Health Care, yes or no?

Often a hot button of debate these days, this issue seeps deeply into the hearts, emotions and lives of everyone around us. Freedom without responsibility is only Darwinism, so freedom in health care with the government in control...might look eerily similar. Some would question what to do. Some would propose that there are no real good answers. Some would disagree.

February 2010

Paul Ryan

Member
U.S. House of Representatives

Health Care in a Free Society

PAUL RYAN is in his sixth term as a member of Congress, representing Wisconsin's First Congressional District. He is the ranking member of the House Budget Committee and a senior member of the House Ways and Means Committee. A graduate of Miami University in Ohio, he and his wife Janna have three children and live in Janesville, Wisconsin.

The following is adapted from a speech delivered on January 13, 2010, in Washington, D.C., at an event sponsored by Hillsdale College's Allan P. Kirby, Jr. Center for Constitutional Studies and Citizenship.

SOMEONE once said that before there was the New Deal, there was the Wisconsin Deal. In my home state, the University of Wisconsin was an early hotbed of progressivism, whose goal was to reorder society along lines other than those of the Constitution. The best known Wisconsin progressive in American politics was Robert LaFollette. “Fighting Bob,” as he was called, was a Republican—as was Theodore Roosevelt, another early progressive. Today we tend to associate progressivism mostly with Democrats, and trace it back to Woodrow Wilson. But it had its roots in both parties.

The social and political programs of the progressives came in on two great waves: the New Deal of the 1930s and the Great Society of the 1960s. Today, President Obama often invokes progressivism and hopes to generate its third great wave of public policy. In thinking about what this would mean, we need look no farther than the health care reform program he is promoting along with the leadership in Congress.

Let me say here at the beginning that even though survey after survey shows that 75 percent or more of Americans are satisfied with the quality of their health care, no one I know in Congress denies that health care reform is needed. Everyone understands that health care in our country has grown needlessly expensive, and that some who want coverage cannot afford it. The ongoing debate over health care, then, is not about whether there should be reform; it is about what the principle of that reform ought to be.

Under the terms of our Constitution, every individual has a right to care for their health, just as they have a right to eat. These rights are integral to our natural right to life—and it is government's chief purpose to secure our natural rights. But the right to care for one's health does not imply that government must provide health care, any more than our right to eat, in order to live, requires government to own the farms and raise the crops.

Government's constitutional obligations in regard to protecting such rights are normally met by establishing the conditions for free markets—markets which historically provide an abundance of goods and services, at an affordable cost, for the largest number. When free markets seem to be failing to meet this goal—and I would argue that the delivery of health care today is an example of where this is the case—government, rather than seeking to supply the need itself, should look to see if its own interventions are the root of the problem, and should make adjustments to unleash competition and choice.

With good reason, the Constitution left the administration of public health—like that of most public goods—decentralized. If there is any doubt that control of health care services should not have been placed in the federal government, we need only look at the history of Medicare and Medicaid—a history in which fraud has proliferated despite all efforts to stop it and failure to control costs has become a national nightmare. In 1966 the cost of Medicare to the taxpayers was about $3 billion. The House Ways and Means Committee estimated that it would cost $12 billion (adjusted for inflation) by 1990. The actual cost in 1990 was nearly nine times that—$107 billion. By 2009 Medicare costs reached $427 billion, with Medicaid boosting that by an additional $255 billion. And this doesn't take into account the Medicaid expansion in last year's “stimulus.”

The health care reform bills that emerged from the House and the Senate late last year would only exacerbate this crisis. The federal takeover of health care that those bills represent would subsume approximately one-sixth of our national economy. Combined with spending at all levels, government would then control about 50 percent of total national production.

The good news is that we have a choice. There are three basic models for health care delivery that are available to us: (1) today's business-government partnership or “crony capitalism” model, in which bureaucratized insurance companies monopolize the field in most states; (2) the progressive model promoted by the Obama administration and congressional leaders, in which federal bureaucrats tell us which services they will allow; and (3) the model consistent with our Constitution, in which health care providers compete in a free and transparent market, and in which individual consumers are in control.

