The Authority for Health Care

Back when the congressional debates over the healthcare bill were first raging, I noted that hardly anyone seemed to be raising perhaps the strongest reason to oppose any form of nationalized or government-directed healthcare. And the reason, I suggested, is that government—no matter what its good intentions—will never be able to resist the opportunities for social engineering that its control of healthcare offers.

I came under some attack, at the time—most of it in the form of a claim that the healthcare bill was trying only to change the way we pay for healthcare, not the social structure of the people using it.

Which was true enough, even if it missed the point. That point, however, has been sharpened by the HHS mandate and Catholics’ discussion of it. Perhaps, under sufficient pressure and adverse polling, the Obama administration will retract the mandate. Or perhaps some future administration will come in and take care of it. But we should also worry about what the ability to impose such a mandate augers for us all.

The best way to think about this may be through asking the question of authority. I’ve raised this topic before, with regard to my opposition to the death penalty, and received some interesting pushback, here at Catholic Vote, from Carson Holloway. Maybe he’ll find the suggestion I want to make here about authority more attractive, even though I think it derives from the same root. In fact, although at this point I’m only nibbling at the edges of the thought, the question of authority may be the way to embrace both the demands of Catholic social teaching and the deep American suspicion of governmental power.

The question, as I see it, isn’t whether we ought to care for the needy, the injured, and the ill among us. Of course, it ought to—and Catholic social teaching is abundantly clear on that. The question, rather, is whether the United States, as a particular form of non-Catholic government, has the authority to undertake these responsibilities. And, if not, whether we dare trust that government with the unauthorized power.

To that second question, the one about trust, I think the HHS mandate has clearly shown the answer: Allowed the power, every ruling regime—liberal or conservative—will tend to use it to compel moral conformity and punish disfavored points of view. Moreover, even supposing the best possible will, the very pressures and techniques of ruling will always tempt national government to use a power as strong and important as healthcare to weaken or abolish the authority of rival and non-governmental institutions.

To the first question, the one about authority in general, the answer is . . . well, I’m not sure. Note that I’m not speaking here of constitutional interpretation, like that we will shortly hear from the Supreme Court. That’s a question about how much authority the Founders (and our current understanding of our founding documents) believe inheres in our particular forms of representation. My question is rather the broader one—broader, the way Catholic thought is always broader, not narrower, than American political thought. Dare Catholic thought admit that the United States has, as one of many legitimate forms of non-Catholic government, the authority to claim to rule healthcare?

As I say, I haven’t thought this all the way through—but in it may lie an answer to the sneers of Catholic supporters of the healthcare bill. Yes, I’m a Catholic who understands, supports, and acknowledges the truth of Catholic social teaching. But I’m also an American who has, as Americans do, some deep libertarian and conservative suspicions about governmental power. And the way to square that circle is to take seriously the limits on authority that Christians as citizens should grant to the non-Christian governments that represent and rule them.



55 thoughts on “The Authority for Health Care

  1. Arlene says:

    Give the government rights over health care, then education, then banking and you will have a socialist nation with No freedoms including religion. I personally want to live in a country with freedom not a government telling how I will live my life and worship my God.
    No our health care system is not perfect but……we don’t deserve what is called Obamacare. Think about it. Why would any employer give any person or any one health insurance when an employer could just pay a penalty, cheap penalty, rather than have a whole department and monies and people to solve the problems with in house health care?. We will all have a form of Medicare. Does any one out there realize the mess Medicare is? How about the mess of the Post Office? How about the mess in the IRS? The American government does not run too many things correctly. I personally think it is too much power and greed!!

    1. Mike says:

      Arlene: I feel like I’ve been transported in a time machine. Is the specter of the Soviet threat still eminent? Where is McCarthy? You’re worried about the “socialist” treat? Do you all remember when presidents like Reagan pointed to West Germany as a beacon of Freedom that the East might emulate? Well, that beacon of Freedom and most of the rest of Western Europe had universal government mandated health insurance back then.

      You wrote: “Why would any employer give any person or any one health insurance when an employer could just pay a penalty, cheap penalty, rather than have a whole department and monies and people to solve the problems with in house health care?.” I guess you could ask yourself why would they pay for health insurance now. “Obamacare” is an old Republican idea- most of us on the left want something more substantial and cheaper.

      Don’t like Medicare? Most people do. Ironically many aren’t aware that it is a government program.

      Isn’t it worth asking, why so many people like government health programs in the US? Medicare is very popular. For veterans the VA Health system (government owned and operated hospitals and clinics) has a very good reputation, often beating outcomes in the private sector.

      Why is it that no democratic country wants to get rid of whatever form of universal care they have and get what we got? I think that you folks on the right are afraid- not of the care part of “Obamacare.” But that it will hurt your beliefs in the “free market” that has failed. There will be one more popular government program like Social Security and Medicare. And the right will have to try and scare citizens that the Democrats are going to take whatever they call “Obamacare” away like they do with Social Security and Medicare today.

