Saturday, December 12, 2009

Subsidiarity: Catholics abet Tea Bagger Independence.

The concept of subsidiarity, a part of Catholic social teaching, sounds a lot like federalism when you spell it out. Those opposed to "entitlement" programs, often right or far right groups depending on the program, kind of overlap with conservatives Catholics when health care reform comes up. Here's a little argument from The Lewis Crusade that refutes those arguments:

The Tenth Amendment of the United States Constitution:

“The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

This is one of the basic dividing lines of the two basic approaches to American politics. The Right emphasizes “not delegated to the United States by the Constitution” and “are reserved to the States respectively, or to the people”.

The Left emphasizes “prohibited byit to the States.” Therein lies the dilemma.

Article I, Section 8, gives Congress power “To regulate Commerce . . . among the several states.”

OK, so here’s the thing. I usually praise Medicaid for being subsidiarist, even while I express frustration that one can’t get medical care in another state if one is on Medicaid.

It occurred to me today, and this is just a little change in thought, as subsidiarity and the question of not trusting federal power in general still come into play, but I’m wondering if the Constitutional argument against government run health care is really valid, since health care is most definitely an interstate commerce issue in our society.

For example, if Medicaid were transferable out of state, I could have taken the girls and gone to Johns Hopkins by now.

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Blogger John C. Hathaway said...

Thanks for the link! I'd like to clarify: I was mainly addressing the question of whether constitutionalism is necessarily incompatible with federal involvement with health care. On the principle of subsidiarity, I'd still rather see things as local as possible, and I don't trust federal power. My own position on health care is that conservatives need to offer a valid alternative to a government takeover.

December 16, 2009 at 3:50 PM  
Blogger L A Neumann said...

Hi John, Thanks for clarifying.

I agree that health care should be delivered at the local level but patients' rights are best protected by government regulation.

As we see with Catholic hospitals that serve 20% of our pluralistic population but impose strict doctrine on delivery of services, patients' rights must be protected for the system to work for all.

I think your supposition that reform has to be government take-over is wrong. When done right (not what we're currently seeing formed in the Senate, I mean), government can best protect patients from discrimination and ensure that health care is indeed a human right and delivered as such.

The "free-market" approach has clearly left us in the horrifying situation we are today with insurers and associations preying on vulnerable citizens, or 50 million uninsured. If you have a better answer to either continuing on like this or enforcing government regulation of patients' rights, I'd love to hear it.

Very best to you! Ann

December 16, 2009 at 4:40 PM  
Blogger John C. Hathaway said...

Hi, Ann,

Well, first, when it comes to the consciences versus services debate, I always raise two issues.

1. Conscience works both ways. If people who want abortions and/or contraceptives want those services, they shouldocto find doctors who do. Patients who don't want to support those procedures should be free to go to doctors who share their beliefs, as those beliefs often correspond to attitudes towards treatment.

2. I've spent my life around doctors. Doctors routinely deny services. I go to a gastroenterologist and tell him my medical history, and he ignores previous diagnoses and my actual problems, and focuses on my dad's history of colon polyps.
Go to the orthopedic doctor for my back, and he tells me he doesn't do backs in his practice.
Go to the chief of cardiology at MUSC and get an MRI of my aorta, and my mom notes my liver's large, and he says, "I dunno. I'm not a liver man," and walks out.
Doctors are human too. Whether for laziness, lack of interest, or professional choice, they deny services all the time.

Indeed, I just thought of this, but there really is no "advertising" in medicine. I mean, there are ads for pharmaceuticals. But when you pick a doctor, unless they come referred by another doctor or patient, it's largely the luck of the draw: who's available and whom your insurance will cover.

So, one suggestion would be having a rule that physicians need to provide more detailed information to potential patients about their practices. If an OB/Gyn is anti-abortion or anti-contraception, she should say so. If a gastroenterologist focuses on one particular kind of disorder (as most do), he should say so.

The other aspect of patients' rights is denial of services from the insurance stand point. A lot of people want government insurance because they think it will be easier to deal with than private insurance . However, most private insurances base their coverage standards on Medicare and Medicaid standards to begin with.

In my experience, having dealt with Medicaid and private insurance, I know it's a lot easier to argue a decision made by private insurance than by Medicaid.

A few calls to the right person at Cigna or BC/BS or a letter from the doctor written the right way will get a denied service covered. If Medicaid denies something, it's an uphill battle, and you practically have to hire a lawyer.

December 16, 2009 at 10:27 PM  
Blogger L A Neumann said...

Great dialogue, John. Yes, I understand the need for individuals to exercise their conscience. However, the latest conscience clauses allow institutions to do so as well - which is how the 620 Catholic hospitals in the US impose their health decisions on their doctors and patients.

As well, the Church doesn't think they must provide information to the incoming patient about their restricted services. Catholic policy determines that offering a referral for, say, an abortion or contraception they disapprove of is still a violation of conscience - contributing to acts they condemn.

Yes, there are all sorts of specialists who tell you what they will and won't, can and can't do. However, the denial of services to women in the area of reproductive health is theologically motivated. Women are to have as many children as the lord gives them.

If science-based health care is a right, why is the government allowing Hyde, again a religious restriction on abortion and sterilization, and other restrictions to hinder women's access, nee to discriminate against women?

And it's not just women who bear the brunt (lest one be opposed to women having access they need.) The elderly won't have their advance directives honored at Catholic hospitals in some cases. Men won't get sterilizations. (Lesbian and unmarried women can't get fertilization services.) Entire communities are effected when a Catholic entity comes in.

Informed consent, referrals are essential. But how do you stop discriminating against women of reproductive age and still honor the consciences of doctors (and institutions) without them?

December 17, 2009 at 5:21 AM  

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