Why I Oppose Government Health Care

As the father of a special-needs child -- my four-year-old son was born with Spina Bifida, requiring not only wheelchairs and physical therapy, but also considerable urological support (the greatest danger of paraplegia is kidney failure), potential orthopedic surgery, and emergency neurosurgery -- you might expect me to support government health care, at least for those with chronic conditions like my son's. Indeed, all of his health care so far has been paid for by the federal government, both because we have been too poor (as a grad student and a full-time mother) to afford any health insurance at all and because his health care has been extraordinarily expensive.

Readers of this blog will be aware of my general reason for opposing government health insurance: government is wasteful, because it makes prudential decisions far from the facts on the ground, and crooked, because politicians are more interested in looking good in the short term than in doing what's best in the long-term. Government health care would shovel lots of money into the pockets of special interests, while making it harder for the rest of us to get normal care.

Health care, however, is different from other issues, because the body is a more, um, personal concern than say the cost of fuel or even housing. You can ditch a broken car, and even go without; you can change your driving habits or downsize your house. But without health care, you lose your life. When the Founders enumerated life before liberty and the pursuit of happiness among the most central inalienable rights, their point was that without your body, nothing else in politics matters. The right to live is the most precious right of all. And yes, this includes the right to safety -- safety from war and crime -- just as much as the right not to be torn from your mother's womb. (Though when "seamless garment" types claim that war is a life issue too, they should realize that their argument cuts both ways: we are at war to try to prevent ourselves from being slaughtered on our way to work Tuesday morning; we pointed nukes at the USSR, not so we could kill, but as part of a strategy to keep them from nuking us; it did work.)

So securing good health care really is a central concern of government. But how?

A central part of the argument against government health care concerns rationing. In a market system (and we don't exactly have a health care market now, because of massive government intrusion and perverse incentives), rationing happens through price. At some point you say we just can't afford to keep this person going -- or you say that we will have to make other sacrifices, losing the house or working a second job. It is a great myth that government health care would elminate the need for rationing. Government resources are not infinite, and someone needs to decide what care is reasonable. Are we going to pay for nose jobs? Sex changes? Hair implants? Liposuction? If we do, the money -- that is, the resources to pay the doctors and all the people who support them, including the people who build lipo-suckers -- will have to come from somewhere. Government health care means we can coerce Peter to pay for Paul's vasectomy; it doesn't mean that the money comes from nowhere.

And government can use coercion to drive down prices, but if they're paying neurosurgeons less than neurosurgeons want to be payed for the joy of being woken at two in the morning to care for a six-month-old whose brain hardware is broken -- as we woke our neurosurgeon a few years ago -- then we're either going to have to give up neurosurgeons, or coerce them. Do we want a health care system in which our doctors are coerced to care for us?

At least there will be limits to the public's interest in coercion -- limits to how much money we want to pay for other people's new eyelids, limits to how much we want to be coerced to be doctors, or served by coerced doctors. The only other solution is rationing.

What will we ration? My son was born with Spina Bifida, the most common survivable birth defect. In the United States today, 90% of children like him are killed in utero; the same is true of Down's Syndrome kids. A neurosurgeon tells me that in Europe, there is no Spina Bifida: all such children are killed. Now, since these things strike more or less at random -- or at least, they're not caused by people's ideological commitments -- that means that 90% of this country would rather have an abortion than a kid with special needs. 90% of people in the United States -- one of the most pro-life countries in the developed world -- wouldn't even want to put such a child up for adoption. Of course, part of this is medical misinformation: people are not told what joy these kids can be.

But the point is, if we have government healthcare, are we going to find a political majority that is willing to pay for the kind of children that 90% would abort from their own wombs? Spina Bifida and Down's are expensive. If you would kill your own child, are you going to give up your nose job or vasectomy; are you going to choose to have coerced doctors; are you going to accept a tax hike that might keep you from shopping at Whole Foods, so that my son can have a wheelchair, regular urology consults, and emergency neurosurgery?

Maybe we kill these children because of medical misinformation. But is that misinformation going to change if we have government health care? Will there not be an even greater incentive to provide that misinformation, since my nose job -- or my good night's sleep, as a neurosurgeon -- depends on it? Why would my son not be the first one voted off the island?

