Obama's Catholic hospital decision

[angus]

http://www.politico.com/news/stories/0212/72345.html

I didnt know about this until today and I am offended as a Christian... I have tried to give the President the benefit of the doubt and believe that he is truly working for what he thinks is the right thing in terms of Obamacare but when he spits in the face of the nation's Catholics...

Imagine if this affected only Muslim hospitals. Hell- Osama was given full Islamic burial rights! The political correctness does not work both ways

You want to fire up the base? I guarantee this will be in every sermon across the nation on Sunday morning and we will vote for the Republican nominee- whoever it is. If Romney wins, I do not like the man but I will vote for him proudly after this decision!

Do we smell a first-amendment court case on the horizon?  My guess is that you might find a sympathetic federal judiciary.  Lately, they have been siding with the first amendment.  Just last year you had:

United States v. Jones, 5-4
Hosanna-Tabor Church v. Equal Employment Opportunity Commission, 9-0
Pleasant Grove City v. Summum, 9-0
Snyder V. Phelps, 8-1
etc.

In some cases you could spin it as a win for religious liberty and in other cases you'd have to say it was a defeat for religious nuts, and in other cases it really didn't have a religious component, but in all cases the first amendment won.  And, to complicate matters, there are a boatload of pending Health Care Reform Bill cases as well.  

If I were a betting man I'd bet that this has the potential to interest the US supreme court.  Some of the legal wonks should chime in.

[angus]

What I don't understand is why health insurance would be provided through an employer in the first place. How are they at all connected?

Most of us aren't independently wealthy, so we have to maintain gainful employment.  In exchange for labor, we are compensated.  Compensation usually includes money, but it may also include fringe benefits.  Given that medical services are the second-fastest inflating sector of the economy, many folks are being priced out of range.  So part of a good job offer might include major medical and dental coverage.  The fastest inflating sector, of course, is higher education, and in some sector that's an added benefit.  Both my wife and I have jobs that include tuition wavers for our children as an added benefit.  We appreciate both the medical and educational options, without which the job offer would hardly have been sufficiently enticing to be acceptable.

Of course, if the government would divorce itself from all aspects of medical services, then the equilibrium price for those services would fall, and we probably wouldn't need to have any insurance programs at all.  That would be preferable, but it is unlikely in our increasingly collectivist society, so most of us want decent insurance coverage as part of the benefits package.

[angus]

Yes, if not for the government, a quadruple bypass would be easily affordable for all without any sort of insurance

I certainly never made such a claim--"easily affordable for all" are your words, not mine--and you are picking an extreme example, but just to be a good sport and play your game, I'd say that one can easily make a sound argument that a quadruple bypass in the United States, which costs about 40 thousand dollars, would cost about five thousand dollars in an alternate universe in which the trend toward government-sponsored medical services, which started in the 60s, had never taken hold.

[angus]

Yes, if not for the government, a quadruple bypass would be easily affordable for all without any sort of insurance

I certainly never made such a claim--"easily affordable for all" are your words, not mine--and you are picking an extreme example, but just to be a good sport and play your game, I'd say that one can easily make a sound argument that a quadruple bypass in the United States, which costs about 40 thousand dollars, would cost about five thousand dollars in an alternate universe in which the trend toward government-sponsored medical services, which started in the 60s, had never taken hold.

What argument is that? Most of the argument I've seen to that end go something like this- government subsidy to X increases demand for X; the higher the demand for X, the higher the price. That seems intuitive enough, but it also assumes that X is more widely used than otherwise, which defeats the whole problem of high cost.

pretty much.  I think we're on the same frequency, beet.  As I said, his is an extreme example.  The population of my household is three, and between us we have 89 years of living, and none of us has ever required a quadruple bypass.  What we have required is azithromycin, casts for broken arms, cough medicine, X-rays, vaccinations, general obstetrical services, general pediatric services, circumcisions, and the like, much of which could be had for the cost of a chicken or a pound of butter at one time.

[angus]

Yeah, lemme know when you find an obstetrician who will work for a chicken... And I'm sincerely pleased to hear that your family has enjoyed good health. Many people are not so lucky.

