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Pope says universal health care an "inalienable right"

B16's address to the 25th annual conference of the Pontifical Council for Health Care Ministry broke no new ground in Catholic teaching, but summarized the church's position on health care quite firmly -- and also implictly challenged those Catholic conservatives in the GOP who are about to take over the House with a vow to repeal Obamacare.ZENIT has the full text here, and here is my PoliticsDaily write-up:

"It is necessary to work with greater commitment at all levels so that the right to health is rendered effective, favoring access to primary health care," Benedict said in a message on Thursday to the 25th annual conference of the Vatican office that promotes health care ministry."Health justice should be among the priorities of governments and international institutions," he added.The pope said that establishing this goal requires "a true distributive justice that guarantees to all, on the basis of objective needs, adequate care," and he said "the social doctrine of the Church has always evidenced the importance of distributive justice and of social justice in the different sectors of human relations."Benedict's secretary of state and second-in-command, Cardinal Tarcisio Bertone, read the papal statement to the annual conference of the Pontifical Council for Health Care Ministry and then delivered remarks that were even clearer than the pontiff's."Justice requires guaranteed universal access to health care," Bertone said, adding that the provision of minimal levels of medical attention to all is "commonly accepted as a fundamental human right."

WWJBD? What will John Boehner do? Not much, is my view, given that papal statements rarely effect Catholic politicians of either stripe, not even the pope-ier-than-thou Catholics on the right.But I do note that there are conservative pro-life Catholic voices that take a line more in keeping with that of the pope's, notably Valparaiso University law professor Richard Stith and R.R. Reno, who have both taken some heat at First Things for their columns proposing to remedy HCR rather than repeal it.They say that alleged abortion funding in HCR (a position of some dispute, as we know) should be eliminated, and then they'd be good with it, like Benedict. The standard conservative Catholic/GOP position, however, is that the whole principle of federalized health care policy is wrong.Still, I wonder if the Stith-Reno-Benedict position would give Republicans cover if they fail on a full repeal, which they seem likely to do. That could work out well for them, as most Americans still favor HCR, and strong majorities favor almost all of its elements, except the individual mandate.

About the Author

David Gibson is a national reporter for Religion News Service and author of The Coming Catholic Church (HarperOne) and The Rule of Benedict (HarperOne). He blogs at dotCommonweal.

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Re: ObamaCare and healthcareYou are aware that ObamaCare is NOT about the actual provision of healthcare? Rather, it is all about $$$, it is about compelling healthy young people to pay into "healthcare plans," it is about compelling employers to provide healthcare plans, it is about insurance companies paying claims, and it is about government bureaucrats deciding what will be allowed to be paid for and what will not be allowed to be paid for. In fact, every study done on ObamaCare indicates that the actual provision of actual medical treatment will go DOWN.

Bender,So are you saying we must have a single-payer plan?

Bender, do you live in a no-fault auto insurance state, where everyone (even the good drivers) are forced to buy car insurance? If so, do you think this is a bad idea too?

Isn't the health insurance run on the principle that healthier people are going to pay in, and sick people are going to use, and it'l will be there when and if the healthier people get sick. I thought that was the general principle that insurance ran on, but I'm not in that business.

"Isnt the health insurance run on the principle that healthier people are going to pay in, and sick people are going to use, and itl will be there when and if the healthier people get sick. I thought that was the general principle that insurance ran on, but Im not in that business."Yes, any insurance whatsoever, including both Medicare and Social Security, from the beginning of time.

"most Americans still favor HCR, and strong majorities favor almost all of its elements"A citation would be interesting. Poll after poll actually shows a majority not just against ObamaCare, but for actual repeal.http://www.politicsdaily.com/2010/10/15/repealing-health-care-reform-try..."Rasmussen Reports -- shows that voters in 26 states favor repeal by a significant margin, voters in four others support repeal by margins of four points or less and voters in two states oppose repeal."At the link you'll find a table of 8 different polling organizations. Only three of them have a majority that opposes repeal.

So, then, you guys do not dispute that ObamaCare really is about money and financing, and not about the actual provision of medical care (and it is the latter that is the "fundamental right" -- actual treatment -- and not the forced payment of money).How about having a system that truly promotes genuine healthcare, rather than a system that is focused on money?

Bender, I don't understand what you are saying. I don't think anyone has agreed with your point, and I'm not sure what your point is. "All about money?"Flanagan, the mainstream polls I've seen, such as this one by Gallup, consistently show a bare majority at least tend to favor keeping or expanding the law. http://www.gallup.com/poll/144422/four-americans-believe-healthcare-law-... still is the Kaiser survey that shows all of the reform's elements are widely popular with the public except for the mandated purchase of health insurance:http://voices.washingtonpost.com/ezra-klein/2010/11/why_repealing_the_he... Of course, HCR has also been ridiculously demonized by opponents, much like TARP, so it's not surprising that it would not be as popular in general, but is widely supported when its provisions are taken out out of the context of "Obamacare" and presented to respondents.

Also, why is it that no Catholics who oppose HCR are willing to weigh in here and explain why the pope is full of hooey, too?

"So, then, you guys do not dispute that ObamaCare really is about money and financing, and not about the actual provision of medical care (and it is the latter that is the fundamental right actual treatment and not the forced payment of money).How about having a system that truly promotes genuine healthcare, rather than a system that is focused on money?"Bender, this isn't some worker's paradise. This is America. EVERYTHING is focused on money. So what are you getting at?

Benedict is just speaking the common sense of Europeans in general -- of course people should not be left to die on the streets when they fall ill -- of course health care should not be the preserve of the rich. It amazes Europeans that poor Americans are so brainwashed as to consider themselves unworthy of these "socialist" benefits.

I think it's just wonderful that the Pope not only called universal access to health care a fundamental human right, but that he specifically said it's an issue of "distributive justice". I get very frustrated when some Catholics say there is nothing in our religion that requires us to support government-funded healthcare; I'm really glad the Pope says otherwise.

Poor Americans are brainwashed by the money ads that rich health care companies continually run so that what is true seems untrue. The principle of advertising. Say it often enough and it seems so. Brand name. But with real Catholics, lack of support for health care is decidedly ungenerous.

Catholic opponents of what they call "Obamacare" may say that the devil is in the details, but it seems that it is now incumbent upon them to say where the devil is exactly and to propose some form of legislative exorcism rather than a whole sale reversal. I also would say that advocates of a single payer approach should make there case with more force and more broadly than they have.

Actually Christians should not need the Pope to tell them that care for the poor is a moral duty.

Right, Joe, Christians should not need the Pope to tell them that care for the poor is a moral duty,but how heartening to have the Pope spell it out that establishing the goal of health justice requires: a true distributive justice that guarantees to all, on the basis of objective needs, adequate care. And how good to hear him say the social doctrine of the Church has always evidenced the importance of distributive justice and of social justice in the different sectors of human relations.He really got it right this time.

David, I am not willing to say that the pope is full of hooyey because that would be disrespectful but I am willing to say that I disagree with him. First, I disagree with employing the Good Samaritan story to justify national health care. It seems that that story does nothing more than call us to personal sacrifice. It does not call us to tax our unwilling neighbors to make equal sacrifices. Whether one fed the LORD when he was hungry or not is something she should have to answer to Christ for, but not to Ceasar. The government's proper role is to keep the peace and to make sure that people's natural rights are protected. Since Gaudiam et Spes, the Vatican has turned everything into a right. This seems to an impoverished understanding of rights. Rights are those thing which bind your neighbors. Your right to life means I have an obligation not to kill you but from the state's perspective, I should not be force to contribute to your well-being by force. To do so is tyranny. To force someone to work for someone's else interest without his consent is the very definition of slavery. Now, before you yell at me, I absolute do believe that Christians ought to sacrifice for others. But "love your neighbor" is simply too radical for the state to ask of us. It seems strange to me that the same people who think we can't do anything about mother's killing their children in a pluralistic society think we should enforce charity among strangers. I also think the Church refuses to learn from its past entanglements with the state. Government money means government control and whatever winds are blowing in the culture are going to be pumped into the Church. I am amazed that the Church is surprised when the state tries to require funding for contraception and other activities contrary to Catholic teachings. Many of our bishops seem to naively believe that a leviathan state that takes almost half of the nation's resources and employs about a 10th of the population is not a threat to the Church's autonomy. This is despite much evidence to the contrary---a Church that relies on the government for money is not a free Church. Many Catholics would give the huge amounts of money that currently goes into government bureaucracies to Catholic schools and hospitals. I wish the Church would keep that in mind. Carolyn HyppoliteP.S. Lest you imagine that I speak from a state of comfort, I currently do not have health insurance. I also spent much of my childhood without health insurance.

Hello Carolyn- Do you believe you can disagree with the Pope on this and still be a good Catholic? If you do, would you also agree that I can respectfully disagree with the Pope on artificial contraception and the ordination of women ( nd a couple of other things) and also still be a good Catholic? Or not?

Carolyn:If people could opt out of having health care that they don't pay for, then under free market "principles" opting out of the health insurance/coverage system might make sense. But state laws in the US are pretty consistent in requiring hospitals to treat people who come in through the emergency room (for example) whether they can pay or not. From where I am sitting (in a CFO office of a major health insurance company), the real "socialists" are the ones who don't want health insurance but do want to be treated if their car hits a tree.In the end, requiring people to have health insurance is no different (in structure) from no fault auto insurance. If you don't want to pay for auto insurance, you can opt out of the system by choosing not to have an automobile. Unfortunately, no one can opt out of the health care system by choosing to not have a body. But except for a very small number of religious fanatics (and an even smaller number of people who can really afford to cover any possible claim out of their checking account) I don't think I have ever run into anyone wearing, say, a bracelet that says "If you find me on the side of the road in a pool of my own blood, please leave me there." Since everyone has a legal right to at least some level of treatment right now, the people who either pay taxes or (to a greater degree) pay for private insurance are already paying for people like you. You are in fact in the state of comfort of a free rider. I would imagine that when you do need to go to the doctor, you pay for it out of pocket. But unless you are extremely wealthy, you are sooner of later going to need care that you can't afford and you are merely asking everyone else to pay for it for you in the name of a (in this case) bogus individualism.

