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This Just About Sums It Up

December 2, 2009

OK, this is Rush Limbaugh. And yet, I’ve always believed that Limbaugh says openly what many on the right think privately, which goes a long way toward explaining his phenomenal success. And here he is in a very short exchange on health care with William Shatner (I know, this is getting weird!). In response  to Shatner’s question about the prevalence of rationing care by cost (the key problem with the American system), Limbaugh compares health care with owning a house on the beach – if you can afford it, you get it, and there’s no moral issue. We all know that this is diametrically opposed to Catholic teaching on the issue, which sees health care as a right. And most opponents of healthcare reform would probably not go as far as Limbaugh. But still, isn’t the attack on the mis-named “government take-over of healthcare” or “socialized medicine” really code for a core Calvinist principle – the objection to being responsible for the welfare of another through the tax system? Aren’t these critics really closet Limbaughs?

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21 Comments
  1. Kurt permalink
    December 2, 2009 3:11 pm

    isn’t the attack on the mis-named “government take-over of healthcare” or “socialized medicine” really code for … objection to being responsible for the welfare of another through the tax system?

    yes.

  2. Cathy permalink
    December 2, 2009 4:32 pm

    I disagree with the assumption. People can disagree with these healthcare proposals and the additional taxes they impose and still take responsibility for the welfare of others.

  3. Pinky permalink
    December 2, 2009 4:39 pm

    MM, forgive me if I’m being too literal here. I can do that sometimes.

    First off, I don’t know any “opponents of healthcare reform”. Everyone wants to improve the system; they just disagree on the best ways to do it.

    Secondly, Limbaugh says that if you don’t have the money for a mansion, you live in a shack. He doesn’t say that the poor should live on the street and die. He’s saying that while everyone should receive basic care, the best should be available to those who can afford it. That reading wouldn’t be in conflict with Catholic teaching.

    Lastly, a question. Where does Calvinism enter into this?

  4. December 2, 2009 5:18 pm

    Cathy – what additional taxes are you referring to? All versions of the reform so far would reduce the deficit. Are you talking about the excise tax on expensive plans? Or the tax on very rich in the House plan that the Senate absolutely refuses to consider?

  5. December 2, 2009 5:25 pm

    Pinky:

    No need to apologize. On your first point, we need to start from the premise that the current system in the United States is a scandal – 47 million without insurance, 25 million underinsured, health care costs the leading cost of bankruptcy, the poor being forced to use too-little-too-late ER care, insurance companies that can deny or refuse coverage at a whim…

    The proposed bills move toward universal coverage, rein in the insurance companies, and implement significant cost savings over time. Are there better ways to do it? Sure, single payer for one. But that’s not on the cards. Based on every criterion, the Republican plans are inferior. That leaves me to conclude that the fundamental opposition is ideological, not prudential.

    Calvinism has everything to do with this – see Cardinal George on this one. The American world outlook (in this context, individual virtue over solidarity) is all related to its derivative Calvinist theology. In Europe, most people believe the poor are simply unlucky, in the US, most believe the poor don’t work hard enough and lack virtue.

  6. December 2, 2009 5:31 pm

    Oh, on your second point, Limbaugh actually says “You’re assuming there’s some morally superior aspect to health care than there is to a house [on the beach]“. I assume he does not.

  7. Blackadder permalink
    December 2, 2009 7:02 pm

    Cathy – what additional taxes are you referring to? All versions of the reform so far would reduce the deficit.

    Um, wouldn’t the fact that the bill ostensibly spends more while reducing the deficit necessitate that it raises taxes?

    Are you really not aware of the new taxes that would be imposed to pay for the bill? (not just the excise tax, mind you, but the increases in payroll taxes and the fines on people without insurance)

  8. Blackadder permalink
    December 2, 2009 7:05 pm

    I’m not really in the mood to defend Limbaugh, but if I’m not mistaken doesn’t the Church teach that housing is also a right? Presumably the fact that housing is a right doesn’t prevent some people from living in better houses than others. Why shouldn’t we say the same for health care?

  9. Steve permalink
    December 2, 2009 7:17 pm

    I don’t believe for a second that only the “rich” will pay higher taxes to fund health care. It’s little more than a selling point for the democrats to promote the plan. The same argument was employed to enact the 16th amendment, for example, and we all know how that turned out.

