That wasn't the interpretation in post 13 at all. . . . it is you who have actually extrapolated that definition. Here is what I said. . .
I am not a socialist nor do I advocate a socialist state. God wants us to depend on Him and Him alone. . . . okay. . . at the end of your work week. . . tell your employer God has you covered and say no thanks to your pay check.
Who are we to tell God how He will provide for those in need?
Everyone must submit to the governing authorities, for there is no authority except from God, and those that exist are instituted by God. 2 So then, the one who resists the authority is opposing God's command, and those who oppose it will bring judgment on themselves. 3 For rulers are not a terror to good conduct, but to bad. Do you want to be unafraid of the authority? Do good and you will have its approval. 4For government is God's servant to you for good. But if you do wrong, be afraid, because it does not carry the sword for no reason. For government is God's servant, an avenger that brings wrath on the one who does wrong. 5 Therefore, you must submit, not only because of wrath, but also because of your conscience. 67 Pay your obligations (to everyone: taxes to those you owe taxes, tolls to those you owe tolls, respect to those you owe respect, and honor to those you owe honor.
Government does not take the place of God. . . but God uses governments. . . for His purposes. In our society. . . which is governed. . . we have social welfare programs in place to help care for the needy. Thank God.
I think you are arguing a point that was never made.
We have a secular gov't which embraces the care and concern for it's citizens. . . . you call this a grave evil because it is the STATE doing this and God wants us to depend on Him.. . . . my point is. . . all good gifts come from God. It IS God who gives the bounty of food on the table. . . . whether it comes from the food stamp program or your paycheck. . . . one way or another. . . the food, clothing, and shelter we have ALWAYS comes from God. . . NO MATTER how it is paid for . . . . . a gov't voucher or a paycheck.
God sets up government for His purpose. . . . to wield the sword. . . . keep the peace. . .not even a tyranny will allow lawlessness. You want to protest the use of gov't money collected in taxes for the use of social programs. . . . SOCIAL PROGRAMS. . . I think your outrage and use of hyperbole such agrave evilis sadly misplaced.
Is it any LESS God's blessing because it doesn't come from the source YOU believe it should? I pointed out to you that God has even used bad men for His purposes. . . He can use what He wants and when hungry people eat. . . it is a blessing from GOD.
I never said Christians should not resist gov't. . . . read Acts chapter 5. . . . it is better to obey God rather than men. . . . and it is also right to have regard for good things in the sight of all men.
The reason I am so blasted opposed to government assistance programs is not out of a desire to not feed the poor, it is because the programs damage our society as a whole. They tend to create a culture of entitlement rather than a culture of obligation. It's that simple.
I think we both agree that individuals have obligations to the poor. I think our point of disagreement is whether individuals can fulfill those obligations through government action or whether those obligations must be fulfilled directly by that individual. I have cited Biblical examples of where individuals have obligation but have asserted that there is no basis in either the Bible or in the tradition of the early church showing that this should be translated to the government. If you can show me, out of either Scripture or out of the tradition of the early church to show me where I'm wrong, I'll be happy to review that.
Your example from Romans 13 shows that I am obliged to pay my taxes and be a good citizen. But it does not put an obligation on the government to care for the poor. Therefore, the obligation still resides with the people.
You may think that I have a very narrow, Biblical view. I know a lot of Calvinists who would gravely disagree with you. But I'll accept your slam on me. After all, Christ and His message should change society...society should not attempt to change Christ and His message.
You have a good point about us not living in a theocracy. We don't and I'm thankful for that, because my particular brand of Christianity has been suppressed by the majority in this country in the past and would surely be again in the modern day if it was allowed. Despite the fact that we do not live in a theocracy, I am still obliged to follow my moral conscience, which is formed through my religious beliefs. The difference is that I have to respect the rights of others to disagree with my specific religious beliefs. It does not mean that I have to not follow my conscience, properly formed, in discourse.
As to the country being blessed, we will likely have to disagree on this. I believe that the country is blessed by God only to the degree that the society and its members live godly lives. That does not mean a theocracy, that means walking upright in our day to day lives.
Mark,
We don't live in a Christian country. . . . be glad we as a people embrace Christian values. You can't tell someone who is not a follower of Christ to do as He commanded. They reject Him. Why would you expect them to individually do what He says? You seem to want to impose that view? Jesus doesn't impose Himself. . . . he offers Himself.
When we as a society seek collectively to do the things He would have us do. . . .you call this "grave evil". . . . I think it is a small miracle.
You say it creates a culture of entitlement. . . . you, that is your opinion. . . . . I look at it much differently. . . as I have seen people on the brink of despair receive assistance. . . . it is a blessing. . . a safety net. . . . poverty is cruel Mark.
We as Christians need to be working within our culture to effect change. . . . with the gospel. . . once you start imposing narrow parameters on people who are seeking to help others. . . . you have something ugly and you are headed to a man made imposed theocracy.
To Add: When did food, clothing, and shelter become an entitlement? Seriously? If we receive these things with thankfulness. . . . I just don't get it. . . . . . I never will. . . . would you rather they go hungry. . . . I cannot believe that. . . so be glad people down trodden and hurting have a good meal . . . . be thankful God does provide.
We wonder why evangelicals get such a bad name? Could it be because they call things like food stamps for a mother with kids grave evil. It doesn't make God look so nice either. I wonder if Jesus made sure everyone had a job when he fed the 5000.
Yes, why did God send his "only begotten son" to save you from your sins, when he already gave you a law. If you would have only worked hard enough, you could have saved yourselves. Now he has created this system where you are reliant on Him instead of you being self reliant! Where does this welfare state come from? How dare the government take His place. Collecting your taxes due and being a "big brother" is His job not theirs!
"Culture of entitlement" is often code for ". . . the poor are unworthy, lazy users and deserve their grinding poverty. . . " and it doesn't usually come from those living hand to mouth.
That's weird. There's only so much to go around, so somebody has to take the short end of the stick. "worthiness" and "entitlement" are kind meaningless labels I would think. It probably helps those who have feel better about themselves. There will always be poor, and nothing can be done about it.
That wasn't the interpretation in post 13 at all. . . . it is you who have actually extrapolated that definition. Here is what I said. . .
I am not a socialist nor do I advocate a socialist state. God wants us to depend on Him and Him alone. . . . okay. . . at the end of your work week. . . tell your employer God has you covered and say no thanks to your pay check.
Who are we to tell God how He will provide for those in need?
Everyone must submit to the governing authorities, for there is no authority except from God, and those that exist are instituted by God. 2 So then, the one who resists the authority is opposing God's command, and those who oppose it will bring judgment on themselves. 3 For rulers are not a terror to good conduct, but to bad. Do you want to be unafraid of the authority? Do good and you will have its approval. 4For government is God's servant to you for good. But if you do wrong, be afraid, because it does not carry the sword for no reason. For government is God's servant, an avenger that brings wrath on the one who does wrong. 5 Therefore, you must submit, not only because of wrath, but also because of your conscience. 67 Pay your obligations (to everyone: taxes to those you owe taxes, tolls to those you owe tolls, respect to those you owe respect, and honor to those you owe honor.
Government does not take the place of God. . . but God uses governments. . . for His purposes. In our society. . . which is governed. . . we have social welfare programs in place to help care for the needy. Thank God.
I think you are arguing a point that was never made.
We have a secular gov't which embraces the care and concern for it's citizens. . . . you call this a grave evil because it is the STATE doing this and God wants us to depend on Him.. . . . my point is. . . all good gifts come from God. It IS God who gives the bounty of food on the table. . . . whether it comes from the food stamp program or your paycheck. . . . one way or another. . . the food, clothing, and shelter we have ALWAYS comes from God. . . NO MATTER how it is paid for . . . . . a gov't voucher or a paycheck.
