Kill Bill

Yes, more health care. As expected, al of the concessions of the house bill have been removed and then some! The senate bill is an abomination of death. There has been, of course, a lot of press about the abortion language in the bill, less so about euthanasia, so I thought I'd talk a bit about that. Of course, some people will immediately say “but the bill doesn't say we'll have euthanasia”, make a joke about “death panels” and start chanting “Sarah Palin” while rocking back and forth.

Yes, the bill doesn't say it will cover euthanasia explicitly. Then again it doesn't say it will cover cancer treatment, but we all expect it will. That's a silly argument, as the bill doesn't actually say what will be covered and what will not. But in fact, this bill does mention euthanasia, and in a very troubling way:

SEC. 1553. PROHIBITION AGAINST DISCRIMINATION ON ASSISTED SUICIDE.

(a) IN GENERAL.—The Federal Government, and any State or local government or health care provider that receives Federal financial assistance under this Act (or under an amendment made by this Act) or any health plan created under this Act (or under an amendment made by this Act), may not subject an individual or institutional health care entity to discrimination on the basis that the entity does not provide any health care item or service furnished for the purpose of causing, or for the purpose of assisting in causing, the death of any individual, such as by assisted suicide, euthanasia, or mercy killing.

This is a conscience clause for those who do not “provide any health care item or service” for the purpose of “causing the death of any individual”. So, there's no language saying that euthanasia won't be covered under the plan, and language that says but not every doctor has to offer it. As troubling (or more) to me is the terminology. A health care item or health care service is something to heal or promote life. Here it is explicitly stated that we are redefining as a health care item or health care service something that is intended to kill the patient.

But that's not all. In section 1323 of the bill, on page 186 it reads:

(F) PROTECTING ACCESS TO END OF LIFE CARE.—A community health insurance option offered under this section shall be prohibited from limiting access to end of life care."

So while an individual doctor might not offer euthanasia, all insurance plans must cover it, and therefore you and I must pay for it. This is pretty telling language for a bill that is supposed to not support euthanasia. If the bill is not going to support it, this language would be unnecessary.

Terminal-ogy

Before continuing on the topic, I'd like to clarify the terms I am going to use. There are different types of care: ordinary, palliative, proportionate and disproportionate. Ordinary care is, well, ordinary. It's the basic care we would give any human being at any time. It includes food, water, shelter from the elements, a reasonable room temperature. You are (hopefully) receiving ordinary care every day. Palliative care means relieving pain or other symptoms. When you take an ibuprophen or some cough medicine for a cold you are getting palliative care.

The Catholic Church requires that all people be given ordinary and palliative care. That means you are not to starve someone to death, leave them out in a blizzard, or withhold pain medication. The Catechism of the Catholic Church teaches:

2279 Even if death is thought imminent, the ordinary care owed to a sick person cannot be legitimately interrupted. The use of painkillers to alleviate the sufferings of the dying, even at the risk of shortening their days, can be morally in conformity with human dignity if death is not willed as either an end or a means, but only foreseen and tolerated as inevitable Palliative care is a special form of disinterested charity. As such it should be encouraged.

The rest of health care is further divided into two categories: proportionate and disproportionate. Proportionate health care must meet all of the following conditions. It must have a reasonable chance of curing or contributing to the cure of the patient. It does not carry a significant risk of death, and it must not be excessively burdensome. Setting a broken leg, for instance, is proportionate health care. Care that does not meet these three criteria is called disproportionate. The Catholic Church considers offering proportionate care to be mandatory, although the patient does not have to accept it. Disproportionate care is not considered mandatory.

2278 Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of "over-zealous" treatment. Here one does not will to cause death; one's inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

There is considerable room for debating whether a procedure is proportionate. A pacemaker might be considered proportionate, but in the case of a patient with a terminal illness or other serious health conditions the risks and burden might put it in the realm of disproportionate care. Every case must be examined on its own merits.

