Why a ‘Good’ Healthcare Bill Could Be a Very ‘Bad’ Idea

Why a ‘Good’ Healthcare Bill Could Be a Very ‘Bad’ Idea November 12, 2009

There are two main kinds of Catholic opposition to healthcare reform coming from that vague place that we might call “the Right”: On the one hand, there are those who critique of the very idea of a government providing medical care to its citizens. On the other hand, there are those who, unlike the previous objection, support the notion of universal medical care, yet, find the details in the bills that have been presented to be morally off-putting.

I admit that I have a hard time distinguishing between the two, and have wondered at times whether this distinction is clear to many of them. (Dearest Blackadder, I know you are of the second, more respectable, variety.) Nonetheless, there is something that they both have in common: Neither of them have much interest, if any, in enrolling in the medical care that would be offered by the government in these bills. So, in that sense, even the second variety has a bit of the first’s distaste for being (personally) enrolled in a government healthcare plan.

In other words, it seems uncontroversial to generalize that much of the opposition to the healthcare bills presented so-far, is disinterested in getting health care from the government. If reasonable options exists, they would seem to prefer to get their own from a private corporation.

At the same time, many of them are working very hard to ensure that the medical care that would be tax-funded would be as moral as possible. Moral healthcare is, of course, what they mean by ‘good’ healthcare. It lacks immoral things such as abortion funding, limitation on conscience rights; and includes—here is the strange thing—options for those who wish to not be enrolled in government healthcare.

This is ‘good,’ moral healthcare: A bill that provides universal coverage without the expansion of abortion rights, the limitation of conscience rights, and allows ways for people to opt out if they want to. What is striking about these three criteria is that they create a potential conflict. While one and two (abortion and conscience rights) deal with what are explicitly moral issues, three (non-governmental options) is simply a way to express what I said earlier: None of these critics wants Uncle Sam to be their healthcare provider.

But here is the dilemma: What if the critics of healthcare and advocates against abortion provisos and limited conscience rights got everything they asked for?

If they got it all, or even a significant portion of it, it may very well be the case that they become morally obliged to enroll in government healthcare on same moral grounds as their objections that amended it. After all, corporate insurance already has a great deal of nasty provisos and many other things that their premiums already support.

In the case of a well-negotiated healthcare bill, the ‘goodness’ of the government option might outright exceed the ‘goodness’ of their current providers. In that case, it seems that issue three (having non-governmental options) becomes something of a moot point. If there is a less morally-objectionable government option available at a reasonable cost, then, are we not required to enroll in it over the more objectionable, morally speaking, corporate options?

Here we see that a ‘good’ healthcare bill could be a very ‘bad’ (read: inconvenient) idea for those who oppose it because it would force them actually use the healthcare they are trying to provide to the poor and the uninsured—but certainly not for themselves. If those details get ironed-out relative to the ignored details of corporate options, then, they would have effectively denied themselves the option to do anything but participate in the morally better, government option.

But this all hypothetical. Here is a very real challenge: Those who express moral objections to the healthcare bill should read the fine print of their current health plans and be sure that they are not advocating against the very kinds of things that they already pay for. Or, in the case of those in Congress, since most of them already secure a healthcare plan via the Fed in some way, then, maybe they should stop saying that the government can’t do anything right when it comes to healthcare. (Unless, they truly don’t like the Cadillac coverage that Congress gets.) It is empirically untrue in their own good-health and awfully whiny and unattractive.

If the healthcare plans that objectors are presently enrolled in cover things like abortion (or anything else they find objectionable), then, they must find a better option to enroll in. If that option happens to be the bill they advocate for, then, they have effectively tied their hands from being able to exercise those sacred “private” options. After all, there is nothing “optional” about doing the best thing, all things considered.

So, to those who are using moral reasoning as a way to politic against healthcare: Be careful what you wish for.

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  • Colin Gormley

    Or we could ban abortion altogether. Then private insurance companies wouldn’t (in some cases have to) to fund it.

    My objections to this bill still hold. I’m glad the Stupak admendment passed, making a bad bill less of one. This attempt of pitting “the Right” against itself to me indicates that this post is more politics than the Catholic Faith informing such.