God sets up government for His purpose. . . . to wield the sword. . . . keep the peace. . .not even a tyranny will allow lawlessness. You want to protest the use of gov't money collected in taxes for the use of social programs. . . . SOCIAL PROGRAMS. . . I think your outrage and use of hyperbole such agrave evilis sadly misplaced.
Is it any LESS God's blessing because it doesn't come from the source YOU believe it should? I pointed out to you that God has even used bad men for His purposes. . . He can use what He wants and when hungry people eat. . . it is a blessing from GOD.
I never said Christians should not resist gov't. . . . read Acts chapter 5. . . . it is better to obey God rather than men. . . . and it is also right to have regard for good things in the sight of all men.
Well, thank you very much for clarifying that point. Now we can move beyond that and deal with the real subject.
Yes, I do believe that the government, particularly the national level government, providing social assistance, particularly long-term social assistance, is a grave evil.
Sorry that you feel that it is a narrow, Biblical view (I guess that is supposed to be a bad thing). And, with reference to somebody in the peanut gallery, it grieves me that my views make Evangelicals, in general, look bad :blink: .
It might be of some comfort to let you know that I am not the only one who holds those views. Let me give you a couple of examples:
In recent years the range of such intervention has vastly expanded, to the point of creating a new type of State, the so-called "Welfare State". This has happened in some countries in order to respond better to many needs and demands, by remedying forms of poverty and deprivation unworthy of the human person. However, excesses and abuses, especially in recent years, have provoked very harsh criticisms of the Welfare State, dubbed the "Social Assistance State". Malfunctions and defects in the Social Assistance State are the result of an inadequate understanding of the tasks proper to the State. Here again
the principle of subsidiarity
must be respected: 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.
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. In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbours to those in need. It should be added that certain kinds of demands often call for a response which is not simply material but which is capable of perceiving the deeper human need. One thinks of the condition of refugees, immigrants, the elderly, the sick, and all those in circumstances which call for assistance, such as drug abusers: all these people can be helped effectively only by those who offer them genuine fraternal support, in addition to the necessary care.
Karol Wojtyla, Hundred Years (1991), paragraph 48
And then another one:
As history abundantly proves, it is true that on account of changed conditions many things which were done by small associations in former times cannot be done now save by large associations. Still, that most weighty principle, which cannot be set aside or changed, remains fixed and unshaken in social philosophy: Just as it is gravely wrong to take from individuals what they can accomplish by their own initiative and industry and give it to the community, so also it is an injustice and at the same time a grave evil and disturbance of right order to assign to a greater and higher association what lesser and subordinate organizations can do.
Achille Ratti, Forty Years (1931), paragraph 79
The two passages above illustrate that my views might not be quite so narrow and "Biblical" as you might consider on first blush. Or at least that there are other narrow-minded people out there who believe as I do.
We have had a fairly significant amount of "social assistance" payments go out since LBJ declared "war" on poverty. You can see that we are spending somewhere in the neighborhood of three quarters of a trillion dollars a year on it. But yet it is utterly ineffective.
The above chart, based on <a href="http://www.census.gov/hhes/www/poverty/histpov/hstpov4.xls">census numbers, show that since 1966 the relative level of poverty is the same in 2007 as they were in 1966. The blue line represents the poverty rate reported by the Census Bureau. The black line is a "trend line."
After spending trillions of dollars on poverty, you'd think that the number would shrink. Think about this a second: In 2007, $724 billion was spent on "human resource" programs (I exclude both Medicare and Social Security, as well as veterans health). There were 7,623,000 families identified as living below the poverty line. You could give each one of those families $94,987 for the amount of money spent on those programs. And this is not just this one time: it has been along that order every year for at least the past 10 years. Don't believe me? Look it up yourself. I gave you the links to the documents.
Bottom line: In addition to being morally wrong, this federal government sponsored "social assistance" paradigm simply doesn't work.
We wonder why evangelicals get such a bad name? Could it be because they call things like food stamps for a mother with kids grave evil. It doesn't make God look so nice either. I wonder if Jesus made sure everyone had a job when he fed the 5000.
Just to let you know, since I'm the one arguing against it (and used the term "grave evil"), I'm not an Evangelical.
As to Jesus feeding the 5,000, I never realized Jesus was a representative of the civil government.
wouldn't the "poverty population" remain somewhat constant due to immigration?
One might think so, but in the Excel sheet from the Census that I linked to above, it shows the poverty rate for Hispanic families being pretty much constant, as well, even though the number of total families (both below and above poverty) rose dramatically. (And that is something that the utterly closed borders types should consider in their rhetoric)
Bottom line: In addition to being morally wrong, this federal government sponsored "social assistance" paradigm simply doesn't work.
Graphs. . . charts. . . JP2???
The reason I say you take a narrow biblical perspective is because you take one thing Jesus directed we as Christians to do. . . . and extrapolate or to be blunt. . . justify. . . an entire political agenda. You magnify one portion of scripture and interpret it to mean something it doesn't. It doesn't make any sense to me. Why are you saying that it is a grave evil for the government to offer social assistance programs? Because that is not the way Jesus commanded Christians to treat the poor?
What does one have to do with the other?
The last time I checked we had a secular gov't . . . a Muslim rep. . . atheists. . . gays. . . a Jewish Senator. . . we are not a theocracy. Not a Christian nation.
Why then do you call what they do as our reps. . . collectively. . . evil and not just evil but, grave evil? Are they lining people up and shooting them in the streets? Are they ignoring the poor by offering no assistance? No, those who represent we the people in gov't are doing what we as Christians are told to do. It is still the same principle.
Romans 2:14&15 They show the work of the law without having the law. . . but it is written on their hearts. It is an innate knowledge of God. . . people value and practice the most basic of tenets. . . compassion and goodness towards others. This reflects what is written on their hearts. Christian's don't have a monopoly on good.
It doesn't usurp your responsibility. . . or mine. . . . it doesn't take the burden off from us as Christians to help those who need it. Jesus still commands us. . . in fact. . . He commands us to love our enemy and to give to them as well.
Now, if you were to say. . . I don't have to give. . . I pay taxes. . . as a Christian THAT would be wrong. Jesus commanded us to do both. It is surely not an either or proposition.
You say it creates a culture of entitlement. . . that is quite a judgment to make on an entire group of people. . . do you know everyone on assistance? Their circumstances?
To my ears. . . when I hear that. . . it just sounds like rhetoric.
We as a society caring for our needy is not a sin. . . where do all good gifts come from? The earth is the Lords and the fullness thereof. . . who does it all belong to?
By not understanding that it all belongs to Him and He sets up the authorities and uses what He will. . . .
Do you know who is actually not giving God the glory here?
You.
God's provision can come from anywhere He pleases. He rained food down from heaven. . . When it is provided, we give Him the glory. . . by calling His provision evil. . . you are missing the mark.
But, you are right. . . it isn't working so we as a nation need to be doing more.
And. . . I am not trying to convince you of anything. . . . I just think it is an indefensible position to have. . . . along with giving people a hole wide enough for a truck to drive through and speak ill of God.
The graph literally took less than 5 minutes to create:
Download the data: 1 minute (I already knew where it was)(+ a 30/10 FIOS connection is sometimes useful)
Create the chart: 30 seconds (Excel is a beautiful thing)
Screenshot and cropping: 30 seconds (Irfranview is a beautiful thing)
Upload to Photobucket: 1 minute
Insert into the post: 30 seconds
(it took longer to write the above than it did to make the chart)
As to the JPII and PioXI quotes, I knew exactly where they were, as well.
