062921.shtml
“Another is that we can’t afford health care, and it would saddle future generations with debt. I don’t know the track record of these bishops on pastoral statements/letters, but I wonder if they’ve said anything about fiscal responsibility in the previous eight years when the GOP was racking up this huge debt we’re saddle with.”
You are free to characterize the size of the debt and deficits with whatever adjectives you like, but you must be aware that the public debt increased $4.4 trillion over the past eight years. The current Executive Branch’s own projections in the latest fiscal budget has the public debt increasing $6.3 trillion in the next four years alone and over $12 trillion in eight, which is obviously ~3 times that of the previous 8-year period. Even assuming, ad arguendo, these obscenely understated numbers are correct, the orders of magnitude are not even close. And all of that *excludes* the few trillion of recent increases to the deficits the Executive Branch found and excludes the impact of any healthcare legislation. If you want to make the argument that inflation is just a cost of doing this healthcare thing, that’s one thing, but to pretend that the new government has not made a dramatic shift in federal outlays relative to the size of the economy I do not think is supported by any information regarding federal outlays and income I am aware of so I do not find it particularly surprising someone would potentially raise the issue of the public debt now relative to the previous eight-year period. And even if that was not the case and it was true that deficit levels have not materially changed, I still do not see why they should not be precluded from raising those concerns now. Isn’t that the old tu quoque fallacy?
John Allen performed a valuable service by calling our attention to this pastoral statement; but by reading the statement through the filter of Allen’s article, it may tend to distort what is, in reality, a pretty balanced account of the US bishops’ approach to the health care issue. Allen (rightly) highlights the parts of the letter that are new and/or interesting to him; but if, for example, anyone has the impression that the letter is primarily about the principle of subsidiarity, or that these bishops are using that principle to bash any proposals currently floating about in Congressional committees – then that is an inaccurate impression.
Specifically: in the section of the statement entitled “What Must We Do?” the statement provides *four* moral principles (one of which is subsidiarity) that, *taken together*, should guide our approach to reforming our system of delivering health care (and the bishops strongly state that the status quo is unacceptable, and reform is necessary). Those four principles are:
* Subsidiarity
* The Life and Dignity of the Human Person
* The Obligation to the Common Good
* Solidarity
We can certainly quarrel with the order in which these are presented, and no doubt there are other things that can be corrected, strengthened or improved. (We can also quarrel with their numbering in the document – there are two roman numeral II’s :-)). But I suggest that this is approach is quite consonant with what the US bishops as a whole have taught.
Let’s take this a step further. Catholic legislators could use these four moral principles as a framework for crafting the actual health care legislation being crafted in the House and Senate. And Catholic citizens could use this framework to critique the legislation and determine whether or not it is something we should support.
I will repeat preceding comments that food, air and health care are the rights of God’s humanity. The Pope’s Encyclical reminds us of that fact. It is our responsibility as Americans and certainly as Catholics to ensure equity in those rights across the entire human spectrum. Government provision is the only method we know of thus far to deliver on that social contract. Basic health care is an essential element of Catholic social justice. Separation of public investment in abortion from the rest of the legislation should be far more central to the debate than invoking a false claim of socialism or “government take-overs”.
MAT, busy day, but just to respond to your rebuttal that “to pretend that the new government has not made a dramatic shift in federal outlays relative to the size of the economy I do not think is supported by any information regarding federal outlays and income I am aware of so I do not find it particularly surprising someone would potentially raise the issue of the public debt now relative to the previous eight-year period.”
Read David Leonhardt at the Times and others who note that Obama’s outlays will account for no more than 10 percent of the huge deficit. The real culprit is in Bush’s budgets and expenditures and the “time bombs” he set for future administrations with tax cuts and big-ticket programs like the prescription meds program. Not to mention, of course, the Republican policies that contributed to the Great Recession that caused this fiscal mess that requires federal stimulus and hampers efforts to invest in the future through things like health care reform.
All in all, Republicans and conservatives have left the country (and the Dems) a fine mess to clean up.
Mr. Gibson – one more item to add. If I have this correct, Obama’s deficit numbers include the costs of Social Security, Medicare, and the wars. Bush never included those costs in his deficits.
that alone makes a significant difference – Obama’s deficts are apples to Bush’s oranges.