"the social doctrine of the Church HAS ALWAYS EVIDENCED the importance of distributive justice and of social justice. . . " (emphasis mine)This time he got it right :-)

" To force someone to work for someones else interest without his consent is the very definition of slavery. "Carolyn H, --So you're against drafting people into the Army?

Irene, I am not willing to call myself a good Catholic....This morning I prayed my rosary half asleep in my bed and then I decided to have a late breakfast/early lunch and ate half a pizza---sloth and gluttony all before noon!. I hardly consider this good Catholic behavior. I do think that the Church has a right to decide which disagreements are allowable, which are not. It seems to me that it's ok for the Church to say that if you don't accept the real presence, you are not one of us. If the Church should decide that I am bound to believe all the quasi-socialist silliness that many of the bishops have been promoting, I would be sad, but the Church must have that right. I still respectfully ask to be persuaded. I have read all the major social encyclicals and I have tried, at times better than others, to be charitable in my personal affairs, which I think I am absolutely bound to before God. I am not persuaded that I am bound before God to accept any particular social arrangement to provide health care that I think is imprudent and incompatible with liberty. I do not believe that I am sinning in doing so but I also do not believe that I make the final call about who is and who is not a faithful member of the community. As for the issues, you raise, I personally think it's ok to disagree about the ordination of women but I think if you go out and have yourself ordained that is sin. Likewise, I think using contraception is clearly sin but I would not say you automatically sin because you have trouble with a particular Church teaching. I am not fond of the good/bad Catholic labels---only God is good. I am much more interested in specifying what actions are sinful and which are not. Peace in Christ,Carolyn

Ann, I am against drafting people into the army. Carolyn

Ann-- good catch. :0

Unagidon, I don't appreciate being called a free loader. I recently decided that I could not afford and did not need health insurance as I am generally in good health. During this time, I have paid what expenses I have needed out of pocket. Of course, it has not been much, mostly dental and allergy treatments, but I do pay for it. Also you said: If you dont want to pay for auto insurance, you can opt out of the system by choosing not to have an automobile. Unfortunately, no one can opt out of the health care system by choosing to not have a body. This is precisely why I think it is wrong to force people to have health insurance. I cannot opt out of a body and I think think I should be taxed for being alive! As for car insurance, my state only requires that I cover damages to the property and bodies of other people. Whether I choose to cover my own expenses is up to me. I decided that since my car is pretty old that I am not going to cover it. But if I should put someone's life in danger I should pay for that; That is just. As for emergency situation, I do agree that you must provide immediate life saving care to people but there might be ways to make people pay for that on the back end. This is slightly off topic but the real problem is the cost of health care is ridicilous and need not be so. My mother had a $15,000 for going to the emergency room after a car accident and getting an ice pack and some pain killers (and some tests). We need to get to the bottom of that,. If an ice pack and pain killers $100 as it should, there would be no need to propose a government health. This insane price tag was paid for by the car insurance company! I suspect that the insurance bureaucracy and government regulations are what makes this problem worse. I once had a doctor tell me that he would sell me some shoe inserts for $200 if my insurance refused to cover it. He was charging my insurance $800! But of course, he knew that I would never pay that price for inserts. If people had to pay more of their health care costs directly, prices would go down; there would be competition. We should start by having insurance cover only serious health problems, not your basic eye exam. Carolyn Carolyn

Carolyn, thanks for your very honest comments. I admire the way you contend with the teachings and pronouncements, as I think too few do so. BTW, my "hooey" remark was a playful way of inviting opponents of mandated universal health care to explain their disagreement with the pope. I'd never say that about the pope, of course. I mean, not to his face...

Carolyn,There are many people who do not have the ability or opportunity to decline health insurance. For example, there are young children, any number of people too ill to think clearly about this or any other significant mater, people without much education, etc. A decent society has to figure out how to make sure that these people get the health care they need. One way of doing so is through health care insurance. We know that private health care insurance in the U. S. leaves many millions of people uninsured. Many of these people are in groups of disadvantaged people such as those I've mentioned. Some institution has to make sure that these people do get care. If there is some other institution that can get this job done, then maybe the government wouldn't have to intervene. I know of no such actual or proposed institution, at least here in the U. S. So the government is it. To be effective, it will have to establish appropriate rules, perhaps even requiring that everyone who can do so contribute to the costs. Governments have mandatory programs to provide all sorts of services, e. g. police protection, food inspection, etc. that no other institutions can do with the necessary thoroughness. Unless one can propose a plausible alternative to government action in these matters, then it is a matter of justice for us to support these programs.I recognize that no programs, governmental or otherwise, are going to be flawless. They will all need regular review and modification. But the fact that one can find some flaw in a program is no reason for simply rejecting the program instead of working to improve it.

Benard, There is no doubt that there is much need in the world, but the first thing, I would like to see is all of us think beyond is this knee jerk reaction that just because there is a need, the state must do something as if it is the only institution that can do something. There are many ways of handling these problems. I am from Haiti and when someone had a huge hospital bill in the family, you called up uncles, brothers and cousins and they all dug deep and chipped in. I am not suggesting that Haiti is a model society but this is one aspect of traditional societies that might be worth reviving. I have come across a few protestant health care cooperatives where people pay a reasonable sum on a monthly basis and the fund is used to help members with serious health care needs. Members also commit to pray or each other as issues arise; I like this model. Also, there are all sorts of charities that are eager to provide for the need and I think there might be a few more them if we had not gotten it into our heads that the government will take care of it. Sure, this will all be messy, but where did we get this notion that life is supposed to be neat and completely without risk? I want us, particular in the Church, to focus more on what it means to live in community, that it means freely sacrificing for your neighbors and your brothers without threats from uncle Sam (or the Church). Also, as I said earlier, we all need to be asking why is health so RIDICULOUSLY expensive as opposed to who should pay for it. If it were more reasonably priced, this would not be an issue. My other main point is that such government system is contrary to basic liberty; I value liberty more than security, and I think it is wrong to take money from one person to give it to another even for a good cause. If you want someone to be charitable and I think we all want that, you should persuade her. CKH

Mark, yes in fact the pope did specifically espouse universal care as a human right for all. But I think you are right that he didn't say it had to be government single-payer or a mixed system like that of Switzerland or the Obama plan. As long as everyone is covered with proper care (as they have not been in the US, obviously), and it seems pretty obvious that there would be an important government component to make that work.

"inviting opponents of mandated universal health care to explain their disagreement with the pope."But David, the Pope never espoused universal health care, did he? If I believe that a free market for healthcare would produce the most efficient system, while still believing a safety net be made available (either through funds provided by the government or private charity) to those down on their luck that they may purchase healthcare through this most efficient of systems, am I not completely in sync with the moral principles the Pope says should guide us?

Carolyn,In this case the state IS the only institution that can do something about health care. The private market is riddled with market failure, and a hundred years have shown that the situation is only getting worse (evidenced by the rise of costs and the decline in quality of care).The history of the highly developed economies shows unequivocally that advanced economies turn to government to manage large-scale risks like health care because markets are not up to the task. The market is plagued by asymmetric information, the near-monopolistic powers of a few huge insurers, etc. In short, none of the institutional arrangements for functioning markets are present.Also, your anecdotes from Haiti illustrate perfectly the virtues of risk management through insurance programs. The difference is that the scale and cost of such a system in the US would be prohibitive for the family unit. How many families do you know who could collectively cover cancer services in the hundreds of thousands of dollars?I am also curious to better understand your reasoning against government's capacity to administer a functional health care system. Risk management is one area where the evidence suggests government is in fact both more equitable and efficient than the market. See Hacker for a richer argument:http://www.prospect.org/cs/articles?article=bigger_and_better

Thomas, I am skeptical that we have hundreds of years of data about the failure of the health care market but we do have a few decades of data that indicate a serious and growing problem. I am not convinced that it is a market problem since the government is greatly involved in health care already and there are good arguments that they are making things worse. But this is beyond the question that I have attempted to answer. As you noted I am not against pooling for risk management. I have spoken about the use of rights and the force of the law. I have said nothing about the efficacy of a government system (while much could be said about it). That is a good discussion, the use of rights makes it a moot point. For example, an argument about the efficiency of slavery does now make a viable moral option because it violates fundamental human rights. The pope said that health care is a universal right. If he is right, then the question of whether the government is the best administrator is irrelevant because in my view, it is the duty of government to preserve our universal rights. If health care is a universal right, then the government must step in and assure that every person has health care. I wonder how far this right extend, if I have a headache, is the government bound to provide me aspirin? I am not sure if the pope means the same thing I mean when I say right but it seems to me that if it is a right, then we are only able to quibble about minor details. In fact, a recent comment by a bishop (I can't remember who) seems to me that the bishops are confused about the nature of rights. The bishop said the Church only cares that everyone is covered no matter under what system including a wholly private system. I find this strange because as I understand them, rights must be protected by the government. It seems to me that health care is a great need, like food, shelter, even love, but I believe that assuring that no one ever lacks for these things often involve the creation of tyrannical systems. I make no great claims that I have a plan to assure that everyone, at all times, will have health insurance; I find the suggestion that I should problematic. But I do think we ought to tackle the more realistic question, of why is insurance so expensive and how can we fix that, and how can we assist those who cannot afford even the more affordable health care by being good samaritans. I also brought up another question of rights, which I think is well supported by Leo XIII and Pope Pius (can't remember which right now) and that is whether a woman has a right to the fruits of her labor. And this seems to me a right that the government is bound to protect. (If you want I can talk about what taxes I think are just). A while I read a story about a well-to do- couple who had what the government in Massachussetts considered to be inadequate insurance. This couple had a great deal of savings and prefered a very high deductable insurance with low monthly premiums. Mass. govt. was not impressed and insisted that they buy more insurance or be fined. Since it was cheaper for them to pay the fine, they did. I find this problematic. A government that can tell a couple what to buy and when they have had enough is too powerful.Peace in Christ,Carolyn

Carolyn said: "I dont appreciate being called a free loader. I recently decided that I could not afford and did not need health insurance as I am generally in good health. During this time, I have paid what expenses I have needed out of pocket. Of course, it has not been much, mostly dental and allergy treatments, but I do pay for it."I am sorry that you don't appreciate being called a free loader, but you are, in fact, a free loader. Yes, you may be in reasonably good health and yes, you may be paying cash for the things you do use. But if you have an accident or a catastrophic event (and sooner or later, the odds are that age or fortune will cause one or the other) someone else will be paying for you. On the other hand, you are not paying for other people's catastrophic events now. So like it or not, you are already part of a national risk system that is being paid for by people other than yourself.You suggest that some of the popes spoke about women having the rights to the fruits of her labor. You are now (and will be when you become old) taking the fruits of the labor of other people who are and will be paying for your health care. Unless, of course, if in the interests of the free market you would rather die than take more out of the health care system than you yourself are putting into it. Because this is how the system works today.