By contrast, in a decentralized health industry, individuals can make the choice to put up that money. In fact, at present there exists an entire organization, the Shriners, who exist entirely to give health care, with private money, to kids with special needs. (The Shriners are Masons, and that makes me nervous, but that's beside the point.) Would the Shriners survive Obama's tax hikes on "the rich" -- that is, people who can afford to pay for my child's health care? (Their 22 hospitals are paid for by a $10.2 billion endowment; I'm guessing that didn't all come from circus tickets.) Would the Shriners survive a system in which all doctors are in the coercive employ of Uncle Sam -- and Uncle Sam is just a friendly euphemism for Nancy Pelosi?

I bring this up apropos of an article in The Australian. (The Australian, by the way, is the best-selling newspaper in Australia; this is not a kook fringe religious right scandal monger.)

THE Rudd Government is under pressure from all fronts, even Labor colleagues, to overturn a decision denying German doctor Bernhard Moeller permanent residency in Australia because his son Lukas has Down syndrome.

The Immigration Department this week rejected Dr Moeller's application for permanent residency, saying the potential cost to the taxpayer of 13-year-old Lukas's condition was too great.

. . .

"It is sad that in this modern day we are still viewing people with a disability, such as Dr Moeller's son, as a burden," Senator Bernardi said. "They can and do make significant contributions to our society."

More here.

I wonder who will decide whether my son, and children like him, makes a "significant contribution to our society." I wonder who makes that decision in Europe, where such children are not born. I wonder what would happen if the kid's dad wasn't viewed as "productive member of society." I wonder, if it comes down to it, whether American tax payers will choose a tax hike when told that kooky Christians want to bring children into the world with "massive genetic abnormalities." I wonder why they abort those children now.

A Little Electoral History

This post will diverge a little from the standard themes of this blog, but I guess we can say Civis supports always viewing things in light of history, and taking a clear sight of the real.

The election on Tuesday had a historic turnout. I think they're saying it was the highest since 1960 -- and given that 1960 was the year of notorious fraud, where Kennedy-Johnson beat Nixon through impossibly high turnouts in Daley's Chicago and Johnson's Texas, 1908 seems to stand as the last time this high a percentage of the electorate turned out to vote. That is interesting, but what does it signify?

Far more important for questions of mandate and "landslides" is what percentage of the vote Obama actually got. The Wall Street Journal has a nice chart on popular and electoral votes for every election since 1900.

Popular Vote
In the popular vote, Obama got 51.6% -- despite 96% of the black vote, overwhelming urban and college support, and lots of new voters. That puts him even or behind (ready for this?) TR I and II, Taft, Harding-Coolidge-Hoover (Hoover!)-FDR, Eisenhower I and II, Johnson, Nixon II, Reagan II, and H.W. Bush. It has been said that Obama got the highest percentage of the popular vote since 1988 -- but the last four elections have had strong third parties: Perot got 19% of the popular vote in '92 and 8% in '96; Nader got 3% in the ultra-close 2000. All we really see is that Obama beat Bush '04.

In fact, looking back, other than 2004, for every election in which the winner got a smaller percentage of the popular vote than Obama 2008, there was a much stronger explanation than Obama has. In 1912, TR ran against the incumbent Taft, splitting the Republican vote. In 1916, Wilson barely won reelection in light of the Great War in Europe. In '48 there were four candidates: not only Truman and Dewey, but also Strom Thurmond sweeping the South and Henry Wallace, whom Truman had fired for being too soft on Communism, picking off about 2.5% on account of his popularity in the Northeast -- and still the papers said Truman had lost. Kennedy lost the popular vote and cheated to win the electoral college. Nixon won in 1968 because George Wallace took the South and Bobby Kennedy was assassinated in June. I won't even begin with comparisons to Carter's 50.1% victory. And in 1980 Reagan won 50.8% of the popular vote and a 489-vote landslide in the electoral college despite John Anderson, whom Reagan had defeated in the Republican primaries, getting 6.6% as a moderate-Republican Independent.

