No, It Isn’t a Good Idea

No, It Isn’t a Good Idea October 27, 2009

There is an idea that keeps persistently arising that seems to be gaining popularity.  It is a variation of two propositions.

a)  The Church should provide health care to all her members from gifts from the faithful.

b)  The Church or a para-church organization should organize a cooperative insurance company to provide medical insurance and/or services.

(a) has no basis in reality.  I’m not being snarky.  I’m being direct.  Relief funds to provide health care and old age assistance for retired priests and nuns are nearly insolvent. Let me repeat that so that it sticks.  Relief funds to provide health care and old age assistance for retired priests and nuns are nearly insolvent.  We both know that the population of aged religious is significantly smaller than the population of Catholics in the United States.  It is smaller than by more than a few orders of magnitude.

But this isn’t the only problem.  In the Archdiocese of Milwaukee there are 650,000 Catholics.  A very rough estimate of the cost of providing health care for this population would be $3,250,000,000.    The bishops appeal last year was for just short of $8 million.   Is there any evidence anywhere that Catholics would be prepared to offer the support necessary for such a system even if they desired such a system?  It isn’t like the Church has the power to tax people.

(b) sounds like such a wonderful idea.  (b) has been tried though.  (b) was part of the reforms under Clinton, if I recall correctly, that allowed associations to market to their members health plans.  If I remember, a few of these organizational plans were even operated by Catholic organizations, although that point is one I’m not all that firm on.  This was originally marketed as a way to allow small business to get the advantages of a larger risk pool.  The only problem is that many of these plans are bankrupt, and nearly all the rest of these plans are no longer competitively bid.

The reason why isn’t all that complex once it is explained.  Picture a teeter totter.  As you go higher, the cost gets higher.  As you go lower the cost gets lower.  You as an individual or small business stand on the fulcrum.  You are a member of 2 risk pools – possibly more, but rarely: You as a sole entity and the association.  You price insurance for yourself and the association.  If the cost is less for yourself, you walk over to the left side of the teeter totter, causing the right side to go up.  When things are re-evaluated in another year, some on the right side of the teeter totter go over the left side because their premiums are now lower when their risks are evaluated in their own right.  This causes the right side of the teeter totter to go up again.  Eventually the right side of the teeter totter becomes a high risk pool that no one wants to touch with a 10-foot pole.

If people perceive that my patience with this topic has been exhausted, it is because they are right.  Our country is being bankrupted by high medical costs because people are holding on to myths and other forms of ignorance.  The problem is the things we think are true, but ain’t, as someone famously said.  The greatest frustration for me in this health care debate is the number of people that think they are entitled to their own facts and think their opinions are valuable because they thought them.  We have the evidence of dozens of socialized systems throughout the world.  We know they provide the best possible way to constrain cost.  After the Terry Schiavo fiasco, we should know that the threat of euthanasia is independent of who’s paying for the treatment.  The evidence so far at least is that governments and ethical codes are one of the things limiting euthanasia as families look for ways to address relatives that have succumbed to debilitation.  We know that the public funding of abortion has very little to do with the rate, considering that we have a higher rate of abortion than many countries that do fund it.  Additionally, there are large social networks in our society prepared to fund any abortion desired.  Certainly there is nothing wrong with trying to advance the abortion debate in this country through the health care bill, and it is entirely noble to fight attempts to increase the franchise.  It must however be kept in perspective and to understand the present bill as marking a significant advance or decline in abortion is to simply be wrong.

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  • Matt Bowman

    “We know that the public funding of abortion has very little to do with the rate”
    The Alan Guttmacher institute disagrees with you. Studies from both sides of the debate show that if the government makes aborton free for everyone through insurance, lots and lots of women will have abortions who aren’t having them now.

  • R

    M.Z.,

    I agree with almost everything you are saying, except your rejection of (b). Wouldn’t (b) describe a non-profit insurer such as Kaiser? Not sure I think that’s a great role for the Catholic Church to take on, but it does seem to work.

    Also, isn’t the Swiss model to have private insurers, but to heavily regulate them and require them to be non-profits? That also would be an example of (b) working . . . maybe not in the current system, given the teeter-totter effect you describe, but how does Kaiser do it then?

  • M.Z.

    Kaiser owns and maintains facilities. I was actually born at Kaiser Hospital, in case you’re ever questioned on Jeopardy.

  • MJAndrew

    Studies from both sides of the debate show that if the government makes aborton free for everyone through insurance, lots and lots of women will have abortions who aren’t having them now.

    There are certainly models that predict this, and but keep in mind that a model into which data collected over the past is inserted is only a predictor and not a guarantor. In this respect, we try to get a model to give us the likelihood of some future outcome, so we cannot unequivocally reject M.Z.’s claim about abortion rates (though M.Z. would be faced with the difficult task of trying to (a) show what’s wrong those models or (b) come up with his own model whose output is a different prediction). Rather, we should be more modest with our claims. At any rate, it is certainly not a foregone conclusion that abortion rates will increase with government funding of abortions, though I can see why from the armchair perspective it may appear to be such.

