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  1. Kurt permalink
    June 20, 2013 11:04 am

    He generally makes the standard private market case against Obamacare with a strange and vapid patina of CST. First, there is simply no way that nationalizing tort law or even giving away for free new products would make health insurance affordable to all. Any more than we could end hunger and the need for SNAP by seeing that every had access to the coupons offered in the Sunday newspaper.

    Citing the WalMart greeter as an example of solidarity is bizarre. The greeter, with absolutely no discretion even in the words and language of the greeting creates no solidarity with the bosses of the corporation.

    And his suggestion that a man declining insurance for himself and his family is a perfectly acceptable and rational decision is also hard to understand. It is the same league as the right to suicide.

    There is a CST criticism that can be made of Obamacare, in that it could do more to encourage non-profit and consumer cooperative delivery of health care. Sadly, he does not go there.

  2. T J Hostek permalink
    June 20, 2013 12:10 pm

    This is excellent analysis. I just wish it had gone further and addressed the issue (which I consider bogus) of Catholic universities & hospitals being required to cover contraception, which claims Obamacare infringes on religious liberty.

    • Thales permalink
      June 21, 2013 9:10 pm

      TJ,
      Self-insured Catholic universities do have to cover contraception in their plans. I don’t know why you would think they don’t.

      • Kurt permalink
        June 22, 2013 8:12 am

        The Administration has asked for proposed regulatory language to extend the exemption to self-insured universities (even though many of them already cover contraception). So far they have not received a response. Waiting….waiting….

        • Thales permalink
          June 23, 2013 9:27 pm

          Kurt,
          Hadn’t heard that. Cite?

        • Kurt permalink
          June 24, 2013 10:57 am

          Federal Register, February 6, 2013, in part:

          The Departments [HHS and DOL] are considering alternative approaches for providing participants and beneficiaries in self-insured group health plans established or maintained by eligible organizations with contraceptive coverage at no additional cost, while protecting the eligible organizations from having to contract, arrange, pay, or refer for such coverage.
          further
          The Departments solicit comment on which of the proposed approaches below would best provide participants and beneficiaries in self-insured group health plans established or maintained by eligible organizations with contraceptive coverage at no additional cost, while protecting eligible organizations from having to contract, arrange, pay, or refer for such coverage. The Departments also request comment on whether there are other approaches that should be considered that would achieve the same goals.

        • Thales permalink
          June 25, 2013 8:09 pm

          Oh, you’re just quoting the request for comments. Well, the affected organizations have submitted comments from what I understand.

        • Kurt permalink
          June 25, 2013 9:27 pm

          I understand they have not given alternative text. Do you have a cite for this and the text of their recommendation? It would be nice for the lay faithful to know in case we would like to support their proposal.

        • Thales permalink
          June 27, 2013 9:30 pm

          It’s my understanding that the alternative text they’ve suggested is along the lines of either “enlarge the exemption that already exists to cover us” or “remove sterilization, contraception, and Ella/Plan B from the required health services”.

  3. June 20, 2013 12:17 pm

    What’s going on at CUA? Did they drink the Paul Ryan-Ayn Rand Kool-Aide?

    • MTJ permalink
      June 22, 2013 4:36 pm

      As a recent (as of May) graduate from the new Business School, I can answer that that’s exactly what they’ve done. The rightward turn is as blatant as it’s dismaying.

  4. Ronald King permalink
    June 20, 2013 2:53 pm

    MM, You always make these issues very clear and I appreciate your efforts very much.

  5. Peter Paul Fuchs permalink
    June 20, 2013 5:20 pm

    Well that was very interesting and impressive for detail and close reasoning, in a very admirably wonky way. I don’t want to get into this issue because it is an issue for Catholics to parse amongst themselves. I am interested in the larger reasons for the “Kool-Aid” drunk at places like CUA, as one of the other commenters notes. You see, MM, you are giving rational reasons based on your religious beliefs, and that is a good things, as it can be discussed. But a lot of these very righty Catholics are in no way so in touch with reality and the benefits of coherence it brings. And I could not think of a better example of this than that crazy fellow named Tom Hoopes at Catholic Vote Action who is convinced of pure falsehoods like the utterly anti-scientific factoids on the order of “over-population” never having had an important role in the etiology of famines. This shows a detachment from reality. It also shows a paranoid world-view where everyone who wants a decent world in a way they don’t agree with is a crypto-Malthusian or some other overwrought epithet. I raise this not because I want to engage the whole abortion debate at all. Just that the notion of “scarcity” per se, is related to the notion of “controlling costs” sanely in others. If right-wing Catholics continue to engage in magical thinking, they will never even consider the very raison d’etre of the practical philosophy behind something like Obamacare.

    • June 20, 2013 8:40 pm

      Your comment is spot on. I’m not surprised to see right-wing Catholics staking unrealistic positions. They are part of the human race, too. What bothers me is that academics can so skew reality as Prof.
      Engelland has. Academics can engage in debate but we expect their positions to be based in reality even though they may come to different policy recommendations for well-thought out reasons. Engelland’s article does not meet that test.

  6. Kurt permalink
    June 20, 2013 6:04 pm

    I don’t think anyone drank the Kool-aid (t). Business schools at Catholic universities have long had faculty and programs without any reference to CST and generally no different than B-schools at secular colleges. The only new development is now they give an uninformed hat tip to Catholic teaching.

    • Peter Paul Fuchs permalink
      June 20, 2013 10:13 pm

      Kurt,

      I think you are probably right in general, but this is something I am very curious about. It does seem that many Catholic universities function quite independently, but then there is the whole Ex Corde stuff with its purity pledges or whatever they are….theological merit badges whatever the word is that that encyclical suggests. it seems there is a de facto parallel track going on that is hyper orthodox, whatever that also means. Do you know, I am curious about the actual mechanics.

      • Kurt permalink
        June 21, 2013 8:08 am

        Catholic universities are required to apply Ex Corde as far as the academic institution determines to be “possible and appropriate.” Need I say more?