I have studied the subject for several years. The reason why is that I wanted to make sure that my conscience was properly formed regarding this area, as it is so vital to one's Christian walk.
The reason I say you take a narrow biblical perspective is because you take one thing Jesus directed we as Christians to do. . . . and extrapolate or to be blunt. . . justify. . . an entire political agenda. You magnify one portion of scripture and interpret it to mean something it doesn't. It doesn't make any sense to me. Why are you saying that it is a grave evil for the government to offer social assistance programs? Because that is not the way Jesus commanded Christians to treat the poor?
What does one have to do with the other?
I, frankly, would have mentioned those documents earlier on, but I've learned that it is generally more productive to restrict myself to Biblical quotes when arguing with non-Catholics.
The last time I checked we had a secular gov't . . . a Muslim rep. . . atheists. . . gays. . . a Jewish Senator. . . we are not a theocracy. Not a Christian nation.
Why then do you call what they do as our reps. . . collectively. . . evil and not just evil but, grave evil? Are they lining people up and shooting them in the streets? Are they ignoring the poor by offering no assistance? No, those who represent we the people in gov't are doing what we as Christians are told to do. It is still the same principle.
Romans 2:14&15 They show the work of the law without having the law. . . but it is written on their hearts. It is an innate knowledge of God. . . people value and practice the most basic of tenets. . . compassion and goodness towards others. This reflects what is written on their hearts. Christian's don't have a monopoly on good.
Just because we live in a country that has non-Christians and does not have a State religion, does not mean that I should stop arguing for Christian virtues to be advocated in the laws and policies of this State. Murder and theft are both considered sinful acts by Christians. Does that mean that we should tolerate them in a "secular" society? Of course not. Should we tolerate the sacrifice of virgins because we are "secular" and have a diversity of religious beliefs? Never. There is something that is called the "natural" law (which you quote a passage referencing). ALL people of good will should be able to recognize those things. Respect for life and respect for private property are two elements of this.
There are four cardinal virtues: prudence, temperance, justice, and fortitude. Those are widely taught in moral theology courses (whether they are identified as "cardinal virtues" or are just spoken of). Those cardinal virtues are simply thrown away because one is not a Christian or that we do not live in a "Christian Society": they should be advocated all the stronger for those reasons. (And, btw, they predate Christ -- they come from Plato, of all sources)
You mentioned the fact that we had a Muslim in Congress. Well, if I was in Congress and wanted to set up a system of private charity to supersede the current government system, one of the FIRST people I would go to is Keith Ellison. Why? Precisely because he IS a Muslim. Islam has a tremendous system of charity. And, frankly, if I knew of any orthodox Jews in the House, I would likewise try to work with them on the subject, too. Again, based upon their traditions.
One other little point: I call the practice gravely evil. I call the practitioners and advocates for the practice mistaken or, perhaps, fooled. The only way, in relation to this practice, that I would call a person evil, would be if the person full well knew the slavery to which its "beneficiaries" are ensnared and the person still advocates it -- particularly if the person advocates it for that reason.
It doesn't usurp your responsibility. . . or mine. . . . it doesn't take the burden off from us as Christians to help those who need it. Jesus still commands us. . . in fact. . . He commands us to love our enemy and to give to them as well.
Now, if you were to say. . . I don't have to give. . . I pay taxes. . . as a Christian THAT would be wrong. Jesus commanded us to do both. It is surely not an either or proposition.
You're right and I am not saying that.
If you got the impression that I was saying that, I apologize for not making myself clearer.
What it does is that it reduces the amount of resources that I have available to give. (If I didn't pay as much tax as I do, then I would have significantly more available to give)
In addition, the government doesn't really encourage charitable giving as much as they could. Let me give you an example:
- Let us say that a doctor wanted to treat some patients on a charitable basis. The doctor cannot do this as a charitable contribution, for two reasons: first, he cannot consider the value of the time he spends doing the charitable work as a deduction. Second, he cannot consider his time, his staff's salaries, or the materials he expends as a deduction, because you can't deduct a contribution to an individual. (Source: IRS Pub 526)
- The same applies to hospitals, labs, pharmacies, and so on.
- The above is not to say that doctors, hospitals, pharmacies, labs, and so on, do not treat patients for free? Absolutely not. I know enough to know that they do, but the way they have to handle it is as a write-off from their profit, not as a charitable donation. (And, of course, there are charitable medical organizations set up to do so and to which contributions are deductible)
Can you picture what a change it would be if primary care physicians, pharmacies, labs, and so on were allowed to provide a portion of their services available and consider the expenses to be charitable deductions?
You say it creates a culture of entitlement. . . that is quite a judgment to make on an entire group of people. . . do you know everyone on assistance? Their circumstances?
To my ears. . . when I hear that. . . it just sounds like rhetoric.
You are apparently drinking too much of the liberal bathwater here (speaking of rhetoric).
A "culture of entitlement" means that somebody owes you something -- and this becomes totally ingrained in our society.
This refers to people like the widows of 9/11 bankers who had their nice houses in Westchester County, large life insurance policies, but yet who felt as if they were entitled to large payments from the government in compensation.
This refers to military retirees, rated at 100% disability, who have nice GS-13 or GS-14 jobs ($75K - $105K per year) in the government (through preferential hiring) and collect a tax-free VA disability pension. (No problems so far) Who then lobby for collecting a taxable DOD pension on top of their tax-free VA pension. (That's where the problem comes in) (and, btw, I am a military retiree who was encouraged to submit disability paperwork but who didn't do so because it's not right)
This refers to people who build expensive houses on hurricane prone beaches or mudslide-prone cliffs, who, after the houses are repeatedly destroyed from hurricanes or brush fire induced mudslides, rebuild in the same spot, knowing that the government will continue to finance the reconstruction through disaster funds.
This refers to major wall street banks or major auto companies driving their businesses into the ground and then demanding government assistance to bail them out.
A "culture of entitlement" does not simply refer to the needy. It infects all of us.
We as a society caring for our needy is not a sin. . . where do all good gifts come from? The earth is the Lords and the fullness thereof. . . who does it all belong to?
We, as a society, absolutely have an obgligation to care for the needy. You and I agree on this much.
By not understanding that it all belongs to Him and He sets up the authorities and uses what He will. . . .
Do you know who is actually not giving God the glory here?
You.
And you accuse me of being judgmental? My oh my. Time to pull the plank from your eye, dear.
God's provision can come from anywhere He pleases. He rained food down from heaven. . . When it is provided, we give Him the glory. . . by calling His provision evil. . . you are missing the mark.
But, you are right. . . it isn't working so we as a nation need to be doing more.
Albert Einstein is often attributed as saying, The definition of insanity is doing the same thing over and over and expecting different results.
Money is not the issue. Changing the overall paradigm needs to be the issue.
Let me use schools as a subset of this. We spend an inordinate amount of money on schools. In DC, the amount spent is around $15,000 per student per year.
Parochial schools in DC spend, on average, less than $6,000 per student (this is subsidized through contributions of people like me so that there are lots of scholarships out there). The parochial schools uniformly turn out far more qualified students than public schools.
Why? Because their paradigm is different.
- Parochial school teachers are there, not for the money, but because they want to teach kids. (They make on average about 2/3 of what they would make in a public school setting)
- Parents are more involved, because they have a sense of community membership and obligation (all of them had to make at least some kind of contribution, even if the contribution was doing maintenance work on the school at night)
- Parents and students recognize that being in a parochial school is a revokable privilege, not a right -- and so the learning environment is far more productive
- One thing, it's not because of some strong Catholic identity (although the Church is deeply involved in schools) -- on average, only about 1/3 of the students within a DC parochial school are Catholic
The point being not that all schools should be Catholic parochial schools. But the paradigms illustrated above (teachers having a sense of mission, strong parental involvement, and a lack of feeling of entitlement replaced by a feeling of obgliation) is what's needed...not simply more money flushed down the toilet.
