*Posted by Joe Wooddell
According to her website, “Sally Kohn makes the world safe for radical ideas. As a veteran community organizer turned political commentator, Sally makes complex political issues accessible for everyday audiences. Sally is a grassroots strategist actively engaged in movement building for equality and justice. She is a Fox News Contributor and has also appeared on CNN and MSNBC. Sally has written for the Washington Post, USA Today, US News and World Report, Politico, CNN.com, FoxNews.com, Reuters, The Guardian and the American Prospect among other outlets” (http://sallykohn.com/about/).
I could simply focus on all the problems in the above paragraph (like the notion of making the world safe for “ideas” instead of people, and the fact that her views of “equality” and “justice” probably don’t make much sense). Instead, however, I shall critique her astonishingly poorly-reasoned March 28 piece, “5 Reasons ObamaCare is already good for you” (http://www.foxnews.com/opinion/2012/03/28/5-reasons-obamacare-is-already-good-for/).
Ms. Kohn defines the following five reasons ObamaCare is good for you as “facts.” First, “millions of Americans have already benefited from ObamaCare.” I’m not sure why that “fact” helps make ObamaCare good for me. If it’s unconstitutional, if it robs me of my right to private property or to keep more of what I earn, if it forces me to pay for things with which I have moral and/or religious qualms, then it might not be good for me.
The second reason Ms. Kohn says ObamaCare is good for me is that, “the law won’t fully take effect until 2014.” It sounds like she’s saying it’s good for me now, because I don’t have to endure the fallout for a couple more years. That strikes me as rather destructive. She says “critics are attacking the law based largely on hypothetical future predictions.” Why is that a bad thing? If there are good arguments that it will ruin the country and that it’s unconstitutional, then it should be attacked. Isn’t the whole global warming frenzy “based largely on hypothetical future predictions”? Isn’t every law we either endorse or denounce based largely on hypothetical future predictions?
Third, Kohn says ObamaCare is good for me, because “the individual mandate was originally a Republican idea.” She means that Romney came up with the idea in Massachusetts, and Nixon supported a similar idea in 1974. Her point is silly; it’s an ad hominem fallacy in reverse (an appeal to authority). I don’t do what people say only because they are part of a particular political party. The idea has to have merit on its own. There are plenty of ideas in both parties with which I take issue.
Fourth, ObamaCare is supposedly good for me, because “the Congressional Budget Office [CBO] recently cut health care reform’s cost estimates.” By how much, one wonders? From trillions to only half the amount? That’s not the primary issue. If the law is immoral and unconstitutional, then the price tag is only minimally important. She then says some estimates contend that repealing the law would actually increase the deficit by $210 billion. But how much would it increase the deficit to keep the law on the books? Perhaps more than $210 billion. However, these are all hypothetical future predictions, which she actually condemned in her second reason (above).
Fifth and finally, Kohn maintains ObamaCare is good for me, because “something had to be done about health care,” that Obama had a plan and the Republicans didn’t. But this is simply false; various Republican lawmakers had plenty of suggestions for fixing the health care system, but they didn’t involve a huge increase in government spending and regulation; and as the minority party in Congress at the time, their suggestions did not receive serious consideration.
In the end, Kohn wrongly maintains that “the president has a messaging problem, not a policy problem” (emphasis in original). She thinks that if he simply did a better marketing job the public would embrace the law. Obama had the platform, however. The media would have given (and did give) him as much time as he wanted, and he failed to make a compelling case. Again, however, all of this is irrelevant if the law is either immoral, unconstitutional, or both; and these are the primary things which believers should seek to ascertain. Breaking the law and/or acting viciously will not, in the end, help the poor.
Would you please explain why mandating health insurance is different than requiring people to have homeowners or car insurance? I am thinking that the last two are about liability, so would health coverage not fall in the same category as millions of uninsured chronically ill and those experiencing catastrophic events access the health care system, resulting in higher costs across the board as hospitals need to recover costs of this treatment?
Good question. There are a couple of differences, and your question leads in many directions. First, there is nothing illegal (yet) about a state requiring its citizens to purchase health insurance. See Massacheusetts as an example. (I say “yet” because there might come a day when some court, and ultimately the Supreme Court, rules that it is, in fact, illegeal for states to require this. But as of yet this has not happened.) It’s different with the federal government. The 10th amendment to the U.S. Constitution says any power “not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.” In other words, the states can do what they want as far what they require of people. (Of course, with respect to speech, religion, assembly, etc., we now have a loophole with the 14th amendment and what has become known as the “incorporation doctrine.” Namely, we are all national citizens as well as citizens of various states, and states cannot abdige our rights to things like speech, religion, assembly, etc., but that’s another story.) And only time will tell if budgets and citizens in states like Massacheusetts will be better off as a result of requiring citizens to purchase insurance. They might find (like the federal government is finding with all kinds of other programs) that it seems to fix problems short-term, but such policies cannot be sustained long term.