  10. Pinky permalink
    December 2, 2009 8:52 pm

    MM, I don’t want to show insufficient respect to you or to a Prince of the Church, so I’m going to read up about what Cardinal George said. I can’t find much so far. It looks to me like the characteristics you’re talking about are a little different than the ones George is talking about, and that those characteristics are more Scottish than Calvinist.

  11. December 2, 2009 9:31 pm

    I laughed out loud when Rush said that if you’re wealthy you live in a house on a beach, whereas if you’re poor you live in a bungalow somewhere. What about those folks who live in housing projects. And I’m sure Rush has a beach house somewhere (how many?)

    His statements are basically a smokescreen that assumes that there is no major gap in income in North American society.

  12. John F. permalink
    December 2, 2009 10:19 pm

    MM, a longish-time VN reader and semi-professional theologian here… I always find your posts on the America-Calvin connection compelling, but I’m far too ill-read in Calvin to understand exactly what the link IS (in other words, ditto Pinky).

    Any recommendations for reading on that link? Someplace in Calvin? Some other thinkers who’s drawn the link out more fully? Heck, an old post on VN where you draw the link yourself?

    Keep the faith!

  13. December 2, 2009 11:02 pm

    “Morning’s Minion Says:
    December 2, 2009 at 5:18 pm

    Cathy – what additional taxes are you referring to? All versions of the reform so far would reduce the deficit.”

    Come on, you don’t actually believe that, do you? Even the con men selling that notion have a hard time keeping a straight face when telling that whopper.

    Separately, to address Limbaugh’s point, is there really an actual RIGHT to health care provided by the government? One can believe there is a moral imperative to help our fellow man without making the massive leap to believing health care is a right which must be provided by government. In other words I may have an obligation, but it would be wrong for me to attempt to transfer that obligation to others through government intervention.

  14. R.C. permalink
    December 2, 2009 11:05 pm

    The problem is NOT that our health care system cannot be improved upon.

    The problem is that our national discussion is hovering almost exclusively around proposals to alter the system in ways that make it WORSE THAN IT IS NOW.

    Granted, most of these proposals would fix this problem or that problem within our current system. Look only at the problems fixed, and ignore the new ones created, and you’d get the illusion that an improvement had been made.

    What we want in a healthcare economy is:

    - Consumer empowerment: No insurance company whom I’ve already paid should, after they already have my money, be able to decide whether or not to use some of that money to assist me.

    - Incentives for consumer caution: If a person thinks he’s buying Service X with “other people’s money,” he’ll tend to overbuy and tend to not bother overmuch with whether he’s getting good value for his money. With his own money, he’s pickier. A whole marketplace of pickier consumers tends to be healthy in that it drives crooks and over-priced providers out of the marketplace.

    - The poor shouldn’t be assisted to buy better health care than they could otherwise afford.

    - Children shouldn’t have to take responsibility for their health care costs like an adult would.

    - The elderly shouldn’t have some relief from their health care costs, lest they be drained to indigence as they age.

    Now most of the current proposals cluster around fixing the last three items, while making the first two worse than they are now. And because they tend to inaugurate new government programs and entitlements, they risk permanently preventing a better solution because government programs are notoriously hard to kill.

    A better proposal would be one that helped in all five areas.

    Here is one such proposal:

    (a.) Set a threshold amount, by law, for persons of a given age, which approximates what’d cover the health costs for persons of that age, statistically, 75% of the time. (A plausible number might be, say, $5,000 for a 30-year-old, but double that for a 60-year-old.)

    (b.) Require by law withholdings from paychecks (similar to FICA) which go into a Healthcare Savings Account (HSA) for each person. A person’s monthly withholding is higher if he doesn’t yet have the threshold amount in his HSA, but drops to half of its previous amount once he has the threshold amount.

    (c.) Provide federal matching funds (similar to employer matching in a 401K) for each payment into an HSA, which are inversely proportional to income. (The low-income folk save up faster than they otherwise would have as a result.)

    (d.) The contents of the HSA are used to purchase health care. There is no middleman; the consumer chooses, and pays doctors directly.

