The Morality of a Single Payer Health Care System

[Rau]

In part, but government has demonstrated a remarkable inability to design, much less operate things such as this. That the design and implementation of ACA was flawed should be assumed, and not a source of surprise.

But it is more. It has components that are contrary to the principles of individual liberty. #Individual mandates are contrary to these principles.
#The HHS mandate is contrary to religious free exercise.
#Statutory mandates as to what must be in an insurance plan is contrary to free choice in the market place.

Not unexpectedly, prices have skyrocketed despite the promises that premiums would be reduced. People lost their plans and doctors despite the promises. It didn’t address the underlying problems in American healthcare: tort, government regulations, limits on consumers to form healthcare associations.

I’m glad you comment specifically on “American healthcare”, which I suppose is the system you know about. The “religious” and “personal rights” based arguments opposing government involvement in the health care system just don’t come up in the Australian environment, which is something I know about, and where the system is widely regarded by Australians and all sides of politics as a good one. I wonder whether all sorts of objection in the US would simply fall away if you had a system that was agreed to work even if it involved substantial government involvement.

 

[JonNC]

I’m glad you comment specifically on “American healthcare”, which I suppose is the system you know about. The “religious” and “personal rights” based arguments opposing government involvement in the health care system just don’t come up in the Australian environment, which is something I know about, and where the system is widely regarded by Australians and all sides of politics as a good one. I wonder whether all sorts of objection in the US would simply fall away if you had a system that was agreed to work even if it involved substantial government involvement.

Well, I don’t think the religious issue would be an obstacle if, for example, businesses and church related organizations had not been required to pay for procedures and products such as abortifacients and, for Catholics, contraceptives. Requiring people to pay for products that are contrary to their faith is unacceptable.
I don’t know well the Australian system of government, but the American system has as its foundation that the creator endows individuals with rights, and that government violation of those rights is not permitted. Government power comes from a granting of it by the people through the states in the constitution.

As for individual rights beyond that, the issue came up in the personal mandates, requiring people to buy health insurance, whether they want or need it or not. Someone who can self-insure doesn’t need it. Policy requirements make people buy coverage they don’t need. Rules were set in place that discouraged the buying of plans that government deemed “Cadillac plans”. None of these target those in need. Few people have a problem helping those in need. ACA went beyond that.

 

[o_mlly]

Does having a left-wing bias really matter if it’s articles are truthful?

I mean, that’s why that website has both bias and factual reporting… Outside of the Associated Press, very little on the “least biased, factual” side is something that’s mainstream, either.

I mean, this is a honest quest since I’m not sure what you’re getting at with that bit of your post.

Yes, I think bias always colors truth and one should always keep in mind the source. It is the “grain of salt” principle.

For instance, this article begins, “When the Republican-controlled Congress approved a landmark program in 2003 to help seniors buy prescription drugs …” leading the reader to think that the legislation was some kind of Republican power play. Not true.

While it is true that the Republicans controlled Congress, it is not true that this bill was, like Obamacare, passed entirely along party lines. The truth is that 19 Republicans voted “No” and 9 Democrats voted “Aye” in the House and 9 Republicans voted “No” and 11 Democrats voted “Aye” in the Senate to pass Medicare Part D.

 

[LeafByNiggle]

The general principle of single-payer health insurance does not violate subsidiarity any more than single-payer public education. Certain practical implementations of single-payer health insurance might violate subsidiarity, but that is not a necessary consequence of the abstract principle. Some single-payer systems are better than others.

 

[o_mlly]

…and -]more/-] “ad hominem”.

I take back the “pants” thing.

The only citation that directly relates to the OP’s request for Catholic teaching …

Has the Vatican or the Magisterium in general ever said anything on the subject?

is Principles of Catholic Social Teaching and Health Care Reform by Bishop Robert W. Finn, Archbishop Joseph F. Naumann. (Full text: catholicculture.org/culture/library/view.cfm?recnum=9101.) Edited comments follow:

*Some symptoms of the inadequacy of our present health care policies are:
3. The Medicare Trust Fund is predicted to be insolvent by 2019.
4. Mandated health insurance benefits for full-time workers have created an incentive for companies to hire part-time rather than full-time employees.
5. Similarly, the much higher cost to employers for family health coverage, as compared to individual coverage, places job candidates with many dependents at a disadvantage in a competitive market.