We are urged today—out of compassion—to support the progressive model; but placing control of health care in the hands of government bureaucrats is not compassionate. Bureaucrats don't make decisions about health care according to personal need or preference; they ration resources according to a dollar-driven social calculus. Dr. Ezekiel Emanuel, one of the administration's point people on health care, advocates what he calls a “whole life system”—a system in which government makes treatment decisions for individuals using a statistical formula based on average life expectancy and “social usefulness.” In keeping with this, the plans that recently emerged from Congress have a Medicare board of unelected specialists whose job it would be to determine the program's treatment protocols as a method of limiting costs.

President Obama said in December: “If we don't pass [this health care reform legislation]...the federal government will go bankrupt, because Medicare and Medicaid are on a trajectory that are [sic] unsustainable....” On first hearing, this argument appears ludicrous: We must stop the nation from going broke by enacting a program costing $800 billion or more in its first decade alone? On the other hand, if the President means what he says, there is only one way to achieve his stated goal under the new program: through deep and comprehensive government rationing of health care.

The idea that the government should make decisions about how long people should live and who should be denied care is something that Americans find repugnant. As is true of the supply of every service or product, the supply of health care is finite. But it is a mistake to conclude that government should ration it, rather than allowing individuals to order their needs and allocate their resources among competing options. Those who are sick, special needs patients, and seniors are the ones who will be most at risk when the government involves itself in these difficult choices—as government must, once it takes upon itself management of American health care.

The very idea of government-run health care conflicts with the American idea of a free society and the constitutional principles underlying it—the principles of individual rights and free markets. And from a practical perspective it makes no sense, given that our current health care system is the best in the world—even drawing patients from other advanced countries that have suffered by adopting the government-run model.

But if one begins with the idea that health care reform to reduce costs should be guided by the principles of economic and political liberty, what would such reform look like? Four changes to the current system come immediately to mind.

One, we should equalize the tax treatment of people paying for health care by ending the current discrimination against those who don't get health insurance from their jobs—in other words, everyone paying for health care should receive the same tax benefits.

Two, we need high-risk insurance pools in the states so that those with pre-existing conditions can obtain coverage that is not prohibitively expensive, and so that costs in non-high-risk pools are stabilized. To see the value of this, consider a pool of 200 people in which six have pre-existing heart disease or cancer. Rates for everyone will be through the roof. But if the six are placed in a high-risk pool and ensured coverage at an affordable rate, the risk profile of the larger pool is stabilized and coverage for the remaining 194 people is driven down.

Three, we need to unlock existing health care monopolies by letting people purchase health insurance across state lines—just as they do car insurance and other goods and services. This is a simple and obvious way to reduce costs.

Four, we need to establish transparency in terms of costs and quality of health care. In Milwaukee, an MRI can cost between $400 and $4,000, and a bypass surgery between $4,700 and $100,000. Unless the consumer is able to compare prices and quality of services—and unless he has an incentive to base choices on that information, as he does in purchasing other goods and services—there is not really a free market. It would go a long way to solve our health care problems to recreate one.

These four measures would empower consumers and force providers—insurers, doctors, and hospitals—to compete against each other for business. This works in other sectors of our economy, and it will work with health care.

So why can't we agree on them? The answer is that the current health care debate is not really about how we can most effectively bring down costs. It is a debate less about policy than about ideology. It is a debate over whether we should reform health care in a way compatible with our Constitution and our free society, or whether we should abandon our free market economic model for a full-fledged European-style social welfare state. This, I believe, is the true goal of those promoting government-run health care.

If we go down this path, creating entitlement after entitlement and promising benefits that can never be delivered, America will become like the European Union: a welfare state where most people pay few or no taxes while becoming dependent on government benefits; where tax reduction is impossible because more people have a stake in welfare than in producing wealth; where high unemployment is a way of life and the spirit of risk-taking is smothered by webs of regulation.

America today is not as far from this tipping point as we might think. While exact and precise measures cannot be made, there are estimates that in 2004, 20 percent of households in the U.S. were receiving about 75 percent of their income from the federal government, and that another 20 percent were receiving nearly 40 percent of their income from federal programs. All in all, about 60 percent of U.S. households were receiving more government benefits and services, measured in dollars, than they were paying back in taxes. It has also been estimated that President Obama's first budget alone raises this level of “net dependency” to 70 percent.