I wish you good health as well.  But that's my point:  no obstetrician will work for a chicken.  It cost about ten thousand dollars to have our baby, and that was more than seven years ago.  Of course, we didn't pay ten thousand.  I suppose we paid maybe 300 of that, not including monthly premium payroll deductions.  But somebody paid bills totalling about ten thousand.  I know because I kept all the paperwork.  Should it cost that much?  Would it cost that much if it weren't for bureaucratic excesses?

Let's say I wake up one morning and I know I have strep throat.  I could go downstairs to a biologists lab and borrow an assay kit and check it to be sure, but I probably wouldn't.  I know what strep feels like, and I know when I have it, and I know what I need to take, and how much to take, to rid myself of it.  Now, if I'm in the ideal world, I walk down to the corner pharmacy, and I pick up a package of pills.  Azithromycin.  for me, 600 mg per day for three days.  for my son, maybe a 200 mg per day for five or six days.  This little package costs me 15 dollars.  That it's.  Just fifteen dollars and a little patience, and I'm all better within a week.

But no!  I gotta go to see a physician, because by law only a physician (or a PA or a certified nurse practicioner) can prescribe antibiotics.  And I gotta pay 50 dollars for an office visit.  Then I have to pay for the strep test, which costs another fifty dollars due to USP bureaucracy.  Then I go to the pharmacist and I pay another fifty dollars for the drug.  That's a hundred and fifty dollars to cure what it ought to cost 15 dollars to cure!  A ten-fold increase over practical reality.  Now, I have insurance, so the office visit is "free" and for the strep test I get charged maybe seven dollars.  And for the drugs I pay the fifty but later I get a check in the mail for sixty percent of that.  So I only end up paying something like 27 dollars, but 27 dollars is still more than 15 dollars, and we're not even counting the premium I pay every month.  And think about those poor bastards who don't even have insurance.  They have to cough up the 150 dollars if they don't want to shrivel up and die. 

It doesn't have to be that way.  It only is that way because of increasing government intervention.  Uncle Sam, along with the various legislatures, have determined what to pay for, how much to pay for it, and how often to pay for it.  They run the game.  They're the house, man.  They are the green 0 and the green 00 on the roulette wheel.  Moreover, this administrative creep has been increasing for fifty years, so it's no wonder that over the past fifty years medical costs have skyrocketed.  And now they're making mandates!  Mandates to insurance companies and mandates to individuals.  Mandating benefits is sort of like saying to someone in the market for a new car, "if you can’t afford a Cadillac loaded with options, you'll have to walk."  And you support all this?!  You must be richer than I.

[angus]

Just have to point out that the insurance company probably didn't pay the full $10k - they don't pay sticker price so to speak, rather they either haggle it down or are already given a discounted rate.

It's true, and I have to say that I'm in the Obamaniacs' corner on this one.  Billing is so incredibly inefficient.  All the time we go for office visits, and there's no co-payment.  Just walk in, get serviced, whatever, and walk out.  Then, a couple of months later I get a "statement" which is not a bill but that has all sorts of information:

Insurance company billed:  $129.97
Network discount:  $64.82
Insurance company pays:  $57.23
Patient responsible:  $7.82

Then, a couple of months later I get a bill for $7.82.

Really?  How many man-hours did you invest coming up with a bill for $7.82?  I'm assuming that the paperwork alone must cost more than $7.82.  It all seems so very inefficient.

[angus]

I know we have some agreement about the nature of the problem, memphis, but obviously we have some different conclusions.  I still think that the fundamental issue in this thread stems not from some anti-Catholic bias, but rather from the kneejerk reaction that the solution to a problem obviously created by too much government intervention is more government intervention.  The solution to the problems created by too much Uncle Sam is less Uncle Sam.  Sometimes the Emperor really is naked, and I admit to no shame in being the child who recognizes that.

[angus]

Repealed.

http://www.usatoday.com/news/story/2012-02-10/obama-birth-control/53036006/1

The article doesn't really go into specifics.  It just says that Obama is planning to adjust the rule.  Even the video it links just talks about some vague, amorphous compromise. 

