Dr. Robert Stackpole of Redeemer Pacific College and the Divine Mercy Institute continues his examination of the two candidates for the U.S.Presidency.
With less than 100 days to go until the important Presidential election, the focus turns to a close examination of the positions of the two presumptive nominess for the Presidency of the United States. Dr. Robert Stackpole considers in this installment the candidates positions on health care policy for the United States.
WASHINGTON, DC (Divine Mercy Institute) - The first part of my three-part answer to a question about the upcoming presidential election generated a lot of comment from our readers.
Normally, while I certainly listen (and often learn a thing or two!) from your feedback, I don't respond to it: it's your chance to share your thoughts, reflections, and constructive criticisms without provoking a debate with me! However, this time I will break my rule of silence because I think there is a point that needs clarification. One of our readers wrote that it was inappropriate to put this "political stuff" on the Divine Mercy website at all.
I must beg to differ, and explain.
Strictly "political" issues would be things like who has the best experience to be the next president, who has flip-flopped more on key issues, who is beholden to which special interest groups, whose tax and spending policies would be best for the economy as a whole, who is right about offshore oil drilling, and who has the most sensible proposals for dealing with global warming. Such questions are purely political, matters of factual analysis and prudential judgement about which Catholic Social Teaching and the Divine Mercy message can have little to say. Those kinds of questions come into any campaign, and would indeed be inappropriate to discuss on a website devoted to The Divine Mercy.
But I did not discuss such issues.
I limited myself in this column only to discussing three allegedly life-and-death issues of moral urgency (abortion, health care, and war and peace in the Middle East) and on such matters Catholic Social Teaching can shed considerable light. Indeed, as I explained last time, the US Catholic bishops have taken great pains to give us documented guidance on how to approach issues of moral significance at election time, and how to prioritize our moral values when we consider how we should vote. Thus, not only do I think this is an appropriate subject to address in this column, I think it is my duty to address it: as someone who teaches Catholic Moral Theology at a Catholic College, if I cannot shed a bit of light on these matters when asked to do so by inquiring Catholics, I had better "throw in the towel" and give up writing this column altogether!
Besides, it is our principal duty as lay members of the Church, according to the Catechism, to do all that we can to "seek the kingdom of God by engaging in temporal affairs and directing them according to God's will.... The initiative of lay Christians is necessary especially when the matter involves... permeating social, economic, and political realities with the demands of Christian doctrine and life" (Catechism, 898-899). In other words, we are to let the Merciful Jesus be the Lord of every aspect of our lives: personal and social, including everything that pertains to family life, work life, economic and even political aspects of our lives. Where Catholic Social and Moral Teaching affects any aspect of our lives, we need to sit up and take notice!
So my last column on this matter was something of a "wake-up" call to Catholics, who (all too often, I'm afraid), like to keep the "religious" side of their lives in a nice, safe, pious corner, where it cannot be disturbed, and cannot inform, anything other than the personal and private realm. Sorry, but that's just not Catholic enough!
On the other hand, I claim no infallibility for my own attempts to try to view the moral issues involved in this upcoming election in the light of Catholic Social Teaching. So, as always, you are welcome to disagree, and to send in your comments to that effect, as the Spirit moves you.
Now, because the first column in this series appeared several weeks ago, I will reprint below some essential passages from it, to remind you of where we are in this discussion. I wrote:
As a faithful Catholic, if you are contemplating a vote for Sen. Obama, you are morally bound to consider whether or not Sen. McCain advocates intrinsic moral evils -- that is, life-destroying violations of the inherent dignity of the human person -- on par with Obama's support for legalized abortion. Unless you can demonstrate at least a moral equivalence between the policies of the two candidates with regard to such intrinsic evils, then you cannot, with a clear conscience, vote for the pro-abortion candidate. Do not bicker about whose policies on balance are better for the economy or will help to bring down the price of oil. Those issues are important, but not nearly as important as the moral priority of opposing intrinsic evils in our society....
Hypothetically, there are two ways to make a moral defense for Obama. Some people might make an argument that goes something like this. Please note that I said "hypothetically" and "some people might argue" what follows. I did not endorse it all myself; I was simply reporting on the views of what some supporters of Obama believe makes a moral case for his candidacy.Several readers misread what I wrote, attributed these viewpoints to me, and sent in abusive and vitriolic replies. Sadly, some folks are just a bit too "quick to the trigger"!
1.)Health Care. Roughly 50 million Americans right now cannot afford health insurance. This is an outrageous social injustice. Obama pledges to provide health insurance for the poor and underprivileged. McCain's plans don't even come close. McCain, therefore, by omission, supports the continuation of this intrinsically evil, life-threatening neglect of the plight of the poor in our society. As the U.S. Bishops stated in their 2007 document on "Faithful Citizenship": "A basic moral test for our society is how we treat the most vulnerable in our midst ... we will be judged by our response to 'the least among us' (see Mt 25: 31-46)."