Thomas Jacobs --Thanks for the excellent Hacker article at American Prospect. An eye-opener.

unagidon You are just being ridiculous. I am not against getting health insurance not do I plan on never having it but it does seem to me that I ought to have the right to decide that as a healthy 30 year-old woman that there are financial priorities in my life more important than health insurance. And the fact that now the public thinks such a decision by individuals is up for public review is exactly what worries about where we are moving. This is the problem with collectivism. People who know nothing about someone's individual circumstances feel like they have a duty to comment on their financial decisions. Will you be commenting on menu choices next? I don't think I had five serving of veggies today. Do I need to discuss that with American public? CKH

Surely Carolyn is perfectly within her rights in calculating that she can neglect insurance just now? In Japan insurance is mandatory for all, though many neglect it in practice, but in the USA there is no such law. She also makes a good point: "we all need to be asking why is health so RIDICULOUSLY expensive as opposed to who should pay for it. If it were more reasonably priced, this would not be an issue." In Japan, health care is much cheaper than in the US, so even an uninsured person can cope financially with unexpected accidents or infections.

I believe Unagidon is entirely correct. Except for the super-wealthy and the Amish, people who forego insurance are of course subsidized by the rest of us. Carolyn above had said she doesn't plan on never having insurance, it's just not a priority now when she's healthy. So she's thinking abut timing her participation in the system. If she times it right, she can still get health care when she needs it; she would have ended up paying less in premiums and she would still be taking out more than she pays in. But if she times it wrong, and gets sick while not covered, she won't be able to get insurance. So the option for someone in that situation would be to either forego care, get Medicaid or go into bankruptcy (stick the hospital with the bill). If we're talking about "rights to the fruits of one's labor", wouldn't the latter options also in a sense be taking the fruits of another's labor?That said, I would still be willing to help subsidize the health care of those individuals who had the means but intentionally chose to forego insurance. (And I would vote that others do so, too, through taxes, even they don't want to) Why? because even though they had been irresponsible, I believe, like the Pope, that health care is a basic human right and everyone is entitled to it.

Unagidon, Not the topic here, but would you be able to tell me, under health care reform, will my small non-profit be able to get claims-rated now rather than the horrible community-rated premiums we pay?

Dear Irene,If it has between 51 and 100 then, sort of. (Businesses in that size range start out with a sort of "community rate" which is then adjusted by claims experience; groups larger than 100 are entirely experience rated). If it has less than 50, then no. However, the good news is that the "community" used for the rating (the community is the size of the pool that the risk is spread over) should get much, much larger and that should drive your rates down.

My heart breaks for those poor Europeans who know not the joy of individual freedom but suffer under the tyranny of collectivism when it comes to distributed and even redistributed costs for health care. But let's go further and privatize parks, roads, and other social goods that we use taxes collected from all (or many, to be accurate) to pay for. Let there by turnstiles at every turn. What I don't understand, genuinely, is why health care is a Rubicon for social conservatives who retain some attachment to the commonweal. I don't understand what ideological or theological principle drives the animus against universal coverage as a mandate.

unagidon- Thanks!

Irene, If it makes you guys feel better, I plan on getting health insurance when I can afford it, but since I have chosen to forgo full-time employment for now to pursue my academic interests, a decision that I don't think the American public is responsible for, insurance became an unjustifiable expense. More importantly, my greatest worry remains not my health but my freedom. What ought to be a transaction between my health care providers, my insurance provider, and myself is now a transaction between me and the public--the system and how much I am paying into it. So, unless I decide to become Amish or become super-rich, I cannot maintain that this is a private matter because I am being pushed into a non-consensual arranged marriage with your benevolent, coercive system. With all due respect, I value my autonomy above your concern. And I repeat, a government (a public) that feels compelled to dictate what economic transactions private citizens ought to engage will ultimately insert itself every area of our lives where it feels individuals are too incompetent to make those decisions. Our founders are rolling in their graves. As for letting people die, I have a great deal of confidence in your generosity Irene---a great deal more than you have in my ability to make decisions. I have so much confidence in your genersority that I do not doubt that if able, you are willing to write a check to a local charity hospital to take care of those down on their luck or just plain irresponsible. I have so much confidence in you that I see no need to force that money out of you. I also suspect that if we cut out our Uncle Sam, we will get more bang for your buck.Peace in Christ,Carolyn

If everyone has a right to expensive health care then everyone who is able may have a moral duty to work beyond his or her planned retirement date, perhaps for many more years, in order to pay for a generous set of benefits.As the dismal science suggests, there may not be any free lunches. Early retirement may be a luxury that an expanded welfare state will have to discourage, already in places like France and soon in our own country.

Carolyn- I completely respect your right to choose not to have private insurance coverage and I believe you when you say you do not intend to take advantage of any public subsidies. You may successfully accomplish that. Even so, I also believe that there are very few people like you, which makes you statistically insignificant. We need to frame a public policy that addresses the millions of uninsured and underinsured people right now who need or might need government subsidy for health care. I don't personally have a problem with the government paying peoples' health costs directly; but for those who don't think that is a good idea, requiring that people with resources buy insurance is one response.I strongly agree with you that costs need to be lowered, but I also think it is a complete red herring. No matter how cheap you make it, there are still people who won't be able to afford even basic health care, let alone major surgery.And as someone who has worked twenty years in various charities, I would certainly not want to rely entirely on the kindness of strangers. Every charity I ever worked for received government money; charitable donations came nowhere covering the costs of our work. I suspect health care charities are the same.

William, I don't have a special atteachment to health care. It is just what we are debating now. The only thing that is special about it for conservatives is that it is one more thing. It is losing ground. I also think conservatives have a problem that it is being handled at the federal level, which we think is another creative reading of the commerce clause. As for maintaining a link to commonweal, I like to read from a wide variety of sources and I like to keep up with what is going ion the Catholic world. I have read commonweal for years although I rarely comment. I thought David's question to conservatives deserved an answer. I think many of my conservative brothers and sisters have been pretending that there is no gulf between them and the pope on this matter so I wanted to give David an answer. Am I invading your space? As for as the Europeans do, I don't enough about it to comment but I will share another anecdote which I think is telling. Most of my extended family moved to the United States but I have an aunt who moved to Canada. In America, most of my family have achieved some measure of success. We didn't always have health care but most of us do now and until very recently, I had very good insurance. I have an uncle who never graduated from the eight grade who is the successful owner a decent size cab company in Miami. On the other hand, my aunt who moved to Canada, who is the only sister out of four to graduate from high school, spent two decades in Canada living off the public. She never worked a day in Canada. And dare I say, it is the same people who are accusing me of freeloading who create the benevolent systems that cause this life long freeloading. It is just anecdote but I think it is telling. Take it from an immigrant, America is a wonderful, challenging, risky and rewarding place and conservatives want to keep it that way. Let the Europeans be Europeans. I don't begrudge them their vacations. Let the French protest that their precious retirement age will be raised above sixty. But please, let there be one America in the world. Let there be one place where barely literate boat people can achieve great things. Before you balk, may I remind you that I grew up in that community. And I want there to be one place where my uncle's story can happen and that place is not Europe.Peace in Christ,Carolyn

How is Carolyn's position taken not to any absurdist extreme but really just applied consistently not also an argument against any form of mandated paid holidays or labor standards. Presumably the public has a compelling interest in health and safety and in matters of non-discrimination, but aside from that, I see Carolyn as arguing implicitly against a minimum wage, mandated family or medical leave, and other efforts to constrain economic transactions between private employers and employees. There is a principle here that extends far beyond health insurance.

There was a story on the news a couple of months ago about a town in, I think either Kentucky or Tennessee, where property owners were expected to pay an annual fee for fire services. (I'm not sure whether the fee was optional, I think it was). Anyway, one owner chose not to pay the fee, and, guess what, his home caught on fire. The fire department came to the scene (to protect the adjacent properties) but they let the house burn down. The owner was just outraged. I think there are similar scenarios in health care; I think many uninsured people are hoping to stay healthy but fully intend to take advantage of government-funded programs if the need arises (I was once in that boat when I was in school). I also think others (and this is not directed at Carolyn), I think others may fully believe they wouldn't take these subsides, but like the man whose home burned, will feel otherwise if they ever really need medical care.

William, You are right. There are broader implications for my argument. But you are in luck. First, conservatives by nature don't tend to be revolutionary. Unlike FDR, we won't change America over night. Right now, we are more interested in holding line. We are too busy thinking about what aspects of our lives liberals want to regulate to seriously think about making serious roll backs. We also prefer, generally not universally, slow and organic changes. Second, we are pragmatic. Not really interested in fights I can't win. There are all sorts of things that I hate but I can't be bothered to do anything about it. I have a personal life and bigger political fishes to fry. But to go back to your question, why health care? It about 1/6 of our economy so it's a big fish and we think we can win. CKH

Irene, So the man was outraged? So what? Is there more to this story? Did he sue? Did he win? Was someone from his house injured or killed? CKH

"Is there more to the story". Nope, just an example of how a man didn't want to be required to pay a form of insurance for a catastrophic risk, but when the catastrophe occurred, too late for him, he wanted the services.

I wish I could say I long for the gold old days before either of the Presidents Roosevelt began to chip away at our hard-won freedom. Or think that FDR destroyed capitalism through such dastardly soul-destroying institutions such as Social Security. We have nearly approached the levels of inequality and poverty of the 1930s, in any case.

Actually, there was a bit more to that fire story since the man had paid the fire service fee for many years, perhaps more than 20 years, and didn't get around to it for one reason or another. I didn't understand that his failure to pay up for this year was a principled act of protest or expression of rugged individualism. Here's the sad part: so his private property burned down when the fire company made sure he was delinquent. His loss. Yet a destroyed farmhouse is also a loss to a community, too. There's a level of common interest in maintain existing, viable structures which is not zero, even when other people own them and fail to exercise prudence. Property values and heritage are often involved. There's an argument to be made for saving a house and making someone pay up, double or more, after the fact. There are reasons why we do not allow people to do whatever they wish to their own property; these reasons exist in complicated relationship with notions of individual freedom and private ownership. I wouldn't want to make an Aesopean fable out of this sad story.

