Wednesday, July 19, 2017

Healthcare Woes -Part II, Faith and Freedom

Healthcare woes- Part II, Faith and Freedom
Politically, the Affordable Care Act (Obamacare) was an easy sell.   Many people, including some people who claim to be political conservatives, felt the importance of taking care of the truly needy.   There is no question but what major health concerns deny those who suffer the fullness of life enjoyed by those in good health.   Many people in America are victims of sudden, unforeseen, catastrophic illness.   The possibility of getting an expensive operation or other medical treatment is out of the question unless they get some kind of assistance.   Nearly everyone I talked to about health insurance and healthcare (two different subjects, although many speak of them as a single, connected thought) said that compassion compelled them to support some kind national healthcare program.

One thing that muddied the waters when discussing the Affordable Care Act (ACA) was that people with “pre-existing conditions” were unable to obtain health insurance.  That is because insurance is pre-payment by many people for potential risks that any of them might fall victim to at some later time.    Insurance is “risk allocation”.   Nationally, we lost clarity when politicians and media lumped healthcare and health insurance into the same cauldron and stirred it until the ACA was produced. Conservatives, and others who understood the distinction, were drowned out in the debates. The media refused to perform the vital function of reporting truth, and stead became cheerleaders for the Obama administration.   The hue and cry went up that no nation as wealthy as the U.S. should at the same time be so lacking in compassion as to deny persons the “right” to basic healthcare.  To bolster their argument, the politicians and the complicit media constantly raised the specter of the poor family who were unable to pay for necessary medical procedures because they had no insurance, or their insurance did not cover “pre-existing conditions”.   Again, insurance is an allocation of risk spread amongst many people who might suffer from a specified malady at some point in the future.   The premiums are determined based upon statistical probabilities that most of the subscribers would NOT be afflicted, and therefore the insurance money would be able to cover the cost of those few who DID become afflicted. If someone want “insurance” for a “pre-existing” condition, it is not really “insurance” they are seeking, but rather it is help paying for medical expenses.   These are two different concepts requiring two different tactics. 
As discussed in Part I, the most abused aspect of the current healthcare conundrum is the systematic use of emergency department (ED) resources for NON emergent conditions.  By misusing and abusing the system, there are strains placed upon the system which threaten to render it incapable of performing in a “real” emergency.  Likewise, when the insurance system (based upon risk allocation for future events based upon statistical probabilities of occurrence) is required to pay for medical expenses for people who already have a condition then insurance premiums will skyrocket as those costs now must be borne by everybody. Then, it is not “insurance” at all, but publicly funded healthcare.   In Part I described how the hospitals and Emergency Services providers are not permitted to exercise much professional discretion because if they want to get reimbursed for expenses, they must pay more attention to “patient satisfaction surveys” than to actual, medically necessary testing and treatment. It is a blatant overreach of government to dictate to doctors who, or how, or to what degree, or by what standards, a patient should be treated.
Any overreach of government should be a concern for every citizen. Compassion notwithstanding, a government that can coerce a person (or institution) to provide a commodity or a service to someone else without compensation is clearly outside of the scope of limited government envisioned and establish by our Founders.  American government is created with limited power, for express purposes (see: Art I, Sec. 8, U.S. Constitution).  As noted previously, ANY function of government that lies outside of those strict limitations, no matter how much it may appreciated by a large segment of society, is de facto, illegitimate.  Even if a politically motivated simple majority of the Supreme Court finds some way to twist it otherwise, the ACA is clearly outside of the scope of government considered by founders to be “legitimate”.  

Among the reasons for keeping government limited was to preserve the highest possible degree of individual liberty while achieving the highest degree (on balance) of social order.   These two (order and liberty) will always be in tension and the increase of one will diminish the other.  Balance is both delicate, and dynamic.

