Medical care is limited in supply. This is because facilities, equipment, personnel, and financial resources are all in short supply. The government cannot create any of these things out of thin air, although the Fed appears to be trying to do just that with the last item.
RICHMOND, VA (Catholic Online) - "There has been a lot misinformation in this debate and there are some folks out there who are frankly bearing false witness." "You've heard that this is all going to mean government funding of abortions. Not true." "This notion that somehow we are setting up death panels that would decide on whether elderly people get to live or die. that is just an extraordinary lie." (President Barack Obama, Bristol, Virginia July 29, 2009)
We all know that, Biblical-sounding verbiage aside, the first and second statements have proven to be manifestly untrue. Obamacare is all about contraception and abortions, just as promised in the Democratic Party platform. But what about the third claim, that "death panels" will not be established and therefore old people will receive whatever is medically possible to prolong their lives?
There are two levels at which this question can be explored - the spiritual and ethical, and the practical and economic. The former involves understanding our duty to our fellow man as God has given it to us, and the latter involves determining what is possible in carrying out that duty.
To address the ethical question, we must first understand what God calls us to do for our neighbor. Everyone knows that Jesus taught us to "'Love your neighbor as yourself" (Mk 12:31). Taken at face value, that is a rather broad admonishment, and when practical examples are cited, becomes difficult to apply. For example, does this mean that you should turn your house key over to your neighbor with a cheery, "Help yourself"?
St. Paul clarifies what this means in Romans 13:9-10: "The commandments, 'You shall not commit adultery', 'You shall not murder', 'You shall not steal', "You shall not covet,' and whatever other command there may be, are summed up in this one command: 'Love your neighbor as yourself.' Love does no harm to a neighbor. Therefore love is the fulfillment of the law."
Thus, a truer understanding of what our Lord commanded us to do is that "Love your neighbor" is a positive statement that includes the specific negative prohibitions given in the Ten Commandments but expands their scope. That is why one can use the Commandments as an outline for an examination of conscience, as they include far more than simply the specific deeds mentioned. For example, not bearing false witness is not limited to testimony in a court of law; it includes lying, not keeping sworn oaths, plagiarizing others' work, gossiping, revealing secrets, and calumny.
Where in the Commandments, or in Jesus' teaching, is there reference to healthcare? The truth is that, apart from Jesus, and later the disciples, healing many sick people, healthcare is not really mentioned. The focus, actually, is much more on spiritual than physical health, which is why the Presbyter says in 3 John 1:2, "Beloved, I pray that in all respects you may prosper and be in good health, just as your soul prospers." Our reliance should be on God, as is says in Proberbs 3:5-8, "Trust in the LORD with all your heart, And do not lean on your own understanding. In all your ways acknowledge Him, And He will make your paths straight. Do not be wise in your own eyes; Fear the LORD and turn away from evil. It will be healing to your body, And refreshment to your bones." This does not mean that we are to turn our backs on modern medicine, but it does mean that we must put it, and our own mortality, in perspective.
After all, one of our primary purposes on earth should be to prepare ourselves for Heaven, not to see how long we can resist death. In St. Paul's first letter to the Corinthians, he says, "Or do you not know that your body is a temple of the Holy Spirit who is in you, whom you have from God, and that you are not your own? For you have been bought with a price: therefore glorify God in your body (6:19-10)." Note that the temple is of the Holy Spirit, not of ourselves. We lose track of that when we mistake contraception and abortion for health care, and embryonic stem cell research for medical care.
Still, we do have a responsibility to be charitable, as charity is one of the three Theological Virtues. Charity is one of the fruits of the Holy Spirit, given to those possessing sanctifying grace. Those who possess this grace also perform spiritual and corporal works of mercy, among which are feeding the hungry, giving drink to the thirsty, visiting the sick, and burying the dead. There is nothing in there, however, about paying their medical bills, or providing them contraception.
We do, however, have the story of the Good Samaritan, who in Luke 10:34-35, went to the injured man ". and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, brought him to an inn and took care of him. The next day he took out two denarii and gave them to the innkeeper. 'Look after him,' he said, 'and when I return, I will reimburse you for any extra expense you may have.'" Does this imply, then, that we must in fact, open our pocketbooks to strangers and say, "Help yourself"? The answer to this question is not easy, and this is where another of the Cardinal Virtues, Prudence, comes into play.
In interpreting the parable, it is important to recognize the fact that it is in fact a parable, an allegory, and was used by Jesus to make a point. Sometimes we don't "get" what Jesus was trying to say, any more than the disciples did. As a frustrated Jesus said in Mk 4:13, "Do you not understand this parable? Then how will you understand any of the parables?" Exegesis on this parable dates to the early Church and in general follows Origen's allegorical interpretation.
