July 22, 2014

A Few Thoughts on the Affordable Care Act Decision and Health Care in the U.S.

I’m no expert, I’m not an overtly political person, and I think about 90% of political debate is bluster and posturing. But I am on the front lines when it comes to health care, and I thought I should share some thoughts on yesterday’s historic decision by the Supreme Court regarding the Affordable Care Act (aka “health care reform”).

There are no easy answers, quick fixes, or purely partisan correctives to the health care situation in America. Government attempts to help all Americans have access to health services, contain costs, and provide excellent care has been a long, complicated process that has been going on for over a century.

  • It was former President Teddy Roosevelt who first proposed National Health Insurance 100 years ago in 1912.
  • Franklin Roosevelt, Harry Truman, and John F. Kennedy all called for national health care reforms but failed.
  • It was President Johnson who finally worked with Congress to create Medicare and Medicaid in 1965.
  • Republican President Nixon sought to require all employers to provide insurance and give federal subsidies to everyone else so they could buy insurance.
  • President Carter pushed a national health care plan in 1976.
  • President Reagan signed the COBRA bill into law which enables workers to keep their health insurance for 18 months after leaving a job, at their own expense.
  • President Clinton failed in his attempt to create a national health care plan. He was able to expand Medicaid so that it would cover millions of poor children.
  • President Bush signed the Medicare prescription drug benefit, expanding care for older Americans.
  • And finally, in the past few years, Congress under President Obama passed the Affordable Care Act.
All of these political leaders understood that health care is not only an important moral and social issue, it is a matter of life or death for our economy. We in the U.S. already spend more on health care than the GDP of Great Britain, and there is no end in sight to rising costs. If entitlement costs are not dealt with radically and courageously, we are on a path to deep economic trouble.

Most of the people blasting the Affordable Care Act have few alternative solutions, just ideology. Ideology doesn’t cut costs or provide care for the poor and uninsured. It’s time for action.

The Affordable Care Act is very similar to Republican proposals offered during the Clinton administration.

The Affordable Care Act is almost identical to what Gov. Romney did in Massachusetts.

Our costs are much higher in the U.S. than in countries where forms of “socialized” medicine are practiced. A recent report in Reuters indicated that America is highest in spending with regard to health care but only 31st out of 34 countries in the OECD (Organization for Economic Cooperation and Development) in providing care for its people. We are spending $8,402 annually for every man, woman, and child in the U.S.

America does not have the best health care system in the world. Statistics don’t lie. America ranks 27th in life expectancy and 31st out of 40 in infant mortality compared to other OECD countries (see study cited above). With regard to other key indicators, we do not fare well in comparison to other countries around the world. We do have some of the best treatment in the world for those who can afford it.

Half the bankruptcy filings in the U.S. are due to health-care related costs. One study in the mid-2000′s showed that 41% of Americans (79 million people) have medical bill problems or are dealing with medical debt.

Those who worry about not being able to pay for reforms fail to recognize that costs are now skyrocketing and we are all paying for it already. For example, more than 25% of my pay package as an employee (of a health care network!) is spent on health care, and that is just my contribution. That doesn’t include what it costs my employer. And every year, it seems, more and more fees are added here and there which increase my co-payments as well.

Every time someone without health insurance goes to an emergency room for care, you and I are paying for it.

I see ridiculous medical practices almost every week in end-of-life care, which is one of the most costly realms in health care. For example, I watch oncologists and other specialists convince patients and families to undergo obscenely expensive tests and treatments, procedures with horrendous side effects that dramatically reduce quality of life, all for the sake of trying to gain an extra month or two. If most of our patients could have been encouraged to choose hospice just a month earlier, they could have been at home instead of shuttling back and forth to doctor’s appointments, hospitalizations, dialysis treatments, or chemo and radiation treatments. They could have had a team of professionals providing support for both patient and family, helping them reach some of their goals for the final season of life. At a fraction of the cost.

It is estimated that hospitals in the U.S. overcharge patients about 10 billion dollars per year. A personal example: Several years ago, we looked carefully at our EOB (Explanation of Benefit) statements at the end of the year. The charges for our family added up to about $13,000. Another column showed that our health insurance negotiated payments with the providers for about $4000. The charges were three times more than the eventual payments! I’m glad they got the costs down for us, but how many people pay more, or even the full charge?

Personally, I don’t think the Affordable Care Act is the answer, but not for the reason many of its critics dislike it. In my opinion, it doesn’t go nearly far enough. And I’m not sure we’ll ever be able to do more than just take baby steps like this.

We simply do not have the quality of political leadership at present that has the spine to work with others to make hard decisions, call the American people to sacrifice for the common good, and do what’s best for the poor and disenfranchised, and for the future of our country.

Comments

  1. I have been to my Department of Motor Vehicles and experienced the “service” there.

    Government controlled healthcare scares the dickens out me. Worse, rationed care, that’ll end up like Medicare is already…broke.

    I also feel terrible for the Canadians. Where are they supposed to go now when they need something done without having to wait for two years for it?

    The only good that will come out of it is that us seniors (who are believers) will get to Heaven quicker.

    • We have rationed care now. Canadians are by and large satisfied with their health care system. This is not government controlled healthcare, it requires people to have insurance. What you say is all false rhetoric.

      • Don’t kid yourself. It’s a foot in the door. Many bigtime Dems have said as much.

        Do you refute that the portion of healthcare that IS controlled by the govt. (Medicare), is going broke?

        There are horror story after horror story about the lack of funding in the UK and Canada for enough Med. treatment. And there are much longer waits for routine cancer screens and treatment.

        Change the system that works pretty well to insure 4% more of our citizens? And at what cost? It’s a joke and that is why most Americans are against it. No matter to the Dems., however. They will cram it down our throats. They know better. Just ask them.

        • I don’t believe in conspiracy theories, Steve. I believe this is a hard and complicated issue. I believe people of good will can disagree on solutions. But I also believe that we need courageous leadership to challenge us all to come together rather than hold on to our little ideologies so that we can find true solutions. The alternative is serious economic trouble and continuing poor treatment of our most vulnerable citizens.

          And by the way, we are talking about 17% of our country being uninsured, not 4%. Nearly 50 million people. I see many of them every day, crowding our hospital emergency rooms.

          • What conspiracy theories? I was referring to actaul quotes from Congressmen.

            4 % have no access or can’t afford insurance. The others choose not to have it. I didn’t have it when I was a young man. By choice. Remember that? Freedom?

            Besides… NO one in this country is denied healthcare, whether thay have insurance or not.

            Govt. run systems are going broke all over the world. And this will lead to a government system, and thi will lower quality and increase costs…just the same as every other industry where govt. is in control. And that is a fact.

          • Steve apparently you didn’t read the article. We spend more on health care than any other country in the world and have far less to show for it. And you’re right — no one is denied healthcare if they go to an emergency room, and guess who’s paying for that?

            As for your statistics, here’s what a recent Gallup poll showed:

            The ranks of the uninsured also have risen overall for four straight years. Gallup reported last month that 17.1 percent of Americans have no health insurance, up from 16.8 percent in 2010.

            Joblessness, lower incomes and the cost of health care are to blame, according to Gallup.

            Two factors appear to be driving up the percentage of uninsured Americans. First, more Americans were unemployed or underemployed in 2011 than in 2008. Second, fewer employees had health insurance from their employer, which may be because employers no longer offered it or the cost was too high for employees to afford.

          • David L says:

            an’t afford insurance. The others choose not to have it. I didn’t have it when I was a young man. By choice. Remember that? Freedom?

            And if you needed emergency surgery and could not show that you could pay for it should we as a society just let you die?

            Serious question.

          • cermak_rd says:

            “can’t afford insurance. The others choose not to have it. I didn’t have it when I was a young man. By choice. Remember that? Freedom?”

            And you could have had even more freedom by not paying your taxes? I’m sorry, going bare is an act of irresponsibility not only because you could have become ill and therefore everyone else would have subsidized your care but because insurance only works when the healthy also carry insurance.

          • Headless Unicorn Guy says:

            I don’t believe in conspiracy theories, Steve

            Then you’re a Heretic, CM :) Today, Christian = Conspiracy Theory Manaic. I think it started during the Cold War of the Sixties or Satanic Panic of the Eighties and blossomed and grew into today’s Grand Unified Conspiracy Theories. And like all GUCT’s, those who deny The Conspiracy must be part of The Conspiracy.

          • Headless Unicorn Guy says:

            And if you needed emergency surgery and could not show that you could pay for it should we as a society just let you die?

            WWARD?
            (What Would Ayn Rand Do?)

            Remember that incident a couple months ago where the subject came up during some campaign appearance and the audience cheered it on?

        • I have a question for Steve Martin. You claim there is horror story after horror story about lack of funding in the Canadian health system, and that Canadians sometimes have to wait 2 years to get treatment. As a Canadian I would like to ask you where you are getting your information. I would also like to suggest you might want to consider finding a better source of news, because you are wrong.

          This kind of misinformation about the Canadian medical system is used all the time as a demonstration of why the US should not have universal medical care. Nobody ever thinks to question it. The reality is we have better outcomes at a much reduced cost compared to Americans. I realize that what has just been upheld in the US is not going to give your citizens what we have here, but I hope it brings your country a step closer. I have both US and Canadian citizenship, and have experienced the medical system on both sides of the border. I wouldn’t trade what I have here for anything.

        • Steve M, this Canadian, who has spent five of his adult years in the US (three in upstate NY and two in Colorado) agrees much more with CM than with you. Why the hyperbole? If I believed the “horror stories” that are sometimes in the Canadian media regarding the US, I would never cross the border again. I haven’t been a big consumer of medical services over the years, but my wife has. She received good care in the US and good care in Canada.

        • Speaking as a Canadian (who has also lived in the USA)… My healthcare in both countries, and the care received by my immediate and extended family, has always been exemplary. The only difference between my experiences was that I was lucky to have good benefits in the States.

          I’m, frankly, appalled by the anti-Canada propaganda and outright lies that I hear on this issue.

      • Headless Unicorn Guy says:

        What you say is all false rhetoric.

        You were saying something about “those with just Ideology, Ideology, Ideology”?

      • Agreed, CM.

        My father’s half of the family are Canadians (Ontario and B.C.) and I’m married to a Canadian (female, the best kind of Canadian ;o) ). None of my Canadian family would give up their system in exchange for ours. Canadians don’t have to “wait” when they have serious health issues. They may, however, have to wait (schedule ahead actually) for things like joint replacements or cataract removal — which cost little to nothing out-of-pocket.

        Ontario has a relatively high sales tax; about 8%GST and about the same Provencial tax. Personal income tax is progressive, and everyone bellyaches about it there just as we do here. But, in my experience when it’s all said and done I think Canadians actually pay no more and possibly less tax than we do in most states in the US. We are taxed at many more levels than Canadians are. AND, Canadians get more in return for their tax dollar. We pay waaayyyy toooooo much for the status of having the best shock-and-awe military industrial complex on the globe.

        Most of the developed nations have a single payer system, and for good reason–administrative cost. Our admin. cost (US) with a gazillion-payer system runs about 35% of the total. Those countries with a single payer system run about 8% or less. France has a multiple payer system (5 payers) and still comes in under 10%. I remember about 5-6 years ago that even the car companies were pointing out that their health care cost for workers put us at a significant disadvantage to other countries (such as Japan). It wasn’t too long ago that GM published that the companies’ work health ins. cost was higher per vehicle than the cost of steel per vehicle.

        I fully agree with PM that the ACA falls far short of what we need. We already have “socialized health care” in the US–and that of the worse kind. Those that can’t pay and clog the emergency rooms are being paid for by those with decent health insurance. We also have had socialized medicine for decades for certain segments of the population. The best socialized hc is provided free of charge to all congressmen, senators and their families. The voted it in for themselves. The rest of us, I suppose, can either go to Texas or go to hell.