There are also perceived strengths of our current system:

1. Most Americans like the medical care services available to them. Our country, in some ways, is the envy of people from countries with socialized systems of medical care.
2. It is important to remember that 85% of citizens in the U.S. do have insurance. Forty percent of the uninsured are between 19-34 years old. … 11 million of those without insurance were eligible for Medicaid or SCHIP but were not enrolled. Those eligible but not enrolled include 74 percent of children who are uninsured.
3. The competitive nature of our private sector system is an incentive to positive innovation and the development of advanced technology. … Doctors and other scientists immigrate to our country because of the better compensation given to those who provide quality medical care or produce successful research.

What Must We Do?
Despite the many flaws with our current policies, change itself does not guarantee improvement. Many of the proposals which have been promoted would diminish the protection of human life and dignity and shift our health care costs and delivery to a centralized government bureaucracy. Centralization carries the risk of a loss of personal responsibility, reduction in personalized care for the sick and an expanded bureaucracy that in the end leads to higher costs.

I. The Principle of Subsidiarity: Preamble to the Work of Reform
This notion that health care ought to be determined at the lowest level rather than at the higher strata of society, has been promoted by the Church as “subsidiarity.” Subsidiarity is that principle by which we respect the inherent dignity and freedom of the individual by never doing for others what they can do for themselves and thus enabling individuals to have the most possible discretion in the affairs of their lives.

II. Principle of the Life and Dignity of the Human Person: Driving Force for Care, and Constitutive Ground of Human Justice
A. Exclusion of Abortion and Protection of Conscience Rights

It is imperative that any health care reform package must keep intact our current public polices protecting taxpayers from being coerced to fund abortions. It is inadequate to propose legislation that is silent on this morally crucial matter. Given the penchant of our courts over the past 35 years to claim unarticulated rights in our Constitution, the explicit exclusion of so-called “abortion services” from coverage is essential. Similarly, health care reform legislation must clearly articulate the rights of conscience for individuals and institutions.

B. Exclude Mandated End of Life Counseling for Elderly and Disabled
Some proposals for government reform have referenced end of life counseling for the elderly or disabled.

[Insist] that the mandating of end of life consultation for anyone regardless of age or condition would place undue pressure on the individual or guardian to opt for measures to end life.

Recently, Bishop Walker Nickless of the Catholic Diocese of Sioux City, Iowa, commented on the dangers inherent in the establishment of a health care monopoly, drawing a comparison to the experience of HMO plans in our country, where individuals entrusted with keeping the cost of health care at a minimum may refuse to authorize helpful or necessary treatment for their clients.

C. The “Right to Acquisition of Health Care” in the Teaching of the Church

The right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it. Yet in our American culture, Catholic teaching about the “right” to healthcare is sometimes confused with the structures of “entitlement.” The teaching of the Universal Church has never been to suggest a government socialization of medical services.

D. The Right to Make Health Care Decisions for Self and Family
This is why some system of vouchers – at least on a theoretical level – is worthy of consideration. Allowing persons who through no fault of their own are unable to work, to have some means to acquire health care brings with it a greater sense of responsibility and ownership which, in a more centralized system, may be more vulnerable to abusive tendencies.
Valuing the right of individuals to have a direct say in their care favors a reform which, reflecting subsidiarity, places responsibility at the lowest level.
E. Obligation of Prudent Preventative Care
All individuals, including those who receive assistance for health care, might be given incentives for good preventative practices: proper diet, moderate exercise, and moderation of tobacco and alcohol use.*

 

[LeafByNiggle]

Universal health insurance, as opposed to socialized medical care, need not take actual medical care decisions away from the individual, although some implementation do that. So ensuring that everyone has the ability to make those health care decisions is not necessarily a violation of subsidiarity.

 

[JonNC]

The general principle of single-payer health insurance does not violate subsidiarity any more than single-payer public education. Certain practical implementations of single-payer health insurance might violate subsidiarity, but that is not a necessary consequence of the abstract principle. Some single-payer systems are better than others.

We don’t have single payer education. Each state is responsible for the education in their state, which is an excellent example of subsidiarity.

