Wednesday, September 23, 2009

Health-Care Debate

Now I'm not one to get involved in the US health-care debate, but I liked this video by Will Ferrell:






I can't resist a few comments (I tried, I really did, but I can't resist):

1. Every western democracy from Norway to New Zealand has universal health care for its citizens except for the wealthiest nation on earth.

2. Putting profit-driven companies in charge of health care sounds like putting Dracula in charge of the blood bank. You need more than market forces to keep greed in check, if you don't believe me, go apply for a loan at Lehman Brothers.

3. I've lived in two countries with universal health-care and it works great (not faultless by any strech, but it works).

4. Australia has both a public and private system and the two can and do co-exist in peaceful harmony, i.e., there is a safety net for the masses and those who want breast implants and ankle reconstructions on demand can have it. My two daughters were born in private hospitals, but I've also made use of the public system for the most part.

5. To oppose access to affordable health care strikes me as a violation of the golden rule.

6. I can understand the desire not to put government in charge of everything, to encourage a free market economy, to create profit-motive, to foster upward economic mobility, and avoid becoming a welfare state - I'm on board - but you can still have all that with more government involvement in health care.

7. Does anyone know of any theological reflections on health care?

30 comments:

Mr. Brown said...

theological reflections on health care

Dude, get to work on it!

I think this is bigger than health care. It's about how the people of God think about Jesus as Lord and consequently about their relationship with government.

I've been spending my sabbatical trying to get my head around this because it is the thing that really divides the church here in the states and, dare I say it, reflects a subChristian view of the gospel. I've been reading Yoder, Hauerwas, Brueggeman, Van Hoozer, Wright et al to see what I'm missing.

I guess Wright will have something to say about this when Paul and the Righteousness of God, Rightly Understood comes out next year. Maybe he'll address it at the Wheaton Conference in April.

In any event, it seems like the health care issue (as distinguished from abortion or gay marriage) is a better entry point into the discussion about the larger problem of politics and faith in American Christianity.

IGalloway614 said...
This comment has been removed by the author.
IGalloway614 said...

1. I find the "every other western democracy is doing it" argument a poor argument for a massive overhaul of a major industry and what would essentially amount to a government takeover of 15% of the economy.

2. Comparing insurance companies with an over leveraged financial services and banking firm is like comparing apples to oranges. A drive for profit is not inherently bad and can foster innovation as well as price reductions if firms are truly allowed to compete (which right now they can't as US citizens are not allowed to purchase insurance across state boundaries by law).

3. I've heard both positive and negative anecdotes about government run systems in the UK and other places but the deciding factor for me is watching how the government runs the existing Medicaid and Medicare programs... which is to say poorly. I have no desire to see that kind of administration applied to the healthcare system as a whole.

4. I agree. Hence the current mix of private insurers with Medicaid and Medicare.

5. I would be careful about suggesting that opponents of universal healthcare are violating the golden rule (thus sinning). Why couldn't a more efficient private system that achieves results also fulfill the golden rule by increasing access and decreasing costs (say by allowing individuals to pursue insurance across state borders forcing more insurance companies into competition with each other)?

6. I agree that what your suggesting here is at least theoretically possible but, watching how the government already handles Medicare, Medicaid, and Social Security, I almost no confidence that they could do better than what we have right now. Furthermore, if the overhaul doesn't work and worsens the system then we would more than likely be stuck with it. There is an extremely poor record in US government of revamping, repealing, or removing systems that don't work or are failing (i.e. Social Security).

Tom said...

As an American who faces this debate I would like to chime in on some of your comments.

Item 1 - I think this is just an appeal to the masses, just because everyone else does it does not make it right and does not give others the authority, moral or otherwise, to force others to do it.
What I find most atrocious about this is the financial penalty that would be assessed by the government if you do not do what they say. This could be as much as $1900 to $3600 for a family of four (depending on the bill). According to our laws I believe this is unconstitutional. This is not an enumerated power of the Government and therefore falls to the state or the people.

