Tuesday, September 8, 2009
I've become so depressed about the prospects of passing meaningful health care reform that I've refrained from posting on the subject. I don't have time for an extensive response to the statement of Bishops Naumann and Finn, but since Rob Vischer was chiding me this morning about my silence on the subject, let me offer a couple of thoughts prompted by their statement and his post.
First, one of the things that is persistently ignored when people react with horror to government involvement in the health care area is that the failed system we have now did not grow up through operation of a free market unaffected by government law and policy. The system that has developed is largely a result of federal tax law which encourages the provision of health care through employer plans by providing favorable tax treatment to those plans. (And those plans started to come into common existence during a time when the governmetn imposed wage controls during WW2 and employers wanted a way to increase compensation without increasing wages.) The dominance of employer-provided medical coverage is a significant part of what skews the insurance market, making purchase of insurance by individual so costly. So when we talk about federal involvement in health care reform, we are not talking about the federal government stepping into an area that has been completely private, but rather helping to address a situation it helped create. Add to that the existing government involvement in health care through, e.g., the VA. (When have you heard anyone saying that subsidiarity means we should cease providing health care to veterans via the federal government?)
Second, I don't dispute the importance of subsidiarity, but subsidiarity doesn't mean there is never a role for the government, just that the government should not intervene when lower levels can be more effective to address the problem. I don't disagree that subsidarity means that "we respect the inherent dignity and freedom of the individual by never doing for others what they can do for themselves and thus enabling individuals to have the most possible discretion in the affairs of their lives." But the problem of the large number of uninsured and underinsured is largely one of affordability, not people making irresponsible decisions. Large numbers of people have no insurance either because their employer does not offer insurance or it offers it at a cost they cannot afford. There is not a whole lot those people can "do for themselves" to rectify that situation.
Third, subsidiary is not the only principle at play here. The sad reality is that people die in this country because they cannot afford to go to the doctor when they are sick. I would think that one thing we could all agree on is that it is unacceptable form the standpoint of Catholic thought for people to die because they can't afford to go to the doctor. If someone has a good lower order solution to address that reality, fine. I'm constantly reading people saying in general terms, that from a Catholic perspective the responsibility to provide for the health care of our brothers and sisters lies with individuals, not the government or that the fact that health care is a right does not mean the government has to provide access to that right. But where is the concrete plan for fixing this broken system we have now without government stepping in?
Fourth, it is clear that some government involvement is necessary. One could argue that subsidiarity argues for a preference for states to address the issue rather than the federal government and we have had some examples of states that have attempted health care reform. I suppose we could wait a couple of decades to see if all of the states (including the poorest states) are able to enact successfor reform, but I've seen little from the experience of Massachusetts and some other states to suggest that is likely to be successful.
Finally, one of the comments in the bishops' statement is to the effect that many people are happy with their medical coverage. I have heard various forms of this statement made as a reason we should hesitate about making changes. One real problem with that argument is that most people have no idea of what their plans would actually cover if they were faced with a serious medical problem or even something out of the ordinary. Let me give an example of my emergency room experience this summer. I experienced some strange symptoms one morning and called my doctor's office. The receptionist put me on the phone with a nurse practitioner who, after hearing about the symptoms and their sudden onset, strongly recommended I call 911 for an ambulence to take me immediately to the ER rather than having my husband take me. The ambulence took me to the ER, where they peformed a head CT and various other tests to rule out the things my symptoms raised concern about (brain bleed, stroke, tumor). The entire experience from call to the docor to return home lasted perhaps four hours. Thus far, I've paid out-of-pocket somewhere beween $600 and $700 for the portion of this experience not picked up by my medical insurance (and who knows if the bills are finished coming in). That amount was not a hardship for me, but it would be for many people. I wonder how many of the people who claim to be satisfied with their insurance expect that a couple of hours in the ER might cost them $600 or $700 out-of-pocket? I sure didn't.