In short, historically Obama's 51.6% running against an unpopular incumbent party with no significant third party is one of the weakest popular-vote victories on record -- with the one exception of Bush in 2004. What he won is not a landslide but a very close election. The high turnout is nothing in his favor; it suggests that people are more concerned than ever, yet very divided. Combined with his low score in the popular vote, the high turnout means not that Obama has a strong mandate, but that he will rule a very divided nation. Indeed, low turnout would be a much stronger sign that people felt confident about what was coming.

Electoral Vote
This is all the more important in the electoral vote. I should write a whole post on the importance of the Electoral College, but in sum, the Electoral College recognizes that there is no such thing as a single coast-to-coast national culture; the United States is a union of many different cultures, and the federal government must bring together, not just one or two, but all of the parts. To reject the Electoral College and let someone get elected president just by running up strong majorities in a couple coastal cities would create an even more divided country.

Obama won 349 electoral votes, a comfortable margin of victory (he only needed 270), but again, far from a landslide. 349 is more than George W. Bush got in either election. But it is less than any election through Reagan-Bush I-Clinton. It is less than Nixon II (a true landslide, against McGovern), Johnson, Eisenhower, Harding-Coolidge-Hoover-FDR, or Wilson I -- an election in which, as we saw, he got only 41.8% of the popular vote, but won because TR split the vote with Taft. Obama got more electoral votes than TR or Taft had in 1900, 1904, and 1908 -- but in 1908 there were only 487 electoral votes (there are 538 now), so that's not very impressive! In fact, his percentage of the College was comparable. Nothing historic.

Again, the electoral victories Obama exceeded were only Truman's (against Thurmond in the South), Kennedy's (a close race), Nixon I (against Wallace in the South), Carter (Carter!), and George W. Bush. Obama did not break 350 electoral votes. In the 28 elections since 1900, fully half broke 400, and three ('36, '72, and '84) broke 500. If we exclude those early elections, with a much smaller College, Obama's victory puts him at the 32nd percentile for Electoral College wins (the best measure of cross-the-country support). Since 1900, he is at about the 40th percentile for the popular vote, despite no significant third party.

And, to put it into perspective, the first George Bush did far better in the electoral and popular vote than Obama, but got thwapped in 1992, while Truman, whom history has judged very well, and Kennedy, whom Obama claims to emulate, both got less than 50% of the popular vote.

Where does this get us? The historic turnout in 2008 only indicates that people care about the election. But Obama's low margin of victory shows that the people of the United States are deeply divided, as they were in 2000 and 2004. Obama has not a mandate, but a very tenuous hold on a very fractured nation.

Let us hope that he does not abuse his power. And, as cultural and political conservatives, let us pray that reform in the Church helps the balance of the culture to tip our direction in the next decade.

Moralism and the Sense of God

My family recently happened to attend a school Mass at one of our local parishes. The pastor, a pretty good preacher, and a good priest, addressed kids aged kindergarten through high school. I can't recall what the readings were (not a good sign), but he preached on responsibility, how we can't just leave things for others to do, but have to take charge ourselves. The theme was decent in itself, and well preached, but it exemplified a danger for preachers, and indeed for all Christians: Christianity is not a moralism.

It is easy, in trying to make the faith "accessible" (as when preaching to kids), to speak in terms of putting the faith into practice -- and to reduce practice to moralism. (It is striking how "putting it into practice" has come to exclude praying, studying the faith, or frequenting the sacraments.) But as St. Thomas says, in practical things, the end is first: that is, if you do not know why you are doing something, do not know the goal you are trying to attain, you will never take the first step. When preaching excludes the reality of God in our lives, as if Christianity were primarily about "being a good person," goodness becomes pointless, and ultimately emasculated. Who cares about treating kindergartners nicely, or cleaning up the school yard, unless you know why these things matter?

I bring this up not to scourge preachers, or dear Fr. Mike, who really is a good priest, but to try to explain, again, the purpose of this blog. In my mind at least, this blog is about the intersection of faith and life. But I know I focus more on politics, economics, and urbanism, than on any religious themes. Has my blog fallen into the same kind of moralism?