Thanks for the additional information, William. When I heard the story on CNN, I was trying to figure out why fire service was a separate charge anyway. Is that how it's commonly structured in rural communities? How can fire services be optional? Or was there some kind of anti-tax movement going on in that town? Was he too poor to pay the tax or was it some kind of principled thing? Or just a one time oversight? Whatever the case, it was newsworthy enough to make CNN.Like you, I think the fire department should have put out the fire anyway (just like I think we should still provide health care for people who choose not to carry insurance). I think we might be agreeing here, though I'm not sure. I don't think essential services should be optional, based on one's ability or inclination to pay. To me, the fire story reflected what would happen if conservatives get what seems to be their wish: a retrenchment from mandatory taxes for the provision of services, even essential services like fire prevention and health care.

To Carolyn,What does the metaphorical construct of a social 'safety net' look like in your ideal conservative view, realizing that as Dr. King said, "I may not get there, but I have seen the Promised Land"? What promises--and what compromises--are envisioned when we get there?

William, It is a sad story and I hope that there were people for in his community and family for him to turn to. Who said there would be no sad stories on this side of heaven? My goodness, most of humanity lives without fire fighters and have always done so. Life is as fragile as you imagine. I am always amazed by all the minute aspects of life that people on the left think ought to be subject of public debate and worse legislation. I once had a conversation with a woman about how the state needs to provide follic acid supplements for pregannt women. I just couldn't believe that we now debating subsidized supplements!I personally think it is too complicated to have fire fighters figure out who did or not not pay their fees during an emergency so we could either require a fire fee or fine the person whose house was saved on the back end. But I see no injustice here and therefore, I feel no need to tell the people of that municipality how to goveren their affairs. Is there nothing that is none of your business? And this stuff about the community interest in the farmhouse is just too much to stomach. YOUR argument taken to the extreme would grant no freedom or private space. For there is nothing that we do that does not have some effect on other people. Like I said earlier, I am sure my failure to eat five servings of vegetables yesterday will affect someone and I think it's only a matter of time before "the community" gets involved. We have to draw the line somewhere and it seems to me that ownership would be a good to start. Surely, this man could have closed his farm house all together and his community would have gone. I bet he and his community has gone on despite this unfortunate incidence. Lastly, we all realize that people have to be motivated to certain behavior. You suggest force and I suggest consequences.Peace in Christ,Carolyn

Dear Carolyn,Given what you know about how insurance in particular and our society in general works, your decision to no buy insurance at this time is perfectly rational and perfectly ethical. From where you are sitting, you would be an individual buying something with your money from a company selling you something. You believe, reasonably enough, that because of your age and state of health, that you would be paying more money to an insurance company than you would be getting back in benefits. So it doesn't make sense for you to do so. Also, you perceive an ethical element in the question of whether you should be compelled to buy insurance or not once you have looked at it in this way and have freely decided not to purchase it.You seem to say that you would be willing to buy insurance at some time in the future and I suspect you would do this when your health or age seemed to warrant it. In that case you would expect that it would be likely (rather than just possible as is the case now) that you would get more in benefits than you pay in. I will suggest that this is in fact the tipping point for you to decide to buy insurance; you will buy it when it looks to you like you will likely get more back than you pay.When this happens (and it will) the question might then be: If you are getting back more than what you are paying into it, who is paying the difference? The simple, or rather, the simplistic answer is that it is the insurance company. The real answer, though, is that other people will be paying for you. It is true that any form of insurance is a form of gambling. It is not gambling as such as is, for example, derivatives trading in America today. But like car insurance or life insurance, you are banking that at least in the long run you may be getting more back than you put into it. The thing is, from a funding arrangement, if everyone waited until they were old and/or sickly to get life insurance or car insurance, no such system would be sustainable. No insurance system whatsoever could survive if it was likely that everyone in the insurance system was likely to pull out more (and much more) than they put into it each year.The reason that we don't have a universal car or life or insurance requirement is that (in the case of car insurance) we are not required to own a car so we can opt out and (in the case of life insurance) we have other kinds of insurance to deal with people who die insolvent; other kinds of insurance to take care of indigent families; and even public funds to bury the truly broke in slit trenches in the weedy back of the cemetery. The reason that we do need a universal health insurance requirement is, at the bottom it it, because we have chosen in our society to not leave people with no health care to bleed to death in the road. If we could toss our sick in the trash and our dead in the river like they do in some other countries, then we could run our health system like we run our car insurance system. But there are at least two good reasons why we don't do this.The first one is that we think it is unethical to do this. In this the Pope is, of course, correct. Not all societies think it is unethical to do this, and in the US we didn't think it was unethical until comparatively recently. But nowadays, one would have to be a truly cold bastard indeed to say that someone who can't afford medicine deserves to die.The second reason might be more relevant to your argument. All insurance does (and I mean any kind of insurance) is distribute a risk shared by all to all. In business, we don't call this socialism; we call this cost effectiveness. If one shares the risk, one has to pay one's portion. This is what you do with car insurance and life insurance. And if, by the end of the year, you don't happen to die and the $500 you paid for a $50,000 policy goes to someone else to die, you don't generally say that you have been ripped off. However, if you say that you don't want to buy life insurance because you are young and healthy, but you think that your heirs nonetheless should get $50,000 if you die, you are not only free loading off the risk pool, you are making it more expensive for everyone else, because they have to cover both their risk and your risk.Business as a system (which is to say capitalism as a system) does not care in the least about the first, ethical issue above for reasons I shall get into. But they care very much about the second risk issue. And as it happens there is a very good purely risk, purely capitalist reason to mandate insurance. Our funding of health care in the United States coupled with the way costs are out of control has skewed things in such a way that people who should be able to afford insurance can't any more because people with insurance are subsidizing so many other people. Risks are not being distributed equally and this is damaging the system so much that it has become a significant competitive problem for the United States relative to all other developed countries. Our country as a whole is paying too much and getting too little as a country. It adds to the cost of everything, and I mean everything, that anyone purchases in or from the United States. The GOP might want to pretend that the current insurance reform was some kind of Bolshevik plot to overthrow capitalism, but the dirty little secret is that it was business who constructed the Health Care Reform and pushed it through, right from the beginning. How do I know? I am in the business and high enough in the business that I am involved.Business doesn't care about the ethics of health care because capitalism is an ethical system that simply does not contain a space for those kinds of ethical considerations. A Christian ethical consideration simply does not exist in capitalism (as such) unless it is converted into a capitalist ethical category. We care about the sick as a capitalist society only insofar and only to the degree where it is profitable to do so. But that leads to one more point.We are all individuals making individual moral choices. But we make these choices in certain social and historical contexts. These contexts to us are like water to fish. They are very hard for us to see. If you look at "conservative" principles outside of their current social context, you would think that we are a society of isolated individuals making our little individual decisions with other individuals. What is hidden is that our society of millions is at least as integrated as (and is perhaps more integrated than) some peasant village of a hundred souls a thousand years ago. The connections of this integration tend to be invisible to most people. So most people don't know (or realize) that other people are paying for them when they themselves are choosing not to have insurance, just as they don't realize that much of what they consume so cheaply was produced by virtual slave labor or that the crap that blows out of the exhaust of their car is going to give cancer to come complete stranger. Are they therefore morally responsible for this? Yes, they are. And declaring that they don't believe that things are this way and that they are therefore not responsible mitigates nothing. You suggest that consequences rather than "force" be the social motivator. You can only be motivated by consequences if you know what they are. But you can be motivated by force if you don't know what it is.

William, I don't really believe in social safety nets. Many on this post have accused me of individualism. I would not describe myself as such. I believe in independence from the state but not from your loved-ones and your neighbors. In fact, I think American individualism (not to be confused with independence) is a problem and the cause for the creation for all these impersonal government programs. My grandmother died in my parents' house and during her aged years, she always lived with one child of her children, but the average American elderly lives alone in a house too big for them with children who have room to take them in, and then they are moved into facilities where die among strangers not their families. This scandalizes me. So, before I talk about public policy, I want to say that I care far more about culture and values than laws. I am more interested in a dialogue about whether it is your duty to God and to the world to spend a healthy decade of your life on the golf course instead of working or helping raise your grandchildren than I am in talking about when the government thinks you should retire. I would be more willing to take criticism from you about my health care insurance as a Catholic who loves me and is worried about my welfare than as a citizen who wants to send the irs to my door.I suspect you ask the question to expose me as a radical. So be it. Marx was a radical but because enough people publically proclaimed his ideas, they are now almost universal accepted. Policies that I would like to see:1. A significant reduction of the FEDERAL government and its complete removal in social welfare. 2. Let the states decide these things. I suspect Calfornia will have different laws than South Dakota and I can live with that. 3. An end to the ponzi scheme called Social security4. An end to all farm subsidies5. Local funding and regulation of education6. And end to funding NPR, PBS, and the arts, etc. 7. Get government out of the marriage issue. I could go on but these would be major achievements.Peace in Christ,Carolyn

Unagidon, You have brought up many issues and I fear that I don't have the energy to respond adequately. I will buy insurance when my income permits. If my health and age were different I might have made different life choices and kept my full time job instead of going to school but given my circumstances, I thought it low risk to choose studies over employment. As for the insurance company, I understand how insurance work. People who are more risk averse always buy insurance and those are do not pay less. You seem to see an in justice in this because the people who always have insurance are covering for those who don't. This is not my understanding of justice. Those people are getting something--- peace of mind which they value more than the dare devils. As long as those buyers understand their temperament and make those choices freely, I don't see what is unjust about it. As for the insurance company they know how to make money.On the issue of letting people die, I think if someone is dying, we should treat him no questions asked. Afterwards, we can go after him for the money. If he does not have it, there are recourses wage garnishment, etc. That person does have the option of bankruptcy but that is hardly a get out of jail free card. If you want, I would be willing to pay a fee that treats someone in a life or death emergency. On the other hand, there are all sorts of conditions short of death that universal health care would cover, like my allergies. While they are unpleasant, they are not life threatening, I don't think anyone should be forced to pay for that. If there something you really wanted me to respond to that I haven't, let me know. Carolyn

Carolyn,At least you saved the National Institutes of Health and Mental Health, the National Park System, the National Highway System, and the delivery of broadband to technology to underserved rural areas for some later stage of the Conservative Restoration! God bless, sincerely!