And. . . I am not trying to convince you of anything. . . . I just think it is an indefensible position to have. . . . along with giving people a hole wide enough for a truck to drive through and speak ill of God.
But, I appreciate your time. Take Care.
You're right, you likely won't convince me of anything. And I won't convince you of anything. But there are always the lurkers who might be convinced one way or the other.
Perhaps, Mark, you could outline a paradigm shift in the healthcare system and how do you imagine that shift coming about and being implemented?
OK.
The paradigm right now is a "semi-Socialist" system. That is a bad thing, in my book. For the most part, people don't care about the cost of the services they receive. They care about things like the size of their copay and the amount of their insurance premiums. That is not conducive toward establishing any kind of market-based controls on the system. I am not talking about the uninsured (either by choice or by mandate), but about the majority of Americans who are covered.
Secondly, through the result of the restrictions on payments to providers by both insurance companies and government systems (medicare and medicaid), physicians need to eke every cent they can out of the system to cover their expenses. We need to do something to encourage them to do more on a charitable basis.
The system I'd like to see is one that is more distributed and where all decisions are pushed out to the doctor and patient level, not at the private / government insurance level. I think that this would make a major shift in how the system operates and would make it more human and less bureaucratic.
Cases like the ones that mstar posted on his "rescission" thread (on 'tacks) are heartbreaking. But they happen as the result of fear on the part of the individuals for not being able to pay for their medical care if they are denied insurance; abuses happen as a result of an insurance system that has to consider things on a dollar-and-cents basis in order to stay in business.
As it stands, you can't go from point-"A" to point-"B" instantly, though.
Here are a few things that would help greatly on that matter:
1) One of the biggest problems we have in this country is a lack of primary care physicians. This country does pretty good with specialists, but family doctors are becoming harder and harder to find. I would not have a problem with a loan forgiveness program for primary care physicians (GP, family practice, internal medicine, pediatrics, and the like), provided that there is a mandate that those physicians agree to work in underserved areas and agree to take medicare/medicaid patients while doing so. The forgiveness program would be that the phyisician is required to serve for 2 years for every year of loans that are to be forgiven and that the loans would be forgiven at the end of that service period (and would continue to accrue interest until they are forgiven). Over a period of several years, that would make a large dent in the shortage.
1a) A useful exercise for the government would be to conduct a study on the constituent costs to a university with the goal being empirically finding out why tuitition is going up at the rate it is. Once the constituent causes are known, there might be something that can be done to control those costs the the universities and, thus, the rationale for tuitition increases.
The benefit of the above is if there are more providers, there will be more competition in a market-based system, thus allowing the system to control itself.
2) Currently, IRS Publication 526 prohibits a person (a human or a corporation) from deducting charitible services delivered. What that means to me is that if I want to work at the food distribution function this weekend, I cannot deduct my hours. And that's OK. But if I am a small businessman, like a family practice physician, I cannot deduct the cost of my services if I want to charitibly see a patient. Nor can I deduct the cost of wages I pay my staff that are expended in seeing that patient. The other part of IRS Publication 526 is that I cannot deduct a chartible donation to an individual; I can only deduct charitable donations to approved charities. As a result, if a doctor did want to see a charity patient, it would not be something he could claim as part of his cost basis (and thus be factored into the amount he charges), he would have to recognize the costs as off his profit as a write-off (thus reducing the viability of his small business). Making a change to IRS Publication 526 to allow charitable services to be deductible for professionals would make a big difference...
The benefit of the above is that it would be in a physician's interest to fill his schedule with uninsured charity cases when he wasn't busy seeing pay patients.
3a) Fully authorize the use of tax-advantaged Medical Savings Accounts. Allow those MSAs to be used to cover deductibles and cost-shares for all medical expenses. Allow those MSAs to accrue value over multiple tax years and allow them to be probated (provided the heir adds the value to his / her own MSA). Put a cap on the amount every year that could be contributed (say, like $10K or $20K per year), in order to prevent them from being some kind of a tax shelter for the super-rich, but, within reason, allow a person to contribute as much as he or she likes to them within that cap. Allow money that has been in the MSA for more than 12 months to be used for services, if desired by the MSA owner, that would not traditionally be covered by insurance (e.g., cosmetic medical and dental procedures, LASIK, alternative medicine, or whatever)
3b) Create an MSA-like account for people who receive some sort of public-subsidized insurance, like Medicare or Medicaid. The difference being that the value would not be probateable and, upon the death of the "owner," would go back to the government.
3c) In conjunction with MSAs, strongly, strongly encourage the use of high-deductible insurance plans. The idea is that an employer buys (with cost share) the high deductible plan, contributes an amount to the MSA to make up for the difference between the "high" deductible and the typical deductible negotiated for employee insurance, and then allows the employee to make up the remainder through before-tax payroll deduction (like what happens with flex spending accounts). For self-employed people, they would buy the insurance and build the MSA themselves (sorry, but that's the way it is).
What this would do is give insured people an awareness of the costs of the routine, non catastrophic medical care they receive. When you are aware of a cost, you are more likely to try to control it yourself, particularly if you have an incentive to be thrifty (save money this year and be able to have a facelift paid for next year). This could be particularly significant if the number of primary care physicians can be increased so that there In addition, over a number of years, the MSA, with its accrued value, could be used to pay for long term care (assisted living, nursing home, or whatever).
There is more (including changing the way that physicians are reimbursed from the flat drg system used today, tort reform, and a couple of others), but the idea is to encourage an actual marketplace for services and incentivising charitable acts on the parts of providers would make a big difference and move us toward a different paradigm -- one of decentralization rather than increasing central control.
I have an early morning meeting and so can't write more about it now (I'll try to add some later on today), but hopefully you get the idea.
Just have a couple of minutes, but want to add one comment for now.
Pre-existing conditions are a factor that everybody is concerned with.
We need to take a look at the issue of pre-existing conditions on a more level-headed basis: boogeymen are not conducive for real discussion.
First, why do most insurance plans have some sort of exclusion against pre-existing conditions? The short answer is to keep premium costs down to an affordable level. One thing you have to remember is that corporations, whether for-profit or not-for-profit, are going to turn a profit (or, at least to not lose money). If any one of these enterprises loses money over a long term, they will go out of business.
So what?
Insurance, if you think about it is nothing more than a shared risk pool. In other words, you have a set group of people who band together and agree to equally absorb everybody's costs. The purpose of an insurance company is to provide the administrative support to allow that group of people to actually participate in this endeavor. To put some concrete numbers behind this, let us use the following examples (that are more-or-less realistic, if not "real."
Size of the insurance pool: 1,000,000 families
Amount of the premium per family: $10,000 per year
Administrative costs: 11%
Desired profit: 6%
What this means is that the size of the pool is: $10,000,000,000.
After administrative costs, there will be $8,900,000,000 in the pool
If they want to hit a 6% profit, that means that they will need to make sure that no more than $8,366,000,000 is spent on medical expenses over the year.
How do they do that? They set up coverage rules, determine how much network providers will be reimbursed, and make a decision on what kind of exclusions there will be on people who sign up to be part of the pool.
If they guess right on setting up the above business rules, they will make a six percent profit.
Let us say that the actual amount they pay out is not $8,366,000,000 this year but is $9,366,000,000. Well, that means that they will have to increase their premiums to $11,020 per family per year.
They will make their profit. Or they will find another business to be in.
