Practical subsidiarity
Too often, we don’t think through the implications of the principle of subsidiarity. Our friends on the right seem to equate it with small government and free market individualism. This is fundamentally misguided. But many on the left almost cede the point, stressing that it must always be twinned with solidarity (as Pope Benedict says clearly in Caritas in Veritate) and leave it at that. Few grapple with the implications of the doctrine itself. But it is quite a powerful concept in its own right, and I think we all spend more time teasing out its implications.
The most formal statement of subsidiarity comes from Pius XI’s Quadragesimo Anno from 1931, in which he says: “Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do. For every social activity ought of its very nature to furnish help to the members of the body social, and never destroy and absorb them”.
In other words, it’s about letting human dignity flourish. It’s about a social order centered on the person, not the individual. This is important, for Pius sees subsidiarity as a bulwark against not only excessive centralization, but also excessive individualism (the “poisoned spring” of the “evil individualist spirit”). This is too often forgotten. Indeed, throughout the encyclical, it seems that the individualism is more directly responsible for the problems of the day. As he says: “things have come to such a pass through the evil of what we have termed “individualism” that, following upon the overthrow and near extinction of that rich social life which was once highly developed through associations of various kinds, there remain virtually only individuals and the State”. In other words, aspects of modern liberalism seek to obliterate or neutralize a whole variety of subsidiary mediating institutions between individual and state. And that leaves people adrift, lacking any organic connection – swimming alone in a vast ocean, vulnerable to all kinds of predators. As Pius XI is well aware, that is not the way it used to be. One way to read Quadragesimo Anno is as a nostalgic call to rectify the injustices of the modern industrial era, an authentically conservative manifesto. It is no coincidence that secular leftists like Tony Judt make similar arguments, from a completely different philosophical perspective.
What, then, is the proper role of government? Pius is emphatic that “the right ordering of economic life cannot be left to a free competition of forces” and cannot “be considered and treated as altogether free from and independent of public authority”. Rather, economic life should be “subjected to and governed by a true and effective directing principle”. In other words, the government cannot just withdraw from the economy. It must pursue the common good – actively.
Sometimes it has a direct role. As Pius noted: “On account of changed conditions many things which were done by small associations in former times cannot be done now save by large associations”. In the modern state, this often justifies a direct role for government in a number of areas, including defense. But more than this, the government must always provide the space within which subsidiary institutions can flourish – always “directing, watching, urging, restraining”. As John Paul II said much later in Centesimus Annus, while the principle of solidarity justifies a direct state role in economic affairs, the principle of subsidiarity justifies an indirect – but no less important - role, to create “favourable conditions for the free exercise of economic activity”. Often, this is a watchdog role that protects small groups from being dominated and swallowed up by larger and more powerful ones. The state is called upon to guarantee a level playing field. Again, it is about protecting human dignity.
What then are the practical implications of all of this? I can think of five off hand, all relevant in current debates.
1. The financial sector. The dangers of a large and out-of-control financial sector were very much on the mind of Pius XI, as be wrote during the turbulent 1930s. Consider his words: “In the first place, it is obvious that not only is wealth concentrated in our times but an immense power and despotic economic dictatorship is consolidated in the hands of a few, who often are not owners but only the trustees and managing directors of invested funds which they administer according to their own arbitrary will and pleasure. This dictatorship is being most forcibly exercised by those who, since they hold the money and completely control it, control credit also and rule the lending of money. Hence they regulate the flow, so to speak, of the life-blood whereby the entire economic system lives, and have so firmly in their grasp the soul, as it were, of economic life that no one can breathe against their will”. These words ring uncannily true today, as we struggle to recover from the greatest financial crisis since the days of Pius XI, brought about by the very same causes – a runaway financial sector driven by greed to seek short-term profit above all, and record levels of wealth inequality.