I am actually quite fond of the national highway system and I believe it is mostly paid for with gas taxes and tolls both of which I think are quite fair. God bless you too :)Carolyn

Carolyn said: "I will buy insurance when my income permits. If my health and age were different I might have made different life choices and kept my full time job instead of going to school but given my circumstances, I thought it low risk to choose studies over employment."True enough. But it is low risk, because you are letting other people take it for you.Carolyn said: "As for the insurance company, I understand how insurance work. People who are more risk averse always buy insurance and those are do not pay less. You seem to see an in justice in this because the people who always have insurance are covering for those who dont. This is not my understanding of justice. Those people are getting something peace of mind which they value more than the dare devils. As long as those buyers understand their temperament and make those choices freely, I dont see what is unjust about it. As for the insurance company they know how to make money."The particular branch of the company that I assist in overseeing has about a million members, so I am sort of in a position to see why people buy insurance. The risk averse thing is tricky because 1) different people have different ideas of risk and 2) different people also have different risks. The complication for number 1 above is that although no one can be turned away from an ER, which means that anyone can free ride if they want to, there are also disparities in the US (and significant ones) regarding who gets what treatment based on what kind of insurance they have. To put this simply, if you have lung cancer and you have a crisis one night (can't breath) you can go to the ER and be treated (and someone else will pay for it). However, you won't get chemo and radiation therapy in the ER and unless you find some other kind of social net to support this, you are basically dead. So a big reason that people buy insurance is so that something that might be treated or even cured will not turn into something that will kill them. I suppose one could be tough and shrug off the risk. But the risk is nonetheless real, and it is arguable that there is a point where this kind of bravery overlaps with stupidity. The second point about different risks is not just about the healthy and young versus the unhealthy and old. You have factored into your own personal risk calculation assumptions around all of the institutions that will bail you out if you get sick; most of which you are not paying for or are not paying much for because you are neither working nor buying insurance. If you didn't have these, it would be interesting to see what kind of choices you would have made.Carolyn said: "On the issue of letting people die, I think if someone is dying, we should treat him no questions asked. Afterward, we can go after him for the money. If he does not have it, there are recourses wage garnishment, etc. That person does have the option of bankruptcy but that is hardly a get out of jail free card. If you want, I would be willing to pay a fee that treats someone in a life or death emergency."You say several interesting things here. First, if what you were talking about was accidents, it might make sense. But about things that will kill you if you leave them untreated but are not happening to kill you at the moment. Do we treat those without question too? And as for going after the money (and it is interesting that you talk about wage garnishment) what if they will never make enough money to pay for the procedure in their entire lives. Say, for example that they have a 10 year old son who needs a heart transplant. Who pays for that? Or do we tell them they are out of luck. You mention bankruptcy and this is interesting too, because bankruptcy itself is covered by a form of insurance and when people go bankrupt, everyone else who doesn't go bankrupt pays. This replaces an older system of putting people into workhouses for life until someone else comes up with the money, if ever.Carolyn said: "On the other hand, there are all sorts of conditions short of death that universal health care would cover, like my allergies. While they are unpleasant, they are not life threatening, I dont think anyone should be forced to pay for that."Good point, and I agree with you. But most medical claims are not about allergies. The biggest drivers of medical cost are chronic things like kidney dialysis that don't make you sick enough to go into the ER but do make you sick enough to die if you are not treated.Yes, there is a big gap, a huge gap in the US around what people want covered. And most Americans want everything (for themselves) covered. But it isn't an all or nothing situation where we either cover everything or we cover nothing.The thing that gets me about these arguments is that every single person in the country unless they are living like the Amish (literally) or are wealthy is completely immersed in insurance systems, safety nets, and the passing of risk to other people who may or may not know about it and who may or may not deserve it. There is no going back. There is no "conservatism" that will make us all live like the Amish again. What conservatives want to conserve these days is their own place in the system. They want what THEY have, but they are afraid that they will lose some of all of what they have if anyone else gets what they have.

Unagidon: The second point about different risks is not just about the healthy and young versus the unhealthy and old. You have factored into your own personal risk calculation assumptions around all of the institutions that will bail you out if you get sick; most of which you are not paying for or are not paying much for because you are neither working nor buying insurance. If you didnt have these, it would be interesting to see what kind of choices you would have made.Carolyn: I made my choices on the knowledge that while poor health is possible, rent and gas bills are certain. I made my decisions on the assumption that my educational decisions today will benefit me more in the long run. As for including all other insitutions into my decision making, I really didn't. I pray for good health and move on. Most of humanity does not have health insurance and make decisions about education without imaging who they will freeload from. As I have this discussion, it occurs to me that a human right must be universally applicable and timeless. It seems silly to me that something that didn't really exist two centurires ago and most human beings have never had is something everyone is entitled to and ought to be coerced into buying. You also brought up what I said about not letting people die and brought up the very good point of chronic diseases that will kill you slowly. I have read that some hospitals have decided to treat poor people who have chronic diseases because of benevolence or because its cheaper than waiting for them show up to the emergency room. I think the best and most moral thing we can do in a free society is to encourage such behavior. I want to live in a world where people FREELY help those in need, even if they were irresponsible. When I lived in Chicago, where homelessness is high, I used to do all sorts of things to help my homeless neighbors, including regularly dropping off breakfast to a man who slept a few blocks from my apartment. I did this freely. It would upset me greatly if it had been forced upon me. I am not willing to use force to make people charitable. I think that is the behavior of a tyrant. Lastly, I don't think we need to be Amish. I am not trying to go back to anything. You are the one trying to figure out how to manage the system. Generally, speaking I have been very happy with the services of the insurance companies that I have dealt with and I am ok with where things are now. It's not ideal but temporary. All this talk about we, we, we. We don't buy anything. Individuals and their employers buy. The only thing I want to go back is the point where the government started meddling in it. We only need to reverse a few decades of legislations. I think the fact that about 85% of Americans have some kind of health coverage is great. I don't need perfection in this world. Many of the people without insurance are like me and despite claims that we are draining system, most of the national cost of health is spent during the last few years of a person's life, not by 30 year-olds. And those people do have coverage; they are just sickly. Anyway, I am really not asking for anything revolutionary here (you are), I want to not be forced into buying something that I can't afford and I don't have a great need for. There is nothing radical or reactionary about it.As for letting people take the risk for me, I think the risk to myself is far great than one else, which is why the decision should be mine.Peace,CKH

On second thought, perhaps, I do want us to be Amish. I don't mean bonnets and horse drawn carriage and but I think we can learn a great deal from these Christians. When your neighbor needs help, you should help them. I once belong to a protestant Church which raised money to help members when they were down on their luck. I think this is the real meaning of the Good Samaritan parable. It seems that today, we say, when you see your neighbor lying on the side of the road, call Ceasar. CKH

Carolyn said: "I made my choices on the knowledge that while poor health is possible, rent and gas bills are certain. I made my decisions on the assumption that my educational decisions today will benefit me more in the long run. As for including all other institutions into my decision making, I really didnt. I pray for good health and move on. Most of humanity does not have health insurance and make decisions about education without imaging who they will freeload from."Yes, they do make these decisions, but since they don't have your safety net, they almost always have to choose not to get educated. (Unless they have the safety net of paid education, which most modern states also have. But we lag behind everyone there too.)Carolyn said: "As I have this discussion, it occurs to me that a human right must be universally applicable and timeless. It seems silly to me that something that didnt really exist two centuries ago and most human beings have never had is something everyone is entitled to and ought to be coerced into buying."So you would be against the abolition of slavery, since that still existed in the United States a mere 150 years ago? Should women have the vote (established about 100 years ago)? Voting rights for Blacks (established about 50 years ago)? Most people in human history lived in some form of servitude (either as slaves, serfs, or peasants). Most people never had the vote. And even where people did have the vote, most women never did.Carolyn said: "I think the best and most moral thing we can do in a free society is to encourage such behavior. I want to live in a world where people FREELY help those in need, even if they were irresponsible. When I lived in Chicago, where homelessness is high, I used to do all sorts of things to help my homeless neighbors, including regularly dropping off breakfast to a man who slept a few blocks from my apartment. I did this freely. It would upset me greatly if it had been forced upon me. I am not willing to use force to make people charitable. I think that is the behavior of a tyrant."I can think of a lot of tyrannies and I can't really think of any that made it a focal point to force people to provide charity for the poor. Can you?Our charity system isn't working. Our health system isn't working. Neither our so-called conservative majority nor our so-called free market system has managed to make either work. You say that charitable behavior should be encouraged. How would you do that? Because apparently religion has not been able to encourage it enough.

I don't often read through a long thread, but enjoy this discussion so much and did just that. CKH, you are a fresh breath of life. A rare combo of principles and respect. Appropriately funny too. "Is there nothing that is none of your business?" Hahaha.This is going to be a Unagidon vs. Carolyn discussion: I thought yesterday and it is now. It is also nice to see for the usual suspects stay out and not distract. There are things I'd like to respond to Carolyn and Unagidon. But I too will keep out of it for fear of sidetracking.

