The High Costs of Healthcare in the Free Market

121203 P Warren Buffett to the RescueThe jury is still out on Obamacare. Opinions vary.

If somehow it were shut down or largely gutted, what would be done to curb the spiraling costs associated with healthcare in America’s free market economy? If the Affordable Care Act goes forward untouched, will it be able to address the problem based on “market incentives” rather than by “government decree,” as one columnist noted?

What’s the solution to making quality healthcare affordable? I believe we all want quality, affordable healthcare. What we differ on includes consideration of responsibility. Who is responsible for making healthcare affordable? The individual? Businesses? The government? The medical community? The insurance industry? Pharmaceutical companies? The religious community? Nobody? If nobody, who will pay? If individuals, since according to some, individuals are all there really are, who will advocate on their behalf, especially those without sufficient money or mental prowess to advocate for themselves and who aren’t eligible for Medicaid or Medicare?

With the latter point in mind, should healthcare be regulated like utilities? This calls to mind a New York Times article on healthcare’s high costs:

A major factor behind the high costs is that the United States, unique among industrialized nations, does not generally regulate or intervene in medical pricing, aside from setting payment rates for Medicare and Medicaid, the government programs for older people and the poor. Many other countries deliver health care on a private fee-for-service basis, as does much of the American health care system, but they set rates as if health care were a public utility or negotiate fees with providers and insurers nationwide, for example.

“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. ”But it is a very weird market, riddled with market failures.”

Consider this:

Consumers, the patients, do not see prices until after a service is provided, if they see them at all. And there is little quality data on hospitals and doctors to help determine good value, aside from surveys conducted by popular Web sites and magazines. Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.

Even doctors often do not know the costs of the tests and procedures they prescribe. When Dr. Michael Collins, an internist in East Hartford, Conn., called the hospital that he is affiliated with to price lab tests and a colonoscopy, he could not get an answer. “It’s impossible for me to think about cost,” he said. “If you go to the supermarket and there are no prices, how can you make intelligent decisions?”

Instead, payments are often determined in countless negotiations between a doctor, hospital or pharmacy, and an insurer, with the result often depending on their relative negotiating power. Insurers have limited incentive to bargain forcefully, since they can raise premiums to cover costs.

“It all comes down to market share, and very rarely is anyone looking out for the patient,” said Dr. Jeffrey Rice, the chief executive of Healthcare Blue Book, which tracks commercial insurance payments. “People think it’s like other purchases: that if you pay more you get a better car. But in medicine, it’s not like that.”

healthcare_letakWho will look out for the patient?

Ron Paul maintains that the solution to providing quality, affordable healthcare for everyone is to make it possible for individuals to look out completely for themselves. He argues that Obamacare is not “socialized medicine,” as some of the program’s opponents claim, but “corporatized medicine. ” Paul writes that critics of nationalized healthcare must go all out and “advocate for a complete free market in health care,” adding, “Some will say it is unrealistic to advocate replacing Obamacare with a pure free-market system, but in fact it is unrealistic to expect anything less than a true free-market to provide quality health care for Americans at all income levels. Continuing on the ‘middle of the road’ in health care by mixing free-markets with government spending and regulations will only continue to take us on the road to socialized health care.”

Can a society of individuals go it alone? What do you think? Can we get there together, or like businesses that falter in a free market economy, will some individuals’ health inevitably falter and fail by falling through the cracks? Is socialized or corporatized medicine the best solution? Or will they only lead to higher costs, where quality, affordable healthcare is never reached? What do you think?

Join me at The Institute for the Theology of Culture: New Wine, New Wineskins’ conference on Healthcare this Saturday, October 19 to further engage these issues.

This piece is cross-posted at Patheos and at The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

Myths We Live By? Voter Fraud & Jim Crow Dead and Gone

United States Supreme Court BuildingA friend asked me the following questions based on my blog post with Tom Krattenmaker on the recent change to the Voting Rights Act:

“Should unqualified individuals be allowed to vote? How do you propose to address voter fraud in a way that is more extremely simple and fair as providing qualifying identification?”

In response, we first need to ask if voter fraud is really such a big issue requiring enormous legislation, or if it is greatly exaggerated. Here’s what New York University’s Brennan Center (at the School of Law) claims concerning voter fraud:

• Fraud by individual voters is both irrational and extremely rare.
• Many vivid anecdotes of purported voter fraud have been proven false or do not demonstrate fraud.
• Voter fraud is often conflated with other forms of election misconduct.
• Raising the unsubstantiated specter of mass voter fraud suits a particular policy agenda.
• Claims of voter fraud should be carefully tested before they become the basis for action.
Here is the link to the full report.