A key problem is the idea of too-big, too-important, or too-interconnected to fail. These kinds of financial institutions know that it is highly unlikely they will be allowed to fail, as the implications could be catastrophic (it was tried with Lehman Brothers – remember what happened?). But because the financial institutions know this, they borrow excessively, pile up leverage, and take too many risks. When the going is good, it’s really good. But when it’s bad, they can walk away and send the bill to the taxpayer.
This is not conducive to a just social order. Financial institutions should ultimately be in the business of bringing together borrowers and lenders, of intermediating capital to where it is most needed. Subsidiarity tells us that the personal level is important. With a small bank, the borrower and lender know each other, trust each other. Today, loans are packaged, securitized, sold off, and dissipated. Financial institutions put their own short-term interests ahead of their own investors, and use complex financial engineering to hide what is often nefarious behavior. But these are the incentives built into the current system, and it needs to change. We need to cut the financial sector down to size, regulate it heavily, stop it gambling with its own money, and put it back in the service of the real economy. This is in accord with subsidiarity, but it goes up against some of the most powerful vested interests out there.
2. Health care. Many American Catholics on the right invoke subsidiarity to attack the Affordable Care Act and other attempts at health care reform. This is a wrongheaded approach, which seems to equate subsidiarity with keeping the government away from private activity. But this is simply and demonstrably wrong. For a start, it might well be the case that health care is one of those areas more suited to “large associations” than ”small associations” as the pooling of risk over as many people as possible benefits the common good. Does this matter if this risk is pooled by government (single payer) or by regulated private insurers (the Affordable Care Act)? Not really. For sure, it is possible that medical decisions taken by government bureaucrats can go against human dignity, but the same is true for private insurance offered by large faceless insurance companies. The latter is certainly the key problem in the United States, at least before the Affordable Care Act, with so many millions denied insurance, or forced to pay large amount out-of-pocket. This extensive rationing of health care by cost is a scourge on American society.
What does Catholic social teaching say? Solidarity calls for universal health insurance, for the healthy to subsidize the sick. Subsidiarity calls for health care decisions that reflect human dignity, especially through a personal relationship between primary care physician and patient. In the field of insurance, it calls for protections against exploitation. It calls for a level playing field between patients and insurers. The Affordable Care Act does this by regulating minimum benefits packages, forbidding discrimination based on pre-existing conditions, and setting up exchanges to give more bargaining power to patients versus insurance companies. It is perfectly compatible with subsidiarity. Those who claim otherwise have never really made a case that goes beyond rhetoric.
3. Trade unions. As has been long recognized by Catholic social teaching, unions are primary examples of subsidiary mediating institutions. Governments must therefore support collective bargaining, and lay down frameworks that allow unions to flourish. As the Church teaches, unions are “a positive influence for social order and solidarity, and are therefore an indispensable element of social life”. This is even more important today than in the past. Unionization rates are at an all-time low in the United States, and are falling in many countries. Expanding sectors of the economy disdain unions, there is an ideological onslaught on collective bargaining, and the forces of globalization push governments to lower labor standards. As Pope Benedict XVI said in Caritas in Veritate: “Through the combination of social and economic change, trade union organizations experience greater difficulty in carrying out their task of representing the interests of workers, partly because Governments, for reasons of economic utility, often limit the freedom or the negotiating capacity of labour unions”. Because of this, “The repeated calls issued within the Church’s social doctrine, beginning with Rerum Novarum, for the promotion of workers’ associations that can defend their rights must therefore be honoured today even more than in the past, as a prompt and far-sighted response to the urgent need for new forms of cooperation at the international level, as well as the local level”. How many Catholics pay lip service to subsidiarity and never even think about the importance of unions in the social order?