Looked at in this way, I see health care reform of the kind promoted by the Obama administration and congressional leaders as part of a crusade against the American idea. This is a dramatic charge, but the only alternative is that they are ignorant of the consequences of their proposed programs. The national health care exchange created by their legislation, together with its massive subsidies for middle-income earners, would represent the greatest expansion of the welfare state in our country in a generation—and possibly in history. According to recent analysis, the plan would provide subsidies that average a little less than 20 percent of the income of people earning up to 400 percent of the Federal Poverty Level. In other words, as many as 110 million Americans could claim this new entitlement within a few years of its implementation. In addition to the immediate massive increase in dependency this would bring on, the structure of the subsidies—whereby they fade out as income rises—would impose a marginal tax penalty that would act as a disincentive to work, increasing dependency even more.

And before I conclude, allow me to clear up a misperception about insurance exchanges: it makes absolutely no difference whether we have 50 state exchanges rather than a federal exchange, as long as the federal government is where the subsidies for consumers will be located. In other words, despite what some seem to believe, both the House and the Senate versions of health care reform set up a system in which, if you are eligible and you want a break on your insurance premium, it is the federal government that will provide it while telling you what kind of insurance you have to buy. In this sense, the idea of state exchanges instead of a federal exchange is a distinction without a difference.

* * *

Americans take pride in self-government, which entails providing for their own well-being and the well-being of their families in a free society. In exchange for this, the promoters of government-run health care would make them passive subjects, dependent on handouts and far more concerned about security than liberty. At the heart of the conflict over heath care reform, as I said at the beginning, are two incompatible understandings of America: one is based on the principles of progressivism, and would place more and more aspects of our lives under the administration of unelected “experts” in federal bureaucracies; the other sees America as a society of free individuals under a Constitution that severely limits what the federal government can rightfully do.

We have seen many times over the past 100 years that the American people tend to be resistant to the progressive view of how we should reform our system of government—and I believe we are seeing this again today. Americans retain the Founders' view that a government that seeks to go beyond its high but limited constitutional role of securing equal rights and establishing free markets is not progressive at all in the literal sense of that word—rather it is reactionary. Such a government seeks to privilege some Americans at the expense of others—which is precisely what the American Revolution was fought to prevent.

Americans understand that the problems facing our health care system today, real as they are, can be addressed without nationalizing one-sixth of the American economy and moving us past the tipping point toward a European-style social welfare state. They know that we can solve these problems while at the same time remaining a free society and acting consistently with the principles that have made us the greatest and most prosperous nation on earth. It is our duty now as their representatives to come together and do so.

“Reprinted by permission from Imprimis, a publication of Hillsdale College.”

Theism

Next on our list, and the last worldview that will encompass the remaining faithviews of our day, is theism. Theism is the belief that there is a single god of the universe that brought all things into existence, gives meaning and purpose to our lives, and will ultimately control our destiny.

Of course, when working to get a basic understanding of life on any realm, one must generalize in order to "set the table," so here we go. There are three major religions that fit into this category. Judaism, Islam, and Christianity. As we all know, there are sub-groups to these religions and factions from them, but we will only deal with them broadly.

Judaism believes in the God of the OT from the Bible. In essence, today's Jewish people are still waiting for the savior of the world to be revealed and bring salvation and power back to their people as promised to Abraham, King David, and so on.

Islam believes that Muhammad, their last 'prophet', gave a new and final account of their god, Allah. They believe that this account, supposedly from an angel named Gabriel, is the rule and norm of their life over and against anything else found in any holy book other than the Koran, Sura, etc.

Christians understand the 66 books of the OT and NT to be the holy, inspired, inerrant Word of God and the rule and norm for all things. They further believe that Jesus was the Savior Who was come into the world to save humanity from their sins, and that His Word, these 66 books, are a consistent story of God's salvation plan for all humanity.

In these theistic worldviews, we will also need to answer the four ultimate questions.

1. Origins - Where did all this come from? Theistic believers would say that god created all things and ultimately has a plan for all of his creation.

