To Each INDIVIDUAL According To His Rights
An American Catholic’s Vision of Healthcare
Dennis Gabos, M.D.
Being raised Catholic instilled values that as an adult I have continued to revere. Among those were individual responsibility, honesty, a work ethic, charity, fairness, obedience of the law, and dutiful practice of our faith. When I wavered from these principles I was held accountable. Our faith teaches us individual accountability here and ultimately before God. It is with this emphasis on individual accountability that I raise a grave concern regarding healthcare. I have the unpalatable impression that many Christians endorse what I consider a most dangerous prospect. That is, the transition to a government run universal single payer system of healthcare—a collectivist concept.
There have been years of analysis before and after the onerous 1,367 page healthcare plan for a government takeover that was rejected in 1993. Interestingly, while Canada, Britain, France, and other countries with “universal” healthcare look for ways to move away from such a model America looks to its own version of socialized healthcare. In Canada “pay for service” clinics are cropping up at the rate of one per week and the government is intentionally ignoring it. Rationing is a reality. Approximately one third of Canadian physicians have referred their patients outside of Canada for care. That is to say, Canadians have insurance for all, BUT not access. Most government systems have similar problems. Many of the centrally planned “universal systems” have had to adopt methods that invoke individual responsibility such as co-pays or deductibles to avoid excessive use by undisciplined appetites for healthcare that is “free.”
Many decry the “the free
market” as cold, callous, and Darwinian; that it will exclude too many. But a
true free market is grounded on individual freedom and securing the integrity of
it. When the market fails its not because individual freedom in providing and
procuring services is evil - its because the process was corrupted. We have
failings as Christians, not because Christianity is wrong but because we let
corruption sometimes enter our human endeavors.
What is the free market? Fifty three of fifty–six of the signers of the Declaration of Independence (who were also signing their death warrant) were Christian. They declared freedom from oppression of religion, of excess taxation, and tyranny. Many have sacrificed their lives to sustain it. This country has a 230 year history of promoting individual freedom yet “promoting the General Welfare” by creating the safety net for individuals who cannot participate in the strongest political philosophy mankind has witnessed. The free market is the expression of individual freedom to one’s rights of “Life, Liberty, and the Pursuit of happiness” in the course of pursuing and providing goods and services. The integrity of the processes and forces of individual freedom are grounded on Morality. We hold that the source of our individual rights derives from a Power that transcends the state and that indeed government derives its power and authority from the people and conversely that the state as the "provider" of freedoms and rights is a failed collectivist concept as seen in Communist and Socialist regimes. Indeed, as Catholics and Americans we hold "these truths to be self evident" and that our inalienable rights derive from The Creator.
But now we should confess what is really wrong in healthcare— 1.The economic discrimination that empowered only the employer to purchase healthcare with tax-exemption the individual citizen never enjoyed, and - 2. The increasing control and intrusion of government over individual healthcare rights.
Regarding the distortion of employer based healthcare. This occurred in 1943 as a wartime policy when tax law was changed to empower the employer to offer untaxed compensation in the form of healthcare benefits. As an unintended consequence the employer became the “mandated” purchaser of healthcare insurance. It took only one more generation for individuals who were now accustomed to someone else paying for healthcare during working years to develop a sense of entitlement to someone else paying for it later. Lyndon Johnson passed legislation that would create “insurance” for all seniors simply because they turned 65 years old even though all senior citizens had insurance or access to a program to obtain it. Nonetheless, government healthcare was forced on our seniors to be supported by future generations in what has been described accurately by Paul O’Neill* as a Ponzi scheme. Indeed, some estimates are that seniors will receive $100,000- $$200,0001 more in benefits from Medicare than they put in to it. The impending Medicare fiscal crisis for upcoming generations is well described by David Walker, head of the GAO. With an onslaught of 79 million baby boomers costs will go up, benefits will go down, the age of eligibility will increase. Medicare by most honest analysts is unsustainable and Medicaid is now almost as costly and covers many who could be covered by insurance that is not government sponsored. David Walker and many others describe an Intergenerational War as generations to come will suffer the debt we create today with excessive entitlement programs.
