Canadian Health Care, Subsidiarity, and Medical Calvinism
I highly recommend Sara Robinson’s ten myths of Canandian health care. Unlike many of the know-nothing critics of single-payer systems, Ms. Robinson has ample experience of the US and Canada health care systems, and deals with the basic facts. The whole thing is worth a read. I will not reproduce everything here, but the second point is particularly interesting:
“2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions. A few reasons for this:First, as noted, they don’t have to charge higher fees to cover the salary of a full-time staffer to deal with over a hundred different insurers, all of whom are bent on denying care whenever possible. In fact, most Canadian doctors get by quite nicely with just one assistant, who cheerfully handles the phones, mail, scheduling, patient reception, stocking, filing, and billing all by herself in the course of a standard workday.
Second, they don’t have to spend several hours every day on the phone cajoling insurance company bean counters into doing the right thing by their patients. My doctor in California worked a 70-hour week: 35 hours seeing patients, and another 35 hours on the phone arguing with insurance companies. My Canadian doctor, on the other hand, works a 35-hour week, period. She files her invoices online, and the vast majority are simply paid — quietly, quickly, and without hassle. There is no runaround. There are no fights. Appointments aren’t interrupted by vexing phone calls. Care is seldom denied (because everybody knows the rules). She gets her checks on time, sees her patients on schedule, takes Thursdays off, and gets home in time for dinner.
One unsurprising side effect of all this is that the doctors I see here are, to a person, more focused, more relaxed, more generous with their time, more up-to-date in their specialties, and overall much less distracted from the real work of doctoring. You don’t realize how much stress the American doctor-insurer fights put on the day-to-day quality of care until you see doctors who don’t operate under that stress, because they never have to fight those battles at all. Amazingly: they seem to enjoy their jobs.”
I’ve noted many times that, in the domain of health care, whether health insurance is covered by a large private sector insurer or a government entity makes little difference in terms of the principle of subsidiarity. After all, why is it that people raise the subsidiarity card against government-run insurance, but have no problem with large impersonal private insurance schemes, especially in the US system where the insurance company’s profits depend on minimizing “medical losses” (which means denying as many claims as possible, or refusing insurance coverage in the first place)? By the way, the Canadian system is run by provincial governments. But far more important from the Catholic perspective is the need for a family doctor and a personal relationship between doctor and patient. And on that front, the US falls far short. Part of the reason is specialization. But part of the reason is that dealing with layers and layers of nasty and aggressive insurance companies places a barrier between doctor and patient. The US system is broken and bankrupt on more than just the financial scale.
I would also like to draw people’s attention to her ninth point, where she characterizes the US approach as “medical Calvinism’:
“People won’t be responsible for their own health if they’re not being forced to pay for the consequences.
False.The philosophical basis of America’s privatized health care system might best be characterized as medical Calvinism. It’s fascinating to watch well-educated secularists who recoil at the Protestant obsession with personal virtue, prosperity as a cardinal sign of election by God, and total responsibility for one’s own salvation turn into fire-eyed, moralizing True Believers when it comes to the subject of Taking Responsibility For One’s Own Health.They’ll insist that health, like salvation, is entirely in our own hands. If you just have the character and self-discipline to stick to an abstemious regime of careful diet, clean living, and frequent sweat offerings to the Great Treadmill God, you’ll never get sick. (Like all good theologies, there’s even an unspoken promise of immortality: f you do it really really right, they imply, you might even live forever.) The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it’s a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can’t complain. It was their own damned fault; and it’s not our responsibility to pay for their sins. In fact, it’s recently been suggested that they be shunned, lest they lead the virtuous into sin.
Of course, this is bad theology whether you’re applying it to the state of one’s soul or one’s arteries. The fact is that bad genes, bad luck, and the ravages of age eventually take their toll on all of us — even the most careful of us. The economics of the Canadian system reflect this very different philosophy: it’s built on the belief that maintaining health is not an individual responsibility, but a collective one. Since none of us controls fate, the least we can do is be there for each other as our numbers come up.
This difference is expressed in a few different ways. First: Canadians tend to think of tending to one’s health as one of your duties as a citizen. You do what’s right because you don’t want to take up space in the system, or put that burden on your fellow taxpayers. Second, “taking care of yourself” has a slightly expanded definition here, which includes a greater emphasis on public health. Canadians are serious about not coming to work if you’re contagious, and seeing a doctor ASAP if you need to. Staying healthy includes not only diet and exercise; but also taking care to keep your germs to yourself, avoiding stress, and getting things treated while they’re still small and cheap to fix.
