Wesley J. Smith: At what cost?

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Wesley J. Smith

Wesley J. Smith

Obamacare is now the law of the land. Because health care and wellness are such essential parts of our lives and our culture, America will never be the same.

For now, Obamacare preserves a private financing system—no public option. Nonetheless, it still represents a government takeover of healthcare. By eliminating risk assessment–and seizing control of benefit determinations—government bureaucrats will now choose winners and losers. Because we are all now ensconced in the same closed system, we each now have a direct financial stake in the health care received by every other one of us.

Government control is, by definition, intensely political. Politically powerful “in crowds” are rarely denied what they want, while “out crowds” may be excluded altogether. The same will be true in health care.

Canada is a vivid example, where terminal cancer patients are routinely refused life-extending chemotherapy by cost containment boards, while support is growing to fully fund IVF (recently allowed in Quebec) and abortions must be publicly paid.

The UK presents another disturbing look into our potential future. In the UK, the National Institute for Health and Clinical Excellence (NICE) imposes an explicitly utilitarian quality of life rationing, with the aged, for example, refused treatments available to younger people. Obamacare was written to establish a similar centralized federal oversight system.

Medically vulnerable patients should now be very afraid because the sheer heft of government–and the even greater weight of culture–are going to shift against them. Again, Europe provides the model. Some countries—Sweden, the UK, for example—are seriously considering or already beginning to limit health care to people with unhealthy lifestyles, smokers, the obese, and to those who are deemed to have a low quality of life, the elderly and those with cognitive impairments.

That same impetus will emerge and strengthen here as time passes. Because what happens medically to each of our neighbors will directly impact us, “suspect” classes–those who are expensive to “maintain”—will emerge and come to be perceived with a less compassionate and inclusive eye by the healthy and able bodied.

Indeed, public expectations about how to best care for seriously ill and disabled people will change, and a subtle idea will grow that they no longer really belong. This could lead to the “duty to die”—already under active debate in bioethics literature.

That trend has already started. In Oregon, Medicaid patients already have been denied life-extending chemotherapy based on cost, and offered assisted suicide as a substitute–not coincidentally–the far less expensive alternative.

Over the years, I think Obamacare will similarly fuel assisted suicide advocacy. After all, what “treatment” is less expensive than killing? Currently, the specter of HMOs subtly pushing the death option has helped keep the euthanasia monster at bay. But now, our societal costs will be reduced if expensive people kill themselves months or years before they would have otherwise died from serious illnesses, disabilities, or age-related morbidity. The old saying, “follow the money,” takes on a whole new meaning.

The nuts and bolts of this dehumanizing system will be created primarily outside the spotlight of representative democracy in the tens of thousands of pages of rules that will now be promulgated by federal bureaucrats to effectuate Obamacare—including the extent of abortion coverage required in insurance plans and which life-extending or sustaining treatments will be refused coverage. Those with the most input in this process will be so-called “stakeholders,” that is non profit groups that advocate for affected people. And that–along with the courts–is to where the brunt of the battle over the sanctity of life in health care will now shift.


  1. Roger Bennett :

    I’m going to play Devil’s Advocate. My credentials, which I’ll not now enumerate, entitle me, I think.
    How is health care to be rationed (for rationed it will be in any system, our appetite for it exceeding our ability to pay)? Allowing that anyone who shows up at an Emergency Room in most hospitals must be “treated” (I think I recall that the criterion is “has the hospital ever received Hill-Burton funds?” – almost universal in the U.S.), I question the adequacy of the treatment one gets that way for any chronic health problem.
    Apart from that ersatz treatment, we now ration economically – those who are wealthy or employed with a health insurance fringe benefit (itself a long-lingering anomalous war measure by business) can get some really good care. Those who aren’t will be lucky to get really good care.
    Daniel Callahan 20+ years ago (to my knowledge – perhaps earlier) defended the sort of system Obamacare brings as rationing publicly and transparently (or something like that) instead of economically and hidden away from public sight. Smith may be right that the reality will be bureaucratic rather than directly democratic, but there’s still some measure of public accountability there. Isn’t there something at least slightly good about that?
    Perhaps this question goes beyond Wesley Smith’s bioethics expertise, but having entered the fray with an argument that glosses over the reality of rationing in any system, it seems legitimate to ask.

    • Roger Bennett :

      Not that anybody is apt to be confused, but my last sentence should have been “Perhaps this question goes beyond Wesley Smith’s bioethics expertise, but since he entered the fray with an argument that glosses over the reality of rationing in any system, it seems legitimate to ask.
      I wanted to surrender before the grammar police came and took me away at an inconvenient time.

  2. Michael Bauman :

    I am a health insurance agent. Health care is rationed by economics, it is also rationed by propaganda. A large number of people who are priced out of the market for comprehensive health care that covers everything with little out-of-pocket cost to the insured have been brainwashed into thinking the deserve that type of policy. They want to use other people’s money.

    Government mandates increase the cost of insurance significantly. (one case in point take two health plans from the same carrier essentially identical in all aspects of coverage, the Kansas plan will cost as much as 30% more than the Nebraska plan–primarily due to state mandates)–Kathleen Sebellius anyone (also a rabid supporter of abortion).

    There are no easy answers. Everybody is a fault, but the overriding issues of personal freedom and morality trump everything else in my book–the less government the better. Don’t forget that tyrannical governments don’t like Christians and tend to think we are mentally deranged — thus the Soviet’s interning Christians in mental institutions.

    Roger, do you really think the government won’t use its power to enforce a social agenda that is non-Christian?

    • Roger Bennett :

      I cannot disagree about the “propaganda” point if you mean that our expectations have been raised to where we expect what amounts to prepaid medical care from our employers, rather than real insurance (i.e., protection against relatively unlikely but economically punishing eventualities). But that’s descriptive of how health care is rationed, whereas by asking “How is health care to be rationed” I meant “how should it be rationed?”