2. Meaning is derived from god's view of who people are, what their purpose is, and what his plan of salvation is. For the theist, it all depends upon which god is being called upon. By that I mean that Allah is very different from Jesus, and YHWH without Jesus is different as well. So the meaning changes, yet all adhere to their "god's" view of meaning imposed upon them.

3. Morality also comes from the god being followed. Each god for these religions will have a different set of concerns and consequences, although some may seem similar. And although it can be easy to find fault in the imperfect people who follow god, the implications of having an individual and personal relationship with god will finally trump any latent convictions hanging on the fence.

4. Destiny again will differ drastically from one god to the next. The Jewish person must work out his faith, knowing that Abraham's covenant requires a response. The Muslim must work out his faith in the 5 pillars, not always sure if his convictions have been enough to make Allah happy [unless the sixth pillar is followed in its entirety, which "should" secure eternity with Allah. Although this teaching seems to follow the conservative teachings of Mohammad in the Koran and Sura, only approximately 15% of Muslims attest to this pillar]. Jesus saves by grace, and is therefore showing an easy, yet profoundly difficult way to the Father. Although salvation comes by belief that He, Jesus, died for our sins and rose again 3 days later and will come again...soon...the road after this salvation comes is often difficult. Following Jesus takes faith and help and direction from Him since the world and even one's sinful nature is opposed to this task. Nonetheless, salvation is secured freely through belief in Christ's work on the cross for all mankind's sins.

Now that these three major worldviews have been generally put forth, I hope you will be able to begin to see the many varieties through these "glasses" so that you can see where you fit in the world we are currently sharing. Knowing where you fit also allows you to understand where others fit in this continuum so that you can positively engage the world(views) around you.

I hope and pray that you find yourself with Jesus. I hope you will see His views of origins, meaning to life, morality and destiny from His Word as not only the best explanation for the world around us, but also the most intellectually stable and profound. And I especially pray that you would not end there, but continue to work out your faith by engaging others in loving, yet challenging, dialogue on questions that are age old..."What is truth?" [John 18.38] May God bless you as you do.

Transcendentalism

The next major worldview is virtually the opposite of naturalism. While naturalism says that all things are made of natural means, transcendentalism says that all things are spiritual. We are all part of a "greater force" in nature itself that only inhabits the physical sometimes.

In this worldview, the idea of "shedding these natural clothes" is an important one. The basic religions that all transcendentalist religions are daughter to are Hinduism and Buddhism. We do not seem to have an exact time frame for the birth of Hinduism, but Buddhism, which flowed directly out of Hinduism, was around about 400 years before Christ. Buddha worked to help people's spirit to get out of the cycle of suffering and reincarnation and join everlasting peace and oneness in nirvana [just why did Kurt Cobain blow his head off? Do you think it had anything to do with his worldview?].

In Hinduism, the greater "force" is Brahman. The goal is to reach enlightenment, which includes peace and ridding yourself of you, that is, anything that is inconsistent with brahman, to become part of brahman. Buddhism is very similar, but nirvana is the term for the 'greater force'.

The ultimate questions are answered in different ways in the transcendental worldview.

1. Origins - Where did everything come from? In the transcendental worldview, everything already existed. Maybe it didn't always exist in the natural form we see it today, but the spiritual dimension [brahman/nirvana] has always been there. Generally, the transcendental is not very concerned with the natural bend on life, since they are really just trying to rid of it anyway. Therefore, understanding 'how things first arose' or 'came about' is not nearly as interesting to the general transcendentalist as it might be for the naturalist. They are more focused on where they are going, which has nothing to do with material existence at all.

2. Meaning - Where do transcendentalists' find ultimate meaning in life? This might be the most coersive part of the naturalist mentality. See, in the transcendentalist worldview, human beings are NOT sinful or mean or bad, they are Divine. They are part of god [brahman/nirvana]. The greater purpose then is to shed anything that is inconsistent with the great 'force'/god around them and become a part of it. In some unusual ways, one can see how attractive this idea might be for someone. "You are not intrinsicly evil or sinful, you are god!" That sure could sound much better, whether it is true or not.