        • Peter Paul Fuchs permalink
          June 21, 2013 5:07 pm

          Kurt, yes I get it. But I think one has to marvel at the brilliance of the whole notion of the “principle of subsidiarity” from the strict point of view of as a brilliant “wiggle word” trope or phrase. I am sure that at CUA that have come up with some farrago with which they can show that by means of the “principle of subsidiarity” helping poor people directly get medical treatment in in fact contrary to CST, and thus not only “possible” but “appropriate” to criticize. That “principle” is example of the type of expansive mental contraptions that Catholics are adept at coming up with, by which anything can mean anything…..and will. It is an unsurpassed talent in the world. I always try to keep in mind though, that it is a huge Church and thus there are plenty of people with more direct compassionate instincts for actually helping the downtrodden of the earth, and not just euphemizing.

  7. Josh DeCuir permalink
    June 21, 2013 9:55 am

    “”The basic point of Obamacare is to bring some order to the completely dysfunctional market for individual health insurance for the large number of people left out of the current system, because they don’t have insurance through their employers and they are not eligible for government programs. It does this by mandating the establishment of exchanges, which create new risk pools for these people, thus mirroring the way employer-based insurance works.”

    Employer-based insurance IS a major problem with the US health insurance market, as wonks from across the spectrum acknowledge. If Pres. Obama had really wanted to reform the dysfunctional health insurance market, he should have begun by universalizing the tax credit employers presently get for providing insurance to employees.

    Further, I think it is inaccurate on your part to describe the exchanges as a “risk pool.” The risk pools are funds of money to be used to cover costs for the poor – much like Medicaid. I think the insurance plan exchanges are quite different.

    • Kurt permalink
      June 21, 2013 4:24 pm

      Josh –

      I think risk pool generally means the pool of people free to elect a certain form of insurance. I think the President would be the first to admit that what he wanted to do and what he was able to do were different things.

      • June 21, 2013 7:00 pm

        Actually, when Sen. McCain proposed universalizing the employer tax deduction, then-Sen. Obama attacked him for proposing the largest tax increase on the middle class in history. Of course, he then promptly proposed an excise tax on so-called “cadillac plans”, including those given by unions.

        • Kurt permalink
          June 22, 2013 5:33 pm

          As I think most who study this matter know, “universalizing” the tax deduction would is essense end the system of employer sponsored health insurance. The result would be that everyone would end up in the individual market.

          Now, that is fine on two conditions: 1) there is also an universal mandate to particpate as we have with Obamacare, and; 2) rather than the government covering 39.5% of the health insurance costs for the very rich, (+$400,000), 28% of the insurance premiums for the middle class, 15% for the working poor and 10% for the very poor, as would be in the case in what you describe of Senator McCain’s plan, there needs to be tax credits and deductions that help the poor and workers more than the rich, as we have in Obamacare.

          And as s a side note, unions don’t give health care plans, we negotiate over them.

    • unagidon permalink
      June 21, 2013 6:37 pm

      A “risk pool” is simply a pool of people amongst whom risk (of any sort) is spread. Right now, in commercial insurance, the risk pools tend to be set around specific products and they therefore tend to be small. Smaller pools are more risky and more expensive. Larger risk pools are more efficient and cheaper (with the best risk pool of all being the entire population of a country). With Obamacare in the exchanges, insurance companies are required to create risk pools of ALL of their individual and small business insured. This is called “community rating”.

  8. Josh DeCuir permalink
    June 21, 2013 9:59 am

    By the way: just to remove doubt, here is Uwe Reinhardt’s view on employer-based insurance – http://economix.blogs.nytimes.com/2009/05/22/is-employer-based-health-insurance-worth-saving/?_r=0

  9. J. Bob permalink
    June 22, 2013 8:58 am

    Let big brother take care of all.

    The government gives, and takes away..

  10. June 22, 2013 2:46 pm

    I always find it a source of fascination with my fellow Catholics who consistently convey an attitude of enlightenment over so called “right-wingers”. I wonder if their hubris causes them to thank God for not being like tax collectors, adulterers, or selfish conservatives. I further wonder why these enlightened Catholics appear to endorse the notion that achieving desired ends justifys the means of getting there. For example, it is perfectly fine to threaten people with governmental punishment, if they fail to “do the right thing” such as forcing healthy young people to subsidize older, more sickly individuals. The message was clear in the narrative that more regulation backed by governmental power was needed to compel proper behavior. All of this rightousness also ignores unintended consequences such as fewer jobs, fewer hours for those with jobs, poorer quality of actual medical care, and cementing the notion that government has the unfettered right to take whatever property it wants from workers who earned their property legally and morally. I am disturbed greatly that this attitude is undeniably eliteist and paves a road to a nation that doesn’t really need God to change souls but only a government powerful enough to force its citizens to comply with the elite’s dictates.

    • June 22, 2013 8:21 pm

      did you get those talking points from ewtn? do you really want to go there? trust me, there are dozens of things wrong in your posting. please leave the church and join some calvinist denomination.

      • June 22, 2013 11:39 pm

        Anger always follows when a liberal’s logic and facts fail. If you formulate a cogent rebuttal, I will respond accordingly. And I find it quite sad that you would ask me to leave my church just because we disagree on what social policies are best for the people of this nation. Seems very mean-hearted and cold. BTW, I also disagree with gay marriage as acceptable for God fearing folk. You?

    • Ronald King permalink
      June 22, 2013 8:31 pm

      Bill do you mean just like we are threatened with hell if we do not follow the proper procedure

    • unagidon permalink
      June 23, 2013 8:46 am

      I find this argument a bit strange. With insurance the healthy and prudent ALWAYS subsidize the users of the benefits. It’s no different now. What makes health insurance different from other kinds of insurance is that the people with insurance also subsidize the people without insurance. Who do you think pays for the free emergency room care and the “pro bono” care that hospitals give out. In fact, if you have commercial insurance of any sort, you are paying the hospital/doctor about 135% to 145% of costs just to subsidize those people. I don’t think that you would agree that the uninsured young should have some sort of right to be free riders in the system.

      In addition to this, the young “subsidizing” the old is how both Medicare and Social Security works today. Are you suggesting that these be eliminated too?