In addition to looking to the Brennan Center, I decided to ask Lisa Sharon Harper, who serves as Director of Mobilizing for Sojourners. Here are her responses:

  • Voter fraud as a phenomenon that needs massive legislation to stop is a myth. Check out the link for The Brennan Center’s report. It is a very reliable source.
  • Voter ID: When voters register to vote, they have to show acceptable federal ID. To demand that they also purchase or pay the expense to obtain state-issued ID to vote at the polls places an undue burden on poor people, the sick and the elderly, who may not have the financial means or the transportation to drive to the site where the ID is obtained. They also may not have the financial means to pay for the additional photo identification card. In this way, the outcome of Voter ID laws is like that of the Poll Taxes that were required for minorities to pay during the era of Jim Crow segregation. It requires an extra fee to vote and that places an undue burden on less resourced people.
  • One of the tactics of people who are trying to limit the ability of particular communities to vote is to narrow the “qualifications” of those who can vote. For example, in some states, one cannot vote if you have a felony record. Seems reasonable. Right? Well, that’s not the way it used to be. Here’s a report on felony disenfranchisement laws by The Sentencing Project.

The long-standing structural dynamics regarding racialization in our society (including the connection between race, economic exploitation and poverty bound up with such problems as the lack of inherited income going back to slavery) impinge on people’s accessing their ability to vote. Even if no one is out to keep people from voting, what many of us take for granted—the financial means and transportation—keep those economically less fortunate from acting on their right to vote.

Now while I reject the claim that voter fraud is a vast problem that requires major legislation, I understand that identification, if handled correctly, could be beneficial. If voter identification were truly free, and if people really had equal access rather than simply having the right to equal access and the right to vote, then it would seem appropriate. But that is just the problem: we don’t all have equal access and voter identification cards are not really free, especially for those without financial means and easy access to transportation. Unfortunately, democracy does not assure us justice for all in every situation, but simply the inherent right to justice for all. We need to make sure that we safeguard justice for all.

Some may say that putting in place voter identification is logical. That’s what makes it so hard to help white people like me see how wrong voter identification is currently for many minorities. We should not enforce voter identification, at least not until it is truly free and universally held by all.

We must make sure that everyone has equal access to voting, not simply the right to equal access. Equal access to voting is not currently available to everyone, especially when voter identification is required. For as Harper argues, “To demand that” voters “also purchase or pay the expense to obtain state-issued ID to vote at the polls places an undue burden on poor people, the sick and the elderly, who may not have the financial means or the transportation to drive to the site where the ID is obtained.”

On a related note, a friend asked me to explain how the Texas law noted in my piece with Tom Krattenmaker creates structural racism. I will quote at length a portion of a Brennan Center report. According to the Brennan Center,

The Texas State Conference of the NAACP and the Mexican American Legislative Caucus of the Texas House of Representatives (MALC) filed suit in federal court to block the state’s new voter ID law because it erects discriminatory barriers to voting in violation of the Voting Rights Act and the 14th and 15th Amendments to the U.S. Constitution.

A federal court in Washington, DC last year blocked Texas’s voter ID law under Section 5 of the Voting Rights Act, finding that the law would make it significantly more difficult for minority citizens in Texas to vote on Election Day. In June, however, the U.S. Supreme Court (in a separate case) ruled the formula used in the Act for specifying the states covered by Section 5 unconstitutional. As a result, Texas is not currently required to comply with the Section 5 pre-clearance provision. Just hours after the Supreme Court’s decision, Texas Attorney General Greg Abbott announced the state would implement the voter ID law.

In the complaint filed today in the Southern District of Texas, the Texas NAACP and MALC argue the voter ID law violates Section 2 of the Voting Rights Act because it makes it harder for hundreds of thousands of minority citizens to vote and denies minority voters an equal opportunity to participate in the political process. The measure was enacted specifically to exclude these groups, the filing contends, a discriminatory purpose that also violates the 14th and 15th Amendments to the U.S. Constitution.

The attorneys representing the civic groups in the case are the Brennan Center for Justice at NYU School of Law, Lawyers’ Committee for Civil Rights Under Law, Law Offices of Jose Garza, the national office of the NAACP, Law Office of Robert S. Notzon, Potter Bledsoe L.L.P., Dechert LLP, and The Law Offices of William Bonilla, P.C.

“Texas’ photo ID law could prevent hundreds of thousands of eligible voters from casting a ballot, including a disproportionate number of minorities,” said Myrna Pérez, deputy director of the Democracy Program at the Brennan Center. “The court was right to block this law in 2012, and nothing has changed since then. We urge this court to stand up for voters and ensure elections remain free, fair, and accessible for all eligible citizens.”