Item 2 - I would agree to this statement only of Lawyers & Law firms & Unions where forced to abide by the same rules as the government is asking private health insurance companies to abide by. Many people in America feel (and with good reasons) that the bill before congress on the issues do not address tort reform (a big problem with U.S. Health Care) and that these bill grossly and unfairly favor Unions by exempting them from high taxes that the bill seek to assess people with good health care.

Item 3 – This is just an opinion. I do not know this one way or the other neither do most Americans and they would rather keep the insurance they now than the one they do not know. I hear a lot from both sides and quite frankly to not trust either.

Item 4 - The U.S. has 2 systems as well, Medicare/Medicaid and Private insurance. Many of the uninsured in the U.S. either qualify for the Medicare/Medicaid and do not use it or can afford the private insurance. Quite Frankly many Americans think that it is insane to spend 850 billion minimum to insure a small percentage of the population when it would be easier to just expand the public system. This leads many of us to think that there are ulterior motive involved with this issue.

Item 5 -I agree with this issue is not that we don't want people to have access it is just how to do it, Bankrupt the country or try something else. I choose try something else. Some states such as Massachusetts Hawaii and Tennessee have tried the public plan and they have failed miserably due to costs.

Item 6 - As in Item 4 we already have that and the program is way over estimates and budget why think this would be better, our government has never run anything efficiently why anyone thinks this time will be different is a wonder to me.

Bruce J. Russell, Sr. said...

6. I can understand the desire not to put government in charge of everything, to encourage a free market economy, to create profit-motive, to foster upward economic mobility, and avoid becoming a welfare state - I'm on board - but you can still have all that with more government involvement in health care.

5. To oppose access to affordable health care strikes me as a violation of the golden rule.

I suppose these are profound debates that Christians need to engage. The problem is that the baby boomer idea of "affordable" is not affordable: hip surgeries, transplants, medicines for chronic ailments unknown 50 years ago. They are casting around for someone else to pay for it.

Now we have a three layer health system serving (1) the wealthy, (2) the middle class (and border crossing Canadians), and (3) the poor.

When all these enlightened, compassionate "progressives" get done with it we will have two health systems serving the wealthy and everyone else.

At that time Christians will be faced with the intensified challenge of loving their sick neighbors who can't afford "wealthy health care". Feeling good about their collectivist politics will then be irrelevant.

Michael F. Bird said...

Fellas, one final point. In the parable of the Good samaritan, the Samaritan did not ask the wounded man which health care provider he was with! He paid the cost for the guy who couldn't pay it himself. This is the teaching of the Lord!

IGalloway614 said...

I'm not so sure that the correct conclusion to be drawn from the parable of the Good Samaritan is a government mandated universal healthcare system. I think the correct conclusion is that we as Christians need to step up. Shame on the Church for not taking a more active role in helping the poor and needy with medical related issues. You're right, we as Christians should help pay the cost for the guy who couldn't pay it himself. I don't think we need to force everyone to do so via legislation.

Mark Goodacre said...

Great stuff, Mike. Music to my ears. One of the bizarre things about the health care debate in the US is that no one ever looks at the analogy of education. No one reasonable disputes the right to free education here, or talks about it as statism, etc.

Brandon Jones said...

If you have the time, David Goldhill has presented the best explanation of the health insurance industry in America and what it would really take to fix it that I have seen. Here's the link to his article in "The Atlantic."

S.Cruver said...

1. The USA does have universal health care, but it does not have universal insurance coverage. Nobody is denied health care in America. Even an illegal citizen will not be turned away.

2. The USA has the best health care system in the world.

3.Health care is expensive because inovation takes time and a lot of money. Also I want my surgeon to make a lot of money. The smartest and most brilliant people are usually drawn to high paying careers, and therefore I want my doctors to be brilliant.

4. If you want fantastic and affordable health care then go to your local Catholic hospital and if you make under a certain income level they won't charge you a thing no matter what procedure you need.

5. ...and whatever the government does I can do better:-)

S.Cruver said...

btw- I love your blog, and I read every post.

Sean LeRoy said...

