Conservative Theology

March 20, 2010

Religion and Politics / Fixing Healthcare


First of all, let me say that, while I agree that there are some terrible problems with American healthcare, it is nowhere near as broken as the demagogues claim.  However, I agree with the idea that we, as Americans, should work to increase access to health care.

However, I totally disagree that the way to do this is through insurance, whether single-payer or otherwise.  Insurance may be part of the problem, but it isn't the whole problem.  In fact, I would argue that a large part of the problem is that we are insuring things that simply shouldn't be insured.

For instance, my homeowner insurance doesn't cover the cost of lights that need replacing.  It covers catastrophic damage.  You know that an insurance policy is broken when you expect to use it.  Insurance only works right when you expect not to use it.  So, I would say that any vision of health care which continues the tradition in which routine doctor visits go through insurance (whether government or private), is about as insane as any vision of home ownership in which you present your State Farm policy to a Home Depot salesperson at the store entrance.

The issue that most people miss is right in front of them -- doctors.  I don't begrudge any doctor the amount of money they make.  What I do begrudge them is the monopoly they have on dispensing medical care.

What needs to happen is to legally separate basic medical care from advanced medical care.  There is no reason in the world why someone should see an M.D. for a runny nose.  None whatsoever.  In fact, I would guess that probably 80% of the medical work could be diagnosed and performed by nurses without any supervision.

The problem is that all medical care is lumped into one bucket.  It is true that a misdiagnossis can be problematic.  But what makes it problematic more than anything is that it comes from a doctor - someone who is supposed to know everything about medicine.  If, instead, we split medical care into two tiers - basic and advanced - it would do several things.

First of all, it would remove the expectation that the person giving basic medical care must be right.  This benefits the patient, since, if things aren't going well, they feel better about seeing someone else.  It also benefits the practitioner, since they are no longer legally assumed to be omniscient.

We need to be comfortable with the idea that there is a difference between giving medical care and practicing medicine.  There should be standard training so that nearly anyone can get the qualifications to give medical care to others.

Let's imagine that we allow all nurses with 5+ years of experience are free to give basic medical care without supervision.  In addition, we cap liability at $40,000 for people who are only giving basic medical care, and also don't require them to carry liability insurance.  This immediately provides a source of care that anyone should be able to afford, and expands the options available to everyone.

Shoot - if given the option, I would choose the nurse over the doctor anyway.  Doctor's forget that they are there to serve the patient, and instead feel the need to impose their own priorities on you.  Nurses are true servants, and are usually a pleasure to work with.  There are certainly many things that need an M.D. which a doctor just can't handle.  But imagine a system in which it was only those situations which got referred to the doctor, and everything else was handled by someone appropriately qualified.

We would have a similar problem in any industry where overqualification was required.  What if we required a degree in geology to be a miner?  What if we required a Ph.D. in computer science to be a network administrator?  What if we required a Ph. D. in biochemistry to mix drinks?  It is easy to see that having overqualified people raises the cost of an industry prohibitively, and prevents access to many.  Why is it that so few people see how that applies to medicine?

In Oklahoma, a nurse makes about $35 per hour.  This is the cost of many co-pays, and that pays for an entire hour of their time.  The average office visit costs about $150 and uses only 15 minutes of time.  Imagine the quality of health care that you would be able to receive for less than you are paying now if nurses get to run their own shows, and weren't liable in the same way that doctors are.

Medicine is not a black art.  It doesn't take an M.D. to give basic care.  It doesn't take an M.D. to know when you need to pass someone onto one (as a point of fact, it is always a nurse that runs triage).  If your goal is to provide a greater amount of access to a greater amount of people, and not just be a control freak, then the best way to accomplish that is to relax government regulations regarding who can deliver health care, and completely remove any mindset that says that using insurance to pay for basic care is normal.