[angus]

Apparently the compromise is that insurers rather than employers would pay for birth control if an employer objects to paying for birth control on religious grounds.

LOL.  That's rather like saying that TSA agents will now be putting on gloves and giving all airline passengers full cavity searches, since the airports object to doing the full cavity searches based on the grounds of common sense, decency, and privacy.  Jesus, Obama is no better than Bush.  If you'd told me 30 years ago that Amerika would one day be a place where I can't board a plane without removing my clothes to let strangers probe me, and where a private company could be ordered by Presidential fiat to provide this or that medical service to its employees, I'd have said that you have been reading too many George Orwell novels.  Or maybe to many Aldous Huxley novels.

 Brave new world, we're living in, boys.  Brave New World.  

[angus]

Calm down Angus, it's just a little birth control. And I am sure the insurance company will get compensated for it. It's not as if birth control costs that much when you look at the big picture of our health care system. They would only need to increase premiums just a tad and they could cover it. And the catholic church wouldn't have to feel icky. Though it remains to be seen how exactly they do it.

Am I being too ideological? 

The talking heads spin it as a "religious freedom issue" versus a "health care issue."  Frankly, it's not either of those aspects that bother me, but the fact that a US President can usurp such great authority.  I'm just not seeing that in the job description as detailed in the US Constitution. 

And, while we're at it, no I don't like taking off my shoes at airports, thankyouverymuch.

[angus]

At risk of sounding like an idiot, is this new "accomodation" to make the insurance companies provide the birth control actually any different? Wouldn't they just pass the cost on back to the Catholic hospitals?

Which ultimately gets passed on to the patients through their premium payments.  just like the cost for the privilege of being prodded and scanned at airports is passed on to the passengers, in the form of a fee when they buy the airline ticket.  Any time the government says "buy this" then the people are burdened, either directly or indirectly, with unnecessary costs.  There's no way around it:  goods and services aren't free.

The fact that he makes an exception for religious institutions is the worst possible outcome.  First, it treats groups of people like political footballs.  Secondly, the perceived "victory" over the injustice of having the government tell the private sector how to operate gives folks a false sense of security.  Better to let them try to make laws and then challenge them in court, or just vote the bums out of office and let a new congress deal with it.  Thirdly, it becomes the new normal.  A government that chisels away the liberties of the people, one by one, becomes authoritarian is a stealthy manner.  All my life it has been "normal" that things like prostitution and marijuana are illegal.  I just haven't known any other way.  But double jeopardy and warrantless wiretapping and medical insurance mandates seem illegal.  In a generation they won't.  My son will not know a time when the government wasn't expected to control every aspect of his life, from cradle to grave.  And so it goes. 

The fact that any bimbos he might one day be banging would be on the pill doesn't bother me.  In fact, I would consider that a good thing.  No, the contraceptive itself is not the enemy.  The enemy is the law that requires it.  It's a small thing, this policy, and it has no direct on me, but it is another nail in the casket of our basic right to operate.  A people who will submit, without a fight, to this sort of abuse from its government does not deserve freedom, and so it shall not have any. 


Ah, I've worked myself into a hissy fit.  I should probably go do something else for a while.

[angus]

That's a slippery slope argument. I think it's worth talking about long term trends in personal and economic freedoms (where there have been historical movements in both directions), but the "My son will not know a time when the government wasn't expected to control every aspect of his life, from cradle to grave" is clearly hyperbolic and inaccurate. A government that mandates the provision of health care insurance is hardly an authoritarian or Orwellian government, unless you think that the Canadian government is Orwellian, and such.

Orwellian doesn't apply to canada.  Nothing applies to canada.  They call themselves a real country, yet they put another country's monarch on their money.  Leave canada out of it.