        The citizens of the US and their self-serving politicians need to stop whinning, grow up, and look around at all (I repeat ALL) the developed nations of this good Earth, ALL of which have “socialized/nationalized” health care and realize that those people live longer, have healthier babies and much less infant mortality, and do not have the strength sapping worry about whether they’ll financially survive a bout with a serious illness.

        Tom

    • I have no idea where Americans get their information about healthcare in Canada. I am tempted to think from the Republican party (just to anticipate objections, I am not anti-republican)

      I can choose the doctor I wish, and the hospital, and can get 2nd opinions. There are wait lists for specialists, but if your aliment is serious you are generally pushed to the front of the queue. Are their weaknesses, yes, but it works for most of the people most of the time.

      Our working class poor has the same medicine as those who are better off. That is not good enough for some, so they go elsewhere if they do not want to wait. But in most things, it is not like the wait list is huge, more for specialties.

      We all pay monthly premiums, unless we do not make enough. I pay $128 a month. It is not the perfect solution, but it does mean we do not have a huge class of people who get nothing.

      • @ Ken.

        Most Americans don’t know an f’in thing about Canada, so what they hear about OHIP or any of the other Provincial systems (aka, “Canadian health system”) almost always comes from those who have a lot to gain by maintaining the trash heap of a health care system that we’ve had. Very few Republicans or Democrates really know anything about the Canadian system.

        T

  2. Michelle says:

    Can I copy this and send it to some friends?

  3. Maybe you can let these doctors in on you “false rhetotic” claims;

    From USA Today (this year):

    When surveyed by Deloitte, 83% of doctors said one likely change to the medical system as a result of the law would be increased wait times — an inevitable outcome of insuring millions more patients without a matching increase in the number of doctors. Not too surprising. Most doctors surveyed also noted that the changes will “pose considerable implementation challenges.” I suspect it would be hard to find someone in the health care industry — or any employer, for that matter — who would disagree with that expectation.

    And it doesn’t get better

    It’s one thing to mandate insurance for all, but quite another to do so without incentivizing physicians or those considering the profession. In fact, the law does the opposite: For many doctors, there becomes a financial disincentive to practice medicine.

    The Association of American Medical Colleges estimates that the USA will be 160,000 physicians short by 2025 (when all patients would be insured under ObamaCare), and this is without even considering those doctors who will limit their practice to insured patients because of decreasing reimbursements or who retire early when faced with increasing costs with little return.

    Doctors are catching on fast to the essential deficiencies of ObamaCare, but so are America’s patients. The concern of doctors is reflected among the American people: Support for the law has sunk to 29% in the latest Associated Press poll.

    ________________

    The full article:

    http://www.usatoday.com/news/opinion/forum/story/2012-01-18/doctors-obama-health-reform-ppaca/52650852/1

    • I fully agree that one of the most difficult problems for ANY solution involves adequately recruiting and reimbursing doctors and health care providers.

      • The point is that the wait times will be increased because people will finally be able to actually go to a doctor instead of suffering untreated! And that’s supposed to be a NEGATIVE? Yes, let’s get more doctors, rather than convenience only the rich or insured!

      • Remember the day when you could casually discuss matters with your “family” doctor during an appointment? Remember the days when an appointment time was matched with a fairly accurate ACTUAL time? What happened? I’ll tell you…

        As insurance plans became more and more prevalent in the work place, and insurance actuaries started reducing physician reimbursements, physicians were forced to become more and more time conscious in order to make enough from the typical appointment to cover costs. As a result, currently, doctor’ offices have become a model of efficiency, at best, and full on patient mills where you are left waiting past your appointment time and then shuffled in, and out of the exam room in record time. Why? Because the insurance reimbursements have forced physicians to do so!

        Increased paper work and mandates, not to mention malpractice insurance, have also resulted in increased clerical staffing in doctors offices, increasing their operating costs. And when was the last time you actually SAW a doctor? The reasons above are also the reasons that you are more likely to see a Physician’s assistant or a Nurse Practitioner. They are usually competent professionals, but they work for much LESS than a Physician! Expect fewer Family Practice offices (the first contact a person has with the medical establishment) while more American graduates go into the specialty fields. It is happening already! And there is NOTHING in the new Health Care Initiative to deal with this!! It only exacerbates the problem.

        This isn’t political rhetoric, it is facts on the ground!

        • Good points.

        • cermak_rd says:

          But if you want to talk over your problems with someone, a nurse practitioner is just the person. This is a person who usually has actual skill at listening and determining what’s important from a clinical perspective and then is able to either prescribe (if necessary and depending on the state with or without a sponsoring MD) or to offer advice (say eat more veggies or exercise more).

          This sounds like just the person who should be the gateway into the system.

          • I see you’ve zeroed in on the one aspect you like, and ignored the rest. So you’re comfortable with doctors’ offices becoming “patient mills”?

          • cermak_rd says:

            If everyone is to get care I don’t see what the answer is other than have an expert at listening as the gatekeeper who moves folks along to the actual services they need. Not everyone needs to see a podiatrist or an ENT. And the GP/Internal Med doctor is more of a specialist now as well. Working in tandem with a nurse practitioner, she can serve more patients.

            Certainly, I see a need for more primary care physicians. And maybe the answer to that is to provide scholarships to promising candidates in exchange for 5-10 years of primary physician work. But this bill didn’t address that, it wasn’t its intent. One might as well mention the difficulty rural areas and small towns have in keeping docs for the same reason, they can be better compensated/have a higher quality of life elsewhere.

      • David Cornwell says:

        The AMA, nurses groups, and many of the heath care providers I know personally are in support of this law

      • I find these projections dubious. Doctors are very well compensated today. If they are compensated slightly less they are just going to hang it up? I don’t believe it. What else could they do for the same generous (or greater) compensation? Perhaps it is “unAmerican” to suggest, but is it possible they are over-compensated now?

        The cost-of-implementation will be dispersed across all providers and the systems implemented at economies of scale. In the 1970′s all the auto manufacturers said that emission control systems would make cars unaffordable. Didn’t happen.

        Becoming a doctor is hard, it is something someone becomes because that is what they wanted to do/be.

    • Richard Hershberger says:

      “…one likely change to the medical system as a result of the law would be increased wait times — an inevitable outcome of insuring millions more patients without a matching increase in the number of doctors.”

      Are you seriously complaining that if we let *those* people have life-saving health care too, then you might have to wait in line behind one of *those* people? So better to let them die rather than inconvenience you? Is this really an argument you want to make? On a Christian forum?

      In any case, it is an overtly short-sighted argument. This is just the sort of thing that market forces are really good at. If there is an increased demand for medical personnel, the increased supply will follow.

      • “If there is an increased demand for medical personnel, the increased supply will follow.” Then WHY are there fewer and fewer Physicians hitting the market NOW? See my post above! There is no question that more people get medical care today than when we were children (in the 50′s and 60′s, at least) but the number of physicians not in a specialty field hitting the market is diminishing! In fact, more and more foreign educated doctors are entering the field today because of the astronomical cost of American medical schools. But they, in turn, are only fulfilling their brief tenure in general medicine until they can enter the very lucrative specialty fields!

        This isn’t a simple matter of using rhetorical devices (ex.: *those* people) and impugning a persons spirituality because they disagree. It IS true, though, that the more people who become eligible for medical insurance, the more people who will be hitting the doctors’ offices. The majority of people don’t really need to see a doctor ( common viruses that medicine usually lets run their courses, etc.) but because it has become so inexpensive to see a doctor due to low co-pays, they are willing to spend the money. Increase traffic WILL become an issue. And the Health Care Initiative does ABSOLUTELY NOTHING to deal with this!

        • True – the ACA doesn’t deal with creating more doctors, but I don’t believe it has to. It doesn’t represent a complete solution, nor does it claim to. I’m just going off gut feeling here, but I’m guessing that completeness in dealing with an issue (ie. perfection!) is not a prerequisite to the passage of a bill. Otherwise our legislators would spend all their time crafting perfect bills and never pass any of them!

          Assuming that our legislature functions correctly (a big assumption these days!), it will create a bill in a future session to address the need for more doctors as that becomes more of a problem.

    • Danielle says:

      OK. But after the initial shock to system from all the new patients, it will adjust. Worst case scenario, there’s some inconvenience in the short-term. In the long term, many people who operate largely outside the system will be getting routine checks, screenings, and life-saving care earlier. That’s a tremendous improvement, esp. for those in vulnerable populations — many of whom currently think the law is not to their advantage.

      Its also an improvement to the system overall, because people are somewhat less likely to be crowding ERs with the later stages of a condition that could have been identified earlier and treated in a doctor’s office.

      As to long leisurely chats with family physicians: I can trade some of this luxury, if greater efficiency means people that need care are getting seen. Yes, if I have a real problem, I want my doctor’s time. But I don’t need to chat it up with her at other times.

      • I wonder if the lines at ERs will diminish. We are forgetting the human element. Even with a wealth of information concerning healthy life styles, we have an epidemic of obesity in this country. That tells me that people are not paying attention to their health. They are not interested in preventative medicine. They won’t go for checkups. they will wait for the pain, then go to the ER.

  4. I am a retired M.D.and Steve has it pretty much right. You break down the uninsured and a lot of them are young, don’t think they need it.More are in a family with incomes of $60,00.00 or more and some are here illegally.. If govt. healthcare is run like the post office, AMTRAC or the V.A. heaven hepl us. Everyone should be able to buy health insurance across state lines and not have to pay for chiropractors,aroma therapy or acupuncture, if they don’t want it. Also Malpractice should be overhauled. Government is not the answer.

    • Dan Crawford says:

      I have had dealings with medical insurance companies for nearly 50 years – they are even worse than state DMVs and other state agencies. Mr. Martin’s rhetoric provides a wondeful obfuscation for the horrid mess of our health care system. Waiting times? Where has he been in the past fifteen years? Socialized medicine? Sorry, even the Affordable Health Care legislation has been so manipulated by Corporate Medicine that it will benefit for-profit corporations more than consumers. The so-called Medicare Drug Benefit is one of the biggest scams going – even the money you pay gets counted against the “donut hole” – a gift from the Republicans in the Clown Academy on Capitol Hill. The multimillionaire Pillsbury Dough Boy, pontificating while bouncing in his chair and yelling into the microphone, his slave-cohorts in the GOP, and his ideological allies have yet to provide any answer for the problems besetting American medicine. Actually, their answer is “we want to redistribute your income to Corporate Medicine the way we redistributed it to the corporate thugs who stole your pension funds. Trust us.” When it comes to American medicine and its horrors, the response of the ideologue who opposes doing anything and clutching to status quo provides compelling evidence that they either live in Wonderland or are deliberately cynical and manipulative. The behavior of the oligarchs in the Republican Party over the past ten years is sufficient to indict them of cynicism. For myself, I will raise a toast to one “conservative” on the Supreme Court who apparently permits his intellect to function occasionally.

      • Ideologues? You rail against ideologue? Try re-reading your own post and then point out your “reasoned” arguments.

    • I agree with you 100%. I dread the thought of Obamacare screwing things up even worse. I am lower middle class, 48 years old, and have a wife and three kids. The wife and I are not insured because we can’t afford coverage for both us and the kids. We just pay for coverage for the kids. If I have a need I go to the local urgent care facility and pay out-of-pocket. No big deal. That is my risk and my choice. As a libertarian, I like to have choices.

      But I would also like to see health care and health insurance reformed. And there are common sense things that can be done. Lower healthcare expenses through things like tort reform and regulation reform so that there doesn’t need to be two paper filers for every person actually administering care. Decouple health insurance from employment and let us buy it across state lines like car insurance. I can get on geico’s site and customize a separate plan for each vehicle that fits my needs and my budget. And then I can compare that plan online with 10 other companies. It would be nice to be able to do something similar to that with health insurance. Maybe then I could afford it. As it is now I get a non-choice of one plan from one company for one price that is way out of my range.