For him, Jerusalem represents heaven; Jericho, the world; the robbers, the devil and his minions; the Priest represents the Law, and the Levite the Prophets; the Good Samaritan, Christ; the ass, Christ's body carrying fallen man to the inn which becomes the church. Even the Samaritan's promise to return translates into Christ's triumphant and millennial return. It was a story not about a stranger paying a sick man's doctor bills but rather, as Charles Dodd put it, the parable, in its simplest form ". . . is a metaphor or simile drawn from nature or common life, arresting the hearer by its vividness or strangeness, and leaving the mind in sufficient doubt about its precise application to tease it into active thought."
So what we have is a rather cloudy picture that indicates that Jesus is telling us that we are all branches from the same tree and we have an obligation to help our brothers and sisters in Christ in some way, but not the exact details on how to do that. One popular idea is that medical care should be "universal" and the cost borne by all of us together, with price being no object. In order to understand why this utopian vision is an impossibility, we must understand a basic fact about economics: the single, overriding aspect of life is scarcity. With the exception of the love of God, nothing is infinitely available.
Economics is the study of the use of scarce resources that have alternate uses. In other words, if you are at war and you can use the oil that your country can produce for either heating your homes or fueling military equipment, but do not have enough for both, some hard choices are going to need to be made. If all the oil goes to the military, there is little point as everyone at home will have frozen to death. If it all goes for heating, then there is little point as the country will be conquered and the people removed from their warm homes and transferred to cold work camps or firing squads. So decisions always need to be made; if there were enough to go around, there would be no need for economics.
The way we are used to having decisions made in a free society is by millions of people every day making millions of decisions that result in the most efficient use of scarce resources. The information upon which they base these decisions is prices. We often hear the uninformed Left screaming about how prices cause economic misery, or how prices are unfair. That is nonsense. If the doctor examines a bit of your liver microscopically and tells you that you have cancer, that information did not cause the cancer, and it is not unfair. It is simply information. In the case of prices, they are the data that tells you what others are willing to exchange for what you want to buy.
A favorite example of the utility of prices is what happened in the Soviet Union when their experts attempted by central planning to control the economy. They decided the price, based loosely on Marx's theory of labor value, meaning the value of something was the result of the labor that went into it. Apart from being untrue, it gave no information on how much people wanted to buy the items, and how much was available. So the stories of warehouses piled with shoes while people had no coats, as the leather went into the shoes they didn't need instead of the coats they did. With prices not fixed, the price of shoes would have decreased and coats increased, and manufacturers would have switched to producing coats.
Governments always respond to economic problems with some form of wage and/or price controls. These do in fact work in the very short run, but as lower prices increase demand, and lower wages decrease supply, there is an obvious shortage situation created which results in shortages. When we examine the health care plan, we see that the advent of more "free care", which is free only for some, will lead to higher demand.
When we look at how the Administration looks at doctors in particular, they are considered part of the "greedy rich", and the solution is wage and price control, meaning lower pay for them. The answer for medical suppliers, hospitals, and all other parts of the health care system is the same - get ready to get paid less. Aside from the fact that the only way this attitude makes any sense is if you consider that anyone and everyone involved in providing health care is a crook, this will inevitably result in a shortage of care. When you have increased demand and decreased ability to provide care, you have a recipe for disaster. There are two logical corollaries of that result - long waiting times and decreased quality of care. It should surprise nobody that this has been the history of government health care schemes wherever they have been tried.
What does "rationing" mean, anyway? The Encarta® 98 Desk Encyclopedia says that rationing is "regulating the distribution of items that are in short supply. Rationing is usually conducted by a government only in response to a severe emergency such as war." Economics is the study of the system that "rations" items in short supply, which is virtually everything as we noted previously. This is normally done by prices. Only when the government interferes with the free marked do we call it rationing.
Medical care is limited in supply. This is because facilities, equipment, personnel, and financial resources are all in short supply. The government cannot create any of these things out of thin air, although the Fed appears to be trying to do just that with the last item. Although insurance, government transfer payments, and all sorts of third party arrangements have already mucked up the relationship between patient and doctor, prices to some extent still control the allocation of these scarce resources. If you know that a medical procedure will cost you $X out of pocket, you can then decide whether or not you are willing to trade your dollars for that service.
Under the facetiously named "Affordable Care Act", even that remnant of choice will be removed. None of it will be your money, and none of it will be your choice. You will be at the mercy of the system. Since the demand for your procedure will have increased, since everybody wants it for free, and the supply will have decreased, because it cannot be provided in the needed quantity at the fixed price, someone will have to make the decision as to when or if you will get the treatment. There is no way around it. The treatment will be rationed, by the market, or by bureaucrats.