      I gather from your stated preference for “personal freedom and morality” that you’re okay with economic rationing. But I’ve met an awful lot of people who who by nature, nurture, or genetically-transmitted mental illness cannot compete on those terms. Did we need Obamacare to provide for them? Probably not – but we needed something. Without joining in the dubious claim that health care is “a right,” I can’t condemn the Dems for wanting to get more people covered.

      My Governor said in the Wall Street Journal today that we’re “Good Europeans” now. I can’t help but recall when Israel demanded a king because all the other kids had kings.

      Assuming that by “enforce a social agenda that is non-Christian” you mean things like artificial insemination for single women and lesbian couples, surrogate insemination for homosexual male couples, sex-reassignment surgery and eventually abortion and, perhaps euthanasia – yes, I assume that may come. As Wesley Smith said:

      Government control is, by definition, intensely political. Politically powerful “in crowds” are rarely denied what they want, while “out crowds” may be excluded altogether. The same will be true in health care.

      But it’s not government’s doing that Christians are an “out crowd” in many quarters. I attribute that largely to the loutish behavior of many prominent Christianoids, and it’s been a long time coming: IVF for conventional infertile couples (which I think is not a legitimate, thoughtful Christian option), contraception (which Christendom uniformly condemned until the 1930s), Viagra for old lechers all are already unremarkable in our pseudo-Christian libertine culture.

      • Michael Bauman :

        Roger, am I am not ‘OK’ when people are denied health care because of their inability to pay for it. Yet, in one respect, that is the cost of living in a fallen world. Every good and service we have is economically rationed. Those type of dilemmas will always be with us. We need to respond in a manner that is in accord with being human in Christian terms.

        To be ‘fair’ and ‘compassionate’ to everyone we end up impovrishing everyone to the same level. That’s Marxism BTW. There are relatively simple and non-federal ways to address the problem without nationalizing (giving control to) health care. Risk is inherent in every single act we take or don’t take. It is not the governments job to try and eliminate risk from the lives of her citizens.

        The power of the state ALWAYS is antithetical to humanity when left unchecked. (one of the philosphical points that led to the creation of the American experiment). The state seeks power for power’s sake. The more that is ceded, the more that will be assumed and used.

        The Preamble of the Constitution lays out the purpose of the U.S. governnent:
        1. Form a more perfect union: it could be argued that tryanny does that but I’d rather understand it as creating an atmosphere where people are not artifically at war with one another. Seems the health bill and many other government policies do just opposite.
        2, Provide for the common defense
        3. Promote the general welfare (not provide for the general welfare)
        The understanding of the role of the Federal government at inception was that it would primarily deal with external matters while the states would deal with internal matters. The Feds would act as a referee throught the elected represntatives of the people (House) and the States (Senate).

        Law was designed to punish bad behaviour not facilitate ideological good (by and large).

        • Roger Bennett :


          You say “We need to respond in a manner that is in accord with being human in Christian terms,” but then you go on – how else can I read this when they’re in such close proximity? – to trash fairness and compassion (both in scare quotes) as Marxist, and to extol principles of our land that are more the product of the Enlightenment than of any “Christian terms” – even Protestant Christian terms, let alone Orthodox.

          It’s hard to know how to frame a rejoinder.

  3. Fr. Johannes Jacobse :

    I recently had to change insurance, then had a minor issue, went to my old doctor and found out he was not covered under my new plan. It was Friday, I needed to have the issue taken care of before the weekend, entered that world of bureaucratic frustration (back and forth with the office staff, etc.) and finally asked someone on the office staff:

    “Look, is there any other way of dealing with this?”

    She pulls out a price chart for cash pricing. I had no idea how cheap it was if you didn’t go through insurance. I ended up paying $80 for what otherwise may have cost somewhere around $200-$300 if billed to insurance (and that doesn’t count my $30 co-pay).

    I’m not saying the insurance companies are a rip-off. I’m saying that cash pricing avoids all the added costs that our present system imposes.

    And if you think the insurance companies are bad, just wait until committees appointed by the likes of Reid/Peolosi/Clinton/Obama start making decisions for us about what will be covered. Yes, health care is “rationed” in a sense by economics (everything is “rationed” under this definition), but government is already well on the road to making our health care system third rate, the place where England has fallen to and Canada is rapidly approaching. Numbers will drive the decline. See: CBO report: Debt will rise to 90% of GDP.

    • Your point about the reduced cost of cash is correct. By further separating the consumer from the direct cost of their action, the recent bill will worsen – not help – the problem of exploding health care costs. For the same reason, it will also further remove control from the consumer as well, allowing the government to set health care policy as it wishes.

      Now it is true that insurance companies may try to do so in their own way, but in a moderately competitive market those efforts are mitigated by competition – which reflects the fact that the consumer can fire them. How do you fire the government? By design, even limited government is not immediately responsive to market forces in the same way that private enterprise is; expansive government, relying as it does on entrenched bureaucracies, is highly insulated.

      As a result, health care decisions that had formerly been exercised by the individual (within limits) can and will be set largely by those in power. And if the costs to “the system” should mushroom, that system will not view “vulnerable life” issues in the same way we do nor with the same concern. To us, the benefit is evident, despite the cost. To them, however, it would be all cost and little benefit. This is why state-run systems increasingly lean toward the kind of morally abhorrent “solutions” that the author describes – and that trend will go as far as possible until the electorate raises a stink. (Mind you, it doesn’t require electoral support for its policies, it just has to avoid electoral push-back, which is a far different line.) So the driving force will be costs.

      Unfortunately, the costs – the ostensible “reason” offered for the creation of this program – will be felt more quickly and will be far worse than publicized. In fact, it has already begun. On Friday, AT&T and other companies announced massive forced writedowns as a result of ObamaCare.

      While politicians are complaining about the “timing” of these announcments…

      Black-letter financial accounting rules require that corporations immediately restate their earnings to reflect the present value of their long-term health liabilities, including a higher tax burden.

      …I wonder if this has been included in the CBO’s scoring. I doubt it. If not, the cost will escalate far beyond what has been contemplated. (But then the CBO has always had difficulty with “dynamic scoring” – accounting for the changes in behavior that a policy promotes. To be fair, anticipating effects – first, second and third order – are difficult and usually comprise the focus of political debates preceding passage.)

