Healthcare, Religious Freedom & Coercion

Over Thanksgiving weekend, I got into a conversation about Hobby Lobby with my father-in-law. The basic point being that the Hobby Lobby owners object to providing the morning-after pill in their employee healthcare package. For more details on the case and context, read here:

This is a big issue, touching on a number of important themes–healthcare, faith in the public sphere, employee rights, religious freedom, and government authority, to name a few.

From the outset I should say that I am personally opposed to the linkage between healthcare and one’s employer. From my HR grad class, I know the broad strokes of this history and rationale (here & here), but it does not serve us well today. I do not believe healthcare costs should be a business expense, and I don’t think it wise for people to get this particular type of insurance through their place of work. But that’s another issue deserving its own blog post. 🙂

So given that (a) I disagree with the situation that presents the problem in the first place, and (b) I am a Christian writing from a certain (there is more than one) Christian perspective, let’s move to a consideration of just two of the issues that are before us. First, there is the question of business operation in a pluralist society. Where is the balance between owners’ and workers’ rights?

I will not solve this, but will only point out that this healthcare conversation is one of many on this issue of rights. We will never settle on just where the sweet-spot is, so while we attempt to locate it, let us come to some measure of acceptance of the fact that we never will come to a final conclusion. Should owners be allowed to pay their workers whatever they desire? As a society we decided no, and put this into law by prescribing a minimum wage. Should owners be able to fire whomever they wish? As a society we decided no, and put this into laws on wrongful termination or dismissal. Should owners determine the type of healthcare their employees receive? This is now under consideration. Should owners who are Jehovah’s Witnesses be free to offer insurance that does not cover surgeries since these procedures require blood transfusions? Where is the line? Libertarians argue that this should be granted, and prospective employees are free to apply to or avoid the establishment. Others argue that employees should have the freedom to get the same coverage from any business that is not directly church-owned or operated. This is an interesting question that will have its day in court.

Secondly, I want to address the issue of government coercion. This is a significant question for Christians. Three portions of scripture often come up in this context, and all three should be noted here.

1) “And they sent their disciples to Him, along with the Herodians, saying, ‘Teacher, we know that You are truthful and teach the way of God in truth, and defer to no one; for You are not partial to any. 17 Tell us then, what do You think? Is it lawful to give a poll-tax to Caesar, or not?’ 18 But Jesus perceived their malice, and said, ‘Why are you testing Me, you hypocrites? 19 Show Me the coin used for the poll-tax.’ And they brought Him a denarius. 20 And He said to them, ‘Whose likeness and inscription is this?’ 21 They said to Him, ‘Caesar’s.’ Then He said to them, ‘Then render to Caesar the things that are Caesar’s; and to God the things that are God’s.’” (Matt. 22:16-21, NASB, Biblegateway.com).

We see Jesus limiting what is Caesar’s, and yet acknowledging that taxes are due him. The state can coerce taxation. At exorbitant amounts. For highly immoral actions. In the book Less Than Two Dollars a Day, Kent Van Til states that

it is clear that the government does have the authority to coerce. It coerces me to pay taxes, to drive responsibly, to support public education, and so forth. It even coerces me to help finance things that many believe are evil–such as fighting unprovoked wars, aborting unborn children, and building anti-ballistic missile systems that don’t work. (p. 155)

The mention of war is especially relevant for me. Whatever disdain the owner of Hobby Lobby has against the morning- or week-after pill, it is matched by my disapproval of much that is done by the CIA and the US military, both of which I have been coerced into funding for years through my taxes. When will Christians feel as much outrage for violence done in their names through the School of the Americas/WHINSEC as they do from the morning-after pill? Do we not know what has been done or do we just not care? Mr. Green, I encourage you to learn more about your military and CIA (start with Smedley Butler to see this is nothing new). Maybe you can add them to your letter.