  • Kurt

    MJAndrew,

    Thank you for a thoughtful post. My own inclination is that abortion funding by itself likely increases abortion rates while a comprehensive social welfare system decreases it.

    But it is a matter of sociological analysis, not of Church dogma.

    Last I checked, being a bad sociologist does not make one a bad Catholic.

  • MJAndrew

    My own inclination is that abortion funding by itself likely increases abortion rates while a comprehensive social welfare system decreases it.

    That is my intuition, as well. Economic and sociological predictors are helpful in shaping our intuitions, too, be that in terms of supporting those intuitions or changing them. But, as you seem to note rightly, these predictors are not dogma (obviously), and I would go even further in saying that they never give us fact (i.e., there is permanent underdetermination).

  • Michael Enright

    Regarding (b) I suppose it just depends on how it is done. If a Catholic organization created some kind of insurance pool for its members to buy insurance that may not help much. I am not so sure that a cooperative that runs on dues and keeps doctors on salary is so infeasible.

  • M.Z.

    Franciscan Health, among other Catholic medical systems, has attempted to subsidize the care of poor folks. They do this hospital pairing. In Milwaukee, the now closed St. Michael’s hospital generated large losses, that were subsidized by other hospitals in the the Franciscan system. I point this out to try and give people an idea how Catholic hospitals are trying to achieve their mission. Where this is running into trouble is that the subsidized hospitals are losing so much money, and competition has reduced the ability of the rich hospitals to generate free cash flow. Over the past decade, the northside (poor) of Milwaukee was served by 3 hospitals: St. Michael’s, Sinai Samaritan, and St. Joseph. St. Michael’s is closed. The only thing keeping Sinai Samaritan open is a huge state subsidy and Aurora will probably still close it before the decade is done. Meanwhile, Aurora is building a palace in the Waukesha suburbs in case their West Allis (westside of Milwaukee) gets to be too black and the wealthy white folks start looking elsewhere.

    As far the Church or para-church operating hospitals and clinics offering an insurance plan to use those facilities, there is nothing in existing law prohibiting that. One problem is accommodating the Medicare population. The biggest problem is that employer subsidies to insureds have closed off the individual market for the most desirable insurance pool. At that point someone might ask about negotiating directly with employers. Well, that is what the Catholic Health Care System does through various PPOs and whatnot. A lot of this is just premised off there being significant savings available on the administrative end and there simply aren’t all that many. We are almost to the point where the only human hand to touch or see a $500 claim is the person at the clinic entering the claim into their billing system. Even back when I was a dumb monkey typing in claims, the cost of me doing so was somewhere around 25 cents per claim. Certainly there would be some one-off savings by switching to single payer, but that is more explanation than I want to offer at this point.

    As far as abortion rates.
    This is old data, but good enough for my purposes:
    Britain: 15.6 per 1000 women of child bearing range
    France: 12.4
    Germany: 7.6
    Italy: 11.4
    Sweeden: 18.7
    United States: 22.9
    You’ll notice, we are almost double the French and triple the Germans.
    (http://www.guttmacher.org/pubs/journals/25s3099.html)

    There are many factors for why the United States is higher than other countries. One of those factors isn’t however massive government subsidization as part of national health plan. But it isn’t like the government is the only source of support for abortion. Planned Parenthood in 1994 received $190 million in private donations. (http://www.plannedparenthoodrx.com/annualreport/report-04.pdf ) That isn’t revenues. That is just plain donations. There is so much public support for abortion in this country that organizations spend money raised here on advocating and performing abortions overseas. I can understand the self serving arguments on both sides that greater public support equals greater numbers of abortions. I just don’t see any evidence what-so-ever that women in this country are denied abortions as a matter of cost. This isn’t the jungles of Brazil. There simply is no great demand for personal initiative to get an abortion in this country; there are plenty of people willing to give time and money to see that a person has an abortion if they so desire.

  • Matt Bowman

    “I just don’t see any evidence what-so-ever”

    I’m not sure what to make of this. Are you denying that the numerous studies exist showing that funding abortion in the US would increase it? Or are you challenging their methodology, and if so, what is the scientific basis of your challenge? The abortion rates in all those countries is not an argument against this, because whatever the rates are in those countries, the question is what happens HERE when we don’t fund abortion HERE.

    Being a bad sociologist doesn’t make one a bad Catholic? Well, that depends on whether “bad” means sometimes incorrect, or whether it means stubborn repudiation of evidence. It’s one thing to say I disagree with those numbers and here’s why. It’s another thing to say that the science doesn’t matter because my personal premises trump whatever else anyone else says.

    • M.Z.

      If you look to the object of the statement you will see “that women in this country are denied abortions as a matter of cost.”

