Pondering Healthcare

There have been lots of articles in the news and blogosphere lately about the Affordable Care Act (ACA), more commonly known as ObamaCare.  It has been controversial for some time, but I would like to take a different type of look at some of the history leading up to the ACA and then at what I consider to be significant flaws.

A Little of the History of Health Care

The idea for something like the ACA is neither new nor the product of just one political party.  One President who called for healthcare reform in a similar format to the ACA was Richard Milhouse Nixon in his budget address to the Congress in 1974:

I am once again proposing a comprehensive plan for national health insurance that would make adequate insurance against the costs of health care available to all Americans. This far-reaching reform is long overdue. I urge early congressional action on it. The budget proposes measures to prepare for this program.

President Nixon included a few more details in that address.

The national health insurance plan I am proposing represents another major step toward improving the lives of individual Americans. My proposal calls for basic reform in the financing of medical care. It would bring comprehensive insurance protection against medical expenses within reach of all Americans, including millions of people who cannot now obtain adequate insurance coverage. Costs of coverage for low-income families would be federally supported, with payments scaled according to family income.

It will take several years for this reform to become fully operational. In the interim, the 1975 budget provides $26.3 billion for existing health programs. Under this budget, the momentum of cancer, heart, and other research initiatives would be sustained, and total funding for biomedical research would exceed $2 billion in 1975, almost double the 1969 level. To support continued reform of our medical care system, the budget proposes a total of $125 million in 1974 and 1975 to demonstrate health maintenance organization concepts throughout the Nation. I am also proposing a Health Resources Planning Act to enhance State and regional capabilities and responsibilities for planning and regulating health services.

Congress did not act on Nixon's request.  Nor was there action under Presidents Ford, Carter, Reagan, Bush (41), Clinton, or Bush (43).  This is despite repeated calls for health care in their various messages to Congress.  (The following are examples and should not been seen as exhaustive or complete).

President Gerald Ford

America needs to improve the way it pays for medical care. We should begin plans for a comprehensive national health insurance system. However, in view of the economic developments and the measures I have proposed to combat recession and inflation, I cannot now propose costly new programs. Once our current economic problems are behind us, the development of an adequate national medical insurance system should have high national priority. I urge the Congress to work with my Administration in order to devise a system that we will be able to afford.

President James Earl Carter

about a comprehensive national health insurance program, which can extend health care coverage to millions of needy Americans while controlling health care costs; and about the need for a human rights policy, which I believe is essential in the pursuit of our foreign policy.

President Ronald Wilson Reagan

I am asking Congress to help give Americans that last full measure of security, to provide a health insurance plan that fights the fear of catastrophic illness. My plan would provide acute care for those over 65 by restructuring the Medicare program. Under my proposal, the elderly would receive catastrophic health care coverage under Medicare, while limiting out-of-pocket expenses to $2,000. This coverage will be made available for an additional monthly Medicare premium of $4.92. The plan also aims to improve protection for the general population and for the long-term care of the elderly. For too long, many of our senior citizens have been faced with making an intolerable choice—a choice between bankruptcy and death. This proposed legislation would go a long way to help solve that dilemma.

President George Herbert Walker Bush

Infant and maternal health is an area where we must invest in the future. It is also an area where we must all be committed to improvement. I am particularly disturbed by the fact that the infant mortality rate for black infants is nearly twice that for whites.

This legislation does not do all that we want to do, but it does do what we can do at this time.

President William Jefferson Clinton

Today is an historic day. The Senate Labor and Human Resources Committee has become the first full congressional committee to report out a health care reform bill. The action of Chairman Kennedy's committee gives me great confidence that Congress will pass legislation this year that meets the expectation of the American people: guaranteed private insurance for every American that can never be taken away. Once again, Chairman Kennedy has demonstrated the leadership that has made him a driving force in the fight for quality health care for the last three decades.

Under the leadership of Chairman Moynihan, the Senate Finance Committee is moving. Chairman Moynihan is committed to achieving universal coverage and bringing legislation to the American people this year.

For the first time in our history, committees in both the Senate and the House are seriously moving forward on health care reform. While much work remains, today's actions prove that the job will be done. The momentum demonstrated in the House and Senate this week is heartening to me and all Americans who want and deserve real health security.

President George Walker Bush

This bipartisan Patients' Bill of Rights reflects the principles I laid out earlier this year. It provides strong patient protections for all Americans, ensures that doctors and patients make medical decisions, and holds health plans accountable by providing patients with meaningful remedies when they have been wrongly denied medical care. The bill also protects employers and their employees from unnecessary litigation that would increase health care premiums and force too many Americans to do without health insurance.

