Friday, March 19, 2010

Health Care - an Alternative

VERY MANY commentators have written about the noxious aspects of the health care reform now before the United States Congress. The claimed noble purpose of providing affordable healthcare to all is to be gained only by a Satanic bargain that promotes the Culture of Death, while usurping power from all other levels of society.

But I do not care to criticize without offering an alternative. Too many have made an art of criticism, attacking the principles of others while keeping their own principles hidden.

Politics in the U.S. today is overwhelmingly dominated by two opposed, yet similar, false philosophies. Libertarianism, while correctly recognizing personal responsibility and private ownership of property, nevertheless grants individuals the right to destroy the livelihood of others via economic activity. Socialism correctly recognizes that government is a necessary component of society, yet seeks totalitarian power over human life. These philosophies are noxious and must be rooted out.

Here are some general principles:
  • Economic activity is primarily directed to the support of families, be they extended or nuclear, and particularly to the support of dependents such as children, the sick, homemakers, and the elderly. It is not the purpose of economic activity to accumulate wealth, nor is it an instrument of social justice as an end. But wealth is not to be despised, and social justice is a means whereby the goal of supporting families is ensured. Families are covenential relationships bound by blood, marriage, and adoption that exist despite legal definitions, and are recognized most certainly by the duty of care given to dependents.
  • Professional health care provides real benefits and liabilities to health. It should not be an instrument of social control, nor should it be a power relationship of the health-care provider versus the patient.
  • A rejection of nominalism. How health care today is regulated depends on the name given to services or goods rendered. Goods that are called ‘pharmaceuticals’ are very tightly regulated, while those that are called ‘nutritional supplements’ are not, even if they may be chemically identical. Likewise, some medical professions are highly regulated where others are not.
  • Health care should, out of charity, be given to all, despite wealth or poverty, whether citizen or stranger, without regard to creed or cult.
  • Power should be kept local as possible. Medical decision-makers ought to be friends and neighbors of their patients, and should not be an anonymous and unapproachable bureaucrat far away. Likewise, funding ought to be kept as local as possible, with a primary (although not only) system of cash or barter payment for service at the time rendered.
  • Both individual and corporate responsibility. Each individual professional ought to be held responsible for his failings; too often incompetents are shifted around in the process of ‘passing the trash’ so that their wrongdoings remain hidden. Likewise, corporate bodies of professionals must to take collective responsibility of ensuring a just order of their profession as well as fulfilling their duties to all others.
  • Free association. Medical professionals should be free to join associations of their choosing, and not be compelled by force of law.
  • Self-regulation and cooperation with authority. No medical professional operates in a vacuum, but depends on his fellow professionals. All medical associations are chartered by the various levels of government, but each association fulfills its duties according to its own means and internal regulation. Likewise, governments ought to be extremely generous in recognizing and approving charters, yet keep the public good in mind, since these associations have independent existence outside of the realm of government, yet exist largely to serve the common good. Finally, government lobbying is done on the appropriate association level, with great care taken to avoid power struggles. The opposite errors of Corporatism (government control of associations) and friendly ‘bought’ politicians (who seek the private interests of the associations over the common good) must be avoided at all costs.
  • Medical malpractice lawsuits mainly enrich lawyers and has led to an overly defensive, and very expensive, style of health care, which has led us to our current situation. Fraternal correction is the preferable means to regulating the professions, and medical associations ought to make this a priority. As these associations are charted by the various levels of government, it is the authorities' duty to ensure the associations fulfill this responsibility. Medical associations also provide mutual insurance for both legal and medical claims.
  • A good society is a harmonious society. While the threat of force is appropriate against wrong-doers, any system that attempts to force people to do good is bound to fail and is destined to tyranny. A harmonious society is marked by order, stability, and predicability, and which absorbs catastrophe in a graceful manner. Change is not for its own sake, but for the better.
  • Private ownership of the means to healthcare. Individual health professionals ought to personally own the tools and facilities needed to provide his services, as he knows best what he needs.
  • Non-profit ownership of hospitals. The owners of hospitals ought not to seek economic advantage over their weak and desperate patients. Lately, for-profit ownership of hospitals has led to numerous closures, as well as extremely unpleasant work environments and bureaucratic control. Ownership by medical associations and social and religious groups has proven fruitful in the past and are superior to both government-owned hospitals and those operated for profit.
  • Relentlessly pro-life philosophy. Trust in a medical system breaks down if the patient knows that a professional may either heal or kill him, or subject him to hazardous experimentation.
  • Distinctiveness of professions. By their rights and duties, each profession ought to be clearly distinguished from another for the sake of the patient and for the solidarity of each profession. This ought to be symbolized by distinctiveness in dress between professions and ranks within a profession. This ought to reduce confusion and the fog that often surrounds contemporary health care.
Both Libertarianism and Socialism have aspects that make them appear to be compatible with Catholic social teachings, yet both are ultimately based on the principle of non serviam — ‘I will not serve’ — and therefore are Satanic and must be rejected by Catholics of good conscience. Rather, let's consider a rational and loving alternative.