What does this have to do with pre-existing conditions?
Namely this: pre-existing conditions add to the money that is paid out to providers. Therefore, it will add to premium costs charged to subscribers. Period.
How much? Well, honestly, I don't know. Nobody has ever really asked that question, at least in the press.
For the most part, people don't care about the cost of the services they receive. They care about things like the size of their copay and the amount of their insurance premiums. That is not conducive toward establishing any kind of market-based controls on the system. I am not talking about the uninsured (either by choice or by mandate), but about the majority of Americans who are covered.
I once had a service covered by medicaid. I was happy I didn't have to pay for it (cause there's no way I could have), but the bill for the service provided was insane. I am angry about the cost, even though I didn't have to pay for it. The cost itself it just wrong. But this is America, we don't haggle over price.
1) One of the biggest problems we have in this country is a lack of primary care physicians. This country does pretty good with specialists, but family doctors are becoming harder and harder to find. I would not have a problem with a loan forgiveness program for primary care physicians (GP, family practice, internal medicine, pediatrics, and the like), provided that there is a mandate that those physicians agree to work in underserved areas and agree to take medicare/medicaid patients while doing so. The forgiveness program would be that the phyisician is required to serve for 2 years for every year of loans that are to be forgiven and that the loans would be forgiven at the end of that service period (and would continue to accrue interest until they are forgiven). Over a period of several years, that would make a large dent in the shortage.
there are programs to reimburse primary care physicians in undeserved areas. But even then the physician could make more $$$$ by not doing that program and going somewhere else, or specializing.
The shortage is also due to the need for more qualified medical schools. Less than half of those willing and able to become doctors get the opportunity.
there are programs to reimburse primary care physicians in undeserved areas. But even then the physician could make more $$$$ by not doing that program and going somewhere else, or specializing.
The shortage is also due to the need for more qualified medical schools. Less than half of those willing and able to become doctors get the opportunity.
(There's also the military doctor route).
One suggestion I have heard that makes sense is to use Certified Nurse Practitioners in primary care clinics. These individuals are highly trained; many of them even specialize. They can handle routine matters, such as earaches, minor wounds, vaccinations, etc. and check with a doctor for the big stuff. Rural or urban clinics with a PCP or two who do "circuit-riding" duty to help pay off their school loans would help. I'd rather see my money go to a system like that.
And of course, I do have a personal stake in this, I'm concerned about the suggestions to cut Medicare costs by say, refusing to pay for treatment that is expensive for cancer and heart disease. Or, as Richard Lamm, former governor of Colorado stated it, do elderly people, 65+ have a "duty to die" to save money for the government?
I don't care for the nurses stations. I tried one once with mixed results. They're better than nothing, but what we need is more doctors, M.D.s and D.O.s. I believe there are a lot of nurses now who should have gone to med school.
. . .
Or, as Richard Lamm, former governor of Colorado stated it, do elderly people, 65+ have a "duty to die" to save money for the government?
WG
No, it's young people's duty to die for their country overseas. That frees up resources for the older generations.
When you tried to make a Biblical case, using Romans 13, for the socialist state usurping the rights and authority of individuals by theft of their resources, you inadvertently made a case in support of Bush's wars of aggression and all his policies on the pretext that the state knows what's best for all.
This thread was entitled "Replying to Obama - God's Partner". Sounds to me like you think God should be Obama's partner.
I didn't buy into bush's crap either, so I guess I'm a sinner by your standards.
When you tried to make a Biblical case, using Romans 13, for the socialist state usurping the rights and authority of individuals by theft of their resources, you inadvertently made a case in support of Bush's wars of aggression and all his policies on the pretext that the state knows what's best for all.
This thread was entitled "Replying to Obama - God's Partner". Sounds to me like you think God should be Obama's partner.
I didn't buy into bush's crap either, so I guess I'm a sinner by your standards.
I didn't try to make a case for the socialist state usurping the rights and authority of individuals. I simply said. . . . obey the laws, pay your taxes and tolls and be a good citizen. What a novel concept. Where is it we can live where we don't have to pay taxes?
I opposed Bush's war. . . . there is nothing wrong with peaceful dissent as it is legal in this country.
As far as you being a sinner. . . . join the club, and in reality you are probably a better person than I. . . . . . .
But, I will continue to pay taxes and continue to support social welfare programs for those in need. . . . call me crazy. . . . I figure it is all a part of grown-up life.
Besides. . . . I really like the down and outers. . . the prisoners. . . . and the outcasts. . . . my peeps. . . . I guess I fit in.
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Sunesis
Garth, knock off the smug self-righteous attitude. We all know you hate God, Christ, the Bible - we get it. You've let us all know, you've made no bones about it. You always come and drop you littl
geisha779
Mark, Since your post is so long I didn't want to copy and paste. . . . God's providence does not exempt you from civil obedience. . . nor from paying your taxes or from obeying the laws of the land.
GarthP2000
Sunesis, ((snickers)) Look who's talking, lady. Look who's talking. And many times you don't even see it. And the same arguments for supernatural occurances could be said re: other characters in t
geisha779
Mark,
That wasn't the interpretation in post 13 at all. . . . it is you who have actually extrapolated that definition. Here is what I said. . .
I am not a socialist nor do I advocate a socialist state. God wants us to depend on Him and Him alone. . . . okay. . . at the end of your work week. . . tell your employer God has you covered and say no thanks to your pay check.
Who are we to tell God how He will provide for those in need?
Everyone must submit to the governing authorities, for there is no authority except from God, and those that exist are instituted by God. 2 So then, the one who resists the authority is opposing God's command, and those who oppose it will bring judgment on themselves. 3 For rulers are not a terror to good conduct, but to bad. Do you want to be unafraid of the authority? Do good and you will have its approval. 4 For government is God's servant to you for good. But if you do wrong, be afraid, because it does not carry the sword for no reason. For government is God's servant, an avenger that brings wrath on the one who does wrong. 5 Therefore, you must submit, not only because of wrath, but also because of your conscience. 67 Pay your obligations (to everyone: taxes to those you owe taxes, tolls to those you owe tolls, respect to those you owe respect, and honor to those you owe honor.
Government does not take the place of God. . . but God uses governments. . . for His purposes. In our society. . . which is governed. . . we have social welfare programs in place to help care for the needy. Thank God.
I think you are arguing a point that was never made.
We have a secular gov't which embraces the care and concern for it's citizens. . . . you call this a grave evil because it is the STATE doing this and God wants us to depend on Him.. . . . my point is. . . all good gifts come from God. It IS God who gives the bounty of food on the table. . . . whether it comes from the food stamp program or your paycheck. . . . one way or another. . . the food, clothing, and shelter we have ALWAYS comes from God. . . NO MATTER how it is paid for . . . . . a gov't voucher or a paycheck.
God sets up government for His purpose. . . . to wield the sword. . . . keep the peace. . .not even a tyranny will allow lawlessness. You want to protest the use of gov't money collected in taxes for the use of social programs. . . . SOCIAL PROGRAMS. . . I think your outrage and use of hyperbole such a grave evil is sadly misplaced.
Is it any LESS God's blessing because it doesn't come from the source YOU believe it should? I pointed out to you that God has even used bad men for His purposes. . . He can use what He wants and when hungry people eat. . . it is a blessing from GOD.
I never said Christians should not resist gov't. . . . read Acts chapter 5. . . . it is better to obey God rather than men. . . . and it is also right to have regard for good things in the sight of all men.
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geisha779
Mark,
We don't live in a Christian country. . . . be glad we as a people embrace Christian values. You can't tell someone who is not a follower of Christ to do as He commanded. They reject Him. Why would you expect them to individually do what He says? You seem to want to impose that view? Jesus doesn't impose Himself. . . . he offers Himself.