      Few correlative factors are purely linear. While a child may slide down the once at $5 per ride and slide 50 times at 10 cents per ride, he is not therefore likely to go down the slide 500 times at a penny per ride, and he certainly won’t go down an infinite number of times if going down the slide is free. Given that the US has a relatively high utilitization rate for abortion and the control group, much of Western Europe, has subsidized abortion, then a logical assumption is that other correlative factors are increasing the utilization rate in the US and additional positive correlative factors are not likely to induce it higher. Now some would argue that widely available and subsidized maternal, pre-natal, and child care carries a negative corelation for abortion, and that explains the discripency. I’m not sure I buy that, or at least I don’t think it is that significant. However if we agree that both factors are present, then we have to evaluate the net of those two factors.

      Since none of this is likely to convince you, let me ask what you believe is the negative correlative factor leading to lower abortion rates one-half to one-third less than ours, and why aren’t we pursuing that strategy? It would seem far more efficacious to pursue that if our concern is for the unborn.

  • Ronald King

    My impression is that a catholic subsidized health insurance program would work, IF, there was any leadership from the USCCB. The church is stagnant and comfortable as a result of the leadership. It is easier to get angry and complain than to think outside the trance of consumerism and comfort and the primitive, self-protective neurosis of social isolation and individualism. Lazy, greed, hate, fear and gluttony come to mind.

    • M.Z.

      Your impression is wrong and has no basis in reality. The Catholic Church subsidizes quite a bit of health care. It’s own insurance programs are broke.

      Life would be a lot easier if leadership from the USCCB was all that was required to fix our health care system.

  • I’m not sure that the Gospel calls us to develop a health care structure merely for the members of the Catholic church. The Gospel calls for justice for all.

  • While it’s true that Western Europe provides funding for abortions through their universal medical coverage systems — they also have more legal restrictions on abortions that the US, legalized it later (thus developed a culture of contraception _before_ a culture of abortion), and their poor minorities have not seen their family structures destroyed as completely as those in the US. Between all those, I think people can question quite a bit how well your comparison holds.

    That said, I would imagine that cost is not the primary thing which could be affect abortion rates if, say, a “socialized” single payer system were instituted here in the US. While costs can certainly keep a woman from procuring an abortion (not everyone who can’t shell out the cash for one is instantly handed money by Planned Parenthood — rolling in cash though they may be) availability of facilities and the number of visits, disclosures, waiting periods, permissions, etc. seem to be more of a factor.

    So if changes in the US health care system resulted in someone making sure that more regions had abortion providers, and that there were fewer hassles involved, the abortion rate would clearly go up. But if there we no more providers and just as many hassles but the cost went down, the rate would probably nudge up a bit, but not much.

    However, I don’t think you can argue that the US is already maxing out its potential number of abortions in that everyone who wants one is getting one, since after all the abortion rate was much higher thirty years ago than it is now. Clearly, something is either keeping people from wanting abortions or keeping them from getting them, and so one has to assume that if obstacles were removed the number of abortions would go up. The question is just how much of an obstacle cost currently is.

  • Ronald King

    M.Z., So, my impression is wrong. Thanks for the clarification. Your impression of my impression is wrong. The catholic system is broken because catholicism is broken and has no direction. It is fragmented with different apostolates all over the world attempting to address their particular issue. There is no unified plan to address the care of those who need healthcare. Over 60 million catholics and we cannot come up with a plan to address everyone’s need for healthcare is a problem with leadership and the selfishness of the masses. Leadership with a vision is everything because people respond to strong leadership. We must have a faith that exhibits a passion for the care of those less fortunate and that passion must start with the leaders of the faith.
    You show people love and the abortion rate will drop. Did you know that there were 150,000 abortions a year in the mid 1800’s when the population was around 25 million?. Abortions decreased based on the availability of support services for women with unwanted pregnancies.

  • Matt Bowman

    This is a 2009 literature review of 38 studies on the effect of abortion funding or lack thereof in Medicaid. The authors conclude, “Approximately one-fourth of women who would have Medicaid-funded abortions instead give birth when this funding is unavailable.”
    http://www.guttmacher.org/pubs/MedicaidLitReview.pdf

    You, on the other hand, are talking about theories disconnected from data, and your theories don’t even grapple with this particular issue but consider only comparisions between the US and other countries, even though what happens in other countries may not have any influence on what happens on the ground in the US. At best your data-independent ideas would be one factor that the people in these studies should take into consideration by adjusting their data–but have you bothered to check to see whether they already took this factor into consideration before you declared their near unanimous result to be hogwash? If you are going to be so sure and dimissive in your assertions, it seems to me you have to dig into the studies themselves first (that is, if you want your readers to have the same kind of assurance you have).

  • Kevin

    Putting aside politics, if you want to be utilitarian in measuring this, the best estimate I read (USA Today) was that preventitive health care will save 18,000 lives. There are over 1,000,000 abortions per year. If you believe that including abortions in a health care will increase abortions only 1.8% I suppose it is a trade off that some can live with. I pray that we can have healthcare without abortion and don’t have to test assumptions that involve the killing of human beings.