Essential--And Unasked--Healthcare Questions

Despite all the talk about the Affordable Care Act, two questions essential to the debate go largely unasked and ignored.  They are the following:

• Who pays for the cost of healthcare?  For example, if someone obtains an emergency hospital service but doesn't pay for it, who covers the cost?  Moreover, when people declare bankruptcy in order to avoid accumulated medical expenses, who pays for that?  Do hospitals eat the difference?  Not really.  The costs become components of the overhead hospitals pass on to paying consumers.  For county-owned hospitals that offer below-cost services, taxpayers cover deficiencies.  In other words, paying consumers not only foot their own healthcare bills, but they cover the costs of non-paying patients, too.  This is an example of what is called the "freeloader" problem in economics and it's a cost that is borne by society, because when it comes to emergency medical services, our morality informs us that we must help first and ask for payment later.  Quite often, however, the freeloaders described here are people who simply couldn't get insurance or lost the coverage they once had.  These situations occur due to job loss or development of pre-existing conditions, which leads me to my second question.
• Do we want everyone who desires coverage to be able to obtain health insurance, including people with pre-existing conditions?  If that's what you believe, you have no option but to support an individual mandate requiring everyone to be insured.  Do you see why?  The fact is in a situation where everyone can choose if and when they obtain health insurance, rational consumers--and most of us are rational when it comes to money--won't get covered until after being diagnosed with a serious illness!  In other words, we'll avoid the need to make premium payments until we're sick and have reason to file for benefits.  In the insurance world this is known as an extreme case of adverse selection and it's terribly problematic.  In fact, insurance wouldn't work in the situation just described.  That's because premiums would be prohibitively expensive since only high-risk individuals would seek coverage.  

So let me summarize what I've just said: If you want everyone to have access to health insurance, you must support the necessity that everyone be required to obtain coverage.  The alternative is to say it's too bad, but people with pre-existing conditions shouldn't expect the benefit of health insurance.  While heartless, it's a legitimate position, but as I've said above, to the extent that our morality informs us that we must provide emergency treatment to the uninsured, the associated costs are borne by society--namely taxpayers or those who pay for their own healthcare--anyway.  Withholding care and letting people die is also an alternative, but tell that to a baby born with a life-threatening, but reparable, heart condition.  

So what's my point?

If you're opposed to the individual mandate in the Affordable Care Act, you're supporting an environment in which only the healthy get insured.  In such a case, we either let people with pre-existing conditions flounder, or we help them and cover their costs of care by paying higher hospital bills.  Doesn't it make more sense to ask everyone to obtain coverage up front and ask everyone to pay a portion of the cost of care?  It not only makes sense from a societal benefit perspective,  but the law of large numbers allows us to better mange risks as well.

Faith Waits

Life isn't fair, which is arguably an implication of believing in a God who defines what is fair, is powerful enough to destroy all that’s unfair, but allows the most virulent incarnations of unfairness to flourish anyway.

Ah, you say, but that’s just the problem of pain, a conundrum of faith you’ve already contemplated to your satisfaction. Some people—perhaps you included—resolve the paradox by saying God is infinitely wise and knows that goodness is possible only in the presence of its opposite. How can anyone, for instance, be judged righteous, who hasn’t recognized and overcome evil? To this you might add another, supremely comforting, idea: While mortality is pain-filled and subject to corruption, it’s but a blink of an eye compared to the eternal reward that awaits the just. Fairness will come in the hereafter.

But do you see the problem with that notion? I’m not referring to the inexplicable narrative of how God creates a world and populates it with children He loves, only to watch them kill and brutalize each other. Rather, I speak of the license it gives the living to do likewise, to simply witness the evil and say: “Thank God, for the pain is only for a moment and He will right these wrongs.” This shining article of faith serves as a salve on the conscience and a boast to all who hear it, but it’s also an excuse to do nothing. The living could mitigate life’s unfairness, but too many abide by a tainted premise: While shit rains, I can wait for God’s will to manifest itself, there’s no need for an umbrella.

And so faith waits.

We pray for peace—just like we pray for the hungry, the naked and the sick—but rarely do we become the miracles we seek. Help for the displaced pales beside the wars, pogroms, class boundaries and other weapons of alienation that displace even more. All the while our faith waits for the end times, or a miracle, or some other divine response to prayer’s equivalent of kicking the ball into God’s court.  I would rather we had no faith in a hereafter at all and worked to bring heaven here.  Maybe our world would be more caring and sharing then.

An Embarrassing Admission

I'm going to out myself.  Here goes.