A while back I was (with hopeful humor) nominate Jim P. as archdeacon of Elbonia, but now I may be serious as he apparently sees no political slant or innacuracies in the Finn/Neumann statement or only wants to minimize them.
I note the new NCR editorial which also cites the clear (and CURRENT) staemnet of Bishop Cupsich of Rapid City.The threads above are amply filed with the inadequcies of the KC Bishops on grounds of both false statements about health care and about the Church’s position.
“that alone makes a significant difference – Obama’s deficts are apples to Bush’s oranges.”
We (or at least I was) were talking about increases in the public debt actually, not the “federal budget deficit”. The former is neutral to accounting treatment actually – it measures actual face amount of the federal governments liabilities to noteholders so all of the items you mention are actually treated equally.
A comment on the Volokh.com disagrees and I think rightly so:
“Wait several years.
Now the right is just stalling. Sorry, your time is up. There are over 40 million Americans with no health coverage at all right now, and untold millions who fear losing their coverage or that it will be inadequate. What we should be doing is adopting a single-payer system, which would cover everyone and produce the lowest society-wide cost. Because of conservative intransigence, instead we’ll have a public option that people will be able to buy into that competes with the predatory, costly private plans. That’s the experiment we’re going to undertake, at the end of which we’ll wonder why we allowed private companies to collect premiums and then cancel people’s coverage when they got sick.”
” The real culprit is in Bush’s budgets and expenditures and the “time bombs” he set ..”
“All in all, Republicans and conservatives have left the country (and the Dems) a fine mess to clean up.”"
David, the election is over and unfortunately the public debt is still outstanding and I reckon the PRC is not in the lien subordination business. So while it appears to be personally gratifying to you to attack your enemies I don’t get what relevance your response has to do with the level and pricing on the public debt, both currently and pro forma for all these new federal health insurance regulations and programs. Are you suggesting some sort of risk premium contraction given the change in government? My money is on the opposite case, literally, but if you have an argument to make about it I would be interested to hear it.
On a side-note, this may shock you but I do not read the NYT with the exception of the opinion page. That said, I am familiar with the Brookings Institution report that reporter seems to have written about and without hijacking this thread into a discussion of the federal budget, I would point out that (1) that paper, even if you assume it is relevant and there is a lot to debate in it, was written after the 2009 Inauguration so I am not sure how you expected these bishops to know about it during the previous Administration, (2) there is nothing preventing the current Government from rolling-back the tax cuts, MCD, etc, but they are not, so they are having their cake and eating it too yet you do not criticism them for “hamper[ing]” “invest[ments]” in “health care”, (3) the notion that the “stimulus” was “requir[ed]” is pretty debatable, and (4) that report was based on the new Government’s *budget*, not actual numbers – since that report was published, the deficit has been revised upward by trillions of dollars.
“A while back I was (with hopeful humor) nominate Jim P. as archdeacon of Elbonia, but now I may be serious as he apparently sees no political slant or innacuracies in the Finn/Neumann statement or only wants to minimize them.”
Hi, Bob, I’m sorry I’ve missed your Elbonia nomination. I deeply appreciate it, and look back with fondness on our joint boondogle of long ago, touring the Elbonian sherry district on a bicycle built for two. :-)
There are at least three threads and dozens of comments here in dotCommonweal about the KC pastoral statement. Based on that volume, one might conclude that there is a lot of substantive engagement with the letter going on here, but in fact, the majority of commenters (and perhaps even posters) seem to be searching for reasons to dismiss the statement out of hand. That’s unfortunate, because the statement is a serious contribution and worthy of engagement.
Let’s suppose, for the sake of discussion, that these two bishops are Republican. So what? Other bishops presumably are Democrats. Judges also are Republican or Democratic, but we expect them to base their decisions on justice and the law, not the party line. Political party affiliation doesn’t diminish the bishops’ teaching office. This is a teaching document. It presents some principles of Catholic social teaching in a pretty straightforward way.
If we can’t deal with the injection of Catholic social teaching into the health care debate, then that’s our failure, not the bishops’.