While the details vary, all of these Presidents of the United States attempted to get some form of additional healthcare for average Americans.  They all failed.  President Obama is the first to get legislation passed, but it doesn't quite make sense.

My complaint is not with the individual mandate which the GOP and Fox News have inaccurately called the largest tax ever.  As a penalty or a tax, the concept is necessary if we are going to have private health insurers managing our health care.  That last bit is my personal biggest problem with the ACA and should be the second biggest problem for Republicans.

First Concern with the ACA

Despite the cries of fear that the government is taking over your healthcare.  Despite the silliness that the government is getting between your doctor and you.  The reality is that private companies are in charge of your healthcare and are getting between your doctor and you.  That might be reasonable, but those companies have a bottom line goal of spending as little as possible.  Their goal is not to keep you as healthy as possible.  Their goal is not to ease the hassles of getting the care you need to survive.  Their goal, as is the goal of every other private corporation, is to earn money.

The ACA is good in that someone with a preexisting condition can now get health insurance.  One cannot be thrown off of health insurance completely because one's care is starting to become expensive.  The insurers are now required to spend eighty percent of their income on health care (that part is dramatic reform).  Those are all good points.

But, that does not change the insurer's goal of making money.  Their only reason to take reasonable care of you is if there is competition and you might change insurers.  The state exchanges that have so many Republican governors concerned might help with this, but it is an idea that has not be tried yet.

Second Concern with the ACA

If a concern is cost to business, why are we perpetuating an employer based health insurance system?

Many who complain about the ACA are complaining that it will cost jobs because it will cost small businesses too much.  The reason it is costing businesses anything at all is because after World War II some businesses added health care as a benefit to attract employees.  This was not mandated by the government.  It was a business choice.

Since that time, we have gone from having a primarily domestic economy to having a global economy.  The businesses which are competition for American businesses are mostly in countries with single payer health care systems.  Businesses in Europe and Asia do not pay for health care at all (well, they do pay taxes which in turn fund the health care but that is generally in the form of income and value added taxes that are not based on the employees).  It is not a level playing field.

Before someone jumps on me for lauding single payer systems, I will note that not all single payer systems are created equally.  One of the best systems, that of Taiwan, is supposed to be in fiscal trouble.  It is not my purpose to present any panacea for health care in this blog, just to ponder what is happening.

Third Concern with the ACA

The gimmick of pushing most of the costs out ten years is as annoying when done by Democrats as when done by Republicans.  Partly because of this, the Republicans can claim that ObamaCare is a failed system when most of it has not been put into effect yet.  Both the Democratic gimmick and the Republican attacks are lies.  Disgusting politics.

Final Thoughts for This Post

Given the Republican rejection of Republican ideas, such as the individual mandate, it is likely that nothing better than the ACA could have been accomplished during President Obama's first term in office.  While political parties are always rooting for replacement of members of the other party, they usual put country first.  The Republicans stopped doing so with the goal of replacing President Obama.  Perhaps it is racism.  Perhaps it is continued fallout from the near-impeachment and resignation of President Nixon.  Whatever the reason, the loss of the GOP as a political party that places the United States first was a huge loss.  I don't know how this can be repaired.

Repudiation: Lawsuit to "Preserve Religious Freedom"

Preserve Religious Freedom -- The Roman Catholic Church

Generally speaking, I have a great deal of admiration for a number of Catholic educators, most of my undergraduate and graduate school professors.  But, the lawsuit their church has filed does not make sense.  Preserve Religious Freedom is the website that explains what the Roman Catholic Church (RCC) is doing.

This lawsuit is about an unprecedented attack by the federal government on one of America’s most cherished freedoms: the freedom to practice one’s religion without government interference. It is not about whether people have access to certain services; it is about whether the government may force religious institutions and individuals to facilitate and fund services which violate their religious beliefs.

The Quaker religion is opposed to wars, all wars.  Yet all Quakers pay taxes that fund the Department of Defense.  There is considerable precedent for funding things that violate religious beliefs.  For the Quakers, there is the conscientious objection to serving.  For members of the RCC, they do not have to participate in those services that they feel violate their beliefs.  Same thing.

The HHS mandate that all employers provide abortion-inducing drugs, contraceptives and sterilization includes only a narrow exemption for certain organizations that the government deems sufficiently “religious.” The exemption applies only if the government determines that all four of the following criteria are met: the inculcation of religious values is the purpose of the organization; the organization primarily employs persons who share the religious tenets of the organization; the organization primarily serves persons who share the religious tenets of the organization; and the organization falls within a certain tax code provision defining a narrow subset of religious non-profits.