“The right to vote is the cornerstone of our democracy. Unfortunately, we continue to find ourselves in federal court defending this most basic right against Texas’ leadership,” said Representative Trey Martinez Fischer, Chairman of MALC. “Multiple courts have ruled that Texas has expressed a pattern of discrimination toward its growing minority demographic — from its cumbersome voter identification requirements to its penchant for drawing intentionally discriminatory legislative maps — and I expect that the courts will once again side with Texas voters over hyper-partisan lawmakers.”

“As we all know, Texas has a voter identification law that has already been ruled to be discriminatory by a three-judge panel in Washington D.C.,” stated Gary Bledsoe, president of the NAACP Texas State Conference. “This law is designed and intended not to counteract nearly non-existent voter fraud, but instead to disenfranchise minority voters. This will continue anti-minority voter dominance by drastically reducing the number of minority votes cast in each election.”

“The Texas photo ID law is the most restrictive voter ID law in the country, and the Texas legislature rejected numerous amendments that would have mitigated its impact,” said Bob Kengle, co-director, Voting Rights Project, Lawyers’ Committee for Civil Rights Under Law. “The evidence will show that large numbers of eligible voters in Texas lack photo ID, that the burden of obtaining photo ID will fall more heavily on minority citizens, and that voter impersonation fraud does not occur at polling places because the existing laws effectively deter it.”

While the GOP appears to be the focus of critique in many cases in the reports I read, my remarks are not intended in a partisan way. Indeed, I would hope that the GOP becomes increasingly diverse—to be shaped by a more diverse populace and representing it. See my earlier post on this subject. There I wrote,

Some Republicans fear that the Democrats will be viewed increasingly as the representatives of equality and justice and the Republicans the advocates of a two class system. The Republicans have a long way to go to be viewed as a party that welcomes minority groups.

I hope the Republican Party will make the necessary changes to be viewed truly as a party for everyone.

I also hope that all of us, regardless of our political stripe, will be discerning and vigilant in making sure that we don’t return to Jim Crow days. With this in mind, I call to mind a discussion with a white friend of mine, Robert Wall, who served as the Fire Chief in Palo Alto, California and in Portland, Oregon, where he was given the task to begin the process of diversifying the fire department racially. Mr. Wall asked and answered a few questions, as we discussed my earlier post with Tom Krattenmaker and the objections that people raise to the claim that Jim Crow days may be upon us in various states throughout the Union.

Fact question: Are legitimate voters being disenfranchised by the Voting Rights Act? That question has stood the test of time as “No.” Question 2: If states are free to pick apart civil rights for “We the people,” will they? Well, if history is any predictor of future behavior, there are states that have shown they will. I still can see southern Governors taking a stand against the National Guard to protect the right to oppress. “Just leave us alone,” was their message.

What is their message today? What is yours?

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

Aborting Healthcare for the Human Unborn

Very newborn baby is still wetOne of my fears with screening fetuses for diseases and handicaps, among other things, is the desire to abort “unwanted” pregnancies. Please don’t take this as a right or left thing. The commodification of human identity is no respecter of partisan politics. The danger exists that the market will govern the totality of our lives, no matter our political stripe. However, it does not govern the biblical narrative’s emphasis on the sacredness of human identity. To put a spin on Jesus’ words, it is not simply the Sabbath, but also the market that was created for man, not the other way round.

Jonathan Sacks, who served as the chief rabbi of the United Hebrew Congregations of the British Commonwealth, writes: “The fatal conceit for Judaism” (and Evangelicalism in many spheres, in my estimation)

is to believe that the market governs the totality of our lives, when it in fact governs only a limited part of it, that which concerns the goods we think of as being subject to production and exchange. There are things fundamental to being human that we do not produce; instead we receive from those who came before us and from God Himself. And there are things that we may not exchange, however high the price (Jonathan Sacks, “Markets and Morals,” First Things, No. 105 {Aug./Sept. 2000}: 28).

See also Michael J. Sandel’s work, What Money Can’t Buy: the Moral Limits of Markets (New York: Farrar, Strauss and Giroux, 2012). Sandel argues that we have shifted dramatically over the past three decades due to market triumphalism’s rise. We have gone from having a market economy to becoming a market society, where nearly everything is up for sale based on thinking—faith—that markets provide the primary means to achieve the public’s good. According to Sandel, while the market economy is a valuable and effective tool for organizing productive activity, we have crossed the line. Not everything should be viewed as a transaction. Where do markets serve the common good, and where do they crowd out other important values and goods? Markets should not govern personal and public relations, including education, health, national security, etc. The financial crisis has caused us to back up and reevaluate the ability of markets to solve all problems.

