Friday, November 13, 2009

Semantics

Before I get to the meat of this post, I just want to share a little aside: when somebody at work recently said, "It's all about semantics," one of his co-workers replied (jokingly, mercifully): "What do you have against Jewish people?!" But I digress.

MM and I had a good conversation recently. I know - husbands and wives aren't supposed to do that - but it occasionally happens around here. I told her that I've really struggled with wrapping my mind around this, and I certainly don't agree with how this idea has translated into legislation in Washington, but I do agree with the basic premise that (as our own Archbishop Chaput phrased it), "The Church regards access to basic health-care services as a right, not a privilege."

I said that I knew everyone already had the right to emergency medical care, but that I knew of a person in our town who had tried to kill himself because he was diagnosed with cancer and couldn't pay for chemo treatments, and it made me think of loved ones who have gone through that struggle or similar ones. Emergency rooms don't offer treatments for leukemia or multiple sclerosis, after all.

MM responded that, for all intents and purposes, government-run health care wouldn't either. Especially in the case of someone whose "best days are behind him or her," the treatment for MS would probably amount to pain meds and a wheelchair. And if you were lucky enough to get chemo or other more aggressive treatments for cancer, the delay in treatment would probably render them meaningless.

Then she said something that I thought was fairly profound. "Maybe," she said, "we can agree that everyone ought to have health care when they need it, but I'd rather not call it a right. If we think of it as a right or 'an entitlement,' we expect it to come from somewhere else - such as the government. If we think of it as an obligation that we have to those who can't afford it, then maybe we end up in the same place, but we get there in a whole different way."

We have something of a model for this way of thinking in our town. There is a fairly small Hispanic community here, and they do a very admirable job of looking out for one another. There are frequently Mexican food buffets to raise money to help with a family whose father needs dialysis treatments, or another who has a young child with cancer. I don't know what kind of dent these make in medical bills, but they serve as a great example for the rest of the community - and provide some hope and reassurance that someone cares whether you live or die, which the person I told MM about apparently did not have.

The whole system of Knights of Columbus life insurance actually started in pretty much the same way. Catholic immigrants to America in the 19th Century frequently held dangerous and poorly-paying jobs, and this often left widows and orphans who today would probably become essentially "wards of the state." But back then, a group of visionary men led by Fr. Michael McGivney decided that it was their obligation to provide a way for Catholic men to give their wives and children some level of support in the event of a death in the family. This did not presume that the government would "take care of them," it was a solution that they could implement on the local level through cooperation.

This is the essence of another principle cited by at least some of the Catholic bishops in regards to the healthcare debate: namely, "subsidiarity." Our Sunday Visitor recently ran an article weighing the two, possibly competing, ideas that people have a right to health care, yet we should strive to
"respect the inherent dignity and freedom of the individual by never doing for others what they can do for themselves and thus enabling individuals to have the most possible discretion in the affairs of their lives," in the words of the bishops of KC, K and KC, MO.

So, this might be a good starting point. I think MM and I are both right to some degree on this: however you want to say it, people do have a right to medical treatment (as far as I'm concerned); at the same time, we would be foolish to expect this right to be fulfilled by the government. I don't think bake sales and buffets are ultimately going to make a huge impact (at least financially) on people's health expenses, and I do think there are places where government could improve the insurance system (such as limiting tort awards and allowing nationwide competition between companies), but MM's point is essential: we need to start with the assumption that we are responsible for meeting the needs of one another in our community.

From there, we "just" need to find the Fr. McGivneys of our time: people who will develop creative ways of addressing an identified problem, without expecting the nanny state to do it for us. Again, quoting Archbishop Chaput (as cited in the OSV article mentioned above),
"Real healthcare reform need not automatically translate into federal programming."

2 comments:

The Red State Ranger said...

First, subsidiarity rocks.

Second, speaking of semantics, where you run into trouble using the word "right" with respect to medical care, and what I think MM was getting at, is in skipping the distinction between positive and negative rights. Most traditional American rights have been negative: I have a right for the Government not to restrict my speech or my ability to keep and bear arms. More modern interpretations of the word and assertions of rights have been positive rights: I have a right for the Government to give me an attorney.

Similarly, with regard to health care, we tend to frame that right in the modern, positive sense of the right. In doing so, however, I fear we run the risk of allowing and even encouraging the government to interfere individual's negative right to health care: The right to attain needed health care without government interference.

Indeed, in placing government bureaucracy at every level of health care, we are all but guaranteeing that we will no longer have that negative right to obtain the health care we need without interference, despite obtaining the positive right to have whatever health care we can get paid for, paid for.

It becomes a question of which right we prefer, the positive or negative. It seems to me that is a direct result on which threat we fear: being unable to pay for medical care or having our medical decisions made for us by a bureaucracy.

Interestingly, one is a material concern, while the other is a personal concern. Make of that what you will, lilies and all.

As for a solution, I wholeheartedly agree with the points you raise. First of all, from a Constitutional stand point, the only thing Congress is truly authorized to do in this case (regulate interstate commerce, in this case interstate insurance restrictions) is the one thing Congress is not doing. Why the heck not?

Perhaps more importantly, however, is your first point: No one is standing up to accept that obligation to support the material needs of others. Someone besides the government needs to support that effort, from a moral, ethical, and monetary stand point. Sadly, it seems the US Catholic Bishops even prefer the government solution, so long as it doesn't pay for abortion. Then who will do it? We're running out of options that don't start at Speaker Pelosi's podium.

Elizzabelly said...

To follow up on the Red State Ranger's comments (which are very well-thought out as usual): right now, if we are unable to pay for medical care, the government actually pays for it, and pays a darn sight better than health insurance, truthfully.

Also, it is very easy to logically discuss health care insurance options when you have a job that provides health care coverage. It is a much more desperate and fearful topic when you don't have group health insurance through an employer, and you have a veeeeeeery expensive condition. Just sayin'.