Yes, it's a slippery slope argument, and the long-term slip on the slope is scary, don't you think?  Say I've a business.  Say I want to offer my employees some fringe benefits, like medical and dental insurance.  Now, maybe the insurance I'm offering covers nose jobs, maybe it doesn't.  Maybe it covers pre-existing HIV, maybe it doesn't.  Maybe it covers birth control, maybe it doesn't.  But whatever I"m offering, that's what I'm offering.  Maybe some folks see it as a good fringe benefit.  If you don't think the wages I pay are sufficient, or if I don't give enough paid holidays, or if you think my insurance program doesn't meets your family's needs, then that's fine.  Don't work here.  No hard feelings.  You move on and I give you a good reference.  But there is no reasonable case to be made that the government should be meddling here, is there?  This is a private contract between my business and my employees, or between my business and the insurance firm with whom I do business.  Full disclosure:  I don't believe that the government should be in the business of medical insurance anyway, and I'm still hoping for a repeal or court review of the medical reform bill of 2010, but if we accept that the government should be in this business, then it gets easier to accept that they can be in other personal affairs.  This is the slippery slope.  

Probably there's a justification for the thinking that occasioned such bad policy.  Probably it was the one-two punch:  The 2001 terrorists attacks, followed a few years later by the Credit Crunch, that made us feel weak and vulnerable.  In the fall of 2001 people suddenly felt scared, and were willing to exchange liberty for security.  Then, in the fall of 2008 they were once again feeling vulnerable and willing to exchange liberty for security.  Politicians have exploited both events, shamlessly, to make policies that are at once popular and help them get re-elected, but at the same time have a long-term detrimental effect on our the liberties of our people.  The Republicans are just as shallow and just as shameless as the Democrats in this regard, although they have different pet issues, they have in common that they exploit the fears of the people in order to hold on to their powerful, lucrative positions.  So now we have a (false) sense of security, whether it manifests as "national" security or "economic" security, it makes us feel warm and fuzzy inside.  And these false securities come at a high price:  we pay for them at a cost to our individual liberties and the freedom to do business unencumbered by excesses and waste.  But we become de-sensitized to them, and they make it easier for future congresses--and future presidents, what with the administration creep that have given presidents of late almost as much authority--to enact further "security" measures.

[angus]

I'd tend to think the insurers would prefer to flip for the few pills that the few woman from these institutions might ask for than pay for maternity costs and all that comes after.

I'd rather drink my cellmate's love juice than have it forced into my rectal canal.

But, all things considered, I'd rather stay out of the cell anyway.  And to live in a land in which I had a reasonable chance of staying out, so long as I mind my own business and let others mind theirs.

Dude, where's my country?

[angus]

Okay, let's try another tac.  I'm not trying to put words into your mouth--or anything else into your mouth, for that matter--but it strikes me as astonishing that it doesn't bother you, or anyone, that we have come to a point of saying, "well, the autocracy will tell us what it will tell us, and we have no other recourse than to make the best of it."  This is outrageous!  A private company is expected to eat the cost, all because of executive fiat.  And this isn't even a congressionally-mandated clusterfuck.  That, at least, is legitimate.  This is presidential fiat on a matter that isn't even remotely related to the executive branch description, as envisioned by The Founders. 

Deeply disturbing. 

[angus]

 They will raise the rates on other customers.  

precisely.

Any other concerns?

with your inability to comprehend the underlying problem?  yes, but I grow weary of trying to explain it.

[angus]

Did you even read my post?

possibly.  I'll go back and re-read it to be sure, and then I'll look up the relevant statute.  The reporting has been fairly sensationalistic, and from what I've learned, President Obama is making the calls.  Such respectable outlets as the Washington Post and PBS are describing it this way.  Now, they're saying that Obama has "retreated."  This is even more problematic.  Apparently a group of bishops has been "appeased."  Their concerns were chiefly religious, I gather, and particular to those occasions in which the world's most political religion finds itself at odds with the world's largest bureaucracy.  The Catholic Church versus the USA is not the angle that concerns me, although it can certainly be reassuring to have the Church as an ally in the struggle against an ever-encroaching federal government.  But the alliance is no more, since the Church seems to have had its concerns addressed.  