3. Morality - How do trancendentalists' decide right and wrong? Since everything is about becoming one with your surroundings, about obtaining peace and unity, about submission to the way of brahman/nirvana, then any moral code would align itself with these goals. If stealing would rob someone of unity with another, stealing would be out of the question. If killing would takes away from a peaceful existence with others, it too would out of the question. The moral codes in transcendental religious belief systems vary, but the main thrust is to pursue unity, oneness, peace and happiness.

4. Destiny - What happens when a transcendentalist dies [according to their religious teaching]? This might be one of the most interesting points of this worldview. Many transcendental religious worldviews have some sort of twist on the teaching of reincarnation. Reincarnation says that when one dies, if they are not yet enlightened to the point of reaching brahman/nirvana, they will come back in another life. Think Brad Pitt in "Seven Years in Tibet". Do you remember why the Buddhist monks stopped digging for the foundation of the new orphanage? They ran into some earthworms. That's right, they decided they couldn't build an orphanage for unwanted children because these earthworms could be "great-grandma" or something. What a trajedy.

There are many ideas of how or why someone will come back as another organism, based on works righteousness and doing better at life, but finally you just keep on coming back until you "finally get it right" and join brahman/nirvana. No wonder Kurt Cobain shot his brains out. Have you ever read the lyrics to his songs? This man was hurting, angry, pissed off and sad. Why wouldn't he kill himself?! If he was enlightened enough, he would go onto nirvana [the name of his band], but if not, he would just be reincarnated anyway and 'get another chance'. The chances would go on infinitely until you reached brahman/nirvana [or in an Americanized twisting, like on the movie "Knowing", you are picked up in the space ship by aliens...Tom Cruize is waiting his turn...they can have him. Scientology is a strange mixing of these ideas from transcendentalism as well as some from naturalism, at least for the question of origins, since they believe that aliens 'seeded' life on earth.].

These ideas have been twisted and changed in more 'westernized' versions. There are many, and they are also made very popular by Hollywood stars, including Wicca, Taro card reading, horoscopes, scientology, kabbalah, and many others. The "living god in the soul" and the power one can obtain by reaching this source is always a draw for many. In fact, many of the main ideas of Star Wars is attributed to transcendentalist thinking. "Become one with the force, Luke" isn't just a line in a movie, but a real worldview that is making its renown known. Yoga and other systems of thought which seek to 'harness the power from within' are all trying to grasp the divine nature in "all of us" [as the trancendentalist would conceive].

Transcendentalists and Naturalists seem to look within for meaning, answers, direction and strength, but maybe the answer is in looking up.

Worldviews

Did you know that you have one? We all have a way in which we understand, interpret and apply ourselves to the world around us.

First, we must take the information we have acquired about a given situation in front of us, understand it in light of cultural principles, and make sure we interpret it correctly. This might look something like a discussion I recently had with my high schoolers:

What if a sophomore girl, passing one of you freshman guys in the hallway, winked on the way by? What would you think? How would you interpret her actions? What would you do about it?

Most of the guys jumped to the "clear" conclusion that she liked "me", and that they were going to ask her to the next dance or on a date.

That would probably be a correct interpretation based upon the usual thinking and actions of our American culture. However, there is also the possibility that the girl is "just kidding" and "messing around with a freshman". As cold as it may seem to us guys, there are women out there that will do that...I suppose we deserve it most of the time.

We are evaluating life with our perspective all the time! This is our worldview. It's like a map of New York City. When you are standing in that seemingly chaotic environment, it seems like a huge mess. But if you take out a city map, find out where you are and where you want to go, you will begin to see the purpose in the world around you.

The same is true for our worldview. It's like a map that makes sense of the world around us. When we correctly apply what we know, it gets us moving in a helpful direction.

The only problem is this: everyone seemingly has a different worldview. I am currently studying the three major worldviews in our world. Of course, there are many variations to these three, but every worldview seems to be connected in one way or another, to one of these three worldviews. So, if we want to engage in order to make an eternal difference in the lives of others, we need to know something about who 'they' are and what 'they' assume to be true through their perspective and worldview.