“Mercy” Killing

According to a report by the New York State Task Force on Life and the Law titled When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context (emphasis added by me):

“American society has never sanctioned assisted suicide or mercy killing. We believe that the practices would be profoundly dangerous for large segments of the population, especially in light of the widespread failure of American medicine to treat pain adequately or to diagnose and treat depression in many cases. The risks would extend to all individuals who are ill. They would be most severe for those whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, or membership in a stigmatized social group. The risks of legalizing assisted suicide and euthanasia for these individuals, in a health care system and society that cannot effectively protect against the impact of inadequate resources and ingrained social disadvantage, are likely to be extraordinary.

The distinction between the refusal of medical treatment and assisted suicide or euthanasia has not been well-articulated in the broader public debate. In fact, the often-used rubric of the 'right to die' obscures the distinction. The media's coverage of individual cases as a way of presenting the issues to the public also blurs the difference between a private act and public policy; between what individuals might find desirable or feasible in a particular case and what would actually occur in doctors' offices, clinics, and hospitals, if assisted suicide and euthanasia became a standard part of medical practice. Public opinion polls, focusing on whether individuals think they might want these options for themselves one day, also offer little insight about what it would mean for society to make assisted suicide or direct killing practices sanctioned and regulated by the state or supervised by the medical profession itself.”

Some people refer to euthanasia as “mercy” killing. The implication is that these people are “better off dead” because they are in pain or because they are suffering. The danger with this type of thinking is that instead of providing palliative care, our response to suffering is to kill. But killing is not palliative care. As Dr. Gregory Hamilton, the chair of Physicians for Compassionate Care, stated in an article in the Oregonian: "Comfort care results in a comfortable patient; assisted suicide results in a corpse.

I think it is important to recognize that the suffering “mercy” killing strives to end is that of those who don't want to watch, or care for, or bear the financial burden for those who are in need. As John Paul II wrote in Evangelium Vitae, "True 'compassion' leads to sharing another person's pain; it does not kill the person whose suffering we cannot bear."

When “mercy” killing is considered a viable option for health care, it becomes the preferred option by those who would seek to reduce costs. You can “mercy” kill someone for $35, while it is hard to find any reasonable medical treatment today that is cheaper. Legalized euthanasia will result in discrimination against the “undesirables” of society; the poor, the immigrant, the weak and elderly, and ultimately, their murder. As reported in Inside Catholic:

“Dr. Diane Meier, a former advocate of assisted suicide, said in a 1998 New York Times article, 'Legalizing assisted suicide would become a cheap and easy way to avoid the costly and time-intensive care needed by the terminally ill.'

Substantiating this claim is the fact that Oregon's Medical Assistance Program (OMAP) for the poor moved to provide physician-assisted suicide to its recipients as soon as the Death with Dignity Act was passed in 1997. Only 18 months later, the OMAP announced plans to cut back on pain medication coverage for the same population. Hospice care has also suffered -- the International Task Force reports that one Oregon insurance company has a paltry $1,000 cap on in-home hospice care. With the cost of a lethal overdose running about $35, there would be little motivation to pay any more for palliative treatment.”

Also, as noted, the issue is presented to the public by the media in a way which lumps all the issues into a single mass. The implication is that if any part is acceptable, the whole thing should be. Thus, many people equate euthanasia with refusal of treatment, when they are two radically different ideas. The difference is like the difference between a fireman being unable to save a life and the arsonist who set the fire. One is recognizing an inability to cure, the other is murder.

But Everything's Great in Europe!

Let's take a look at what has happened in a country that has euthanasia. According to the International Assisted Suicide and Euthanasia Task Force there are widespread abuses in countries that have euthanasia (bold is mine, italics are in original).