So you would be against the abolition of slavery, since that still existed in the United States a mere 150 years ago? Should women have the vote (established about 100 years ago)? Voting rights for Blacks (established about 50 years ago)? Most people in human history lived in some form of servitude (either as slaves, serfs, or peasants). Most people never had the vote. And even where people did have the vote, most women never did. Carolyn: I mean it is silly to have a inaliable right that can only be applied to in modern societies with insurance. I don't mean that rights are those things that we have always recognized. If that were the case, then nothing would be a right since all things have been abused. Thus, the right to freedom is universal even if humanity has done a poor job providing it. I would say that we have a universal right to worship as we see fit even if the Church has not always recognized it. I confess this a new thought and I need to chew on it. :)You said: I can think of a lot of tyrannies and I cant really think of any that made it a focal point to force people to provide charity for the poor. Can you?Our charity system isnt working. Our health system isnt working. Neither our so-called conservative majority nor our so-called free market system has managed to make either work. You say that charitable behavior should be encouraged. How would you do that? Because apparently religion has not been able to encourage it enoughCarolyn: I am not saying that forced charity is the mark of tyranny, only that it is a type, an admittedly benevolent one, but tyranny nonetheless. I also think liberals and conservatives will always disagree on what "working" means. It seems to me that liberals often expect something close to perfection and therefore it is easy to see things as not working. Conservatives ask, how well does it work in comparison and what are the trade offs of the alternatives? And then conservatives look at the trade offs and say "worth it or not." In this case, conservatives think, that the trade off is liberty, American ingenuity, and our generally charitable culture is at stake. If you value security above liberty, you will think it worth while. I am not sure that there's an obvious right answer there, only what people value. As for our charitable culture, there are those who argue (I am sorry I can't think of any good titles at the moment) that social safety nets discourage charity and that the more you add, the less charity you get. Americans give far more to charity than their Europeans counterparts. I think the part about religion deserves a great deal of attention. Our religious leaders do a terrible job of challenging us to engage in the kind of radical self-sacrificing love that the goapels calls us to. We all know that the average boring homily tells us to be nice and avoid road rage. The USCCB is more than happy to take money from the government, even at the risk of their Catholic identity and mission, than really calling Catholics to step up to the plate. I am really disturbed by the closing of Catholics school and the price tags of those are still open. Catholic education should be affordable to working class families, especially Catholic ones. But for that to happen, the government needs to have less of our money. I can honestly that when I was employed full time and had more money if more of it were at my disposal, I would have done more to support Catholic institutions and charitable endeavors. I suspect that there are millions like me. You say that our so-called free market does not work, I say your so-called war on poverty has not work. If we look at India, we see that for years, the government tried many things to lift people out of poverty and then it tried decreasing its regulation and letting the market do some work. India is now lifting more people from poverty every year faster than you can say community organizer. Of course, there are still poor people in India. It is far from perfect, but such is life on Earth. CKHP.S. I am not sure what is the point of the sarcastic "so-called" was but I am inclined to agree with you. A market with things like bail outs, and farm subsidies is a "so-called free market." :)

Thank You history man, The unfortunate part is that I have not looked a lick of Hebrew today :(. CKH

Carolyn said: "I also think liberals and conservatives will always disagree on what working means. It seems to me that liberals often expect something close to perfection and therefore it is easy to see things as not working. Conservatives ask, how well does it work in comparison and what are the trade offs of the alternatives? And then conservatives look at the trade offs and say worth it or not. In this case, conservatives think, that the trade off is liberty, American ingenuity, and our generally charitable culture is at stake. If you value security above liberty, you will think it worth while. I am not sure that theres an obvious right answer there, only what people value."You seem to assume that since I tend to denigrate people who these days call themselves conservatives that it follows that I must be a liberal. But I'm not.There are people who call themselves Conservatives who insist that, say, a single payer system would be a threat to "liberty, American ingenuity, and our generally charitable culture". I will counter that the drain on our finances of all the uninsured plus the dysfunctional health delivery system is the real threat to liberty. It is one of our great social problems. American ingenuity has simply failed to solve the problem, and as one of the people who is involved in this capitalist ingenuity, I can tell you that we in the business sector know it. We know that our ingenuity has built an excellent insurance system for some and has managed to enrich many of us in the business. But we know that we cannot and will not be able to help the 50 million uninsured, nor will we alone be able to control costs. This is a businessman speaking here. On the other hand, since the Health Care Reform, we have been using our impressive ingenuity to figure out how to profit in the new environment that we all claimed (and some thought) was going to kill us as businesses. And we are all so ready for it already, that when some of the incoming GOP congressmen started talking about repeal, they got visits from many lobbyists telling them to lay off. Regarding our "generally charitable culture" I am always both amazed and fascinated when people talk as though there are millions of people itching to donate money and rescue the poor and downtrodden, but they are prevented because the government .... what? What I see instead are people using excuses ("If my taxes were lower I would have extra money and could then donate it") and rational-isms ("I just know that the generous people of the United States would rush in and fill the gap if we eliminated Medicaid, food stamps, etc.") In short, liberty, entrepreneurship, and charity are not threatened by government intervention in our rotten health care system any more than they have been in every other modern developed country. Carolyn said: "As for our charitable culture, there are those who argue (I am sorry I cant think of any good titles at the moment) that social safety nets discourage charity and that the more you add, the less charity you get. Americans give far more to charity than their Europeans counterparts."In 2008, the US ranked #9 in charity given per capita, behind 5 European and three Middle Eastern countries. So, no. But it is interesting that the 5 we ranked behind also have more developed safety nets than we do. So it is not true that safety nets discourage charity (either).Carolyn said: "You say that our so-called free market does not work, I say your so-called war on poverty has not work."But I don't appeal to some war on poverty. I appeal to American capitalism. Our free market health care system does not work. People sometimes talk like there is an inverse relationship between growth and regulation. This is simply not true. All modern economies are heavily regulated. From within our system, as the system exists and has existed for the last 100 years, there are some regulations we like and some we don't. But we use our capitalist ingenuity to get around the ones we don't; not (necessarily) by violating them but by working around them.Carolyn said: "I am not sure what is the point of the sarcastic so-called was but I am inclined to agree with you. A market with things like bail outs, and farm subsidies is a so-called free market. :)"I was definitely not being sarcastic. I was being technical. The idea of the "free market" as spoken of in modern "conservative" (also being technical here) circles is simply a myth, in part for the reasons you outline but in part because we have long lived in a world of monopolies. Monopolies are hand in glove with the government. But ironically it is also the government that stands in the way of monopolies from taking more than they have. People in organized political parties who talk about "small government" as some kind of principle are in the pockets of big business.

Unagidon, I am sorry accusing you of being a liberal. Perhaps, an unfair assumption of my part. It is easy for people to fall into stereotyping and argue with a "type of person." You said: the drain on our finances of all the uninsured plus the dysfunctional health delivery system is the real threat to libertyCarolyn: I agree that there is a problem. As I mentioned earlier my mother walked out the ER with an ice pack and some pain killers and few weeks later she got a bill for over $15,000. This is a problem. I admit that. But I perceive an eagerness on a part of certain people, you may not be one of them, to send that bill to Uncle Sam. In fact, a group who are eager to go to Uncle Sam about everything and their solution is, this bill is too high, let's take it to Uncle. My reaction to that bill is "what the hell? What is in that ice pack? Do they not know that they can get ice packs from Wal-Mart for less? (I couldn't help it :). Seriously, we need to get tp the bottom of that. I might be interested in talking to you the role of Uncle Sammy afterwards but first, as a nation, we need to get some heads to study this problem and give us real answers. Sending the bill to the government is not a solution. It will only increase costs since people are more like to use things when they are not paying for it directly. Second, I don't know about these other people who are dishonest about their plans to give to charity but I assure you I am very serious. I gave what I could and if I had been able to keep more I would have given more. You can believe it or call me a liar, but I stand by my words. Third, as for America being lower in charitable giving than I claim. I am interested in that data. I realize that people like to read their own biased sources, which is why I occasionally like to check out the folds at Commonweal (Have you read first things lately?:), but I have read differently. I also wonder if that data includes government aid to other countries and UN projects. The numbers that I have looked tend to be focused on individual gifts to private charities. On markets, I have never claimed that there is no role for government to play but the devil is in the details. We do have a highly regulated and I think it is too heavily regulated. As for the government protecting me,well, I can only imagine that they must be doing a good job because I am generally satisfied with my experiences in the market place. I would describe the market as oligarchist instead of monopolist. Perhaps, microsoft is a monopoly but I love my windows. I was even satisfied with my last insurance company but I am rarely satified with my experience at the DMV so I am skeptical of letting those people further enchroach into my life. Are there politicians in the pocket of big business, sure. Is it bad? Yes. Should we tolerate it? No. But we should realize with human nature being fallen, we actually have it pretty good here in America. Trust me corruption could be a lot worse. It seems to me that we are not going to agree on "works" whether you are a liberal or not, but we do agree that more people should be covered. Perhaps, you think 100% ought to be covered, I think this utopianism but I am willing to go with more. We also agree that health care is sucking a great deal of resources from our economy. Wow! Look at all this common ground! Therefore, before you force me into this arranged health care marriage, can we look at the the cost issue? I am even willing to submit to those awful things called congressional investigation if it will get us to the bottom of why hospital aspirin is so outrageously priced. Can we fix that problem? And perhaps afterwards, the uninsured population will drop to 25 million. I know you will not be satisfied with this. But the commonweal folks have been telling me to be giddy about Obama because he wants to reduce abortion so I don't feel about asking you to reduce the uninsured. As for signing me up for health care, I know many on the left have been wondering why are people on the right so angry about this? It is because for years many of us have been offended everytime we looked at our pay check and realised that someone was taking money from us and putting it into a moribund retirement program and short of going to jail, there was not much we could do about it. And besides, conservative are generally more interested in living their lives than activism (think about it 9 out of 10 times someone asked you to sign a petition, it was a liberal). But it does not mean that it does not bother us. More than the money, it was nerve, that the "anointed public" had appointed itself to make decisions about my retirement. I have friends who could tell you that I longed for another tea party for many years but I doubted that there were any Americans who still had the testicular fortidute. So, recent developments have given me much hope. You had hope two years ago but I have hope now. I have hope that next time, I look at my pay check there will not be one more thing. So, I don't think we are about to let this health care business go by silently. I also have doubts.. This is not the America of Partick Henry but I sadly admit that America of Britney Spears and American idol. "Give me comfort and entertainment and don't bother me with the details." But I hope. In the meantime, we agree on increasing the number of people who can afford health insurance by reducing costs, I think. Let's tell Washington about it.Peace in Christ,CKHIf I was a bit sarcastic, forgive me. I did have a glass of wine but I mean no disrespect :).

Could we please take charities off the table as a substitute for government intervention? I have always worked for public charities, we fill in the gaps for government services (often with govt money), we don't replace them. It's really not a serious solution at all and we shouldn't be talking about it as if it were.