2) “Every person is to be in subjection to the governing authorities. For there is no authority except from God, and those which exist are established by God.” (Rom. 13:1)

The best commentary on this that I’ve read is the chapter on the topic in John Howard Yoder’s The Politics of Jesus (see #6). Basically, Yoder explains that “subjection to” is not equivalent to “obey.” We obey as far as we morally can, and then we refuse to do evil, taking the punishment for our just actions.

Where is this line that we will not cross? That is a great debate. As is shown from the verse above, coercion by the state to pay even for immoral activities is within the line. That is, the Roman government used the taxes Jesus sanctioned to pay for all kinds of things a Jew or Christian would not approach.

3) “But Peter and the apostles answered, ‘We must obey God rather than men.'” (Acts 5:29)

This is sanction for refusing to obey the government’s dictates when they call us to do things that are directly opposed to God’s word. Again, in relation to verse #1, this does not include taxes. Those who demand and use taxes will be accountable for those actions.

Summary: None of this is simple. However, in general terms we see that we are called to pay taxes even for “bad” things, that we are to be subject to authorities, and that we are to obey God rather than men when the two call us to directly perform different actions (taxes excluded).

As I stated at the beginning, I wish no company in the US had to deal with healthcare, but since that is how our society is currently structured, I do not see a biblical basis for refusing to make a payment coerced by the US government simply because I disagree with it. It is fully Mr. Green’s right to advocate for a changed law; however, I don’t believe he can make a biblical argument against paying the tax if the law does not change.

Your thoughts and reactions?

NOTE: A follow-up post will cover more from Alan Kreider, Ellen White & Jesus.

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>Even more random links.

Articles, Organizations & Websites:

Films & Videos:

>Saturday Potpourri

>Two sets of randomness today:

First, this past week in Peace Colloquium, we were introduced to the following resources:

Second, these random articles interest me:

>Health Care Reform — U.S. Style

>Health care is in the news as both houses of Congress are working on ideas.

Previously, I have written these posts on the topic here and at another blog:

Now I direct your attention to a few newer articles by variety of authors:

And some older articles:

>Health Care

>Two stories on health care today:

1. Daschle to lead effort to overhaul health care (Robert Pear, International Herald Tribune, 12 Dec ’08)

Will he be able to do any more than the reformers before him? Maybe if we support the efforts. Talk to your representatives. Let your local leaders know this is wanted by the populace.

2. Mugabe is a ‘modern-day Hitler’ (BBC.com, 12 Dec ’08)

That’s quite a claim or accusation. Supportable? And at what point is it a truly failed state? Aren’t we getting pretty close with 11.2 million percent inflation (CNN) and a cholera outbreak along with the previously crises?!

And why did I include an article about Mugabe under the heading “Health Care”? Compare these statements made in the same week (day?):

WHO: “The World Health Organization says the outbreak has not been contained and the death toll has increased to 792 people, reports the AFP news agency.”

“The WHO has warned that the total number of cases could reach 60,000 unless the epidemic was stopped.”

Mugabe: “‘I am happy to say our doctors are being assisted by others and the WHO [World Health Organization] have now arrested cholera.'”

>U.S. Federal Budget Proposal

>I have shared the questions I would like to ask the current round of presidential hopefuls. These questions reveal my priorities. The 2009 budget proposed by President Bush reveals his.

Why is this on a blog about justice? I do not believe it is right to spend $650 billion on defense, more than the next 168 countries combined, while we continue to fail to support the Millenium Development Goals with our repeatedly promised .7% of GDP (.15% currently). We have the opportunity to help over a billion people gain access to food, water and housing, but instead we build tanks, missiles and machine guns. Are we any different from the Rich Man who neglected Lazarus (Luke 16:19-31)?

Thumbs Up

  • Increases for abstinence education, Pell Grants for college students from low-income families and grants to school districts.
  • Almost $20 billion increase in State Children’s Health Insurance Program over the next five years, still falling short of plans passed twice by Congress.
  • 10.3 percent increase (total of $22.7 billion) in foreign aid with increases for HIV/AIDS programs, anti-drug and -crime programs, development aid, and security packages. Some of these proposals are not my foreign aid priorities, and this is still FAR short of the .7% of GDP we have promised for meeting the Millenium Development Goals (The End of Poverty).