First off, I guess, you need to distinguish between coverage and care; as many thoughtful commentators have stated, the two are not the same. To me that's where the debate needs to start...
Secondly, there are plenty of other solutions besides another US Gov't take over. In other words, what's creating the problem in the first place - I'd suggest it's over-regulation. If that's the case, then to suggest, as you do in the post, that we need another "outside" force at work to curb the greed of the existing system is totally insane. The Gov't has screwed up virtually everything else w/ exorbitant greed, why would we allow them to get their grubby hands on the health care system?! Where's the "faithful in little/given more" principle in THAT?
What's further, other national systems are going broke and others are reverting back to a market oriented approach.
For those interested, check out this study by the Cato Institute that deals particularly w/ cost (a complaint levied against the US system) --> http://www.cato.org/pub_display.php?pub_id=9272

Handyman94 said...

On the parable...it was the application of love that the good Samaritan lavished on the mugged individual. This loses personal meaning when it is substracted from your paycheck.

Jesus also was said to have walked into the temple past two blind men. When they called for him is when he ministered to them.

Welfare from the government has to be governed by laws, not something Jesus was intending to implement. Like all worldly systems, it will include those who will abuse the power. This sort of thing should be done by community. One suggestion would be to require citizenship for access to the plan (not removing being human when someone needs attention).

The largest reason for my resistance to the government health care reform in the U.S. is that it no longer becomes a privelege met with appreciation and thankfulness. It becomes a right for something you don't deserve. Where's my right to a personal theological library? Isn't that also something that benefits my health? I demand it, now!

I'm aware of the possible counter-argument that we don't deserve Christ either. However, I'm no where close to a universalist or an armeniest, but not a staunch Calvinist either. I mean that salvation is a free gift of unmerited favor from God. When that is met with humility and thankfulness, it produces good works due to the Spirit within that testifies of the inward change and acceptance of the free gift.

Government sponsored health care in America would not be the same as it is in other countries. We have many more illegal citizens to thin the resources. I love giving. I'm having a hard time seeing the kind of fruit I see from personally helping people who can't repay me compared to this universal health care system.

In the spirit of ushering in Christ's return, maybe we shoud just relinquish our entire pay checks and let the government pass out as each has need? That will guarantee armeggeden in about three days.

Richie said...

Mike,

I love your blog but I would advise a great deal of caution in making moral judgments about fellow Christians in other countries. In fact, this is a very good area to be sure that one has indeed taken the log out of one's own eye before trying to take the speck out of someone else's eye.

As someone with a good knowledge of early Judaism and Christian origins I think you would agree that Jesus' answer about "who is my neighbor?" would not have been taken by any of his listeners as a mandate to set up a universal health-care system in the Roman Empire. In fact, it is very hard to find any clear example in the early NT church of Christians being overly concerned with the physical or material welfare of those outside of the family of faith. They did, in fact, take collections, etc. for the "needs of the saints" and when famines occurred they took up collections "according to their ability" to help bring relief - not to the Roman Empire - but for the poor or needy believers both in their own communities and in other communities such as Jerusalem. This certainly doesn't preclude acts of material charity to those outside the faith but there is no doubt that their primary ministry to those outside the faith was simply evangelism.

I'm 54 years old and am an American citizen - born and raised in the United States. I have also spent a large part of my life living and traveling in both Eastern Europe and Western Europe. My wife spent the first 30years of her life in Europe in communist Poland where I also lived for five years. I've also spent many years of my life teaching both European and American history, government, politics, etc. If there are two basic generalizations that are true about both Europe and the U.S. they are:

(1) that the history, government, politics, and present day life of both Europe and the U.S is extremely complicated, diverse, and unique to itself;

(2) that neither the U.S. (in all of its diversity) nor Europe (in all of its diversity) really understands the other. In fact, they usually misunderstand each other.

Most American Christians actually do know the golden rule and endeavor to practice it in their lives just as most European Christians do. That, of course, does not mean that they will either understand or agree with the application of it in the other's country.