      Takeover by a corrupt and wasteful government isn’t the answer. More freedom is.

      • Headless Unicorn Guy says:

        As it is now I get a non-choice of one plan from one company for one price that is way out of my range.

        Oh, you have a choice:
        TAKE IT OR LEAVE IT.

      • >Takeover by a corrupt and wasteful government isn’t the answer. More freedom is.

        Yea, and, uhm…, what is the freedom that I had before ACA? Oh, right: NONE.

        There is not a single person who doesn’t need health care. There are just people who believe at-the-moment that they do not. Until they fall off a ladder.

        FACT: Everyone uses healthcare, nobody makes the choice not to use it. They just make the choice to cheat and have someone else pay indirectly.

        Therefore everyone should pay directly.

        PLEASE, *RAISE MY TAXES and put the insurance companies out of business. They I have *FREEDOM*. Because then I can at least vote on the policies used to distribute funds.

      • TPD,

        You and your family will positively benefit from ObamaCare. The “corrupt government” has been screwing with your health care for years by giving you “more freedom” to buy insurance companies golden plans…

        T

    • cermak_rd says:

      But won’t a lot of those young people now going bare be insured because their parents can cover them. Don’t forget this ACA is a series of small steps.

      Insurance companies can now not refuse to cover those with preexisting conditions.

      As a result of that, and in order to stop people from not getting coverage until they need care, there is a mandate.

      Children can be covered by their parents until they turn 26.

      Other miscellaneous provisions to make it work like the exchanges, subsidies, etc.

  5. Christians should be able to discuss politics and law without accusing each other of not caring about the common good or the poor.

    My understanding of human nature and economics leads me to believe government based solutions to economic problems rarely help, and usually lead to bad outcomes and a cultural acceptance for avoiding personal responsibility to help one’s neighbor. I give to charities and research institutes and try to help out those that are sick and need help. I try to repent when I don’t do enough. But voting or not voting for particular political programs or parties isn’t something anybody should feel guilty about. Jesus didn’t come to resolve political differences like this. His kingdom is different.

    • I agree Boaz.

      But let’s remember something fundamental here. As an idealist, I believe in an America where government is “of the people, by the people, and for the people.” It is not something separate from the people, as hard as it may be for us to see that at times. I do not give up my individual responsibility when I ask “the government” to organize a program to help people — it’s one of the very ways I exercise my individual responsibility. I pay for it with my taxes, I support it through my votes, I respond to it through my feedback. I give up more individual control and responsibility when I give to a charity in which I have no voice — and that includes many churches.

      The problem I have with our political leaders today is that they are not creating this vision of a common America. They are not calling us to shared sacrifice, not giving us a model of working together for the common good. In the last century it took two world wars and a depression to pull us together. I hope it won’t require that in our near future.

      • Your idealistic image of the USA overlooks the degree to which political decisions are imposed by wealthy elites, who manipulate the masses through the media which they control. (Noam Chomsky’s thesis in Manufacturing Consent.) Your vote means nothing.

        • Headless Unicorn Guy says:

          Except for the Governor’s races (which are term-limited) every election in California for the past 15 years has been exactly the same: All Incumbents Re-Elected, NO EXCEPTIONS. We’re even seeing Congressional/Assembly/State Senate seats being passed down from father to son like any other inheritance.

          • cermak_rd says:

            Agh! Don’t get me started on neo-feudalism. We have had a few cases of that here. In 2005, Bill Lipinski retired from his US Congressional seat in the third district. He waited to retire ’till after the primary in order to, in essence, pass the baton to his son, Dan Lipinski through the machinations of the Democratic central committee.

            I didn’t forgive Dan (voted write in every election) until recently, when I got redistricted out of his district. I am now in the 4th with Gutierrez and am happy.

            In 2006, John Stroger, the Cook County President (and this is a fairly high profile office), had a stroke. Information was suppressed ’till after the primary about the seriousness of this stroke. After the primary, they finally fessed up, the Democratic central committee chose Stroger’s son, Todd. When people objected to the feudalism of this, they pointed out the Lipinski situation as precedent.

            And it’s no good saying people should vote for the Republicans in the general in these cases as there really isn’t a functioning GOP party here in Chicago, meaning the ones that run are cranks. I would imagine it’s the same problem in CA. One party is dominant in a district and the non-dominant party is so weak it can only get cranks or unknowns to run.

    • Rick Ro. says:

      Amen!! This is exactly why I think Christians need to be very VERY careful when discussing or getting involved in politics, because when we argue our side of some political issue, we make Jesus Christ look horrible to the other side.

  6. Will Tripp says:

    The Internet Monk has become the Huffington Post for liberal Christians. The Spirit of God has departed!

    • I don’t see this as a liberal vs. conservative issue.

      I see it as (1) a matter of how to try and best serve our neighbors in this life with regard to their health needs, (2) a matter of fiscal responsibility as a society.

      I’ve also said the solutions are complicated and people of good will can disagree about them. I only ask that we come together and commit to working them out.

      Is that liberal?

    • Bye, Spirit of God! Sorry things didn’t work out for you!

    • Rick Ro. says:

      Meant to be sarcastic or not, I tend to agree with the sentiment. Political issues like this would be best left debated in other arenas, not at a site supposedly “continuing Michael Spencer’s legacy of Jesus-shaped spirituality.”

      • Michael was unafraid to speak about political issues. In fact, the blog actually focused on such things in the early years. We don’t do it much, and I probably wouldn’t have with regard to this issue, were it not for the fact that this is the arena in which I exercise my ministry. Believe me, it gets frustrating at times as a Christian and a minister in a health care system that often gives lip service to patient care and service to the community and then acts like any other profit-seeking business.

      • I have a strong suspicion that Jesus shaped spirituality is highly reflected in how people are cared for.

        T

  7. A good analogy would be with public education. No one wants to pay for other people’s children (the rich with their private schools do not want to pay for the poor, families without children do not want to subsidize families with); on the other hand, society benefits from an educated citizenry. The result is a highly uneven public education system as a sort of compromise measure.

    On the other hand, medical expenses promise to skyrocket in the future–both because of the aging population, and because of new technologies which offer greater options for extending life and health. To what extent these expenses should be borne by the general public or private purses is a basic moral question which no simple answer can realistically address. (For example, given that we cannot fund everything, whose diseases should have priority?)

    • Donalbain says:

      Excuse me. *I* want to pay for other people’s children. Please don’t use universals.

      • cermak_rd says:

        Me too. I consider it part of the social contract. An educated populace is important to our future and I do not want to live in a society where family wealth determines the destiny of the children. Already America is falling behind other nations in social mobility. It’s not a good trend.

        • David Cornwell says:

          Exactly. And some of the “reforms” are simply ways to let for-profit organizations find more opportunities to stick their paws in for more.

  8. My biggest issue with so-called healthcare reform is it didn’t really reform healthcare. Rather, it reformed health insurance. And there’s a huge difference between the two.

    You truly want to reform healthcare? How about starting with meaningful tort reform, so specialists can perform high-risk surgeries without paying exhorbitant rates for malpractice insurance, and doctors can quit ordering excessive levels of testing to try to keep the number of lawsuits down.

    How about the state of California, which mandated huge expenditures by hospitals in seismic retrofits, help the hospitals out so they don’t have to pass those costs on to their patients (oh wait, they can’t do that – the state is already going broke).

    And how about Medicare and MedicAid (in California known as MediCal) pay there own way, instead of forcing hospitals and doctors to demand more from insurance companies and other paying patients to cover the shortfall from the government patients. And yes, this is real; it’s called a hidden tax because those of us who have insurance are paying for a government program without actually paying the government. But of course we never blame Washington for our insurance rates, because most of us simply don’t see the hidden tax aspect caused by the Medicare shortfalls in payments, especially to hospitals.

    And I could come up with more, but I’ll stop there. But you get the idea.

    So no, “healthcare reform” really wasn’t really healthcare reform at all. Rather, it was an effort to spread the costs of healthcare over a larger percentage of the population by mandating insurance for all. But ultimately, because it doesn’t address the cost of healthcare it is, in my not so humble opinion, simply an exercise in shooting the messengers (a.k.a. the insurance companies). And that’s a whole lot easier than trying to tackle the mess that our free-market based medical system has become.

    • I mostly agree with you but consider this a case of being careful to not let the perfect compete with the good. If we accept nothing but the perfect health system we’ll never make any progress. Kennedy said that one of his greatest regrets was not accepting Nixon’s compromise system (which was positively radical compared to this rather wimply adjustment to our system) because he thought he could get a fully socialized system. Our system is slightly better now than it was previously.

      Also, don’t sell the bill short. It is about 75% about insurance, but there are portions of it which are not related (I read the entire bill including several preliminary versions). In particular there are several portions designed to support Evidence Based Medicine. It’s some of the best parts of the bill really.

      Tort reform has been tried in several states and hasn’t really had the impact they hoped it would. There is some evidence that the malpractice insurance companies were just pocketing the profits though. It’s not likely to have a huge impact. I think it’s still worth doing, but mostly for reasons unrelated to healthcare.

      There are lots of things that could be addressed. Even the way we educate, train and certify Drs could use some significant work. One of the biggest changes that could be made is to the general “Pay for procedure” approach to healthcare. In general a Doc doesn’t get paid much for sitting and talking with a patient for 15 minutes, but once they so much as write an order for a liver function check they are suddenly “doing something” and get paid more for that. I think contributes to the over-abundance of tests as much as legal concerns do.

      • I agree wholeheartedly; we can’t put good improvements on hold simply because they aren’t the best possible or most complete improvements. And my thoughts are just that; the thoughts of someone who has a little more exposure to the issue than most and would like to see improvements.

        More than anything I’d just like to see meaningful and significant discussion regarding actual healthcare costs, not just the cost of medical insurance. But I’m not sure Washington has the courage to tackle many of the underlying issues, grounded as they are in our almost sacred free market system.

        • I agree with you that the core problem is that we pay too much for healthcare. The uninsured problem largely follows from that. We pay too much for healthcare, therefore lots of people cannot afford insurance, and it stops making economic sense for healthy people to buy it, therefore the healthy people are not in the insurance pool, and insurance becomes more expensive for the people that still have it. Reducing costs, and looking at other countries with better healthcare systems, mostly means paying doctors and hospitals less money, unsurprisingly that’s not the solution they want, and so instead we pass a health-care reform bill where the lion’s share of the increased coverage comes from pushing costs off of individuals and onto the government. (which presumably will continue to just deficit fund all of this “in the long run”?)

    • I’m just curious what you mean by “meaningful tort reform.” As a Texas based lawyer I have seen the results of “meaningful tort reform” first hand. Texas has what are called damage caps: specifically a $250k damage cap on pain & suffering. Consequently, in one case a jury decides that a plaintiff is entitled to $150k pain & suffering because they didn’t believe that a doctor was particularly negligent whereas in another case, where the doctor was drunk while performing an operation, the jury awards $800k but the cap is then legally enforced so the plaintiff only receives $250k. Consequently, the individual in my first hypothetical is fully compensated whereas the individual in the second is not fully compensated. Some states, such as Georgia, have found these types of damage caps to be unconstitutional under their state constitution because it unfairly prejudices those who are harmed by the worst forms of negligence. I’m not sure how much this really helps the healthcare system as a whole. I doubt that medical bills in my state are any better because of Texas tort reform. Instead, tort reform as a whole has decreased medical liability and put many lawyers out of business.

      Additionally, lawyers also pay exorbitant amounts of money for malpractice insurance but I don’t hear anyone asking for legal tort reform so that we can take larger cases with less risk of being slapped with a malpractice lawsuit or a guaranteed cap on liability after the fact. I bet lawyers would charge less if they were protected from malpractice liability.

