Healthcare Reform: Get it done!

Pass major healthcare reform now! Carpe diem!

It is hard to keep this debate civil, and I only have a couple minutes to let months of double, double toil and trouble overflow with some semblance of sanity.

1. It is much easier to get your voice heard when you say I OBJECT or YOU LIE, but much more difficult when you just want your legislators to get major healthcare reform passed. All they have to go on from the public is stupid polls asking loaded questions such as “are you happy with your current healthcare?” – So, are you happy with the way costs keep going up and coverage keeps going down? Are you happy with the unpredictability of coverage? These questions are not covered by these simple-minded polls. I have very good medical insurance and I am not happy with it because of these factors. But if you ask me if I’m happy about my healthcare, how can I say no? You’ve heard about the three kinds of lies according to Mark Twain and Disraeli?

2. One of the biggest lies going around is that America has the best healthcare “system” in the world. This claim confuses the concept of technology with the concept of system. We might have the best technology overall (or perhaps some other component is claimed by those who make it?); but study after study shows that we do not have the best system by most counts. We spend more per person on healthcare for less benefit, and we allow far too many people to fall out of the healthcare system considering our great wealth. There is both a cost-benefit case against our system and a social justice case against our system. On these two broadly-inclusive measures it cannot accurately be claimed that we have the best healthcare system in the world.

3. Almost totally ignored in the current debate is the desirability of enabling American workers to become more competitive. Currently just about all social policies tie workers down to specific communities. If they lose their jobs, they cannot explore average paying jobs in other states or beyond their commuting range. Going past that limit would remove them from important social benefits including the most important one for families—healthcare. With healthcare tied only to jobs, workers with families are limited to jobs in their locale. In the past undocumented immigrants who had a home to go to if caught by the IRS were able to take the jobs these workers might have taken if something resembling universal healthcare had provided a security blanket. Who knows what changes are currently happening.

NPR’s dangerous idea

NPR’s board is about to decide whether to ban sectarian religious programming from its member stations. 

That this should even come up for a vote in a major media network in the free world is baffling.

Although NPR apparently wants its member stations to be not only non-commercial and non-political but also non-sectarian, in doing so they are creating a non-religious environment. Rather than welcoming varieties of religious expressions, they only want to peer at religion from the outside.  They think they can have religion without having religions.

They are at the opposite ends of the spectrum consistently advocated by Barrack Obama since he first enunciated his three major principles for religion in the public sphere in his Call to Renewal speech back in 2006.  I summarized these principles back then as follows—

Rule # 1:  FREE EXPRESSION 

Summary:  When people participate in public discussion and debate, they should be free to fully express their beliefs.  Believers should be free to express their religious concerns.  Likewise, those who do not identify themselves as religious should be free to express their beliefs as they see them.

Rule # 2:  COMPROMISE 

Summary:  Although both religious and non-religious viewpoints should be heard and discussed, the goal of public discussion is to establish common agreement on value judgments in order to obtain the broadest possible base for legal action in a pluralistic, democratic society.

Rule # 3:  GOOD WILL 

Summary:  Recognize the limits of the political process:  accept that significant change comes slowly; speak fair-mindedly about the issues; presume the best from each other.

 

NPR is now considering a direct contradiction of all three of these principles.

 

# 1:  FREE EXPRESSION 

NPR is considering denying its member stations the option of allowing local churches to buy time to broadcast services.  It is basically saying that there is to be no free expression of religion on its member stations.  This rule is not required by the government—it is self-imposed censorship.  I guess it is up to supporters to decide what they think of this rule.

Apparently NPR is willing to allow other types of programming on its member stations.  But religion is so controversial, so universal and deeply ingrained in people that it is like sex, difficult to control.  Perhaps we could think of NPR as going through a Victorian stage, seeking to cover up religion, attempting to deny its pervasiveness and power except to provide objective reports with clinical detachment. 

 

# 2:  COMPROMISE 

 

Apparently there are some problems that led to this issue being raised in the first place.  I can only speak to my own station, WDUQ in Pittsburgh, which is owned by Duquesne University of the Holy Ghost (I put it that way because that is the source of your tax receipt for donations to NPR through WDUQ).  Donating to NPR is donating to religion in Pittsburgh.

Although I very religious and I am a huge fan of NPR and I am not a supporter of across the board legalized abortion, I no longer support WDUQ because they returned a $5,000 donation from Planned Parenthood after initially accepting it because they felt it compromised their message.  I do not believe this was justified; I had an amiable email dialogue with the university chancellor in which we clarified our views; and we have left it at that.  My donation levels were very small and do not amount to anything significant anyway.  Furthermore, I want Duquesne University to be free to exercise its religious viewpoints.  And I want NPR to figure out a way to allow for freedom of religious broadcasting.