Thumbs Down

  • Additional $36 billion for defense, an increase of 8% to over $650 billion. This does not include additional funding ($70 billion) for the Iraq war. Read more about U.S. expenditures on the military here–military budget, world military spending, countries and military expenditures.
  • $18.2 billion cut in Medicaid, nation’s single largest payer of children’s health care for working families.
  • $700 million cut from discretionary health programs that children depend on, ranging from poison control hotlines to funding for training children’s doctors.
  • Eliminates $283 million federal program to help make homes more energy efficient. Cuts energy aid to poor households by $500 million, a 22 percent drop.
  • Over $400 billion budget deficit.

It will be interesting to watch how the debate over the budget progresses. I do hope some priorities will be changed. Voices needed.

Sources

>The End of Poverty (Jeffrey Sachs)

>I cannot encourage you enough to read The End of Poverty. Just do it. Promise yourself that you’ll find a way.

The first few chapters relate Sachs’s own evolution as a development economist and advocate—a process that leads him from Harvard University to countries around the world and eventually to Columbia University where he helped found The Earth Institute. We follow him along the journey of gaining insights into the roles that geography, population growth, and disease play in the poverty trap.

The subsequent chapters describe the needs of the poor, the misconceptions most of us have regarding what is being done and what the real problems are, and finally the way forward.

Sachs quantifies, maps, deconstructs, and personalizes the problems. Thankfully, he does not end there. He also quantifies the needed response, demonstrates the possibilities we have over the next couple of decades, and offers policy advice on increasing capacity and accountability.

For less technical, but more spiritual analyses of the same topics, see Walking with the Poor (Bryant Myers), Red Letters (Tom Davis) and Rich Christians in an Age of Hunger (Ron Sider).

>U.S. Healthcare System Diagnosis: Sick

>

I have previously expressed my thoughts on the U.S. sickcare system and SiCKO, Moore’s documentary.

These headlines support my views:

>SiCKO

>I am less than satisfied with our medical system here in the United States. This sentiment derives from both personal experience and policy analysis. Let me explain.

Insurance Companies
I watched Michael Moore’s new documentary, SiCKO, approximately one week after receiving a large sum of money from my insurance company for medical bills dating back to 2006. This reimbursement came only after acidic phone calls and emails. In fact, every reimbursement over the past year and a half has been delayed until I’ve filed complaints and become “unfriendly” on the phone. So yes, I already greatly disliked our health system with its third-party payers (insurance companies) before putting Moore’s documentary into the DVD player.

Cost
The high cost of care here is frustrating. For example, I received an MRI in South Korea for less than $200 (which my insurance paid for); I’ve been told this procedure would cost closer to $2,000 here in the U.S. While births are estimated to cost between $7,000 and $9,000 in the U.S., our American friends just had a baby in South Korea for $160 out of pocket.

Even with insurance here, you can still go under. Last year my wife had an outpatient surgery, and our portion of the bill, the part insurance didn’t cover, was $3,000. I’m glad she had insurance back then, yet it is frustrating to still be paying off the bill a year later. A study published in Health Affairs has estimated that approximately one half of all personal bankruptcies involve medical bills. Crippling.

Let’s look at this from a macro view, rather than the micro view of my life. Spending on health care as a percentage of GDP has risen significantly in the U.S. In 1960, it was 5.1% of GDP; in 2002 it was 15%. Also, the U.S. spends more per capita on health care than does any other country (Rand Health, U.S. Health Care).

This leads me to two different thoughts. First, if we’re spending the most, then our system should be the best, and consequently, our health should be the best. Second, if it turns out that we don’t have the best care even though we’re spending more, then we shouldn’t fear the so-called “high cost” of other systems (read universal health care/socialized medicine).

Performace
Is this the best health care system that industrial societies have devised? The World Health Organization’s 2000 ranking of health care systems around the world placed the U.S. at number 37. Forty-one countries have longer average life spans than the U.S. (Boston Globe).