      1. Joe M says:

        Mike. More government control of our lives is a more socialist view of government. There’s nothing outdated or irrelevant about that fact. You may choose to be ok with that type of system. That’s your choice. Many of us value the individual liberty that is given up in more socialist systems. That is a valid and traditionally American view. Your bringing Reagan’s talk about West Germany into this is misleading. Reagan was vocally against government involvement in healthcare. — Polls regarding Medicare are also misleading. Because government long ago created that system, many people have designed their retirement plans around depending on it. They feel like it is something that they have already bought. A more fair assessment of how people feel about Medicare would be to ask whether they would prefer Medicare or a replacement retirement plan of equal value from a private insurance company. Given the impending insolvency of the government, I’m pretty sure that most people would prefer the private company that is less likely to be cut down or simply vanish from existence by the time that they need it. — What is truly scary is that you think that government programs have a good reputation. When a joke appears on the show “Parks and Recreation” where a character says “It’s not government work unless it’s done twice!” everyone gets it and laughs. The efficiency of government is literally a nationally understood joke. I can’t speak for every conservative. But, I suspect that most of them are like me and do not have any fear of the merits of Obamacare. I AM afraid of the care part. If you aren’t aware of the abundance of complaints about quality of care in socialized systems in other countries, you simply haven’t looked very hard.

  2. Paul Nichols says:

    The problem is that with the Government “taking” authority, which is not the same as it being “given” authority”. Since you’re leaving the Constitutional issue aside, let’s just say the Government “has” the authority. The problem I see is that the Government WILL * WILL * WILL begin to make decisions on a person’s “worthiness” of care. At a certain age, will the Government say “You don’t qualify for extreme measures, so please go away”. Anyone who doubts that this will happen HAS to be, in my estimation, willfully ignorant.
    Because the Government does NOT have a “guiding morality”, if you will, whatever IT decides will be considered “right” and “moral”.

    Any Government with the authority to abuse it’s people WILL eventually do so. And once they have this power, there will be no option for us to appeal it’s decisions. The “death panels”, as we call them, will be looking out for the Government first, and the person second (if we’re that lucky).

    But it’s a difficult debate to navigate; as one person asked when I stated Obamacare was unconstitutional, “What, you don’t think people should have healthcare”? As IF that was the issue.

    1. Mike says:

      Isn’t that what happens already. If you have insurance, they pay up until your coverage runs out. Then private insurance dumps you on the public system. Does anybody reading this really think that private insurers or even Catholic hospitals will pay any amount for any service no matter what the odds are of survival? We have always rationed health coverage, only in the private sector it’s largely based on ability to pay.

      1. Joe M says:

        Mike. When insurance companies have to compete with each other to sell policies, there is pressure on them to provide the most coverage for the lowest price. That way, we can ensure that people are working hard to make the system efficient and cost effective. — There are dozens of examples of government performing poorly in comparison to private organizations. Cost per outcome of public vs. private schools. Wait times for time-sensitive medical procedures in Canada and the UK. Ma Bell vs. private phone industry. The DMV. — The government does not have a good track record in regard to maximizing quality and efficiency.

        1. Mike says:

          I’m all for insurance companies competing in a highly regulated marketplace (like in Germany as an example.) But again the US has the closest thing to a free market. Yet we pay about double and get arguably less in return. The market in the US (if there ever was a real free market) is broken. Wait times are also shorter in other

          You ironically tried to show earlier how bad cancer rates were with a study that put Cuba above the US. Again, you picked two countries that generally do have longer waits than the US, but other countries the right calls “socialized” beat the US in waiting times.

          Another irony is mentioning Ma Bell. As you may recall, Ma Bell was a private company that the US government broke up the Bell system monopoly and regulated the subsequent “baby Bells.” Without government action, much of the economy would end up with big winners like Ma Bell that could control prices.

          When regulated, or even owned by the government somethings can do pretty well. As much as people seem to hate the US Post Office, I’m still amazed that for a buck, I can send two letters anywhere in the US! BTW, if there are any Tea Party folks reading here: the founding fathers set up the US Post Office as a monopoly. I think at the moment the post office is being slightly subsidized – but they’ve more or less broken even for 200 years.

          In health care in the US there is a “socialized” example that works well: the VA. The Veteran’s Health system is owned and operated by the government. They have good outcomes at low costs. Why can’t we all get in on something like that?

          1. Joe M says:

            Mike. We pay more than necessary for health care. However, it is false that we get less in return. The systems you keep commending, as I have pointed out, cost less but also provide lower quality of care. The market in the US is broken BY government manipulation. For example, policies that compel employers to provide coverage. Instead of competing for every individual policy, insurance companies can focus on big employers and ignore the little guys. — As I pointed out above, even the researchers of the CONCORD study don’t believe that Cuba’s numbers are as good as you think. — Ma Bell was a government sanctioned monopoly due to the Communications Act of 1934. Essentially, it was a single payer system. And we all know how that went. Free market principles do not embrace monopolies. Whether they are publicly, privately or union created. — Talk about irony. The US Post Office is scheduled to close 252 of its 461 processing centers next month, to avoid bankruptcy. This was an organization that declared that over-night delivery was not feasible. It took private businesses to prove them wrong and provide what has become a beneficial service to society. — VA services are low in cost TO vets because the government subsidizes a lot of it. That doesn’t mean that the actual cost of the care is low. In fact, the subsidization of any care historically causes prices to rise faster than inflation. It’s common sense. When spending someone elses money, people tend to be less concerned with costs. And medical care providers certainly don’t mind raising rates without complaint or risk of losing business.