      In short, despite the wishfulness of those on the Left, this program is a financial and moral problem. All of this to cover 30 (or 45 or 18 or whatever) million uninsured? It creates far, far more problems than it solves, which is why it is difficult to take the stated reasons – cost control and a long-term solution to the uninsured – seriously.

      • Fr. Johannes Jacobse :

        The 30 to 45 million uninsured include illegal aliens, the young, and others who voluntarily refuse insurance. Illegal aliens are already covered through emergency room treatment. It is one of the factors contributing to California’s impending economic collapse, and a huge problem here in Florida as well. I’m not saying we should deny coverage, only that one reason for costs spiraling out of control is that many people who are counted as uninsured have access to health care already. You pay it through higher premiums and taxes.

        That government can run the insurance industry better than the industry can run itself is sheer foolishness. And that is basically what Obamacare does; it takes over the insurance industry by removing all healthcare decisions made by the user and the industry and places them in government appointed panels. The insurance industry needed reform, no doubt about that, but this bill will turn the American system into the British system in short order.

        Also, all your financial and health information will become the property of the government. The IRS will be the chief enforcer of the new plan (the bill requires the hiring of 15,000 more IRS agents). Your information will be open to the prying eyes of committees appointed by people like Reid/Pelosi/Clinton/Obama. If you ever had any run-ins with functionaries drawn to their careers because of the authority their positions confer (I have), you see how dangerous ceding your individual responsibility to them can be.

        Palin is right. As costs mount, rationing will set in and the abortion mentality will bleed over into killing the aged and infirm. It is inevitable and England and Canada prove it. This bill needs to be repealed or gutted.

        BTW, did you know that the Democrats who voted for the bill exempted themselves from it? What does that tell you?

        • Roger Bennett :

          “Palin is right. As costs mount, rationing will set in and the abortion mentality will bleed over into killing the aged and infirm.”

          I fear you’re right, but things take unexpected twists and turns sometimes. I thought AIDS would lead to quarantining (or worse, though by “quarantine” I had in mind interment camps) of homosexuals or at least those that were HIV positive. Instead, we ended up with AIDS as a politically protected disease and a stronger-than-ever gay rights movement.

          Or maybe that’s just “sex trumps everything” at work.

          • Fears of a quarantine were unfounded since transmission occurred through particular behaviors.

            As I noted above costs will push the system toward a more ruthless posture toward “vulnerable life” issues, described in the initial article. It is inexorable.

            When WE face health issues, we recognize the costs (which can be daunting), but we also see and deeply value the benefits. That is, we face the full force of both costs and benefits. We will bear the financial cost if we do pay for the care, and the immense cost of health and life if we do not.
            Distant bureaucrats do not because they never see or feel the benefit. Never. They do however see the cost. When anyone faces a decision in which the cost is clear and the benefit is “distant,” which way do you think they will go? As the costs go up, the pressure will increase on only one side of that equation.

            And the pressures that cause costs to increase will – as Michael, Father, George and I have already noted – necessarily skyrocket. Indeed, every possible mechanism for efficiency (competition, direct payment of costs versus mediated costs, etc.), have been removed, rendering a very inefficient – and thus expensive – system. Given the system, then, the costs can only go way, way up. And as costs mushroom, pressure will be increased to reduce them, leading – at best – to reduced care.

            While it may be true that this same dynamic is at work when dealing with insurance companies, it is only one of many pressures informing the insurance company’s decisions. They must also compete, can be fired, suffer immediately from “bad p.r.” and will need future business, too. So if this dynamic is “unjust” when dealing with an insurance company – which faces mitigating forces – how much more unjust will it be with a government employee who can NOT be fired by the consumer and has NO concern or need to compete for future business. The outcome is so heavily weighted toward financial costs – which WILL mushroom given the built-in inefficiencies – that increased suffering is the ONLY possible outcome. That and a two-tier medical system – if you are rich enough – that is far less just than the current one (unless, as Michael notes, it is outlawed).

            If this trend comes to fruition – and I can not see how it is avoidable if we do not repeal the program – then we won’t actually need death panels because that those decisions will become the default bureaucratic position – first at the margins, then increasingly for other high-cost/”low potential” (i.e., vulnerable) lives. Despite the best intentions of supporters, this program will cause far, far more problems – and suffering – than the very few it seeks to address. And this doesn’t even begin to address the inevitable opportunity cost – the loss of medical and pharmaceutical advances (currently fostered by myriad ventures) that we have taken for granted – which will be immeasurable.

            To wax a bit theological, I fear that what we are seeing here is just one more example of the fall at work: humanity grasping for god-like control and finding that the promise was self-delusional, and that the actual outcome of this effort was death and chaos instead.

          • Fr. Johannes Jacobse :

            You may be right. Full blown AIDS patients might find themselves on the let-them-die list. AIDS treatments are very costly.

    • Michael Bauman :

      Fr. Hans, the primary reason for the cash price being so much lower is that the ‘cost control’ measures instituted by HMO’s and PPO’s are being gamed. If a preferred provider organization’s contrct says they will reimburse the provider at level X (after contractual discounts) the ‘cost’ of the insured service by comes X*percent of discount while the cash ‘cost’ is just X.

      • George Michalopulos :

        As a rule, whenever a third party is involved in any transaction, the price increases automatically. There’s no real way of getting around that. If that third party is some governmental agency, then the price rises exponentially dependent upon the paper (i.e. laws/regs) that are mandated. This also leads to an increase in time to reimbursment.

        As a side note, procedures that are not deemed medically necessary (botox, breast augmentation, lasik, etc.) are cheaper/more affordable because third parties (insurance companies/government) won’t pay for them. Therefore, to increase the sale of such procedures, medical clinics lower their prices accordingly, which they can do because timeliness/regulations/assorted nonsense is not an issue.