Now I love both America and Europe, preferring some aspects of one and some of the other. However, Europe is not America and America is not Europe. Each is the result of its own long and unique history in all aspects of its life producing its own present day unique and diverse culture. All analogies between the two are immediately subject to be fraught with error and the solutions for one are rarely the solutions for the other. Christians in all countries have to apply the golden rule according to the reality of their own situations and according to the determinations of their own consciences as they are being conformed to the mind of Christ.

In Christian ethics as in real life as a whole there is rarely a one size fits all solution. In sum, a universal Christian ethic there is, but a universal Christian application of that ethic there is not.

Joe Rigney said...

Mike,

Gotta say that I'm about 180 degrees from you on this one. As long as we have to pay doctors, nurses, pharmaceutical companies, etc, then health care will be a profit-driven business. The only question is whether profits will be set by the people through the market or by a smaller group of people through the state.

The idea that politicians and bureaucrats are less profit-driven or more selfless than insurance companies is just silly.

And as for the Good Samaritan, aren't you drawing the wrong point? The Samaritan paid for it himself; he didn't get Caesar to tax the guy down the street to cover the hospital bills. Coerced compassion ceases to be compassion.

Sorry, my friend, on this one I think that your red hair has finally gotten the best of you. (I say that as a fellow red-head. :)

AndrewCas said...

I don't know to much about the debate and frankly i don't care. i'm not in the USA not my battle to fight, here in Australia we have Universal health care and its not that good. I live in QLD (Queensland) and we have universal ambulance care and it sucks, as people call the ambulance for dump reasons, i.e. i have a headache (mean while the person hasn't drunk any water all day), i stubbed my toe and it hurts, i am feeling weak (mean while person hasn't eaten for all day). I'm not just making these up either. And it is examples like the ones just given that mean the Ambos sometimes don't get to real emergency's and not the Ambos can't not respond to a call. I don't think the USA would be able to run if it had universal health care, as its hospitals are all ready over crowed and it would only be worse. i know that our hospitals over hear are almost always over crowed and we have some of the best health care. Sorry Michael you have been over seas for to long, our system sucks big time. Sure its better than what the US currently has and by no means is it any good, i.e. I remember that when the nurses union went on strike they asked school students to come in and help the hospitals out .

Richie said...

Mark,

I love your blogs and am very thankful for your contributions to biblical studies. However, the reason that people who favor a public option for heath care in the U.S. don't use the analogy of "public education" in the health care debate is that public education in America is so poorly run. This is acknowledged by almost everyone, though it is better in some areas than in others. If public education was to be used as an analogy at all it would be most properly used by those who don't won't any form of public or government run health care. So, the "right to education" has hardly been solved by public education. That is precisely why people in America are turning to charter schools, home schooling, and private schools in great numbers. And, of course, members of Congress and the federal government lead the way in this movement all the while courting the votes of the public education establishment.

In addition, the "right to education" is not a "right" acknowledged by the U.S. Constitution but rather by most state constitutions. And, public education in the U.S. is run by the states - constitutionally - rather than the federal government. If anything, most Americans want more local control of education rather than more state, or especially, federal control. In short, all the trends are away from "public" education because of its history of inefficiency, failure, and the vast amounts of tax money that have been wasted in supporting it. None of that bodes well for the success of public health care in America.

Luke said...

Wow, much opposition today! I'm an American citizen and I completely agree with you, Mike. Our healthcare system is shattered. Not broken, shattered. It is a complete joke. There have been many times I've needed to go to the doctor over the past few years and haven't simply because of the cost. Even my co-pay and deductible are outrageous, and that's with a plan I have to spend nearly $200/month on.

The main people I see opposing more socialized medicine are generally wealthy people who have good coverage already. They think, "Hey, I have it pretty well so our system must work." The Christians' response to this has been nothing short of embarrassing to me, because what they're doing is essentially deifying right-wing politics and the founding fathers. They have the "laissez-faire" mindset, and think everybody should just take care of themselves without any involvement from anywhere else.