Mine may be misguided.  I freely admit, as always, the possibility that I am thoroughly confused about the whole thing, but at the moment I'm convinced that it wasn't all a bad dream.  It seems that the federal government took it upon itself two years ago begin a series of worrisome mandates, and to begin the expensive task of seeing to it that the entire population is covered under medical insurance.  At some point it seems that it became morally and politically fashionable to assume that it is the government's right and responsibility to ensure medical coverage to the masses.  I hold out slim hope that it was just a bad dream.

[angus]

I don't see what's more radical about this than regulations that require all buildings to be constructed with fire exits, all food to be processed in a certain way, certain industries to charge non-monopolistic prices, and the whole gamut of government regulations on industry. You can agree or disagree with the specific regulation, or even agree or disagree with the constitutionality of this type of government regulation as a whole, but I don't think you can single out the requirement of contraceptive coverage by insurance companies as more extreme than these other things. The main difference seems to be that one is relatively new and politically charged, while the rest have been with us since we were little.

Further, the fact of the modern world is that Congress is made up of politicians and inherently limited in number; each Congressmember's career is of limited and uncertain duration. Congress cannot oversee all of the laws it enacts. So it delegates much of it to the executive branch. Again, this is nothing new. The executive branch was designed to execute. Part of the execution, is the creation of more specific rules designed to execute the more general or broad intent of Congress, in a process overseen by the courts and by Congress itself. What Obama is doing here is "making" one of those rules. But the Federal Register is thousands of pages long. This is not some novel post-9/11 invention. The President is not 'usurping' any authority, he is implementing a bill passed by Congress, which Congress delegated to him the authority to implement.

Ah, there it is.  But you have edited your post, how can I be sure I ever read it at all.  Anyway, going with what's there now, I'd say that it is very much like requiring fire exist, superficially.  After all, the fire exits are mandated for public safety, and in response to past disasters.  I think mandating certain medical provision--(soldiers must get certain vaccinations before being sent into foreign deserts and jungles--are both preventative and reactionary, like the fire escapes. 

However, unlike the cost of providing medical services, fire escapes are relatively inexpensive, one-time affairs.  As a practical matter, it's very different, and fire escapes don't have to meet United States Pharmacopia standards.  And we're not seeing an eight-fold increase in the cost of fire escapes over the past four decades, are we?  It's very different with drugs and medical services.  Moreover, a building has no rights.  There is no guarantor that a building can say, "By god I'm an American building, and you cannot tell me how many doors I must have."  People are not buildings.  People have liberties.  Or, at least, they used to.

[angus]

It's just birth control.

I guess that's really at the heart of the matter.  Is the federal government legitimately sovereign over medical insurance?  If you think it is then this is just birth control.  It really is just one of many services that the government can and should underwrite, or mandate, or regulate.  That's a respectable, intelligent position.  Just not one that everyone shares.

I think at this point our best bet is to win large GOP majorities in both chambers as well as the executive branch, and repeal the entire bill. 

[angus]

It's a good point, Beet, that the campaign for universal, government-run medical care spans a century.  I was aware of that, as it gets mentioned quite often, but the fact that it has never come about--still hasn't, given the loopholes in the latest bill--testifies to the fact that this is something that we have rejected, time and time again.  And we may yet again.  As I said, all we need is control of the congress and the presidency to get it repealed.  It's not an impossible goal, and if we can rally the base around a decent candidate, it could happen.

[angus]

"failing to cover prescription contraceptive medication for women has been found by federal courts to violate a woman's civil rights, and the Affordable Care Act passed by Congress directs me to implement these provisions, and it's my job as president to faithfully execute the laws."  

I think that'd be a reasonable answer to the charge being made by those specifically objecting to birth control as something special. 

Of course, to those of us who don't see birth control as any different than nose jobs or X-rays, and who think none of it should be in the purview of the federal government, the best solution is legislating an end to the very inappropriately-named Affordable Care Act, and all other acts dealing with medical care, and putting it back in the private sector where it belongs.

Birth control is a very good thing, make no mistake of it, and it is best liberally applied.  Government, on the other hand, is a necessary evil, and should be kept minimal.