One aspect of liberty is that every person has a fundamental right to their own property.  Chief among private property is the product (or fruit) of one’s own labor.  Originally, it was held that no one, not even government had authority to reach into a man’s pocket to take what he had earned by the sweat of his own brow.
A corollary to that principle is that man’s right to the creation of his own wealth may not be used to fund government without express authority to do so, for such a “taking” would be considered theft.  The necessary functions of government were expected to be funded mostly by “…collect[ing] Taxes, Duties, Imposts and Excises.” (Art I, Sec 8, U.S. Constitution)
“The Taxing and Spending Clause (which contains provisions known as the General Welfare Clause and the Uniformity Clause), Article I, Section 8, Clause 1 of the United States Constitution, grants the federal government of the United States its power of taxation. While authorizing Congress to levy taxes, this clause permits the levying of taxes for two purposes only: to pay the debts of the United States, and to provide for the common defense and general welfare of the United States. Taken together, these purposes have traditionally been held to imply and to constitute the federal government's taxing and spending power.” (Wikipedia)
“The Appropriations Clause provides Congress with a mechanism to control or to limit spending by the federal government. The Framers chose the particular language of limitation, not authorization, for the first part of the clause and placed it in Section 9 of Article I, along with other restrictions on governmental actions to limit, most notably, executive action.” (
In The Federalist No. 58, James Madison described the principle means by which the people would control government:
The House of Representatives cannot only refuse, but they alone can propose the supplies requisite for the support of the government. They, in a word, hold the purse—that powerful instrument by which we behold, in the history of the British Constitution, an infant and humble representation of the people gradually enlarging the sphere of its activity and importance, and finally reducing, as far as it seems to have wished, all the overgrown prerogatives of the other branches of government. This power over the purse may, in fact, be regarded as the most complete and effectual weapon with which any constitution can arm the immediate representatives of the people, for obtaining a redress of every grievance, and for carrying into effect every just and salutary measure.

Originally, and for many years in the early days of the Republic, the people actually seemed to wield considerably more influence over their representatives than we see today. We (the people) control government, by keeping control of our wealth- that which we have created as a result of our own efforts and initiatives.

Christians, well-meaning but constitutionally and Biblically ignorant, often recite Bible verses commanding giving and promoting charity.  It is true that the Church of Jesus Christ is to minister to the needy in our midst.  It is the mission of the church to be ministers of the grace of God. But Christians err when they entrust the ministry of the church to the civil government.   According to Romans 13: 1-7 the mission of civil government is to be the minister of justice.   When the government becomes the minister of grace (the church’s job) we get bloated government, out of control programs and spending, welfare fraud, medical fraud and abuse, etc.    Likewise, when the church tries to assume the role of minister of justice (government’s job) then we get witch trials, and inquisitions.   Each entity has its own proper sphere of authority.   I always wonder how it is that those who advocate for “separation of church and state” nevertheless, strongly advocate for government control of weddings, schools, medicine,  and other “ministries” typically associated with the church.
We certainly have been blessed as a nation with a level of national prosperity unrivaled in modern times.   With that blessing of abundance and wealth we certainly should, on a personal level, reach out to those who are genuinely needy.  We have an excellent opportunity to let our compassion reach the very ones who need it the most.  But this always remains a ministry of the individual and the church, and NOT the civil government.   In the early to mid-2000’s the “compassionate conservatives,” Republicans bloated government, nearly doubling the debt the nation had previously taken over two centuries to accumulate. Compassion is laudable, but always subject to rational constraints.  It is imprudent to be so compassionate that you endanger yourself, as when a person who cannot swim jumps into the deep water to save another from drowning.  Compassion will kill them both.
Thus, well-intentioned Christians argue that we are fulfilling our Christian service when we get behind government programs to help the poor and the needy.  But this is NOT the teaching of Jesus.  Support for government charity programs cannot be found in the Bible except in the context where government and church are a single entity.  THAT is a condition that many Americans, ALL atheists, and even most conservatives find dangerous and undesirable.   Most agree in some kind of “separation” of church and state although not in the same ways nor for the same reasons.  Still, when the church is the minister of God’s grace and the Civil government is the minister of God’s justice, it seems to satisfy the outcomes that most citizens desire. 