        My prediction is that if Obamacare is allowed to stand, you will see a significant number of providers opening up shop on a cash only basis and a lot of middle income people taking advantage of their services (which will be provided more expeditiously).

        • Michael Bauman :

          If cash only shops are not already prohited in this bill, they soon will be.

          • Geo Michalopulos :

            not possible. Another iron law of economics is that black markets always arise. Even in totalitarian states like the USSR massive underground econmies flourished.

      • Fr. Johannes Jacobse :

        Michael, put this in English for me. I want to understand it.

        • Michael Bauman :

          Fr. Hans, say a doctor thinks $50 is fine for an office call, then he joins a preferred provider oganization that offers 25% discounts on office calls. To get the same amount of money the doctor has to see more people in less time or charge the insurance company more to gain the same $50.00 Often times they do both.

          Then there is the practice of ‘unbundling’–preferred provider representatives will often suggest this to new providers. Say that as part of the office call, the doctor also will do a test of some sort that is done for each office call, say check height, weight and blood pressure. Instead of billing for the office call and the build check, the office call is billed as one action while the build/BP check is build as another because they each have separate billing codes. On more complicated procedures and hospitalizations it becomes even more complex creating a billing for a box of tissue paper even though it can (and sometimes is) used for more than one patient. Thus the insurance companies are billed for 50% to 60% more for services rendered. Everyone is complicit.

          I am not familiar with how HMO’s do it because we don’t have them around where I live.

          Combined with excess testing,otherwise known as CYA medicine in an attempt to avoid malpractice suits and the overhead of such government regulations as the privacy portion of HIPPA, and, and, and….

    • Roger Bennett :

      “Yes, health care is “rationed” in a sense by economics (everything is “rationed” under this definition)….”

      Point taken. Can I extrapolate thus: “Unless health care is ‘a right’ (which I avoided endorsing above at 2.1), why should we have a government program to fund it any more than we have a government program to fund the acquisition of, say, Famous Amos Cookies?”?

      But if that is a legitimate extrapolation, then should we abolish Medicaid? Medicare? Social security? All social safety net programs? Everything in a fallen world is scarce, after all. But aren’t some goods and services so necessary to basic human dignity that we owe them (I guess that makes them “rights” of a sort) to all but those who willfully refuse to work?

      This isn’t meant to paint anyone into a corner or mock anyone’s position. Where’s the line between basic human needs and mere desires of which it may be said “if you want it, earn it economically yourself”?

      [I started off playing Devil’s Advocate and I still am. I don’t think an uncritical mutual admiration society is helpful. Let’s sharpen each other a little.]

      • Fr. Johannes Jacobse :

        But if that is a legitimate extrapolation, then should we abolish Medicaid? Medicare? Social security? All social safety net programs?

        Theoretically yes, practically (and humanely) no. The system is flawed, and ultimately unsustainable. It is funded (and thus driven) by debt and in short order that bill is coming due. What is needed I think is more sober thinking which includes embracing something our parents and grandparents knew but our generation has yet to learn: You don’t get something for nothing.

        What may prove to be our undoing (and hopefully the catalyst for sobriety) is that we just cannot sustain an increasing debt burden. Our national debt fueled the entitlement expansion (the money had to come from somewhere), and personal debt eroded the sense of responsibility of planning for the future. It led too, I think, to the bubbles (dot com, housing, etc.) because when debt fuels expansion, the real value of a product is divorced from the effort expended to produce it. “Free” money floods into the economy, and any sense of the real value of things gets distorted.

        Obamacare will increase debt by the trillions. But there is simply not enough money to pay for it (hence rationing, but ultimately collapse — third world health care like England). It is going to shock the markets and decrease confidence which in turn will stifle any economic recovery.

        Meanwhile, people are dependent on government entitlements. You can’t just throw them off. Wrenching times are coming though and there will be plenty of pain to go around. I don’t think the political will exists yet to make these changes because I don’t think the society has sobered up to the point where they see the changes as necessary. The sooner we return to fiscal soundness however (and fiscal soundness has a very strong moral component to it — for both society and the individual), the better off we will all be. The ironclad laws of economics (everything must be paid for in the end) may force us to it.

        What I would like to see is a restoration of American manufacturing prowess. A good place to start would be to drill our own oil. Billions would stay in our economy, hundreds of thousands of jobs created, we could start paying down the debt, we could reign in entitlements, in short find our way back to morally sound fiscal health. Learning to live within our means again would take care of many of the problems our profligate ways have created.

        • Roger Bennett :

          I think we need to be reducing our need for oil, too, by becoming less auto- and truck-dependent. We can’t extract enough more to last for long, even if you dismiss anthropogenic global warming.

          But that transition from oil will be wrenching, too.Those of us who aren’t farming should probably live at much higher population densities in neighborhoods where basic necessities within walking distance. (“New Urbanism” is the buzzword, and Andrew Gould is very much involved in Charleston when he’s not designing Orthodox Churches.) But we’re individually heavily invested in our suburban digs, which are extremely auto-dependent for basic necessities of life, let alone for the commute to earn money to buy those necessities. Socially, we’re invested in aging infrastructure to serve those suburbs that’s becoming prohibitive to maintain.

          Maybe I can happily play Devil’s Advocate on health care because I see all these other problems – including entitlements as Father Johannes notes – of similar or even greater magnitude. Too bad John Derbyshire’s book “We Are Doomed” fingered the wrong problems mostly; the title was better than the book.

          • I am more optimistic. It is human ingenuity that has increased energy exploration, production and efficiency. We have been reading about peak oil in the US not long after it was first drilled in Titusville, PA (1859). Until the advent of horizontal drilling and ceramic proppants, we believed that natural gas was scarce, yet these technologies have opened up immense new shale reserves (many of which have even greater reserves further down). In the meantime, the efforts of myriad ventures will continue to seek to develop new methods of exploiting existing energy sources as well as increasing the output of alternative sources. Of course, we can stifle that ingenuity and severely reduce our rate of progress by limiting our efforts to government-sponsored efforts.

          • Fr. Johannes Jacobse :

            I never heard of Andrew Gould until you mentioned him above. Looked him up. Beautiful work. New World Byzantine.

