Monday, June 4, 2012

Liberty, Healthcare, Choice

I have found the debate around religious liberty, insurance, and contraception to be rather interesting.  That is about my only word for it.  Despite all the talk around it, it has been a rather content free debate.  This has mostly been because activists have been dominating the debate.  These activists aren't educated on the issues involved.  I realize that comes across as elitist, and I'm afraid that is the extent of my apology for it.

There are two approaches to solving any problem.  One approach is the top down approach.  In this approach, existing systems are examined and adjustments are prejudiced over inventions in the decision matrix.  An example of this was the health care reform act.  The existing system was basically retained and it was used to come up with the policy solution.  There are of course faults to be had with this approach.  In health care, I think a detriment to policy was the retention of the employer in the health care relationship.  An employer interest in the health care choices of employees has been alleged and legitimatized by the USCCB when nothing more than a fiduciary interest has been shown.  The argument has been allowed to persist despite no showing of an interest beyond the fiduciary.  Allegedly this is the product of our best and brightest moral theologians.  Never mind that holding the supposition that a fiduciary interest is enough to establish a moral claim would mean that the rich and powerful would be allowed to accumulate greater power under the guise of righteousness.

The other approach to solving problems is the bottom up approach.  This has been taken most often by Catholic bloggers and seems to be preferred by third way people in general.  Over the past couple of years I have come to take a dim view to this approach.  For starters, it seems to be preferred merely so that people can pose for holy pictures, knowing that their 'solution' will never be adopted.  If that is the way the game is going to be played, I propose we ordain unicorns to treat all the health care issues in this country and pay for it with fairy dust.  Logically there really is no reason to treat my proposal as less serious than these bottom up crack pot theories.  A solution that can't or won't be implemented isn't a solution; it is posturing.  That is not to say that bottom up approaches should entirely be rejected.  However, the prerequisite of a bottom up solution is that everyone has to agree that the status quo is unacceptable.  Everyone must agree that regardless of the final form of the solution, one must be moved forward upon.  That is why in practice bottom up solutions are nearly impossible to implement.  That is why one of the easiest ways to oppose a project without having to formally oppose it is to demand a bottom up solution.

Personally, I would have supported the adoption of a single payer health care system.  Seeing the difficulty of passing what little was passed with the reform act, I'm personally satisfied that the choices and compromises sought in achieving the act were both necessary and prudent.  While I don't believe there is a strong case to be made for a social obligation for contraceptives, I don't believe their subsidy rises to the level of grave social harm that requires repudiation of the gains made.  For those sincerely opposed but supportive of the dignity that health care provides people, I think repudiation is akin to opposing vegetarianism due to the field mice killed by the machinery that picks the grain.  For those using it as a trojan horse, I find you contemptible.

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