March 11, 2010

Religion and Politics / Social Justice: the Theological Concept vs. the Political Concept


Jim Wallis has a new editorial where he *surprise* misses the point of a conversation entirely.  Wallis critiques Beck for telling his audience that they should leave their churches if they are teaching "social justice".  Now, while I think that's rather extreme, and that Beck should have phrased this differently, I don't really disagree.

The problem is that there are two meanings of social justice - there is a theological concept and a political concept.  The social justice theological concept, as Wallis correctly notes, is relatively uncontroversial within Christianity.  Based on what I know of what Beck says on the radio, Beck would agree with the theological concept of social justice.  Beck actually wants to return to the days when people helped each other, and politicians looked out for the people rather than tried to screw them.  Both of these things are part of the theological concept of social justice.

The social justice political concept, however, is quite pernicious.  It is, indeed, a way to bring radical leftist politics into public conversation using religion as a masquerade.  I've read books by authors that openly admit to doing this.  Shoot - I know people who openly admit to doing this.  They use religion as a tool for their political agenda.  That is, their interest in theology is only to use it as a means of pursuing their political agendas.  They wouldn't care about theology at all if it weren't such an effective tool.

The social justice political concept is basically Marxist philosophy decorated with the sayings of Jesus.  Most of it has the following basis for reasoning:

  1. Total resources are static
  2. Anyone who has more than someone else got that way by stealing it
  3. Only by putting "really smart" people in control of all of the resources can they be appropriately handled

Now, the way in which they are able to smuggle this through as being "Christian" is that the Bible has very little to say on #1 and #3, and because there have been people in the Bible for whom #2 applied, it can be safely generalized to everyone else.

However, the social justice political movement often forgets the things that are in the favor of conservative economics, like (1) reality, and (2) the rest of the Bible.

Most people don't know this, but a large portion of the Bible is about getting money (read Proverbs).  In fact, much of this points out that social injustice is not the only cause of poverty!  Sometimes it is the cause of poverty, but poverty can also be caused by poor choices.  And wealth can be caused by many small, good choices over a long period of time.

As far as reality goes, social justice politics simply ignores the fact that the largest causes of social injustice in the past have been bad economic systems.  If your economic system isn't producing enough to feed everyone, then any distribution of it is going to be socially unjust.  If your economic system is very abundant, then even your social injustice will be more socially just than the injustice of a bad economic system.

I think it was in a meeting between Gorbachev and Thatcher, where Gorbachev asked Thatcher how she fed her people.  This is the thinking of social justice - it was the job of Gorbachev (or other really smart people in the Politburo) to feed everyone.  This is insanity.  In reality, no matter how smart you are, you pale in comparison to the combined, specialized knowledge that is contained throughout the economy.  By centralizing decisions, you put your own wishes ahead of everyone else. I could go on, but instead I'll just refer you to Thomas Sowell's Basic Economics: A Common Sense Guide to the Economy.

The big problem, though, is that the political social justice people have been allowed to set the terms, definitions, expectations, and vision for what "social justice" is supposed to mean.  So, even when someone is not part of the "social justice" political group, often times their vision for what social justice is and looks like comes from the social justice politics.  We often forget that the pre-reflective perspectives we have on issues usually have a specific source.  Our common ideas of heaven and hell usually come not from the Bible, but from Paradise Lost and The Inferno.  That is true even if you have never read Paradise Lost or The Inferno.  Likewise, the picture that is often in our heads about social justice come not from the Biblical picture of social justice (though there are certainly connections, just as there are in Paradise Lost), or even from what we know about economics, but from the Marxist viewpoint that has been politically active promoting their perspective.

Therefore, while I disagree with Beck about saying that if someone says 'social justice' in the Church you should leave, I also think that Wallis is being horribly naive in his response.  All in all, I think that Beck is much closer to the truth than Wallis, because of the pervasiveness of the political social justice movement that inadvertantly (and sometimes intentionally) affects our view of theological social justice.