Third, there’s a somewhat larger awareness that stress leads to big-ticket illnesses — and a somewhat lower cultural tolerance for employers who put people in high-stress situations. Nobody wants to pick up the tab for their greed. And finally, there’s a generally greater acceptance on the part of both the elderly and their families that end-of-life heroics may be drawing resources away from people who might put them to better use. You can have them if you want them; but reasonable and compassionate people should be able to take the larger view.
The bottom line: When it comes to getting people to make healthy choices, appealing to their sense of the common good seems to work at least as well as Calvinist moralizing.”
She hits on a critical point here. Surveys show consistently that about two-thirds of Europeans view the poor as unlucky, while roughly the same percent of Americans view the poor as lazy. Calvinism in action! The same holds true for health care, where individual responsibility for one’s health is a sign of virtue. It explains the lure of actuarial over social insurance– the idea that one’s insurance premia should be related directly to one’s personal health risks (think medical savings accounts) instead of being based on the principle of solidarity, whereby the young and the healthy subsidize the old and the ill, knowing that they will be helped when they reach this stage in life. Needless to say, the priorities in Catholic social teaching are somewhat different.
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An interesting read. Makes me more than a bit jealous of the Canadians. Although, I must say, her comment about pharmacists dispensing drugs w/o “moralizing” is disturbing given the current pressure on pharmacists to get their secularist libellum by sacrificing to the gods of abortion and contraception. But, overall, I found her arguments convincing.
Ms. Robinson’s article reminded me of a recent article about Britain’s National Health Service:
“Patients could be denied treatment because they smoke or are overweight, Patricia Hewitt said yesterday.
“The Health Secretary insisted it was right for those whose lifestyle choices could make treatment ineffective to be refused care in some circumstances.”
http://motors.thisislondon.co.uk/pages/live/articles/news/news.html?in_article_id=435498&in_page_id=1770&in_page_id=1770
Apparently it’s possible to have “medical Calvinism” even with a government run health care system. In fact, if America really does have the sort of Calvinist tendencies that Ms. Robinson suggests, then putting health care decisions in the hands of the government is probably not such a good idea. At least under a private system people who have done things the majority disapproves of can still receive treatment; they aren’t subject to the whims of the Calvinist majority.
here. Surveys show consistently that about two-thirds of Europeans view the poor as unlucky, while roughly the same percent of Americans view the poor as lazy. Calvinism in action
How is that evidence of anything? I am Canadian, and Catholic with no “Calvinist” inclinations, and frankly from all of my observations, a majority portion of the poor in either country are not “unlucky” but lack motivation and ambition. Some of that is due to their upbringing, but as we all know there is a time when all people have an opportunity to step beyond the weaknesses of our parents. The American story is full of people coming to these shores penniless and without education, but building themselves up generation by generation. The bottom line is that most of the poor are there because socialistic entitlement programs rob them of their will to pull themselves up by their bootstraps.
Blackadder makes very good points about the fairness in a government healthcare system which is so fundamentally opposed to the concept of subsidiarity.
God Bless,
Matt
ps. and it does not work, these systems are collapsing under their own weight of innefficiency.
Well, it’s interesting to see that you’re not the only person who so thoroughly misunderstands “Calvinism”! Just as “Calvinist” does not describe the notion our country has enemies, it does not apply to the notion that people often fall into bad health from their own actions. Indeed, that’s practically the opposite of Calvinism. A true analogue to “Calvinism” in the realm of physical health would be the notion that everyone is “totally sick” in every conceivable way, but that God chooses to make a few people healthy through no action of their own.
By the way, MM, since you so often praise the value of “preventive” care, what do you think of this study? http://www.arthurdevany.com/?p=928
“1. Canada’s health care system is “socialized medicine.”
False. In socialized medical systems, the doctors work directly for the state. In Canada (and many other countries with universal care), doctors run their own private practices, just like they do in the US.”
Hmm. Working for someone is getting paid by that someone. The state pays for everything, the definition of single payer, meaning that the doctors get paid solely by the government.
“2. Doctors are hurt financially by single-payer health care.
True and False. Doctors in Canada do make less than their US counterparts. But they also have lower overhead, and usually much better working conditions.”
They make less. That hurts financially, yes? Also, they are forced to deal with one provider. If I ran my own business, I’d be disappointed to have the government dictate to me who I could deal with.
“3. Wait times in Canada are horrendous.