The word "fair" is frequently bandied about by those favoring universal health care, but it is rather hard to define. Resorting to my American Heritage® Dictionary of the English Language, Third Edition, I read that something that is fair is, "a. Having or exhibiting a disposition that is free of favoritism or bias; impartial: a fair mediator. b. Just to all parties; equitable: a compromise that is fair to both factions". That sounds wonderful, but how do you say it is "unfair" that someone has less money than you do? We often hear politicians talking about "fairness" in income, about an "unfair distribution" of wealth, as if there were some big pot of money somewhere and, when it was passed out, some got more than others, or as if the distribution could have nothing to do with effort on those who received it.
The misuse of "fairness" in this country is legion. There was a time when civil rights were denied to blacks, but thankfully that shameful bit of history is long behind us. What has taken its place, however, is hardly "fair". Affirmative action has substituted racial and sexual preferences for old discrimination. Often the justification for this is statistics, whether they be accurate or not, and for "redress" for past sins. There are already provisions in the unbelievably comprehensive social engineering of Obamacare that more non-White medical students must be accepted by schools, and other similar provisions. Imagine a care rationing situation where statistics as to the higher rate of hypertension in Black patients led to preferential treatment for those patients, or affirmative action medicine led to their preferential treatment to redress past inequities, or even present ones. This is not some sort of appeal to White supremacists or other looneys to engage in conspiracy theories, but it is simply the way the government has dealt with scarcities in other areas, and for that reason it is not inconceivable.
A much more likely scenario, especially considering the data that show that the most money is spent on elderly patients in their last year or so of life, would be to form some sort of "death panel" mechanism that says that after such-and-such age, or with such-and-such a diagnosis and prognosis, you are simply not eligible for treatment. In a system that is run for the system, to keep it solvent, unlike Medicare and Social Security, rather than being run for the patient, this sort of rationing is inevitable.
The question for Americans is, and should have been from the beginning, is who do you want to make those decisions? Non free-marketers scoff at Adam Smith's "invisible hand" and call it chaos, preferring decisions made by some of their luminaries. However, the history of central planning has been dismal failure, because there is no way that any person or persons can possibly have all the information to make the millions and millions of decisions that are made every day in a dispersed economy.
In their arrogance, they fail to see that because they do not understand something does not mean that it does not exist. To a person who is not a cell biologist, the inner workings of the cell are simply a black box, the implications of which for Darwinism will have to wait for another paper. It is easy for someone who does not understand the irreducible complexity of the cellular mechanisms to create Darwinian Just So Stories that reveal more about their lack of knowledge than their insight. So with economists who think they can control a huge economy efficiently without price information.
So, what are we called to do for our neighbor, particularly with regard to his health care? The key is our call to charity, or love. Christ did not call for the government to provide healthcare, or much of anything else, for that matter. His injunctions were directed at individuals: you and me. What has happened over the years is that we have forsaken our duty to our families, our neighbors, and our communities by saying, "Let the government do it. They have all the money". Jesus' admonitions and the principle of subsidiarity, require that we solve these problems at the lowest level. Do we actively participate in the care of elderly members of our families? Do we visit the sick and elderly of our parishes? Do we know who in our parishes have no health insurance, and what would we do if we knew?
Much of the push for "affordable health care" then has been driven by our own desire to shift our responsibilities onto the State. When that happens, the State will take them on, but only if it is done their way. When you stop being responsible for your obligations, you then become like a whiny adolescent and start to agitate for whatever you think should be done for you, or is due you because of some imagined "right". That could include a $500,000 liver transplant for a patient who will probably last no more than six months, or free contraceptives that you could easily buy with the money you saved having a coffee rather than a latte. When you do not participate monetarily in an expense, nothing seems unreasonable to you any longer. So the nation is transformed into whiny patients and heartless administrators. So much for the doctor-patient relationship.
What can be done at this point? Unfortunately it is a bit late for that discussion. It is important, however, to understand that the government does not have a pot of gold, nor a goose to create it, and if there was one, it was killed by the current economic situation. What we have to do at this point is to understand that resources are scarce and they will be distributed, and to ensure that the distribution is made by an informed conscience.
Dr. Frederick Liewehr is an endodontist who teaches and works in private practice. He converted from Protestantism to Catholicism in 1983, having been drawn ineluctably to Christ's Church by the light of Truth. He is a member of St. Benedict parish in Richmond, a Fourth Degree Knight of Columbus and a Cooperator of Opus Dei.
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