        2. Mike says:

          Joe: Also, I’m curious why there is no outcry to make other essential services private. Shouldn’t the military, police, and fire also be private? If you need their services and you have enough money, shouldn’t you be able to get to the front of the line for any of those services?

          And another thought regarding your comment: “The government does not have a good track record in regard to maximizing quality and efficiency.” As I see it, you folks (the right) put people into office that say government doesn’t work. If the don’t want it to than of course it won’t, they can make sure it doesn’t. But some things do work pretty well. Despite some challenges our public universities are among the best in the world, public or private. Other countries have healthcare that is better in many ways than what we have, and pay much less despite having government fingerprints all over it.

          I can admit that I don’t want government building iPods or sneakers – though in another ironic twist they are all made under a government that calls itself communist! But looking around the world, it’s hard not to come to the conclusion that whatever we got here in the US for health insurance, it isn’t working very well. If there were any other product, you’d be on my side. If you needed a car to go to work and you were on a budget, would you choose a Jaguar or a Honda Civic? Maybe the Jaguar is a little faster and has a better stereo, but it costs twice to own and operate and breaks down more frequently.

          Now that’s your choice. A private car is not a matter of life and death. And when you have a breakdown in your Jag, you can’t drop it off at the mechanic and force them to fix it even if you don’t have any money. But healthcare is in fact different. Nobody knows for sure when they’ll need care. They might not be able to shop around for it. And it can be a matter of life and death. And you are pro life right?

          1. Joe M says:

            Mike. The concept of limited government is not a promotion of no government. Conservatives agree that some government is necessary. Privatizing the military or police could jeopardize the ability of government to ensure rights and fulfill duties defined in the Constitution. — I hope we all agree that people at large are not perfect. There is corruption on both sides of the aisle. Us people (the right) say that government should be limited, partially because corrupt people can do less damage when they have less power. You people (the left) keep saying “Trust us. We’re going to do this better next time.” But, time and time again, “next time” is worse than before. — I agree that the system is broken. It seems that we just disagree about the nature of the problem and how to fix it. Personally, I am very happy with the quality of health care that I get. I wouldn’t trade the quality of care I get for any system in the world. Honestly, I suspect that even the single payer advocates like yourself, deep down, aren’t really sure that they would prefer UK care over what they have in the US. What I am not happy about is the cost that I pay for the care. I don’t mind paying more than anywhere in the world for the best care in the world. It should just be brought down closer to inflation. And that can be done by removing government manipulation.

          2. Mike says:

            Joe: You wrote “And that can be done by removing government manipulation.” But problem is we have less government manipulation here. All the examples of where things work better have more government “manipulation.” We get less, cover fewer people. I’m not sure how anybody could claim that we get better care on the whole, we score pretty poorly. I don’t have lots of experience directly with health care in the UK. But I do have relatives there (one of my wife’s cousins kids had leukemia, another cousin has type I diabetes.) I did go to school in Central Europe many years ago. In fact I’ve spent alot of time with doctor students at one point. One complaint I heard from one of them is that they were required to make house calls. Imagine getting your doctor to come to your house here! I’ve used only minor services myself (eye doctor once, and a quick blood test.) I have visited others in Central European hospitals, and they seemed much nicer than my experiences here (nearly empty waiting rooms for example.) I’ve never ever, ever, ever talked to anybody who thought that the US healthcare system was what they wanted.

          3. Joe M says:

            Mike. The evidence does not agree with you. For example, the CONCORD study shows that if you get cancer in the US, you are more likely to be alive in 5 years than if you were to be treated for the same disease in another country. You cited Cuba’s placement in that study to try and support your argument. Now, you’re going to turn around and deny the validity of the entire study? — That we might have less government manipulation in the US does not mean that that manipulation is not damaging to costs. The evidence that it is damaging cost is clear. Health care costs are increasing at a higher rate than the costs of other goods and services that are not as regulated. This is a measurable fact.

          4. Mike says:

            Joe: as best as I can tell all you can do is cite small selections of one medical journal and pick the handful of places where the US is near the top. Choosing one study covering one disease where the US does well doesn’t seem very useful. To use the car analogy from my previous post: you could make the case for the Jaguar because JD Powers said that in the first month it scored highest in customer satisfaction. If you need something dependable and on a budget, you might look at the overall reliability rate and cost of ownership. If you are rich, a Jaguar and the US healthcare “system” are both good. Then again really rich people get good health care in the third world too.

            The Lancet Concorde study also concluded:

            “USA radiologists recommended universal health care as a critical part of health care reform; one respondent stated “failure to provide basic health care insurance to all citizens is an inexcusable moral failure”. This mirrored recommendations by the non-USA radiologists; 16 of 18 (89%) non-USA respondents recommended that the USA move to a universal health care system.” Not that I’d expect you to point that out.