True and False again — it depends on which province you live in, and what’s wrong with you.”
They addressed the where you are side, but notice they didn’t bring up the “what’s wrong with you” portion. I wonder why?
“5. You don’t get to choose your own doctor.”
Wow. That’s a huge “benefit”! I think I’d rather see a specialist who is the best rather than an angry one who only gets paid the same as a general practice doctor.
“6. Canada’s care plan only covers the basics. You’re still on your own for any extras, including prescription drugs. And you still have to pay for it.”
Hmm.. So it’s true. What exactly is debunked here? If single payer is so great and puts everyone on an equal footing, why is there a need for private insurers? Doesn’t that give the rich an unfair advantage?
“7. Canadian drugs are not the same.”
Of course they’re the same. The policies that price them aren’t though. It’s been well documented that Americans pay more for drugs “because we can”. Isn’t that a normal idea pushed by Vox Nova? Make the “rich” pay more to help the “poor”? America is a “rich” country so we subsidize for all the “poor” countries.
“8. Publicly-funded programs will inevitably lead to rationed health care, particularly for the elderly.”
Anecdotal evidence at best. One can cite many cases where exactly that has happened.
“9. People won’t be responsible for their own health if they’re not being forced to pay for the consequences.”
I don’t know how this busts a myth. Aren’t Christians called to respect their own bodies?
“10. This all sounds great — but the taxes to cover it are just unaffordable. And besides, isn’t the system in bad financial shape?
False. On one hand, our annual Canadian tax bite runs about 10% higher than our U.S. taxes did. On the other, we’re not paying out the equivalent of two new car payments every month to keep the family insured here. When you balance out the difference, we’re actually money ahead. When you factor in the greatly increased social stability that follows when everybody’s getting their necessary health care, the impact on our quality of life becomes even more signficant.
And True — but only because this is a universal truth that we need to make our peace with. Yes, the provincial plans are always struggling. So is every single publicly-funded health care system in the world, including the VA and Medicare. There’s always tension between what the users of the system want, and what the taxpayers are willing to pay. The balance of power ebbs and flows between them; but no matter where it lies at any given moment, at least one of the pair is always going to be at least somewhat unhappy.
But, as many of us know all too well, there’s also constant tension between what patients want and what private insurers are willing to pay. At least when it’s in government hands, we can demand some accountability. And my experience in Canada has convinced me that this accountability is what makes all the difference between the two systems.
It is true that Canada’s system is not the same as the U.S. system. It’s designed to deliver a somewhat different product, to a population that has somewhat different expectations. But the end result is that the vast majority of Canadians get the vast majority of what they need the vast majority of the time. It’ll be a good day when when Americans can hold their heads high and proudly make that same declaration.”
OK, so the system still has issues. How does this bust the myth? I don’t know anyone who pays the equivalent of two car payments a month for health care insurance. That sounds just as propagandist as anything she tries to “bust”. If I had to pay 10% more taxes for the same level of care, I’d be WAY behind, so I don’t see how this applies. As far as the vast majority, vast majority, vast majority, I thought the idea of universal coverage was to cover ALL. Sounds like it hits the mark.
Well, Stuart, I don’t understand Calvinism, this author does not understand Calvinism, Cardinal George does not understand Calvinism, Cardinal Laghi does not understand Calvinism…. I guess we all should be seeking tutelage from you on the issue! Clearly, you would tell us that American exceptionalism and manifest destiny has nothing to do with Calvinism, that the much-touted “Protestant work ethic” and individualism have nothing to do with Calvinism…
Teutonic,
great points.
God Bless,
Matt
Tim: you really have a lot of catch-up to do in this debate– go back and see the old posts. The starting point, though, is pretty straighforward: compared to countries of simailr income levels, the US health care system is appalling. It costs twice as much for worse outcomes, leaves millions without insurance, and millions others denied coverage, and leads to longer waiting lists, more emergency treatment, and less patient-centered care than anywhere in the developed world. The reason is that health care is treated as a business, and insurance companies are rewarded by Wall Street for keeping “medical losses” to a minimum. The reason single-payer systems work so much better is that you take out the middle-man– the person making profits from somebody else’s illness. Weeding people out and screening poeple is incredibly expensive, remember. If you want to argue against any of this, you will need to face some stubborn facts: the US pays more, and gets less in return, than those in other countries.