    Finally my objections (which have yet to be answered on this site). The bill costs 1.2 trillion. If this money is going to be saved though reform, why don’t we make the reform BEFORE spending the money to cover those uninsured. Also, the 1.2 trillion cost is a projection, which historically have always been WAY lower than actual costs. Why don’t we make sure we acutally have the money before playing roulette with 1.2 trillion on the line?

    That would be the most moral and prudent solution.

  • Kurt

    Neither of them has much interest, if any, in enrolling in the medical care that would be offered by the government.

    Sam, you are being much too kind to the Right. An immeasurably small number of conservatives decline government financed health care (Medicare part B, TRICARE, etc).

  • Cathy

    I agree with Colin.

    He has a pragmatic view of this healthcare bill. How do we provide healthcare assistance to Americans if our country cannot afford the costs? Foreign countries already finance this country’s debt. This puts us at risk.

    This website presents politcally biased statements towards the left and discourages opposing viewpoints.

  • Colin and Cathy:

    You are both quite right. There is another objection that gets tossed around: the fiscal objection. However, as I see it, this is not a main objection. The reason it is not is because both parties have zero credibility when it comes to not spending too-much money. The only controversy is in what they spend it on. The Dems claim that this will cut costs and there is comparative evidence (looking at other countries) that it can, but who really knows. There are other cases where it has caused problems, but the costs of those problems is still remarkably higher than what we pay here. I tend to pinch my nose over this when it comes to fiscal responsibility since both options (corporate or government) spend and waste like drunkards.

    But, again, this is not the objection that is getting played to the degree that the socialism (main objection #1) or abortion (main objection #2) are. Being that my intuitions feel that way, I focused on those two as the main ones.

    You may notice, however, that given the predicament I describe between those moral interests, anyone with moral reservations should be vary careful about what they root for if they don’t want to be enrolled in government healthcare.

    In fact, it may be to their strategic advantage to make this bill as immoral as they can so they can object to ever having to be enrolled in it.

    I would be glad to write on the economic issue, although I may look the fool since it is not my forte, but for now I would appreciate it if you directed your criticism to what I DO say here, which still remains untouched.

    And Cathy, regarding the political bias of of this site, two things:

    1. Thankfully you don’t pay us for it like I do to some journals (ahem! First Things) that frequently write things I feel are unfair. We do this all this stuff here for free.

    2. If you want to paint me as some apologist for the Democratic Party, then, to put it bluntly: you’re wrong. My record here speaks for itself on the issue of partisanship. As I have said before, I consider myself something of a postmodern theocrat, or a leftist conservative—or maybe just as Catholic as I can fail to be (again and again) but keep trying to become.

  • Cathy

    Sam:

    Fair enough regarding the politcal views; I did not try to paint you as an apologist. I did experience criticism regarding opposing views from another contributor.

    I do not oppose absolute government intervention, however I do oppose universal coverage as proposed.

    In addition to the fiscal issue, my opposition to universal coverage, as proposed by Congress is due to its restrictive mandates. I work with small businesses and see this bill ‘biting the hands that feeds’ the workers – small employers. This is due to the additional payroll taxes and mandates. Members of congress have lost touch with small business and the fact that they are the biggest supplier of jobs to the American workers.

  • David Nickol

    small business . . . are the biggest supplier of jobs to the American workers

    Is this true? I hadn’t heard it before.

  • Kurt

    Cathy,

    Small businesses are exempt from the taxes and mandates. Did you mean large and medium sized businesses?

    For small businesses that do not offer health insurance, it seems to me that setting up an exchange so their uninsured employees can buy insurance on their own is a beneficial thing to the small business (or at least neutral if they are unconcerned that their workers are uninsured).

  • Blackadder

    Since Sam mentioned me by name, there are a couple of clarifying points I’d like to make.

    First, I don’t have any moral objection to using government health care. I think we should privatize the Post Office, but I still use it to mail letters. Anyone who thinks its hypocritical for conservatives to advocate the elimination of a government program while being willing to make use of that program until it is abolished is, I think, guilty of that foolish consistency Emerson rightly derided as the hobgoblin of little minds.