          5. Joe M says:

            Mike. The CONCORD study offers the most comprehensive set of data available on this issue. And the US is not just on top in a handful of places. As I pointed out, they are either at the top or within 3 places of the top on EVERY category. They are within the margin of error for France and Cuba’s data is thought to be wrong by the authors of the study themselves. There are other studies that show the US on top for treating other common diseases as well. The evidence does not support your claim that health care in the US is of poor quality. — The problem with your Jaguar story is that the study includes people diagnosed with all levels of insurance. — Health care can be provided universally without a single payer system. As I pointed out to you in another thread, conservatives have been consistently proposing such systems as far back as Nixon.

          6. mike says:

            CONCORD is for one only about cancer. Though an important disease, cancer is not the most common killer. And if you dispute the top two results and want to keep pointing at number three what’s the study worth? Of course not all the other systems are single payer, “Obamacare” for example is not single payer. Nor is Germany or I believe the majority of other countries that provide universal access. The conservative answer was “Obamacare” before. But can you point to anywhere on the earth where the “Nixon plan” you point to (vouchers or other gimmicks) results in universal coverage?

          7. Joe M says:

            I’m not disputing the results of the study, I’m citing them. The poor data from Cuba and the margin of error for France’s data are PART OF THE STUDY. — Different presidents have had various plans to address the same issue. McCain proposed a tax credit (many called a voucher at the time) for every person to use toward paying for a health insurance policy. — In what way do you think that would not result in universal coverage?

          8. mike says:

            Joe: you wrote “You cited Cuba’s placement in that study to try and support your argument.” No I didn’t, it just seemed to debunk yours. You said the US is better at (a narrowly selected set) of cancer outcomes than Europe. YOUR study had Cuba at the top of that list, followed by France, then the USA.

          9. Joe M says:

            Mike. The study does show that the US, over-all, performs better at treating cancer than any other country tested. The only cherry picking of data from the study going on here is coming from you.

          10. Mike says:

            Joe: care to print a list of who fares best at what? You’ve only mentioned cancer so far, but as you well know there are thousands of ways people can die. And on the whole they die later in similar countries that have some sort of health system than here.

          11. Joe M says:

            Mike. No. I don’t think it’s necessary to print a list of other outcomes. Mainly because it’s a ridiculous idea to rate higher a system that doesn’t treat cancer as well as another. What are you saying? That Europe is behind on cancer treatment but really good at treating the flu? Cancer isn’t some obscure thing. It’s one of the leading causes of death.

          12. Mike says:

            Joe: you wrote”The only cherry picking of data from the study going on here is coming from you.” So where’s your data for all diseases?

        3. Mike says:

          The truth is insurance companies compete to drop the sickest people ASAP and keep the healthy. They did that until we wrote laws to prevent that from happening.

          1. Joe M says:

            Even with problems regarding uninsured people included in the data, statistics show that our system measures at either the best or near best in the world at delivering quality of care. — If forced to choose, I would rather my children have a lower chance of dying of cancer AND paying too much for health care. Apparently, you prefer the other way around?

          2. Mike says:

            So you are only afraid of cancer? You and I and our kids can die of all sorts of things. On average, we are worse off here. Depending on which cancer we’re talking about we could be better off being treated in Japan, Cuba?!, France, Canada, etc. On the whole however, the US falls far behind and pays MUCH more. Just a fact. You can keep pointing to a couple of parts of one study of one disease all you want. Step back and look at all the numbers and we don’t look good at all for lots of things.

          3. Joe M says:

            Mike. I’m confident that cancer results are indicative of over-all quality of care since it is one of the leading causes of death. In order to buy into your position, you have to believe that in other systems, hundreds of thousands of doctors collectively forgot to focus as much on cancer as the deaths from it warrant. — And lets not lose perspective here. As your argument has fallen apart, you’ve been moving the goal posts. You’re now suggesting that unless the US is number one of all countries in every category, it must not be good quality of health care. However, that is to ignore that even if the US is #3-#4 in some categories or over-all, it’s still doing better than the vast majority of government run systems that you prefer.

  3. Everett says:

    Joseph, thank you for this excellent reflection. It better articulates some of the thoughts I’ve been trying to nail down for myself, in regards to both authority and trust.

  4. Mike says:

    You wrote:”And the way to square that circle is to take seriously the limits on authority that Christians as citizens should grant to the non-Christian governments that represent and rule them.”

    Catholics pay for all sorts of things they may disagree with, just like everybody else. Your and my tax dollars fund wars, weapons, the death penalty. Yet instead of uproar, some of these anti-Catholic policies get applause from many Catholics and endorsement from Should gays be exempt from paying for government programs that go to children’s health or schools? Of course not. We’re a democracy not a theocracy.

    And of course most Catholics already use artificial birth control- so we might ask what life might be like under a Catholic government that you mention? What if American Catholics had their contraceptives banned under a Catholic government. There are only a handful of officially Catholic countries. And ironically in some of them artificial contraception use is higher than their non-officially-Catholic neighbors. The list of high birth rate countries is a who’s who of poverty and disease- where the list of low birth rate countries includes the wealthy democratic Catholic majority countries like France, Austria, Italy, Spain. I have a hard time any American Catholic would want to live under a Catholic Government.