And by the way, your comments show that you do not understand the core distinction between single payer and single provider. Also, the doctor does not “do business” with insurance companies– he or she goes to this source to get get paid that portion which the patient does not cover. US doctors need put a huge amount of resources ninto this endeavor, becauswe of the multitute of insurers, and the fact that they fight tooth and nail against paying claims. This is not a healthy system.
You also mention anecdota evidence. Frankly, I’m tired of fools making points about hip replacements in Canada because they heard some right-wing blowhard make stuff up. Go to the facts, please. THe facts point to more rationing in the US than elsewhere.
MM – Don’t get angry because you link to people who do nothing different than the talk radio crowd. Those arguments were just as easily picked apart as anything Rush or Hannity would spout.
It would be nice if everyone would stick to the facts, wouldn’t it?
MM — that response doesn’t work . . . if you want to make an argument from authority (which would be fallacious anyway), you have to be referring to an actual authority on the subject. You’ve had many chances to defend your use of the term “Calvinism” by referring either to Calvin or to Calvinist theologians and then making an actual argument. If you ever did so, I missed it.
Stuart– read Henry’s latest post. But I guess he doesn’t understand Calvinism either, does he? You are forever repeating this riduculous strawman argument– as I’ve said many many times, the American civic religion is infected by a very bad dose of derivative Calvinism that colors its view of everything from the role of government to the nature of the state of Israel. Whether Calvin himself is smiling or turning in his grave is beside the point.
Tim: I have always argued from facts. Just look up the old health care posts from last summer. I have neither the patience nor the inclination to keep repeating the same points.
Start here: http://vox-nova.com/2007/06/26/health-care-reform-in-defense-of-single-payer-systems/
Al follow: http://vox-nova.com/2007/07/02/sicko-is-healthy/
http://vox-nova.com/2007/07/11/waiting-for-health-care/
http://vox-nova.com/2007/07/25/national-right-to-life-committee-is-clueless-on-medicare/
http://vox-nova.com/2007/10/12/why-i-like-hillarys-health-care-proposals/
Just a few statistics pulled from these posts:
The idea that Americans face shorter waiting times than patients under single payer systems is a fallacy. A problem in making comparisons is that single payer systems typically keep centralized statistics on waiting times, but not so in the US. But the lack of statistics does not mean the lack of a problem. And the evidence all points to the fact that “American people are already waiting as long or longer than patients living with universal health-care systems”. A recent survey by the Commonwealth Fund found that only 47 percent of Americans could get a same or next-day appointment, lower than any other country except Canada. Remember too that health care is rationed extensively by cost in the US. More than half of all sick Americans stayed away from a doctor on cost grounds– needless to say, this is off the charts by comparison with countries offering universal care. In Europe, GPs make up half of all physicians, but less than a third in the US. And only 40% of doctors in the US provide after-hours care, as opposed to 75% elsewhere. Where do Americans get their primary care? From emergency rooms. About 26 percent of all Americans visited emergency rooms over the past two years because they could not see their regular doctor.
MM,
US. More than half of all sick Americans stayed away from a doctor on cost grounds– needless to say, this is off the charts by comparison with countries offering universal
You don’t cite a source for this statistic, is it Michael Moore? Even if it’s accurate you provide no context? It’s not a bad thing that everyone with a sniffle or a cough doesn’t rush to the doctor for treatment, that is what happens in socialist medical systems. There is no recognition of the costs involved because they are borne by the whole of society.
This whole argument about Calvinist influence is a giant ad hominem, instead of arguing with reason y’all just throw out the blanket accusation of Calvinist influence. Similarly politicratus and others just say you haven’t read enough to know what you’re talking about, again it’s a thinly veiled ad hominem.
God Bless,
Matt
MM – I’ve read your posts…
And agree with Matt that you seem to pull the statistics out of…thin air.
I don’t have time to get into the weeds of comparative health care statistics right now, but isn’t there something odd of saying that fewer Americans could get a same or next day appointment than any country “except Canada” when you’re arguing that the U.S. should adopt Canada’s health care system?
From a Doctor who actually practiced medicine in Canada:
http://www.city-journal.org/html/17_3_canadian_healthcare.html
Somehow I think his views might be a bit more on target than those of Sara Robinson, lefty blogger.
http://dneiwert.blogspot.com/
And since we had top 10 myths from a leftist perspective, here from a conservative perspective we have the the top ten things believe about Canadian health care, but shouldn’t:
http://www.heritage.org/Research/HealthCare/hl856.cfm
> “I’ve noted many times that, in the domain of health care, whether health insurance is
> covered by a large private sector insurer or a government entity makes little difference
> in terms of the principle of subsidiarity. After all, why is it that people raise the
> subsidiarity card against government-run insurance, but have no problem with large
> impersonal private insurance schemes”
Which is why Bush hit on the right path with the HSAs. Can I see one of you single-payer advocates argue why universal healthcare through HSAs with subsidies for the poor is a bad idea?