          • Roger Bennett :

            I try not to discount human ingenuity or to attribute magical qualities to it. I haven’t read the book you linked to, but I have read others of the genre, including Julian Simons’ The Ultimate Resource.

            As for fossil fuels, I’d say there’s a difference between optimism and waiting for a deus ex machina plot twist. By the accounts I know, we passed peak oil in the U.S. around 1970, in the world probably early last decade. We are assuredly burning it faster than nature is making it, and I don’t expect it to become more abundant through human ingenuity. I could get a pleasant surprise – sort of like rolling the clock back on Alzheimers by 6 months through Aricept, but the trajectory downward then resumes inexorably.

            Limits and caution are marks of true and rooted conservatism and extremely congruent with Orthodox values. I’m reading here – and not naming names; Chrys just happens to be nearby – a lot of anti-government, “let magical free enterprise do it’s stuff” stuff that echoes secular modern pseudo-conservatism. One might think that preserving and enhancing material prosperity was the highest good. That strikes me as falling disappointingly short of the AOI Mission: “The American Orthodox Institute is a research and educational organization that engages the cultural issues of the day within the Orthodox Christian moral tradition.”

          • Roger, since I often agree with your comments, I take your point seriously. I can see how the comments offered might convey a magical or uncritical view of competitive markets. Some observations.

            First, the lack of a critical appraisal probably reflects the reaction to command-centered health care. Command-centered economics invariably fail since they lack the responsive nature and competitive efficiencies of the free market. And while I believe that a relatively free market provides the freedom needed for each person to exercise their vocation and be rewarded for the value that they offer to their neighbor, it is certainly not a utopia nor a religion. I don’t see that as a “failing” of AOI at all, because the topic is not the critical limits of the market. I think the tone reflects concern about health care from a perspective that appreciates the what a competitive market can do. In fact, if you want to see the “flip side,” look at any one of a number of posts on the need for asceticism in the face of an increasingly consumption-based culture. A life centered on consumption is spiritual bankrupt, yet this is exactly what free markets can foster if there is not a higher value – and for many, unfortunately, there is not.

            Speaking for myself, there is certainly a place for government. Government plays an essential policing role; prudent regulation is very helpful in maintaining good order and safe products. I like it to a hockey game: too much regulation kills the game, too little and there are endless fights since the players take it on themselves. So long as there is vice, corruption and sin, a firm hand will be needed to provide safeguards.

            At the same time, the government does not generate measurable value (primarily because participation is not voluntary but coerced). And in terms of generating value, what humanity has achieved via competitive markets would probably seem “magical” to our ancestors.

            As for peak oil, that is debatable. It was expected to peak in 1970, as postulated by the Hubbert, and domestic production did peak then, but – as has been the case for over a century, our understanding of proven global reserves keeps growing. (A major field off the coast of Brazil was discovered last year.) Unconventional sources keep increasing those known reserves.
            As for being fossil fuels, our understanding of how oil is generated is changing. Some new discoveries seem to indicate that oil may be abiotic and not organic at all.

            Either way, our understanding continues to grow and we really don’t know with certainty how much there is. As in most areas of life, a little “epistemological humility” is essential. This, however, is not to disregard the need to steward scarce resources – which is in a way the very essence of economic activity. If so, then an Orthodox critique based on a sacramental and ascetical understanding of life is vital.

          • Roger Bennett :


            Thanks for the clarification/affirmation.

            As I thought about my last comment – the mission of AOI – I realized that my own comments weren’t distinctively Orthodox. I’ve just been visiting a different mix of websites and reading different books than many here, it appears: Front Porch Republic; Distributist Review; Kunstlercast; and [Expletive Decleted] Nation along with Wall Street Journal, New York Times, Washington Post and Townhall.com. Others perhaps have been frequenting the libertarian Manhattan Institution and such.

            I would hope – though I haven’t exemplified it – that maybe some interaction could flesh out some distinctively Orthodox positions on public policy issues other than the life issues and marriage (important though those are). Our theology is distinctive, including our theological anthropology, and while I don’t want Orthodoxy to be viewed in utilitarian terms as a handmaiden of politics, it seems likely that we can say something unique on some issues. Wesley Smith may be on that track with “human exceptionalism.” For now, I’m hobbling along with an ersatz mix of natural law, Catholic social teaching (e.g., subsidiarity, Distributism) and probably more Enlightenment than I care to admit.

  4. George Michalopulos :

    two words: “death panels.” Palin WILL get the last laugh.

  5. Michael Bauman :

    Senator Max Baucus on passage of the bill:

    Too often, much of late, the last couple three years, the mal-distribution of income in American is gone up way too much, the wealthy are getting way, way too wealthy and the middle income class is left behind,” he said. “Wages have not kept up with increased income of the highest income in America. This legislation will have the effect of addressing that mal-distribution of income in America.

    Health care? Anybody see the desire to actually provide care for people?

    • Fr. Johannes Jacobse :

      It’s demagoguery. He claims to be speaking for the middle-class, yet he exempts himself from the legislation he claims will help them. We’ll be sitting in waiting rooms like the Brits and illegal immigrants in America do today, while he flies off to New Zealand for treatment on your dollar.

      • Massive hypocrisy and demagoguery.

        They practice the very essence of communism: “All animals are equal, but some animals are more equal than others.” –George Orwell (Animal Farm)

  6. Here’s just some of the pain and suffering that ObamaCare will bring out:

    – A $500 billion cut in Medicare.

    – Federal bureaucrats deciding who gets care and who dies.

    – Tax increases on Medicaid eligibility and making states pay for it, forcing tax increases throughout the nation.

    – Big hikes in federal income and capital gains taxes.

    – Young people forced to pay $8,500 for an individual plan.
    – Families forced to pay $12,500 for a family health insurance plan.
    (If they fail to get the “right” plan, they will be fined 2.5% of their incomes. If they fail to get a gov’t approved plan or pay the 2.5% tax they will face prison time.)