“The data indicate that, despite long-standing, court-approved euthanasia guidelines developed to protect patients, abuse has become an accepted norm. According to the Remmelink Report, in 1990:

• 2,300 people died as the result of doctors killing them upon request (active, voluntary euthanasia).(7)
  
• 400 people died as a result of doctors providing them with the means to kill themselves (physician-assisted suicide).(8)
  
• 1,040 people (an average of 3 per day) died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients' knowledge or consent.(9)
  
  
  
  • 14% of these patients were fully competent. (10)
    
  • 72% had never given any indication that they would want their lives terminated. (11)
    
  • In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible. (12)
    
  
  
  
• In addition, 8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the primary purpose of controlling pain, but to hasten the patient's death. (13) In 61% of these cases (4,941 patients), the intentional overdose was given without the patient's consent.(14)
  
• According to the Remmelink Report, Dutch physicians deliberately and intentionally ended the lives of 11,840 people by lethal overdoses or injections--a figure which accounts for 9.1% of the annual overall death rate of 130,000 per year. The majority of all euthanasia deaths in Holland are involuntary deaths.
  
• The Remmelink Report figures cited here do not include thousands of other cases, also reported in the study, in which life-sustaining treatment was withheld or withdrawn without the patient's consent and with the intention of causing the patient's death. (15) Nor do the figures include cases of involuntary euthanasia performed on disabled newborns, children with life-threatening conditions, or psychiatric patients. (16)
  
• The most frequently cited reasons given for ending the lives of patients without their knowledge or consent were: 'low quality of life,' 'no prospect for improvement,' and 'the family couldn't take it anymore.'(17)
  
• In 45% of cases involving hospitalized patients who were involuntarily euthanized, the patients' families had no knowledge that their loved ones' lives were deliberately terminated by doctors. (18)
  
• According to the 1990 census, the population of Holland is approximately 15 million. That is only half the population of California. To get some idea of how the Remmelink Report statistics would apply to the U.S., those figures would have to be multiplied 16.6 times (based on the 1990 U.S. census population of approximately 250 million).
  

Falsified Death Certificates ---In the overwhelming majority of Dutch euthanasia cases, doctors--in order to avoid additional paperwork and scrutiny from local authorities--deliberately falsify patients' death certificates, stating that the deaths occurred from natural causes. (19) In reference to Dutch euthanasia guidelines and the requirement that physicians report all euthanasia and assisted-suicide deaths to local prosecutors, a government health inspector recently told the New York Times: 'In the end the system depends on the integrity of the physician, of what and how he reports. If the family doctor does not report a case of voluntary euthanasia or an assisted suicide, there is nothing to control.' (20)

Inadequate Pain Control and Comfort Care -- In 1988, the British Medical Association released the findings of a study on Dutch euthanasia conducted at the request of British right-to-die advocates. The study found that, in spite of the fact that medical care is provided to everyone in Holland, palliative care (comfort care) programs, with adequate pain control techniques and knowledge, were poorly developed. (21) Where euthanasia is an accepted medical solution to patients' pain and suffering, there is little incentive to develop programs which provide modern, available, and effective pain control for patients. As of mid-1990, only two hospice programs were in operation in all of Holland, and the services they provided were very limited. (22)”

Consider more recent cases in the UK. According to the latest volume of the IAETF patients in the UK are being put in euthanasia protocols mistakenly or due to negligence or poor care. In the interests of brevity I will only cite two short passages:

An 80-year-old grandmother who doctors identified as terminally ill and left to starve to death has recovered after her outraged daughter intervened. Hazel Fenton, from East Sussex, is alive nine months after medics ruled she had only days to live, withdrew her antibiotics and denied her artificial feeding. The former school matron had been placed on a controversial care plan intended to ease the last days of dying patients. Doctors say Fenton is an example of patients who have been condemned to death on the Liverpool care pathway plan. They argue that while it is suitable for patients who do have only days to live, it is being used more widely in the NHS, denying treatment to elderly patients who are not dying. [Sunday Times, 10/11/09]

Fenton lived to tell the tale. Not so for 76-year-old Jack Jones. Jones was hospitalized in the belief that his previous cancer had recurred and was now terminal. The family claimed he was soon denied food and water and put into deep sedation. But his autopsy showed that he did not have cancer at all, but actually had a treatable infection. The hospice denied wrongdoing but paid £18,000 to Jones’s widow. [Daily Mail, 10/14/09]

It Can't Happen Here

You might think doctors here in the US would certainly not be part of starving someone to death or withholding medication, but it happens. Consider the case of Terri Schiavo. According to media reports she was allowed to die “naturally”. The fact is she was allowed to die slowly of starvation and dehydration, while her parents sat and watched for 13 days, not being allowed to give her food or water. I can only imaging what it would be like to watch my child die, knowing that I could prevent it except the state forbade me from doing so.