So nationally, Congress has no power to require citizens to purchase a product they don’t want. The primary argument on the other side is that Article I, Section 8 of the U.S. Constitution grants Congress the power to “regulate commerce . . . among the several states. . . .” This has become known as the “commerce clause” and most people simplify it by saying Congress has the power to regulate interstate commerce. Anyway, the argument goes like this: Everyone is going to need health care at some point, and in fact everyone will receive health care at some point, and this use constitutes “commerce.” So Congress has the power to regulate it. But the other side (my side, for example) responds thus: This is a slippery slope to EVERYTHING being regulated! For example, everyone will need to purchase food and water at some point in his life as well. Should Congress have the power to regulate what food and water you buy, and from whom? This strikes me as absurd at best, and tyrannical at worst. Yet there are some (don’t laugh) who would do just that! They would mandate what you do and don’t eat, how much water you do or don’t drink, etc. It’s crazy.
Anyway, back to your question. So that’s the first point: no one is (yet) saying states can’t require citizens to purchase health insurance, only that the federal government can’t. The second point I would make is this: Homeowner’s insurance is NOT required. If you pay cash for your house and you don’t want to insure it, that’s your business. If you take out a mortgage, then you don’t actually own the house, and the lender is perfectly within his rights to require that you purchase homeowner’s insurance, so long as he is the actual owner of the house. With renter’s insurance, it might be similar. The landlord might have a compelling interest in you purchasing a renter’s insurance policy, and so might require it. Of course, there are plenty of landlords who do not require this, and if that’s what you want, rent from them instead.
With respect to automobile insurance, I have two comments: First, the same argument might apply to people who take out a loan for their car as applies to those who take out a loan for their house. The lender has an interest in requiring you to purchase insurance. That’s no problem; he’s the lender, he can require what he wants. Second, if you pay cash for a car and own it outright, how can someone make you purchase insurance? The answer is in the first paragraph above: The states (currently) have this power; the federal government doesn’t.
Thanks, your points are well taken, even the part about the dangers of government telling us what to eat and drink (just read an interesting book on how that has actually happened with the meat, dairy, and sugar industries). I would be interested to read a good conservative view on how to “fix” or improve the health care system (i.e. among other things, bringing outrageous costs down and making services more affordable to the average person or family). As for the person who chooses not to obtain available coverage but cannot afford to pay huge hospital bills out of pocket, is it immoral for that person to go ahead and access the health care system anyway? As for the millions of Americans who would like to have coverage but it is unavailable or cost prohibitive to them, often resulting in poverty or bankruptcy if they become ill or injured, is this a moral issue as well?
Last two questions first: No, it is not necessarily immoral for a person to ask for treatment or to try and access the health care system even though he chooses not to obtain or cannot afford coverage (as long as he’s not cheating or breaking the law; you are welcome to ask for anything you want). However, neither is it necessarily immoral for a doctor or hospital to deny him treatment in such a case. I don’t have to feed or help everyone who comes to me for food or help just because I’m a Christian. Not even Jesus did that. Great prudence and wisdom is required to know when to help and when not to, and there are lots of factors to consider.
Regarding the so-called “millions” who don’t have “coverage,” I’m not sure who these people are. Everyone was already covered, before ObamaCare. We have a medicare and medicaid system in this country for just such people. (Of course, it’s bankrupting the country, and you only mention that they are the ones going bankrupt when ill/injured. I’m not sure why I or my country should go bankrupt just so they don’t have to go bankrupt.) The point is this: every legal citizen (and many illegals) have access to emergency care through public programs already. We didn’t need ObamaCare to “fix” that. What “progressives” (a misleading term; it assumes everything they endorse is “progress”) want is “equal” outcomes for everyone. They can’t stand the fact that some people are rich, smart, good-looking, talented, entrepreneurial, successful, etc. and others are not. They hate it that such people get “perks.” But the fact is the world is not “fair” in this regard, and it never will be. Given the opportunity, nearly any person in any other country would come to the U.S. if he could, because it’s still, despite all the chaos, the land of opportunity. The political systems where everyone is supposed to be “equal” (like North Korea, Cuba, middle Eastern dictatorships and theocracies, and even China) are the places people are trying to leave to get here. So to answer your question, yes, it’s a moral issue when talking about people who might go bankrupt when they become ill/injured. But the moral question is this: is it moral to force me to work harder, longer hours, and to pay more in taxes in order to ensure that there are equal health outcomes for all? As a believer I should help people, especially (but not only) other believers (and my family first) (see Gal. 6:10 and 1 Tim. 5:8). And I shouldn’t be forced by government to help more and more people, esepcially to the point of bankrupting myself or the country.