Physicians recently slated for a 10% Medicare cut saw that deferred but there are plans to cut 40% over the next nine years. Physicians are beginning to leave Medicare. Options for seniors other than Medicare HMOs don’t exist. And if a senior wants out of Medicare, he forfeits all Social Security past and future2. Would it be Moral for employees to lose their 401Ks if they opted not to have an employer’s health insurance?
The basic problems are now obvious. When the user is not the purchaser the system is perverted. Americans pay 14 cents on a dollar for healthcare. Imagine that someone else paid 86 % of your shopping bill for a year and how it would change your buying habits. When the user is not the purchaser markets are stifled. As a matter of fact free markets then don't really exist!
The Catholic Principle of Subsidiarity3- “...it is wrong to withdraw from the individual and commit to the community what private endeavor can accomplish” - has been grossly violated. The Catholic church should support the individual ownership of health insurance with the freedom to buy a variety of plans. This will require legislation. The closest we have come to this presently is with the very empowering concept of “Health Savings Accounts”, an untaxed spending account (in which unspent monies are retained by the individual) coupled with true high deductible insurance; not prepaid excessive healthcare to which we have devolved. I’m saying that true individual freedom in healthcare financing has not occurred during the last 65 years and is the cause of most of our problems. This is an affront to individual liberty, individual accountability, and the Principle of Subsidiarity.
Regarding the uninsured. Let’s keep in mind that uninsured does not equal “uncared for” just as “insured” in universal healthcare systems does not equal “cared for.” Care is available in ERs and through charitable endeavors4. (see Pgh. Catholic March 31, 2008) Some facts need to be known. 20% of the uninsured are not citizens, begging the question—“Should American citizens be forced by higher taxes to pay for non-citizens?” One third of “the uninsured” have simply not registered for government programs they qualify for and are actually insured. Many of the uninsured are young and healthy and priced out of insurance by the bias of employer based insurance. Millions are simply uninsured resulting from the portability problem created by tax laws and employer owned insurance in the first place. For all practical purposes the employee only rents healthcare through the employer. The true chronically uninsured are 4-6% not 17%. Changing tax laws will reduce the number. Should 95% of Americans already insured become the subjects of a new government program with its inherent callousness and inefficiency run by politicians so remote from the individual’s needs for 5% chronically uninsured?—or should we do the right thing?- change tax laws and restore individual freedom to the process coupled with true means tested subsidies to help those who need it. This would promote the General Welfare not create the Welfare state we have. Government already pays almost half of all costs. Part of the solution is found in our strong tradition of faith based charitable intervention. This will provide care in a more compassionate, focused, and just manner.
If the church does not support its very own Principle of Subsidiarity and “commits the responsibility to the community” (government), rather than to individuals then it “creates serious harm” as we have seen in other socialist schemes. Would the church endorse the notion that all schools should be government schools if few cannot pay for school, that all food and shelter should be managed by government if few cannot procure it?
If collectivist (socialist) concepts are forced upon the profession of medicine there will be rationing of dialysis, bypass, pharmaceuticals, etc. If we move to government healthcare know that physicians will functionally be government agents not patient advocates. This occurs in other countries. We have already seen the conflicted state of physicians dealing with HMOs attempting to ration care against their recommendations. Physicians may be forced to perform abortion, clandestine euthanasia, apply embryonic stem cell therapy and more or deny care that you won't know you should have had.
If we move to a government run system keep in mind that the cost of Medicare was seven times higher in 1990 than originally projected. Taxes will escalate to the point where citizens will have much less disposable time and income to support a most noble cause—their Church– and at a time when there is a need for laity to give of their time and money this will only precipitate a new crisis.
Let’s reinvigorate the Principle of Subsidiarity. The role of government is to facilitate our individual rights to engage the Productive Forces of Personal Freedom. The most basic right we have is to manage our lives. This has been stifled, not promoted, by government. Let’s have freedom coupled with responsibility in healthcare combined with the safety net needed for the few and not the snare of government that will harm many.