The two basic principles of Catholic Social Justice (the concept of social justice comes from Holy Mother Church) are subsidiarity and solidarity: control is local and people work together.

Consider this model for implementation of health care reform:
  • Health care professionals generally operate as owner-operators of their own businesses. Each physician, duly educated and accredited, owns his own practice and owns his own means of doing his work, and regulates his own hours of operation and business practices.
  • The organization of work for health care professionals is directed towards the end of allowing one worker the ability of completely supporting his or her family.
  • Each patient and each physician can agree to enter into, or exit a relationship, based on their own needs and desires. The price paid generally will be on a sliding scale, where better off patients pay more than the poor.
  • Health care professionals freely join various local associations of similar professionals: each city may have one or more physician associations, nursing associations, and so forth. But each professional also has the duty to belong to one of the associations. Each professional, duly accredited, has equal say in how their particular association is operated. One association may be Catholic, another secular, and so forth.
  • Each heath care association is responsible for ensuring the well-being of its members and their families.
  • These associations are recognized by the local government. All regulation, oversight, and disciplinary actions upon medical professionals is done solely at the level of these professional associations. Government enters into contracts only with these associations.
  • These local medical associations, as a whole, have both the right and the duty to provide healthcare to all in the community without exception.  All persons within a region has the right to health care from these associations, and they in turn have the responsibility to pay any debts owed to the best of their ability.
  • It is up to the local medical associations to decide how to provide medical care to the indigent; this care is the responsibility of the association as a whole, which will define its own policies (in coordination with government) on how to care for those who do not have the ability to pay.
  • Liability for medical malpractice will first be arbitrated within the local association and each member of the association will be subject to association discipline; only when this is exhausted can the dispute be taken to the civil courts.
  • Medical insurance will be issued or coordinated by the local medical associations, with primary insurance coverage being handled by the association itself. Pay-for-service ought to be used typically, especially in lucrative practices.
  • A three-tier system within each profession is assumed.  Apprentices gain practical knowledge at the side of a Master; Journeymen have to 'pay their dues' by doing undesirable work for modest pay (yet have the right to future reward), while Masters will be able to reap the reward of lucrative medical practices. Labor practices will be regulated within each association, and all members will be bound to these practices.
  • Medical schools are tightly integrated with the labor practices of these local associations: apprentices may spend half their time on the job, the other half in classes, for example. Journeymen may be required to be in residence in the medical schools part of the time. Masters may be required to teach or make the rounds at the medical schools part time.
  • Hospitals are largely privately and locally owned, some may be owned by municipalities, and are non-profit; all revenue goes towards professionals who work there or is used for upkeep, maintenance, and expansion. They may be owned by the various medical associations, by religious orders, or charities.
  • Public health measures, like vaccination and quarantine, is the responsibility of local medical associations in harmony with local government. The local associations will determine if local conditions require particular public health measures or not.
  • Charitable giving to this endeavor is strongly encouraged, and the local organization of the institutions ensures donors that their gifts will be used both wisely and verifiably.
  • The entire medical enterprise will be self-funded; tax funding will be required only in cases of extreme urgency, such as war or disaster.
  • Local medical associations will freely organize into larger bodies which will coordinate with higher levels of government. However, the assumption is that most decisions — and funding — will take place at the lowest local association level.
The main problem with this system is that the type of care given will vary — often greatly — between localities.  The quality of the interaction between government and the professions will also vary greatly. But the advantage is that organization will always be much closer to meeting local needs.  This organization is closer to individual patients, individual health care professionals, and local elected officials, who will have a real, day-to-day influence on how the health care system operates.

I humbly offer this alternative. Thank you.

2 comments:

  1. I have only one quibble--with your comment on medical malpractice suits. In fact, no more than one-fifth of such lawsuits are successful, and the legal standards governing medical malpractice are difficult to satisfy, compared with other civil actions. And while fraternal correction within medical associations would be desirable, would it be able to make whole (as through an appropriate legal award of damages) the victim of genuine malpractice?

    On the whole, the principles you outline would make for a healthier society, physically and spiritually.

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  2. ...and I have a quibble.

    "Health care should, out of charity, be given to all..."

    True, but individuals are also entitled to be compensated for their labor and goods. In other words, while health care *should* be given it should *not* be taken.

    Also, having a regulating body that has an economic interest in the industry it regulates sets up a conflict of interest which will inevitably lead to abuse.

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