When we as a society seek collectively to do the things He would have us do. . . .you call this "grave evil". . . . I think it is a small miracle.
You say it creates a culture of entitlement. . . . you, that is your opinion. . . . . I look at it much differently. . . as I have seen people on the brink of despair receive assistance. . . . it is a blessing. . . a safety net. . . . poverty is cruel Mark.
We as Christians need to be working within our culture to effect change. . . . with the gospel. . . once you start imposing narrow parameters on people who are seeking to help others. . . . you have something ugly and you are headed to a man made imposed theocracy.
To Add: When did food, clothing, and shelter become an entitlement? Seriously? If we receive these things with thankfulness. . . . I just don't get it. . . . . . I never will. . . . would you rather they go hungry. . . . I cannot believe that. . . so be glad people down trodden and hurting have a good meal . . . . be thankful God does provide.
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Spoudazo
We wonder why evangelicals get such a bad name? Could it be because they call things like food stamps for a mother with kids grave evil. It doesn't make God look so nice either. I wonder if Jesus made sure everyone had a job when he fed the 5000.
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Bramble
God forbid a child who's mom make s $8 an hour and Dad took off goes to bed with food in his stomach. Or meds for an ear infection.
That the poor are unworthy, lazy users and deserve their grinding poverty seems to go hand in hand with those that believe a prosperity doctrine.
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Bolshevik
who said that?
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Bramble
You are not familiar with the prosperity doctrine? It is very popular in my area. Our local 'mega' church holds this theology.
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lindyhopper
Yes, why did God send his "only begotten son" to save you from your sins, when he already gave you a law. If you would have only worked hard enough, you could have saved yourselves. Now he has created this system where you are reliant on Him instead of you being self reliant! Where does this welfare state come from? How dare the government take His place. Collecting your taxes due and being a "big brother" is His job not theirs!
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geisha779
"Culture of entitlement" is often code for ". . . the poor are unworthy, lazy users and deserve their grinding poverty. . . " and it doesn't usually come from those living hand to mouth.
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Bolshevik
That's weird. There's only so much to go around, so somebody has to take the short end of the stick. "worthiness" and "entitlement" are kind meaningless labels I would think. It probably helps those who have feel better about themselves. There will always be poor, and nothing can be done about it.
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waysider
I can agree to half of that.
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Bolshevik
which?
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markomalley
Well, thank you very much for clarifying that point. Now we can move beyond that and deal with the real subject.
Yes, I do believe that the government, particularly the national level government, providing social assistance, particularly long-term social assistance, is a grave evil.
Sorry that you feel that it is a narrow, Biblical view (I guess that is supposed to be a bad thing). And, with reference to somebody in the peanut gallery, it grieves me that my views make Evangelicals, in general, look bad :blink: .
It might be of some comfort to let you know that I am not the only one who holds those views. Let me give you a couple of examples:
Karol Wojtyla, Hundred Years (1991), paragraph 48
And then another one:
Achille Ratti, Forty Years (1931), paragraph 79
The two passages above illustrate that my views might not be quite so narrow and "Biblical" as you might consider on first blush. Or at least that there are other narrow-minded people out there who believe as I do.
We have had a fairly significant amount of "social assistance" payments go out since LBJ declared "war" on poverty. You can see that we are spending somewhere in the neighborhood of three quarters of a trillion dollars a year on it. But yet it is utterly ineffective.
The above chart, based on <a href="http://www.census.gov/hhes/www/poverty/histpov/hstpov4.xls">census numbers, show that since 1966 the relative level of poverty is the same in 2007 as they were in 1966. The blue line represents the poverty rate reported by the Census Bureau. The black line is a "trend line."
After spending trillions of dollars on poverty, you'd think that the number would shrink. Think about this a second: In 2007, $724 billion was spent on "human resource" programs (I exclude both Medicare and Social Security, as well as veterans health). There were 7,623,000 families identified as living below the poverty line. You could give each one of those families $94,987 for the amount of money spent on those programs. And this is not just this one time: it has been along that order every year for at least the past 10 years. Don't believe me? Look it up yourself. I gave you the links to the documents.
Bottom line: In addition to being morally wrong, this federal government sponsored "social assistance" paradigm simply doesn't work.
Just to let you know, since I'm the one arguing against it (and used the term "grave evil"), I'm not an Evangelical.
As to Jesus feeding the 5,000, I never realized Jesus was a representative of the civil government.
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Bolshevik
wouldn't the "poverty population" remain somewhat constant due to immigration?
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markomalley
One might think so, but in the Excel sheet from the Census that I linked to above, it shows the poverty rate for Hispanic families being pretty much constant, as well, even though the number of total families (both below and above poverty) rose dramatically. (And that is something that the utterly closed borders types should consider in their rhetoric)
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geisha779
Graphs. . . charts. . . JP2???
The reason I say you take a narrow biblical perspective is because you take one thing Jesus directed we as Christians to do. . . . and extrapolate or to be blunt. . . justify. . . an entire political agenda. You magnify one portion of scripture and interpret it to mean something it doesn't. It doesn't make any sense to me. Why are you saying that it is a grave evil for the government to offer social assistance programs? Because that is not the way Jesus commanded Christians to treat the poor?
What does one have to do with the other?
The last time I checked we had a secular gov't . . . a Muslim rep. . . atheists. . . gays. . . a Jewish Senator. . . we are not a theocracy. Not a Christian nation.
Why then do you call what they do as our reps. . . collectively. . . evil and not just evil but, grave evil? Are they lining people up and shooting them in the streets? Are they ignoring the poor by offering no assistance? No, those who represent we the people in gov't are doing what we as Christians are told to do. It is still the same principle.
Romans 2:14&15 They show the work of the law without having the law. . . but it is written on their hearts. It is an innate knowledge of God. . . people value and practice the most basic of tenets. . . compassion and goodness towards others. This reflects what is written on their hearts. Christian's don't have a monopoly on good.
It doesn't usurp your responsibility. . . or mine. . . . it doesn't take the burden off from us as Christians to help those who need it. Jesus still commands us. . . in fact. . . He commands us to love our enemy and to give to them as well.
Now, if you were to say. . . I don't have to give. . . I pay taxes. . . as a Christian THAT would be wrong. Jesus commanded us to do both. It is surely not an either or proposition.
You say it creates a culture of entitlement. . . that is quite a judgment to make on an entire group of people. . . do you know everyone on assistance? Their circumstances?
To my ears. . . when I hear that. . . it just sounds like rhetoric.
We as a society caring for our needy is not a sin. . . where do all good gifts come from? The earth is the Lords and the fullness thereof. . . who does it all belong to?
By not understanding that it all belongs to Him and He sets up the authorities and uses what He will. . . .
Do you know who is actually not giving God the glory here?
You.
God's provision can come from anywhere He pleases. He rained food down from heaven. . . When it is provided, we give Him the glory. . . by calling His provision evil. . . you are missing the mark.
But, you are right. . . it isn't working so we as a nation need to be doing more.
And. . . I am not trying to convince you of anything. . . . I just think it is an indefensible position to have. . . . along with giving people a hole wide enough for a truck to drive through and speak ill of God.
But, I appreciate your time. Take Care.
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markomalley
The graph literally took less than 5 minutes to create:
(it took longer to write the above than it did to make the chart)
As to the JPII and PioXI quotes, I knew exactly where they were, as well.
I have studied the subject for several years. The reason why is that I wanted to make sure that my conscience was properly formed regarding this area, as it is so vital to one's Christian walk.
I, frankly, would have mentioned those documents earlier on, but I've learned that it is generally more productive to restrict myself to Biblical quotes when arguing with non-Catholics.