  9. Tommy Farrell says:

    I am always amazed at the debate about health care in the states. The contrast is always framed as big-government inefficiency against the great competition of the private sector. Except that (as Mike showed in the article), the US has a terribly expensive health care system that provides poor results for the nation as a whole. Nobody from the political right seems to notice that they are defending a cartel of insurance companies and health care providers that are very efficient at ripping off the population and have no interest in directly competing with each other. The strength of ideology against ‘socialist’ health provision seems to blind people to the fact that the current system is plainly immoral!

    • I totally agree with Tommy. The for-profit medical industry is the bane of the US. What exactly is the problem with having non-profit health insurance? As a self-employed person, I’m paying more than $1,300 a month to insure my family. That is a crippling sum. What enrages me is not that my healthy family never consumes a fraction of that, and is basically covering those who are actually sick — that’s the point of insurance. What makes me breathe flames is the thought of all those rich insurance execs banking their yachts off some tropical island while I sweat to pay for it. Yes, even the inefficiency of the post office irritates me less than that!

      • David L says:

        As a self-employed person, I’m paying more than $1,300 a month to insure my family. That is a crippling sum. What enrages me is not that my healthy family never consumes a fraction of that, and is basically covering those who are actually sick

        While some of this is true, a lot of your costs are truly for insurance. Paying a modest sum now in case of a large expense later. My recent appendectomy with only 2 days in the hospital cost $15,000+. Anything more complicated costs way more.

        • Tommy Farrell says:

          It ‘cost’ that much for a simple operation and 2 days in hospital? And you think the government would be less efficient than that?

          • My point was where his money was going. Not to if the government would be more efficient. As long as health insurance (not health care which is closely related but not exactly the same) has to possibly pay for more and more expensive options, monthly payments will go up. You may never need a $1,000,000 transplant but if only one in 1000 needs it then everyone has to kick in $1000 to cover it. Toss in MRI’s instead of XRays, Viagra instead of … well .. oh well, etc… and you have to pony up to pay for it. If you want INSURANCE costs to do way down, restrict possible treatments to the choices available in 1970 or earlier.

            Back then if you got really sick you died. No $1,000,000 options.

          • Tommy Farrell says:

            @David L: But that’s a shallow argument. You are assuming that it really costs that much for the insured event, when this is plainly not the case. The WHOLE problem with the system is that the ‘price’ is being strongly manipulated by health care providers and insurance companies. The solution to the problem is to bring the price more in to line with what should be a reasonable cost for the service. As mentioned below, anyone defending the current system is defending the worst possible combination of non-competition and government intervention.

      • David Cornwell says:

        Agree!

    • I seems to me that Isurance Companies, Hospitals, and lawyers who benefit from medical mistakes are in competition! But, I think we would agree that they are not competing over who can be of service to a person. They are competeing over money! Nothing new under the sun.

      • cermak_rd says:

        Sure blame the lawyers. But I don’t think that many people will argue that someone who has been profoundly brain damaged due to a medical mistake should be compensated by being provided a placement in a dignified facility for the rest of their life.

        • I am sorry if I offended you, your profession, or your family. The truth is we are all to blame, even me. What’s blame? It’s sin. So, we need someone to save us from our sins. Do we have such a one. Yes. Do people want to hear that? It seems to me mostly no. Are people interested in our feeble attempt to inject Judeo-Christian morality into this issue? Don’t think so. In fact we are the enemy of progress at this point. And some of that label is well deserved. Look at some of these posts. Is everyone here a Christian? I don’t know. If you are and you are, in a round about way calling your brother a fool, without any facts to back that up. Then you are in error. And this is not acceptable to our God and Savior. And I have done this too. And it is wrong. Unless God’s opinion is in an arguement, that arguement is dead. What does God require of us? “To act justly and to love mercy and to walk humbly with your God” (Micah 6:8)

    • Right, Tommy.

      Tom

  10. Adrian Osborne says:

    Hi as a Canadian who has family in the United States I have to say this is a baby step in the right direction. The wait times here are no worse here than they are there. When I go to a ER with a broken leg for a example I don’t have to worry about a bill its like what a medical bill? The part of Canada where I live is mostly rural, and there is a shortage of docs. Where they are going south of the border to the U.S. why because as a doctor friend of mine said they know where to get rich. In a Communist country such a Cuba people get free healthcare. The U.S. is one of the only developed country in the 21st century that doesn’t have free healthcare. I invite the U.S. to come join the 21st century

    • Yes Cuba is a model. Yes Cuba paves the way forward. Don’t forget their ability to suppress dissent, or cirticism of the government. Don’t forget the suppression of religion, or their international communist adventures. Don’t forget about the propaganda, and state controlled media. Try cirticiizng Castro Adrian.

      Saying Cuba is a model state is like saying Jerry Sandusky would make a great youth baseball coach.

      • Headless Unicorn Guy says:

        Eagle, I saw this in the Social Justice movement of the Eighties (until John Paul II shut it down HARD). Castro’s Cuba held up as the Shining City on the Hill. The New Trinity of Marx, Lenin, and Castro, with Ronald Reagan as Satan. I have never seen such pat-on-the-head condescension as when an actual refugee from Fidel’s Paradise actually dared to object.

      • Eagle are you saying that because Cuba is Communist therefore their healthcare is no good?

        • Oh no! someone said something good about a communist country, to the barricades! I wouldn’t want to be a one party right wing state like Singapore either, but they also have a better health care system then we do.

        • Ken I fail to see why we would look at Cuba as a model. It’s a communist dictatorship. Italy under Moussilinni was good for business. Does that mean we adopt an Italian fascist culture becuase it helped foster some business?

          • Jack Heron says:

            Eagle, I think this is kind of Ken’s point. Just because System X is good for Thing A does not mean we adopt it for everything. And contrariwise, just because System X is bad for Thing B does not mean we reject it for everything. It is possible to approve Cuba’s record on healthcare while disapproving strongly of its record on human rights and freedom of speech. (Or vice-versa, I suppose.)

      • I didn’t read Adrian holding up Cuba as a model of perfection. Rather, as my home-state’s ex-gov and one of our ex-presidents would say, “Even a blind hog can find an acorn now and then.”

        T

  11. Thank-you for the history lesson. And some actual thought on the subject. Sorely needed. We are bombarded with rhetoric and I fear people do not see it for what it is. I my opinion it is the cost and the regulation that are the problem. I would grant that the regulation is not punative but born out of sincere desire to make things better. But, the question is, does it? If a nurse has to spend more time on paperwork than she does on actual care, is that a good thing? You lost me a little when you said that turning things over to the gov’t was an act of personal responsibility. Sure, if that gov’t is responsible. I’m not so sure that it is. Perhaps that’s my coservative bent speaking. I’ll grant that. For me the danger lies in not listening to God on this issue. My philosophy’s, political ideologies be damned if they do not conform to the mind of Christ. What concerns me at this point, and this is a valid point, rhetoric, dogma, I don’t know at this point without reading the whole Bill on my own; Am I going to have to pay for the shedding of inocent blood? Abortion. Well, the economy being crushed and the misery that would bring is terrible. But, if the gov’t mandates that I shed innocent blood, then I must for conscience sake say no.

  12. I for one wanted this decision overuled. This is a disaster one many levels.

    1. Our national debt is growing and being held by China. It’s time we think of our entitlement spending as a threat to our national secuirty.

    2. I do not want to see the United States become like Greece and be on a financial cliff. Yet like the fundagelicals we are on that path.

    3. Many young people don’t expect Social Security to be there for them. The program is going to be bankrupt and long gone. Yet its entitlement spedning that is the source of our budget problems. You can gut defense, you can close the Dept of Transportation, Education, etc… and our entitlement problems will continue to grow. Nancy Pelosi needs to really grow some balls and be honest about this.

    4. I love our government but it has problems. Some of my friends in the Washington, D.C. area who work in government have told me interesting stories about the in’s and outs of government. Moody managers, and hiring process that can drag on for monthes. My old small group leader worked for the Bureau of Labor Statistics as a mathmatcian. It took 2 years to hire him to move through the government system. Do we want that type of burocracy to dictate who and when a person will get cancer treatment? Will the person be dead by the time the government approves it?

    We needed some reform I don’t deny that. But this was too far…why can’t they do it piecemeal? Why do they have to scrap the whole system? Why not address the problmes individually?

    As for me I’m torn. I’m a liberal on social issues but a conservative on fiscal issues.

    As a liberal I view the right to an abortion as a fundemental human right. I want to keep the fundagelicals out of the White House and Supreme Court. I want to see government out of the bedroom. And I want to see gay rights expanded, as gay rights are civil rights. I also want to see some more liberals on the Supreme Court.

    Yet I despise the health care reform and I am shocked by some of the leaks coming out of government. Good God!! 8-O

    As a conversative on economic issues I don’t want to add to our entitlement problem. I want to reform our current entitlements, and keep us on the path of fiscal responsibility. I don’t want our military to look like Greece’s military. The sequestation issue bothers me deeply. And we need to get a hold on entitlement spending becuase we need departments like Transportation, FDA, Housing, Defense, etc.. to be on solid ground

    While I usally vote Democrat I am thinking of voting more and more Republican in November. Yet I that turns my stoamch also..especially after my invovlement in Mormonism. I am weary of Romney in that way.

    This Affordable Care Act is going to accelarate us over the cliff. Chaplin Mike I seriosuly disagree…your kids arn’t going to have much of a country tomorrow with the way we are spending today.

    BTW..I’m not a Tea Party person as I view the Tea Party as the reincarnated Third Reich.

    • Mr. Poet says:

      Eagle: Social liberalism and fiscal conservatism cannot co-exist. The majority of social liberals want more spending, and liberal spending leads to liberal results. And socially liberal ideology leads to unintended fiscal problems. For example, take Social Security and the number of workers per recipient of Social Security benefits. My paternal grandfather was one of twelve children. He fathered three children. My maternal grandfather was one of six children. He fathered two children. The birth rate collapsed in one generation, and it is still decreasing. Why? Because of a liberal idea: contraception. (And abortion, although my neither of my grandmothers had an abortion as far as I know.) Social Security was implemented during my grandparents’ generation, when it looked like the current birth rate would support such a system. And if the birth rate had remained the same, we probably would not have had the problem we have now.

      Now, you may think abortion and contraception are fine ideas. But one reason economics is called the dismal science is because anything you do has an economic consequence, no matter how much you want your idea to work.

      • Danielle says:

        Well, not as pure categories. There is a pragmatic middle ground.

      • I think social liberalism and fiscal conservatism can exist just fine. It’s the neo-conservative extreme anti-tax fiscal policy that is incompatible. Regular fiscal conservativism of the “pay for what you spend” school is reasonably compatible with social liberalism.

    • Donalbain says:

      Its funny how you keep referencing Greece, but forget that the Greek economy is being saved by Germany. A state with a Bismarkian healthcare system, not a USA style free market. Similarly, Israel, Australia, New Zealand, Norway… all have systems of healthcare with more government intervention than the USA. And they manage to spend more and have better outcomes than the USA.

      You are buying into the mindless gubmint bad! Me hate gubmint of the right wing.

      • Donalbain says:

        Also, I should note that the US national debt is not held by China. China holds less than 10% of US public debt. Most of the public debt of the USA is held by the government of the USA and private (mostly American) investors.