    – New taxes on medical devices like arterial stents, prosthetic limbs and automated wheelchairs.

    – Massive reduction in subsidies to Medicare Advantage for the elderly.

    – Rationing of health care as the number of patients grows while the population of doctors shrinks.


    Also, AT&T just announced it will book $1 billion in first-quarter costs related to the health-care law signed this week by President Barack Obama, the most of any U.S. company so far.


    Other companies have also confirmed the increased costs they will now face.

    AT&T, the biggest U.S. phone company, joins Caterpillar Inc., AK Steel Holding Corp. and 3M Co. in recording non-cash expenses against earnings as a result of the law. Health-care costs may shave as much as $14 billion from U.S. corporate profits, according to an estimate by benefits consulting firm Towers Watson. AT&T employed about 281,000 people as of the end of January.

    And just how will AT&T and all those other companies make up that $14 Billion in additional costs?
    (a) service cuts,
    (b) layoffs, and/or
    (c) price increases.

    Welcome to “free” healthcare for everyone! And this is just week one (1)!

    • Chris, exactly right. This is just one more – devastating – example of why we should not let recently-minted attorneys (i.e., staffers) draft legislation when they have never run so much as a lemonade stand. The unintended costs and consequences – which were never contemplated in the policy or the “scoring” of it, are massive and will force the costs to explode. This is, in short, a financial disaster.

      On a related note, one of the worst things that the Federal Government did during the Great Depression was that it kept changing the rules. This significantly extended and deepened it. At a time when we have only recently begun to emerge from the threat of financial collapse – and not so far that we can’t relapse – this kind of social tinkering is reckless. Add to it Cap & Tax, and a number of other expansive “game changers” and we are increasing the likelihood that the Great Recession will be with us for a long time to come. Small business, which has been the engine of job growth, has been effectively paralyzed and possibly crippled by these changes. “Compassion” never looked so irresponsible or careless . . . which is not true compassion.

      While health care reform is desperately needed, one would like to see a “cure” that is at least modestly better than the disease. This “cure” makes the disease look downright healthy!

  7. Michael Bauman :

    One more word from the “you can lead them to water” front.

    If the government gave a 100% tax credit to all health plans (refundable tax credit for those below a certain income range there would still be people who would refuse to get health insurance and/or complain that it did not cover every little hang-nail.

    Actual case in point. I have a group health client with about 10 employees who pays 100% of the group health insurance premium for all of his employees and their dependents. The wife of one of the employees is always calling because she has to pay $10 or $25 out of her pocket (the premium her husband’s employer pays for her and ther family is close to $1000/month). To quote her when I informed her of this… “I don’t care…, it should cover it all”.

    In general the more an employer pays toward insurance, the less it is actually valued.

    • George Michalopulos :

      Michael, tell your client to “suggest” to his employee that his wife shut up. I’m sure that there are other people in your area who would love this guy’s job. Whiny, ungrateful people deserve no sympathy.

      • Michael Bauman :

        The point George is that people always tend to be ungrateful and demanding when they have nothing at stake. It tends to make us that way.

  8. Scott Pennington :

    The Weekly Standard has a good piece on why and how to repeal Obamacare.


    The “why” is actually what stands out to me.

    There is a silver lining in all this, although it may not be of too much comfort. This law is so awful in its economic effects that it will either be repealed in 2013 or so, or it will lead to a profound economic crisis which will force the US into choosing – – perhaps by democratic methods, perhaps otherwise – – to either socialize or decisively reject the creeping socialization of the twentieth century.

    Leading up to that decision, however, there will likely be a lot of nasty trauma, possibly including widespread violence (depending on how the public reacts to the increasing tax burden, the inflation that will come, the unemployment and higher interest rates, etc.).

    The right should be ready to use this. As the Obama-ites said, “Never let a good crisis go to waste”. If conservatives are smart about this, they might be able to manage the decisive defeat of progressive socialism in this country.

    • Roger Bennett :

      I’m not picking on you, Scott; we just both seem to be tracking the same stories. And the story you link to is quite good. But I’m out of “Devil’s advocate” mode now.

      I don’t know what you mean by ” decisively reject the creeping socialization of the twentieth century.” If you mean return to “free markets,” with the social Darwinist rationing of everything according to who can best afford it, I’m not with you.

      I’m one of the folks who’s had it with our current capitalist system as well as rejecting socialism. What we euphemistically call “free markets” has really been state capitalism (which isn’t socialism if you stop and look critically for a few minutes), which has privileged huge concentrations of capital. I don’t trust economic power any more than I trust government power, although I’ll note preemptively that you technically can opt out of the former (unless participation is mandated by the latter – one of the main constitutional issues about Obamacare).

      When there’s a huge concentration of economic power, you can either use the power of government to bust it up or you can try to “regulate” it (i.e., defend and promote it), thus adding more bureaucrats than it takes to bust it up. Reaganomics is essentially deregulation coupled with disbanding the department of trust-busting and promotion of do-good programs through incentivizing the “private sector” (e.g., sub-prime mortgages).

      That pretty much became bipartisan policy until the collapse, and now the Dems want to pretend to regulate to prevent a recurrence even though the experts hadn’t a clue about the bust that was coming last time.

      I’m in favor of busting up economic power as well as devolving power to more appropriate levels than government, and that will produce loud cries of “Socialism!” if we even come close.

      • Scott Pennington :

        “If you mean return to “free markets,” with the social Darwinist rationing of everything according to who can best afford it, I’m not with you.”


        My point is that the entitlement culture will bankrupt us, lead to higher inflation, interest rates, unemployment, etc. The social programs we have now, Social Security, etc. are insolvent. Now we have a massive new program which was insolvent, as a practical matter if you discount accounting tricks, the moment it was signed into law.

        Whether you’re “with me” or not is not a huge concern to me. The public will move decisively away from the social democratic position as the effects of what they’ve done become more clear. If you recall the Carter years, you might remember how little patience the public has with a pathetic economy. I doubt it makes any difference what either of us say or what either party says at this point. Unless this is repealed, it will make what’s happening to Greece look like a picnic.