RPFN,
I’m a huge fan of HSA’s with catastrophic coverage. It’s what I have even though I could easily afford a full coverage solution. It makes sense from a subsidiarity perspective, from a personal liberty perspective, efficiency, etc. etc.
Insurance is overused when it comes into play on routine events.
Another idea that might have merit is voluntary cooperatives, I believe there is a couple that are based on Christian ideals.
God Bless,
Matt
Stuart– read Henry’s latest post. But I guess he doesn’t understand Calvinism either, does he?
MM — I did read it, and I don’t see anything whatsoever that would support your caricatured notion that “Calvinism” means either 1) a willingness to fight a preemptive war against another country, or 2) the attitude that people who get certain kinds of diseases should have taken better care of their health. Again, do you ever plan on making an actual argument that refers to anything said by any actual Calvinists?
If it’s that hard for you to do so, maybe you should reconsider your sloppy language usage. In fact, how about coming up with a different all-purpose pejorative for anything with which you disagree. “Neoconservative” might do, for example; no one seems to care anymore what that term originally meant.
Also, do you grant the point that most “preventive” care doesn’t really save money? (Not that it’s a bad thing to provide, mind you, just that your usual claims of monetary savings from “preventive” care may be unsupported.)
Similarly politicratus and others just say you haven’t read enough to know what you’re talking about, again it’s a thinly veiled ad hominem.
Ha, ha! It’s not an ad hominem if it’s true. And you and I both know it’s true in your case!
RPFN– because it would not work. I appeal here to the work of Jonathan Gruber of MIT who shows tha the tax credit solution to health care is incredibly inefficient. Think of it this way: the whole point of HSAs is to present a great deal to the young and healthy, forgetting about the rest. In such a world, insurance for the old and infirm would prove prohibitively expensive, even if they are forced to charge community rating (which they are not under the so-called “free market” approach).
Stuart– no, I do not concede the point. It’s late, and I have no time to look up sources right now, but I certainly have seen studies that show the benfit of preventive care, and especially of a holistic approach to health care– within the US, I seem to recall a study on the VA system.
Matt: you are arguing from (i) subsidiarity– perhaps that has some merit on its own; (ii) “personal liberty”– not Catholic, based on laissez-faire liberalism, and so I discount; (iii) efficiency– decidedly not the case– see the work of Jonathan Gruber.
And you are missing (iv) solidarity, which would argue for social rather than actuarial insurance (hint: social means risk sharing, not “socialism”); (v) preferential option for the poor– and the poor do not qualify for the kinds of tax benefits under the HSA approach.
One more point, Stuart: are you arguing that a system relying on preventive care is not more cost effective than one relying on the ER? I can only see that to be to the case if the patient refrains from actually getting the care in the latter case– which indeed is the case in the US where rationing by cost is rampant.
One more point, Stuart: are you arguing that a system relying on preventive care is not more cost effective than one relying on the ER?
I’m agnostic on the question. I can readily imagine 1) so-called preventive treatments that are not cost-effective at all; 2) preventive treatments that do, in fact, prevent a more costly disease from erupting later; 3) preventive treatments that keep the patient alive for so much longer that it ends up costing the medical system much more. In any event, as I said, none of this has any bearing on whether it would be a good thing to provide such treatments — it would be cruel, for example, to urge the denial of preventive care on the ground that it would save money by letting people die sooner. At the same time, it strikes me as very dubious to claim that preventive care is basically a free lunch — that it will give people better care AND save money for the system. Maybe it won’t do the latter at all, and it would be more prudent (not to mention more honest) not to promise the moon here.
Policraticus,
Similarly politicratus and others just say you haven’t read enough to know what you’re talking about, again it’s a thinly veiled ad hominem.
Ha, ha! It’s not an ad hominem if it’s true. And you and I both know it’s true in your case!
Hmmm, where did you learn argumentation? Maybe you need to read more on the subject. An ad hominem need not be false to be a fallacious argument, it only needs to be unrelated to a refutation of the argument.
Glad I could help.