    (e.) To handle unexpected large expenses (defined as expenses which are higher than the threshold amount in a year), each person is required to carry catastrophic-cost coverage. To handle expenses which are less than the threshold amount, but less than they’ve saved up, each person carries “stopgap” coverage. These are the only two forms of insurance involved, and the only way that insurance companies enter into this system.

    These two forms of insurance are paid from your HSA. Of course, as soon as your account exceeds the threshold amount, you can drop the “stopgap” insurance (which gets less and less expensive the closer you are to the threshold anyway, for obvious reasons).

    (f.) The HSA’s are property, transferrable to heirs. But the contents of an HSA may only be used for health expenses.

    The above-described system creates consumer empowerment, and encourages a sense of “ownership” of the money, which in turn encourages shopping around. The matching funds equalizes low-income earners with higher-income earners, albeit only partially. It also encourages savings, especially since one’s monthly withholding drops (tho’ it’s not eliminated altogether) once one reaches the threshold.

    However, it doesn’t help the children and the elderly, so to the above system, I add the following:

    (g.) A government health care system will pay a percentage of all health care costs for the very young and the very old, with the percentage changing according to age, as follows:
    – Pre-Natal to 2 yrs: 90%
    – 3 yrs to 5 yrs: 75%
    – 6 yrs to 8 yrs: 60%
    – 9 yrs to 11 yrs: 45%
    – 12 yrs to 14 yrs: 30%
    – 15 yrs to 17 yrs: 15%
    – 18 yrs to 69 yrs: no assistance
    – 70 yrs to 79 yrs: 20%
    – 80 yrs to 89 yrs: 40%
    – 90 yrs to 99 yrs: 60%
    – 100 yrs and above: 80%

    There you go. It’s a market-driven system, in which the poor and the children and the elderly are assisted, but everyone still has incentive to save and to shop around and to be thrifty and informed consumers.

    Now, I’m not wedded to the above numbers. And I’d want the age-thresholds for the elderly to change proportionally as life expectancies increase.

    But as a general outline, the above is far better than the kinds of things currently being proposed…and the kinds of things currently being proposed are of a type which makes it permanently harder to scrap them and replace them WITH a healthier system, like that described above.

  15. Kurt permalink
    December 3, 2009 12:03 am

    Presumably the fact that housing is a right doesn’t prevent some people from living in better houses than others. Why shouldn’t we say the same for health care?

    We should. The difference is that beyond fundamental needs, there is a lot of additional distance you can go in housing. 5 bedroom townhouse on 5th Ave with a park view.

    In health care, there is only a small part of the market beyond basic use — elective cosmetic surgery, private hospital room, services of a masseuse (though I think the one Mr. Limbaugh used on his vacation was not a licensed health care professional nor covered by any insurance plan).

  16. Steve permalink
    December 3, 2009 9:18 am

    Not to oversimplify the issue, but the elephant in the room that nobody wants to talk about is the fact that insurance itself is the real problem. The escalating costs of healthcare are largely fueled by the fact that almost everyone thinks that they are entitled to any kind of healthcare that they want, with little or no consideration for its cost. IMO, any of the “fixes” that are currently being proposed will not actually fix the system due to the fundamental foundational flaws within the system. The radical change that is needed is to eliminate dependence on insurance – at least for basic health care, whether private or public. Sure, it would likely be a painful transition (which is why it will never happen by choice) but it is probably the only way to bring costs under control for the long haul.

    To give this a little perspective, a while ago I read a blog where the writer did a comparion of costs from 1952 and today. He adjusted the costs to inflation so that the 1952 costs would reflect today’s.

    (Today’s) cost of having a baby in 1952 (from his blog):
    Private deluxe room: $183 (per day or per stay, I can’t tell)
    Baby care: $48.50 per day
    Obstetrical service: $244
    Cesarian section: $244 additional, plus anesthetic charge
    Circumcision: $40.50.

    His daughter’s birth actually cost him $13,000 in 2002, but using 1952′s invoice it would have cost $475.50.

  17. December 3, 2009 10:00 am

    Actually, despite the nefarious behavior of the private insurance companies, insurance is not the real problem when it comes to costs. It is certainly the real problem when it comes to the real moral issue – lack of access to needed care and rationing based on cost.