4. Monied interests. It is a grave injustice that money can so easily buy influence. This scourge is an old one, and one that has infected the Church over the years, but it is a particular problem in American politics today. This poisons political and social life. Over the past quarter century, the dominance of large corporate interests – combined with a dysfunctional political system – has fueled a massive increase in inequality. As wages stagnate, the wealthy gain from ever-lower top marginal tax rates, excessive deregulation, a runaway financial system, the gutting of social safety nets, and curbs on union power. Small, poorly-funded consumer advocates are frozen out; large, wealthy, corporate advocates are welcomed with open arms. Prudential stewardship of the environment is scorned. And much of this is hidden behind closed doors and effective propaganda.
Pius XI’s “economic dictatorship” is not only alive and well today, but thrives on steroids. What he wrote eighty years ago is just as true today, if not more so. As he noted, the “bitter fight to gain supremacy over the State” by industry has terrible consequences – “economic dictatorship has supplanted the free market; unbridled ambition for power has likewise succeeded greed for gain”. He condemned “the virtual degradation of the majesty of the State, which although it ought to sit on high like a queen and supreme arbitress, free from all partiality and intent upon the one common good and justice, is become a slave, surrendered and delivered to the passions and greed of men”. This all violates justice, dignity, subsidiarity.
5. Social safety nets. The Church recognizes social safety nets as important. Rights recognized by the Church include subsidies for unemployed workers and their families; pensions and insurance for old age, sickness, and work-related accidents; and social security connected with maternity. As noted by Pope John Paul II in Laborem Exercens: “The obligation to provide unemployment benefits, that is to say, the duty to make suitable grants indispensable for the subsistence of unemployed workers and their families, is a duty springing from the fundamental principle of the moral order in this sphere, namely the principle of the common use of goods or, to put it in another and still simpler way, the right to life and subsistence”.
This seems pretty clear. And yet, many Catholics who veer toward the right like to quote the same pope who, in Centesimus Annus, criticized the “social assistance state” which “leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients”. How can these two statements be reconciled? Quite simply, the legitimate attempt to provide social safety nets can backfire, if subsidiarity is insufficiently respected. Strangely, many on the right see this as an argument for paring back state efforts to guarantee security. Clearly, this is not in accord with solidarity.
So what is the solution? There are any number of approaches that work well. In-work benefits, providing subsidies to low-income wage earners, are quite effective in reducing poverty (think of the earned-income tax credit). The famous “Danish model” insists that everybody who receives unemployment benefits enrolls in training or reduction. But more fundamentally, welfare states can be constructed entirely around the principle of subsidiarity, as happened in many postwar European Christian Democratic states. This means a welfare system funded by the state, but managed by subsidiary mediating institutions in a fully autonomous manner, by bodies that are legally independent in the targeting and execution of their functions. Of course, this costs money, but then again, subsidiarity is more concerned with what a government does than how much it spends. Too many on the American right, overly influenced by the individualism that so concerned Pope Pius XI, seem to lose track on these distinctions.
Comments are closed.
MM writes, ‘The most formal statement of subsidiarity comes from Pius XI’s Quadragesimo Anno from 1931, in which he says: “Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do. For every social activity ought of its very nature to furnish help to the members of the body social, and never destroy and absorb them”.’ … Pius sees subsidiarity as a bulwark against not only excessive centralization, but also excessive individualism (the “poisoned spring” of the “evil individualist spirit”). This is too often forgotten.’
It’s funny that you draw this emphasis from the quote. To me the emphasis in the quoted passage quite clearly is on preserving the initiative of individuals as against the community; and of small organizations as against larger ones. Yet you see it as warning against “excessive individualism”. I see no such warning in this passage.
MM writes, ‘In other words, aspects of modern liberalism seek to obliterate or neutralize a whole variety of subsidiary mediating institutions between individual and state. And that leaves people adrift, lacking any organic connection – swimming alone in a vast ocean, vulnerable to all kinds of predators.’
Pius’s argument seems specifically applicable to a situation where the national government seizes control over a sector of human life (or, if you prefer, the economy), rather than letting smaller organizations (states? Counties? Charities?) handle it. To do so leaves “virtually only individuals and the State”. Each individual has far less influence over the national government than over local governments or organizations.