What I find ironic is that the majority of these people would be irate if they had to pay for their child's education. We're socialist with K-12 education, but everywhere else it is wrong? Give me a break and stop drinking the kool-aid.

Mark Goodacre said...

Thanks, Richie. I suppose I am lucky in having excellent public schools where we live. Your points are well taken. I think, though, that few would argue that public education should be a matter of private funding, though, right? On some level, there is a commitment to public education for all, free at the point of use? That's where the analogy with health comes in in countries like Britain. Cheers, Mark.

Tim Ricci said...

Brother Michael:

The reason so many Americans are opposed to federal universal healthcare is because it is not the Constitutional job of the federal government to do so. The US Constitution grants very specific enumerated powers to the federal government. I oppose federal universal healthcare because it's a violation of our Constitutional system.

If states want to provide universal healthcare they are free to do so.

You raise the theological question (which is the all important question), I think the church universal needs to step in and provide full orbed care for their communities. This would be difficult, but I believe it's or call.

Michael, keep writing, every book has been gold so far!

Mike W said...

Wow. What amazes me (and it seems Mr Bird too) is the way some Americans think their system is just fantastic, even though it restricts the healthcare available to the poor.
As someone who has a heriditary disease, insurance companies will not touch me.
But I live in Australia, so, on top of the free hospitals and free visits to doctors everyone gets, my country offers me free dental, physio, psychologist, fitness assesments, blood tests and radiography. I'm not even sick yet. I may never get sick. If I do, my fellow countrymen will put a multimillion dollar machine in my house to keep me alive. And they will run a transplant scheme so I have a chance of returning to somewhat normal life.
All this without the fear of a giant debt. (A medical company did send my Mum a bill once by mistake. Dad never complained about paying tax again).

If you don't trust your government to run it, demand better government

Margaret said...

Mike -- I love your last comment. If the Americans don't think their Government is up to running hospitals and schools, how can they think it is up to running their country!

I live in New Zealand - a country with a very large public health system which provides us with longer life expectancies, better health on almost every conceivable measure, using a far lower proportion of our resources than the American system. We do have a small private health system -- but it is small because most people (like me) are more than happy to use the public one. Yes we won't get face lifts on demand ... but we have better things to do anyway!!!

I cannot understand why so many Americans are fighting so hard to keep a system that deprives them of their money just so they can have a shorter and sicker life. Why would anyone want to?

Mr. Brown said...

There's really something shocking about the fact that it's the godless liberals who want to take care of their fellow man via universal health insurance and it's the followers of Jesus who oppose them. Even without doing the heavy theological lifting needed, something's very wrong with this picture.

If there was ever an issue on which Christians and unbelievers could make common cause, it's this one. But a vocal minority of American Christians love to be rugged individualists so long as they have health insurance; and they also make clear distinctions between the deserving and the undeserving. So discriminating love finds its way in the back door for a lot of folk when they consider whether they want their tax dollars to insure that others are insured.

Again, Mike, I hope you'll take up the challenge and do something on the theology of politics. Your friends in America will appreciate it.

Sean LeRoy said...

Mr. B,
I think it's a big stretch first of all to assume that it's love for fellow man that is at the heart of the lib's push for universal coverage. Think about it for a sec...(also, fyi look into the 'patient dumping' scheme in Chi-town and who's at the center of it).
Christians, like myself, oppose it because it's horrible policy and we strongly believe that it cannot ultimately deliver the goods. Add to this the fact that we believe God didn't ordain human gov't to be a service provider, but essentially a peace keeper, and it stands to reason why so many Christians oppose Obamacare. No one would disagree that reform is needed, however, the politicians in power have created the problem in the first place thru massive regulation. Why would you vote to give those same politicians more power, if they've not been faithful with the power already vested?!
Finally, I believe the theological perspective on this important issue springs from two foundational Biblical principles - work and freedom. I'll let you chew on the ramifications of that...

Tom said...