      • I say this as someone trained in history. Facism has a long history in Europe you can almost throw a dart at a map when you consider where it has popped up over time..Italy, Spain, Germany, Greece, etc… Germany has been a stable country for a few years but let’s not forget their past. Will the Germans be willing to absorb another person’s debt long term given their own problems? Didn’t I read in the New York Times not long ago about how Angela Merkel was working at cutting back state programs due to their economic cost? And if Greece’s and other countries financial woes contribute to a decline in the world economy and Germany is left holding the bag..is it possible to see the ghost German nationalism stir again our of anger? The Germans are proud people and any government is capable of doing anything in dire situations. Sadly the globalized economy has made much of the world unstable and as a guy who has studied history the world looks darker ahead and all it takes is one weak link. Pick your poison…

        • Headless Unicorn Guy says:

          Except with the ongoing Mooch & Sucker Show (with Germany as the Sucker), it’s going to be Randian Objectivism instead of National Socialism this time around. “DEUSTCHLAND ERWACHE!”

        • donalbain says:

          Well, if you ate going Godwin so soon, I guess we are done here. Enjoy your paranoia, I see you are headed back to the Christianity you moved away from.

        • Yes, The thought of Germany being isolated and blamed, as it was after WWI, surfaced into my head also.

      • Headless Unicorn Guy says:

        Its funny how you keep referencing Greece, but forget that the Greek economy is being saved by Germany.

        In what’s becoming a never-ending Mooch & Sucker Show.

        Greece is the Mooch and Germany’s the Sucker.

      • Headless Unicorn Guy says:

        Germany. A state with a Bismarkian healthcare system, not a USA style free market.

        I would like to remind everyone that German and French bureaucracy actually work pretty well and usually get the job done. Even discounting the difference in size and homogenity, American bureaucracy is a mess somewhere between the British and the Russians in reputation. Germans and French could pull it off. I doubt we could.

      • Right. Especially about the “mindless gubmint bad! Me hate gubmint of the right wing” part.

        Frank Schaeffer has some interesting things to say about that;

        http://revolutionnyc.com/audio/20111016.mp3

    • Radagast says:

      I am fiscally conservative as well and I also work on some big government projects and procurements. And here I agree with Eagle – there is a lot of fiscal waste and mis-management in the government, with most organizations just looking to spend money allocated to them before the end of the year and trying to figure out ways to increase the pot. There is also overkill in bureaucracy and red tape. The best person is not chosen for a job, but a specific type of person to fit the quotas.

      In the end the governemt will balloon, with more and more money being allocated. Additionally the IRS is getting involved as well to help with making sure non-conformists get with the program.

      I am not in agreement with those who say our healthcare sucks. I personally believe we are at a crossroads, where entitlement will become the driving factor in this country. And I will sit back and watch the subtle changes as the years go by and watch the “I want it for free” mentality that lurks within all of us overshadow other qualities that made this country successful. Our government has embarked on a direction it will not be able to sustain without major changes in how we live our lives. Hope you all are ready for it.

    • The United States doesn’t have an entitlement problem. It has a healthcare problem, all those big future unfunded (and kind of mythical) liabilities are health-care liabilities, and solution is to pay less money that we are projected to for healthcare. Any attempt to do this is going to be a giant government program, because our health-care system is a giant government program. Government is heavily involved at every level, and more than half of all spending is the governments. There are places that have “health care systems” that don’t have a lot of governmental involvement and support, but that was in quotes because those countries don’t have health care systems, they have desperately poor populations, with terrible public health.

  13. Clay Knick says:

    Mike, that last paragraph is pure gold.

  14. Chaplain Mike,

    I thought this piece by Fr. Ernesto from last year is relevant to this; there’s hypocrisy going on on the conservative side of things regarding not providing health care for people while at the same time requiring emergency rooms to treat people: http://www.orthocuban.com/2011/02/the-bottom-line-of-the-healthcare-debate/

  15. Susan Wells says:

    Chaplain Mike, I hear what you are saying. At the same time, while most Americans may be happy with socialized medicine, they are in for a big suprise. I lived in Canada for 4 years and had health insurance. The quality of their care is far below the care we as Americans receive. My Canadian friend had a torn ACL. This is a simple procedure here and the doctors there messed it up. She now suffers from the “healthcare” she received as a Canadian Citizen. Now, when she needs care, she makes a trip to the United States.
    Keep in mind too that the “ideal” we should strive for as believers is to take care of one an
    other. For instance, the Amish are self insured because they all take care of each other. When my mother was on chemotherapy, she met an Amish family at the hospital. The husband had a milk can sitting next to him and my mother asked him why he brought it in. He smiled and said, what is inside is what we will use to pay the bill—His milk carried all the money the Amish community collected for him to pay cash for his wife’s care,
    I am saying this because the focus in the Chrisitian America has been on growing a big church. But once the church is paid for — why not start taking care of people’s mortgages, health care, etc. The care should be coming from the church which in our country is seriously sickly and infected with various false doctrines about Christ. Christ said ”Love and care for the body of Christ like it ws your own” — well He implied this didn’t he? I think your ideals should be focused more on how you can be the answer in your corner of the world for those without healthcare; instead of saying “oh, well I’ll pray for you and then walk away and do nothing.” this is not the gospel.We all know better. Don’t we?

    • Susan I have sympathy for what you are saying, but I know of many situation in my own experience in the US where simple procedures have been botched too. If statistics mean anything the US generally lags behind other countries in quality of care.

      As for Christians caring for one another, most definitely. However try convincing most American Christians to truly sacrifice like that. Sacrifice to the point of actually giving up my lifestyle? We can dream but I can’t see it happening.

    • cermak_rd says:

      You seem to be advocating a mutual aid society, and other than small, clannish groups, you’re about 90 years too late. The Depression shredded the programs that existed at the time because it was just too devastating. Once the Depression was over, people knew that this kind of program hadn’t worked at the time of their greatest need. Banks became trusted again, slowly, because of the FDIC, but mutual aid societies pretty much withered. And with the current tide described by “Bowling Alone” I don’t see them returning.

    • Danielle says:

      What happens when you aren’t from such a tight knit community, and you need chemotherapy? I really agree with the spirit of what you are saying, but I have a hard time imagining this working out as a universal solution.

      Also, I am not sure the failure of one doctor in a particular surgery should be taken as reflective of the expertise of all doctors in Canada… For the most part, people do get excellent care in England, Sweden, and Canada. Not that those systems are perfect.

    • Many monastaries handle it the same way, but like the Amish, everyone involved is volunteers. (Except the amish children, I guess.) They understand from the git go that if the care or cure would be so expensive as to bankrupt the community, they will be cared for at home lovingly until they pass away. That’s not so bad, but getting most people to really commit to that would be hard.

    • David Cornwell says:

      Waiting! Ha! We do that now. I”m a cancer survivor. My doctor was concerned over the possibility of a relapse. Yet I had to wait about 10 weeksf or more for a colonoscopy.

      1

      • David Cornwell says:

        Writing from ASUS pad today. So please excuse errors.Taking me time to get the hang of writing.

    • At the same time, while most Americans may be happy with socialized medicine, they are in for a big suprise. I lived in Canada for 4 years and had health insurance. The quality of their care is far below the care we as Americans receive. My Canadian friend had a torn ACL. This is a simple procedure here and the doctors there messed it up. She now suffers from the “healthcare” she received as a Canadian Citizen. Now, when she needs care, she makes a trip to the United States.

      My goodness. I can assure you that Canada does not have a monopoly on bad doctors. I am sure for every person who has had a bad experience with an ACL operation in Canada, there are thousands who have had good experiences.

      My experience with healthcare in Canada has been:

      1. A true emergency will get treated like an emergency. Triaging becomes a big part of the system. For example:

      When my father was diagnosed with Colon cancer several years ago, he was assessed and operated on extremely quickly. When he had a hernia, he had to wear a belt for a couple of months until he got scheduled in for an operation.

      I contrast this to Larry Norman who was reduced to begging for help on his website, so that he could afford medical treatment.

  16. Is the post section working?

  17. David Cornwell says:

    I haven’t had time to fully digest your piece here today Chaplain Mike, but from my quick reading I agree with you. This is complex and far from perfect, but a lot of the negativism against the act has been pure propaganda. There are arguments to be made that this isn’t a complete solution or even the totally best approach, but it is progress. Even if there are temporary setbacks, it will never be the same again, and that’s for the good.

  18. Curiously, the health care issue has less to do with health care than supply and demand. Does anyone wonder why computers, television sets, cars, tax preparation, and now even houses have gotten cheaper over time rather than more expensive. Governments have created an economic floor, guaranteeing a minimum price for a commodity that never goes down and only goes up, like taxes and public sector wages. Why is anyone surprised that health care prices have skyrocketed. Take away the floor, get government out of health care, let the free market work, and watch prices fall. Now, of course, that will never happen until the overall collapse, like the Soviet Union. Like every socialist venture attempted in the history of man. And now that the Supreme Court has okay’d taxes for anything, even those things people don’t do, the sky’s the limit. How many politicians do you know who love to raise taxes to protect or help their favorite constituents. I think it may be time to put in the 220 service and extra fire insurance for the garage for my new Chevy Volt. Or to look for a good supply of AA batteries and a place in the woods to wait out the storm. Good luck, everybody.

    • “…guaranteeing a minimum price for a commodity that never goes down and only goes up, like taxes and public sector wages.”

      Public sector wages should go down? Do you know of any private jobs where salary has gone down? Also, federal employees haven’t seen a raise in a few years now.

      “And now that the Supreme Court has okay’d taxes for anything, even those things people don’t do, the sky’s the limit. How many politicians do you know who love to raise taxes to protect or help their favorite constituents.”

      This is sky-is-falling rhetoric. In the government of the United States there is always recourse to the citizens to elect different representatives should they enact outrageous taxes. That option is available to the American people with regards to the ACA “tax”, and it will make for quite an interesting election year to see if the majority want it repealed.

      • “Do you know of any private jobs where salary has gone down?”

        Yes. Realtors, investment professionals, teachers to name a few. And teachers are a perfect example; public employee teachers haven’t seen wage cuts, but private sector education (where I currently work) has seen repeated wage reductions. Even my friend who works in IT at Hewlett Packard had to take a 10% wage decrease along with the other 60-some people in his department. Private sector wages are falling. I don’t know if it is across the board, but it certainly isn’t uncommon.

        • Good points. I shouldn’t have generalized based only on my experiences. I guess my point was really to ask whether it’s realistic to have the expectation that just because someone works for the government you should be subject to salary decreases. In the private sector it can be a reality, as you demonstrate, but it is definitely not an expectation.

          • Do you know of any private jobs where salary has gone down?
            In the private sector it can be a reality, as you demonstrate, but it is definitely not an expectation.

            Check out Nucor. Now the biggest steel producer in the US. They get paid about $30K to $50K per year. I think. But they get huge add ons depending on how profits run. So many were making north of $80K for years until the recession hit. Now they are back down to mostly under $50K. And yet every time I’ve read or seen something about them they are an incredibly loyal work force. And there are others. I’d like to think we need to educate the public such that it is up to them to grow their company and make it better and not treat it like nothing more than a source of wages no matter how well or bad the company is doing.

            And government employees are an issue with this mindset.

        • Radagast says:

          I was one of those folk…

    • I’m sorry, caring for people’s health is not (should not be) a free market commodity. Care for the sick is rooted in the religious mandate to love and serve our neighbors. In a secular society it should be viewed as part of building healthy and safe communities. It is a central responsibility of civil societies to care for their citizens. The intrusion of big money and profit motives into health care is the root of all evil.

      • Care for the sick is rooted in the fact that a fellow human being is suffering. Religion has nothing to do with it.

      • Care for the sick is a Religeous Mandate. So we should push our Religeous Mandate on to a secular society and pay for it with other peoples money! If other people don’t want to pay we tax, [confiscate] their money. Jesus said to the rich young ruler, give to the poor. He didn’t tell the Roman govt. to do so.