MM writes, “For sure, it is possible that medical decisions taken by government bureaucrats can go against human dignity, but the same is true for private insurance offered by large faceless insurance companies.”
Any “large, faceless” insurance company is far smaller than the “large, faceless” U.S. government. And letting insurance companies compete against each other for business is a way of allowing the individual consumer to exercise more influence over them than they could ever hope to do over the national government.
I agree with you that ‘it might well be the case that health care is one of those areas more suited to “large associations” than ”small associations”’. That might be the case, or it might not be. It’s debatable. But personally, I think a pay-as-you-go healthcare system — supplemented by catastrophic insurance, as in the case of homes and cars — would much better embody subsidiarity.
MM writes, ‘What does Catholic social teaching say? Solidarity calls for universal health insurance, for the healthy to subsidize the sick. … The Affordable Care Act … is perfectly compatible with subsidiarity. Those who claim otherwise have never really made a case that goes beyond rhetoric.’
Branding your opponents’ arguments “rhetoric” is a sure-fire way of defeating them. Eh?
MM writes, “How many Catholics pay lip service to subsidiarity and never even think about the importance of unions in the social order?”
How many Catholics who are accused of opposing unions, in reality don’t oppose unions per se, but only feel that joining a union ought to be voluntary? How many oppose joining unions for reasons of conscience, since the funds collected by unions are used overwhelmingly to support Democratic political candidates, who in turn are overwhelmingly pro-abortion? How often are these concerns not taken seriously but blown off as mere “rhetoric”?
MM writes, “Over the past quarter century, the dominance of large corporate interests – combined with a dysfunctional political system – has fueled a massive increase in inequality….”
And at the same time, people are healthier and living longer than ever before.
MM writes, ‘As [Pius XII] noted, the “bitter fight to gain supremacy over the State” by industry has terrible consequences – “economic dictatorship has supplanted the free market; unbridled ambition for power has likewise succeeded greed for gain”. He condemned “the virtual degradation of the majesty of the State, which although it ought to sit on high like a queen and supreme arbitress, free from all partiality and intent upon the one common good and justice, is become a slave, surrendered and delivered to the passions and greed of men”. This all violates justice, dignity, subsidiarity.’
It’s also the result of universal suffrage. Universal suffrage is what makes it necessary for politicians to have large amounts of money, which in turn makes them beholden to corporations.
MM writes, ‘The Church recognizes social safety nets as important…. And yet, many Catholics who veer toward the right like to quote the same pope who, in Centesimus Annus, criticized the “social assistance state” which “leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients”. How can these two statements be reconciled? Quite simply, the legitimate attempt to provide social safety nets can backfire, if subsidiarity is insufficiently respected.’
I think you have nailed it here: We ought to have safety nets for people with little or no control over their economic destiny. But safety nets often backfire and destroy initiative, depending on how they are implemented. For example, supplementing the salaries of low-wage workers: That lets their employers off the hook, doesn’t it? If there is a threshold at which supplemental wages kick in, that gives employers an incentive to keep wages below that level. It also gives employees an incentive not to take jobs that pay above the threshold.
Certainly there may be workable solutions to this and I definitely favor trying to figure them out.
An idea which occurred to me as a result of another post on this blog, still sticks with me: Why not require everyone to give a certain proportion of their income to “charity” (or whatever you want to call it), but let them decide for themselves which charity receives it? To me that seems like the perfect compromise between liberals, who want to force “the rich” to give more, and conservatives, who don’t like government seizing their money and using it in ways that may violate their consciences. This would make a lot of money available for charitable purposes, yet preserve subsidiarity since the use of the money would be decided by individuals and private organizations rather than the national government.
“Any “large, faceless” insurance company is far smaller than the “large, faceless” U.S. government. And letting insurance companies compete against each other for business is a way of allowing the individual consumer to exercise more influence over them than they could ever hope to do over the national government.”