The Bible is consistently clear that it is the CHURCH that minsters to the needy.  It is individual Christians who are to give out of the abundance wherewith they have been blessed.  It is the “cheerful heart” of the believer that honors God and releases His blessings.  In the same vein, it is God who places Himself in the position of our savior, provider, protector and sustainer.    When we establish government in the place of God, we are creating our own god and making him in our own image.  Government becomes our idol and the object of our worship.   “Thou shalt have no other gods before me…” (Ex 20:3-5) When we place our faith in government, we diminish our faith in God and His provision.  When our conduct and our allegiance and our trust is in something other than God, we are in a dangerous place.  “That which is not of faith is sin” (Ro 14:23)
There is another danger, an immediate yet politically  catastrophic danger that comes from allowing government to occupy the place of god in our culture.  It is from God that we understand fundamental truths about human nature and how to conduct our relationships.  It is in the context of our identity in God through Christ that we understand our rights as they pertain to individual liberty and social order.  We (Christians) rely upon God’s Word to reveal to us how we are to conduct ourselves in civil society and from that, that our civil liberties are defined.  When government defines or redefines those liberties then our form of government is threatened as well as the fundamental tenets of our faith, upon which our notions of civil government are derived.
When discussing “health care” most people immediately think of physical conditions, usually those that can be aided by some medical intervention (i.e. surgery, chemo treatment, etc.) In nearly every discussion I have had with advocates of national health care, I am reminded of anecdotal stories of some poor person or family that was devastate by a catastrophic illness and unable to access the medical treatment necessary.  Thus, it is argued, it is unconscionable for a wealthy nation which places such a high value on the right of every individual to enjoy “life, liberty, and the pursuit of happiness”, to deny that person the very treatment necessary to protect that right.   Such an argument is not only contrary to Scripture but also to the very heart of the Constitution and historic notions of liberty.
Remember (those readers who are genuinely old)  when the Roe V. Wade decision came out and the popular defense was that the “right” to an abortion was in the interest of the “health of the mother”.   (Few people then openly argued that abortion would be used a birth control).   But there, as now, “health” was  usually considered a physical criteria.  Almost immediately, however, “health of the mother” was expanded to include “mental” health, “emotional” health, “economic” health, etc.  ANYTHING that might have any impact on the mother’s life was deemed permissible.   Then, in the case of Planned Parenthood v. Casey (1992) the Supreme Court ruled that anything that might interfere with the mother’s choice, regardless of reason, would henceforth be “unconstitutional”.  
Take that concept and apply it “healthcare”.   Let the government decide for us what is a “health” issue.  What we may eat?  Check.   Whether we may have a gun in the house? Check.  What sex we may choose to pretend that we are?  Check  What activities may be deemed to be safe enough for us? Check.  Once government decides that something is a “health” issue, it must be covered because it is now a (government-created) “right” and as such, it is now a DUTY for everybody else to foot the bill.   Remember a little bit ago when I described how it was considered a sacred right of the individual to KEEP their wealth.   Remember how I pointed out that the balance of power and the control of government was always intended to remain in the hands of the people?  But now, people who KNOW that obesity, and drug addiction, and foolish choices are SOLELY the responsibility of individual who “owns” that issue, are nevertheless being coerced into paying the medical costs even when there is NO accountability or requirement for the “patient” to modify their own behavior.  So, people who make bad choices may continue to engage in their destructive lifestyles, and use the hospital ER to get their pain drugs, at NO expense to them because productive, prudent people are being forced to cover the costs.   This is all defended by liberals who argue that “we” (all) must be forced to show compassion, and NOT to require accountability, because the liberals (well-meaning but ignorant, and/or foolish) believe that it is a “right” for every citizen to have “health”.  In support of this, the liberals will tell stories of “that poor family “ even though statistically, those who are having the most impact on the health care system are the 50%- 90% who are using the emergency room as their “primary care” doctor.

In part I, I showed how there is no legal duty for government to be in the business of providing health insurance, and that government intervention into health care has created bureaucratic boondoggle of massive inefficiency, fraud and waste. In part II I show how national healthcare, and national health insurance are two different animals and require two different discussions and perhaps many different approaches to solve the problems.  I also show how arguments made in defense of national health care and insurance are NOT supported by Scripture, and further, that they violate basic principles of individual liberty and responsibility, and therefore are inconsistent with the U.S. Constitution. I further make the case that government coercion for this or any other similar well-intentioned “ministry” violates notions of separation of church and state, and threatens our fundamental liberties.
Any portion of this paper may be cited with proper attribution.
John A. Sterling, MA, JD
July 19,2017

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