      • June 23, 2013 3:46 pm

        WRT commercial insurance, the contract between the covered individual and the insuring company is 100% voluntary. If I chose to only carry catastrophic coverage and pay other medical costs out of pocket, that is my decision to make as a free person. I don’t need the government in the middle of this transaction. Obamacare, of course, removes that personal freedom. I am compelled by the punative power of government to comply with its dictates. I don’t like government taking more and more of my freedoms away. I really don’t like having to subsidize morally repugnant abortion pills in spite of my religious beliefs (one more freedom gone forever).

        We are already seeing young healthy people opt out of paying for insurance coverage and taking the tax penalty instead. It is simply a lot cheaper and makes better sense for them. The Obamacare system is far too complex and has too many waiver features to function effectively. It is costing jobs and will increase useless, expensive bureaucracy that does not improve the effectiveness or efficiency of medical delivery.

        The poor will always be among us and so will free riders. As a compassionate society, we will have to pay for them one way or the other. And I’m ok with that idea. But I’m not ok with the expansion of government control and power over individuals. The cost to personal freedom, especially religious, is just too high a price to pay. There are simplier solutions thatmay not be perfect but are far less threatening to liberty.

        Medicare and SS fiscal projections reveal broken systems on the path to bankruptcy. The population pyramid upon which they are based did not withstand the test of time. Dramatic changes to those programs are inevitable or they will self eliminate by running out of money. Taxing young people more is not a viable alternative. They don’t have the extra money to give.

        BTW, tell me how it is moral to take money from young people with very limited incomes and are trying to get through expensive schooling or starting families when this money is transfered to people who have had a lifetime to earn and save for their retired years. Seems a bit unfair to pick on the kids when they are just starting out.

        • Kurt permalink
          June 23, 2013 5:53 pm

          WRT commercial insurance, the contract between the covered individual and the insuring company is 100% voluntary. If I chose to only carry catastrophic coverage and pay other medical costs out of pocket, that is my decision to make as a free person. I don’t need the government in the middle of this transaction. Obamacare,
          As does Medicare and as do employers who demand workers take part of their compensation in health insurance rather than cash (incentivized by the government’s tax code).

          I really don’t like having to subsidize morally repugnant abortion pills in spite of my religious beliefs (one more freedom gone forever).

          Which is a policy of the Bush Administration. I would be interested in learning about how you spoke up against President Bush on this.

          We are already seeing young healthy people opt out of paying for insurance coverage and taking the tax penalty instead.
          We have not seen one such young person. This is not even operational yet. What we have seen is a rush of enrollments of young adults in the parts of Obamacare already operational.

          . It is costing jobs and will increase useless, expensive bureaucracy that does not improve the effectiveness or efficiency of medical delivery.
          It allows millions of people to obtain private commercial health insurance by giving the uninsured tax deductions and credits, leaving administration to the efficiency of the private market.

          . As a compassionate society, we will have to pay for them one way or the other.
          So, you are not suffering some new imposition of government involvement. We are just bringing some order to what already is being done.

          Medicare and SS fiscal projections reveal broken systems on the path to bankruptcy.

          Actually, not.

          tell me how it is moral to take money from young people with very limited incomes and are trying to get through expensive schooling or starting families when this money is transfered to people who have had a lifetime to earn and save for their retired years. Seems a bit unfair to pick on the kids when they are just starting out.
          Every employer who offers health insurance charges the young the same as the old. You object to this? But as far as young people who have very limited income or are trying to get through schooling, they are not having any money taken from them.

        • June 23, 2013 9:42 pm

          Your first point makes no sense, suggest you rephrase. If you are suggesting we remove government as a non value added middle man in delivery of medical care I agree however. Second point, you just identified yourself as a pure partisan and not honest in your commentary. If the Bush administration was mandating funding of morning after abortion pills, my reaction would be identical. I never heard that howeverand doubt its veracity. Next point, we’ll see who is right. Fourth point, you’ve never run a real business and are full of stuff and nonsense. Next, Obamacare is unmanageable and will result in confusion and massive unintended consequences. It doesn’t and will not provide order as you suggest. It will also continue to divide the country. Next point, actually yes. Finally, you avoided the difficult part of the question. Young people need their money to start their lives, retirees had a lifetime to work and prepare.

          Look, you’re a loyal Democrat, I get it, it’s just fine. I understand your political agenda. Big government is good, bigger government is better. Hard working, financially successfully people owe their property to those who choose to not engage in sweat producing activities. And you prefer to use the punitive power of government to achieve your ends. Reminds me of a bully who uses the government as the weapon of choice

        • unagidon permalink
          June 23, 2013 7:08 pm

          I’ll take your questions from back to front.

          “tell me how it is moral to take money from young people with very limited incomes and are trying to get through expensive schooling or starting families when this money is transferred to people who have had a lifetime to earn and save for their retired years. Seems a bit unfair to pick on the kids when they are just starting out.”

          This is the way that insurance always works in every case. In health insurance the young and healthy subsidize the old and the sick. There is nothing remarkable in this except in the Right trying to bracket out the young as a disgruntled political group. The fact is, unless you are filthy rich, you will not be able to pay your own medical bills when you get older. Period. Under our current system, the old and sick are also subsidized by the young and healthy. But it’s also the case that anyone with commercial insurance is subsidizing anyone without insurance and we are talking about 35 to 50 million people who don’t have insurance and want it in the United States. Is it unjust to pay your premiums and not use 100 percent of them for benefits in a given year? Insurance spreads risk, The young will pay now and they will reap the benefits later. You seem to think that people can just save their money and they will be fine when they are old. They won’t be.

          Of course, when they are of retirement age, they will have Medicare. You didn’t answer my question about Medicare and Social Security. But let’s say that we eliminated them Why not? Why shouldn’t people just save for their retirement and their future medical bills? Because in the case of medical bills, the average person won’t be able to cover them no matter how frugal they are. AND, more importantly from your position, the average person will not be able to afford any sort of insurance to cover these bills. Who on earth would sell an old person health insurance and not charge them exactly what they would be expected to pay out in benefits, plus the administrative costs of the insurance? Is it moral to put this burden on young people? It’s on them now, unless they are free riding. There isn’t a transaction that you can name that doesn’t have some kind of insurance buried in it. You can’t even get a bank account without the drag of FDIC on it. Would you eliminate insurance altogether? Then eliminate capitalism too.