        • But from a purely practical view, religious organizations can not possibly provide the level of care for the sick the government can. I guess you could make the argument that if the government were to stop taxing everyone to pay for social services, then everyone would have more income available to donate to religious organizations for them to provide the same level of care. But I have no confidence that Americans would give to social services voluntarily at the same rate that they are currently taxed to do so.

          So while it sounds nice to neatly separate religious and secular, I just don’t think we would end up with as high a standard of living for as many people if taxes weren’t used to provide it.

        • I gave a humanitarian secular foundation also.

          • “If ti’s for your own good, or societys good,” it’s o.k. to force one to do it. So let’s enact sunday laws, ban alcohol and big gulps and make everyone a vegitarian! Social justice is spending other peoples money to salve your own conscience.

          • Vern, I just don’t see your point. All laws, theoretically, are efforts on behalf of our elected representatives to do something for society’s good. Our government does all kinds of things I don’t agree with, and spends my money to do so. Thus it has ever been and ever will be. The democratic process gives us opportunity to respond to whether or not we think our representatives are doing a good job and keeping the right priorities.

            If I think using the apparatus of government to help people have better healthcare because it is the duty of a democratic society to help take care of its citizens, particularly its most vulnerable ones, then that is a statement of both my priorities and my belief in what I think may be a good process for doing it. If you disagree, you can vote against it and lobby against it and express yourself against it. But don’t throw stones at me and tell me I’m just trying to salve my conscience or impose my religion upon others. I’m simply advocating a position that may or may not end up being public policy.

            There is far too much name-calling and incendiary rhetoric going on in this debate.

        • …no, but what about Robin Hood? “Steal from the rich to give to the poor!”
          For better or worse, he’d do well in politics today.

      • Phil M. says:

        I don’t agree that a profit motive and providing societal good are at competing ends. There are many fields that deal with personal safety that don’t necessarily have nearly as an immediate effect as healthcare but they’re dealing with people’s lives. Take architecture, engineering, and construction for example. In these fields, professionals are making decisions everyday that affect the lives of millions of people, and these industries are as profit driven as any industry out there. They can be downright cutthroat, really. The thing is, there all sorts of professional societies, building codes, testing, etc. that’s done to insure that projects are done correctly. It’s not the government isn’t involved at all. It is on many levels, but when it comes to deciding who performs the actual work, it’s not.

        I guess being primarily small companies, my idea of the profit motive is perhaps different. Smart businesses don’t see profit as something that’s extra for them to simply line their pockets. They take profits and reinvest them in R&D, hiring the right people, and expanding the business. I think it’s very easy to demonize the insurance industry, but in reality, that industry is dealing with a lot of things that are outside of its control.

      • “…caring for people’s health is not (should not be) a free market commodity.”

        There is evidence that says otherwise. Look at laser eye surgery. It is not covered by most plans and that is a good thing. As technology has advanced the surgery has become safer, quicker, and less expensive. It is free market competition in action. If it had been covered by health plans and everyone had a “right’ to laser eye surgery it would have gone UP in price instead of down because there would have been no free market pressure to “find a better way.”

        • Dozens of countries have socialized health care systems where people have a “right” to surgery, many of them for several decades, and when you look at these surgeries they haven’t all become more expensive and labor intensive over time. These ideas about how socialized medicine work aren’t theoretical, you can look at the entire rest of the developed world, it’s not the dystopia you describe.

        • I’m not talking about elective procedures. I’m talking about basic health services.

          • I’m talking about basic health services.

            Are you saying that corrective eye surgery will not be considered basic in 10 or 20 years and a mandated coverage. With the 30 year old folks wondering how it could have never have been considered so?

        • I wouldn’t call all socialized medicine dystopian. There may be models out here that work for the citizens, I don’t know. Obamacare is just not one of them.

          I have seen others on this blog call our pre-Obamacare model a “free market” model. It is not. Capitalism and free markets are not always the same thing. The pre-Obamacare model was capitalistic but also monopolistic. Monopolies are not free markets. Free markets can provide good affordable care as shown in the example of laser eye surgery. But instead of a working free market or a working socialized medicine model we now have the worst of both worlds. We have a monopolistic monstrosity being taken over by an ineffective bureaucracy. This is a step in the wrong direction as it compounds one problem with another. We need true reform.

  19. I have a disease that has connected me to english speaking people across the world, as it is rare and tends to trap us at home. We have a vibrant, centralized online community. This has put me in a position of perspective on health care provision. I have also been uninsured against my will for years at a time, and on cadillac health insurance through a great employer. All of us, no matter what country we’re from, have serious complaints about the inherent rationing scheme. The only thing that differs is WHAT complaints we have. It has become quite clear to me that every country has a rationing scheme, some on purpose (socialized medicine) some ad hoc (insurance based medicine), and some are a mix.

    Here are some examples from the world of crippling spine diseases:

    In France, you get great health maintenance, but no or ridiculously insufficient disability equipment, leaving people shut ins that could be out, even working.

    In New Zealand, you get amazing care, even things like feeding tubes with little hassle, and home visits from specialized nurses, but that end of the line stuff like ventilators are unavailable.

    In Canada, some things take a lot more hoop jumping to acquire (like trache ventilators), but they don’t require economic power to get, and you can hire a college student to keep an eye on the thing while they are writing papers if you want.

    In the UK, getting past the general doctor level to the specialist you need can be a big challenge, but once you’re there you don’t go undiagnosed for lack of necessary tests. The disability paperwork is famously ridiculous, but once you’re in the system, you do pretty well, and it doesn’t prevent you from giving back to society.

    In Australia, getting seen by a specialist seems less difficult than the UK, as well as getting tests, due to very efficient specialty groups, but the whole system is so interlinked that a “not our type of problem” report from one specialist can get your PT, OT, and equipment care cut off just like that.

    In the US, getting your life saved once you get to the breaking point at the ER is pretty much guaranteed, but quality of options, care, equipment, and life varies wildly before that point. Getting care for basic things, even diabetes or broken legs, can be easy to get for very little at a sliding scale clinic if you can regularly get free time during the week (the waits are quite long), but if you can’t afford an expensive test, you could have an undiagnosed neurological condition for many years. One doctor can’t ruin your care, you can just take your dollars to another, but if you have no money you probably won’t see either till it is much later than is helpful. If you do have enough money or insurance coverage, the sky is the limit on what kind of care you can have, there is not artificial cap.

    Given the needs of any given individual, some rationing systems are going to be inherently better than others for them, but even figuring out what would best for a single large family would be hard. Healthcare could be an essentially infinite cost project, if you just keep pushing your standards up, and no country in the world can afford that. In this world, someone is going to go without something important, and all we can do is minimize it. What I would ask as an american who has gone without is simply honesty, that we acknowledge our country rations too, just in a much less organized way.

  20. Danielle says:

    I agree 100 percent with the overall thrust of the piece.

    I don’t think the current law will fix all our problems. But it’s an attempt to get nearly 100 percent of the population into the system and to make the system sustainable. At present, we neither have health care for all–beyond people being guaranteed care when the collapse in the ER waiting room–nor do we have a system for which we can pay.

    Even if you disagree with the current law, we need to do more than say that it’ “good” for people to have a “choice” to go without coverage, and without routine care, as though they’re empowered by this economic situation. Its also useless to pretend that the results of private decisions to not affect the cost of care for everyone else. Eventually, paying $90 to the urgent care center stops working as a tactic, and the system winds up (1) bankrupting you and then (2) cutting its losses and getting the funds for your (possibly inadequate) care from elsewhere.

    Whatever policies we support, let’s at least get our hands dirty and forget perfect models and pure ideology.

  21. Richard McNeeley says:

    Just some thoughts from the consumer side.
    My mother spent the last 8 months of her life in the hospital and a care facility, the total cost about $800,000. My father had round the clock in home care for the last 2 years of his life, I don’t know the total cost. Fortunately they had insurance and the assets to pay for their care. 5 years ago I fell off a ladder shattering my right elbow and injuring my back, total cost so far about $50,000, again mostly paid for by insurance. Without insurance I and my parents would have still received care, but others would have had to pick up the tab. I am not sure what the solution is, but I do know that we all pay for the uninsured.

  22. Health Care is not quite like other forms of economic activity. There is often less information on your choices (due to a variety of reasons). Very strong reasons to not go with the lowest cost option (due to the desire to live). Compare a free without government influence health care market with say a free without government influence restaurant market. Death and other bad outcomes are way worse than a bad meal. Cost is way higher in the former case (particularly as you age). Yes I know that a bad meal could be food poisoning but people usually get over that (and it become part of the restaurant information that is shared among the public).

    The key to efficiency is accountability. Both governments and businesses (if you will let them) will seek to shield themselves from accountability (consider layers of bureaucracy and/or monopolys and/or regulatory capture). Capitalism often has an inherent mechanism of accountability. If your product or service does not appeal to the customers, you go out of business. I however see no immediate future in which the Democratic or Republican parties go out of business or get serious competition.

    Such are my wandering thoughts at the moment.

  23. I don’t want to let people live in misery or die due to a lack of medical care.

    Costs are going up because we can now do more than in the past. Way more. Heart, lungs, liver, kidney transplants. Sure we can. Open heart surgery every two years. No problem. (technically)

    But at some point this all has to be paid for. And if the costs of all of this are rising faster than growth in a robust economy there is not enough handwaivium in the universe to cover it over.

    Which leads to rationing. So do we expend (from some source in the economy) $1,000,000 to extend my life a year or treat 1000 pre-schoolers from poor families with bad teeth. To be honest I’d give up the year and opt for the latter.

    As to the current bill. It’s a mess. I is supposed to be a cost saving item but like much in government accounting a lot of it is smoke and mirrors. Much of the savings are in PROPOSED future legislation that has yet to be put before Congress. Cutting reimbursements to docs. Eliminating Medicare benefits. Things like that which we all know how likely a lot of that is going to happen.

    Another big deal with the bill is the entire evidence based reimbursements. Anyone remember the dust up over mammograms and PSA testing? Proposed changes in how we as a nation do these things based on science got shelved over emotional desires. And then there’s the penalize docs if their patient results are below average. Any one doctor or group of doctors will be open to the normal statistical variations. It will be more luck than care in many cases. And heaven help the docs who get my mother and/or mother in law. They both seem determined to commit suicide by ignoring doctors requests/pleadings/threats. My mother incurred about $250K or more in bills a few years ago due to refusing to have a $100 procedure done a few years before that. And my mother in law fights against taking any medicine that doesn’t apply to what she feels bad about that day. And if you penalized for bad results do you really want to set up shop in rural Mississippi? Or even the Chicago south side?

    Now even IF Congress and whatever admin takes care of this deals with the missing legislation and evidence based care, there is some gimmicks in the numbers. The CBO is required to do 10 year projections. But no more. The bill front loads the “income” and defers much of the expense until later in the first 10 years. So even if it all works out as planned (future legislation and all that) the second 10 years are projected to be a huge deficit without new taxes.

    Again, I think we have a mess in our current system. And I don’t like the thought of ignoring people in need. (I have less trouble ignoring people of sound mind who tell me to FO but I don’t want their kids to be killed due to them.) But until we figure out a way to stop the GROWTH in costs this bill is doing nothing but shuffling the same deck of cards.

  24. Readers should be aware that the provisions in ACA come from the (very conservative) Chicago School of economics. The only thing that would improve this bill is a single payer system. But the SCOTUS decision is NOT ABOUT ACA. It is about whether the federal government can take your money if you refuse to purchase certain goods and services. Please, let’s not confuse the two.

  25. Wow…the bullshit eminating from I-Monk today is pretty profound.

    Let me tell you guys about my father. My Mom is stung by the irony that my Dad who was a practicing neurosurgeon for 30 years is now dealing with a brain tumor that he treated in other patients for decades.