 

[Rau]

We don’t have single payer education. Each state is responsible for the education in their state, which is an excellent example of subsidiarity.

From the perpspective of a person living in a given State, isn’t it single payer?

Would you be happy with a health system delivered state by state?

 

[LeafByNiggle]

We don’t have single payer education. Each state is responsible for the education in their state, which is an excellent example of subsidiarity.

It is similar to single-payer health insurance in that it has an individual mandate. Everyone must pay for education, even if they don’t have children. Is that a point you find offensive in the ACA? Universal health insurance on a state-wide basis like public education may not be as flexible when moving between states, but it is better than every man for himself.

The decision in subsidiarity is how far up or down the ladder of size is most appropriate for any particular function. Subsidiarity calls for utilizing the lowest level that is practical.

But the decision as to what that level is - that decision is one of prudential judgment on which people of good faith may disagree. So while I don’t think state-wide universal heath insurance is as practical as nation-wide, I would not be that opposed to it. But what I gather the opponents of single-payer health insurance want is not some state-wide universal health insurance program, but leaving all health insurance responsibility in the hands of the individual or the family.

 

[JonNC]

From the perpspective of a person living in a given State, isn’t it single payer?

Would you be happy with a health system delivered state by state?

It would at least be in keeping with the constitutional principles of limited power and the 10th amendment. It would be closer to control of the people, and not controlled by a far off bureaucratic monstrosity.

You here with this question reveal one of the lies told about ACA, that it was basically the same as “Romney-care” in Massachusetts. Had California followed through with their plan, that would be constitutionally acceptable.

I might add that, as a teacher, I oppose federal interference in education, as well. It has done far more harm than good

 

[JonNC]

=LeafByNiggle;14894397]It is similar to single-payer health insurance in that it has an individual mandate. Everyone must pay for education, even if they don’t have children. Is that a point you find offensive in the ACA? Universal health insurance on a state-wide basis like public education may not be as flexible when moving between states, but it is better than every man for himself

On a federal level, yes. There is no constitutional mandate for either, nor is there a constitutional limitation on states implementing either.

The decision in subsidiarity is how far up or down the ladder of size is most appropriate for any particular function. Subsidiarity calls for utilizing the lowest level that is practical.

Agreed, and the constitution mandates specific powers to the federal w, reserving the rest to the states and people.

But the decision as to what that level is - that decision is one of prudential judgment on which people of good faith may disagree. So while I don’t think state-wide universal heath insurance is as practical as nation-wide, I would not be that opposed to it. But what I gather the opponents of single-payer health insurance want is not some state-wide universal health insurance program, but leaving all health insurance responsibility in the hands of the individual or the family.

Agreed, with the understanding that what the federal level may do is limited to the enumerated powers, and that change in those powers must be accomplished by amendment.
If the nation wants single payer, amendment is the only legitimate way to achieve it

 

[Rau]

It would at least be in keeping with the constitutional principles of limited power and the 10th amendment. It would be closer to control of the people, and not controlled by a far off bureaucratic monstrosity.

You here with this question reveal one of the lies told about ACA, that it was basically the same as “Romney-care” in Massachusetts. Had California followed through with their plan, that would be constitutionally acceptable.

I might add that, as a teacher, I oppose federal interference in education, as well. It has done far more harm than good

So single payer is a secondary concern - involvement of federal government is the larger issue.

 

[JonNC]

So single payer is a secondary concern - involvement of federal government is the larger issue.

Not really. You asked the question that way. I believe everyone has a right to healthcare, but nobody has a right to someone else’s labor or property in order to acquire it. I truly believe that the best answer to healthcare is market solutions combined with vigorous church and charitable action to help those in need. But if we as conservatives and liberals, churches and charities, fail to step up and help the least of his children, I do see a possible role for local and state government

 

[LeafByNiggle]

On a federal level, yes. There is no constitutional mandate for either, nor is there a constitutional limitation on states implementing either.

Agreed, and the constitution mandates specific powers to the federal w, reserving the rest to the states and people.