          Regarding Obamacare, its primary goal is to provide insurance for the uninsured and the under-insured. The market has simply failed to do this. The market will always fail to do this. Show me a country where the market has succeeded in this. The fact is, we (in the insurance industry) are going to make money under Obamacare. We’re capitalists after all. The idea that medical outcomes will deteriorate and that costs for people who are insured now will go up is simply wrong. Or to put it another way, you are going to have to show me how this is going to happen outside of just stating it.

          You dismiss the free rider problem. I will tell you as a businessman that I don’t like paying 40 percent higher costs subsidizing the un and under insured. It is also a terrible drag on the economy. It is also unjust to me personally. And the problem of the uninsured is also a moral problem as Morning’s Minion has quite eloquently pointed out. You have argued that Obamacare equals an expansion of the size of the government and that a larger government means less personal freedom. I think that the health care “market”, which does not operate under real price transparency and quality transparency, and which is therefore not a free market, is the real threat to freedom (and the economy as well). It is regrettable that the Federal government is on the only institution large enough to take on the task, but this is the case. The “market” cannot right itself, however much we may fantasize about it.

        • Kurt permalink
          June 24, 2013 10:41 am

          Bill —

          Most of your post seems to just make a bunch of assertions, so I don’t see the point of responding other than to say I disagree. You did write: If the Bush administration was mandating funding of morning after abortion pills, my reaction would be identical. I never heard that however and doubt its veracity.

          The Bush Administration did. You’ve not heard about it because the sources you have learned about the “HHS mandate” from are dishonest. I’m sure you are an innocent in this. But anyone, even from the conservative side, who could actually explain the basis for saying that abortion causing drugs are included in the HHS mandate would know my statement is accurate.

        • June 24, 2013 11:27 pm

          Kurt…so Cardinal George is wrong about the HHS mandate requiring Catholic institutions to pay for services that are immoral?

          And yes, you are correct. I judge Obamacare to be unnecessary, inefficient, unmanageable, and even dangerous due to the expansion of government power. I have provided logical rationale to support each point, so my arguments are not assertion based. Obamacare was the epitome of backroom political dealmaking with no transparency provided to the public. Remember N. Pelosi’s own words that you have to pass the bill in order to see what’s in it. It’s an unpopular mess that is helping divide the country.

          However, you and I have complete agreement that all Americans need to have access to medical care. It is truly an important moral issue to help those suffering the pain of injury and illness.

          I am simply convinced we can collectively find far better alternative solutions.

          Thank you for your challenging rebuttals, I enjoyed our dialogue.

          Bill

    • June 23, 2013 11:07 am

      I always find it a source of fascination with my fellow Catholics who consistently convey an attitude of enlightenment over so called “right-wingers”. I wonder if their hubris causes them to thank God for not being like tax collectors, adulterers, or selfish conservatives.

      Bill – any argument that assumes all kinds of things about your opponent’s motives is probably a weak one.

      I further wonder why these enlightened Catholics appear to endorse the notion that achieving desired ends justifys the means of getting there. For example, it is perfectly fine to threaten people with governmental punishment, if they fail to “do the right thing” such as forcing healthy young people to subsidize older, more sickly individuals.

      Bill, the scale of the problem of lack of adequate health care for millions of your fellow citizens is a systemic problem, and thus calls for systemic solutions. In a world like I described in a recent post, local, completely voluntary solutions might have made some sense. In a highly advanced and complex industrial civilization, not so much. When confronted with a system that routinely bankrupts the sick, what would your solution look like.?

      All of this rightousness [again with the assumed motives!] also ignores unintended consequences such as fewer jobs,

      How so?

      fewer hours for those with jobs,

      Ditto…

      poorer quality of actual medical care,

      Actually, the opposite is true. The EU spends half of what the US spends on health care, and gets better health care outcomes.

      cementing the notion that government has the unfettered right to take whatever property it wants from workers who earned their property legally and morally.

      Well, no, “the government,” in a democratic republic like we have, does things that we the citizens ask it to do (because it is really not some alien entity as you would have it, but rather an institution chartered by We the People to do things and solve problems that we as individuals or members of more local groupings are incapable of doing), and income taxes per se are perfectly just and reasonable – in fact, I would argue that, given the system we live in, not just income taxes but much more steeply progressive taxes are a moral necessity.

      I am disturbed greatly that this attitude is undeniably eliteist and paves a road to a nation that doesn’t really need God to change souls but only a government powerful enough to force its citizens to comply with the elite’s dictates.

      …which means who knows what plus I doubt it.

      • June 23, 2013 1:18 pm

        Matt…thanks for taking the time to reply and not just just tell me to leave the Catholic Church. My opening two sentences were observations and a tie to Jesus’ words about a Pharisee that I find apt and not part of my argument. Interestingly, you didn’t address my thought on the ends justifying the means. In my view, having a good intention doesn’t mean you have carte blanche to do whatever you wish to achieve your goals. Mao’s Great Leap Forward typifies how “noble and necessary” intentions can have incredibly evil and destructive results. He also saw the need for systemic change BTW. History is replete with examples of political elites citing the need for systemic change as the reason for the people to suffer….to include Nazis and the Final Solution.

        My solution to this medical care problem would have started much simpler and easier to adjust with real world experience. The many thousand of pages of laws and implementing regulations we have now are far too difficult to integrate and manage successfully. The independent variables are too numerous to control and optimize. Plus, the bill is laden with political favors, exemptions for patrons who do not want to participate, and, of course, the mandate for abortion pills and contraception. Again in my view, religious freedom rights have been smashed. The cost of Obamacare includes a loss of individual liberty. My solution would have been a phased approach that focused exclusively on the problem at hand, the uninsured. I would have expanded Medicaid to ensure their access to medical care. With empirical data guide me and a clearer understanding of impediments to delivery, I would have fine tuned my program to become more effective and cost efficient over time. WRT voluntary solutions not working anymore, you do a great disservice to Catholic and other religious hospitals. People of faith do indeed make a great difference in this highly complex world. And they change souls in the process. Heavenly salvation is not enabled by government mandate, coersion, or punishment.