God Bless,
Matt
Morning’s Minion,
RPFN– because it would not work. I appeal here to the work of Jonathan Gruber of MIT who shows tha the tax credit solution to health care is incredibly inefficient. Think of it this way: the whole point of HSAs is to present a great deal to the young and healthy, forgetting about the rest. In such a world, insurance for the old and infirm would prove prohibitively expensive, even if they are forced to charge community rating (which they are not under the so-called “free market” approach).
There’s two issues here, efficiency is one and the other is the disparity of medical costs between different groups (especially the elderly). On the first point, any government system fails miserably, surely you won’t argue that? We can go into detail using any number of entitlement programs.
On the second point, what does forcing the young and healthy into a government health care system do? It increases the size of the program and the amount of waste thus involved. Even if the old and infirm need a government funded solution it doesn’t mean the young and healthy should add to it’s burden (remember the principle of subsidiarity). As to the funding of a solution for those who truly can not pay there is a number of categories of solution currently in place that work well to more or less extents. The system of charitable health care providers was the most efficient, but it’s been deeply damaged by government interference, so unless it can be restored it will not be effective. Following Catholic principles the system should start at the most local level and move to higher levels only when the lower levels fail. So a county or state system would be much more closely aligned to the needs of the people (and frankly in keeping with US Constitution).
One of the important requirements of a better healthcare system is lowering the costs, this works better in a competitive environment, and would involve some changes (removing anti-competitive government interference such as employer incentives, excessive settlements and the resulting malpractice insurance requirements etc.). If these cost reductions can be achieved it’s not inconceivable that even the old and infirm by securing insurance and saving sufficiently before they become ill could cover their own expenses. Remember, all taxation does is move money around and add overhead, it does not actually reduce the net cost of anything.
Matt: you are arguing from (i) subsidiarity– perhaps that has some merit on its own;
Thanks.
(ii) “personal liberty”– not Catholic, based on laissez-faire liberalism, and so I discount;
That is incredible, you argue that the concept of personal liberty is not Catholic but is laissez faire liberalism? How very radical! Personal liberty is in fact a Catholic teaching, and not laissez-faire liberalism. Lord Acton is a heretic then? “Liberty is not a means to a higher political end. It is itself the highest political end.”
In fact, there is an entire section on the principle of freedom in Catholic teaching in the Catechism.
IN BRIEF
1743 “God willed that man should be left in the hand of his own counsel (cf ? Sir 15:14), so that he might of his own accord seek his creator and freely attain his full and blessed perfection by cleaving to him” (GS 17 # 1).
1744 Freedom is the power to act or not to act, and so to perform deliberate acts of one’s own. Freedom attains perfection in its acts when directed toward God, the sovereign Good.
1745 Freedom characterizes properly human acts. It makes the human being responsible for acts of which he is the voluntary agent. His deliberate acts properly belong to him.
1746 The imputability or responsibility for an action can be diminished or nullified by ignorance, duress, fear, and other psychological or social factors.
1747 The right to the exercise of freedom, especially in religious and moral matters, is an inalienable requirement of the dignity of man. But the exercise of freedom does not entail the putative right to say or do anything.
1748 “For freedom Christ has set us free” (? Gal 5:1).
Now if you read this you will see that liberty is fundamental, but it is not unbounded, especially by Christian morality, but only when necessary by civil authority.
(iii) efficiency– decidedly not the case– see the work of Jonathan Gruber.
refuted above.
And you are missing (iv) solidarity, which would argue for social rather than actuarial insurance (hint: social means risk sharing, not “socialism”); (v) preferential option for the poor– and the poor do not qualify for the kinds of tax benefits under the HSA approach.
These goals do not require the radical infringement on subsidiarity and liberty envisioned by a socialist system which is what is advocated – risk being passed to the state, not shared as you imply here. I have no problem sharing my blessings with the poor through charity, I further don’t object to a smallest possible degree of coercive taxation to ensure that their is care available for those that can not afford it, according to the principle of subsidiarity this should be provided principally at the most local level (county I should think).
God Bless,
Matt
Stuart
You would do well to re-read the post.
One characteristic described by McGrath is the tendency of Calvinism to look for a way to triumph over the world by mastering the world; with the tendency to see things as “good” vs “evil,” the world being “evil” it needs to be mastered intstead of the master. Since Calvinism has had a major influence on the US and its political ideas in the past, it is not a stretch of the imagination to see present US policy is a continuation of the underlying Calvinistic tradition.
