Thursday, November 12, 2009

Subsidiarity-denying the poor their due?

Deal Hudson has actually apologized for writing off the influences of pro-life Democratic Members of Congress, while praising the Stupak-Pitts Amendment. Unfortunately his followers there aren't pleased, for after all, he's often argued that this topic does not belong with the federal government at all, that under the Catholic principle of subsidiarity, the free market is a better place for health care.

I disagree with Deal that subsidiarity means the free market, but I will concede that he has a point. Not because, as the Reaganites tell us, the federal government is incompetent. But rather because human bodies do respond to climate, and different climates need different health care.

I believe the current proposal handles this by putting the exchanges in the hands of the states, with "public option lite": the public option only available after the free market has proven itself inadequate to cover the 90% target. BTW, this means that the current proposals from the Senate and the House are *NOT* universal health care, they're 90% health care. But that's a far cry from the 73% health care coverage we have now, so I believe it's worth doing.

So here's my question for all you theologians out there: Is the value of subsidiarity so important that you that you're willing to let the poor go without a health insurance system to support it? KNOWING full well that the next pandemic (and pandemics almost always start among the poor) or bio-terrorism attack (since this entire debate has shown an area of weakness that the terrorists would be stupid NOT to take advantage of) could well end up hitting you, due to lack of health care for your neighbor? And better yet, what would Christ (or more to the point, his character in the parable of the Good Samaritan) say about this debate over subsidiarity, while people are dying?

Now on to my second point. I've often been told by the non-Catholic free market people that subsidiarity is a ridiculous idea, that economy of scale means centralization and collectivism will always beat out subsidiarity for profitability. If you read the comments at the above link, you'll find one libertarian who actually disagrees with that view- claims that charity given personally has lower overhead than charity given in a group.

But beyond all that- by claiming a Universal God and Universal Message and Universal Right and Wrong, isn't the biggest break of subsidiarity the Roman Catholic Church herself? Would those of you who think of subsidiarity as an *absolute* value, then agree with the congregationalist Protestants that church theology should come from below rather than above?

Oh, and just to throw some fun into it, here are the Billionaires for Wealthcare, a little know counter protest to the 9-12 protest, with "Save the Status Quo", along with MSNBC's great commentary on the counter protest.

Because that's the option at this point: save the status quo.


Anonymous said...

The question on self-determination is a little more nuanced than you seem to want to make allowances for, as CST principles are universal not merely written for the American market, ie how persons elsewhere in the world are free under subsidiarity to determine the means to attain their ends, especially in places without layers of sophisticated public institutions that may offer economies of scale that permit a better match between human dignity and sacredness of life. Mission societies are often the most readily available health care, and they surely don't operate with wage-based insurance as payment schemes, they are most often fee-for-service or straightforward charity.

In most cultures, the family is the "healthcare provider" with the "insurance policy" being any income surplus on hand to pay for incurred expenses. The free market is the only way such persons have access to treatments they lack the skills or materials to provide themselves in exchange for economic goods at market prices. This is the way its done on most of the rest of the world other than in the North American and Northern European countries.

The way the healthcare is paid for is a different thing from the way the healthcare is provided. Currently the prices (fee for service) is extortionately exaggerated because Americans have become dependent on full-service insurance. The bishops would do well to task some of their many Catholic Universities with solving this intellectual conundrum - how to re-structure the delivery of catastrophic care (intense, lengthy or costly unforeseen interventions, such as for trauma from accidental injuries, terminal illnesses or chronic conditions with no remedial therapy, paralysis for example) and separate foreseeable health maintenance expenses from insurance policies. This is where subsidiarity could reap the highest rewards: for Catholic physicians and hospitals, instead of competing with for-profit institutions in all manner of specialities that are life-style driven such as bariatric surgery, knee replacements etc.) could specialize in delivery of basic check-ups and preventative and palliatibe care for an affordable fee structure while financial firms could specialize in tailoring insurance policies to suit Catholic values or not, with Catholics free to purchase other more comprehensive, 'secular' and pricier policies that cover elective procedures.

The conundrum is that the provision and the payment are two separate matters: most of us DO wish to secure provision for all, but are not willing for it to be a free-for-all. The question of the just or prudent price cannot be handled at the Federal level (that is a fact, aggregates are at best means of widely differing quantities and qualities that only the consumer himself is best equipped to weigh in the balance for his or her family's needs and tastes, consider the famines of centrally planned states such as N. Korea, we know better to not rely on centrally-planned nutrition, so why centrally-planned health? )

Anonymous said...

oops that was me, Clare Krishan

Ted Seeber said...

First of all Clare- glad to see someone here at all.

First, I'd like to point out that free market services, worldwide, are indeed broken. We don't compare our Northern European and North American health care systems to the third world for a reason; that reason being that "most cultures" barely have any form of technological health care to begin with. Subsidiarity is fine, but it doesn't scale well.

Which is a lesson that I think the Church has already learned somewhat- We don't care for souls in a free market subsidiarity system, we care for souls in a highly centralized hierarchical charity, especially the Roman Catholic Church, which has got to be the biggest single centralized institution on the planet.

Provision and payment are NOT two separate matters; as we found out in the Reformation (at least on it's surface, we now know the Protestants had some other more secret agendas as well) and the Counter-Reformation, payment can actually corrupt provision greatly.

So having learned the lessons of the Counter-Reformation and removing any *direct* demand of payment for the Sacraments, which are the "Services" that care for the soul, why would we want a health care system that wasn't a "free for all"- Charitable giving of the services in return for freewill donations?

Well, that's how I see it anyway- secularism of course messes this all up, assigns a profit motive to making health care as expensive as possible (always charge the most the market will bear, after all, is the first rule of the free market, NEVER consider the needs of your neighbor, and in health care, you've got a pay-or-die consumer) which leaves the government to bail us out, taxing the rich to care for the poor because the rich are too stupid to do it themselves.

I'd rather have subsidiarity. but if it is a choice between provision for all and subsidiarity, provision for all *MUST* be the higher value. If for no other reason than a loose coalition of preventative physicians will never be able to network enough to collect the data needed to spot the national security hole this debate has made obvious to even the most dimwitted Sola Jihad Islamic suicide bomber: He no longer needs a bomb. All he needs to do is contract an airborne third world illness that we have no vaccine for, immigrate, and start coughing on people.

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