Health Care Reform

A few thoughts on the proposed reform of health care. American bishops' criticism of it has mostly focused on the unborn and on conscience. But though I have not myself studied the document at length, I have heard from reliable persons that the proposal is unsound, even rotten, from beginning to end.

A few articles have been written critiquing the proposal from the point of view of the Catholic principle of subsidiarity. See this article by Bosnich and this one by De Vous. The principle of subsidiarity means, basically, that decisions and actions should be made by the persons most directly concerned, unless this is impossible. The principle of subsidiarity does not of itself exclude the managing of the overall financing of health care at the highest level. However, it does require that decisions be left up to the individuals in need of health care and who provide it (doctors and hospitals). A couple of examples: (1) The possibility of choosing other means of financing, e.g., should be left open. If the health care system is on the broad level financed by taxes, people should be given the possibility of financing their health care by other means–e.g., through private insurance, or from their own income–and be proportionately freed from the taxes that finance health care. (2) Patients and the doctors who treat them should be able to make the decisions relevant to the health care. This is thoroughly violated by the proposal, which aims directly, or indirectly through monetary sanctions, at reducing the decision-making power of individuals, doctors, and hospitals, and increasing the power of the bureaucratic administration.

Many other criticisms (rationing of healthcare, the requirement for end-of-life counseling) build upon or follow from this basic problem of the government taking over too much responsibility for decisions that should be made at an individual level. If, e.g., co-payments are reduced to such an extent that patients have little financial reason to refrain from treatments that are not really necessary, and yet financial considerations must be taken into account, then they will have to be taken into account, and the decisions made by others. This is practically an unavoidable consequence of the top-down approach that is determined to provide health-care for all, but which does not in fact have unlimited resources. In principle a much better approach would be to have those who can finance their own health care do so, and to provide it for those who cannot by way of non-profit institutions, individual assistance, etc.

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