Second, Calvinist’s work ethic has a basic “sink or swim” mentality; if you don’t swim, irregardly of your situation (such as you don’t know how to swim), it’s ok that you drown. Put into economics and the distribution of goods, this has helped establish capitalistic, dog eat dog, world. When health is seen as just another economic good, intead of an intrinsic right, then it is easy to see how Calvinistic ethics will lead to an unequal distribution of health goods as well. Which is what we see, and indeed, which is what McGrath also points out is seen as a way out of the state funding of social services.
Thanks, Henry. On re-reading your other post, I don’t see your first argument at all, and only a glimmering of the second. (But at least you’re not calling me a liar for supposedly misinterpreting you. That’s an improvement. Indeed, it’s a better policy by far to assume that if someone else misunderstood you, it was your fault for writing so unclearly.)
I still suggest that “neoconservative” would make a better all-purpose pejorative for MM to use.
Stuart
I mentioned how Calvinism saw the need to master the world, to control it. McGrath was then to show how this devolved in secularism and turned Calvinism upside down while still being influenced by Calvinism and essentially the way Calvinism has been assimilated in society.
Here is a quote I didn’t give then, from 319. “As Roland Bainton, one of the most distinguished analysts of the early sixteenth century, remarked, when Christianity takes itself seriously, it must either renounce or master the world. Given the political realities of the age, Protestantism could only aspire to mastery; unlike Islam, it never achieved religious mastery of the secular but was obliged to work with more or less sympathetic rulers.”
Discussing Calvinism on 323, McGrath points out, “Those who seem to master the world are often those who have actually been mastered by it. Those who are counted successes by the world are often those who have capitulated to its norms. Latent within Calvinism is a purely profane approach to life, in that the failure to…. [see the rest of the quote in my post].
Hopefully that clarifies some things. I thought the summary combined with the quotes would have been sufficient.
Matt: I don’t know where to begin as pratically everythiung you mention is simply incorrect. Can you please read the first of my linked posts above, where i laid out my argument in favor of single payer? You are starting from the ideological premise that the government “fails miserably” on effciiency grounds, but that is patently not tre in the domain of health care. In fact, evidence the world over shows that single payer systems have far cheaper than the US system, cover more people, and deliver better outcomes in terms of health indicators. Nobdoy disputes that– the opponents of single payer afrgue instead that rationing by cost is replaced by rationing by time– but if you delve deeper into that, it turns out not to be true either. Bottom line here: if you want to do health care on the cheap, as in the UK, you will have extensive waiting times. If you don’t, like France, you won’t. But France’s expenditure on health care is still miniscule compared with the US. The problem is that the middle man (insurance companies) are taking a huge cut in the US– to make profits, they need to spend a lot of resourcesn (50 billion a year) weeding out claimants.
Here is a natural experiment: the Republicans tried to move Medicare (a traditional snigle payer program for the elderly) toward the private sector with Medicare Advantage- instead of paying the provider directly, the government would pay a subsidy to an insurance company to take the Medicare patient. What happened? Medicare Advantage cost between 10-20 percent more per patient than traditional Medicare, which has minimum overhead.
Now, you will often hear that Medicare is financually unsustainable, and that is true. But this is a problem the world over: constantly improving health care technology is pushing up health care costs everywhere, private and public sector alike. Governments will need to address this in the near future. But the point I am trying to make is that single payer is actually the most efficient system out there– and we need efficiency in the current environment.
On subsidiarity, again, don’t fall into the ideology trap. Why is single payer a violation of subsidiarity while insurance through a large profit-making insurance company or a large corporation is not? What is more de-humanizing: a government bureaucracy that pays for health care (something the Church regards as a basic right) or a profit-making insurance company trying to minimize “medical losses”?
As for Lord Acton being a heretic, I think that case could quite possibly be made. And by the way, you misunderstand the Church’s meaning of human freedom, which is the freedom to make the right moral choices. What laissez-faire liberals regard as “freedom” can, in Catholic teaching, be regulated based on the common good e.g. gun ownership.
An ad hominem need not be false to be a fallacious argument, it only needs to be unrelated to a refutation of the argument.
Ha, ha! I never intended it to be a premise of my argument. Rather, it was cited as a fact. I love it when you try to get all logical.
MM,
“I appeal here to the work of Jonathan Gruber of MIT who shows tha the tax credit solution to health care is incredibly inefficient.”
He also acknowledges that it’s the only way which is why he supports the idea.
“Think of it this way: the whole point of HSAs is to present a great deal to the young and healthy, forgetting about the rest. In such a world, insurance for the old and infirm would prove prohibitively expensive, even if they are forced to charge community rating (which they are not under the so-called “free market” approach).”
