Monday, December 28, 2009

Subsidiarity and Health Care Reform.

One of the common arguments given by the religious right against government reform of health care is the Catholic principle, as espoused by Pope John Paul and others, of subsidiarity which states that what can be done at the local level should be, and not mandated by the highest orders of government. The concept, when stated as such, and wielded as such, becomes an argument against government regulation and for free markets or traditional structures of family and society that are an undying but dated myth.

Yet this approach to subsidiarity, as I've seen demonstrated on endless Catholic right blogs lately, often warps the objectives of health care reform (which as it stands now passed by the House and Senate and slated for reconciliation and passage this week, to my mind, is no reform at all but a give-away to the medical industry).

Subsidiarity is one of the tenets of Catholic social teaching and, in American political parlance, is not so different from what we call federalism: that states have independence from the federal government to manage and govern themselves.

This article by Daniel Kuebler from the National Catholic Register (January 2010 issue) makes a number of inaccurate and broad assumptions about the objectives of health care reform (and other "entitlement" programs) and the role that federal regulation must play in our society. Most damagingly it mistakes individual autonomy and personal freedoms for benign forces and avoids the privilege that is given to some segments of society by "free market" ideology and substitutes such concepts as justification for discrimination. Kuebler opens with:

During the campaign to push health-care reform, President Obama and his progressive supporters have repeatedly made a dubious distinction between freedom and responsibility. Those who oppose government-mandated or government-run health care are berated for shirking their responsibility to help create a fair and just society. Worse yet, they are chastised for placing personal freedom over responsibility to their fellow man.

Unfortunately, this false dichotomy between freedom and responsibility is embedded in the progressive worldview that currently dominates our national political leadership. Worse, it represents a grave danger to any society built upon progressive principles.

Progressives tend to view society as something that needs to be ordered from the top down. Those at the top are given the task of making key decisions and ordering society as they see fit. Government “experts” determine how to provide health care, who should go to college, what we should eat and what kind of cars we can drive. And, like parents of rebellious teenagers, they remind us that the restrictions and rules they have imposed upon us are all for our own good.

It is easy to see how individual freedom runs afoul of this way of governing. Anyone acting freely — that is, in a manner not in accord with the principles laid out by the government — is not acting responsibly and needs to be reprimanded. In the progressive mindset, individual freedom easily gets a bad name.

This is not to say that people don’t abuse their freedom. It happens all the time. However, the cure for this is not to take away freedom but to encourage the responsible use of it. The problem with progressive governments, which have their hands in every aspect of our lives, is that they actually discourage responsible use of human freedom. Why should a citizen act responsibly if the government is going to take care of him regardless of how he lives his life?

Universal day care provided by the government does not encourage responsible parenting. Rather, it allows those who neglect their children to continue their irresponsible behavior, often in good conscience. After all, the government is taking care of the kids for a few hours each day. In this environment, the government gradually encroaches upon the natural role of the parent, deciding, among other things, what moral values should be instilled in day-care kids.

John Paul II recognized this problem in his 1991 encyclical Centesimus Annus. “By intervening directly and depriving society of its responsibility, the social assistance state leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients.”

John Paul recognized that it is best to deal with problems and issues such as poverty, child care and health care not universally but locally. “It would appear that needs are best understood and satisfied,” wrote John Paul, “by people who are closest to them and who act as neighbors to those in need.”

This traditional Catholic insight, known as the principle of subsidiarity, is not unique to John Paul II, but has been echoed by Pope Benedict in Deus Caritas Est (God Is Love): “We do not need a state which regulates and controls everything, but a state which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces that combine spontaneity with closeness to those in need.”

Firstly, Kuebler confuses government regulation and government control. It's an unfortunate but common conflation of concepts. Of all the necessary roles of federal government, I believe all can agree that it must primarily protect citizens. This protection is least questioned when it addresses protection from outside aggressors, as we witnessed most harshly under the Bush government when such a role, aided by strong public approval, pushed our administration to invade other countries and reduce citizen freedoms through the patriot act and other spying programs.

But when it comes to social services, what Kuebler forgets is that not all of the US population is starting from an equal footing. Kuebler starts off with the example of government-provided day care as detrimental to society's traditional family structure and undermining of parent's responsibility to children. His false position is that aiding mothers and family's with government-funded day care is unnecessary. Not all family structures, he fails to understand, are traditional and not all family incomes allow for stay-at-home parenting. In other words, Kuebler is working from an idea of "traditional" family that doesn't exist - and frankly never really did.

All the encouragement in the world isn't going to help a single mother living in the section 8 housing across the street from me to earn enough money to support her children if she doesn't have child care. Punishing this single mother for having children out of wedlock or for divorcing the father of her children is where he is headed - which is blatant discrimination against a woman for her life choices or for lack of the same economic and educational privileges that I imagine he enjoys. And the position starts from an idea of the US family that simply doesn't exist.