        I am an executive with a large consulting firm. Obamacare increases the cost of doing business, especially in service industries. I have personal experience to confirm that the calculus of deciding if and when to hire new staff has been impacted by new insurance mandates. Controlling costs is fundamental to a successful business and if the cost of new hires generates too much overhead burden, then we don’t hire. We find other ways to generate revenue. The result, fewer full time jobs are available and reduction in the hours of current staff to get them below thresholds occurs. This is bad for business (less growth) and bad for the un- and underemployed. Do the research yourself if you think I’m wrong.

        The overall quality of medical delivery will decrease I’m afraid. Medical technology is now being taxed I understand and profit margins impacted. Remember, you tax something if you want less of it, subsidize it if you want more. The legal scope of PAs and nurses care responsibilities is being greatly expanded, not because they are trained and ready to deliver high quality care, but because there aren’t enough doctors to go around. As with European countries with socialized medicine, wait times for doctor visits and procedures will inevitably rise in this country. If you think those surveys that indicate European socialized medicine produces better overall results at a lower cost, please take a careful look at the design of the experiment. You may find the analysis wasn’t really objective and was stacked in favor of a desired outcome.

        We live in a Constitutional Republic not a democratic republic and there is a world of difference between the two constructs. In this country, the Constitution trumps and highly constrains pure majority rule. It is founded on the inalienable rights of the individual citizen. The federal government consequently has only limited and enumerated authorities. Fifty one percent of the population doesn’t get to dictate to the other forty nine. That’s why We the People still have courts to protect us from majority over reach.

        In terms of steeply increasing the rate of progressive taxation, you never made your argument as to why this is just. Taking property from someone just because the government has the power to do so is evil. Taxation becomes immoral confiscation of legally and morally earned income. It is fine for “The People” covet and take what they haven’t worked for or earned in your thinking apparently. Fiscal success is to be punished if I understand your points properly.

        By its nature, government limits freedom of the individual. But I agree that some level of government is absolutely necessary for society to function. Personally, however, I assert that a too large government quickly becomes a threat to liberty as it spreads its influence into all aspects of private life. I prefer imperfect freedom to serfdom. I resist all expansions of government that take my personal liberty away…step by step.

        • June 23, 2013 2:22 pm

          Quick response to Bill:

          I believe you position owes more to American liberalism than to Catholic social teaching. You talk about about personal liberty, and do so in a liberal (Lockean) sense as freedom from coercion. But that is not how the Church looks at it at all. It condemns both collective ownership of the means of protection and laissez faire liberalism as the twin rocks of shipwreck. It denounces the liberal philosophy as the “erroneous affirmation of the autonomy of the individual”. The role of the state in economic life to facilitate the common good, either directly through solidarity or indirectly through subsidiarity. It is not to stand back and act as an impartial referee. Thus believe your views on taxation and the mandate are colored by this excessive liberalism. We can of course argue that something goes too far from a prudential point of view, but first we must take off the ideological blinkers.

          Second point – it is indeed true that European countries deliver better healthcare outcomes at lower cost. Much lower cost. Less than half as much as percent of GDP. That is simply a fact. It is also a fact that single payer systems are pretty efficient, as the exploit economies of scale from a single large pool plus monopsony power. But private insurance, properly regulated and tied to mandates, can work well too. The system that does not work is the US system. It is simply unconscionable that so many are left out. And rationing is actually more pervasive here than in other countries. None if this is to say that healthcare systems in other OECD countries are without flaws. But they do tend to do a better job than the US system, which (from the Catholic perspective) violates justice.

          Third point – I’m not sure exactly what costs of Obamacare you are referring to when you talk about the impact on your business. But I must point out something important. In Catholic social teaching, profit is important, but it cannot be an end it itself. There is such a thing called the priority if labor over capitalism. I believe it was John Paul II who said the legitimacy of the capitalist system depended on it creating jobs.

          We must also remember the strict duty that every employer has in justice – to grant a living wage that is not necessarily the same as the market wage, to provide sufficient benefits (including healthcare), and to recognize and support unions. Does your company do these things? Does it provide a role for workers in managing the company? Does it engage in profit sharing? Does it provide adequate annual, sick, and family leave? I ask because these are all supported by Catholic social teaching.

          On the other side of the equation, does it make decisions excessively based on shareholder returns and the financial value of the firm? Does it put profits and large returns for top management ahead of welfare of other stakeholders, such as workers, suppliers, consumers, and the environment? Does it deny the right to collective bargaining? I ask because these things are all forbidden by Catholic social teaching.

          So you see, it’s quite inadequate to say that Obamacare will hurt your bottom line without paying need to the far larger respective of the duty if business in the modern capitalist economy. And this goes far beyond any government regulation.

        • June 23, 2013 4:54 pm

          Mornings Minnion…great reply and thanks for taking the time to do it.

          First, living in America I absolutely cherish my personal liberties and genuinely fear powerful, large, and unconstrained governments. When individual rights are subordinated to the collective good as defined by ideologically energized political leaders, the state’s preferences becomes preeminent in all elements of private life. Nazi, Communist, and other dictatorships come easily to mind. Regimes like these have caused unimaginable suffering for hundreds of millions throughout history and I do not want to repeat the horror in this country. Accordingly, I will always resist the loss of freedom in order establish a more powerful government. And of course, I absolutely reject the requirement to subsidize morning after abortion pills. Religious freedom is also taking a beating.

          However, I do support finding effective methods to deliver necessary medical care to those who need it. But the solution could be far less expansive, intrusive, and frankly, manageable.Obamacare will be a mess in implementation, it is far too complex to avoid unintended and unwanted consequences. Simplier solutions that are easier to adjust and fine tune would be more effective and cost efficient in delivery to the uninsured.

          Beg to differ with you on the expected quality of medical care under Obamacare. Europe’s system is measured on things unrelated to the actual delivery of timely care to patients. There are a lot of sociological elements included in the statistical metrics and analysis. Here, doctors will now need to spend more time administering their practice due to the complexity of new regulations and less with their patients. We will see an even greater use of expensive tests to screen sick folks since the doctor is not able to spend sufficient time with them. Obamacare also has so many opt out and waiver provisions that it will be inherently unfair in application. Care isn’t going to improve, it will only degrade according to surveys of MDs.