The young and healthy become the old and infirm. The whole point of HSAs is to allow the young and healthy to save up for later.
“Liberty is not the power of doing what we like, but the right of being able to do what we ought.” – Lord Acton.
“(ii) “personal liberty”– not Catholic, based on laissez-faire liberalism, and so I discount;
That is incredible, you argue that the concept of personal liberty is not Catholic but is laissez faire liberalism? How very radical! Personal liberty is in fact a Catholic teaching, and not laissez-faire liberalism. Lord Acton is a heretic then? “Liberty is not a means to a higher political end. It is itself the highest political end.”
In fact, there is an entire section on the principle of freedom in Catholic teaching in the Catechism.
IN BRIEF
1743 “God willed that man should be left in the hand of his own counsel (cf ? Sir 15:14), so that he might of his own accord seek his creator and freely attain his full and blessed perfection by cleaving to him” (GS 17 # 1).
1744 Freedom is the power to act or not to act, and so to perform deliberate acts of one’s own. Freedom attains perfection in its acts when directed toward God, the sovereign Good.
1745 Freedom characterizes properly human acts. It makes the human being responsible for acts of which he is the voluntary agent. His deliberate acts properly belong to him.
1746 The imputability or responsibility for an action can be diminished or nullified by ignorance, duress, fear, and other psychological or social factors.
1747 The right to the exercise of freedom, especially in religious and moral matters, is an inalienable requirement of the dignity of man. But the exercise of freedom does not entail the putative right to say or do anything.
1748 “For freedom Christ has set us free” (? Gal 5:1).
Now if you read this you will see that liberty is fundamental, but it is not unbounded, especially by Christian morality, but only when necessary by civil authority.”
Matt – Nice… I’ve been meaning to shoot out the idea of liberty and freedom as some non-Catholic horrible idea.
MM,
the reason why large health insurance carriers do not violate the principle of subsidiarity is THAT THEY DO NOT DEMAND PARTICIPATION in funding or in recieving treatment. Hope that helps.
Having said that, I believe it was government regulation (via tax credits for business) that caused the growth of massive insurance companies and the subsequent increase in medical costs (along with massive judgements in malpractice). I oppose this, and believe the power should be in the hands of the people. I like the personal tax credit idea and then the freedom of the individual (subsidized according to his means) to purchase health care using any combination of full coverage, catastrophic, or out-of pocket they chose.
God Bless,
Matt
I think that anyone who is so hyper-sensitive about misuses of the word “liberal” ought to be a bit more precise regarding nomenclature.
The connection between everything that is being ascribed to Calvinism, and Calvinism itself, remains flimsy. And qualifying the concept by calling it “derivative” Calvinism is a weak fix. For example, the tendency to see the world in black/white terms is historically a notion far broader and deeper than Calvinism per se. It could also be claimed as going back to the Puritans, or even to cathars and bogomils, or Essenes, or Zoroastrians. Come to think of it, a certain Jewish preacher also spoke of dividing people into sheep and goats.
Likewise, the notion that “our” nation is chosen by God — if simply referring to that as chauvinism isn’t colorful enough, one can presumably trace that to British theories about being the lost twelfth tribe of Israel, or to Ceasars who so often managed to trace their genealogies back to some divinity, or to a hundred other such examples. None of the above concepts, either as a whole or in part, is peculiarly Calvinistic, and it speaks to the poverty of the underlying arguments being made here if a more appropriate term can’t be found.
Given Henry’s penchant for thought experiments, a certain analogy I’ve made before bears repeating: how appropriate would it be for some Paul Blanshard type to label everything undemocratic or authoritarian in US society as “derivative Catholicism”? In support of his tactics, he could provide rich detail about church hierarchy, longstanding Vatican criticism of certain tendencies within democracy, various Catholic immigrant factions and their participation in corrupt political machines, etc., but would all those footnotes make his argument any less idiotic?
Why shouldn’t people here be expected to be similarly circumspect when discussing Calvinism?
(And for what it’s worth, I thought Henry’s post about Calvinism was very good work.)
Given that US policy toward Israel is so often described as “Calvinistic” on this site, here’s a competent article by James Q Wilson discussing the support Israel enjoys from American Christian groups.
Lo and behold, he manages to make it all the way through without using the “C” word once.
http://www.city-journal.org/2008/18_1_evangelicals.html
(Hat tip to artsandlettersdaily.com)