Irene, Absolutely not. Charities are a huge part of the solutions. My only problem with them is they have now become too entangled and too dominated by the state. It is a shame how much of the USCCB's budget depends on the state! Where is the ACLU when I need them? America should have a variety of strong institution that balance each other fulfilling their respective duties. But today our other social institutions are increasingly weakening in health and influence---like the family and the Church. Meanwhile, government grows in power. It is entangled in everything. It costs $10,000 for every man, woman, and child. Thomas Jefferson is rolling in his grave. The government's proper role in my view is to seek peace and justice but not charity. I suspect that the real gap is we disagree on what is a matter of justice (Hint: I do not buy John Rawls's notion of justice.) While I recognize that Health Care a great need (like food and shelter), unless someone is unjustly kept out of the market place, it is not a matter of justice. Therefore, not an issue for the state, especially the federal government. I am also skeptical about its ability to create solution. When the government gets involved in this business, it creates life long dependency. The government is also slow, expensive and inefficient. When Habitat for Humanity goes down to New Orleans, they build houses; they do it quickly. But from what I last heard much of the Katrina projects that the govt. was responsible for are still not done. Compare Detroit, "a model city" that the government invested a great deal in to Miami (where I grew up), a city built by immigrants, especially Cuban immigrants who hate nothing more than socialism. A honest person must admit that Detroit sucks and Miami is awesome. Before you cry "globalization, deindustrialization, manufacturing jobs," I must tell you that Miami's textile industry was complete wiped out by global forces but the city moved on, other industries developed, etc. I propose that the variable is too much government. Unagidon, You implied earlier that without social safety nets, people around the world are not able to make educational decisions. This is just not true. Even when I was in Haiti where we have no such things people made educational dedcisions. Humanity is not brought to a halt due to lack of insurance. Of course things have gotten much in Haiti in the last two decades so I imagine increasingly fewer people are able to make these choices but that's another topic. CKH

On Charity: It seems to me whether charity is part of the solution is not the real question. When people are down on their luck and can't afford necessities, they will turn to charity. The real question is whether that charity will be freely given by one's neighbors or coerced by the government under threat from the IRS. However you do it, it is still charity. My experience working in private charities is that the people are grateful and they are moved by the kindness of stangers and that sometimes motivate them to make changes. They develop real relationships that change their lives. On the other hand, a close family member of mine who works for the department of Human Services tells me that his clients are arrogant, have a real sense of entitled not gratitude and are shameless in their abuse of the system to get all they can out of it. And until Bill Clinton ended welfare as we know it, many of them had no plans to be independent, productive citizens. Now, we all know much everyone here detests freeloading. There is great evidence that govrnment programs induce a great deal of it. Peace in Christ,Carolyn

Not only is it erroneous to assert that charities can be a replacement for government in delivering essential services, it is also false to claim we will somehow see more charitable contributions if we cut taxes and government services. That certainly wasn't the case, at least in my corner of the charitbale world, after the income tax cuts of 10 years ago and the big changes to the gift/estate taxes. We saw no new charitable money then (nor did we expect to), though we did see a cut in government money, resulting in a net reduction in our already limited capacity to deliver services.It really doesn't pass the laugh test to suggest a reduction in government programs would somehow benefit charities.

Dear Carolyn,You aren't sarcastic. You are passionate, which is a very good thing.The reason that hospitals charge so much for an aspirin is a rather simple one, and if I tell you why they do it might help me make my point better. (I will talk about hospitals here, but what I say will more or less apply to doctors and other kinds of medical professionals.)If we categorize them in terms of how and how much they pay, there are five kinds of people that go to hospital. These are Medicare patients, commercial insurance patients, self-pay patients, Medicaid patients, and indigent patients.Like any business, hospitals have a cost structure, which is the sum total of how much it costs them to perform whatever it is that they perform. Any good enterprise will include in their cost structure a "profit". (It's a profit if it is a for profit concern and it is a surplus if it is a not for profit concern. But it's the same thing.)To cover its costs, any concern will have what is called a "cost to charge ratio", which is simply what it charges against its own costs. So for example if some concern wanted to break even, it would charge precisely what its costs are. That is, for every dollar it pays out for salaries or equipment or whatever, it would charge a dollar. In this case, the cost to charge ratio would be 1:1.The cost to charge ratio at a hospital in the United States is typically about 2:1 (they charge 2 dollars for every one they spend) to about 10:1 (they charge 10 dollars for every one they spend). In the case of your mother, she happened to go to a hospital with a high cost to charge ratio. But the thing is, with all of these high cost to charge ratios, hospitals only manage a profit margin (in general) of 1 to maybe 5 percent, with most of them at the lower end of the range. If they are charging at least double to ten times their cost, how can this be?The real question is: "who pays what and why do they pay what they pay?" Most of a hospitals business comes from Medicare patients. Medicare patients (and they are not all old, but they all tend to be sicker than everyone else) do account for most of the hospital work in this country. The government pays the hospitals from the Medicare taxes that most of us pay. But the government only pays 98 percent of charges. This means that most of the income that a hospital gets (think about 2/3 of its income) is paid to them below cost. There is a good reason why the government does this. The basic hospital rate (the "base rate") is set by statute for the whole country each year. This rate is adjusted for each hospital based on location (New York has higher costs than Hope Arkansas, so its hospitals get paid more) and some other things, including volume of charity care, whether the hospital is a teaching hospital, etc. The reason that the government pays less than cost is that this is the only mechanism that it can use to create an incentive for the hospital to become more efficient and cut its own costs.Now usually it would be the "free market" that would do this. Is the government displacing the Invisible Hand of Adam Smith here? It would seem so. But the government has to do this, in fact, because there is no free market for medical services in the United States. For a free market to work, one needs to have two things: 1) prices have to be transparent and 2) quality has to be transparent. In order for prices to move, one has to be able to compare prices between providers of a service. One also has to know which provider is better, because part of a price is the quality of the service. The consumer doesn't just want the cheapest price, they want the cheapest price for the best service, so they have to measure this as well.There is neither price nor quality transparency for medical costs in the US, so the market can't act in the way that it does for the price of bread. There is a reason why this is that I won't get into here. But you can't comparison shop for your appendectomy nor is there an objective and reliable way to compare one doctor to another in terms of their abilities. The point is, hospitals are paid below cost at the get go for most of their services. But they still have to break even or make a small profit. But the next group of patients are Medicaid patients. Medicaid patients are paid for basically by the state. The state pays for them at about 30 to 60 percent of cost. The state does this because our society thinks that we need to provide some minimum of medical service. The problem here is that state has one idea of what "minimum" means and the hospital has another idea. The hospital wants to treat a Medicaid patient like any other patient. So they just suck it off. Medicaid patients are a variable percentage of a hospital's patient mix. Let's pretend that it's 10 percent. If Medicare patients are 66 percent and Medicaid patients are 10 percent of the patients, then 76 percent of patients are seen at below cost. The hospital now has to find a way to break even on a patient base of only 24 percent (100% - 76%).But in this 24 percent is another group of patients. These are the ones that can't pay for anything. This population consists of people who do not qualify for Medicaid (and states have been cutting more and more people out of the Medicaid pool over the last 10 - 20 years to save themselves money.) The hospital is required by state law to provide emergency care for these people and in some (rare) cases they will also provide other kinds of free care. (Emergency room care, by the way, is the most expensive form a care in general). But since all of this care is provided for free, if you add it to the 66% of patients who are paid below cost, you have a larger group of patients who are paid even more below cost. Let's say that these people amount to 4% of the hospital census. This means that a full 80% of the patients are paying below hospital costs. So in order for the hospital to even break even, it has to inflate, massively inflate what it charges for the last two categories of patients; those insured commercially and those (like your mother) who have no insurance and will have to pay out of pocket. Now of these last two groups, those with commercial insurance pay different amounts depending on what insurance company (and product) they have. Insurance companies negotiate discounts from the massive mark-ups that a hospital has to make in order to break even. The size of the discount will depend in general on how much business the insurance company has with the hospital. The more business it has, the larger the discount it can command. Of course, this leads to two things. First, this means that the majority of a hospital's commercial business will be at the highest discount rate. This discounted rate is (and has to be) at a more than 100 percent of cost, since insurance companies know that they have to cover the costs of (in this case) the 80% of patients who are paying below cost. Otherwise, the hospital would go out of business. But the largest insurer pays the least, followed by each payer in its turn by size. The irony here is that in a free market the largest one who pays the least will have the lower price in the market and end up with a higher market share, which means that the hospital's reimbursement will continue to fall absolutely. This leaves a single group of people left for the hospital to use to break even. This is people like your mother who don't have insurance, but who aren't on Medicare, Medicaid, or who aren't indigent enough to get straight charity. So the hospital is bound to charge her a lot for even an aspirin. It has no choice.Now for all of this to work in a "free market", everyone would have to pay their appropriate share or else not get services; just like you do when you get your oil changed. You, the guy next to you in the Mercedes and the guy next to him in the beat up 20 year old pick up truck all pay exactly the same for the oil change. No one subsidizes anyone. But the market can't work this way with medical care. First, because we as a society will not allow people to be turned away. Second, because the people who need the most care (the elderly) have no cash flow to pay full price as a rule. And in fact, since no one could have predicted that kinds of expensive medical advances would occur when these people were working and saving, even the good savers would not have been able to save enough. So the reason the market doesn't work for the 50 million that don't have insurance turns out to be very simple. The market works for people who can afford the service and 50 million people either can't or won't. The genius of American capitalism will never figure out a way to serve these people for free. Never.The good news is that there is now just about enough money flowing through the system to fund the whole system, even before "Obamacare". (The Right even admits this when they say the the US already has "universal" insurance because everyone gets to go to the ER when necessary.) The problem isn't that there isn't money enough in the system and not Uncle Sam has to pay for things through your tax dollars. The problem is that there is plenty of money in the system for everyone but it is not being allocated in a way to promote maximum efficiency. This is why the US has the best health care technology and the worst outcomes in the civilized world. The health care reform is not some socialist plot (if it was, the doctors and hospitals would be nationalized) to get the government to pay for everything. The health care reform is a plan (not a very good one, but better than nothing) to do the reallocation of resources that the market is unable to do. It is no more and no less than this.People who think that their rights are being violated if they can't opt out of a national health care system are simply disregarding the fact that they are already in a system that they can't opt out of. Whatever they say or do, if they have an accident or a heart attack they WILL go and WILL be seen in an ER, although someone else will pay for it. From the point of view of we who are paying for it, people who want the right to "opt out" think they have a right to be paid for by people like me. So do I want you to be compelled to pay your share? Well, yes. Is this unjust? I don't think so. If you think that you have conservative argument about why I should pay your hospital bill because you have some right not to have to, I would love to hear it.

