Reflections on Christmas and Health Care

The Man said that it’s harder for a rich man to enter the kingdom of Heaven than for a camel to pass through the eye of a needle. It’s not because God hates money, which is fortunate for me, since as it happens I myself love money, all evil’s root though such love may be. Rather, it’s because being rich creates choices, and choices are opportunities to fall short of expectations. For better or worse, He doesn’t keep score in a way we can keep track of on earth – who can say for sure whether in any given year we have too much or give too little, or even who’s rich and who’s poor for that matter. The safe bet, though, is that however much we’ve done, we haven’t really done enough.

I’ve been thinking lately about what this means for a rich nation, such as ours. We have choices in public life – and I’ve been wondering whether it’s coherent to imagine a personal political philosophy that is fundamentally detached from individual morality. I’ve come to the conclusion that it’s not. While nations themselves don’t enter heaven per se, citizens of rich nations do, and they thus face the same challenges and choices in public life as they do in private life. (As St. Francis said, "Preach the gospel at all times. If necessary, use words.") If the divine mandate is not to be codified in the law of the land, permitting our social contract to deviate from what we know to be our right and good instructions is nevertheless a failure of principle, and of conscience. So I’m supporting the health care bill that Obama is likely to sign next month, and the reasoning couldn’t be simpler.

No matter what happens to aggregate medical costs over time, there will never emerge a good reason for a private insurance company to take on or retain a customer with a better than average chance of incurring high medical expenses. And there will never emerge a good reason for a private insurance company to abolish caps on company payouts. Increasing competition across state lines, tort reform, these are all excellent ideas – but they don’t solve the coverage problem because insurance companies are all about playing the averages. It isn’t because they’re evil or don’t care about people – on the contrary, ignoring those practices would be a betrayal of the company’s shareholders , and ultimately they’d go out of business. And thus, by no one’s design, the sick and the poor and increasingly underserved in the greatest nation on earth; a nation that continually, fumblingly claims to strive for a Christian character. That’s what’s fundamentally unacceptable with the current system, and everything else, including rising aggregate costs, is secondary by comparison.

Once we agree on the moral imperative that something must be done, we then turn to the means. To my mind, the simplest way to address the limitations in the private insurance market would be to tell those companies not to worry about it, keep whatever rules they want to stay profitable, and the federal government will manage an insurance plan for the balance of the population, so that everyone had an option. This solution, however, has already been dismissed as deeply un-American, in that it’s grossly unfair to the poor beleaguered insurance companies, who would then have to compete with a heavily subsidized player who could never go out of business. I’m not certain exactly why as Americans we’re supposed to care more about those companies having a tougher road to hoe than we are about the sick and the poor, but so be it. Instead the Democratic party has decided that the better solution (or at least the one that keeps campaign contributions coming to that same Democratic party) is to heavily regulate the insurance industry to abolish the practices that underserve the sick and the poor, and in exchange flood them with new healthy customers via an individual mandate to buy insurance. With the mandate come federal subsidies for people who can’t afford the premiums, and the healthy customers pay for the sick ones. That’s it; that’s the bill. It’s not perfect, but it’s absolutely 100% better than nothing, and if this is our choice as a rich nation, to provide incremental care or not provide incremental care to citizens who need it but aren’t getting it, one imagines that a rich nation would need a really, really good reason to choose no.

So, there’s increased taxes, the deficit, and the debt, that’s one reason. But looked at in context, you have to say that a $2 trillion bank bailout that didn’t unlock or secure the financial system, and a $600B annual defense budget with no end in sight when our biggest threats are essentially crime families living in caves, are reasonable expenses, but expanding medical care to 95% of all Americans at a cost of about $100B per year is not. I’m not convinced.

There’s the notion of government bureaucracy intruding into medical innovation and consumer privacy, that’s another reason. But then you’d be forced into saying that you prefer the insurance bureaucracy, motivated entirely (and understandably) by profit, to a combination of private insurance and government, presumably motivated by profit and politics, respectively. A morass, maybe, but not a good reason to just sit tight and hope for the best. Besides, every single provision in the bill that could be criticized on this rationale is borne out of a good faith effort to control cost. If you don’t like them, so be it, but then see objection 1.

Then there’s the specter of emerging tyranny, and the end of the American experiment in a cataclysm of arbitrary regulation. Okay. There’s no fighting ideology in the space of a single blog post – but in a decade where the American government has eroded our traditional notions of privacy, accountability, transparency, adherence to the rule of law, and protections against torture, in unprecedented fashion , hopefully you’ll forgive me for being skeptical that reform of the health insurance system is going to be what makes the sky fall down on us. Not good enough to say no.

This is politics – it’s messy and it’s not perfect. But it’s the only expression of our national will that we have, and the Senate bill meets the fundamental requirement that we support those less fortunate than ourselves. Everything else, including the outcry from the left over the loss of the public option, is noise. Most of us will never be faced with a debilitating medical expense, whether because of our employment, education, or other support structure. Ignoring or deferring the plight of those who do, because we’re afraid of how much money it could cost, or whatever else we might be forced to give up, or because we think we might get something better later, just doesn’t work. I cannot summon any fear that the United States can’t be safe, and free, and prosperous, and generous, all at the same time. This is the right choice for a rich nation, and as a Christian and as an American, I’ll celebrate when President Obama signs it, warts and all. Merry Christmas, good friends.