My forthcoming book is The Limits of Liberalism, and I am happy to say that I have finished the manuscript except for some editing of the final chapters. But in this posting I am writing about the limits of liberty.
June (my wife) has long been involved with a parent education program marketed as Active Parenting, and one of their parenting principles is "freedom within limits," a significant slogan. (That is also the title of the third chapter of J. Melvin Woody's book Freedom's Embrace.) A proper emphasis on freedom or liberty always includes a concomitant emphasis on responsibility.
In my posting on September 23, I mentioned listening some to “talk radio.” Mark Levin is one of the commentators I hear for a few minutes each week on my way home from Rockhurst University where I teach on Thursday evenings. Levin is the author of Liberty and Tyranny: A Conservative Manifesto, which has been on the bestseller lists since it publication in March of this year.
The liberty Levin writes and speaks (loudly and abrasively) about is partly freedom from what he thinks is excessive taxation. The first section of his “conservative manifesto” is about taxation—and his first appeal is for the elimination of the progressive income tax. Then under “7. Entitlements,” he admonishes: “Fight all efforts to nationalize the health-care system.”
Because of our responsibility to support the public good, we are not free not to pay taxes, including some taxes that we have problems with. For example, we are not free not to pay taxes to support war—a serious problem for those of us who are pacifists, and even for many who are not pacifists but who oppose(d) the war in Vietnam and Iraq. (I admire those who have had the courage to practice war tax resistance, but I have not been able to do that myself.)
People are not free not to pay school taxes, even though they do not have, and maybe have never had, children using the public schools. Those taxes are justified, rightfully, as being for the public good.
Here in Liberty (I like the name of this town!) where I live, people are not at liberty not to pay a library tax as part of their property tax, even though they may never set foot inside it. Again, it is for the good of the community.
If we Americans are taxed to support libraries, schools, and even wars that we oppose, why can the critics say that some taxation to help provide universal health care is a form of tyranny and a violation of liberty? Is it not for the public good that everyone in our country has access to health care? And for us Christians, isn’t helping the needy a part of our responsibility? We may not necessarily be our brother’s keeper, but we are our neighbor’s neighbor. And Jesus taught us to love our neighbors as we love ourselves.
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While I entirely agree that true liberty involves freedom with responsibility, I think that the leap to universal health insurance is a stretch. The root of the problem is that health insurance coverage is equated with health care. All individuals in this country (legal and otherwise) do receive health care by showing up in emergency rooms, community clinics, county health facilities, and public not for profit hospitals (e.g. Truman hospital in the Kansas City area). Services are provided no matter the ability or means to pay. If an individual does not seek health care for a condition, then that level of personal responsibility for the self is on that person. It the same as the old saw that you can lead the horse to water, but you can not make the horse drink the water.
ReplyDeleteThe health insurance side of the issue is fascinating. Health insurance in the pre-Medicare days (early 1960's and earlier) was inexpensive and a cheap add on to the benefits package for employers. Health care and health insurance inflation begin with the government getting involved in health care. Medicare has done much to improve the length of lives in the 65 and older population. The trade off has come with the government setting reimbursement rates for all medical services since the 1960's (e.g. $100 for complete 4 day maternity care in the early 1960's; now it is $10,000 for similar care of 1 to 2 days). So the entity (CMS, the Center for Medicare and Medicaid Services) which sparked the rapid cost increases in medicine and medical insurance, is the entity to be trusted with reducing costs while enlarging the insurance coverage. By 1980 Medicare was originally projected to cost nine billion dollars for the coverage it provided. The actual numbers were 57 billion. The projections missed by a factor of over 7. If the projections are again being missed by this same factor, then the cost to the tax payors will be 6.3 trillon over the next 10 years with the state taking over most of the health insurance.
Health care is available to every person in this country right now. The health insurance "reform" is not truly reform but rather a remaking of the system for paying for health care. Most people do not want to pay more in order to receive less care which are the only two options to cover this centralization of health care.
I appreciate DHJ for posting the above comments--and I would like to know who DHJ is.
ReplyDeleteAt a later time I may write more about this, but at this point just a brief comment: I acknowledge that there is some health care available for the poor in this country. The Emergency Medical Treatment and Active Labor Act is a U.S. Act of Congress passed in 1986. It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status, or ability to pay.
There is a considerable amount of public funds channeled to that compulsory emergency care, as I think there should be. My main question, though, is this: how many of us who have health insurance would be satisfied to have it cover only emergencies, only the medical assistance we could receive in hospital emergency rooms?
I appreciate your response to my response. Interestingly, I am in the process of getting private health insurance for my family. Since I am self-employed, I do not have the option of an employer sponsored plan with guaranteed acceptance. I am looking for a high deductible plan, because I want the insurance to be there only if needed for a catastrophic health emergency (Isn't this premise behind auto insurance, life insurance, homeowners insurance, etc?). I believe that if I am personally responsible monetarily for the basics of health insurance (e.g. office visits, basic lab tests, etc.), then I will be more judicious in selecting whether or not to seek care instead of unthinkingly seeking care because I have insurance.
ReplyDeleteI have observed this behavior at least twice in my personal and professional career. The first case involved Native Americans at government health clinic in Oklahoma. Until the 1980's documented Native Americans received unlimited eye care and eyeglasses at no charge. The result was that glasses were lost and broken multiple each year by most individuals. Not surprisingly, the rules were changed so that eyeglasses cost an amount equal to the charges to fabricate the glasses (still a nominal amount but not a trivial amount). The change in behavior was marked. The incidence of lost and broken glasses was nearly eliminated because of personal responsibility.
From a personal standpoint I have been responsible for paying the extra health costs for my children for many years. Their mother has spared no expenses in seeking care for them for any number of conditions over the years. For personal reasons, she has decided to pay the extras for both 2008 and 2009. The children have had similar health issues as before; however, the utilization of health care has almost been non-existant for the children in both of these years. The positive from this is that the children are doing fine without the excessive use of medical resources.
Some level of personal responsibility is necessary in order to judiciously utilize health resources.