          My company is a highly ethical member of the broader community. In my judgment, it’s internal and external behaviors fully comply with Catholic teachings. However, the realities of a business case are still in play. My company, or any other company, must control costs to remain in business and the control of labor costs are usually the biggest driver. This isn’t meant as a dig, but I suspect you’ve never run a business and shouldered the responsibilty of making payroll for your employees. You may not have the perspective to fully understand how business actually works. Please take my word, higher labor costs mean fewer jobs and fewer hours for those already working. It’s a fact in business, regulations drive the cost of doing business which in turn stunts job creation and economic growth.

          Hope I answered your comments adequately. Thanks for taking time out to chat

        • unagidon permalink
          June 23, 2013 7:19 pm

          “My solution to this medical care problem would have started much simpler and easier to adjust with real world experience. The many thousand of pages of laws and implementing regulations we have now are far too difficult to integrate and manage successfully. The independent variables are too numerous to control and optimize.”

          I would like to reassure you, working as I do for one of the major insurance companies, that we are doing just fine in the implementation of the regulations. Insurance is already heavily regulated and we do just fine.

          “under Obamacare. Europe’s system is measured on things unrelated to the actual delivery of timely care to patients. There are a lot of sociological elements included in the statistical metrics and analysis. Here, doctors will now need to spend more time administering their practice due to the complexity of new regulations and less with their patients. We will see an even greater use of expensive tests to screen sick folks since the doctor is not able to spend sufficient time with them.”

          Two points about this. Yes, there may be a shortage of doctors for a while under Obamacare when 50 million people who are uninsured now (and millions more who are under insured) start being able to get treated. Apparently you think that all of these people are the price we have to pay so that you can get a fast appointment with your doctor. An honest sentiment to be sure, but is it a Christian one?

          Second, you don’t seem to be familiar with the legislation. There is nothing in it that increases the paperwork that doctors have to do. It’s all about insurance companies. It is true that physicians will have to fill out more insurance paperwork because they will be seeing more insured patients. I don’t know what the remedy is for that (although I am quite sure that the capitalist system will figure out a way to deal with it). But keeping millions uninsured so that doctors have less paperwork is not a moral solution.

          “My company, or any other company, must control costs to remain in business and the control of labor costs are usually the biggest driver. This isn’t meant as a dig, but I suspect you’ve never run a business and shouldered the responsibility of making payroll for your employees. You may not have the perspective to fully understand how business actually works. Please take my word, higher labor costs mean fewer jobs and fewer hours for those already working. It’s a fact in business, regulations drive the cost of doing business which in turn stunts job creation and economic growth.”

          Sorry to hear that your costs are going to go up. But everyone’s costs are going to go up to the same degree in the same way, so I guess you are going to have to increase your prices. On the other hand, your workers will be receiving something closer to a living wage than what you are obviously paying them now. I know you’ll say that a non-living wage is better than no wage at all. But capitalism has proven quite flexible in dealing with Medicare, Social Security, capital gains taxes, unions, and the minimum wage in the past. I’m sure they will find a way to profit in the future, even if they don’t get to shift their workers’ medical costs to the rest of us as they do now.

        • unagidon permalink
          June 23, 2013 7:33 pm

          Bill said: “I would have expanded Medicaid to ensure their access to medical care.”

          He also said: “I am an executive with a large consulting firm. Obamacare increases the cost of doing business, especially in service industries.”

          You do know that Medicaid pays something like 60 cents on the dollar in actual medical costs. The fact is, each and every Medicaid person and each and every uninsured and under insured person is subsidized in the United States by every commercially insured person. Yes, Obamacare will increase the cost of doing business. And it’s high time it did. The need for medical services is a constant in the economy; it’s part of the function of being a human organism. All kinds of business have been passing on to the rest of us the health care costs that will be suffered by workers who businesses will not insure their workers and it’s high time that this subsidy that we are paying the businesses you are consulting for be ended. Sorry if the elimination of that subsidy lowers people’s profit margins. But that’s capitalism. You have to pay your own way.

        • June 24, 2013 12:53 pm

          Unagidon … Please tell me how you know my company doesn’t currently pay close to “lliving wages”. You can’t can you? So obviousy you just make things up as you go to support your opinions. Your personal integrity and credibility are questionable. I also don’t appreciate the none too subtle inference that I must be an evil manager hell bent on pushing wages down to increase profits. Again, you have zero evidence behind that inference. Also, you make work for an insurance company but your glossy observations that capitalism will work everything almost magically indicates you know precious little about actually running a business and the tough decisions that must be made.

        • Unagidon permalink
          June 24, 2013 3:19 pm

          Bill, I’m sure you and your colleagues make a living wage and then some. It’s the service companies that you provide wage capping advice for that don’t, if they don’t supply healthcare and therefore have to be subsidized by everyone else. The days of the free ride are coming to a close and for once the “hard decision” is going to have to be endured materially by management. We as a nation cannot afford the status quo that you so love.

          Regarding the ability of capitalism to endure this, I guess this depends on how good a consultant you really are. On the face of it you seem rigid and unable to innovate and to deal with reality. You might consider another line of work.

        • June 25, 2013 1:11 pm

          Bill – in no particular order:

          We live in a Constitutional Republic not a democratic republic and there is a world of difference between the two constructs. In this country, the Constitution trumps and highly constrains pure majority rule. It is founded on the inalienable rights of the individual citizen. The federal government consequently has only limited and enumerated authorities. Fifty one percent of the population doesn’t get to dictate to the other forty nine. That’s why We the People still have courts to protect us from majority over reach.

          You’re responding to an argument I’m not making – plus, you’re presenting a false choice. We live in a constitutional, democratic republic. Democracy is absolutely essential and structural to our system of government, and our system has gotten steadily more democratic as our history has unfolded. In the late 18th century, only white, property-owning men could vote (speaking of elitism…); in the ensuing 200 years, the right to vote was extended to non-property-owners, former slaves, women, former slaves and their descendents again (in the civil rights era) and so on. We have a representative democracy, not a pure democracy; representative democracy is still a form of democracy.

          My opening two sentences were observations and a tie to Jesus’ words about a Pharisee that I find apt and not part of my argument. Interestingly, you didn’t address my thought on the ends justifying the means. In my view, having a good intention doesn’t mean you have carte blanche to do whatever you wish to achieve your goals.