Then there's the case of baby Gabriel.  The East Tennessee Children's Hospital (ETCH) “ethics” panel decided not to treat baby Gabriel, specifically the hospital was going to stop feeding him milk and giving him his medications. According to an Alliance Defense Fund press release:

“After doctors decided that Baby Gabriel was not worth treating, ETCH started discriminating against him by denying his basic care. Staff stopped bathing him, ceased applying cream to alleviate his chapped skin, reduced his diaper changes, and have not allowed his physical therapy. ETCH doctors have also discouraged Palmer's attempts to have her son transferred to other medical facilities where he could receive treatment.”

Consider the case of Barbara Wagner. Barbara was diagnosed with lung cancer and was hen told that the treatment prescribed by her oncologist would not be covered by insurance. Instead she was told the “health” plan would cover an alternative treatment, doctor-assisted suicide.

"'Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit of the Oregon Health Plan,' read the letter notifying Wagner of the health plan's decision.

Wagner says she was shocked by the decision. 'To say to someone, we'll pay for you to die, but not pay for you to live, it's cruel,' she told the Register-Guard. 'I get angry. Who do they think they are?'"

So these things do happen, today, and they happen against the wishes of patients and their families in our “free” country. Do we really want to make this the norm, rather than the exception?

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The Horse's Tale

There once was a horse who lived in peace and freedom, except for one thing. He knew there were wolves nearby, and he was afraid they would come and attack him some day. He knew this, even though they had not shown themselves, because for some time he had been hearing them howling at night.

There was also a man living nearby. The horse and man had never been friends, because the horse wasn't quite sure the man was trustworthy. Although he wasn't a bad man, he had his own goals and looked out for his own interests, which didn't necessarily coincide with the best interests of the horse.

One day the man approached the horse. He said "I know you're afraid of those wolves. I've been hearing them too. I know that you don't always trust me, but I am willing to help you so that we can both rid ourselves of these wolves."

The man went on to explain that although he had a club to beat the wolves, he couldn't stay up all night and watch for them, so he wanted to get rid of them once and for all. He needed the horse's speed to catch the wolves so he could get close enough to use his club.

The horse was still suspicious of the man's motives, though, and refused. But after a few nights of listening to the howling of the wolves coming closer, he was desperate for a solution. One Saturday evening he acceded to the man's wishes. The man quickly got a bridle and saddle and put mounted the horse.

The horse bravely started out towards the forest, where he thought the wolves lived. "Get your club ready!" said the horse, but the man just pulled on the reins, dug in his spurs, and howled.

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You want me to do what!?

The Constitution of the United States of America, in the Bill of Rights, explicitly guarantees you the right to free exercise of religion, but I am not required to pay for your religion.

The Constitution of the United States of America, in the Bill of Rights, explicitly guarantees you the right to free speech, but I am not required to pay for your air time to speak it.

The Constitution of the United States of America, in the Bill of Rights, explicitly guarantees you the right to free press, but I am not required to buy your paper.

The Constitution of the United States of America, in the Bill of Rights, explicitly guarantees you the right to assemble, but I am not required to rent you a convention hall.

The Constitution of the United States of America, in the Bill of Rights, explicitly guarantees you the right to bear arms, but I am not required to buy you guns and ammunition.

The Constitution of the United States of America, in... well, where is it? They claim it's in amendment 14^*, but there's nothing in there about abortion... oh, it's implied but not mentioned - and you want me to pay for it?