 

I also saw somewhere that NPR was considering allowing listeners to contribute directly to the main network, with perhaps a portion going back to the local station.  That would be fine with me.  And I would resume contributions in that way.  One thing religious broadcasters have taught the political world beginning with Howard Dean through Barrack Obama is the power of small contributions coming from many people.  Collecting donations centrally to counter-balance local conflicts might be a good compromise for others too.  But NPR does not seem willing to take this step.

 

# 3:  GOOD WILL 

 

I have not seen any issue brief about this issue from NPR--only the statement that they are planning to vote.  Perhaps they want input. But if they exclude serious God-talk from their member stations, then I think they are raising questions about their own good will.  I think the onus will be on them to defend their actions.  It’s an exceedingly small thing, but if they don’t provide a mighty good explanation if they vote to exclude religious programming, then NPR won’t appear on my Facebook page anymore. 

From what I have seen so far, it looks to me like they just think it is a matter of their rules and regulations.  That is not good enough for me.  Organizational rules are driven by people’s values and beliefs. 

Why do they think they need a rule to exclude sectarian religion from their member stations?

That is the question I want answered.  This is a self imposed rule.  Not imposed by the government. 

But as upset as I am that they are even considering this question, I’m waiting to hear what they have to say.

Obama, Islam, and the Golden Rule

Can you believe that some people have focused on President Obama’s use of the Golden Rule as evidence of an underlying natural law and used it to criticize him and to disparage Muslims? 

You would think these are antichrists incognito since their purpose must surely be either to undermine belief in creation or to undermine the moral leadership of the president.  There can only be a natural moral law — “the law that binds people of all faiths and no faith together” — if there is no creator.  Without a creator every apparent “law” is simply happenstance and depends on the perspective of the perceiver.  That is why science can only claim to have verified hypotheses to varying degrees of certainty, but can never lay claim to absolute truth.

Those in the theistic traditions usually support the role of leaders in encouraging moral leadership, and most others also support them as well because it makes good sense.

But it is not the atheists that seem to be complaining about Obama’s use of the Golden Rule. It seems to be either disaffected Christians or right wing fundamentalists who argue that Obama shows that he does not understand Islam because Islam does not have a Golden Rule tradition.  That was claimed again on a talk show on WPIT following the president’s Notre Dame speech.

Here is what President Obama actually said at the University of Notre Dame [highlights added]--

For if there is one law that we can be most certain of, it is the law that binds people of all faiths and no faith together. It's no coincidence that it exists in Christianity and Judaism; in Islam and Hinduism; in Buddhism and humanism. It is, of course, the Golden Rule — the call to treat one another as we wish to be treated. The call to love. The call to serve. To do what we can to make a difference in the lives of those with whom we share the same brief moment on this Earth.

So many of you at Notre Dame — by the last count, upwards of 80 percent — have lived this law of love through the service you've performed at schools and hospitals; international relief agencies and local charities.

I’ve added the highlights because they show how Obama is defining his understanding of the Golden Rule.  He understands and applies it in a very general and practical way, not in an interior and deeply spiritual manner.  He is appealing to action and not to internal reflection.  Neither is he defining it in a technical and rationalistic manner for a debate.  He is sketching it for the moral imagination, much more like Jesus did than like the legalistic accusers then and now.

Obama’s remarks at Notre Dame are similar to those he made at the National Prayer Breakfast in February, where he was apparently more detailed concerning his reference to Islam.

A Jewish blogger gives the details but then goes on to rant, much of which is excluded here--

"We know too that whatever our differences, there is one law that binds all great religions together... In Islam, there is a hadith that reads “None of you truly believes until he wishes for his brother what he wishes for himself.”  --  from Obama's remarks at the National Prayer Breakfast

Here is the Hadith in full and uncensored. -- "Abu Hamzah Anas bin Maalik who was the servant of the Messenger of Allaah reported that the Prophet said: "None of you truly believes (in Allah and in His religion) until he loves for his brother what he loves for himself."

While Obama might try to pass this off as the Golden Rule, the Hadith mentions "Brother", which means fellow Muslim. Infidels not included….   Mohammed's remarks as contained in this Hadith is limited strictly to Muslims.  

Without even doing much research on the matter, it seems to me that until specialized knowledge is uncovered, it is reasonable to assume at least the following:

(1) Islam’s all-encompassing worldview of loving for one’s brother what one loves for oneself is no less incoherent than loving a God who plans to torture people forever if they reject him before they die.  I put it that way because that is the way the doctrine of hell has been understood by many until quite recently, and perhaps still continues to be understood by many Christians.  Let’s face it, the truth about worship is that you become like what you worship, and we will become like the God we worship.  That is why the biblical God demands that we have no other Gods before him.  My point here is not that Christians are becoming cruel because their doctrine of God proves it, but that if Christianity’s view of hell can change, then so also can Islam’s view of love.  Islam is much more flexible than we outsiders give it credit for, and we should not demonize it.