    Second, while I do think there is a moral problem with providing health insurance coverage for abortion for the most part the problem lies with the insurance provider, not the insurance customer. In the case of a government-run plan, the provider is, in a sense, me, which makes this morally problematic for me in a way that a private entity covering abortion is not.

  • Colin Gormley

    Sam:

    Appreciate the reply. Fair point about staying on topic.

    I believe the answer to the main question is no. A prolifer is not obligated to enroll in an abortion free gov healthcare plan. This is because we are all (U.S. citizens) paying for abortions either directly or indirectly through our taxes, either in federal contracts or foreign aid, etc. All money paid by taxes goes into the general fund, thus my money is (possibly) going to Planned Parenthood’s federal contracts.

    The banning of abortion funding from the healthcare bill is a NOT ANOTHER DIME stance as far as I’m concerned. I oppose any expansion of this at any level, under any circumstances.

    Thus moving from a private insurer who’s money I cannot control to the government whose money I can’t control is a lateral move IMO.

  • Cathy

    Kurt:

    The exemption is for employers with less than $500,000 in annual payroll. This does not necessarily exclude small business. For 2012, the bill mentions 10 or fewer workers. Ten is an arbitrary number for business size. What happens when ten turns to eleven? Does that make them a medium-sized employer?

    Why the mandate? Some employers will pay a higher wage if they do not offer health insurance to an employee who is covered under another plan. Why would that be immoral? I would not consider that employer ‘unconcerned’ about the employee’s welfare.

    I know of employers that provide money to employees so they can contribute to an HSA instead of offering a company health insurance. They did this because the it was cheaper for employee as well as the employer.

    I maintain my position regarding universal healthcare for my reasons previously stated and believe that Congress should have acted differently.

  • Kurt

    The exemption is for employers with less than $500,000 in annual payroll. This does not necessarily exclude small business.

    Sure seems that way to me. Half a million in payroll and can give their workers a basic and needed benefit.

    For 2012, the bill mentions 10 or fewer workers. Ten is an arbitrary number for business size. What happens when ten turns to eleven? Does that make them a medium-sized employer?

    Yep. Cathy, you introduced the term small business, Perhaps you should have provided a standard rather than using an arbitary term.

    Why the mandate? Some employers will pay a higher wage if they do not offer health insurance to an employee who is covered under another plan. Why would that be immoral?

    I don’t know. It is illegal under long standing law. An employer can’t offer health insurance to some employees and deny it to others because they are covered under their spouses’ plan.

    We do have the sad legacy of “men’s work” (heavy industry, construction) offering full benefits and “women’s work” (retail, restaurant trade) offering no benefits. There is no virtue in perpetuating this. We should be moving away from one inudstry paying for the spouses of people who work in another industry.

    I would not consider that employer ‘unconcerned’ about the employee’s welfare.

    I would.

    I know of employers that provide money to employees so they can contribute to an HSA instead of offering a company health insurance. They did this because the it was cheaper for employee as well as the employer.

    I know of such employers too. It is terrible. It is certainly cheaper for the boss. If you are young, healthy and high income, it can be beneficial. If you are not all three of these, it is a raw deal.

  • Cathy Kulig

    Kurt:

    First, I did not appreciate your sarcastic comments.

    My point is that small businesses know how to run their operations better than Congress. The mandates will make it more difficult to run a business. They will also discourage people from starting their own businesses. The number Congress lists for exemptions may work for some businesses but will not work for others (payroll size/number of employees). The owners should be free to choose. These mandates will also hurt workers by encouraging lower wages.

    You misunderstood my comment. If an employer offers health insurance, an employee can refuse it if he/she is covered under a spouse’s plan. The employee can negotiate a higher wage as part of the hiring process. Don’t tell me that I am giving illegal advice.) Which brings up a good point not addressed by the healthcare bill – why should health insurance remain attached to employment? Maybe portability with individual coverage would reduce some of the issues our country faces today.