Just because we live in a country that has non-Christians and does not have a State religion, does not mean that I should stop arguing for Christian virtues to be advocated in the laws and policies of this State. Murder and theft are both considered sinful acts by Christians. Does that mean that we should tolerate them in a "secular" society? Of course not. Should we tolerate the sacrifice of virgins because we are "secular" and have a diversity of religious beliefs? Never. There is something that is called the "natural" law (which you quote a passage referencing). ALL people of good will should be able to recognize those things. Respect for life and respect for private property are two elements of this.
There are four cardinal virtues: prudence, temperance, justice, and fortitude. Those are widely taught in moral theology courses (whether they are identified as "cardinal virtues" or are just spoken of). Those cardinal virtues are simply thrown away because one is not a Christian or that we do not live in a "Christian Society": they should be advocated all the stronger for those reasons. (And, btw, they predate Christ -- they come from Plato, of all sources)
You mentioned the fact that we had a Muslim in Congress. Well, if I was in Congress and wanted to set up a system of private charity to supersede the current government system, one of the FIRST people I would go to is Keith Ellison. Why? Precisely because he IS a Muslim. Islam has a tremendous system of charity. And, frankly, if I knew of any orthodox Jews in the House, I would likewise try to work with them on the subject, too. Again, based upon their traditions.
One other little point: I call the practice gravely evil. I call the practitioners and advocates for the practice mistaken or, perhaps, fooled. The only way, in relation to this practice, that I would call a person evil, would be if the person full well knew the slavery to which its "beneficiaries" are ensnared and the person still advocates it -- particularly if the person advocates it for that reason.
You're right and I am not saying that.
If you got the impression that I was saying that, I apologize for not making myself clearer.
What it does is that it reduces the amount of resources that I have available to give. (If I didn't pay as much tax as I do, then I would have significantly more available to give)
In addition, the government doesn't really encourage charitable giving as much as they could. Let me give you an example:
- Let us say that a doctor wanted to treat some patients on a charitable basis. The doctor cannot do this as a charitable contribution, for two reasons: first, he cannot consider the value of the time he spends doing the charitable work as a deduction. Second, he cannot consider his time, his staff's salaries, or the materials he expends as a deduction, because you can't deduct a contribution to an individual. (Source: IRS Pub 526)
- The same applies to hospitals, labs, pharmacies, and so on.
- The above is not to say that doctors, hospitals, pharmacies, labs, and so on, do not treat patients for free? Absolutely not. I know enough to know that they do, but the way they have to handle it is as a write-off from their profit, not as a charitable donation. (And, of course, there are charitable medical organizations set up to do so and to which contributions are deductible)
Can you picture what a change it would be if primary care physicians, pharmacies, labs, and so on were allowed to provide a portion of their services available and consider the expenses to be charitable deductions?
You are apparently drinking too much of the liberal bathwater here (speaking of rhetoric).
A "culture of entitlement" means that somebody owes you something -- and this becomes totally ingrained in our society.
This refers to people like the widows of 9/11 bankers who had their nice houses in Westchester County, large life insurance policies, but yet who felt as if they were entitled to large payments from the government in compensation.
This refers to military retirees, rated at 100% disability, who have nice GS-13 or GS-14 jobs ($75K - $105K per year) in the government (through preferential hiring) and collect a tax-free VA disability pension. (No problems so far) Who then lobby for collecting a taxable DOD pension on top of their tax-free VA pension. (That's where the problem comes in) (and, btw, I am a military retiree who was encouraged to submit disability paperwork but who didn't do so because it's not right)
This refers to people who build expensive houses on hurricane prone beaches or mudslide-prone cliffs, who, after the houses are repeatedly destroyed from hurricanes or brush fire induced mudslides, rebuild in the same spot, knowing that the government will continue to finance the reconstruction through disaster funds.
This refers to major wall street banks or major auto companies driving their businesses into the ground and then demanding government assistance to bail them out.
A "culture of entitlement" does not simply refer to the needy. It infects all of us.
We, as a society, absolutely have an obgligation to care for the needy. You and I agree on this much.
And you accuse me of being judgmental? My oh my. Time to pull the plank from your eye, dear.
Albert Einstein is often attributed as saying, The definition of insanity is doing the same thing over and over and expecting different results.
Money is not the issue. Changing the overall paradigm needs to be the issue.
Let me use schools as a subset of this. We spend an inordinate amount of money on schools. In DC, the amount spent is around $15,000 per student per year.
Parochial schools in DC spend, on average, less than $6,000 per student (this is subsidized through contributions of people like me so that there are lots of scholarships out there). The parochial schools uniformly turn out far more qualified students than public schools.
Why? Because their paradigm is different.
- Parochial school teachers are there, not for the money, but because they want to teach kids. (They make on average about 2/3 of what they would make in a public school setting)
- Parents are more involved, because they have a sense of community membership and obligation (all of them had to make at least some kind of contribution, even if the contribution was doing maintenance work on the school at night)
- Parents and students recognize that being in a parochial school is a revokable privilege, not a right -- and so the learning environment is far more productive
- One thing, it's not because of some strong Catholic identity (although the Church is deeply involved in schools) -- on average, only about 1/3 of the students within a DC parochial school are Catholic
The point being not that all schools should be Catholic parochial schools. But the paradigms illustrated above (teachers having a sense of mission, strong parental involvement, and a lack of feeling of entitlement replaced by a feeling of obgliation) is what's needed...not simply more money flushed down the toilet.
You're right, you likely won't convince me of anything. And I won't convince you of anything. But there are always the lurkers who might be convinced one way or the other.
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lindyhopper
Perhaps, Mark, you could outline a paradigm shift in the healthcare system and how do you imagine that shift coming about and being implemented?
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markomalley
OK.
The paradigm right now is a "semi-Socialist" system. That is a bad thing, in my book. For the most part, people don't care about the cost of the services they receive. They care about things like the size of their copay and the amount of their insurance premiums. That is not conducive toward establishing any kind of market-based controls on the system. I am not talking about the uninsured (either by choice or by mandate), but about the majority of Americans who are covered.
Secondly, through the result of the restrictions on payments to providers by both insurance companies and government systems (medicare and medicaid), physicians need to eke every cent they can out of the system to cover their expenses. We need to do something to encourage them to do more on a charitable basis.
The system I'd like to see is one that is more distributed and where all decisions are pushed out to the doctor and patient level, not at the private / government insurance level. I think that this would make a major shift in how the system operates and would make it more human and less bureaucratic.
Cases like the ones that mstar posted on his "rescission" thread (on 'tacks) are heartbreaking. But they happen as the result of fear on the part of the individuals for not being able to pay for their medical care if they are denied insurance; abuses happen as a result of an insurance system that has to consider things on a dollar-and-cents basis in order to stay in business.
As it stands, you can't go from point-"A" to point-"B" instantly, though.
Here are a few things that would help greatly on that matter:
1) One of the biggest problems we have in this country is a lack of primary care physicians. This country does pretty good with specialists, but family doctors are becoming harder and harder to find. I would not have a problem with a loan forgiveness program for primary care physicians (GP, family practice, internal medicine, pediatrics, and the like), provided that there is a mandate that those physicians agree to work in underserved areas and agree to take medicare/medicaid patients while doing so. The forgiveness program would be that the phyisician is required to serve for 2 years for every year of loans that are to be forgiven and that the loans would be forgiven at the end of that service period (and would continue to accrue interest until they are forgiven). Over a period of several years, that would make a large dent in the shortage.