2.)War and Peace in the Middle East. We now know that the war in Iraq was really started as a reckless War for Oil by Bush-Cheney, the moral equivalent of an intrinsically evil "war of conquest." It led to the needless loss of hundreds of thousands of innocent Iraqi lives and the needless deaths of more than 4,000 U.S. soldiers. Obama was (rightly) opposed to this war from the start, and he promises to get us out in 16 months. McCain (wrongly) supported this unjust war from the start, and he predicts we will need another five years to finish it. So McCain will extend indefinitely this unjust war. Also, given their positions on the Iraq War, McCain is more likely than Obama to drag us into another reckless, unjust war in the future (perhaps with Iran). On the life-and-death issue of war and peace, therefore, McCain fails another basic moral test.
3)Abortion, Health Care, and War and Peace. These are surely the most crucial life-and-death issues facing America today (and not the price of gasoline, although we are all feeling the pinch from that fiasco, right at the moment!). Obama clearly fails the moral test on abortion. Does McCain clearly fail one of the other two? That would clearly make a vote for Obama at least possible. Does McCain clearly fail both of the other two? That might make a vote for Obama even preferable.
So that is where I left off last time, promising to take a closer look at the Health Care issue in this installment,and War and Peace next time.
(1)Health Care: the Obama people might have a strong moral advantage here if Sen. McCain was merely defending the status quo, and pledging to keep the U.S. health care system as it is, with about 50 million people unable to obtain health insurance, and relying mostly on the hospital emergency rooms for what intermittent care they can find. Despite the fact that we are one of the most prosperous countries in the world, millions of Americans cannot afford the prescription drugs or the surgeries they need. It is a morally unacceptable situation, and a direct violation of Matthew 25: 31-46, and Catechism 2448: "[Human misery elicited the compassion of Christ the Savior.... Hence, those who are oppressed by poverty are the object of a preferential love on the part of the Church."
However, Sen. McCain does not seek to maintain the status quo on this matter. Like Sen. Obama,he proposes major changes to the health care system designed to make it more accessible to the poor, and to keep people from losing their health insurance when they lose their jobs. Thus, Sen. McCain cannot be charged here with maintaining an "intrinsic social evil" on par Sen. Obama's support of the legal permission to kill unborn children. There is just not a moral equivalence here that I can see.
Now, one may legitimately debate about whose health care plans will actually work the best, especially for the poor, and I will add some thoughts on that below. But these are thoughts of a practical and factual nature, requiring a prudential judgement to be made -- they are not details on which Catholic Social Teaching can give much firm guidance.
Our present health care system, and McCain's response to it, was well described in an article by Clive Crook of the National Journal on May 3:
" At present, most Americans are covered through employer-based plans. This arrangement is under-written, so to speak, by the tax break that employers get for their health insurance costs. Workers have limited choices among insurance providers, and little reason or opportunity to press suppliers for lower prices....Employer insurance not only neuters the forces that would otherwise press down on costs, it also locks workers into jobs they otherwise might not want and multiplies the sense of insecurity that so many Americans complain of lately. If you lose your job, your health insurance is at risk as well. Thrown on your own resources under the current system, you might not be able to find affordable insurance, so a medical emergency might mean financial ruin....
"McCain's approach is to encourage people to buy their own insurance rather than get coverage through their employers. He proposes a refundable health insurance tax credit of $2,500 a year for individuals, and $5,000 for families. The government would pay this credit directly to health insurers for workers who don't have coverage now or who opt-out of their employer-based plans....His proposal would widen access to health insurance and make insurance more portable from job to job."
Another commentator on this issue, Rich Lowry of RealClearPolitics,lauded the virtues of McCain's proposal on May 3:
"If individuals are shopping for health care, insurance companies would have an incentive to provide better plans at lower cost. If they purchase their own plans, their insurance wouldn't be dependent on their jobs. This change therefore mitigates two of the besetting problems of the current system: affordability and access. One economist estimates that some 20 million more people would get insurance."
Maybe so, but notice: 20 million is not 50 million, and that's the number that have no health insurance right now. A $5,000 health insurance tax credit to a family of four surviving on a $30,000 annual income sounds great -- until you consider that in order to get a health insurance family plan, they may have to come up with another $5,000 themselves (unless their employers will provide it). Not very likely for low-wage earners. Thus, Clive Crook's critique of the McCain plan should also be quoted:
"It would fall way short of providing universal coverage. Even with the proposed tax credit, many millions of bad-risk individuals -- including those with pre-existing conditions -- would find it impossible to afford coverage. Younger and healthier workers would have an incentive to drop out of employer plans in favor of cheaper alternatives, a step that would raise premiums for those left behind."