I was eating lunch with a few liberals the other day. While they don’t share my pro-life stance, they concurred that there is a moral tension that progressives like themselves need to account for in discussions of abortion. They added that many in their circles balk at such notions; it would entail conceding to the enemy—those on my side—a moral victory of sorts.

Not so quickly. Conservative Evangelicals like myself need to account for the moral challenges of the progressives. What do we do about the crisis many women face, when they feel they have nowhere to go and are in a desperate state? Crisis pregnancy centers certainly can help quite a bit, but there is quite a bit more that needs to be done. Along these lines, it is not enough to safeguard a fetus’s safe arrival into the world; we have to make sure that their life in the world is safe and that they won’t fall through the cracks. Those like me who are “pro-life” need to be pro-life all across the board. We need to make sure that we safeguard programs for the poor, including food stamps, so as to alleviate malnutrition and related challenges to caring for a child’s health.

Back to screening for pregnancies. R. Kendall Soulen says of the market and the commodification of human life:

The market . . . promises to make the consumer king, and encourages us to think that we are in charge. But the market charges a high price in return, namely, the increasing commodification of human life itself. To take just one example, as genetic knowledge becomes more complete and available to consumers through law, prospective parents will be subject to pressure to screen their pregnancies in order to screen out inefficiencies such as mental retardation, genetic disorders, etc. (R. Kendall Soulen, “‘Go Tell Pharaoh,’ Or, Why Empires Prefer a Nameless God,” Cultural Encounters: A Journal for the Theology of Culture 1, no. 2 {Summer 2005}: 54-56).

What happens if the child doesn’t have a disorder of any kind, but isn’t the “right” gender or have the right genetic disposition for becoming an ideal human specimen? How ideal is a society that allows such preferences to shape our valuation of human life? Wouldn’t it be interesting if the Affordable Care Act were to safeguard the lives of the unborn because of its stance that insurance providers cannot turn away those with “pre-existing conditions” who want healthcare coverage? Wouldn’t it be honorable if we as a society did not judge fetuses and those around us based on their pre-existing conditions and genetic makeup but based on the unconditional regard for the sacredness of all human life?

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

A Healthcare Conundrum? Hip Replacements for the Terminally Ill

healthcare_letakWhat do you do? You are a healthcare administrator and you have to make a decision. You have a patient with terminal cancer who needs a hip replacement. While the hip replacement would increase mobility, the operation would cost untold thousands of dollars. There is also the fear of complications that can result for patients with terminal illnesses. Here’s what one study said about a few of the challenges,

Advanced cancer, severe cardiac and pulmonary disease, and other disorders that threaten overall survival have long been regarded as contraindications to total joint replacement… The reluctance to operate in these settings may stem from concern about a higher risk of perioperative complications in patients with terminal disease or from discomfort with using an expensive procedure for patients with limited life expectancy.

Do you decide to authorize the operation or determine to give the patient enough medication to endure the pain until death? What do you make of the patient’s desire to experience as high a quality of life as possible in the time of life remaining? Would your decision vary based on whether or not you sensed the patient would live only six months, a year, or up to two years? Would you also account for the possibility that if money goes to a hip replacement for this terminally sick patient there may not be enough money to
attend to patients with other pressing needs? Most people would imagine that health insurance would cover the hip replacement, so who cares? But the patient in question doesn’t have insurance or the insurance the patient has would cover the hip replacement.

For the Christian, other considerations will likely come into play. Someone might say that Jesus would leave the ninety-nine patients to go after the one who was in desperate need. Someone else might respond: Jesus would also make sure the ninety-nine were attended to until he returned; and what if it were not one who is in crisis, but ten or twenty in desperate need? Another person
might counter: who said anything about desperate-hip replacement does not rise to the level of a lost sheep’s soul needing to be saved! Prepare yourself for still another line of thought: the Bible doesn’t belong in the discussion since it is an ancient book and we are dealing with modern realities. If that is true, perhaps some hospitals will need to consider more than replacing hips to changing names, abandoning “Good Shepherd” and “Providence” for something more contemporary.

For all the differences in the debate over healthcare reform in our country, people on various sides would agree that we are facing huge challenges; there is a need for reform, whatever it may be. Rigid ideology of one sort or another straightjackets complexity and brings about short-sighted and ill-fated solutions. Complexity for complexity sake can lead to an affirmation of the status quo and paralysis. We have to engage in healthy conversations for the sake of advancing public health.