(2) Islam does accept that Jesus was a legitimate prophet from God.  It seems reasonable to assume therefore that they would accept his teaching of the Golden Rule.  Why do Christians seem to think that Muslims can’t claim Jesus?  After all, Christians claim Abraham, David, Jeremiah and Isaiah without claiming to be Jews.  It is not legitimate to say Muslims do not have the Golden Rule in their tradition when they acknowledge Jesus as a prophet from God.  They do believe many of the biblical manuscripts are corrupt, but some Christians and scholars also believe that.

Get off Bush’s Back and Create Public Service Banks

True, President Bush’s policies snookered us.  He allowed himself to be deceived about the need to start a war in Iraq that will cost us dearly for decades to come after he already committed to cutting taxes guaranteed to force us eventually either to reduce social programs or to face astronomical deficits.  But most people wanted lower taxes now and, like the president, figured the future will take care of itself.

Now we face those astronomical deficits sooner rather than later because the skeleton in our closet was evicted and everyone recognizes it – we have been spending beyond our means at every level of society.  We can’t blame this on President Bush.  We have to solve this part of the economic crisis at a personal level right now.

And we find ourselves in a catch-22 situation at the very heart of the capitalist system.  As President Obama says, if everyone stops spending, then there will be no demand for goods, and then ultimately no jobs, either.

But capitalism says we want to keep on spending more and more, always expanding to new horizons, never being satisfied with just having enough to meet our own needs.  And that seems to be the fatal flaw in the system.

Companies on the stock market push for higher returns every year.  And of course we all want that because we have 401(k) retirement plans invested there.  These companies will even move out-of-state or out-of-country, dumping faithful employees to go where they can make a better profit so we can get higher returns on our investment.

And this is just the simple version.  Reality is much more complex.  Those people who earn those big salaries get paid big for their ability to create alternative realities with words and numbers.  But all that really matters is what they produce.  It reminds me of what Jesus said, that it’s not what goes into a person that defiles him, but what comes out of him! (Mark 7:15)

And what are they producing right now?  It looks to me like they are starting to raise interest rates fairly high on credit cards, for one thing, charging rates far above prime even for customers with good payment records.

And they have tightened up credit beyond reasonable limits, even for the most credit-worthy customers.

Banks seem to be resisting the idea of making employee compensation more modest, yet they are putting the squeeze on the public.  If you can’t keep your rates reasonable; then you should not be paying such high salaries.

Does this make sense? 

It is time to stop blaming President Bush and start putting the focus on our own consumption habits and on our own banking industry, which is apparently not willing to voluntarily make its own cut-backs.

Its starting to look like the government needs to create a new set of laws for a new kind of banking industry to develop.  As some have pointed out, the credit unions have been doing fine. It is the banks that are in trouble. Let the old banking system die away and let’s get a new one not built on ever expanding profit taking.

We need banks that are primarily a public service industry and not primarily profit making businesses. 

 

The Tyranny of an Undisclosed Conscience

Displacing professional standards by an undisclosed conscience can only result in tyranny – and other undesirable unintended consequences of a new Federal rule are also inevitable!

Beginning January 19, you can go to a hospital that says it provides family guidance services yet be denied legitimate healthcare information without your knowledge or consent simply because of the conscientious beliefs of the clinician serving you that day.  For example, “for more than 30 years, federal law has dictated that doctors and nurses may refuse to perform abortions. The new rule would go further by making clear that healthcare workers also may refuse to provide information or advice to patients who might want an abortion.” (Los Angeles Times, 12/2/08)  

The BIG difference between the old and the new scenarios, as we will see below, is that when using a hospital that objects to certain services such as abortion, you used to know what to expect; but under this new rule you no longer know what to expect since what information you receive will depend on each clinician’s personal conscience. It really does NOT matter what the published literature of the hospital says anymore.  The conscience of the individual clinician prevails in every case.

Since this is a federal rule, it trumps local laws:

Many states currently have laws requiring that rape victims treated in hospital emergency rooms be offered the option of taking emergency contraceptive pills to prevent pregnancy. But she [president of Planned Parenthood] said that because providers who don't believe in emergency contraception could now simply opt not to tell women about that option, "under this rule, we believe that in fact now women who are the victim of sexual assault either would not be guaranteed either information or health care access to emergency contraception."(NPR, 1/3/09)

 

This rule has severe penalties:

The far-reaching regulation cuts off federal funding for any state or local government, hospital, health plan, clinic or other entity that does not accommodate doctors, nurses, pharmacists and other employees who refuse to participate in care they find ethically, morally or religiously objectionable. It was sought by conservative groups, abortion opponents and others to safeguard workers from being fired, disciplined or penalized in other way. (Washington Post, 12/19/08)