As for your question regarding a conservative view of how to fix or improve the health care system, bringing costs down and making services more affordable, I cannot personally recommend any particular books. I know George Halvorson, President and CEO of Kaiser Permanente, has written several books and articles, although I have not read them. (I realize that when “progressives” hear “President and CEO” of anything, they get upset.) You might also look at work by Larry E. Carter, Jon Kallberg, Roger D. Blackwell, and Timothy S. Jost. I cannot vouch for any of these, but a quick amazon search on “conservative health care” produced these.
The main point conservatives would make is something like this: How have electronics, food, clothing, cars, and any number of other things become more and more affordable over the years? The answer is this: competition and the ability to make a profit within a free market system, operating under the rule of law. This is why nearly everyone shops at Wal-Mart: “always low prices, always,” or “save money, live better.” These are their slogans, and they’re true. Capitalism and free market economics gets a bad rap because people have abused it and broken the law, but the answer is not to become socialist; rather, the answer is to institute the rule of law more effectively across the board. To do this requires virtuous lawmakers, law enforcers, and judges, and to get these requires that we not only believe in and teach the right sort of morality and ethics, but that we believe there is such a thing! Unfortunately, many people (say they) don’t believe in ethics today; but then they get all upset when you don’t do “right” by them. They want to have their cake and eat it too, which of course is impossible.
The government is great at making and maintaining highways and a superb military. I can’t think of much more they’ve improved. (Maybe civil liberties, but even these movements were led by private individuals; and the rights were always there, recognized by the Constitution; they simply weren’t applied, unfortunately.) So when “progressives” don’t hear conservatives concocting some federal, national “plan” to make the health care system better, they see that as no plan at all, which only betrays their own bias toward the notion that the federal government is the answer to everything. When conservatives say, “keep your incompetent hands out of my way,” progressives get upset.
Thanks for reading and commenting.
Good post and excellent analysis. That said…one must first acknowledge that everyone has access to health care in the America. The first problem is this – for those who do not have insurance, the care may only be on an emergency basis and the cost is covered by the likes of me paying higher premiums, co-pays, etc. Everyone has access to medication as well though it, too, may be on a need only basis. That cost is also my burden for those who have no insurance.
The next thing to remember is the amount of fraud in billing. It is a matter of how much one can cheat the system without being caught. Then there is the matter of the drug companies forcing Americans with insurance to cover the cost of giving away or charging little to those countries outside the U.S. and forbidding Americans from purchasing same from another country at a lower cost. If one reports fraud, the report is ignored (believe me).
There was a time when employees paid most of their insurance. As the unions were able to gain concessions, employees paid less of a percent or, depending on the union, nothing. And now, employers are paying less or eliminating coverage altogether. One might argue that employers should pay for everything. Let me just say this. No one on this earth is due anything – not legally – not morally – not justifibly – not even from a Godly standpoint. What you are able to get is strictly based on negotiation.
Now, consider this. The fees charged are criticized – doctor fees, hospital fees, insurance fees.
The cost of an education is out of sight. The cost of running a hospital is horrendous. The losses incurred by insurance companies is burdensom. Does this mean that I do not find fault with fees? No. But, if you want to discuss moral issues, no one is worth more than one million dollars a year. And that is simply a reasonable statement – nothing more. But because that salary or whatever you want to call it is based on what one is able to negotiate or command, the population suffers. You talk about health costs and ignore entertainment, media, sports etc. Had there been fewer regulations to hamper business forcing them to leave the country or hire foreigners at reduced wages, there would be more people employed who could finance the great ponzi scheme. But, just for the record, Social Security was a retirement program gone awray with the Great Society that degenerated into SSI. And Medicare was a retirement program degenerated into Medicade. That is why neither has funds to cover anyone because both are financed with IOU’s and there are not enough workers to fill the till. And as an added burden, every American taxpayer is supporting illegal and unemployed and everyone who is not contributing his share. And now, the government wants me to give them the rest of what I have. The argument that auto insurance is forced has a moral basis. Who will be responsible if there is no insurance? Wait ’till you have an accident. I could go on; but I won’t.