For the record, my mother does have insurance so the hospital bill was the cause of a good laugh and nothing more. It wouldn't have been so funny if she had to pay for it, but we sent that bill to the insurance company and those suckers actually paid it. Now, you have quite accurately described the cause of the problem. This reflects my view perfectly but you have said it better than I could. Again, look at all that common ground! It seems to me from your very own description it is the lack of a free market that is the problem. I know this from experience, I have tried to do just what you said. Compare prices among health providers and I get a stone wall. Basically, we can't tell you how many millions we plan to charge you until we do. I once had a rash and I told the doctor that if this visit would cost more than $300 I could not do it so I wanted to know how for the visit. I just wanted an assessment of what was wrong with me. I understand that they can't tell me the cost of treatment ahead of time. I also asked to know how much things cost as we go along. I could not get that information. Instead the reception kept repeating like a prerecorded robot, "funds are collected as services are rendered" with an obnoxious, goofy smile to make matters worse. I am not disregarding that I live in a system. I am saying I don't want to do things as they are. It often seems to us that we get govt. involved, makes things expensive and complicated and then that very govt. tells us that they need more power and money to fix the very problem that they created. You are also right that many on the political right aren't willing to call for the radical changes that are necessary to make this a genuinely free market. Lucky for me I have no plans to run for office so I fearlessly say can and need we wean ourselves off all of it. As I said before I am not for revolutionary, sudden changes but it seems to me that honest conservatives and libertarians ought to be calling everyone under 40 years old to recognize that social security, medicare, and medicaid are going to bankrupt this country and that they should for the sake of our economy and our independence (not just individual independence but also independence from the Bank of China), to take a loss on what they have invested in these programs so that in about 25-50 years we can be weaned off these things. It will be tough. People my age will have pay to take care of obligations we have made as a country eventhough we will not benefit ourselves but I want my children to be free adults who make independent decisions about their retirement. So again, I don't deny that I live in a system that I can't opt out of. It is precisely because I do that every Tom, Dick and Harry feels compelled to tell me what to buy, when to but it and how much of it to buy. Listen America. I love you but on these matters I want a divorce. Peace in Christ,Carolyn Peace in Christ,Carolyn

Health Care and immigration:One of the things we have not talked is immigration and health care. I bet if you break down that 50 million number of the uninsured a good chunk of them are immigrants (legal and illegal). Let me assure you, having grown up in Miami where you can't walk a mile without meeting an immigrant and sometimes an illegal one that these are some of my favorite people. But it is unreasonable to expect that in a country that takes in so many people, though at times reluctantly, that they are going to have everything from the start. Like every immigrant family, we started out with nothing, living with relatives, and then a one-bedroom apartment, and then a two-bedroom, and then my father got a job with health insurance and they rented a house and then they bought a house. All their children went to college. It's a slow progress. I actually think we do the immigrant community no favors by calling for their inclusion in public health care. I know you mean well, but it will only inflame the American people against them. It already has. But if you are concerrned about health care for immigrants, Miami is a great place to open a free or low cost clinic. I wish the USCCB's office on migration would work on these things. All these marches with the bishops and the Mexican flags are useless; unless, you think making protesters feel good about themselves for speaking truth to power is useful endeavor. If the USCCB cares about migrants, they should spend their resources and energies helping them lift the burdens off the tax payers. Haiti, at least when I was there, is a socially conservative society and my parents were appalled by much of what went on in our public schools. They desperately wanted to put us in Catholics schools but could not afford it. How about a fund for Haitian immigrant children to go to Catholic schools. That would be justice for immigrants. Peace, CKH

Carolyn,There are good reasons why our health-care market is not a real free market, and I think unagidon's last comment did an excellent job of suggesting what some of them are. In a real free market, hospitals would not offer any medical services to those who couldn't pay for them. The destitute would die at the door of the ER. Is that OK with you? It's OK with me that the guy driving the beat-up pickup truck has to pay as much for an oil change as the guy driving a Mercedes -- and that he will be turned away if he says he can't pay at all. It is not OK with me if the guy driving the pickup gets cancer and is refused treatment because he can't pay. Some free-market zealots ask rhetorically What's the difference? A product is a product. Most of us have no trouble answering this question -- indeed, I think it is only rancid ideology that would keep a person from answering it correctly. The difference is that the driver of the pickup can live without an oil change, and because he knows he may die without cancer treatment, and is perhaps already in terrible pain, he will be willing to lose whatever little he has to pay whatever his health-care provider demands. Otherwise put, being a patient is really nothing like being a consumer, and so there is no reason to suppose that the normal market dynamics of supply and demand would or should govern the provision of health care.

Matthew, I think I have addressed the points you raise in previous posts. Perhaps, not to your satisfaction but I have given my best answers. I agree with you that health care is not like other transaction. it is a great need but because it requires the labors and services of others it is still an economic transaction. Food is an even greater need. I have lived without health insurance for 10 months but I could not live without food for 10 months. Should there be a single payer system for that? Peace in Christ,Carolyn

Carolyn,What doesn't involve "the labors and services of others"? You present this as a definition of the economic; I say it's also a definition of the social -- and therefore includes activities that even most libertarians would hesitate to leave to the free market, such as national defense. Your comparison with food is an interesting one. As a matter of fact, I do think that everyone in a society as rich as ours should be guaranteed a sufficiency of food; and in fact we already do guarantee this sufficiency with something called food stamps. But the differences between food and medicine are both obvious and important. First, technology (including both modern agriculture and modern transportation) has tended to make food cheaper, partly because there is a natural limit on how much food we need. Technology tends to make medical treatment more expensive, because it increases, without forseeable limit, the number of problems that can be addressed by medical treatment. Another relevant difference: while no one can be sure how much it will cost him to feed himself adequately for the rest of his life, we all have a decent idea of how much food we'll need as long as we're alive. None of us knows how much medical care we'll need from one year to the next -- and if it turns out we need more than most people, that isn't (usually) our fault. This is why it makes sense to pool risk as much as possible, and, yes, a single-payer system is the most efficient way to pool risk, as well as the most just.

I have lived without health insurance for 10 months...But not without access to health care if you become sersiously ill -- unless you choose to adhere to your principles and not solicit medical services you or your family may be unable to pay for.

Matthew, I am a little tired so this is not the most energetic and well-thought response I can muster. While many things can be described as "economic" some transaction are done for the purposes of livelihood. People go into medicine to make a living. They may have a passion for it but it is their job and they expect renumeration. I realize that you think the government ought to be the renumerator but I don't for all the reasons that I have previously stated. Also, I suspected that you might feel that way about food. I think that we are rich has nothing to do with it. We are rich because we are productive. Productive people should decide what to do with their spare income. I would hope that if they are Christians, they would help those in need. But as you might suspected, I also believe in the Pauline maxim, "He who does not work shall not eat." So, it should not susprise you, given all that I have said, that I don't think it is the role of the Federal Government to provide food stamps.I do not doubt that the health care market is more complicated than the food market but I do think it does not need to be as complicated as it is. I also believe that it does not need to be costly as it is. For all the claim that the free market does not work in health care, it seems to me that we are doing much to stand in the way of free markets. I suspect that allowing market forces to work would drive down prices and then more people would be able to afford it. Of course, not everyone. But everyone has never been able to afford everything ever. The difference with health care and many other things today is now we all think that everyone should be able to have everything that exists. More importantly though, this discussion began on the question of human rights. I don't think anyone has a right to anything that necessarily imposes costs on their neighbors. I also think it is morally wrong to force someone to work for the interest of another. I don't think that applies to the military because the military serves your interest by protecting you, just like the police man. It is easy to make it seems that conservatives believe in no government . We believe in limited government, that is government that maintains peace and justice. And by justice, I mean something strictly define, like someone stole your property and the government arrests him. This use of coercive force is moral and necessary. Places, like Haiti don't have it, and they are chaotic. But beyond the necessities of keeping social order and defense, I am skeptical about govt intervention. This does not mean that I do not participate in the system. The system is very hard to get out of as Unigadon illustrated but because something is difficult to avoid and even if it occasionally benefits me does not mean that I think it is right. Peace in Christ,Carolyn

Antonio, The point that life has many necessities is not abrogated by what you have said. Both food and health care are important but food is important on a more regular basis. Yet, we generally expect people to provide it for their own food. While there is food stamp, it is a exception, one that we normally consider to be temporary. I am also willing to make exceptions. As I said before, I would be willing to pay an emergency room tax that assures that in a life or death situation, people are treated, no questions asked. In a life or death situation, you don't have time to find out who is insured or not or who has what principles. Also, I also realize that I might become sick. That does not change the fact that I think people should not be forced into covering for me without their consent. Many people have brought up the fact that I will feel different when I am sick. Maybe, you are right but you should not listen to me when I am sick because that is when I am biased and self-interested. Generally, people think clearly and logically when they are not emotionally involved. It is best that we draw conclusions from principles rather than our feelings when we are in a tight spot. Also, realizing that I might becoming sick does not change the fact that not having health insurance in the smartest decision for me right now. Yet, I would like to be live up to my principles because I believe they are just but that will be very hard if I show up the emergency room and I am charged a fortune for the privilege of breathing hospital oxygen. It would help me greatly if the hospital bill was something I could hope to pay. One of my favorite authors has written about this very thing. Thomas Sowell who is still alive so it wasn't that long ago tells a story about how as a young man back in the 50's he had a hospital bill and health insurance was not popular back then and certainly not considered a divine right and he just made payments until it was done. He wasn't rich and his point was that there was a time that you could go to the hospital and have a bill that you could hope to pay. I also hope that if I did have a long chronic conditions that there would be enough good people who would help me simply because they wanted. There are lots of organizations, like doctors without borders who do just that. And I naively believe that in a world where we didn't rely on government coercion that there are millions of people who would want to help me because they want to. I am not a heartless, radical, individualist. I am willing to rely on my neighbors and I am willing to let them lean on me. I only long for a nation in which these activities are done in love and freely. Peace in Christ,Carolyn

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