The Moral Core of the Health-Care Debate

I totally agree with your comments on tort reform.

The story of Israel's demand for a king provides us with some excellent basic principles to live by.

We should look to God as our provider, healer, provider of justice, etc. When we begin looking to government for those things, we're asking for trouble.

God's system involves freedom...the people interacting more directly with God, whether than having all of these middle men. People are allowed to make choices and people (doctors and hospitals) are allowed to experience the natural consequences of their choices.

"You ask "How can I be sure that will work?"
I say, "It will almost certainly work better than a national, top-down system of control and distribution.""

You're talking about something that can and should exist but does not due to greed. You say "it will almost certainly work better than...." but look around you. If it did work better, we'd have it now. If it did work better, we would not be looking to the government. It is because of selfish and greed filled people, including Christians, who are comfortable and unwilling to share their good fortune with the poor that we have anyone looking to the government for help. the help is NOT being freely given. I have donated and belonged to a parish in a church of over 1 billion people and yet when I have need I go to my church and I am turned away and told to go to Welfare. Yes, I was literally told this by my church whom I donated thousands of dollars to when I was able. When I was in crisis and in need, my church turned its back on me. And then they petitioned everyone for money to build a new sports stadium for their adjoining school which cost about half a million dollars. This is the fact of the matter. For every Christian who is willing to share their wealth you have at least 2 or 3 or 20 Christians who are tight fisted, avaricious and consumed with their own luxuries. Who cares if someone dies when you're in need of the latest texting plan for your $600 cell phone? Kill them all and let God sort them out. That's what YOU say.

And if your home is invaded by prowlers do you fall to your knees and go to "Daddy/God" or do you call Mommy/911? And should you wait on God to enact justice on your behalf when your need is immediate? You said, "Since God has a larger perspective than we do, his idea of justice can sometimes be to slow for our taste. So when daddy doesn't give you what you want, what do you do? We go to mommy." God's idea of justice may be too slow for your taste, so you call 911. When something is stolen you don't wait for God to get it back, you file an insurance claim. You will find that 99% of the time in your life you will NEVER wait on God and His justice and insight. You will always run to the established "mommies" to aid or save you. I should also add that 911 is a government construct that taxpayers pay into, so if you don't agree with using other people's money for your own foibles, don't dial it in an emergency.

Freedom, exactly. And I think the reference to Israel's demand for a king is relevant, whether one is a biblical "literalist" or whether you follow and concur with the line of reasoning God used with his people: "Practically speaking, this is what you are asking for--do you REALLY want this? Think about it!" which is what I hope people do, instead of just accepting Obama and Rev. Wallis when they assure us that all the changes will somehow be for the better, except for those bad, bad people who are motivatated by profit-- instead of by the undefined "morality" in Rev. Wallis's canting piety.

I totally agree with your comments on tort reform.

The story of Israel's demand for a king provides us with some excellent basic principles to live by.

We should look to God as our provider, healer, provider of justice, etc. When we begin looking to government for those things, we're asking for trouble.

God's system involves freedom...the people interacting more directly with God, whether than having all of these middle men. People are allowed to make choices and people (doctors and hospitals) are allowed to experience the natural consequences of their choices.

Good point. "Romans 13:4For the [one in authority] is God's servant to do you good"
I think NATCOZ's criticism was directed at a government that sees itself as autonomous, not as a servant of something higher--the personal God who gave it a function, and the rules, like the Ten Commandments, that define "good."
And, on a personal level, why are some people so passionate about this being THE Solution, and THE Time to do good by expanding government dramatically? In what are YOU placing your trust?

What! The government has no business in justice?

Quote:"We should look to God as our provider, healer, provider of justice, etc. When we begin looking to government for those things, we're asking for trouble."

Prior to Israel demanding a king, God, through God's judges/prophets were the providers of justice. I think one reason Israel demanded a king (aside from the problems with Samuel's sons) was because they wanted justice on their terms. Since God has a larger perspective than we do, his idea of justice can sometimes be to slow for our taste. So when daddy doesn't give you what you want, what do you do? We go to mommy. We look for an alternative authority to appeal to. Problem was, there was no such authority...until they invented one by placing a man in that position...king. One of the functions of the king was to provide justice, but that doesn't mean justice is best found via a king...or a government.

One of the tendencies.of governments is to crowd in on or invent other purposes for itself. So a government which started out with very few and restrictive roles gradually grows totalitarian. This is how government justifies it's existence. It can come in the form of a hostile takeover, or it can come as a sales pitch convincing us we need government. The concept of "state" takes over the government. Essentially, all along the way, the government is replacing God. So really, the state grows from a distrust of God.