    My Dad lost his father when he was 18 months old. His father died of pneumonia in the northern Montana highline near Canada. My grandmother, now a single mother moved back to be near the family in the western Montana “Pittsburgh” of Butte. My Dad got many scholarhsips due to hard work and desired to be a doctor. To help put himself through college he took individual jobs. He worked in cleaning out the sewers one summer. Another one he worked in a mining smelter in Anaconda, Montana. Working around the clock he worked with melted zinc, and silver. It was jobs like this that helped put himself through college.

    My Dad trained at some of the most accomplished medical schools in the country. Chicago, Duke, etc… And he dedicated himself to his career. I’ve had some disagreements with my Dad over faith, and a few discussions with him about it. My Dad is the Catholic and in his career he regularly bit the bullet and took on patients who couldn’t pay. He absorbed it as a business loss. One of his friends was a neurosurgeon from Canada who immigarted here because the single payer system undercut his business costs and to support his family he left Canada to move ot the United States.

    For my Dad the costs of business over time became a huge burden. What finally convinced him to leave medicine was the high medical malpactrice costs. It was a third of his business expenses. He loved medicine but took another job. Before he became ill he advised young people against going into medicine.

    Some of you here spouting idealism don’t know what you are aying. Yes the idealism is attractive. But in the case of my father it affected him personally and became a burden that weighed on him. I’m disgusted to see this post. When I consider my Dad’s business losses in taking care of people here and there who had limited means to pay, it sickens me that some of you are advocating a form of “heath care” that helped force my Dad out of business. On another note if this is what Christianity is about than maybe my Dad was a fool for taking care of a migrant here or there and putting his trust in a Catholic faith that many of you adore. In some ways it can show a flip side to the uglyness of faith. Thus in the end the healthy nature of atheism and agnosticism.

    Thanks guys….

    • Malpractice insurance is a real concern, Eagle. I don’t think anyone said otherwise.

    • sayla1228 says:

      I guess the only way to avoid burdening doctors like your dad and the health care system is to never never get sick, have cancer or never take care of your health.

  26. I don’t know much about these issues, but it really does seem to me that many fiscal conservatives seem to be afraid that because socialism is bad, then socialized medicin is also bad. This isn’t true. While fully socialist nations have tended to fair badly, non-socialist nations, especially in Europe, have managed to implement socialized healthcare with great success. Now, there are good and bad ways of doing it, but free market capitalism, the entrepreneurial spirit, and vocational freedom are not all going to be squashed just by socializing medicine. I think.

    • non-socialist nations, especially in Europe, have managed to implement socialized healthcare with great success

      I’d say more of a mixed success. And they, in general, have not figured out how to deal with the rising costs that exceed the rate of growth in their economies. To be honest I don’t think any of them have deal with that aspect.

    • Phil M. says:

      I wonder if it’s even fair to compare a European-style system to the US, though. Germany has the biggest population in Europe at 82 million or so, but by area, it’s less than the size of Montana. It just seems that the sheer geographic size and diversity of the US is going to make a more centralized system inherently more complicated.

      • cermak_rd says:

        And diversity more than number of people. Finland has a socialized medicine scheme and it seems to work well. They also have a top-notch educational system. But they also have an extraordinarily low level of childhood poverty by American standards.

  27. I admit this discussion frustrates me. When I hear people say, “I don’t want to pay for someone else’s healthcare,” I want to say things like, “Because you’ve somehow convinced yourself you aren’t already paying for it?” Or “Because you don’t realize the whole point of the individual mandate is to require everyone who can to pay up?” Or “Because it should be every man for himself, and if people can’t afford healthcare they should die already?” Or when they say, “I don’t want the wasteful, inefficient government involved in healthcare,” I want to say, “Because private insurance companies have proven to be so efficient and cost-effective?” Or “Because all the statistics that say national healthcare produces better outcomes at lower cost are entirely made up?” Or when they say, “I’ve heard horror stories about healthcare in countries with a national program,” I want to say, “Because no one here in the US has a horror story about our current healthcare program?” Or when they say, “A deregulated free market is the way to go,” I want to say, “Because all the traditional mechanisms that drive price down in a free market don’t actually exist in healthcare?” Or when they say, “It’s all partisan,” I want to say, “You mean the plan that is almost entirely what Republicans were presenting for 20 years, until they magically decided it was a bad idea at the exact nanosecond that Obama proposed it?” Or, “Because polls consistently show that even Republicans favor most provisions of the plan, often by a large majority, so long as you don’t let on that it’s actually Obama’s bill they’re supporting?”

    It’s not a perfect bill, but it’s a step in the right direction.

  28. It’s not true that the ones who have insurance bear all the costs of the ones who don’t.

    I have a self-employed friend who had to have emergency surgery. She set up a payment plan with the hospital and the doctors. The bad part was, I had had the same surgery earlier and had access to some better options for pain management that they didn’t even offer her because she didn’t have insurance.

    What’s even worse is that she had to pay the full price for everything on her bill. The big insurers get big discounts, so they pay sometimes as little as 30% of the charge and the provider has to eat what’s left after the co-pay. If my uninsured friend could have paid the prices the insurer was allowed to pay, she would have been in a lot better shape financially.

    Nothing in this bill addresses this issue. Prices will continue to go up and so will premiums. We will all end up with Medicaid-quality care while the insurance companies keep making profits and paying dividends.

    • When the first Blue Cross/Blue Shield insurance companies were set up for health care, they were not-for-profit companies.

      • Right. And more and more of them are going to for-profit status. Our local BCBS did. IMO they should not get the discounts a non-profit would get and then distribute that money to shareholders.

        I know the health system needs overhauling. I just don’t think this was the best way to do it.

  29. Michael says:

    This is probably so far down that no one will ever read this, but I’m writing it anyways. This health care debate has made me come to a realization. “Constitutional” is to angry political junkies what “biblical” is to angry religious people; not a descriptive term, but a bludgeon aimed at those who would disagree.

    • cermak_rd says:

      Oh come on, it’s amusing to hear people say well, now that the Supreme Court has ruled, it’s still unconstitutional. Which makes no sense. Whatever the court says is what is constitutional. Dred Scott was constitutional. I believe the word we normally use for Dred Scott is wrong, not unconstitutional. And given Dred Scott was ruled on prior to the 13th Amendment, it probably was a constitutional decision. Wrong, but constitutional.

  30. If America would just not build new Aircraft carriers for 650 billion dollars each and not build f22 raptors for 22 million dollars each how much affordable health care could we afford? How about not inciting forerign wars? How about policing ourselves instead of the whole world? How about acting like the Christian nation we claim to be? How about voting for Ron Paul instead of the two who are the authors of this horrible health care plan….. Shalom

    • Should we go back to the isolationist days? Its a good think we didn’t listen to the isolationsist in the 1940′s or 50′s. The US government’s first obligation should be to defend itself and the Constitution. You can gut defense all you want but entitlement programs will keep growing and growing. I do not want the US to look like Greece. I don’t want our military to be hollowed out. We need to get a handle on entitlement spending and reign it in. What is really needed is social security reform. Means testing, delayed benefits since people are living longer, etc.. We don’t need another entitlement program that accelerats us over the cliff. Why can’t the following individually be done?

      1. Works with companies about extending coverage for youth?
      2. Make pre-existing conditions illegal.
      3. Emphesis preventice care, and regualr docotr visits to catch things earlier.
      4. Work through legislation issues such as mental health cae, and obesity, etc…

      Why the hell do we have to nationalzie the entire program? I don’t need a suppository the size of a basketball rammed up my &^%!!!

  31. cermak_rd says:

    No one has really engaged Chaplain Mike about the other part of his post the one about futile, end of life care. I think this is an important aspect. Not that I want to cut someone’s grandma off of her life-saving care, but oftentimes these treatments and tests offer much hope but little practical benefit and sometimes have negative outcomes.

    I think given the touchiness of this topic (heck, just having counseling for end of life issues led to claims of death panels), that it will be met by each individual being responsible for himself and using his own autonomy to say no or to sign a DNR statement and living wills and such.

    • I think a lot of trouble would be saved if living wills were more common – even if they weren’t perfectly legally binding, they would take the guilt off of the family while the example oncologist is pushing them for that next treatment. Instead of people arguing about what their relative wants, they can read a document about how in general they want their treatment to go.

      I’m not sure how to encourage them to be more common, anything government related would be a huge political mess. So many people don’t think they need one at their age, or in their condition, etc. Some way of centrally registering it across all hospitals would be very cool.

      • Speaking of living wills, etc… My former boss’s father died about ten years ago. He was basically brain dead after (I think) some major heart problem and so the family decided to pull the plug (I believe he was on a respirator). After a day or two while still waiting for him to pass away, people actually attempted to come and take him to a scheduled dialysis treatment elsewhere in the hospital. I’m sure they would have successfully done it had my boss or his brother not been there to say NO. And I’m sure insurance and/or Medicare would have been charged for it.

  32. For Congress to pass ANY bill or extensive piece of legislation with out reading the bill and carefully discussing how the law of unintended consequence may work out in the wording of such legislation is reprehensible and a dereliction of responsibility and duty.

    That should be a MAJOR concern regardless of one’s view of the appropriateness or necessity of said legislation. or agreement or disagreement with the SCOTUS ruling….
    .

  33. Randy Thompson says:

    Chaplain Mike, thanks for your excellent article. Our health care system is broken and grotesquely expensive. I agree: What we have in place now doesn’t go far enough.

  34. Well, I’m a single mother to two children. I graduated in 2010, in one of the longest recessions in our country’s history, with no prospect of a permanent job, working as many hours as I can at whatever temp job I can find. I am glad you are happy that I am forced to buy insurance I don’t need, coverage for anything you can think of. I rarely go to the doctor and don’t need and can’t afford more than the most basic high deductible coverage. But I suppose it is morally right that I subsidize you by spending a huge chunk of my income on insurance that covers everything under the sun. Because it’s not enough that I work day and night to give my children a chance at a better life. No, we have to kill more jobs and tax me more so liberals can have their little hearts warmed by thinking they are telling me what is best for me. God can judge you. Oh, and 78% of the people who filed for bankruptcy from medicals bills had health insurance.

    • Lizzie you are just making my argument that the new changes are only baby steps toward a real set of solutions.

      And please, the rhetoric and name-calling is not helpful in any way whatsoever.

      • Lizziee says:

        Sorry, I didn’t think liberal was name calling. And it’s not rhetoric. And when I sit and cry in front of God, I know in my heart that he sees what is happening. It is that much harder to find a job now, to take care if the children depending on me. I usually love your posts but don’t get offended at me for speaking the truth. I’ve had a job since I was thirteen and I am not blind to the effects if this bill.

        • Lizziee,

          You will be better off as a result of this bill. Insurance cost will be subsidized for those below specified income levels. It will make it easier for you to take care of your children.

          T

  35. Rick Ro. says:

    Well, since Jesus seems to have left the building, I’ll offer up a post I made to Facebook this morning…

    I’m so happy that 26 years ago the Good Lord put all the puzzle pieces in my life together, to the point I recognized the need to acknowledge Him as Lord. I am so very happy today that I know He loves me, and has adopted me into His family. I am every so exceedingly happy about that today, for as I read about everyone screaming at each other over Obamacare, that it is either our nation’s savior or our next disaster, and as I read people claiming “victory” and crying “foul,” and as I think about the fear-mongering of politics and that everyone is more concerned “WIN” rather than “WIN-WIN”…well…I know my Father in Heaven loves me, and I take great comfort in not having to look to my government for salvation.

    Peace, out.

    • IMHO, Jesus showed that he cared a great deal about ministering to people with health problems. Christians have been at the forefront of serving their neighbors in this way for centuries. “Healing” ministry in all its forms is mission work of the highest order, practiced and modeled by our Lord himself and his apostles.

      The politics part is an extra layer, but since it affects how I do my job and carry out my Christian vocation, I’m a little offended that you characterize what we’ve talked about today as “Jesus leaving the building.”