Amen there. I routinely work with private and public insurance (Medicaid, Tricare). With the former one usually succeeds in overturning their decisions on meds, studies, etc. With the latter, almost never.
There are clearly problems with private insurance, but they are less problematic with public insurance.
But personally, I think a pay-as-you-go healthcare system — supplemented by catastrophic insurance, as in the case of homes and cars — would much better embody subsidiarity.
That was the John Kerry plan, rejected by the Republicans.
How many Catholics who are accused of opposing unions, in reality don’t oppose unions per se, but only feel that joining a union ought to be voluntary?
Zero, in my experience and judgment. I’m convinced they simply oppose unions.
Kurt — can you step into the realm of ideas and out of the realm of seeing every issue in terms of how you can blame Republicans for something?
I am in the realm of advocating for good public policy. John Kerry ran a presidential campaign on the health care proposal A. prefers. I prefer that plan as well as well. But Kerry lost. So instead, many of us (the President, I, and millions of others) who may have preferred the Kerry plan instead proposed the Romney-Gingrich-Dole plan. It has its shortcomings, but it is law, rather than just an idea on paper.
I know I am guilty of having a preference for achieving something good over just having a good idea.
I’m just saying that if the conversation is what best fulfills the Catholic notion of subsidiarity, it’s quite a departure from the intellectual debate to stoop to the realm of crude political gestures (“Nyah, Republicans are bad!”).
To make my point I have to give some context. First, let me say that it is utterly clear that the views of the Catholic Church, and especially of Pius XI, had nothing essentially in common with Mussolini’s regime. But, at the same time, it would be a little strange and super-human if his famous encyclical which you discuss were not in some way a product of the Church’s reaction to their very vexed circumstances at the moment of writing it. Thus, I think it is utterly fair to read the emphasis against “individuality” as some sort of tandem resonance and reaction to the hyperbolic anti-individualist excitement of the lictorial fasces.
This touches on a research project I have recently been undertaking, so I can’t be too specific. But it means that generally that the anti-individualist strain may have more foundation in the many battles the Catholic Church had to fight, and often in the diplomatic realm. I want to be clear again, it says nothing intrinsically about Church positions, because there is simply no evidence to support that. But as a semantic matter, and perhaps more, on the very level of choice of theme, I think it does. It means that the anti-individualist ethos is more like a conceptual callous built up from repeated assaults in the Twentieth Century on the ability of the Catholic Church to set its own terms for itself. And in this “right” to set its own terms for itself that they should have, many would agree. But it was certainly not so simple for the, as they contended with fascism and then with communism. Pretty cleverly, would be the assessment of many. But the siege mentality endemic to the reactive stance unfortunately has continued. Thus they seek out some enemies where there really are not any of the sort that came before. In this context, the broader point would be that given this siege mentality the removes any chance of an insight like subsidiarity having anything like a coherent meaning as very unlikely. It is lost in the continued spirit of polarizing reaction, a lot of which was, from a fair historical perspective, not really their direct fault in any way.
In other words, it’s about letting human dignity flourish. It’s about a social order centered on the person, not the individual. This is important, for Pius sees subsidiarity as a bulwark against not only excessive centralization, but also excessive individualism (the “poisoned spring” of the “evil individualist spirit”). This is too often forgotten.
And this is key!
We really need to get beyond the ideology here and assume that “competition” always leads to better outcomes. It doesn’t. This was pointed out in health care a long time ago by Nobel Laureate Kenneth Arrow. Basically, there are huge market imperfections that call for strong regulation. Left to their own devices, insurance companies have a huge incentive to cherry pick the healthiest people, and to deny coverage whenever they can. If we ignore this (as we do too often in the US today), the outcome is a gross injustice that violates both solidarity and subsidiarity.