God is our provider of justice? Absolutely! Unless we take matters into our own hands, in which case he'll back away. He says, "vengeance is mine." The implication for us that we should be patient and trust him. And if we can't, we'll go looking for another method...invented authority of government to give us justice now.

What you describe in terms of what happened in the Soviet Union was very true. But that may well have happened because EVERYTHING was socialized there, and in the worst way. People got paid for doing the same amount of work, whether they worked well or poorly, and productivity was so low that the money they got was worthless. So yes, the joke then was that the people pretended to work and the government pretended to pay them. Under the Soviet system, money had very little value since even with money one couldn't get the stuff one wanted with the shelves being empty and such. That's clearly not the situation here, with money being readily traded for all sorts of materials goods.

The British NHS has its problems; the Canadian health-care system has its problems too. Our system has its problems as well. If we're honest, we'll admit that there is an asymmetry of information, and medical care is currently not a free market. There are perverse incentives on all sides; on the insured consumer to overconsume, on the provider to overprovide (since they're paid for doing more stuff, not to mention defensive medicine), on the insurance companies to minimize payments (so they have an incentive to deny any and all claims), and so on. On the bright side, reports of the Mayo Clinic and Cleveland Clinic engaging in actions that "work" at lower cost suggest that true reform is possible. Capitation schemes (where physicians are paid per patient, rather than for services rendered) create an incentive to do less, and *might* create a situation where lower quality care is rendered. But hopefully, if the rate paid is still a reasonable one, the physicians will provide the care they think is best, because they're in it to "help people" and their work is no longer subconsciously affected by financial considerations.

Tort reform has a lot to do with excessive regulation. People have to accept that we can demand good medicine, but not perfect medicine. Maybe a scheme similar to Workers Compensation, as is being tried in France, can help in that regard. I am thinking how reforms of drug patents (when there is a patent, there is a government-mandated temporary monopoly) can further help things. Trade longer patent periods for price caps, and maybe drug companies won't be stuck into destructive boom/bust cycles the way they often are now.

With all that being said, I remain firmly convinced that the status quo is unacceptable, with health-care currently eating up 1/6th of ALL spending. Paperwork is responsible for 1/3rd of health-care spending today, and hopefully the administration's push for electronic medical records can cut down on that.

--
...the spirit helps us in our weakness. We do not know what we ought
to pray for, but the Spirit himself intercedes...Romans 8:26

Jack Miller
3301 Stacy Court
Winston-Salem NC 27107

Government is certainly the provider of justice. I don't see this as a justice issue, in biblical terms.

The goal is to find an affordable health care solution for the largest number of people. I simply don't trust government to provide that.

Prior to Israel demanding a king, God, through God's judges/prophets were the providers of justice. I think one reason Israel demanded a king (aside from the problems with Samuel's sons) was because they wanted justice on their terms. Since God has a larger perspective than we do, his idea of justice can sometimes be to slow for our taste. So when daddy doesn't give you what you want, what do you do? We go to mommy. We look for an alternative authority to appeal to. Problem was, there was no such authority...until they invented one by placing a man in that position...king. One of the functions of the king was to provide justice, but that doesn't mean justice is best found via a king...or a government.

One of the tendencies.of governments is to crowd in on or invent other purposes for itself. So a government which started out with very few and restrictive roles gradually grows totalitarian. This is how government justifies it's existence. It can come in the form of a hostile takeover, or it can come as a sales pitch convincing us we need government. The concept of "state" takes over the government. Essentially, all along the way, the government is replacing God. So really, the state grows from a distrust of God.

God is our provider of justice? Absolutely! Unless we take matters into our own hands, in which case he'll back away. He says, "vengeance is mine." The implication for us that we should be patient and trust him. And if we can't, we'll go looking for another method...invented authority of government to give us justice now.

What you describe in terms of what happened in the Soviet Union was very true. But that may well have happened because EVERYTHING was socialized there, and in the worst way. People got paid for doing the same amount of work, whether they worked well or poorly, and productivity was so low that the money they got was worthless. So yes, the joke then was that the people pretended to work and the government pretended to pay them. Under the Soviet system, money had very little value since even with money one couldn't get the stuff one wanted with the shelves being empty and such. That's clearly not the situation here, with money being readily traded for all sorts of materials goods.

The British NHS has its problems; the Canadian health-care system has its problems too. Our system has its problems as well. If we're honest, we'll admit that there is an asymmetry of information, and medical care is currently not a free market. There are perverse incentives on all sides; on the insured consumer to overconsume, on the provider to overprovide (since they're paid for doing more stuff, not to mention defensive medicine), on the insurance companies to minimize payments (so they have an incentive to deny any and all claims), and so on. On the bright side, reports of the Mayo Clinic and Cleveland Clinic engaging in actions that "work" at lower cost suggest that true reform is possible. Capitation schemes (where physicians are paid per patient, rather than for services rendered) create an incentive to do less, and *might* create a situation where lower quality care is rendered. But hopefully, if the rate paid is still a reasonable one, the physicians will provide the care they think is best, because they're in it to "help people" and their work is no longer subconsciously affected by financial considerations.