          Yes, agreed: the ends don’t justify the means; consequentialism is wrong.

          Mao’s Great Leap Forward typifies how “noble and necessary” intentions can have incredibly evil and destructive results. He also saw the need for systemic change BTW. History is replete with examples of political elites citing the need for systemic change as the reason for the people to suffer….to include Nazis and the Final Solution.

          Well, sure – but what does that have to do with anything I’ve said, or for that matter, anything ever proposed by mainstream American progressives in the last 100 years?

          Taking property from someone just because the government has the power to do so is evil. Taxation becomes immoral confiscation of legally and morally earned income. It is fine for “The People” covet and take what they haven’t worked for or earned in your thinking apparently. Fiscal success is to be punished if I understand your points properly.

          Let me go all FDR on you:

          “An old English judge once said: ‘Necessitous men are not free men.’ Liberty requires opportunity to make a living — a living decent according to the standard of the time, a living which gives man not only enough to live by, but something to live for.

          “For too many of us, the political equality we once had won was meaningless in the face of economic inequality. A small group had concentrated into their own hands an almost complete control over other people’s property, other people’s money, other people’s labor — other people’s lives. For too many of us life was no longer free; liberty no longer real; men could no longer follow the pursuit of happiness.

          “Against economic tyranny such as this, the American citizen could appeal only to the organized power of government. The collapse of 1929 showed up the despotism for what it was. The election of 1932 was the people’s mandate to end it. Under that mandate it is being ended.

          “The royalists of the economic order have conceded that political freedom was the business of the government, but they have maintained that economic slavery was nobody’s business. They granted that the government could protect the citizen in his right to vote, but they denied that the government could do anything to protect the citizen in his right to work and his right to live.

          “Today we stand committed to the proposition that freedom is no half-and-half affair. If the average citizen is guaranteed equal opportunity in the polling place, he must have equal opportunity in the market place.

          “These economic royalists complain that we seek to overthrow the institutions of America. What they really complain of is that we seek to take away their power. Our allegiance to American institutions requires the overthrow of this kind of power. In vain they seek to hide behind the flag and the Constitution. In their blindness they forget what the flag and the Constitution stand for. Now, as always, they stand for democracy, not tyranny; for freedom, not subjection; and against a dictatorship by mob rule and the overprivileged alike.”

  11. June 22, 2013 11:40 pm

    Jesus is the light and source of salvation, not proper procedure

  12. Kurt permalink
    June 23, 2013 10:19 am

    For example, it is perfectly fine to threaten people with governmental punishment, if they fail to “do the right thing” such as forcing healthy young people to subsidize older, more sickly individuals. The message was clear in the narrative that more regulation backed by governmental power was needed to compel proper behavior.

    Bill, thank you for saying that. I obey the law and I make it a point to live among other moral people who behave likewise. Yet the government forces me to pay for police protection for those who tolerate living among criminals and potential criminals. Not to mention the government forcing me to pay for the education costs of other people’s legitimate and bastard kids.

    • June 23, 2013 5:38 pm

      Never indicated I don’t believe in the the necessity of government in our society, there are roles that only government can and should provide. Police and the military are two primary examples. I am willing to pay for those functions both in terms of dollars and loss of personal freedom because there are no better options available. Obamacare is different, there are many other alternatives to choose many of which require no need for government involvement. Consequently, I challenge the desire to expand their role where it is not necessary.

      • Kurt permalink
        June 24, 2013 10:33 am

        Bill —

        You judge it to be not necessary and you have the right to challenge it. Other citizens judge it to be necessary and therefore advocate it. We have a system of constitutional, representative government to consider these differing judgments.

        • June 24, 2013 2:53 pm

          What exactly did I judge to not be necessary? If you answer an unconstrained, ever expanding government then you answered correctly. Remember, we live in a Constitutional Republic with strict limits on federal powers. The founders deliberately intended to constrain the government and the power it accrues. I am 100 percent in agreement with them. I don’t care what the majority of people want the Feds to do, the Courts are there to reel in their political over reach. For some reason, several posters seem to believe we live in a majority rules country and we don’t. However, a strong majority of Americans consistently poll against Obamacare….should their political desires be recognized by the democrats or just ignored?

        • Kurt permalink
          June 24, 2013 5:41 pm

          What exactly did I judge to not be necessary?

          Obamacare, even as modified by the Roberts court. You have every right to that judgment, as I do to my discernment.

  13. David Cruz-Uribe, SFO permalink*
    June 23, 2013 7:50 pm

    Bill,

    the plural of anecdote is not data; nevertheless I have a bit of anecdotal evidence regarding American healthcare versus healthcare in the rest of the developed world (primarilly Europe, Australia and Japan). Academics tend to be a trans-national lot, and they often spend long periods of time in other countries: graduate school, postdocs, research leaves, even long term employment in a country other than origin. In my experience, no academic I have spoken to who has experienced both health care systems has ever found the American system either better or cheaper. Their experiences cover the gamut from travel emergencies (Including appendicitis), pregnancy and delivery, pediatric issues, routine health care, etc.

    No European/Australian/Japanese mathematician has ever told me: “I wish my country would adopt a system closer to what the US has.” Conversely, lot’s of Americans have said very positive things about their experiences overseas and want to recreate them here.

    • June 23, 2013 9:10 pm

      David, it’s always fun to be nitpicked. Means I struck a chord. I appreciate your anecdoctal evidence from a small, non-representative sample…but I am not sure what it actually establishes in terms of this discussion. Honestly, I also have heard positive things about Japan’s system and I need to learn more. I am very much in favor of improving our medical delivery system, I just don’t want to make massive changes that expand the power of government with dubious probability the change will achieve actual improvement. Guess I’m still a bit of a child of the sixties…government needs to be watched carefully and controlled to prevent over reach and abuse. Can you say IRS,NSA, and Benghasi….

      Thanks for response and best of luck to you in your academic pursuits.