    Your comment on HSA’s proves another point for me. Congress is mandating a ‘one size fits all’ package. Something that works well for one person may be detrimental to another. Let people choose!

    Finally, your comments to me prove that you unaware of the risks and hardships owners have with running a small business. Refrain from your judgements until you walk in their shoes.

  • I don’t want sound like a drone, but I have yet to read any head-on objection to my thesis here, despite the very unsympathetic comments. So I will ask this question again:

    “If there is a less morally-objectionable government option available [than corporate healthcare options] at a reasonable cost, then, are we not required to enroll in it over the more objectionable, morally speaking, corporate options?”

  • Kurt

    My point is that small businesses know how to run their operations better than Congress. The mandates will make it more difficult to run a business.

    Except there are no mandates on small business (i.e those with payrolls under a half a million dollars) and the mandates on medium and large businesses will make it less difficult for workers and their families to have needed health care.

    They will also discourage people from starting their own businesses.

    I think people should be discouraged from starting a small business if they can’t see it as able to help pay for their workers health insurance once the business grows to a half million dollar payroll.

    The owners should be free to choose.

    If business was in the forefront of supporting single payer or some other plan for universal coverage that de-linked insurance from employment, I would have more sympathy. But they have used their lobbying power the other way, opposing anything but modest changes. That in large part is why we have no option but to build on the current system of employer provided insurance.

    These mandates will also hurt workers by encouraging lower wages.

    Workers are hurt by being denied health care.

    You misunderstood my comment. If an employer offers health insurance, an employee can refuse it if he/she is covered under a spouse’s plan. The employee can negotiate a higher wage as part of the hiring process. Don’t tell me that I am giving illegal advice.

    Well, you are. It’s illegal. I don’t see how under the table secret deals are a virtue. And again, what is the virtue in shifting costs from one employer to another?

    Your comment on HSA’s proves another point for me. Congress is mandating a ‘one size fits all’ package. Something that works well for one person may be detrimental to another. Let people choose!

    The plan passed by Congress will expand the choices workers have. An HSA is not a choice, it is a tax avoidance scheme for high income people.

    Finally, your comments to me prove that you unaware of the risks and hardships owners have with running a small business. Refrain from your judgments until you walk in their shoes.

    I am on the board of directors of a small (<$500,000 payroll) business and chair the personnel committee. Our workforce is of a low wage industry but we exceed industry standards by providing full benefits (no premium) to our employees for their health insurance.

    Yes, it is difficult, particularly two years ago when our insurance company cancelled our policy for no legitimate reason. It was degrading shopping for new insurance during which our employees had to disclose their medical history. The current system stinks to high heaven. The House plan would make things much better for responsible employers like us.

    But the bottom line is that I am going to allow any workers I am responsible for to go without health insurance. I could not live with myself.

    Those are the shoes I walk in.

  • David Nickol

    If abortion is the issue that trumps all others, as many conservatives argued during the presidential election, then the conclusion seems inescapable that those who have any private insurance, either for which they pay entirely themselves, or toward which they pay something (as I think most people do who are covered by their employers) must get rid of that insurance immediately, and not merely if they can find something less morally objectionable at a reasonable cost. They must get rid of the coverage immediately even if they have to pay more for other coverage or go without coverage.

  • David Nickol

    In the case of a government-run plan, the provider is, in a sense, me, which makes this morally problematic for me in a way that a private entity covering abortion is not.

    Blackadder,

    Your answer addresses the matter of the “public option” (if we get one) selling insurance that covers abortion. But those trying to impose abortion restrictions are not limiting them to the public option. The Stupak Amendment would prevent anyone who gets any government subsidies at all from buying a private policy on the insurance exchange that covers abortion. You, as a taxpayer, wouldn’t be the provider. The provider would be the private insurance company that offers abortion coverage. Under the Capps Amendment, no taxpayer money would go toward abortion coverage.

  • Thales

    Sam,

    Can someone answer your question based on prudential considerations? Let me try to answer your question this way:

    The ideal type of government is a monarchy, a government with a dictator who is all-good, all-knowing, who is entirely just and moral. However, in our imperfect world, it is not prudent to set up a government like this because there is a high likelihood that this monarchy will devolve into an immoral totalitarian dictatorship. It is better to have a government of the many.