Agreed, with the understanding that what the federal level may do is limited to the enumerated powers, and that change in those powers must be accomplished by amendment.
If the nation wants single payer, amendment is the only legitimate way to achieve it

On the straight question of morality, then, it appears you agree with me. I would disagree with you about a federal system being unconstitutional, but I would prefer not to argue that point here since this thread is specifically about the morality of such a system, which must be independent of man-made constitutions.

 

[JonNC]

On the straight question of morality, then, it appears you agree with me. I would disagree with you about a federal system being unconstitutional, but I would prefer not to argue that point here since this thread is specifically about the morality of such a system, which must be independent of man-made constitutions.

Actually, I disagree with your disconnecting the two. I think the framers made a significantly moral stand on limited the federal government, knowing how easily power can corrupt. A federally dictated single payer system will be corrupt, and will abuse power.

And to be clear, I think any kind of government plan has the moral flaw of wealth redistribution. The more we can rely on the market place coupled with compassion and charity the better.

 

[Rau]

Not really. You asked the question that way. I believe everyone has a right to healthcare, but nobody has a right to someone else’s labor or property in order to acquire it.

It’s not so much claiming a right, but rather a communal concurrence to offer that support, and through the convenience of progressive tax systems.

I truly believe that the best answer to healthcare is market solutions combined with vigorous church and charitable action to help those in need. But if we as conservatives and liberals, churches and charities, fail to step up and help the least of his children, I do see a possible role for local and state government

I’m not aware of any working model of your idea to seek to emulate, and I do see widespread support for alternatives which you find intolerable.

 

[Vonsalza]

Hey Jon. I’m going to limit what I respond to because I don’t have a ton of time.

No, because it wouldn’t be true.

So to be perfectly clear, just so I understand your paradigm on these things, systems like the Canadian system and systems the British system are effectively the same to you. Right?
If so, :doh2:

Maybe it is, but it was arrogant and condescending.

Then I apologize, but I’d still like the question answered. You’re fearful of tyranny and death and all sorts of other major problems. So what is your reply to the fact that we’re not seeing anything like that in other countries? Sure, there are issues, but so did pre-ACA and post-ACA healthcare in America.

Sure, plenty of Canadians are critical of their healthcare. But it seems the great majority are very satisfied and very defensive of their national program.

If government sets to laws on what is paid for, you don’t think that will alter the doctor’s practice?

There are at least a score of nations with such a regime that are doing a better job than we are, Jon.

The same way you are advocating that “big pharma” not be allowed to negotiate drug prices with government.

100% incorrect and you darn well know it. Shame on you, seriously.
“Big-pharma” WILL negotiate with the government on the price of a drug as they hold the monopoly on it (duh!). What will be different is that both parties will finally have negotiative parity. One party controls the supply, one party controls the demand. Parity. They both have each other over a barrel. As such, the negotiations will be on even ground.

Healthcare is a consumer product and service.

Papa and a rapidly growing number of people also see it as a right.

Get government out of the way, institute market based policies, and that will improve.

Jon, you need to learn that the local hospital is, in many, many ways, not a traditional competitive environment. As such, a lot of your ideas that apply to the competitive market simply do not work here. It’s like you’re trying to look at quantum physics with a Newtonian approach. No bueno.

lol. It won’t be a market.

It’s ALWAYS a market. The overwhelming majority of markets in which you participate are regulated in some way…

 

[Vonsalza]

Yes, I think bias always colors truth and one should always keep in mind the source. It is the “grain of salt” principle.

By all means, keep it in the back of your mind. It’s a smart thing to do. Helps you maybe preempt where your opponent’s going to go.

But if you’ve ever tried to dismiss an argument on this principal alone, you’ve committed a classic fallacy of logic.

 

[Vonsalza]

And to be clear, I think any kind of government plan has the moral flaw of wealth redistribution.

I pray you balance this with the fact that the market cannot solve all problems in an acceptable way. As such, government intervention is absolutely necessary.

 

[LeafByNiggle]

Actually, I disagree with your disconnecting the two. I think the framers made a significantly moral stand on limited the federal government, knowing how easily power can corrupt.

You can think that if you wish. But if you wish to convince others of the morality of the US Constitution you can’t rely on the Constitution itself as a moral authority to support your argument because that is circular reasoning. You can’t prove the Constitution is moral by assuming it is moral first.