      The only building Jesus left was the holy huddle of the righteous in order to minister to the poor and needy.

    • Marcus Johnson says:

      I think Rick Ro. was saying that there’s something about the way professed Christians talk to and respond to each other when they disagree that causes people like him, and me, to think that Jesus has left the chatroom.

      Personally, I’m just as concerned about the way the majority of my church will debate this topic. To be perfectly honest, I’m planning on skipping this Sunday, just to avoid the nasty conversations I think I’m going to get pulled into.

      • Now I can agree with that.

      • Rick Ro. says:

        Exactly, Marcus. For a site purportedly about continuing Michael Spencer’s legacy of Jesus-shaped spirituality, I guess I expected more of a discussion about how Chrisitans DISCUSS this subject with Obamacare supporters and dissenters, rather than basically seeing two sides square off against each other. Everything I’ve read here I could read at liberal sites, conservative sites, news sites, etc., and this debate should be reserved for those sites. The “spiritual” and Christ-like response and discussion is what seems to me to be totally lacking here. That is why I said Jesus has left the building.

        So how about it, folks? How should Christians who believe in Obamacare discuss this issue with people who hate this decision? How should Christians who hate this decision discuss this issue with those who support it? How do we glorify God the Father in this debate? How do we turn non-believers toward Christ and the cross in this debate?

        THAT is what I expect from the Internet Monk site, not “here is why this political decision is good/bad.”

        • Follow up post tomorrow afternoon, Rick, to continue the discussion as you have suggested. Thanks for the prompt.

          • Rick Ro. says:

            Looking forward to it, CM. Sorry if my words offended you earlier. I certainly didn’t mean to belittle you or the work you do. It was just that I didn’t see any of Christ or the cross entering into the discussion, which troubled my spirit a bit. It also seemed to me that intentionally bringing Christ and the cross into it could make for some healthy (and dare I say “unifying”?) discussion and maybe some wisdom in how to talk about this with people who believe differently than we do.

        • IOW, “let’s talk about talking.”? I’d call that form over substance.

          T

      • Marcus Johnson says:

        Chaplain Mike, PLEASE take Rick Ro.’s post under advisement. I think there is a great way for us to turn this conversation from political debates to something much more transcendent and spiritual. Think we could possibly get into a discussion about something like what Rick Ro. is proposing?

        • Yes. I started to respond to Rick but had to do something else away from the computer. What I was going to say was that this was simply one person’s initial response to the SCOTUS decision in the context of the work I do, but there is much more about which to talk. I am formulating some ideas for a follow-up post tomorrow afternoon.

  36. Marcus Johnson says:

    Not that I don’t love political debates, but I think introducing a discussion about the Affordable Care Act is a lot like that blacklight spray the techs on ‘CSI’ use to detect the presence of bodily fluids. Sure, it may look like a five-star hotel room, but under the blacklight, you can see everything is covered with blood and semen and filth.

    Same with this discussion. We may all pretend to affirm the love of God, but something about the way both sides are arguing this debate suggests that we are as unfamiliar with how to apply that love to political debates as we are with how to fly a space shuttle. I guess the only way to try to get clean is to rip both sides, so here goes nothing:

    For the anti-ACA crowd: Health insurance is like water in the desert. When you realize you desperately need it, it’s usually too late. If the law that mandates that we get health coverage also makes it possible for us to obtain it for free or at a low rate, then what’s the problem? And if the law doesn’t make insurance cheap enough, shouldn’t the rallying cry be, “It’s not low enough; you need to make it so people like me, and people less fortunate than me, can afford it?” As a veteran, I can tell you how ineffective the VA health care system can be, but if the alternative is trying to wrangle some coverage from a private insurer for much-needed therapy, then I’d rather deal with a bureaucratic nightmare. You’re right, we can probably do better than the ACA, but we cannot do nothing, and it seems as though this side of the debate has nothing to offer here.

    For the pro-ACA crowd: This law is much more complicated than, “Now we can all get free health care.” We don’t know where the money is coming from to afford all of this, and if we think that a financially-strapped government can afford this initiative without sinking deeper into debt, then we’re either pretty naive or we are lying to ourselves. Granted, I appreciate that this whole deal doesn’t go into effect for another two years, but before we show up on the deck of a battleship, wearing a flight suit and standing in front of a banner that reads “Mission Accomplished,” shouldn’t we at least be sure we know what the law is that we are defending? I can guarantee you that, if tested today, neither supporters nor protestors of the bill would know the language or the implications of this bill. More importantly, the creators of this bill seem more invested in getting our support than in ensuring we are informed.

    Alrighty, hopefully that does equal disservice to both sides of the argument. Let the games continue!

    • Rick Ro. says:

      Love this, Marcus!

    • There is no free healthcare. Somebody will pay for it!

    • Marcus Johnson says:

      Vern, I believe I said “free or at a low rate.”

      • One problem is I think a majority of people think “free” health care should be provided.

        I was in a focus group that turned out to be BCBS trying to figure out how to attract more people to their plans. A dozen or so folks in the room. For all but two of us the biggest complaint was that health care wasn’t free. And for most of those it was a desired that it be free for anything they wanted. 10 checkups a year. Free. Blood work quarterly because they think they are getting something mentioned on Oprah. Free. Sort of breath. Let’s talk about a free lung transplant.

        Even when it was brought up that the money had to come from somewhere and if not at least partially from their pockets then from the pool available to them for wages and such, they didn’t get it. At all.

      • Marcus Johnson says:

        Hence my desire to rip into the pro-ACA folk just as much as the anti-ACA folk. We speak in these hyperbolic rants without really considering the practical benefits and drawbacks of this bill. I am very much concerned about where the money is going to come from, and I think neither side has actually considered how this is going to happen.

  37. JoanieD says:

    Chaplain Mike writes, “One study in the mid-2000?s showed that 41% of Americans (79 million people) have medical bill problems or are dealing with medical debt.”

    People are so worried about how they are going to pay these bills, how they are going to pay for insurance. If Canada and the Scandinavian countries and other places can figure out how to have health care for all its people without the incredible hassle and expense of medical insurance/doctors’ bills/hospital bills, it seems that the USA should figure it out. We are just so totally wrapped up with insurance companies. If we can’t come up with some government-based system, then wouldn’t it be great if we could pick a doctor and a hospital and just send them a flat amount each month to keep them going and that would cover all our services? Let’s say I send my doctor’s office $30 a month and $100 a month to the hospital. That is still a lot of money for me and for many of us. But if we knew that we would never get a huge medical bill, the stress would be greatly reduced.

  38. Marcus Johnson says:

    It was common law in Israel for landowners to allow poor people to glean their fields (Leviticus 19:9 and 23:22). The poor people were not employed and did not have any inherent right to the wheat, but the idea behind it was that everything that we think we earn was actually given to us from God, and he gives to everyone freely.

    Years later, a hippe socialist communist said, “You have heard that it was said, ‘Eye for eye, and tooth for tooth.’ But I tell you, do not resist an evil person. If anyone slaps you on the right cheek, turn to them the other cheek also. And if anyone wants to sue you and take your shirt, hand over your coat as well. If anyone forces you to go one mile, go with them two miles. Give to the one who asks you, and do not turn away from the one who wants to borrow from you.” The Roman Empire was notorious for forcing people to perform menial labor tasks, with no expectation of reimbursement, and in a manner much more brutal than anything our current federal government could be capable of. However, Jesus (the hippie liberal) suggested that showing the love of God means that we have to sacrifice time, money, even our pride.

    We are so worried about keeping our pride, our freedoms, and our money, that we forget that none of our earthly possessions were ever ours to begin with. What if it all belonged to God, and he just gave it to us so that we could do good in the earth? Would we still be as antsy about paying into a system that doesn’t give us a 100% return on what we put in? Would we still be so resistant to paying for the healthcare of someone else?

  39. Without entering into the general debate regarding this HealthCare bill, I would like to address one oft-repeated error in your article.

    “America does not have the best health care system in the world. Statistics don’t lie. America ranks 27th in life expectancy and 31st out of 40 in infant mortality compared to other OECD countries (see study cited above). With regard to other key indicators, we do not fare well in comparison to other countries around the world. We do have some of the best treatment in the world for those who can afford it.”

    In both life expectancy and infant mortality rates, the statistics are so badly skewed as to create a completely false picture that proves an effective “talking point” for those not concerned about truth. Most of the OECD countries do not count “live births” in the same way we do in the U.S. (there are various reasons for this and all the methodologies can be supported in one way or another) We count every baby that reaches 21 weeks of gestation while in many countries they only count those who are carried full term, and some count only those who live outside the womb anywhere from 24 hours to 30 days before being considered a “live birth”.

    The most common reason for premature deliveries and deaths at birth are low birthweight and drug dependency, problems which create overwhelming odds against preemies.
    So, in the U.S. we are averaging in MANY zeros in calculating life expectancy while counting as infant mortalities tens of thousands of babies not even counted in the countries to which you are comparing us.

    If you want to be honest in comparing life expectancy, start with those who reach 35 and calculate how many of those reach 65, 75, 85… you will get an entirely different picture. Where you work in end-of-life medicine, go do this in those countries to which you are comparing us and then tell me our life expectancy is less than theirs; we have far more extreme elderly than any other nation I can find data regarding.

    But if all you want is a talking point to criticize our health care, then sure, average in all those zero age deaths that other countries don’t count as “live births” and you will get the propaganda you cited.

    One place I agree with you strongly is the flawed medical practices regarding end-of-life care and especially cancer treatments. As Christians, we should quit defending the massive outpouring of resources to sustain the elderly without a significant quality of life… death is as natural as birth and our objective should be preparing people for the afterlife, not postponing it briefly at extreme costs to families and society. (Medicare has paid over 2 million to sustain my father’s life in a fashion he has never wanted to live. Can we afford to do that for everyone and what is our point?)

    • Jack,

      Your last paragraph is especially pertinent. Even our architectural terminology has been changed to minimize/deny our mortality; the “parlor” was the space in the house where the body of the deceased was placed before burial – the name of this space was changed to “living room”.

  40. Hiya! I know this is kinda off topic but I’d figured I’d ask. Would you be interested in exchanging links or maybe guest authoring a blog post or vice-versa? My website goes over a lot of the same topics as yours and I think we could greatly benefit from each other. If you happen to be interested feel free to send me an e-mail. I look forward to hearing from you! Awesome blog by the way!

  41. David L says:

    It is estimated that hospitals in the U.S. overcharge patients about 10 billion dollars per year. A personal example: Several years ago, we looked carefully at our EOB (Explanation of Benefit) statements at the end of the year. The charges for our family added up to about $13,000. Another column showed that our health insurance negotiated payments with the providers for about $4000. The charges were three times more than the eventual payments! I’m glad they got the costs down for us, but how many people pay more, or even the full charge?

    I’ve been thinking about this since the day you wrote it and can’t quite shake off the feeling that I need to respond.

    When you buy a discounted airplane tickets was someone who paid full price overchared?

    And yes I know health care and airline travel isn’t exactly the same but still. Discounting for volume is standard is most of the commerce of the entire world. Is it wrong?

    Hospitals in the US are fairly regulated. Profit and non profit both. In most states they have to get a state agency permission to expand or add new services to make sure costs don’t go up paying for empty beds or under used MRI machines. In this context they have overall revenue targets (profit and non profit both) that they are allowed to hit.

    Now you bring in the large insurance contracts. They negotiate hard. Especially in areas where there are multiple choices. So insurance plans get discounted and ala cart buyers get charged whatever is needed to make up revenue numbers add up. Or at least that’s what they try and do by setting prices a year or two in advance.

    Now I can argue there’s a lot of things wrong with this system but calling it overcharging isn’t one of them.