Over at PrawfsBlawg, Rick Esenberg responds to my question about Bishop Nickless's statement regarding the importance of defending the private sector in health care. Rick comments:
Rob asks whether Catholic Social Thought actually claims that "a flourishing private sector" is the predominant concern when it comes to a society's provision of health care? "
If the question is put in that way, the answer is "no.' It is not the "predominant concern" although, in fairness to Bishop Nickless, I am not sure that he claimed it to be. He did say that it was the only way to prevent a "top down" rationing of care and CST does suggest that we be skeptical of that type of decision making. This, I think, is what may cause him to say that any bill that undermines the viability of the private sector is suspect.
As I suggested last week, subsidiarity is premised, at least in part, on the subjectivity of individuals and the associations that they form. The state is to empower and facilitate - rather than stifle - human agency and creativity. While this is cannot be read as an uncritical endorsement of markets or a rejection of the need for state regulation and even intervention in their operation (there is much criticism of unbridled markets in CST and robust support for assistance to the poor and to the weak), flourishing private markets are a way in which human creativity is expressed. There are, it seems to me, an almost infinite numbers of ways to control costs and to socialize (or insure) the cost of care. Choosing among them will almost certainly affect incentives to innovate. The notions that the state can choose the "best" form of insurance (mandating coverages and setting limits) or specify the conditions for optimal innovation seem rather dubious and, beyond that, restrict the subjectivity that is at the heart of subsidiarity (and, I would argue, solidarity).
This doesn't mean that the Obama health care plan (whatever it turns out to be) is inconsistent with CST or that current arrangements are not, by its lights, in need of reform. Large numbers of uninsured rests very uneasily with the premises of the Church's social encyclicals. But I think it does suggest why a "flourishing private market" is, if not the predominant concern, an important one.
Rick's insights are sensible, but I still wonder whether we are too quick to assume that CST embraces a market approach to health care. (Has the Church criticized any other countries for their state-run health care systems?) Obviously, CST opposes a market in the sale of human organs, as the commodification of such goods defies human dignity. I don't think the sale of health care is equivalent to the sale of human organs, but it's also not exactly like the sale of tires. The American tendency is to take a very narrow view of the category of "needs and common goods that cannot be satisfied by the market system." (Centesimus annus) To be clear, I'm not rejecting the practical importance of the market when it comes to health care; I'm just hesitant to claim CST's imprimatur.
Monday, September 21, 2009
I'm quite sure that I do not know how to solve the problems we have in this country regarding access to health care; I'm also pretty sure that the bishops don't know how to solve the problems either. (Nor do I expect them to know.) I find the statements of individual bishops on the topic to be interesting, primarily because their views often appear to be shaped by their own cultural or political views as much as by Church teaching. Take, for example, the statement of the Sioux City bishop, R. Walker Nickless:
[T]he Catholic Church does not teach that government should directly provide health care. Unlike a prudential concern like national defense, for which government monopolization is objectively good – it both limits violence overall and prevents the obvious abuses to which private armies are susceptible – health care should not be subject to federal monopolization. Preserving patient choice (through a flourishing private sector) is the only way to prevent a health care monopoly from denying care arbitrarily, as we learned from HMOs in the recent past. While a government monopoly would not be motivated by profit, it would be motivated by such bureaucratic standards as quotas and defined “best procedures,” which are equally beyond the influence of most citizens. The proper role of the government is to regulate the private sector, in order to foster healthy competition and to curtail abuses. Therefore any legislation that undermines the viability of the private sector is suspect.
Does the Church actually teach that "a flourishing private sector" is the predominant concern when it comes to a society's provision of health care?
Thursday, September 17, 2009
Is the National Right to Life Committee engaging in scare tactics? I was disturbed to read that the Baucus bill "will gravely endanger the lives of America's senior citizens." Then I read the analysis:
With respect to rationing, the proposal contains a Medicare provision that, beginning in 2015, would severely financially penalize physicians who are in the top 10% of medical resource use. This provision does not link funding to outcomes or quality; instead, it will force a "race to the bottom" with relentless pressure on doctors to limit health care for their older patients. On top of the significant Medicare cuts in the bill, this will gravely endanger the lives of America's senior citizens.
The bill does contain language to prevent the use of comparative effectiveness analysis in a manner that would discriminatorily deny treatment because of age, disability, or terminal illness; however, this language would not affect the financial incentive to ration care as described above.
Does this mean that, in order to satisfy "pro-life" concerns, we have to ensure that medical providers do not have any financial incentives to limit the expense of the care they provide? Does our current system of health care avoid such financial incentives? If not, why is the NLRC applying a more stringent standard to the government? Or is it a more stringent standard applied to whatever reform is favored by President Obama in particular because the pro-life community does not trust him?
When I think back to the condition of the dormitory bathroom that I shared in college, I still shudder a bit. I haven't checked, but I'm pretty sure it was designated as a Superfund site shortly after graduation. We may not have cleaned it regularly ever, but we shared it, for better and for worse. I don't know if Catholic legal theory has something specific to say about the new trend in dormitory luxury hotel living on college campuses, but I'm pretty sure Charles Taylor would be concerned. Privacy and luxury are the two essentials. Millennials -- facilitated by their boomer parents, I might add -- apparently place a premium on both. (I probably would have too, but nobody gave me the option.) As one 19 year-old student explained, "I've never had to worry about anyone else . . . I've always been alone."
Tuesday, September 15, 2009
In response to my post about Kanye West, Marc DeGirolami adds:
In addition to the self-creation angle, I wonder whether “being real” is now a justification (or maybe only an excuse) for various sorts of vice that might coincide with brutal honesty. Rudeness, arrogance, even cruelty – all are justified so long as one is being truthful or telling it like it is. For a society that seems sometimes to have such difficulty with the presumption to know ‘the truth’ (scare quotes!!), this seems an unexpected development. It also may belie the studied artificiality (i.e., the not “being real”) that is necessary to preserve and foster many types of social relationships, which may actually be quite fragile and unable to withstand honesties that are delivered with brutality.
David Brooks offers a nice reflection on the "line of narcissism" we've crossed as a culture since World War II, exemplified in recent days by Rep. Joe Wilson, Kanye West, and Michael Jordan. Brooks overstates things a bit, asserting that "Humility, the sense that nobody is that different from anybody else, was a large part of the culture" back then. I'm pretty sure that's a stretch. But his broader point is insightful. Our sense of identity is wrapped up with a perceived need for self-creation, self-expression and distinctiveness. (As Kanye explained after he crashed the stage, "I'm just real.") I don't think the law has driven this cultural shift, but it certainly has not stood in the way, and at times has added its eloquent imprimatur.
Monday, September 14, 2009
In light of our recent conversation about Christianity's debt to Kant, we might find helpful Purdue philosophy prof Patrick Kain's recent paper, Kant's Defense of Human Moral Status. Here's a summary:
The determination of individual moral status is a central factor in the ethical evaluation of controversial practices such as elective abortion, human embryo-destructive research, and the care of the severely disabled and those in persistent vegetative states. A review of recent work on Kant reveals the need for a careful examination of the content of Kant’s biological and psychological theories and their relation to his views about moral status. Such an examination, in conjunction with Kant’s practical-metaphysical analysis of the origins of freedom, reveals Kant’s principled basis for his contention that all human beings possess moral status.