Tort reform has a lot to do with excessive regulation. People have to accept that we can demand good medicine, but not perfect medicine. Maybe a scheme similar to Workers Compensation, as is being tried in France, can help in that regard. I am thinking how reforms of drug patents (when there is a patent, there is a government-mandated temporary monopoly) can further help things. Trade longer patent periods for price caps, and maybe drug companies won't be stuck into destructive boom/bust cycles the way they often are now.

With all that being said, I remain firmly convinced that the status quo is unacceptable, with health-care currently eating up 1/6th of ALL spending. Paperwork is responsible for 1/3rd of health-care spending today, and hopefully the administration's push for electronic medical records can cut down on that.

It is because the churches can not be trusted to provide for their own parishioners that the government even needs to be involved. Christians are failing other Christians and non Christians alike. Many are more than happy to sit back and watch others suffer and die as long as their own position is safe.

"People got paid for doing the same amount of work, whether they worked well or poorly"

But like the workers in the vineyard who were paid the agreed upon amount regardless of their hours invested, should we be questioning who receives what kind of pay for their work? So many Christian businessmen do not want to be forced to pay anyone anything above minimum wage because it would cut into their personal profits, and would argue that no one should force them to pay more. But we will question the same freedom in a socialist society? Were the Soviet workers slaves or did they freely choose to work for the same pay as their coworkers? We can not have this both ways. Capitalism and Socialism share the same concept here yet we can not condemn it only when seen within Socialism.

People of faith need to be the steady moral drum beat driving the debate and keeping our politicians accountable. This is a critical and long-overdue opportunity to fix a broken an inequitable system which must not be derailed either by powerful special interests or by those, on any side to just want to score political points. It is up to all of us to make sure that doesn't happen.

Yes. Yes. Yes. Long overdue overhaul, and much needed reform. Which is exactly why more government involvement is not the right solution.

Hmmm. Interesting. Would you know the reason why they refuse to have health insurance? Is it theological?

Would it be possible to post some of the questions that were asked and the answers received during the call?

You have a good point. IMHO, our current system seems to inherit the worst of both worlds. On the one hand, health-care is heavily regulated in terms of tort, who may practice, what drugs may be prescribed, and so forth. Government has perhaps foolishly mandated that people get the proverbial Cadillac, or nothing at all. On the other hand, there's price opaqueness, which makes it hard for market mechanisms to actually work. And yes, there is a moral dimension to the problem. Is it ethical to have a society where people with treatable/curable conditions are nevertheless allowed to get sicker/die because they're unable to pay for the care? (In spite of them holding a job, or at least are honestly trying to.)

I have repeatedly pointed out my misgivings on any "reform" that does not address total costs. There are numerous "right" leaning reforms that I at least would be really for, such as malpractice reform (reducing defensive medicine), open listing of prices and reviews by patients, changes to the patent laws to make drugs less expensive, and so forth. Also, studies have shown that paying providers by the amount of procedures performed leads to more procedures, but not better outcomes. So moving to a salary system would make more sense. The current system has a lot of inefficient "moral hazard" built into it, and does need changes.

Combine that with say an individual mandate coupled with a "must-issue" mandate, and we might be onto something. (Individual mandate - needed unless we're REALLY willing to let those who can't pay die preventable deaths, and must issue to avoid people with chronic disease from being unable to get coverage anywhere, or have them tied to their job due to coverage issues.)

I can't remember where I read it, but I think that you are exempt from that if it's for religious reasons.

Jim. I've met you. I have respected you but I'm growing more and more restless that you are part of the propaganda in the same fashion you've lambasted the religious right. This is no third way. This is Jim Wallis giddy about being on the inside. Wow. But it must be rich to be invited onto Stewart's show and MSNBC and the like. Jim, welcome to the mainstream. I think I'll find another source. I don't believe you're sojourning much these days, eh?

I am a Mennonite and in my church there is no objection to health insurance. As a matter of fact, the Mennonite Church has insurance that any Mennonite in a congregation can buy into. And all the Mennonites I know, have signed up for Medicare. There is a program with MMA that anyone can make a donation to a program to assist persons who may not have insurance or have an illness that is not covered.

I am curious if Sojourners has considered the Amish, Mennonite, and German Baptist communities in this discussion. As I understand, many in their community choose not to have any sort of health insurance. My relatives who are apart of that community will be forced purchase health insurance or face penalties. They have deep convictions that are opposed to purchasing health insurance.

Would it be possible to post some of the questions that were asked and the answers received during the call?