Actually a free market economy has not been so successful for the health care system for the following reasons. The product being sold (health care) is not like cars or electronics in that we don’t usually have a choice about the need for the product; we can live pretty well without a television set. Shopping around for the lowest prices on cancer treatment or prescription medication is not a reasonable option. Unlike most of our economy where competition actually brings prices down, and low cost alternatives do exist (like Wal-Mart) medical procedures and drugs have fixed pricing and never go on sale (and I sure wouldn’t want a “bargain-priced surgery” anyway because it’s often true that you get what you pay for). Hospitals and doctors in the same town do not lower costs to attract more patients. There are no buy-one-get-one-free x-rays, surgeries, or cholesterol-lowering pills. Pricing a hospital stay at $1000+ per night is not at all like marketing hotel prices to tourists. Customer loyalty is not part of this equation, and in fact, patients without insurance get charged a much higher rate than insurance companies that negotiate prices on everything, resulting in the “write-off’s” you see on billing statements. When I was car shopping, I knew I had the upper hand to the salespeople because I could decide to walk out and go down the street if I didn’t like their offer (and they knew it as well, so they did everything in their power to make me a happy customer). Bargaining power is vital to an effective free-market economy. In the health care system, the bargaining power belongs to the giant insurance corporations that are able to deny you the “product” that you’ve partially paid for in “premiums” — in fact, they have a vested interest in never actually providing anything to you at all. The point is that price setting in the medical and pharmaceutical industries has nothing to do with supply and demand. Your comment relating “how have any number of things become more and more affordable over the years” to economic competition clearly does not apply to health care costs, which have become more and more outrageous and less and less affordable over the years. Lastly, regarding your statement that “everyone was already covered by Medicare and Medicaid” — not true! Medicare covers people over age 65 or disabled who have paid into that system for a number of years. Medicaid is a means-based system with strict eligibility guidelines. Millions of people without insurance fall between the cracks and do not qualify for assistance. For example, a family of five with children over six years old with an annual income over $27,000 does not qualify (2012 HHS poverty guidelines). Millions of American families fall into that category and either cannot afford huge monthly insurance premiums, are not given the option by their employer for coverage, or are unemployed with no health insurance and have no money to pay medical bills out-of-pocket.
Doctors can and do compete for patients’ business, and great doctors make a lot more money than merely good or mediocre doctors. I’ve seen both of these things happen, and it’s as it should be. Contrary to your first point, I think it is perfectly reasonable to shop around for the best prices on cancer treatments or prescription drugs. Everything’s negotiable. I have seen hospitals and doctors lower prices to attract more patients, and I’ve experienced it personally.
With respect to health care (vs. TVs, etc.) being a need as opposed to a want, and therefore “not like” other products as you put it, the analogy fails. Food and water (and perhaps electricity) are also needs, and producers and retailers compete for business on these items all the time. But with respect to competition, I was mostly (though not solely) referring to insurance companies: they should be allowed to compete for our business. Price fixing almost never has the intended beneficial effect, and usually produces one or more detrimental effects. (Instead of reading a conservative book on health care, as you requested earlier, I recommend a conservative book on economics. Here are two: Thomas Sowell’s “Basic Economics,” 4th ed., and Jay Wesley Richards’s “Money, Greed, and God.”)
With respect to everyone being or not being covered, you make a fair point. I should have been more clear. Anyone in my town can walk into the county hospital and receive treatment in an emergency, and the poorest among us qualify (as you say, they are “means tested”) for Medicaid. The rest of us have to make due. In the end, I don’t believe health insurance or health care is a right; rather, it’s a privilege. And I shouldn’t be allowed to force you to pay for my cancer treatment, no matter how prosperous you are. I realize I might have to eat these words someday, but I hope and pray I can stand by them on principle, even if I have to die from a horrible disease. I hope, if I (or a loved one) contract such a disease, I don’t march on Washington or start a petition or gripe and complain about how unfair it is that so many people are so well-off, and about how I should be allowed to force them to pay for my treatment. Believers should help one another (family first, then fellow believers) as well as unbelievers, and people in general should give liberally to charity and good causes. The funny thing is, studies show that conservatives consistently outgive liberals in all of this. Again, thanks for the feedback. I respect your opinion.
Do you think that basic healthcare is a public good? In one sense it clearly is not because it is not a non-exclusionary good–service can easily be refused to those who cannot pay. However, healthcare reform is an issue precisely because ‘free-riders’ are by law not allowed to be excluded from services like emergency room care. It seems that most people agree that that kind of exclusion is, at very least, disagreeable, if not morally abhorrent. Is there not something objectionable about a nation that expects its poor to die quietly rather than burden the public treasury with the cost of their emergency medical care? Maybe Obama’s plan isn’t a good one, maybe it is unconstitutional for the federal government to force an individual to purchase a service, but that seems somewhat less objectionable than the current system. I, for one, am willing to pay something so that others do not have to have to experience the hypothetical situation in your comments of stoically accepting an otherwise preventable death for lack of funds.