  14. KONG permalink
    June 23, 2013 9:58 pm

    First a confusion exist between healthcare and health insurance. No one is denied healthcare in this country. No hospital will deny healthcare to anyone in need.
    Second, insurance is simply a guard against financial loss. Health insurance in its current form is like a membership in a club with an agreed upon cost for medical services. When did we expect our insurance to cover a routine doctor’s visit, this drives the cost up? No one would expect their car insurance to cover maintenance services like oil changes and tires. Why do we expect the same for our health insurance? I want insurance to protect my financial assets if some unforeseen medical condition occurred, not cover routine maintenance.
    Third, we as Catholics are called to help those in need. The church doesn’t say how to help those in need, it simply says help those in need. I believe there is a divide among Catholics on how to help those in need. Some want the government to do it, others believe private Catholic based groups should . Who does a better and more efficient job of helping those in need the government or the church? Who would get more out of a dollar the church or the government? Who would do more to lift up those in need the church or the government. Lastly, what message do we want to give those in need. When the government offers assistance it will be attached with a secular, anti-god, politically correct message. When the church offers assistance, the message of God’s love and salvation will be offered. Catholics who do you want offering assistances to those in need, the church who is concerned about this life and the next, or the government who is only concerned about this life?

    • Kurt permalink
      June 24, 2013 10:44 am

      Kong,

      Given the Church herself has said she cannot take care of those in need of health care and that the government must play a role, I think the legitimate question you ask has been answered.

    • June 24, 2013 3:01 pm

      Very well said!

      • Unagidon permalink
        June 24, 2013 4:29 pm

        Kong is wrong. Hospitals cannot refuse emergency care. They can and most certainly do deny other kinds of care for people who can’t pay for it.

        But even if Kong were right, the care is not free. It’s subsidized by all commercially insured.

      • Ronald King permalink
        June 25, 2013 7:36 am

        Three years ago I was diagnosed with an illness which accumulated a bill of $185,000 just for the treatment and not including the aftercare and follow-up. Without health insurance I would be dead or close to it by now. I wonder how many of those 30-plus million who are without health insurance have died or are dying due to lack of health care?

  15. Ronald King permalink
    June 24, 2013 3:40 pm

    I like how “Obamacare” has influenced debate about healthcare. It seems to me that the freedom we lost was our freedom to ignore the poor and live a life of being “comfortably numb”. Whoever fears “big government” taking their “freedom” from them has always been afraid of someone taking something from them. Life, for this person, has always been a competition against someone or something for power and security aided by hypervigilant aggressive instincts to guard against any perceived threat. Alliances are then built upon goals and beliefs which support this worldview. There seems to be some internal instinctive alarm which signals a warning when too much of their wealth is being requested to help those less fortunate. The authority who requests this is then seen as the threat to one’s freedom and security. It reminds me of Jesus and the rich young man.

    • June 24, 2013 5:26 pm

      Superficial, highly speculative and judgmental comment lacking any verifyable content. Basically just dime store level psychological ranting and character assassination. Nothing more. BTW, Cardinal George just wrote about the same threat to freedom of religion. Guess he’s also one of those hyper vigilant aggressive people you characterized.

      Political freedom is not the historical standard for mankind, oppression is most common. Our freedom as individual citizens is diminishing in favor of state control. We see examples of governmental excess everyday in the news. The process appears to be accelerating. I prefer to work within the system to reverse this worrisome trend. I have no desire to be ruled by self anointed political elites who know best and assume responsibility for my welfare. I am a free man capable of leading my own life. I don’t desire the safety of childhood resting in the strong arms of my governmental nanny.

      • June 24, 2013 7:14 pm

        Unagidon…you don’t even know what company I work for or the services we provide and yet this doesn’t stop you from making judgmental and insulting assertions without any factual evidence. Your analytical methods would bring failings grades even in elementary school. You also depict me as some sort of business leader eager to exploit working folk. You have no evidence of any immoral behaviors on my part. And yet, your words are clearly judgmental and a bit hateful. Btw, disciplined analysis yielding decision quality conclusions is not rigid and it sells very well in the professional consulting markets

        I think you simply don’t like people who disagree with your positions. When you can’t win an argument on its merits, you seek to disparage on a personal level. It’s reeks of stunted maturity frankly. I respect your right to own opinion…wish you could offer the same courtesy to others

        • unagidon permalink
          June 25, 2013 5:57 am

          Bill, the one who is name calling is you, and this for the second time.

          This is you, isn’t it?:

          “I am an executive with a large consulting firm. Obamacare increases the cost of doing business, especially in service industries. I have personal experience to confirm that the calculus of deciding if and when to hire new staff has been impacted by new insurance mandates.”

          So you are in fact a consultant who does in fact work with service industries and you do in fact work on the Obamacare problem. You have in fact said that the provision of medical benefits will affect (by which I think you mean “limit”) the creation of new jobs. You have consistently criticized Obamacare because of the additional costs you see it producing for new businesses. You have not focused on the problems of the uninsured and you offer no solutions (by solutions, I mean tangible “actionable” solutions) to THAT problem. I can only go by what you write about yourself. You can elaborate, but you don’t get to hide behind your faux outrage.

          Regarding your personal integrity, you are the one complaining the Obamacare is going to lead to a deterioration of medical services and the reasons you provide all have to do with the influx of new members into the health care system. I note that you didn’t respond to my comments to you in that regard. Shame on you for wanting to maintain the status quo of un and under insured so that your personal services are not affected.

      • Ronald King permalink
        June 25, 2013 12:19 am

        Bill, Based on your emotional response it appears I must have struck a chord. I do not know Cardinal George but if the shoe fits so be it.

  16. Thales permalink
    June 25, 2013 8:49 pm

    For those who don’t think the HHS mandate creates a problem of religious freedom, I wonder if they would have the same opinion if the mandate required coverage of late-term partial birth abortions.

    • Kurt permalink
      June 25, 2013 9:36 pm

      I think the Administration’s decision to include contraception and exclude abortion is a arrangement that will prove endure for the long term. Had both been included or excluded, it might have well resulted in a ping-ponging depending on congressional majorities. Therefore I think the inclusion of contraception helps keep abortion out, which I find to be a virtue.

      • Thales permalink
        June 27, 2013 9:28 pm

        Ah, Kurt, but that’s not my question. I’m curious about whether you would have considered it problematic if surgical abortion had been included. If late-term partial-birth abortion had been included in the insurance, would an affected institution have a legitimate religious freedom complaint?

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