        • Roger Bennett :

          I agree completely with your first paragraph. I just think there’s got to be something better than what we’ve been doing economically, pretty much on a bipartisan basis, since Reagan’s apparent success. (Only of late have things become bitterly partisan as Obama wanted signature legislation at any cost and the Democrats swung back far left economically.)

          I’m not sure what that “something better” is, but I’m hanging out on the Front Porch a lot lately to see what it might be.

          • Scott Pennington :


            I’m not a purist when it comes to “free markets”. The “third way” that might be able to save some reduced welfare system is partial privatization.

            I tend to see the current downturn as being due to two main things: 1) government mandates regarding foreclosure lending to (un)qualified borrowers and 2) lack of transparency in banking and business in general.

            The downturn really got started with the wave of defaults and foreclosures in the last years of the Bush presidency. Both Bush and McCain warned everyone about the unsustainability of the governments lending practices (counting welfare as stable income, etc.). Alas, Bush had a Democratic Congress to deal with in his last two years. When it was Bush and a Republican Congress, the economy was not doing too shabby.

            Nonetheless, Bush made some mistakes like exacerbating the entitlement and spending problem and leaving Rumsfeld’s minimum footprint strategy in place in Iraq even when it was obviously failing, etc.

            This, together with constant cheerleading from the mainstream media, led to the election of our socialist president.

            I’m not using the term “socialist” as hyperbole. I’m completely serious. Obama believes in, and will continue to pursue insofar as he thinks it is practically possible, the acquisition of the means of production by the government. You can count on it.

            “The Supreme Court never ventured into the issues of redistribution of wealth and sort of more basic issues of political and economic justice in this society. And to that extent as radical as I think people tried to characterize the Warren Court, it wasn’t that radical. It didn’t break free from the essential constraints that were placed by the founding fathers in the Constitution . . . ”

            Bear in mind that the government was engaging in a great deal of redistribution of wealth back in 2001 when this quote was made. And this is Obama’s consistent philosophy. He said the same thing in more stark terms for his college thesis at Columbia:

            “The so-called Founders did not allow for economic freedom. While political freedom is supposedly a cornerstone of the document, the distribution of wealth is not even mentioned.”

            This fundamental problem our President has with the Constitution is that it protects private property and freedom from government. It envisions economic advancement not as a right but as an opportunity made possible by political freedom. Now, I personally don’t think you need to have the degree of political freedom we have in this country in order to have a strong market based economy. However, Obama’s take is very different from that. He is hostile to the very idea of a market based economy.

            The man is a socialist.

            Eventually, the entire entitlement system is either going to collapse or be at least partially privatized. The taxes necessary to maintain what we have now would be so high as to throw us into a depression, which would kill the golden goose charged with paying the bills. Alternatively, the amount of borrowing we would have to engage in to fund the entitlement culture we have would cause us to lose our credit status, be seen as a much greater risk of default, and result in much higher interest rates on our debt.

            This is why I have some reason for hope. In the next decade or two we are going to hit a solid wall and the consequences will be something quite different than what we have now and I don’t see how anyone in either party can change that eventuality.

      • George Michalopulos :

        Roger, capitalism with all its faults is vastly more preferable than socialism or the social-democratic schemes of Western Europe. The time period from 1984-2008 will be viewed as an economic golden age. Even the first seven years of W saw an explosive growth in GDP for the US.

        Now of course, I’m speaking here economically only. I’m not talking about the quality of our spiritual lives or the wonderfulness of our culture. And of course, the real golden age of the American family was the 1950s (and quite probably America itself). Still, in comparison to Japan and Europe, each of which experienced lost decades in the 1990s-2000s, America was a booming place.

        Were there increases in disparities in wealth? You bet. The number one culprit was the massive infusion of women into the workforce, something Progressives have wanted for over a century. Why? Because women work for less money. (The GOP in 1922 placed the Equal Rights Amendment in its party platform; the National Association of Manufacturers also wanted women in the workforce back in 1912.) Number two: untrammelled illegal immigration (Cesar Chavez may have been a Communist but he was a border restrictionist. His union strictly policed the southern border and reported breaches). Three: the continued destruction of the black family/rise of a permanent white and Hispanic “underclass.” Anyway, the growth of the entitlement state which is unsustainable in all scenarios can be traced to these three phenomena (certainly there are others: loss of manufacturing base, the devolution of public education, etc.).

        Still, all things being equal, the growth of the American economy –even with these millstones around our collective necks–was a sight to behold during this time period. Can we get it back? Doubtful, I believe that under Obama we are going to experience a new Caesarism with a downward slide to banana-republicanism.

        • Roger Bennett :

          “1984-2008 will be viewed as an economic golden age.”

          That sounds like “history will vindicate my position.” Maybe. Maybe not.

          I’m afraid we’re talking past each other, though; I’m not defending social democracy (except maybe when I was explicitly playing devil’s advocate earlier in this discussion – trying to dash a little cold water in the face of Chicken Littleism). I’m in favor of something sustainable, though it’s likely to be less spectacular than 1984-2008. See my response to Scott’s remarks at 8.1.1.

          It’s hardly astonishing that a cut in top marginal income tax rates that were punishingly high, coupled with a virtual abandonment of anti-trust enforcement, would produce explosive growth for a while. But the propensity for that approach to produce “bubbles” that collapse is becoming pretty standard economic doctrine. And those collapses, in our present bipartisan state capitalist mindset, elicit growth of faux regulation to make us rubes feel safe until the next collapse.

          What sane person, in retrospect, could have expected housing prices in some regions to continue rising at 15-25% per year when wages were rising 3%? Who could have thought that an average family – let’s say $80,000 household income – could buy a $600,000 house because “it’s an investment” to be sold next year at a profit so you can buy a $750,000 house? But people made “buy the pig, put lipstick on the pig, sell the pig at a profit, repeat” a way of life in places like California, and now they find themselves upside down on a $750,000 mortgage while earning that $80,000 per year.