    1. Djohn says:

      You fail to understand a simple distinction, Catholics Pay taxes, these taxes may indeed be used to pay for things that we, as Catholics, find morally objectionable, say funding Planned Parenthood and other institutions of child murder. However, these Taxes are taken by the state under threat of force ( as all taxes are) and Catholics are required to render them up as giving to Caesar what is Caesar’s. The only option other than doing so is revolution. However, this requirement is a fundamentally different kind of thing. This requirement forces people to enter into a personal contract, and it requires faithful Catholics to enter into a personal contract which includes things which are morally abhorrent to them. This is not paying taxes to a state which then does objectionable things, those objectionable things are out of the ability of the individual to stop, and do not require individual participation. The paying of Taxes in and of itself is not evil, despite what my be done with them. However, entering into a contract which produces evil is a direct participation in that evil. For example, I pay my taxes, the State may choose to have someone assassinated, this using my tax money, however, that is quite a different thing than e, as an individual taking out a contact for someones assassination. Obamacare is the analogous to this example, taxes may be used for abortions, birth control(title X) etc, BUT this requires individual Catholics to do it, and that is not the same.

      1. Mike says:

        @djohn: How is “Obamacare” different from you paying federal taxes that you know go to pay for the war machine. You don’t have to pay for abortion coverage, only contraception. Why no uproar over the war infrastructure? Catholic (and everybody’s) tax money in 100’s of Billions of dollars is spent every year on the military. The military is by its nature designed to “break things and kill people.” What are you doing to stop your money going to the military? 90 birth control pills will likely prevent one pregnancy from ever happening. One nuclear weapon could end in the deaths of hundreds of thousands of living breathing human beings. We pay for that too!

        1. DJOHN says:

          Mike— my entire post was dedicated to explaining to you how exactly it was different, in one case I am doing something which is morally permissible, paying taxes, and those taxes may or may not be used in a just manner, however, paying them is not immoral, and not paying them requires the willingness to be imprisoned or die ( which is always the states solution to resistance). This is not the same at all. This requires one to do something which is directly morally objectionable, contract for morally objectionable activity. Do you not see that distinction? And Plan B is required to be covered, if you believe that life begins at conception then this causes an abortion, as it prevents implantation.

          Also Catholic Church is not Utilitarian, the rights of the many do not out way the needs of the few, or the one. It is not okay to kill one innocent person to save another innocent person, it is not okay to kill one innocent person to save a million people. It is never okay to actively cooperate in evil, whatever you might believe the positive effect might be.

    2. Joseph Bottum says:

      Um, Mike, not sure where you got this. Yes, Catholic governments–i.e., confessor states–would have their own problems and their own questions of authority, different in certain ways from the problems and questions of modern democracies. So? What has that to do with what I wrote?

      It’s a little weird to be accused of promoting theocracy in a note about whether the logic of political theory ought to make us want to limit government–and limit government in a way that is not, on its face, a direct teaching of Catholic social theory (which, generally speaking, likes government).

      But, just to reiterate, let me state my thesis again: I think the modern democratic state lacks the logical authority to impose the death penalty, and I’m beginning to think it also lacks the authority to direct American healthcare, for related although not identical reasons.

      1. Mike says:

        @Joseph: Of course you know we already do “direct” American health care now. Millions of Americans get care directly from government agencies (like the VA or Indian Health) or have services paid for in full or part by Medicare, Medicaid, or the plethora of patchwork agencies that pay for the poor, indigent, and seniors in this country.

        Just a funny reminder of how silly some of this stuff gets: an elderly relative of mine literally said “get the government out of my medicare” back in the Clinton days.

        All in all government involvement in healthcare seems to work quite well (look at life expectancy and costs for the rest of the rich world.) Maybe we can look at where government doesn’t work well.

        1. Joe M says:

          Mike. By what measure do you think that government involvement in healthcare seems to “work quite well”? It’s true that outcomes are better in the United States than many other modern nations. However, those modern nations have MORE government involvement, often single payer systems. That evidence suggests that government involvement is making healthcare worse than it could be. In terms of cost, healthcare in the US has become more expensive at a much higher rate than inflation. This indicates that extra-market influence is causing us to pay a lot more than necessary. — The evidence suggests that government involvement in healthcare has been a disaster.

          1. Mike says:

            @Joe: It isn’t true that outcomes in the US are better than in most of the first world, at least in totality. If you look around the world, to the EU, Canada, Australia- on average everybody spends much less and lives slightly longer than the US. Is that not proof enough?

          2. Joe M says:

            Mike. Life expectancy is not a logical measurement of healthcare quality. A multitude of personal decisions and social patterns that have nothing to do with healthcare affect life expectancy. For example, violent crime, over-eating, smoking, participating in war, etc. — A logical measurement of healthcare quality would be the success rate of treatment for common diseases. For example, cancer survival rates in the US are significantly better than in single payer systems. And that’s including the people who have no insurance in the data. If you get cancer in the UK, Canada or Australia, your odds of being dead in 10 years is higher than if you were to have the same disease in the US. That is far more telling about the comparative quality of systems than life expectancy.