For some distinctively theological reflection on health care see:

http://pauljgriffiths.wordpress.com/2009/09/19/political-quietism-the-convertibility-of-the-transcendentals-healthcare-reform/

This bit of reflection is by a Roman Catholic theologian teaching at Duke Divinity School, but it seems to me a faithful way to orient the discussion. As Griffiths says, "This is not an argument. It is a picture." That is not to say that argument is unnecessary. But I think that rather than starting with the shape of the currently partisan political shouting match, it is helpful to get our ultimate vision as hitched up to something satisfyingly Biblical and theological.

Tim Ricci said...

As a Christian I am not opposed to helping the poor and needy, in fact, I believe strongly that as a pastor (youth pastor) my job is to take care of the needs of my entire community not just the needs in my own church.

My opposition to universal healthcare at the federal level is based on principle. The US is a constitutional republic and our constitution clearly enumerates the powers that are given to the federal government. Being a healthcare provider is not one of those powers. However, I am not opposed to individual states creating a state-run healthcare system for their residents. Constitutionally individual states have the right and power to do so if they would like.

Also, most Americans oppose universal healthcare because most are satisfied with their current coverage. There are reforms that must take place, but the answer does not lie in blowing up the entire system. They very poor and elderly are taken care of by state/federal programs. Most of the uninsured in the US are young, middle-class and just out of college.

Again, I look to the Church to step up and provide social services, not the government.

Blessings to you!!

Joe Rigney said...

Luke,

Part of the reason that costs of health care are so high is that there is a massive and expensive third party bureaucracy between you and your doctor. That problem is not solved by inserting an even bigger and more expensive bureaucracy in its place.

Second, saying that American health care is shattered seems extreme when you consider the health care in other parts of the world. Zimbabwe has shattered health care. Myanmar has shattered health care. A sense of proportion would be good.

And it's not the uber-wealthy who are opposed here (witness the uber-wealthy celebrities in the video above). It's middle class folks who are tired of their tax money getting wasted by politicians and bureaucrats.

And finally, we already do have to pay for the education of our children via taxes. And our neighbors' children. And I'm not sure what most kids get in public school can be accurately called an education anyway. If most Americans were told that they could spend the taxes that go to public education on education they choose, the public schools would empty in a flash.

Thoughts?

Joe Rigney said...

Mark G,

Actually I would argue that education should be a matter of private funding. It is parents who are supposed to bring up their children in the discipline and nurture of the Lord, not Caesar. (And I don't mean that you're required to home school; just provide for an adequate education).

The fundamental issue (in my mind at least) is the role of the government. As Sean said, should the government be a service-provider or a peace-keeper? And the lynchpin for me is that the government only acts through coercive force. Before the government can give something to someone, it first has to to take it from someone else. At the very least, Christians should be very careful about encouraging the use of coercion to promote the cause of love.

S.Cruver said...

This is why I like America. We have the freedom to choose to voice our opinions in so many creative ways even if we disagree or agree with the current administration. Here is video with a different viewpoint than Will Ferrell's. http://www.youtube.com/watch?v=LO2eh6f5Go0

Ross H. McKenzie said...

One issue that gets debated is about the quality of the current US system versus government systems elsewhere in the world.
I thought I might add my own limited personal experience and perspective. My wife is from the US and I lived for 10 years in the US. We had one child in the US and one in Australia. I would be the first to acknowledge that the US has the best university system in the world and that Australia's health care system has serious problems. Hence, I am not America bashing!

However, I find claims that the US health care system is the best in the world debatable, even for middle class families. When we had our first child in the US most decisions did not appear to be motivated by what would be best for the mother and baby, but rather what procedures and practises would minimise the chance of litigation (e.g., unneccessary proceduces and precautions), what could make the hospital money (e.g., billing for unnecessary services and products), save the insurance company money (e.g., discharge from hospital after 24 hours, incredibly breif consultations with the obstetrician where she stood with her hand on the door knob the whole time!) . Having the second child in Australia was completely different and so much more laid back.

The above issues only pertain to the efficiency and quality of the provision of health care to middle class families. The much more serious questions and issues are those about access and quality of health care for the poor and uninsured.