When Kuebler gets to health care, his argument's inside-out logic is most obvious:

This is the problem with the progressive nanny state. It numbs our better instincts and saps our personal responsibility. It does this because it loses sight of the individual in its desire to advance society. In the case of health-care reform, Obama and his supporters have tried to sell their package as a way to reduce overall costs and improve our country’s standard of care. Whether one is buying this or not is irrelevant, because the premise behind health-care reform is deficient. As Pope Benedict indicates in Caritas in Veritate (Charity in Truth), “Progress of a merely economic and technological kind is insufficient.”

Progress that champions a cold cost-benefit calculus for the allocation of health-care resources is progress we can do without. A bureaucracy that views human beings as commodities to be herded through a health-care system — in some financially expedient manner in order to help minimize the impact on the national debt — can hardly be called progressive. Nor is it progress to look to expand federally funded abortions or mainstream euthanasia, even though it may make financial sense in the short term.

In the long term, though, “progress” that marginalizes human life will have devastating effects.

Firstly, he erringly assumes that "liberal" or "progressive" are cohesive labels with uniform concepts and ideologies. Even while the democratic party is torn over the measures laid out in the health care bill. It would be a stretch in any world to call this bill a government mandate of health care (or reform, for that matter.) What it ultimately amounts to is a government bail out of the insurance industry which is empowered to insure every citizen at costs that it determines. This bill protects the free market at a serious and debilitating cost to health care for all.

Secondly, Kuebler misreads the Catholic church's position on health care. Again and again the US Conference of Catholic Bishops has made clear that they support reform (even demanding coverage of illegal immigrants and competition for private insurers in the form of a government run public option), but that they have (wrong-headedly) chosen to hinge their support on the funding of abortion. Their own discrimination against women has seriously gotten in the way of their support for universal, affordable health care.

Thirdly, and most glaringly, Kuebler fails to note that our current system of providing health care, which is largely what he argues to support, doesn't work. The free market or what he touts as the glorious "individual freedoms" and personal responsibility is a ruse. If the system treated all citizens equally, we wouldn't be at a point where 50 million Americans are one broken leg or one diagnosis away from bankruptcy or death. No mention here of the 25,000 who die each year without health insurance.

Personal responsibility is a simple argument to make when you leave out economic, educational, and racial privilege. Which is what our current system does. But Kuebler discounts them quickly and easily because he has a traditional myth of family and community structure to cling to. He rather ignore the working poor, the generationally poor, the underprivileged, the ill, the under-educated, and the discriminated against because they don't fit well into his model of "personal responsibility."

By condemning "practical" or financial considerations, he clearly states that he would rather not make economic ends meet but discriminate against "nanny state" beneficiaries for their inherent life situations. And yet, it is precisely the financial and practical considerations that government is charged to address. It's the old Reagan era argument that women on welfare are draining the federal government of funds, are lazy because they are poor, and are immoral because they don't have a man around to bring home the bacon. As if a poor woman tending her child at home, surviving at the very bottom of the economic ladder, forced to live on food stamps and go without the basic comforts that many others enjoy is living the good life on his dime.

Then Kuebler throws in some good old justification for suffering:

When the government denies the sanctity of life, strips man of his freedoms and subsumes all responsibility, the human person wanders aimlessly through a state of self-indulgence. There is nothing to strive toward, and no reason to behave responsibly, if the government is poised to take care of everything. Private virtue is no longer needed, and individuals gradually lose the ability and desire to shape the moral norms of society.

By painting women's reproductive rights as self-indulgent he gives away his discriminatory views that a woman's role in society is sanctioned by the church and should continue to be so. Parenthood is a responsibility one should embrace as punishment for illicit sex, for not keeping the father happy and at home, for not having access to proper contraception. Poverty is rightful suffering afflicted on those who are too lazy to get good educations, land well-paying jobs, or for being born in the wrong families, he determines.

Kuebler can take the high road all he wants because he ignores the segment of society, ever-growing, that has been subjugated by the myth of traditional family, "boot straps" ideology, and discriminatory teachings of morality. What his argument for subsidiarity boils down to is blatant but euphemized discrimination against those who do not ascribe to his traditional (religious) ideas of family or women's roles. All challenges that befall those who do not nor can not live the way he believes deserve whatever suffering they have, be it lack of insurance, single parenthood, or minimum wage jobs that don't provide enough money for rent and other needs. He refuses to accept that the class structure in society is man- and corporate- made. And he refuses to acknowledge that government's role is to protect citizens from such discriminatory and preying tactics.

For all his claims of the righteousness and rightness of self-sustaining community, I'm not certain that I would want to be his neighbor, lest my "personal responsibility" not meet his mythical ideas of godly behavior. That's not freedom or autonomy. It's justified prejudice and blaming of victims. Where's the plurality and compassion in that?

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