          3. Mike says:

            @joe: Life expectancy wouldn’t be a logical measurement if it were just for one small sample. But since the list of countries that lives longer than the US and pays less is so long and diverse, it seems pretty obvious that a system of some sort is really paying off. That could range from the most government control, like the UK and Scandinavia down to something similar to “Obamacare” (with individual mandates) like in Switzerland or Singapore. How is it that a list of 30+ very diverse countries can beat us? If I had the time, I could look up smoking rates for example, but I have a hard time imagining we smoke more then the French, do you agree?

            As for living longer in the US, I’m guessing you’re referring to a study by a right wing health advocacy organization “Health Affairs” that’s been debunked (it was partially funded by the cancer drugmaker Bristol-Myers Squibb FYI.) The author was Thomas Philipson. “Philipson is a fellow at the conservative American Enterprise Institute and at the Manhattan Institute, served in the administration of President George W. Bush and was a healthcare adviser to Sen. John McCain’s 2008 presidential campaign.” One quote about that study from Reuters: “This study is pure folly,” said biostatistician Dr. Don Berry of MD Anderson Cancer Center in Houston. “It’s completely misguided and it’s dangerous. Not only are the authors’ analyses flawed but their conclusions are also wrong.”

          4. Joe M says:

            Mike. Your explanation of life expectancy still doesn’t make logical sense. That there are some countries with longer life expectancies than the US is unremarkable since any number of social patterns being part of ONE country (the US) could be responsible for the difference. For example, diet could account for Japanese people tending to live 3 years longer than Americans. — The study you refer to is not the one that I am familiar with. There have been multiple studies of cancer survival rates that reach the same conclusion. For example the work published in the peer reviewed medical journal Lancet Oncology or the CONCORD study. Even if the study you refer to was my source, that it came from a conservative and someone else thinks it’s “folly” is not an example of “debunking” it.

          5. Mike says:

            Joe: why not? Japan is one example, but there are about 30. Those countries vary from very homogeneous to very diverse. From warm to cold climates. Are there not enough social patterns in all of those countries to make a reasonable assumption? I’m not sure what more proof you could ask for. Also, it would seem logical if other countries were willing to pay as much as we are, they could get even better care, right? Perhaps they could live much longer than we do?

            As for the most recent news story about cancer survival rates, I consider it advertising not news. It was paid for in part by a company that makes expensive cancer drugs that were part of the story. And the authors of the study are noted proponents of free market solutions for health care. Neither of those points were disclosed in many of the news outlets covering the story.

          6. Mike says:

            Joe: BTW, I just did a quick lookover of the Concord study. Interesting you should use that as an example. Of course there’s lots of debate about how useful it is anyhow. But who scored better than the US in the Lancet study YOU MENTIONED? The US did very well but was beat by Cuba in several instances. Hmmmm, sure you want to cite that story?

            Also, Hawaii, the only state with an EMPLOYER MANDATE has the best cancer survival rates in the US.

          7. Joe M says:

            Mike. From the CONCORD study, regarding Cuba: “The 5-year survival estimate for Cuba was 84·0%, but this was likely to be an over-estimate: some 28% of records were excluded because they were registered solely from a death certificate.” — Quality of health care in the US is not the problem. Cost is. It’s not surprising that Hawaii has high survival rates since mandating employer coverage has the effect of inflating costs. Thus, medical services are lucrative business there (not to mention the attraction of living in Hawaii), attracting skilled doctors and motivated medical service professionals. The downside is that the lack of competition in the health care industry, only worsened by employer mandates, has inflated the price Americans pay for care to unsustainable levels.

          8. Mike says:

            Joe: You cited the study, not me. The US wasn’t #1, just close. And Cuba “beat” the US in some cases. France did too, are they fudging numbers too? At every step you seem like you are coming up with some small excuse why your side doesn’t fare well. If you step back and look at systems as a whole. Why not look at infant mortality, diabetes, life expectancy?

            The Lancet study you cite also acknowledges: Cancer survival is a valuable indicator for international comparison of progress in cancer control,despite the fact that part of the variation in cancer survival identified in this study could be attributable to differences in the intensity of diagnostic activity (case-finding) in participating populations. That’s to say that there is a “lead time bias” that favors aggressive detection that in the end does not extend life.

            Hawaii’s per capita health expenditures are almost identical to the US average ($6,856 vrs $6,815 average, 2009 stats.) I just got back from Hawaii last week, and most everything is more expensive than on the mainland, yet healthcare is within 1% of average?! Not bad, eh?

          9. Joe M says:

            Mike. You were the one who cited the Cuba portion of the study. Not me. I didn’t make an excuse. I pointed out that the authors of the study believe that Cuba’s result shows higher than it really is. Don’t you think that fact is relevant to your claim that Cuba is #1 in the study? — By what definition does this study not show the US “faring well”? Even if we buy that Cuba did better at treating one type of cancer, the US still does better on average at treating all cancers combined. Hardly the picture that leftists try to paint of the US system offering low quality care. — France did well with some types of cancer. But, was behind on others. The US was either at the top or within 3 (probably 2 given Cuba’s poor data) on every chart. Also, the US was within the margin of error for France’s data. So, in fact, the US could be ahead of them in those categories as well. Again, not the doom and gloom scenario of poor quality you apparently believe. — I’m not sure what you’re trying to say with your “case-finding” point. Yes. Aggressively detecting helps. And apparently, that isn’t as much of a problem in our private health care system as it is places where they apparently do house calls. Perhaps wasting a doctors day driving to one patients house doesn’t help as many people detect cancer as multiple patients being able to see them that day at an office. — Hawaii’s healthcare cost would be something to brag about… if it weren’t increasing each year at several times the rate of inflation, just like the rest of the country. This is a national problem. Not a state problem.