I’m not sure if it is a public good or not, but I’m also not sure I even believe there are such things (regardless of economic and political science scholarship over the past sixty years). I’m not sure the number of people “dying quietly” on the “current system” wouldn’t actually go up over time on Obama’s plan. (And I’m not even saying the utilitarian answer to such a question would be THE answer.) Like you, I also am willing to pay something, but I prefer the freedom to spend my own funds on whom I choose, not on whom/what (and how, and how much, and for what reasons) the government chooses for me. Thanks for the thoughtful comment.
I agree that it is better, that there is greater moral value, when individuals freely choose to do good than when they are forced to do so by some outside force. However, freedom is not an absolute value and it is an utopian dream to imagine that charity alone can provide the kind of social safety-net that, as a nation, seems obligatory. I’m not an expert in the healthcare system, or economics, or constitutional law. What concerns me more than any specific law or program is the attitude with which evangelicals exhibit in this debate and the extent to which they have allied themselves, all too often thoughtlessly, with conservativism (to the harm of both, I think). There must be a way to exemplify the virtues of Christianity, to have compassion on the most vulnerable around us, and at the same time hold to a measured, well-reasoned public policy. I will leave it at that as I’m afraid I’ve strayed inexcusably far from this post’s topic. . .
To reply to retropop’s second item: As you imply, there are different types of conservatism (economic, religious, social, military, etc.). I hope I don’t ally myself with any of them thoughtlessly. Like you, I am no expert. You make some interesting points. I just wonder if the whole thing hasn’t turned into a “false dichotomy.” In other words, the current system on one hand and ObamaCare on the other are not the only two options. Again, thanks for commenting.
RetroPop makes good sense in describing a case of choosing the less morally offensive way: Not turning away those who need emergency care. The problem is that misuse/overuse of emergency departments is severely taxing the system (as I witnessed as a hospital social worker). One reason this is occurring is poor primary and preventative care due to lack of health insurance by those who also cannot afford to pay privately (high medical bills being what they are). I believe that the Affordable Care Act is morally superior to the present system in several ways: dealing with “free-loaders” by mandating insurance coverage; making health care available to those who have been denied coverage; and reigning in insurance companies who do not compete for our business but provide as little as possible per premium dollar. It is not about forcing “you” to pay for “my” care but rather making health care more affordable and accessible to all Americans through the private insurance system. And yes, allowing “the poor to die quietly” and “accepting an otherwise preventable death for lack of funds” is morally repugnant as evidenced by the historical establishment of hospitals, hospices, and clinics to minister to the sick quite apart from the individual’s ability to pay.
Arguing that it’s either ObamaCare or the current system is a false dichotomy. Given the option, I’ll take the latter. But there are other options. (And by the way, “Affordable Care Act,” just like so many other names of bills/acts/laws, is a misnomer (like “No Child Left Behind). Many people think it will make care LESS affordable, not more.)
But that dichotomy is all too obviously false to be troubling. The more interesting question is the extent to which the government has a responsibility, as a representative of a corporate entity, to the widow and the orphan, so to speak. Your seem to indicate that, one, we do not have that kind of corporate responsibility, and, two, even if we did, discharging that responsibility would not be feasible (requiring illegal or immoral action). It seems to me that there is a kind corporate responsibility applicable in this case and that government is the best candidate for discharging that responsibility. As far as I know, however, this may not be feasible. It would be massively expensive and there are many factors mitigating the effectiveness of government programs (bureaucracy, an uninformed electorate, no incentive to serve customers, etc.).
I am honestly perplexed by these issues. I am disgusted by the rhetoric of politicians, which, lamentably, is not uncommonly heard parroted from the pulpit (the conservative/liberal divide seems to hold equally well for theology as for politics). The several schools of political/economic thought seem to divide over an arbitrary choice of basic values (freedom, fairness, etc.) and acceptance of questionable models. A satisfactory answer eludes. How do you come by your confidence on these issues?
It’s not that I am so very confident that one position is absolutely right and the other wrong. Rather, it’s that I am not convinced that health care is the responsibility of the state, and that I am basically convinced of the immorality of and slide toward tyranny from a wholesale government takeover of such a large aspect of our lives. I am open to counter-arguments, but I have yet to hear any convincing ones.