Indeed, since McCain proposes ending the tax break employers presently enjoy for paying health insurance premiums for their workers, many employers will reduce or end their employee health insurance benefit plans, thus forcing people to rely on the new proposed health insurance tax-credit, which really only covers about half of the cost of individual and family insurance.
In short, McCain's proposed reforms look messy, and looks at best like a half-solution to the problems of many of the working poor and unemployed.
He would have been much wiser to go all the way to a national health care voucher system, paying the full amount of health insurance (up to a certain limit) for all Americans, who could use the voucher to buy any private health insurance plan they choose. That would result in universal coverage, and greater market competition and efficiency all at once. Moreover, by relieving all employers of the responsibility of offering health insurance to their employees, it would be, in effect, a huge corporate tax cut, which would spur economic growth and job creation, and thereby swell government tax revenues, largely paying for the extra government expense of offering the vouchers.
What is Sen. Obama's solution to the health care mess?
Obama proposes to create an optional, federal National Health Insurance plan. As his website put it (Feb. 16, 2008):
"Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress. The Obama plan will have the following features: guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions...Affordable premiums, co-pays, and deductibles. Subsidies: individuals and families who do not qualify for Medicare or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan...Portability and choice: participants in the new public plan will be able to move from job to job without changing or jeopardizing health care coverage. Quality and efficiency: participating insurance companies in the new public program will be required to report data to insure that standards for quality, health information technology, and administration are being met."
In other words, what you have in the Obama plan is an option to keep your present employer plan, or opt-into the new federally subsidized system, with subsidy level based on income level. The advantages of this plan are obvious: it would quickly establish nearly universal, portable health coverage for all Americans.
The disadvantages are in the fine print. For example, Obama proposes a new, sweeping and strict regulatory system for all health insurance providers. In other words, present private health insurance providers will be choked by an aggressive new regulatory system, while they have to compete against a government subsidized National Plan. It's a bit like the government setting up its own, heavily subsidized public auto company, "Fedcar," and then putting the regulatory screws on all the private sector auto companies (GM, Ford, and Chrysler) who do not have the benefit of government subsidies to keep their prices low. It's unfair competition. The result will be the gradual extinction of truly private health insurance options, with the remaining private options so heavily regulated that they are private in name only. In other words, the Obama plan is a slow but inexorable route toward socialized medicine.
As someone whose family has lived with the life-threatening bureaucratic nightmare of "free" socialized health care here in Canada, I can assure you this is not the path that Americans ought to take. It just trades one set of life-threatening problems for another. In a socialist system, there is essentially one health insurance and health care provider, the government, with little in the way of market forces or competition to make the system efficient and keep costs down (exorbitant costs which are somewhat hidden, of course, because the whole system is paid for out of tax revenues). The result is that people have to wait months and months for the surgeries they need, and the wealthy flee to foreign countries to get timely surgeries done.
Meanwhile, since the doctors and nurses work more for the government than for their own patients, malpractice is far too common, and almost impossible to prosecute (since the government health care bureaucracy usually closes ranks to protect its own). As just one example: my own wife one time waited so long for a surgery that she almost died before it could be done, and one surgeon openly joked to her about a wrong surgery he had performed on her (knowing that there was precious little she could do to hold him accountable for it)!
To sum up, as best I can see, Obama's plan (while not intending to perhaps) makes a largely socialist medical care system almost inevitable. This would gradually degrade the health care of everyone in America. On the other hand, it provides much more immediate coverage of all of the unemployed and the working poor, who would be able to find health insurance fairly quickly under the Obama plan, while the McCain plan (though it moves in a more sensible direction overall) does not go far enough in its present form, because it leaves at least half of the poor still out in the cold.
Both morally and practically speaking, I think the whole issue is almost a "wash" between them -- although I think the Obama plan has the edge here, because the need for more adequate health care for the poor in the US, and especially for poor children, is clearly urgent (while McCain's solution seems better only if pursued further than he has proposed). Catholic Social Teaching, we must recall, asks us to have a "preferential" concern for the plight of the poor. Nevertheless, the poorest of the poor, in the sense of "most helpless and vulnerable" members of our society are unborn children, and there is certainly nothing here on the health care issue that is the moral equivalent of Obama's support for the legal permission deliberately to put those children to death in their mother's wombs.
Continued next time on War and Peace....
Robert Stackpole, STD, Director, John Paul II Institute of Divine Mercy.Got a question? E-mail him at firstname.lastname@example.org
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