          10. Mike says:

            Joe: As for Cuba, if you want to say how great the US is at healthcare and offer up a study that cites Cuba as beating the US in at least one category….seems you invited that. Seems to me that countries that do housecalls (actually, I only have personal knowledge of one but understand there are others) end up living longer on the whole. If your supposition is that less government intrusion results in better overall results, again why is it that there is a long list of countries that some of you keep branding “socialist” that live longer than we do and pay half? And we don’t even need to go abroad to prove that government involvement appears to have good results at better prices. Look at the VA. Or you mention Hawaii- they top the study you point to and have a government mandate that employers pay health insurance. Shouldn’t it be the opposite. You’d expect that the freest of free market states in the US would have the best results according to you, but it’s the OPPOSITE. Why isn’t it a bright red state that’s got low cost and great results? Is there an example in the US of a state that beats, say France on OVERALL outcomes and price? Why not?

          11. Joe M says:

            Mike. Now you’re just making the same arguments that I have addressed ad nauseum. No matter how many times you bring up life expectancy, it will still be a poor measure of healthcare quality, for the same reasons that I gave you. If you adjust for murders and fatal accidents (let alone other non health care events/decisions that effect life expectancy) the US life expectancy is the highest in the world. — My supposition was not as you describe. Government intrusion can have different results depending on the nature of the intrusion. In some cases it can inflate costs. In other cases it can harm quality of care. — Again, the data does not comply with your assertions. Hawaii is consistent with my argument. It has good quality of care at too high of a price. That is the same problem across the nation. By what logical connection do you think that an employer mandate changes the quality of cancer treatment in Hawaii? Do you think doctors do a better job depending on who pays for their bill? Your argument makes no logical sense. — And why didn’t you ask yourself the same question you pose to me? If government control of healthcare is so great, how come every one of those countries performs worse than the US over-all in treating cancer? Is a system really good if it gives housecalls but can’t keep you alive as well when you get cancer? If government control of healthcare is so great, how come the states that perform the worst aren’t all red states? Bright blue New York is consistently the worst performer in quality and cost. In fact, the entire liberal North East pays more than the rest of the country. — Maybe you should explain the problems that appear for your argument when you ask those questions.

  5. Djohn says:

    I get really tired of hearing from Liberal Catholics about Catholic Social teaching, since most of them seem to have never actually read the documents that such teaching is based on. The American government is not a Catholic government, and as it funds the murder of the defenseless in its own country, one would be hard pressed to argue that it has any authority at all. It has power, not authority, I opposed the Healthcare bill simply because it was a violation of human dignity, it FORCES people to enter into contracts with private companies, that is fascism plain and simple. But the fact is that the American government is not trust worthy, the HHS mandate is just the latest example.

    The civil government divorced from the Church does not have this kind of authority, and never can, the positions that it does are defined errors and heresies, yet we continue to have these kinds of debates and the Bishops often support legislation which clearly goes beyond the civil governments authority.


    1. Mike says:

      @Djohn: you wrote:”it FORCES people to enter into contracts with private companies” and attributed that to liberal Catholics. But the notion of forcing people to buy PRIVATE insurance is a conservative one. The RIGHT came up with the idea (Republicans and the Heritage Foundation.) Much of the left wants the system to look like Canada, UK, Scandinavia etc where funding is public and comes through tax dollars. Of course “Obamacare” ins’t fascism- that’s a term that extremists use against governments they don’t like.

      1. Djohn says:

        First, I will make the very controversial statement that there is no “Right” in the United States. the Republicans are not the Right, they are just a different kind flavor of Left. But that is neither here nor there.

        Fascism economically speaking, is predicated on the union of private property and the interest of the state, normally (but not necessarily) this is the union of Corporate interest and property and state needs. A legal mandate to purchase a private product under penalty of law is virtually a textbook case of Fascist policy. It is no different than criminalizing strikes or lockouts, it is a subjugation of the private market for State needs and the “general welfare”. The union of corporate interest and state interest is a absolutely fascist ideal. Try reading some about the Fascist movements.

        This is not like eminent domain which takes something once for the price of the Market (at least in theory) this is a general, permanent usurpation of the rights of persons to make decisions and administer their personal property, and even their life, in the name of state interest.

        I am not using Fascist as an epithet I am using it because that is what Obamacare is. We have a distaste for the word because of the Nazi’s but I did not say it was a Nazi policy, I said it was a Fascist one, that’s because that is what it is.