 

This rule extends to a wide network of healthcare workers:

The Bush administration announced its "conscience protection" rule for the healthcare industry Thursday, giving doctors, hospitals, and even receptionists and volunteers in medical experiments the right to refuse to participate in medical care they find morally objectionable.  (Los Angeles Times, 12/19/08)

The final rule, however, affects a far broader array of services, protecting [pharmacy] workers who do not wish to dispense birth control pills, Plan B emergency contraceptives and other forms of contraception they consider equivalent to abortion, or to inform patients where they might obtain such care….  While primarily aimed at doctors and nurses, it offers protection to anyone with a "reasonable" connection to objectionable care -- including ultrasound technicians, nurses aides, secretaries and even janitors who might have to clean equipment used in procedures they deem objectionable. (Washington Post, 12/19/08)

 

No More Basis for Trust

When you go to a healthcare organization such as a Catholic hospital that clearly states its ethical position, you know what to expect, and you know you will be served professionally within the bioethical beliefs of that organization.  So, for example, they will not offer you abortion services, though they are required to offer alternative options.

Rules already are in place to protect any person, doctor or pharmacist from going against their conscience by providing abortion or contraception information or services to patients or clients. But current practice requires people to inform people that other options are available elsewhere. (Pittsburgh Post-Gazette, 1/3/09)

As we have noted above, however, this new rule does not allow youto know you are not being denied certain services, which means you will not know what to expect.  "The provider can deny information and services to their clients without their knowing it is being denied."  (PittsburghPost-Gazette, 1/3/09)

You will be under the total control of each clinician’s conscience regardless of their ethnic or religious background, or even any misguided confusion of a partially developed or guilty conscience they may be experiencing at the moment.  Some warn that “As written, the rule also would protect health care providers opposed to vaccinations or other medical procedures.”  (Pittsburgh Post-Gazette, 1/3/09)  It will take a long time to sort out because no one will know when it is being employed because clinicians who take advantage of it are not legally accountable for their actions.  This rule does not require anything from them; rather, it permits them NOT to do what other laws, professional codes, and ethical codes DO require them to do.  It is truly antinomian.  

When I think how many healthcare organizations are turning over ever more of their clinical functions to nurses and much less educated providers; when I think how narrowly educated these specialized medical technicians are; and then when I think how the mass media has made almost all of us highly vulnerable to every wave of pop culture thinking and current fads, I wonder what kind of conscience we are turning our future medical care over to? Whatever the current movies are promoting?  What kind of social strategizing does the Bush administration have in mind?  Certainly not the good of the unborn – that is plain to see, since there have been no commensurate increases in social services to support the increased birth rate this rule is intended to accomplish.

This rule seems bound to create moral chaos. There is no basis for trusting one’s clinician since they legally do not have to tell you anything that offends their conscience. They are not compelled to give you as much respect as God gave Adam and Eve. They may even deny you your own right to refuse treatment by denying you the right to even know about it. If there ever was a place where the “house of cards” imagery applied, this is it. You can’t just say conscience takes priority in one clinical area but not in another. If it applies to bioethical issues, why should the underlying principle not also apply to alternative medicine, mental heath, and controversial medical treatments? It makes no sense to view this rule as limited in scope: the legal basis for justifying this one area must surely apply to other areas as well.  But my bet is that the whole thing will collapse because it makes no practical sense. 

 

Unintended Consequences?

No one can fully predict the legal implications of this rule if it stays in place since it supersedes other related laws and seems to sanction a kind of libertarianism in medical ethics as far as denying medical treatment is concerned.  As noted above, some are concerned about medical procedures not mentioned in the rule being included as matters of conscience for some clinicians. There are all kinds of matters of conscience that this rule will undoubdedly bring to light. This rule is not simply a regulation – if it continues it will create a new ethical  paradigm – the belief that personal ethics trump responsibility to clients in the professional relationship.

From all reports, the creators of this law seem to presume a traditionally Christian-based bioethical stance as either the legal heritage of the USA and/or the proper direction which the USA should take.  It appears that they have their own minds made up since they have not adapted the rule based on widespread public input. (Huffington Post, 12/19/08)  They seem unconcerned about the need for people of various viewpoints to live together amicably in a multicultural society, and in a society that does not reflect their common moral viewpoint.

And curiously and in contradiction to the Christian tradition which they seem to represent, this rule appears to be another example of the Bush administration’s nietzschean approach to create social change. In more genteel new age terms, this tactic could also be characterized as an attempt to create their own reality.  This from a president who said Jesus was the most influential political thinker in his life!  Jesus, the one who said “the truth will set you free” (John8:32).  Yet President Bush wants to be known as a president who promoted a culture based on hiding the truth?