To try to exculpate myself from that accusation, I need to introduce a distinction--and it is really the central distinction on which this blog rests. We might lable the distinction as the difference between a "practical" morality and a "contemplative" morality. (I am trying to side with the latter.)

An excessively practical morality is interested in "being a good person," in a purely earthly sense. Subjectively, there is something of keeping a clean conscience, and keeping clear of bad entanglements. In relation to the world, it is a matter of results: caring for the weak, making other people happy, etc. Let me stress: these are good things, and I do not mean to disparage them, any more than I want to disparage telling the big kids to watch out for the kindergartners and clean up messes.

But a truly Christian morality is above all contemplative. Which is to say, first, that it is directed to God: the purpose of being good is not goodness in itself, but the contemplative embrace, unitive prayer. Mother Teresa expressed this one way when she said she saw the poor as "Christ in his most distressing disguise." Dragging the poorest of the poor out of the streets of Calcutta was not about social work or "making the world a better place." It was about embracing Christ. And thus her hours of prayer before the Blessed Sacrament was not a means of attaining energy for her apostolate, but was the goal of her apostolate: she did what she did in order to embrace her God, and to be embraced by him. Such a worldview can only be maintained by a robust life of prayer: not just for divine assistance, but to train the heart to penetrate to the one thing necessary.

A corollary to this contemplative goal of morality is that it changes the norms of morality. Our care for the created world can be an embrace of the Creator only when we embrace it precisely as creation. Which is to say, truly Christian morality -- contemplative morality -- is not a matter of following rules, or seeking results, but of receiving the created world as a gift. And that means truly receiving the world as what it is, the way the Creator made it.

The purpose of this blog -- the purpose of my writings about urbanism, economics, political philosophy, and occasionally culture -- is to nourish this kind of contemplative, receptive view of man in the world. In this view, the question for morality is not "how ought things to be," or "how would we like the world to be," but "how did God make us? What has God given us?" To see God in politics is to embrace the world as he made it. The question is not what city would be prettiest, or most fun, but what nature did God give us, what is the nature of cities, what is the nature of human relations, and economies, and polities. We should see the world as something real: not just a blob to be shaped according to our visions, but a reality to be embraced; a norm for us, not just something on which we impose our moral norms.

Though it is receptive, this is not a passive view of politics. Abortion, for example, is not wrong just because we don't like it, or because it imposes on another persons rights, or because it threatens the rights of the rest of us (though all those things are true).

Rather, the Christian opposes abortion because it is contrary to nature. It is contrary to the nature of the mother, who is most herself in nourishing her child, and the nature of doctors, who are most themselves, who fulfill their nature, in healing, not killing. And it is contrary to the nature of neighbors to idly watch self-destruction: I can only be myself, be the social being I was created to be, by withholding the implement with which the troubled woman threatens to maim herself. And it is contrary to the nature of society to be heedless of its very foundation, the love of parents for children and the love that binds families together. I cannot be a citizen and not care for the right ordering of society. It's not just that I should or shouldn't. It's that I already am, by nature, a citizen. My task is to live like one, to embrace the task I have been given by what I am.

And that I am a citizen is not a choice, not a preference, not even a prudential decision, but a fact of my creation. I fight against abortion -- and against all the other things that threaten the nature of man -- not just because it's mean, or ugly, not only because God tells me to, but because so doing fulfills my nature. It is a matter of receiving the world God gave me, embracing him -- learning to embrace him, practicing to embrace him, receiving his embrace -- by treating Nature, the world and human nature as he choose it to be, as a gift from him, a place of encounter with Nature's God, the Creator.

This, I suppose, was the heart of Fr. Mike's preaching about taking care of kindergartners. It is the heart of my pontificating about how a life built around the automobile is not an authentically human life. But two things need to be said, again and again. First, the purpose of embracing our nature is to embrace the God who made it so. And second, because of this, morality is not about obligations or being kind, but about contemplating how the world is, and living accordingly. The purpose of this blog is to present a view of politics based on receiving the world as it is -- receiving the nature of economics, culture, cities, and polities -- not just fashioning them according to our better lights.