        1. Mike says:

          Are you trying to equate “Obamacare” with fascism? Seems like quite a stretch. The victims of fascism now all embrace something similar to “Obamacare.” Obama, a black man, was by that fact out of favor with the fascists I’m familiar with. Those who fought European fascism, from the Jews (in today’s Israel) to the British and most everywhere in between all have a form of universal health care. If universal health care is fascism maybe fascism isn’t so bad. But I’m pretty sure you don’t have the right definition of fascism.

          Does that make me and the pope fascists too? We (the pope and I) both think that “moral responsibility of nations to guarantee access to health care.” Should he have said individuals instead of nations? That would be more free market friendly. But then again the actual policies of the church are pretty anti capitalist to start with. Sounds like Catholics on this site don’t like church policy very much.

          1. Djohn says:

            Your lack of understanding of fascism is understandable, it has been demonized in our culture since WWII, that is not to say I approve of it, but that it is often misunderstood. Being black has nothing to do with being fascist, there have been plenty of Fascist in Africa. Fascism is an economic system, this system takes a lot from the left and a little from the right (fascism is a net left system) and is based on the union of private property with state interest. Whereas a socialist would simply single payer the system, and a far left socialist or communist would just nationalize the system and directly incorporate it into the governmental structure, fascist see the advantages of private enterprise and do believe in some level of right to ownership, simply not to control of what you own. In this case the government is demanding that all persons purchase something from private firms which are regulated by the government, this keeps the profits in the private sector, and administration in the private sector, outside of direct governmental control, and subsumes the private interest for the state interest.

            Lets take a look at the system — The Insurance Corporations are guaranteed profits by the government, refusal to participate in the program is met with repression (tax penalties, which like all tax penalties will be met with force if refused to pay) and the corporations serve the interest of the state ( mitigating cost in healthcare). They fall in line, do what they are told, behave themselves and the large stockholders and corporate heads get rich, by government mandate. This is classic fascism.

            By the by, the bail out and partial takeover of Wall Street was also fascist. The Car manufacturers I am not sure, that smacked more of symptom socialism to me, but giving the companies back makes it lean to fascism…. I am iffy about that.

          2. DJOHN says:

            Further, your attempt to associate the Holy Father with fascism is a terrible attempt to discredit the idea. First this is certainly not the only way to achieve universal healthcare, it is just the fascist way. Second, we already have universal health care for all forms of care that the Church says one has a right to… i.e. catastrophic care. Third, I would ask you for a Epistle or Bull in which his Holiness made any such demand.

            But to answer your question directly, fascism was a big hit in the world in the 20’s, people in Britain, the US and many other countries saw it as a very viable alternative to communism and socialism, a way that private property could be maintained and the workers could be calmed dawn and given a decent life. It was willing to make concessions to other interest, recover from economic disaster and get the trains running on time. All it demanded was a totalitarian type of state, but not so totalitarian as the Leninist. During the Cold War many of the Fascist policies were incorporated in the west, They were expedient and effective. Eisenhower made a point of warning against these policies taking over the government.

          3. Mike says:

            You all seem to dance around the actual words of the pope: “moral responsibility of nations to guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay.” He said NATIONS, not individuals, or some other entity. For the left, there is little interest in private insurance for example.

            And funny you should mention Eisenhower. He oversaw the American occupation of Germany. Correct me if I’m wrong, but Germany had continued its health insurance system (the one that had been around since Bismark) under American Occupation. I seem to recall that Eisenhower’s critique was largely of the military industrial complex, right? Did Eisenhower ever critique health insurance, like that Pope Benedict received under American occupation?

          4. Djohn says:

            Mike, having a discussion with you is like discussing Scripture with a pentecostal, You have already decided what you think things mean and God forbid anything challenge that. But I’ll play your game.
            Fine NATIONS have to provide healthcare. France, Spain, Germany, all must, according to the holy Father,provide for access to healthcare. The US however is not obliged to do anything of the kind, not, if, as you say, NATIONS must provide it, because the United States is not a Nation, it is not even a union of many nations, there is not a single State in the Union that would , currently, qualify as a Nation. Nation’s are ethnically unified groups of people. The Gypsy’s are a Nation, without a State to be sure. However, according to your interpretation of the Holy Fathers statement, they are obligated to provide healthcare for all the other Gypsy’s, however, Alabama is not, because it is not an tight nit ethnically unified group. You are sure that the Holy Father used Nation to mean that NATIONS are obliged to do so, then arguably, Nation-States would also be so obliged, so I give you many European country’s might have that obligation, as might China, but not the US, nor India, nor many other Countries.

            Are you sure that NATION was such an important word in his Holinesses statement? I mean if he chose his words so carefully that this excluded individuals, or other entities, AS YOU CLAIM, then I can only assume it was a deliberate choice on his part to make sure the Gypsy’s provide for their own, as should the Comanche, but not say, New York.

      2. Joe M says:

        Mike. Who came up with an idea does not designate whether it the idea is right or left. Increased government involvement is an increasingly leftist solution. A law forcing people to buy insurance is left of the level of government involvement we currently have.

        1. Mike says:

          Joe: left or right, seems that increased government is part of the solution for health care. At least if the goal is cutting costs and increasing life expectancy.

          1. Joe M says:

            Mike. As I’ve pointed out, extra-market influences are making health care more expensive than it should be and life expectancy does not correlate well to quality of health care.

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