Before I moved from California last year, I was a registered Republican.  (There, it took a lot for me to admit that--the embarrassment is overwhelming).  Now that I live in Wisconsin, I'm not required to state my political affiliation, but if it were necessary, I wouldn't do so as a Republican--not anymore.  The party, in short, abandoned me a long time ago.

I'd been wondering how to best describe my feelings of abandonment, when I saw a scene in an episode of HBO's Newsroom that resonated with me.  In this scene, a news anchor for a fictional cable news program justifies his identity as a Republican after making several disparaging remarks about the party.  This is what he says:

I call myself a Republican because I am one.  I believe in market solutions.  And I believe in common sense realities and the necessity to defend ourselves against a dangerous world and that's about it.   

The problem is now I have to be homophobic.  I have to count the number of times people go to church.  I have to deny facts and think scientific research is a long con.  I have to think poor people are getting a sweet ride.  And I have to have such a stunning inferiority complex that I fear education and intellect in the 21st century.  Now most of all, the biggest new requirement--really the only requirement--is that I have to hate democrats.

Amen!

I cannot align myself to this new breed of Republicanism that claims to be Christian, but battles efforts to feed the hungry and care for the sick.  I reject its assertions that science is trying to deceive the populace and that we have no obligation to heal the planet because God will fix our problems.  I'm tired of how the party works to dismantle voting and women's rights that stood as bold lines against hatred and bigotry.  I'm sickened by its depictions of the poor as lazy and its solutions that disproportionately benefit the rich.  Most of all, I'm disheartened by its apologetic worldview that rejects fact and reason in search of ways to justify its intolerance.

Great Idea: Let's Arm Schools

After the shooting at Sandy Hook Elementary, one of the solutions many gun advocates offered to solve the problem of mass killings was to post armed security guards at schools.  In the wake of the most recent shooting in our nation's capitol, it's clear that this is far from a reasonable solution to the problem. 

Facts regarding the tragedy continue to emerge, but two widely reported pieces of information should be noted: 

• At least one of the twelve who died was an armed security officer
• The gunman apparently used two firearms that he took from his victims to continue the rampage

Ignoring the cost of the solution, which would be problematic given already stretched budgets, do we make our public places safer by putting them under the protection of armed security?  I doubt it.  The Navy Yard was apparently heavily armed and guns were in the possession of people whom I imagine were well trained.  Yet, some of the weapons appear to have become tools used to murder more innocent victims.  I shudder at the thought of the accidents and deadly crossfire that will occur if schools are similarly armed. 

For information about the most recent shooting, go to this link. 

The Doubt Essential to Faith

When I was a young Mormon missionary, I was intrigued by a dialogue that I would hear regularly during one of the lessons we taught investigators.  The lesson was entitled, The Plan of Salvation, and one of the first tenants it covered was our reasons for being born into mortality. According to Mormon theology, there are two grand purposes for our lives here on earth: 1) To gain a body and 2) To learn to walk by faith.  In combination, the two conditions allow us to be tested.  Regarding the second purpose, my missionary companion and I were very quick to point out that faith is not a perfect knowledge.  Humans, we taught, were caused to forget their pre-mortal existence with God, so that faith was not only possible, but that uncertainty would become an ingredient of their lives.  

Now, here's the interesting part of the story.  No sooner would we cover this concept than my companion would say with the greatest conviction: "I bear you my testimony that I know these things are true."  And he would repeat the same mantra, time and time again, after relating new theological concepts.  Was my companion a bit nutty?  Of course not, because that's exactly what our lesson plan taught us to say, but do you see the irony in this?  We were essentially saying: Faith isn't a perfect knowledge, but we can know that it's a necessary part of our existence and that all aspects of Mormon theology are true.  

As I've pointed out before, the fundamentalist's dogmatic and unshakable boast that he knows God's will on a matter disregards the fact that faith has far more to do with uncertainty than knowledge of what is true.  Yet, Christians deem uncertainty as a kind of failing and a sin.  When I tell my Mormon friends that I've become agnostic to everything that the church teaches, except for the most fundamental of Christ's commandments that we're to love each other, they believe I've committed some horrible wrong that keeps me from true communion with God.  I would know otherwise, they say, if I'd only humble myself and pray with real intent.  

I've done that, of course.  For decades there was nothing more important to me than to one day know that the church was true, but God answered my pleas in a way that surprised me.  The fact is, if we harbor no doubts about Noah and his ark, or if we stick to literal readings of Genesis, then we relegate Christian culture to a scientific backwater that fears facts and learning.  We might as well read chicken entrails for the value it provides.  

Press this link for a wonderful TED speech given by Lesley Hazleton, who has apparently been doing a lot of thinking on this topic.