We can deal with this by banning denial of coverage and enforcing some kind of community rating, delinking health premiums from risk status (otherwise they might offer insurance, but it would be prohibitively expensive). But this in itself leads to another problem. It means that healthy people need to pay more than would otherwise be the case. So they might drop out, making the remaining pool sicker and costlier. This creates huge burdens for insurance companies. The answer to this is an individual mandate, making sure that everybody has to be insured, thus keeping costs down for everybody.
This is all implicit in single payer. The essence of the Affordable Care Act is to do this for private insurance, combined with subsidies for those on low incomes to make sure they can afford it. And this is what those in the thrall of the “evil individualist spirit” utterly dislike – a compulsion to do purhase insurance, and to subsidize others (either directly with subsidies or indirectly with community rating). This is the real issue; let’s not pretend otherwise.
One more thing. Despite what ideologues claim, public insurance is actually cheaper than private insurance in the United States. When we talking about controling costs, yes, Medicare is a problem, but private insurance is a far bigger problem. Like most public systems, Medicare can use its monopsony power to drive down costs (and advantage of being “large”).
And this is one of the fatal flaws in the Ryan plan – by privatizing Medicare, it increases overall costs. Under a private system the cost of treating an average 65 year old would rise by 40 percent. The government saves simply by paying a much smaller fraction of these higher costs, diminishing over time. It’s not cost control, it’s cost shifting. Like everything else about the Ryan plan, it makes the poor poorer and the vulnerable more vulnerable.
Regarding health care. I understand that some institutions may require largeness to operate. Lately I have been turning the idea of subsidiarity and universal health care. I think that if universal health care is good, then the idea would still fit into subsidiarity. Meaning, those closest to the issue would deal with it. If they could not solve it, then go to the next level.
For example. Some medical needs are so rare that they very expensive and may need to be cared for on a national level. The use of the national health care for the everyday cold though seems to be like using a cannon to kill a fly. Perhaps there should be a process whereby health needs are addressed to appropriate level. This would not do away with national health care, but leave those things that require national health care to it proper place.
The use of the national health care for the everyday cold though seems to be like using a cannon to kill a fly. Perhaps there should be a process whereby health needs are addressed to appropriate level. This would not do away with national health care, but leave those things that require national health care to it proper place.
Under Medicare and under ACA, care for the common cold is left at the lowest level — most often the individual (maybe with spouse or mommy and daddy) and some OTC drugs. In a serious case, a trip to the family doctor or nurse.
MM writes, ‘this is what those in the thrall of the “evil individualist spirit” utterly dislike – a compulsion to do purhase insurance, and to subsidize others (either directly with subsidies or indirectly with community rating). This is the real issue; let’s not pretend otherwise.’
It would be charitable in you not to accuse people with whom you disagree of “pretending”, rather than assuming their sincerity. For myself, notwithstanding your implication of my dishonesty, I sincerely and utterly dislike, in principle, the government forcing people to purchase a private product. I sincerely worry about the precedent it sets.
It’s obvious to me that the Dems did it this way because they knew that funding national healthcare through a tax increase would go over like a lead balloon. By having it go through private insurance companies, they could claim that it’s a private sector program and therefore not socialism. But in effect, it is socialism. I’m not saying that’s necessarily bad in itself. But “let’s not pretend otherwise”. ; )
That being said, I admit that you make a persuasive argument here. However, what you are arguing is, essentially, private insurance versus public insurance. (Or, to be more exact, private insurance left to its own devices, versus private insurance forced to behave in a certain way by the public authorities.) Within that context, I am closer to being convinced by what you say.
However, my ideal is neither of those but rather, eliminating both insurance and government from the equation, excepting insurance for catastrophic illness or accident. By insulating the consumer from the true cost of the product, you give an incentive for unlimited use of the product, and therefore ever-increasing costs. I see no reason to think this would change under the ACA (except maybe temporarily due to the influx of new payers).