* Amendment 14 - Citizenship Rights. Ratified 7/9/1868.
1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
2. Representatives shall be apportioned among the several States according to their respective numbers, counting the whole number of persons in each State, excluding Indians not taxed. But when the right to vote at any election for the choice of electors for President and Vice-President of the United States, Representatives in Congress, the Executive and Judicial officers of a State, or the members of the Legislature thereof, is denied to any of the male inhabitants of such State, being twenty-one years of age, and citizens of the United States, or in any way abridged, except for participation in rebellion, or other crime, the basis of representation therein shall be reduced in the proportion which the number of such male citizens shall bear to the whole number of male citizens twenty-one years of age in such State.
3. No person shall be a Senator or Representative in Congress, or elector of President and Vice-President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may by a vote of two-thirds of each House, remove such disability.
4. The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned. But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.
5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article.

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Things I Wish I'd Thought Of

Sometimes I see news stories about someone becoming rich off an idea and someone inevitably says “I wish I'd thought of that!” Things like the iBeer iPhone app. This is an essential application for any iPhone or iPod touch owner. It simulates actual beer that sloshes around and "pours" according to the movement of the phone. Here's a guy who spends some time writing a program and it goes viral and he sells a million copies of it. Or maybe something like Ruth Wakefield's story. She put pieces of chocolate in her cookies, expecting them to melt, and invented the tool house cookie (aka chocolate chip). She didn't become rich, but did get a lifetime supply of chocolate. Yum!

The people of whom I am most envious, however, are not the “viral video” types, but a class of people I call “ethical entrepreneurs”. These are people who come up with an idea or product that not only benefits them, but also the poor or neglected members of society. How good would it feel to go to work every day knowing that the world was a better place because of what you do? we all like to think we do our small part, but sometimes it would be nice to see something concrete.

Suzanne Sadler thinks so too. Her blog "The Entrepreneurial Catholic" is all about family enterprise. Working for yourself and your family, while serving others is a truly Catholic way to work and live. Only a few posts, so far, but she has some great advice and ideas for starting a business that will change your life and other lives as well.

So what kinds of things do I admire? One of the inventions I like is the “Q drum”. This is a donut shaped plastic container that enables someone to easily transport up to 50 liters of water from a water source by pulling it along the ground. This is a big help for people living in areas without a safe water source in their home. Another is this human powered irrigation pump. It can help poor farmers in undeveloped areas grow more crops and be less dependent on weather. Suzanne Sadler called to my attention the safe bottle lamp. This is a simple kerosene lamp that won't cause a fire if it tips, helping to save third world children and families from burns or death.

Then there's the "Freedom Leg" from Forward Mobility. This is a lightweight brace that replaces crutches by redistributing force to the upper leg. It's more comfortable and helps strengthen the upper leg muscles. The company uses Kids First Enterprise to manufacture its devices in Vietnam. Twenty percent of that Kids First's workforce is disabled, and all of its profits go to projects that support the disabled and disadvantaged. How cool is that?

Of course, my area of expertise is computers, and you don't find many poor impoverished people needing software. However, the other day I came across this cool invention. With a few cheap parts and some software this inventor has found a way to turn a cell phone into a holographic microscope. In many places in the world, access to a medical lab or hospital may be difficult or impossible, but cell phones are everywhere. A doctor even in a remote area could use this invention to diagnose certain diseases.

So, got any good ideas you're willing to share? I'm interested.

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Grace and Taxes

I've been wanting to write this for a long time, but the words would not come. Recently, I read several pieces, by Matt Warner and others, that said what I wanted to say with enough eloquence to make me want to copy their work and add my own meager words to it.
I don't support the health care plan passed by the house recently. As you know, I've been attacked for being selfish and “un-Christian”, since how can you deny the right of the poor to have healthcare? Well, the easy response to give was the most obvious flaw in the healthcare plan; that it would support and fund abortion. In theory it does not, although I truly believe that the concessions made by the Stupak amendment will be watered down or removed entirely before the senate is done.