Easy answers are hard to find. Tough questions and nice names come more readily. We will be addressing such issues as these at The Institute for the Theology of Culture’s: New Wine, New Wineskins’ conference on healthcare Saturday, October 19th. We hope you will join us.

This piece is cross-posted at Patheos and at The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.

The Voting Rights Act and Post-Racialized America—Can We Vote on That?

By Paul Louis Metzger and Tom Krattenmaker

United States Supreme Court BuildingWhy is it that while talk abounds of growing racial diversity in our country, a new wave of voting restrictions is sweeping over parts of the country and falling hardest on minorities? Perhaps there is more than coincidence at play.

The Supreme Court’s reframing of the Voting Rights Act to make the individual states responsible for overseeing voting procedures has led many to fear the return of Jim Crow era policies to the country’s polling places. We share this concern. For us, it is not a liberal vs. conservative thing, since one of us is a self-described, secular-leaning progressive (Tom) and the other (Paul) is an Evangelical with more conservative views on many subjects. Nor is it something that only African Americans raise as a concern; we are both white.

No matter our demographic, we have a responsibility to hold accountable the leaders in our democratic system: our elected officials must remain diligent so that Jim Crow policies do not return but simply remain a terrible scar from a deep wound from our democracy’s past. Thus, we firmly believe the federal government must figure out a way to hold the states accountable on voting policies. Discussion ensues as to how Congress might step in so as to protect the rights of minority voters.

We don’t live in a post-racialized society, contrary to what many say. We wonder if those who have made this claim have asked minority groups for their opinion. Let these groups cast votes as to whether or not we live in a post-racialized America.

What is racialization? Racialization (e.g., race’s impact on health care, education, job placement, place of residence, urban development, etc.) does not express itself in fixed, constant terms, but through variables that ebb and flow and evolve. Further to what was stated in a previous post on the subject at this blog,

It is worth noting that according to Michael Emerson and Christian Smith, racialization does not proceed by way of “constants,” but rather “variables.” And yet, many Americans view racialization not in terms of its evolving nature, but in constant, static terms. Thus, Americans tend to limit racialization to a specific timeframe and do not comprehend that racialization is very adaptable and undergoes an evolution over time. Emerson and Smith maintain that there are “grave implications” for failing to recognize that racialization evolves over time…: the more we fail to account for racialization or think that we live in a post-racialized society, the more entrenched racialization becomes (Michael O. Emerson and Christian Smith, Divided by Faith: Evangelical Religion and the Problem of Race in America [New York: Oxford University Press, 2000], p. 8).

We are grieved to see the voter ID laws and the like already being implemented in states including South Carolina, Texas, and Mississippi. Take for example Texas. According to Frontline,

It only took a few hours for TEXAS to move forward on its voter ID law, considered the strictest in the nation. The law requires Texans to prove their citizenship and their residency in the state. To qualify, you’d need to present forms of ID that are expensive and difficult to obtain for some low-income Americans. It requires a passport — the cheapest of which is $55 — or a copy of your birth certificate, which not all Americans, particularly older ones, have.

A court blocked the law in 2012 because it discriminated against Latino and black voters.

This is not simply a Southern phenomenon, however. While the concern historically and in many respects presently focuses on Southern state voting procedures, racialization plays out in subtle but insidious ways in the North in places like our home city, Portland, Oregon, and it can have a huge and negative impact on voting for ethnic minority groups. As African Americans find themselves pushed to our less-well-off suburbs through property tax increases, subtle forms of red-lining in bank loan practices, and aggressive, even manipulative home buyer practices in some cases, they have less and less solidarity to advocate politically for policy changes at the state level of government. Since Portland is the largest city in Oregon, African Americans were able to advocate strongly for their concerns as a voting bloc for decades in the face of policies that would not represent them well. More and more, gentrification fragments their voices and weakens their ability to effect change. We must figure out ways as community leaders, politicians, bankers, real estate and business owners to reverse this trend. So, too, with the Voting Rights Act.

In a democratic society, all of us are at risk of losing our rights if any one segment loses its rights; after all, ours is a government of all the people by all the people for all the people—with justice (or injustice) for all. We need to guard against voting restrictions promoted as color blind, but that many of us know come down hardest on minorities. So, too, if we are going to say at any point that we live in a post-racialized America, we need to make certain that all people have a voice and a role in the political process—minority populations included. After all, that is the democratic thing to do.

This piece is cross-posted at Patheos and The Christian Post. Comments made here are not monitored. To join the conversation, please comment on this post at Patheos.