I might buy your point that by giving government a monopoly over costs, it could exert downward pressure on costs. (Although, when you say this, are you referring to the ACA, or true government-run healthcare?) But, as explained elsewhere, I believe that in reality, the only way to control costs is to ration the services provided. This rationing can be done in one of two ways:
By government taking over healthcare and explicitly rationing the available services; or by making healthcare totally private, and have rationing take place implicitly, by virtue of what people can afford to pay — which is how the vast majority of goods and services are rationed, including food, clothing and shelter. This is why not everyone lives in a mansion and drives a BMW. Yet when it comes to healthcare, people do expect the equivalent of mansions and BMWs to be available to everyone. This is why costs are so high and ever-increasing.
If you place no limits on the types of treatments available, then there must also be no limits on the costs for those treatments. When you do start limiting payments for those services, then the services must dry up. (Actually, this is a third way of rationing them.) It’s unrealistic to expect companies to continue designing and manufacturing mansions and BMWs (i.e. innovative drugs and machines) if they are not going to make money on their investments.
One major problem I see with putting government in charge of healthcare, is that due to political pressures, no one will want to be responsible for rationing care. Thus it will not be rationed, and costs must escalate endlessly, as they already are.
I can’t stress this enough: Rationing is the essential point, but one which is rarely addressed directly. If we provided only health services which were available in, say, 1975, then costs might well be as cheap as they were in 1975. With unlimited amounts of money available to pay for health services, hospitals, manufacturers and drug makers have had every incentive to provide better and better, and more and more expensive, treatments. The “better” part is good; the “expensive” part, not so good.
Suppose BMW could make the safest car possible, with cost no object. Each year’s model would indeed get safer and safer, but it would also get more and more expensive. Normally, people would stop buying them once they reached a certain cost threshold, since they must pay for cars with their own money. But if cars are paid for with large pools of money, so that people don’t bear the costs individually, they are insulated from the cost increases and continue demanding the latest and best safety features.
They get mad at BMW for greedily charging more and more and making big profits. They demand that the government subsidize safety features in cars — after all, how can you put a price on safety? Finally, it’s decided that everyone must pay into a national pool so that BMWs with the latest and best safety features can be provided to everyone regardless of ability to pay.
The thing is, even with that large pool, one of two things must eventually happen: Either BMW stops innovating more and better safety features year after year; or else the costs of those safety features must continue rising indefinitely. Yes, the government can try to exert downward pressure on the prices BMW charges for those features. But in reality, if the features stop being paid for, BMW is going to stop designing and manufacturing them.
Rationing is the only thing that can stop costs from rising. It’s not enough to control who pays. Demand is what has to be moderated in order for costs to be moderated.
Is it best to moderate demand by force, from above, i.e. via the government? Or is it better and more democratic and subsidiaric [sic] to let demand be moderated by what people can afford to pay?
Kurt writes, “John Kerry ran a presidential campaign on the health care proposal A. prefers.”
Somehow I suspect we really are talking about two different things. Can you summarize the provisions of the Kerry plan so I can confirm or deny whether that’s actually what I prefer?
Senator Kerry proposed a pay-as-you-go healthcare system — supplemented by catastrophic insurance.
Gee, you’re a big help. I guess you don’t want to go into details. Which is fine I guess, but I would appreciate your not continuing to say that I support Kerry’s plan until I have been able to confirm what Kerry’s plan actually consisted of.
When looking at healthcare it is always interesting to hear everyone’s opinions. The problem is that is all you often hear is people’s opinions and their efforts to support those opinions. People do not cite examples facts or models of the opinions they are proposing. I have heard many people propose what Agellius is proposing using the same justifications that it works for cars so why not health care. I have also heard many support the ACA touting it’s good points and the expansion of coverage.