So I could continue to argue about abortion coverage, or euthanasia, or other life issues, but that is all probabilistic argument right now. Instead, there are the harder-to-explain (at least for me) reasons. For many of my friends the reason is money. They are already overtaxed, and with faltering economy, high unemployment, and depleted savings, the last thing they want is congress to spend another $1,000,000,000,000.00 (remember when the U.S. Deficit hit that number a few years back? Now we're talking about spending that much money in one bill in addition to the rest of the budget).

But although I don't want any more taxes, and I think spending money you don't have is ridiculous and criminally irresponsible I have reasons that bother me as much or even more. At the risk of sounding cryptic, I sum up my reason as “there is no grace in paying taxes”. Let me expound on that a bit.

Jesus explains in Matthew 25:34-40 (quoted from the New American Bible http://www.usccb.org/nab/bible/matthew/matthew25.htm)

Then the king will say to those on his right, 'Come, you who are blessed by my Father. Inherit the kingdom prepared for you from the foundation of the world.
For I was hungry and you gave me food, I was thirsty and you gave me drink, a stranger and you welcomed me,
naked and you clothed me, ill and you cared for me, in prison and you visited me.'
Then the righteous will answer him and say, 'Lord, when did we see you hungry and feed you, or thirsty and give you drink?
When did we see you a stranger and welcome you, or naked and clothe you?
When did we see you ill or in prison, and visit you?'
And the king will say to them in reply, 'Amen, I say to you, whatever you did for one of these least brothers of mine, you did for me.'

From this passage and others we get the seven “corporal works of mercy” which are:

• Feed the hungry
• Give drink to the thirsty
• Clothe the naked
• Shelter the homeless
• Visit the sick
• Visit those in prison
• To bury the dead

One can clearly extend the “visit the sick” to mean “care for the sick” and conclude “we must pass healthcare legislation!” But just because legislation says it will care for the sick, does that make it an appropriate remedy?

What I mean by “no grace in paying taxes” is this. When I perform corporal works of mercy I m doing God's work. When I pay my taxes, am I doing God's work? I have no choice in the matter, so I am not choosing to do these things. On the contrary, anyone who does not pay taxes is fined and in the case of healthcare thrown in prison as well.

Likewise, since money is fungible I can't even claim that my money went to help the uninsured. In Luke 20:22-25 Jesus is posed a question about taxes

Is it lawful for us to pay tribute to Caesar or not?"
Recognizing their craftiness he said to them,
"Show me a denarius; whose image and name does it bear?" They replied, "Caesar's."
So he said to them, "Then repay to Caesar what belongs to Caesar and to God what belongs to God."

I've heard that used to defend paying taxes for healthcare legislation. But I'll note two interesting things. First off, Jesus does not say it is good to pay taxes or even right to pay taxes. He says it is lawful to pay taxes. In other words, you are not sinning when you pay taxes. But the cool thing is that there is always another level (usually many) in every Gospel story.

Jesus tells the scribes and chief priests that they should pay Caesar the coin, which belongs to Caesar because it has Caesar's image on it. He also tells them to repay to God what belongs to God. What do you suppose we have that is made in the image of God? Ourselves. That giving of ourselves is not part of paying the tax, but in addition to it. We can't sit back, pay taxes once a year and say “I have fulfilled a moral obligation.” we personally need to feed the hungry, give drink to the thirsty, clothe the naked, shelter the homeless, visit the sick and imprisoned and bury the dead. Forcing others (and being forced ourselves) to do it is not in keeping with the Gospel.

Matthew Warner has expressed it succinctly and far more beautifully than I can in his post at Fallible Blogma “A Tired Democracy”:

There will always be people in need. We must help them – not empower some ultimately corrupt government to do so on our behalf. Jesus commanded us to love/feed/help/clothe others. Nowhere does he teach that we are to force others to do so on our behalf. And I would challenge every Christian out there who continues to attack “rich” people they’ve never met, and those of you who demand and empower our government to take from one to give to another, to search your heart as to whether Jesus would ever do that? Or to find one place where Jesus calls us to do that?