While looking at this, we will use four worldview questions to create a table for discussion on this subject. The worldview questions will be termed the "Ultimate Questions." The Ultimate Questions are:

1. Origins - How did everything get here?

2. Meaning - Why are we here?

3. Morality - What is right and wrong, and who decides?

4. Destiny - What happens when we die?

1. Naturalism

Naturalism is the idea that nature, or the physical, is all that exists. There is no supernatural, and no metaphysical. People who assert a naturalist perspective believe that all matter has always existed. Matter, in the physical world, is eternal. Just to compare, I believe that God is eternal, but a naturalist would believe that matter is eternal.

They will generally assert a belief in some evolutionary development over millions or billions of years. The story generally goes like this: About 15.5 billion years ago [it was 14 billion in 2007], all the matter in the universe was pushed together into a dot smaller than a dot on this page. [Yep, that's the theory] It was spinning super-fast, and finally exploded...this is where they get the "big bang" connection. The explosion formed all the planets and most of the stars almost immediately and the universe began expanding rapidly.

About 4.5 billion years ago, the earth was a hot molten planet. It rained on the rocks for millions of years and finally, around 3 billion years ago, in the prebiotic soup, just the right chemicals came together at just the right time to produce life. That 'simple' cell organism found something to eat and someone to 'marry' and over the course of 3 billion years, slowly mutated into every form of life we see today by random chance mutations.

Now I want to be very clear: I don't believe this stuff. There are serious and huge problems with this theory. The problems are not just with Christianity, but with sound intelligent reasoning. However, a majority of people in the Western World [of which America is] believes this in some way or another. So it is very important to understand other perspectives. Paul could only speak to those on Mars Hill in Acts 18 because he understood and could apply not only his worldview, but his hearers perspectives as well. This is how he gained such a platform with them!

But let's go back to the naturalist. There are many variations to this theory, but they all stem from the same "root" teaching. So the answer to the first ultimate question on origins for the naturalist is that everything came from natural means. There was no supernatural involved. Everything that is 'true' for the naturalist is physical, the metaphysical is not true. [Does that mean that any thoughts are not true, since thoughts in and of themselves are not physical? Haven't heard a good reply from a naturalist on that one yet, so please feel free to respond.]

Since the naturalist believes that we are nothing more than a cosmic mistake in all of this, there really is no meaning to life. Although we can come up with meaning on our own [like living for our personal pleasure, wanting more money, living for immediate gratification, etc.], there is no real meaning to life. You live, you die, and that's it.

Again, since life is just an accident, we will not be able to validate a higher standard that isn't also accidental. If my brain is just a random accident, then all the thoughts that come from it are as well. The same will be true for everyone else's ideas and thoughts, therefore, no one can form a code of morality that won't inherently be accidental in nature. Therefore, the naturalist will come up with his own code of ethics that meet his own fancy or needs. He may state that stealing is wrong, but cannot intellectually support that standard in his own worldview. He must either steal the Christian worldview for a minute, or be totally inconsistent with his as he hopes his ethics will stop others from stealing what he has worked so hard to accumulate.

Since the naturalist does not believe in the supernatural or metaphysical, then when he dies, he dies and that's it. There is no afterlife and no judgment.

You can see how these ideas could rapidly move someone down a line of chaos in their beliefs and actions. "I choose what is right and wrong" [sounds like the days of the judges when "everyone did what was right in their own eyes" - Judges 17:6; 21:25], "there is no meaning to life", and "I won't be judged"...that could lead down some very interesting paths indeed, for we know that beliefs lead to values, and people act on what they value in life. Therefore, if I have a naturalist belief, then I will have values based upon my feelings and emotions and wants, and I will act based on those, whether consistent or inconsistent.

Chew on that. Ask God to give you His eyes for other people, to understand them, but also to learn how to love them even when they are unloveable.

ESV Romans 5:8 but God shows his love for us in that while we were still sinners, Christ died for us.

Look for opportunities to ask an interesting question that will probe into the naturalist's worldview and shatter it a little, since the reasoning will not satisfy. Then always be ready to give a reason for the hope you have in Jesus Christ! For His glory. Bless you as you be salt and light. Next we will visit the transcendental worldview.