          Wanna try to regulate that hangover away, or shall we try systemic sobriety instead?

          More important to me are the cultural issues, which you acknowledge are (quite?) a separate matter. It’s not just economically dubious, but spiritually dubious, when people start thinking they can get rich off of something analogous to a chain letter (see the prior 2 paragraphs), which is part of what the giddy 1984-2008 economic bubble produced.

          The Saints and monastics commend rootedness and sobriety. Our nation celebrates mobility and giddiness. Here ends my current effort to inject a little Orthodox sobriety into this economic “he said, she said” thread.

          Blessed Pascha to all!

          • George Michalopulos :

            Roger, excellent points. Right now I only want to address one of them in particular, the point that in fact has caused the present mess: the housing bubble. This bubble was created by demagogues who demanded that people who otherwise could not afford to own houses, be given every opportunity to do so, in violation of all prudential safeguards. Barney Frank of course will be consigned to Dante’s eight circle of hell for his role in this as will the Congressional Black Caucus, his partners in crime. But that is a story for another day. Prudent people, for whatever reason, were not using their houses as piggy banks.

            To say however that there were “no” regulations during this period is overstating the case. Indeed, there were terribly onerous regulations of an evil sort. Things like Sarbanes-Oxley or Waxman-Markey and others of their ilk which distorted the marketplace, often forcing banks to make improvident loans. Was there criminality on the back end? Yes, because banks were forced to make these insanely stupid loans, they sold mortgage paper on the secondary markets, etc. etc. etc. So now here we are.

            Please let me explain myself a little further when I judge an era to be a “golden age.” I look at things relative to one another. In that light, the previous quarter-century as a “golden age of explosive economic growth,” the numbers speak for themselves –GDP growth, stock market, unemployment, debt:GDP ratio, etc. (The worst annual deficit under Bush was $400 billion, and that was because of Katrina on top of two wars.) I say the same thing about czarism, which absent the First World War, was an economic boomtime for the Russian Empire. It certainly beat anything that came afterwards, no matter how “noble” its intentions. As with Lenin, so with Obama, who also seeks to overturn the republican order to “help distribute the wealth around,” as he told Joe the Plumber. No one in their right mind looks back on the Soviet experiment as anything but an analloyed error.

            Please understand however that within that same time period, I am fully aware that this was not a spiritual or even cultural, golden age. The reason I’m not a libertarian is because I treasure tradition and culture, of which we’ve had very little beginning sometime in the 1960s. Perhaps this downturn is from God in that He will allow us to attain a measure of sobriety and appreciation. In that sense, I completely agree with you.

          • Roger Bennett :


            We may be pretty close to “the same page.” It might be best to just do a numbered list.

            1. I didn’t say “no regulation.” But regulation generally was lightened, especially under Reagan himself, and anti-trust was virtually abandoned. “Too big to fail” is part of the result.
            2. Subprime: you flesh it out more, but I noted it at 8.1.
            3. I’m unfamiliar with Waxman-Markey, but a vignette from my son’s wedding weekend in 2005 tell a bit about Sarbanes-Oxley. I introduced my ELCA Lutheran brother to my wife’s ELCA best friend from high school, and they sat on my back porch lamenting: she, a chemist in an industrial setting, was charged with responsibility to track raw material inventories so as not to violate S-O (I think it may mandate FIFO for reporting purposes); he, a CFO, was pondering “going dark” – getting his company off listed exchanges – to avoid S-O compliance costs that were hugely increased from what they’d ever spent for attorneys (except, perhaps, when first going public).

            I’ve been toying with a notion that I’ll now run up to flag pole for possible salutes: is it possible that the best a God-fearing person – a person seeking rootedness and sobriety – can do in our economy and culture is to drop out? Rod Dreher calls this “The Benedict Option,” named after the first Benedict (the monastic), most recently here.

            But I’d hate to think that’s true because I think the souls of my neighbors are more important than their pocketbooks, and our mobile, giddy society tends to starve souls.

    • George Michalopulos :

      Scott, there’s a third option in the offing: a national sales tax, or more accurately a VAT (value added tax). Philosophically, a sles tax is far preferable morally to an income tax but a VAT (which is a sales tax on steroids) is far more insidious as it capable of stealth increases. Of course, with our luck, we’ll have the worst of both worlds: a VAT and an income tax.

  9. cynthia curran :

    Well, I agree with father Jacobse about California’s problem with health care, having a lot of young adults that have low job skills raising families and being uninsuranced. As mention above most of its related to illegal and some legal immirgation. Ca is about 27 percent foreign born and a lot of the foreign born is lower skilled compared to the native population. And Florida is closed to 20 percent. As for Orthodox civilzation, the Byzantines had many indivduals find early hospitals and the emperor-the state did as well. I was thinking that many small business have networks that start companies up-what about them helping start up companies purchased insurance at the beginning. Most conservatives and libertarians religious or not,have not put into practice ideas that are independance of the federal government to stop the left expanding the role of the state in health care.

  10. cynthia curran :

    Well, Roger a lot of the jobs are now in the older suburbs and some newer not the cities and yes you still have to drive. According to a study most folks live in burbs not older larger cities. In fact, Silcon Valley, is mainly in cities that surround San Jose not San Jose it self. The idea that most people will move back to larger cities that are 400,000 or more is not reality. Jobs and fast growing suburbs like Mesa Az, Irvine Ca, and Plano Texas have both Jobs and houses.

  11. cynthia curran :

    Well, a lot of those houses in Calfornia were in the central part of the state which doesn’t average 80,000 a year. Frenso is not Orange County or San Diego. It is basically an agricultural place. And getting people that make under 50,000 a year to buy houses in the 300,000 to 400,000 is not good. In fact, most of the area in California which had defauled the most were Stockton, Frenso, and Riverside which have communities way below the average income in California. All are also area with a lot of hispanics. Hispanics Ca average more 20,000 less than whites on average income. Not saying there were not defaults in white areas like some of San Deigo burbs or South Orange County-which doesn’t have the immirgant group that north Orange County does.

Care to Comment?