Lastly, there is subsidiarity. I had internalized the definition of this word many years ago, without having the word to describe it. I only came across it in the Catechism of the Catholic Church recently, and it has been used often by the bishops in discussions of the current healthcare legislation. The CCC has this to say (http://www.vatican.va/archive/catechism/p3s1c2a1.htm#I):

1883 Socialization also presents dangers. Excessive intervention by the state can threaten personal freedom and initiative. The teaching of the Church has elaborated the principle of subsidiarity, according to which "a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to co- ordinate its activity with the activities of the rest of society, always with a view to the common good."

1885 The principle of subsidiarity is opposed to all forms of collectivism. It sets limits for state intervention. It aims at harmonizing the relationships between individuals and societies. It tends toward the establishment of true international order.
So we have to examine the question, “is healthcare reform necessary on a national level?” I would argue that some forms of healthcare reform are appropriate on a national level. Things like interstate competition between insurance companies, and availability of generic treatments from foreign sources should be addressed at a national level. Sadly, none of these issues is addressed by the current health care bill.

Bishop James Van Johnson had this to say in “Skinning the Health Care Cat"  (which I also quoted in “Why I Can't Support the Health Care Bill Part II” and which I will repeat part of here - color added to text by me):

“One might legitimately ask if giving a large, inefficient, but powerful bureaucracy like the federal government control of health care is a wise move. For one, this runs counter to the well-known principle of subsidiarity, so prominent in Catholic social teaching: “a community of a higher order should not interfere in the internal life of a community of a lower order, depriving the latter of its functions, but rather should support it in case of need and help to coordinate its activity with the activities of the rest of society, always with a view to the common good."

How much of a role the government should have is a matter of prudential judgment. However, there are ethical dimensions to this question. Certainly, it has a role to play, but that does not necessarily mean that it should be the sole provider of health care. The government can act to remove abuses, and to regulate the health care industry so that the markets efficiently serve all the people.

Archbishop Joseph Naumann and Bishop Robert Finn have this to say in “Principles of Catholic Social Teaching and Health Care Reform” (text colored by me - I didn't have the audacity to color any of the popes' text - it is all relevant):

The writings of recent Popes have warned that the neglect of subsidiarity can lead to an excessive centralization of human services, which in turn leads to excessive costs, and loss of personal responsibility and quality of care.

Pope John Paul II wrote:

“By intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients, and which are accompanied by an enormous increase in spending.” (Pope John Paul II, Centesimus Annus #48)

And Pope Benedict writes:

“The State which would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person—every person—needs: namely, loving personal concern. We do not need a State which regulates and controls everything, but a State which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need. … In the end, the claim that just social structures would make works of charity superfluous masks a materialist conception of man: the mistaken notion that man can live ‘by bread alone’ (Mt 4:4; cf. Dt 8:3)—a conviction that demeans man and ultimately disregards all that is specifically human.” (Pope Benedict XVI, Deus Caritas Est #28)

While subsidiarity is vital to the structure of justice, we can see from what the Popes say that it rests on a more fundamental principal, the unchanging dignity of the person. The belief in the innate value of human life and the transcendent dignity of the human person must be the primordial driving force of reform efforts...

It is very clear that, respectful of this principle, we must find some way to provide a safety net for people in need without diminishing personal responsibility or creating an inordinately bureaucratic structure which will be vulnerable to financial abuse, be crippling to our national economy, and remove the sense of humanity from the work of healing and helping the sick.

The Church clearly advocates authentic reform which addresses this obligation, while respecting the fundamental dignity of persons and not undermining the stability of future generations.

Both of us in our family histories have had experiences that make us keenly aware of the necessity for society to provide a safety net to families who suffer catastrophic losses. Yet, these safety nets are not intended to create permanent dependency for individuals or families upon the State, but rather to provide them with the opportunity to regain control of their own lives and their own destiny...

For example, legislation that excludes legal immigrants from receiving health care benefits violates the principle of solidarity, is unjust and is not prudent. In evaluating health care reform proposals perhaps we ought to ask ourselves whether the poor would have access to the kind and quality of health care that you and I would deem necessary for our families. Is there a way by which the poor, too, can assume more responsibility for their own health care decisions in such manner as reflects their innate human dignity and is protective of their physical and spiritual well being?