The opening sentence of this paragraph is erroneous.  The HHS mandate does not include employers providing any drugs or services.  The mandate includes provision of insurance.  Apparently the RCC does not feel that this separation is adequate.  Even upon providing insurance, the decisions regarding whether to use any of these are between the individual and their doctor, not involving the RCC.

Perhaps that is why the RCC objects so strenuously.  They cannot use their influence as an employer to prevent their employees, who may not be members of their faith, from using contraceptives.  An employer, they don't get to dictate their employees' sex lives.

This exemption runs contrary to decades of federal laws that have consistently honored and respected the conscience rights of religious institutions and individuals (see, e.g., http://www.usccb.org/issues-and-action/religious-liberty/conscience-protection/upload/Federal-Conscience-Laws.pdf). This radical and narrow definition of what constitutes a “religious employer” attacks religious freedom by defining it away: by extending religious freedom protection only to houses of worship, HHS’s exemption reduces religious freedom to the freedom of worship.

Not at all.  Every individual is still free to follow her or his conscience.  Religious freedom is based on the Establishment Clause of the First Amendment to the United States Constitution:  Congress shall make no law respecting an establishment of religion or prohibiting the free exercise thereof.  There is no United States official, established religion.  And the question is whether as an employer the RCC can call dictating healthcare to its employees the free exercise of religion.  To agree with the RCC on this strikes me as "radical".

Dropping down a bit on their Issue page, the argument becomes completely absurd.

Effectively, the mandate prohibits us from asking what we’ve asked for more than 200 years, “Are you hungry?” Now we also have to ask, “Are you Catholic?” To qualify for the exemption, and so to be permitted to follow their beliefs, Catholic institutions may have to stop providing educational opportunities to as many non-Catholics as they currently educate, stop serving as many non-Catholics in need as they currently serve, and stop employing some of the non-Catholic employees they currently employ. But this kind of withdrawal from the world violates our religious commitment to serve all in need without regard to religion.

No.  If the RCC stops providing charity to the general community, that is entirely their choice.  They are not being asked to stop hiring non-Catholics as they are not being asked to force contraception on anyone.  This is a threat to take away their community service, nothing more.  They may even follow through on this threat (they did so when they stopped providing adoption services in Massachusetts in protest of marriage equality, including non-discrimination laws on adoption, in that state).  But the threat is entirely their choice.  Their hand is not being forced by the government.

The exemption also involves an invasive federal government inquiry into an organization’s religious beliefs and practices, conferring powers on government forbidden by the Constitution. Specifically, for an institution to know whether it meets the government’s definition, it must submit to a governmental investigation whereby federal employees determine the religion of those employed and served by the entity, whether their beliefs are the same as the institution, and whether the institution hires and serves “primarily” those of in agreement.

This is the single point where I think that the RCC has valid concerns.  There is a loss of privacy.  I still believe that they, like every business, should be required to open their books to the government.  Determining the employees' religions is not an invasion into the frequency or ardor with which they practice those religions.  It is purely to make a determination of granting an exemption to a standard of care for employees.

Businesses have claimed invasion of privacy when OSHA inspects to determine if working conditions are safe.  I don't see this fear of invasion by the federal government as very different.  Dropping to the end of their issue.

In sum, the HHS mandate jeopardizes religious freedom—a fundamental right enshrined in the Constitution—and undermines access to a wide range of social services. Catholic schools, universities, hospitals, and social service agencies are in the business of educating and caring for Catholics and non-Catholics alike. As the President acknowledged, these organizations do “more good for a community than a government program ever could.” The mandate jeopardizes all of these good works by forcing Catholic institutions to violate their religious beliefs.

The RCC is what "jeopardizes all of these good works".  There is no violation of religious beliefs in providing comprehensive insurance to employees.  The lawsuit is a political distraction that will cost taxpayers when the government defends itself.

Thanks to Joe My God for the heads up.

FollowUp 1: Claims of Threat to Religious Liberty

This week, Chicago's Francis Cardinal George wrote a column on healthcare.  He makes some claims that are clearly erroneous.

This year, the Catholic Church in the United States is being told she must “give up” her health care institutions, her universities and many of her social service organizations. This is not a voluntary sacrifice. It is the consequence of the already much discussed Department of Health and Human Services regulations now filed and promulgated for implementation beginning Aug. 1 of this year.