    One could say that a problem with government healthcare is that even if a moral system is first set up, there is a possibility that immoral elements will creep into it, and once that happens, (1) there is no altenative option to take; and (2) it is hard to reverse or remove this immoral element. This is not to say that immoral elements won’t creep into private insurance health care – but in a private insurance health care system, (1) generally there are other alternatives that you change to, and (2) it is easier to reverse or remove this immoral element.

    So is it possible to answer your question by saying that if there is a choice between a government, non-abortion plan and a private, abortion plan, one should choose the government plan — but that if there is a choice between having mediocre private plans or having a good government plan, one should choose mediocre plans for the sake of being prudent? (ie, choosing a mediocre, imperfect democracy over a benevolent monarch).

  • Cathy

    Sam:

    I am not sure if this addresses your thesis and have a difficult time due the fact that choices are black and white. This issue is too complicated to address in simple terms. Also, you might be looking for someone more aligned with your thoughts on this issue.

    However, I would say ‘no’ due to the reason you include the term ‘require’. I may not agree with the government’s definition of ‘moral’. Also, government is not a static body and is subject to change over time. We may agree with the moral code of today’s leaders but may disagree with them tomorrow.

  • Colin Gormley

    I answered your question in my previous post. If it is insufficient I would like an explanation.

  • Sam,

    I think BA probably answered your question pretty solidly, though from a conservative/libertarian point of view (so maybe it didn’t register as a clear answer from your POV.)

    To expand slightly: First off, I think you’re off that conservatives are saying that they don’t want to belong to a government health care plan per se as a matter of choice. Rather, they’re arguing that the plan on the table for regulating private health insurance, subsidizing it, and developing a “public option” is simply not a good plan for one of several reasons (depending on the conservative talking):
    – Too expensive
    – Won’t work well
    – Gives the government too much power
    – Not the government’s job

    As for whether pro-lifers who currently have private health insurance which provides for abortions would be morally required to switch to a “government option” (in fact, these would mostly be private insurance options which were available through the exchange and potentially with government subsidy if you don’t make enough money to afford the whole premium — according to congress’s ideas of what you can afford) which didn’t provide for abortion, I think you’re confusing issues here.

    About 80% of Americans currently get their health insurance through their employers. The bill out there right now would mostly only affect those who curently don’t have health insurance at all, or who buy individual health insurance. For those of us with employer-based health insurance, we really don’t have a whole lot of say on whether our plans cover abortion — our moral obligation is simply not to get one.

    If one is an employer, I think one could make a pretty clear case that it’s one’s duty (if possible) to choose a health care plan which doesn’t cover abortion, IVF, etc.

    The issue with the health care bill is that now all voters are essentially in the employer position. Congress is already setting all sorts of rules for what the private insurance policies available on the exchange would cover, what their deductibles would be, maximum out of pocket per year, etc. Those on the right wing are simply saying: If I as a voter and tax payer am being put in the position of spec-ing out and helping to subsidize health care plans, then by golly they better not cover abortion.

    That strikes me as entirely fair, and pretty well divorced from the question of whether people would choose to take advantege of the policies on the exchange — should it ever materialize.

    By a sort of analogy: I would say that if you own a convenience store it is your moral duty not to sell porn. However, I’m not at all clear we have a moral duty not to buy coffee at a convenience store without first making sure that it doesn’t sell porn.

  • Thanks for the replies. I am swamped right now, but hope to address some points in an upcoming post.

    By the way, thanks for reading this stuff. I appreciate it.

  • Kurt

    DC,

    Wouldn’t you agree that rather than saying that with the health care bill “all voters are essentially in the employer position” it would be better phrased “all voters are essentially in the shareholder position?”

  • No.

    I would say that voters have a much more direct responsibility for how their country is run (or at least, a much more direct responsibility to try to influence how their country is run) than shareholders do in regards to how a company is run.

    This is because I think the relationship between citizen and state is much different than the relationship between stockholder and corporation.