So, even with the Stupak amendment I oppose the current health care legislation. Aside from the fact that I believe it will bankrupt our economy and do more harm to citizens and good, I have these objections. It still contains at least the capacity (and arguably the reality) of life issue abuses. It is unjust. It violates principles of subsidiarity. And it supplants good works with corrupt buearocracy.

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Urgent that you tell Congress to vote "NO" on Obamacare

As reported at http://www.cnn.com/2009/POLITICS/11/04/health.care/index.html

Washington (CNN) -- House Democratic leaders have put the finishing touches on their health care bill and could bring it to the full chamber as soon as Friday.
House Majority Leader Steny Hoyer of Maryland, the chamber's second-ranking Democrat, said Wednesday that the bill would probably come to a final vote Saturday.
A 42-page manager's amendment posted Tuesday night made mostly technical changes in the nearly 2,000-page health care bill compiled from three Democratic proposals passed by three House committees.

This means that the existing bill, without any pro-life concessions or amendments, will be put to a vote this week. If this bill passes it will mean the largest expansion of abortion since Roe v Wade, and your tax dollars will be directly paying to murder innocent human life.

Please CALL (too late to write) your representative and tell them to vote NO on the health care bill! You can find the phone number to call at

http://www.visi.com/juan/congress/
http://www.congressmerge.com/onlinedb/
http://www.numbersusa.com/content/congress/phone-numbers-and-mailing-addresses-memb.html

If you don't know who your representative is, you can find that information on those sites by entering your address.

You can call any time of day or night (like right now). You will not be speaking to a person, but an answering machine. Simply say you urge them to vote NO on the health care bill. Leave your name and address. That's all you have to do, and it will take less than one minute. Please don't put this off!

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Money is Fungible

Last year for my birthday my mother gave me a check, with the admonishment “Don't put this in the bank. Use it to treat yourself to something nice.” Of course, the check went straight into the bank account. I did treat myself to something nice (some books) but I paid for that with a credit card and paid the credit card with another check. Did that check that I wrote use the same dollars form the check she gave me? Who cares? Money is fungible.

Money is what? Fungible. It's not only fun to say, it's true. Something is fungible if individual units of that thing are interchangeable. So a United States ten dollar bill can be exchanged for any other United States ten dollar bill (barring the fact that a numismatist might favor one over the other). Or to put it another way, there's no way to tell whether the money my mother gave me was the money used to buy the books, and it doesn't matter!

Other things are fungible as well. Gold, oil, wheat, electrons – the list is endless (well, long at least). The fun part about fungibility (yes, it's a real word) is how you can use it to manipulate public opinion to support legislation.

Let's take schools, for instance. If you go to public school, the state pays all your expenses. Teachers' salaries, books, a building, perhaps a nice library, playground, etc. are all paid for by the tax payers. Catholic schools perform the same function as public schools and have the same expenses, but the state doesn't fund them. Why not? The specter of “separation of church and state” rears its ugly head (oh there will be more blog posts on that topic). Since money is fungible, if the state gives one dollar towards teacher's salaries, part of that dollar might somehow wind up paying for a crucifix for a classroom, and we can't have that.

So let's accept that money is fungible and get on with our lives. But wait! According to the Capps amendment to our current health care bill, we can have abortions covered, but they will only be paid for by the money from premiums. Your tax dollars won't be the dollars that pay for that. All of a sudden, money has become un-fungible (and no, that's not a word) when it suits the agenda of politicians.

This week there will be an important vote (hopefully) on this bill. Please call or write your representatives immediately and tell them abortion is not health care, and we don't want to pay for it. Tell them to support the Stupak amendment. You can find you representative's contact information by going to http://www.house.gov/ and entering your zip+4 code in the top left. A phone call would be best, but at least visit http://usccb.org/action and send them an email. Do this now. We are out of time to act on this. Thanks.

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