Not at all true.  The compromise reached by the Obama Administration includes that health insurance cover what many of those Catholic institutions already cover.  The Roman Catholic Church (RCC) is not being asked to give up any institution.

Why does a governmental administrative decision now mean the end of institutions that have been built up over several generations from small donations, often from immigrants, and through the services of religious women and men and others who wanted to be part of the church’s mission in healing and education? Catholic hospitals, universities and social services have an institutional conscience, a conscience shaped by Catholic moral and social teaching. The HHS regulations now before our society will make it impossible for Catholic institutions to follow their conscience.

The premise is flawed.  There is no "end of institutions" unless the RCC makes a deliberate choice to end them.  It's touching that so much work went into creating these institutions that are not being terminated by the government.

So far in American history, our government has respected the freedom of individual conscience and of institutional integrity for all the many religious groups that shape our society. The government has not compelled them to perform or pay for what their faith tells them is immoral. That’s what we’ve meant by freedom of religion. That’s what we had believed was protected by the U.S. Constitution. Maybe we were foolish to believe so.

First, no one's "freedom of individual conscience" is under threat.  That one is given the option of using contraception does not mean that one must do so.  Individuals are free to choose.  Second, inclusion of contraception in health insurance does not threaten "institutional integrity".  The RCC can still tell its parishioners to not use contraception.  That returns us to the first point, freedom of individual conscience.

This is where it gets a little more interesting.  The Cardinal implies that their employees, including those who are not Roman Catholic, must not be given the choice of whether or not to have contraception available as part of the health insurance provided by their employer.  They want to make all health decisions for their employees, irrespective of that "freedom of individual conscience".

What will happen if the HHS regulations are not rescinded? A Catholic institution, so far as I can see right now, will have one of four choices: 1) secularize itself, breaking its connection to the church, her moral and social teachings and the oversight of its ministry by the local bishop. This is a form of theft. It means the church will not be permitted to have an institutional voice in public life. 2) Pay exorbitant annual fines to avoid paying for insurance policies that cover abortifacient drugs, artificial contraception and sterilization. This is not economically sustainable. 3) Sell the institution to a non-Catholic group or to a local government. 4) Close down.

No.  Those are ignoring an important choice which involves no change whatsoever for many of the RCC institutions.  That is, allow contraception to be included in the health insurance and simply tell the Roman Catholic employees that you frown upon them using those as much as you frown upon them doing other things that you consider sinful.  That does not require secularization, fines, sales, or closure.

This is an artificial problem, created to stir up political controversy.  The Cardinal wants the RCC to overstep the Establishment Clause and have a greater "institutional voice in public life."

In the public discussion thus far, efforts have been made to isolate the bishops from the Catholic faithful by focusing attention exclusively on “reproductive” issues. But the acrimony could as easily focus next year or the year after on assisted suicide or any other moral issue that can be used to distract attention from the attack on religious liberty. Many will recognize in these moves a tactic now familiar in our public life: those who cannot be co-opted are isolated and then destroyed. The arguments used are both practical and theoretical.

No one is trying to "isolate the bishops from the Catholic faithful".  That is absurd.  This is about public health policy, not about communications with your congregations.

Despite the efforts of the late Jack Kevorkian, assisted suicide remains illegal.  Neither should it be illegal nor should the RCC be limited from preaching against assisted suicide within their churches.  Again, the Cardinal wants the RCC to overstep the Establishment Clause and have a greater "institutional voice in public life."

Practically, we’re told that the majority of Catholics use artificial contraception. There are properly medical reasons, in some circumstances, for the use of contraceptive pills, as everyone knows. But even if contraceptives were used by a majority of couples only and exclusively to suppress a possible pregnancy, behavior doesn’t determine morality. If it can be shown that a majority of Catholic students cheat on their exams, it is still wrong to cheat on exams. Trimming morality to how we behave guts the Gospel call to conversion of life and rejection of sin.

Slow down.  "There are properly medical reasons, in some circumstances, for the use of contraceptive pills, as everyone knows."  I'm not sure that everyone knows that.  Some of the medical reasons are to save the life of the woman taking those medications.  This is what the RCC does not want to insure.

Preaching morality is fine.  Enforcing morality is something else entirely.  The Cardinal is calling for the latter for all of its employees, not just those who are Roman Catholic.