    But when it comes to costs, it is the delivery system – the incentives are set up so that doctors, hospitals, and drug companies earn far more than they do elsewhere, without providing any better service. The new bill goes further than ever before to tackle delivery system problems (see Jonathan Gruber), but we are still talking baby steps.

    But when it comes to insurance, the solution is rather obvious – move to the biggest risk pool possible to lower costs (hence the individual and employer mandates) and make insurance companies treat people fairly (hence community rating and other regulatory restrictions). This also furthers the goal of solidarity.

  18. Steve permalink
    December 3, 2009 10:18 am

    I don’t think that insurance companies are the main problem, rather, we have a health care entitlement mentality because insurance pays for it all. It pays for checkups, exams, basic tests, basic prescription medicine, surgury, treatments – everything. We have no concept of cost, and almost never even ask for the cost before services are rendered. This will not change with any of the health care proposals currently being offered and, in my opinion, will force whatever system in existence to ration; be it government or private. If we do not make our economic/health decisions for ourselves then those decisons will be made for us. It’s that simple. The “delivery system” should, largely, be me and you.

  19. David Nickol permalink
    December 3, 2009 11:24 am

    If we do not make our economic/health decisions for ourselves then those decisons will be made for us. It’s that simple. The “delivery system” should, largely, be me and you.

    Steve,

    Exactly how do we make these decisions for ourselves? I have had two significant medical experiences this year.

    First, I was hit by a cab and taken by ambulance to an emergency room. How was I supposed to research the costs? Was I supposed to tell the ambulance drivers to take me to the cheapest hospital? (I was very lucky and suffered only bruises, but the costs paid by my insurance came to well over $1000.)

    Second, my left eye was hemorrhaging internally, and I went to an eye and ear hospital on an emergency basis. I had surgery a few days later, but exactly what procedure would be performed depended on what they found once they got into the eye. (it was a detached retina.) How do you shop around in a case like that? I got a separate bill from the anesthetist. I didn’t have any choice in choosing her based on anything at all, let alone her fee.

    Yes, of course, if you want something like Lasik you can shop around and find a good price. But that is a case in which you already know exactly what treatment you want. You can’t shop around for eye surgery the same way you can shop around for a large-screen television.

    If you have a doctor you trust, and he recommend surgery, a drug, or some other course of treatment, how often are you going to say, “How much does it cost? No, that’s too expensive.” If you don’t have insurance, you may be forced to find yourself in that position, but the whole idea of insurance is to enable you to pay for needed treatments that you could not otherwise afford.

    We already have rationing based on cost.

  20. Pinky permalink
    December 3, 2009 12:33 pm

    John F, I’m having problems with the America-Calvin link because I *am* familiar with Calvin’s writings. You don’t see the American independent streak, strong split between religion and politics, or sense of earthly justice in Switzerland or Huguenot France. In the US, you find the strict work ethic in the Calvinist Scots-influenced North, but not in the Calvinist French-influenced South. The country with the strongest sense of “you get what you deserve” is Japan.

    I can accept that some American attributes came to us through Calvinist northern Europe, and they differ from the Hispanic Catholic cultural traits. I just want to be careful before I draw a cause-effect link.

  21. Steve permalink
    December 3, 2009 1:24 pm

    David:
    I think you’re partially missing my point.

    I’m not talking about making every decision about every aspect of your health care, especially emergency treatment and the like. I’m talking about how we got into this mess in the first place and how to get out. It wasn’t always this way. There was a time when health care worked.

    I think that there is much blame to go around as to how we got into this, but I also think that we have a large part of the share of blame. By accepting the notion that we could have any health care that we want without considering the cost because “insurance will pay for it,” we have put ourselves where we are and have artificially inflated the costs. The only real way out, as I see it, is to begin to take responsibility for our bad decisions, and to begin to take control of our own destiny. I’m not sure how this could be accomplished though, because I think we’re in too deep. Also, as I said previously, I don’t think it will happen by choice because it would simply be too painful, but I also think that if the current attitude continues where we think that an insurance company or the government or what-have-you (“someone else”) should always pay for my health care, then either the house of cards will eventually come crumbling down, or rationing will become severe as costs soar higher and higher. Either way we will be forced to take responsibility.

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