I would like to point out that if someone cannot afford a car they walk, ride a bike or a bus or ask a friend for a ride. Their life is certainly more difficult and it is harder for them to bring themselves into a situation where they can afford a car, but they can get by. If they cannot afford healthcare they miss being diagnosed with a serious illness and die. This has happened to people I know in this country it is not a made up example! Our current Medicaid system does not provide the same level of care as the most modest of private insurance and this lack of care has lead to Medicaid patients being denied service and suffering severe consequences as a result. To claim it is the equivalent of a mansion or BMW is to show a lack of understanding.
I do feel the ACA has many good points, but solving the main problems associated with our current healthcare system is not one of them. The major problems associated with the US system are quality of care and high cost. By quality of car I mean the number of mistakes, it is no accident I put that first. There is a direct relationship between the quality with which any product is made and the cost to make it. The more effort put into reducing errors, the lower the cost. This equation is how American businesses lost their prominence. The ACA does not adequately address this.
When looking around the world for models of what has worked, the only system which has improved quality and reduced cost is a single payer plan, or socialized medicine. There are several ways this type of plan has been implemented (not all of them are really socialized medicine) but the result of a well designed plan is always the same. Improved quality and lower costs. The examples exist not only in the countries of France, England, Germany and others that are always mentioned, but also in the VA system and in a few private systems in the US. I would like to challenge those who propose any solution to health care to provide examples or models of where what they are proposing works. We can then discuss numbers and measures and compare plans and due what is right. I realize this comment does not address the point of how Catholic thought applies to large government, but as long as the argument is between claims of a government takeover of medicine and claims of others not caring for the poor we will get nowhere.
Paul writes, “I would like to point out that if someone cannot afford a car they walk, ride a bike or a bus or ask a friend for a ride. Their life is certainly more difficult and it is harder for them to bring themselves into a situation where they can afford a car, but they can get by. If they cannot afford healthcare they miss being diagnosed with a serious illness and die.”
I agree. Therefore the question is, how can healthcare be made affordable? The main thrust of my lengthy comment was that costs can only be controlled if the product is rationed.
There are various ways of rationing. It can be done explicitly from the top down, by government telling people “you can have this kind of care, but not this other kind because it’s too expensive”. Or it can be rationed the way most other things are rationed (e.g. food, clothing & shelter), according to what people can afford. The problem with the former is that no one has the political will to do it.
I didn’t necessarily say that the “car” model of rationing is the best way, only that it does succeed in rationing the supply of cars in such a way that even a large proportion of the poor are able to afford cars, be they ever so humble.
Granted, healthcare is more essential than a car — though a car is pretty vital in some ways. Therefore, although I think this system would make healthcare more affordable for more people by virtue of its inherent ability to ration the product, nevertheless if people still could not afford it then I think charity could fill the void — especially if my other plan of making people give a certain proportion of their income to the private charity of their choice, were implemented.
The point of my comment is at the bottom. There are systems in place in several countries of comparable circumstances to the US. Those countries do a much better job of providing health care to their whole populations than we do and they do it at a higher quality and lower cost. They are the model for the system proposed by many progressives but rejected by congress. There is no example I know of where a market based health care system has provided care for as high of a percentage of the population or met the high levels of quality at the low costs of the single payer plans offered in Europe, Japan and Canada.
OK, now I think I get it. “… the Kerry plan would provide “reinsurance” for private health plans, picking up 75 percent of the medical bills exceeding $50,000 a year.”
The Kerry plan is not what I meant by “pay-as-you-go” — and possibly I was misusing that term. But setting that aside for now…
I think it’s an interesting idea. I gather that the Republicans by-and-large rejected it because it would have been paid for by rescinding the Bush tax cuts. However one of the news articles I read stated that Gingrich actually supported it.
But this plan still would not address my main concern, which is that healthcare needs to be rationed. In the debate over the ACA the Republicans were crying, “This is going to lead to rationing!” While the Democrats replied, “It will NOT lead to rationing! That’s a Republican scare tactic!”
But for heaven’s sake, rationing is precisely what is needed. NOT rationing is what has got us into this mess. But it’s political suicide to say so. Yay for universal suffrage.