Skipping down several paragraphs:

The provision of health care should not demand “giving up” religious liberty. Liberty of religion is more than freedom of worship. Freedom of worship was guaranteed in the Constitution of the former Soviet Union. You could go to church, if you could find one. The church, however, could do nothing except conduct religious rites in places of worship-no schools, religious publications, health care institutions, organized charity, ministry for justice and the works of mercy that flow naturally from a living faith. All of these were co-opted by the government. We fought a long cold war to defeat that vision of society.

When organized charity is mixed with denial of medical coverage where the RCC determines what may and may not be covered, then perhaps the RCC should be constrained to those activities that involve only those of their faith.  While I generally oppose restrictions on religions, those religions cannot be allowed to impose their will on those who are not of their faith.

The strangest accusation in this manipulated public discussion has the bishops not respecting the separation between church and state. The bishops would love to have the separation between church and state we thought we enjoyed just a few months ago, when we were free to run Catholic institutions in conformity with the demands of the Catholic faith, when the government couldn’t tell us which of our ministries are Catholic and which not, when the law protected rather than crushed conscience. The state is making itself into a church. The bishops didn’t begin this dismaying conflict nor choose its timing. We would love to have it ended as quickly as possible. It’s up to the government to stop the attack.

This is a big lie.  The Cardinal needs to re-read the last sentence of Exodus 20:12.

12 Thou shalt not murder.  
     Thou shalt not commit adultery.  
     Thou shalt not steal.  
     Thou shalt not bear false witness against thy neighbour.

There is no attack against religion.

If you haven’t already purchased the Archdiocesan Directory for 2012, I would suggest you get one as a souvenir. On page L-3, there is a complete list of Catholic hospitals and health care institutions in Cook and Lake counties. Each entry represents much sacrifice on the part of medical personnel, administrators and religious sponsors. Each name signifies the love of Christ to people of all classes and races and religions. Two Lents from now, unless something changes, that page will be blank.

The only reason for those hospitals and health care institutions to not be listed is if the Cardinal decides that allowing people "freedom of individual conscience" is too dangerous to keep the hospitals and health care institutions open.  Otherwise, this is just a huge scare tactic.  Particularly ugly from one who is supposed to uphold the Ten Commandments.

Thanks to Joe My God for the heads up.

6 February 2012: Original Pedantic Political Ponderings post.

11 March 2012:  FollowUp 2.

Repudiation: Christian Anti-Defamation Commission

It can be argued that the Christian Anti-Defamation Commission is none of the above.  Their first installment in a series of ten proofs that President Barack Obama is not a Christian is filled with lies that neither promote Christianity nor defend it from anything real.  Watch and see.



Lies I caught:

1.  Life is defined by the Bible to begin at conception.

Genesis 2:7 is the first time that the Bible discusses the soul.  The soul is associated with the first breath, not the moment of fertilization.

2.  Death Panels in ObamaCare.

Despite the claims in this video, there are no Death Panels in the Patient Protection and Affordable Care Act (which detractors call ObamaCare).  President Obama said that the death panel claim is a lie.  It is a lie according to Politifact.  The denial of neurosurgery to patients over 70 is a lie according to Snopes.  The caller to the Mark Levin show was telling a lie when he claimed to be a neurosurgeon.

3.  Abortion funding in ObamaCare.

Not true.  President Obama signed Executive Order 13535 that applies the Hyde Amendment to the Patient Protection and Affordable Care Act.  In short, ObamaCare does not include abortion funding.

4.  Reproductive care means abortion.

No.  The World Health Organization says reproductive care should be

access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

The only hint regarding abortion is "fertility regulation of their choice", which is best handled through contraception not abortion.

5.  ObamaCare is anti-life.

Exactly the opposite.  But this 501(c)3 that masquerades as a non-political charity is loading in every deception that they have available to distort both the intent and reality of the Patient Protection and Affordable Care Act.  While the Act could have been improved, Republicans in Congress made that impossible.  Many of the ideas that were originated by Republicans, including presidential contenders Mitt Romney and Newt Gingrich, are now disavowed as socialist plots to overthrow America and proof that President Obama is a secret Muslim.

Unlike abortion, telling lies is forbidden in the Ten Commandments.  Thus, one could say that the Christian Anti-Defamation Commission is not Christian or at least not adhering to Christian tenets.  Rather than defend Christianity, the Christian Anti-Defamation Commission is slandering the President of the United States.  Thus, one could say that they are not anti-defamation.  The word commission is a nebulous enough term that we can grant that much.  Still, one might wonder from whence came this commission.  Their history page states who founded them, not who commissioned them.

Thanks to Joe My God for the heads up.