Also, “American babies are three times more likely to die in their first month as children born in Japan, and newborn mortality is 2.5 times higher in the United States than in Finland, Iceland or Norway” (CNN.com, Jeff Green, 10 May ’06). Our infant mortality rate places behind 32 other countries (Wikipedia).

So, no, we are not the best. We can be humble and realize that we can learn something from other countries. But then why do people from other countries come to the U.S. for medical treatment? I agree that we have some of the best medical equipment and some of the best research hospitals. People in foreign countries with significant financial resources can afford to come here for world-class treatment in these fine centers. But excellent equipment and expertise in specific centers is very different from having an overall healthcare system that provides for all of its citizens. In fact, we are the only industrialized western country that does not offer universal healthcare.

We have free public schools, free libraries, free police protection (yes, there’s no “free lunch,” these are financed through taxes). Why do we accept these government services, but then worry about “socialized medicine” when the conversation turns to our nation’s health? And increasingly, Americans are going abroad for medical treatment. Three Billion New Capitalists describes “medical tourism.” For example, it may be less expensive to fly to India to have hip surgery than it is to have the procedure at home–possibly one tenth of the cost.

Access to Insurance
My wife and I are currently among the 47,000,000 people in this country without health insurance (National Coalition on Health Care). Reason? We’re currently unemployed. Attaching medical insurance to the place of work is crippling. If you change jobs, then you have to go through a waiting period before benefits begin at the new job. Also, ailments that were being treated in the previous plan are now considered pre-existing conditions. Because of my neck problems, I’ve been told that group plans are my only chance for coverage.

What other insurance is through the employer? Only workman’s comp, as far as I can tell, which makes sense. But we don’t lose our auto, fire or life insurance when we change jobs. Why health insurance? Let’s take a look.

I took Human Resource Management during my business studies, so I can share a bit of the history of how we got here. In the 1940s, employers were looking for ways to increase employee compensation while staying within wage limits. Non-wage benefits were seen as a positive way to cope with the system. A good idea, right? Sure, at the time. But with decreased job stability and increasingly stubborn insurance companies, it is time for a new system.

Hopefully, tax laws will change soon, making it easier to get insurance directly. However, even if these laws do change, the dramatic upward trend of healthcare costs will continue to push insurance out of reach for many individuals and families.

We have seen that the U.S. healthcare system is (a) expensive, (b) below industrialized performance standards, and (c) not reaching millions of people. We need to admit that it is in our society’s best interest to consider other systems.

Options
What countries can we learn from? How about these (WHO world ranking): France (1), Austria (9), United Kingdom (18), Canada (30) and Australia (32) are good starters. We don’t have to copy every policy from any one country, but we can learn from them. It’s time.

You can start by watching SiCKO. This film can’t replace a more systematic analysis of the issue, but it is a good place to get motivated to do the more mundane policy and statistical research needed to improve our health.

Summary
We have world-class facilities and practitioners in certain research centers, but we have nearly 50,000,000 people who can’t afford these services because they lack health insurance. Even with insurance, medical costs are still debilitating. Getting health care through an employer creates significant problems. While U.S. citizens on average pay more for healthcare than anyone else on the planet, our system still ranks only 37th in the world. I think we need to seriously consider major changes.

Possible Solutions
I am for universal health care coverage. This can take different forms. Two options are national care provided by the government and compulsory health insurance through the private market with government subsidy. This is sure to continue as a headline issue as we move to the next presidential election.

Continuing Ed Starter-kit
Overview of health care systems (Wikipedia)
Overview of U.S. health care (Wikipedia)
Overview of U.S. health care (The National Coalition on Health Care)
Overview of Canadian health care (Wikipedia)
US/Canadian Health Care Comparison (Wikipedia)
Illness And Injury As Contributors To Bankruptcy
Learning from International System Comparisons
Rand Health, U.S. Health Care
Jim Wallis and Socialized Medicine (anecdotal)