1a) A useful exercise for the government would be to conduct a study on the constituent costs to a university with the goal being empirically finding out why tuitition is going up at the rate it is. Once the constituent causes are known, there might be something that can be done to control those costs the the universities and, thus, the rationale for tuitition increases.
The benefit of the above is if there are more providers, there will be more competition in a market-based system, thus allowing the system to control itself.
2) Currently, IRS Publication 526 prohibits a person (a human or a corporation) from deducting charitible services delivered. What that means to me is that if I want to work at the food distribution function this weekend, I cannot deduct my hours. And that's OK. But if I am a small businessman, like a family practice physician, I cannot deduct the cost of my services if I want to charitibly see a patient. Nor can I deduct the cost of wages I pay my staff that are expended in seeing that patient. The other part of IRS Publication 526 is that I cannot deduct a chartible donation to an individual; I can only deduct charitable donations to approved charities. As a result, if a doctor did want to see a charity patient, it would not be something he could claim as part of his cost basis (and thus be factored into the amount he charges), he would have to recognize the costs as off his profit as a write-off (thus reducing the viability of his small business). Making a change to IRS Publication 526 to allow charitable services to be deductible for professionals would make a big difference...
The benefit of the above is that it would be in a physician's interest to fill his schedule with uninsured charity cases when he wasn't busy seeing pay patients.
3a) Fully authorize the use of tax-advantaged Medical Savings Accounts. Allow those MSAs to be used to cover deductibles and cost-shares for all medical expenses. Allow those MSAs to accrue value over multiple tax years and allow them to be probated (provided the heir adds the value to his / her own MSA). Put a cap on the amount every year that could be contributed (say, like $10K or $20K per year), in order to prevent them from being some kind of a tax shelter for the super-rich, but, within reason, allow a person to contribute as much as he or she likes to them within that cap. Allow money that has been in the MSA for more than 12 months to be used for services, if desired by the MSA owner, that would not traditionally be covered by insurance (e.g., cosmetic medical and dental procedures, LASIK, alternative medicine, or whatever)
3b) Create an MSA-like account for people who receive some sort of public-subsidized insurance, like Medicare or Medicaid. The difference being that the value would not be probateable and, upon the death of the "owner," would go back to the government.
3c) In conjunction with MSAs, strongly, strongly encourage the use of high-deductible insurance plans. The idea is that an employer buys (with cost share) the high deductible plan, contributes an amount to the MSA to make up for the difference between the "high" deductible and the typical deductible negotiated for employee insurance, and then allows the employee to make up the remainder through before-tax payroll deduction (like what happens with flex spending accounts). For self-employed people, they would buy the insurance and build the MSA themselves (sorry, but that's the way it is).
What this would do is give insured people an awareness of the costs of the routine, non catastrophic medical care they receive. When you are aware of a cost, you are more likely to try to control it yourself, particularly if you have an incentive to be thrifty (save money this year and be able to have a facelift paid for next year). This could be particularly significant if the number of primary care physicians can be increased so that there In addition, over a number of years, the MSA, with its accrued value, could be used to pay for long term care (assisted living, nursing home, or whatever).
There is more (including changing the way that physicians are reimbursed from the flat drg system used today, tort reform, and a couple of others), but the idea is to encourage an actual marketplace for services and incentivising charitable acts on the parts of providers would make a big difference and move us toward a different paradigm -- one of decentralization rather than increasing central control.
I have an early morning meeting and so can't write more about it now (I'll try to add some later on today), but hopefully you get the idea.
Thanks for actually asking.
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markomalley
Just have a couple of minutes, but want to add one comment for now.
Pre-existing conditions are a factor that everybody is concerned with.
We need to take a look at the issue of pre-existing conditions on a more level-headed basis: boogeymen are not conducive for real discussion.
First, why do most insurance plans have some sort of exclusion against pre-existing conditions? The short answer is to keep premium costs down to an affordable level. One thing you have to remember is that corporations, whether for-profit or not-for-profit, are going to turn a profit (or, at least to not lose money). If any one of these enterprises loses money over a long term, they will go out of business.
So what?
Insurance, if you think about it is nothing more than a shared risk pool. In other words, you have a set group of people who band together and agree to equally absorb everybody's costs. The purpose of an insurance company is to provide the administrative support to allow that group of people to actually participate in this endeavor. To put some concrete numbers behind this, let us use the following examples (that are more-or-less realistic, if not "real."
Size of the insurance pool: 1,000,000 families
Amount of the premium per family: $10,000 per year
Administrative costs: 11%
Desired profit: 6%
What this means is that the size of the pool is: $10,000,000,000.
After administrative costs, there will be $8,900,000,000 in the pool
If they want to hit a 6% profit, that means that they will need to make sure that no more than $8,366,000,000 is spent on medical expenses over the year.
How do they do that? They set up coverage rules, determine how much network providers will be reimbursed, and make a decision on what kind of exclusions there will be on people who sign up to be part of the pool.
If they guess right on setting up the above business rules, they will make a six percent profit.
Let us say that the actual amount they pay out is not $8,366,000,000 this year but is $9,366,000,000. Well, that means that they will have to increase their premiums to $11,020 per family per year.
They will make their profit. Or they will find another business to be in.
What does this have to do with pre-existing conditions?
Namely this: pre-existing conditions add to the money that is paid out to providers. Therefore, it will add to premium costs charged to subscribers. Period.
How much? Well, honestly, I don't know. Nobody has ever really asked that question, at least in the press.
Are we willing to accept those extra costs?
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Bolshevik
I once had a service covered by medicaid. I was happy I didn't have to pay for it (cause there's no way I could have), but the bill for the service provided was insane. I am angry about the cost, even though I didn't have to pay for it. The cost itself it just wrong. But this is America, we don't haggle over price.
there are programs to reimburse primary care physicians in undeserved areas. But even then the physician could make more $$$$ by not doing that program and going somewhere else, or specializing.
The shortage is also due to the need for more qualified medical schools. Less than half of those willing and able to become doctors get the opportunity.
(There's also the military doctor route).
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Watered Garden
there are programs to reimburse primary care physicians in undeserved areas. But even then the physician could make more $$$$ by not doing that program and going somewhere else, or specializing.
The shortage is also due to the need for more qualified medical schools. Less than half of those willing and able to become doctors get the opportunity.
(There's also the military doctor route).
One suggestion I have heard that makes sense is to use Certified Nurse Practitioners in primary care clinics. These individuals are highly trained; many of them even specialize. They can handle routine matters, such as earaches, minor wounds, vaccinations, etc. and check with a doctor for the big stuff. Rural or urban clinics with a PCP or two who do "circuit-riding" duty to help pay off their school loans would help. I'd rather see my money go to a system like that.
And of course, I do have a personal stake in this, I'm concerned about the suggestions to cut Medicare costs by say, refusing to pay for treatment that is expensive for cancer and heart disease. Or, as Richard Lamm, former governor of Colorado stated it, do elderly people, 65+ have a "duty to die" to save money for the government?
WG
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Bolshevik
I don't care for the nurses stations. I tried one once with mixed results. They're better than nothing, but what we need is more doctors, M.D.s and D.O.s. I believe there are a lot of nurses now who should have gone to med school.
No, it's young people's duty to die for their country overseas. That frees up resources for the older generations.
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Ron G.
geisha...
When you tried to make a Biblical case, using Romans 13, for the socialist state usurping the rights and authority of individuals by theft of their resources, you inadvertently made a case in support of Bush's wars of aggression and all his policies on the pretext that the state knows what's best for all.
This thread was entitled "Replying to Obama - God's Partner". Sounds to me like you think God should be Obama's partner.
I didn't buy into bush's crap either, so I guess I'm a sinner by your standards.
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geisha779
I didn't try to make a case for the socialist state usurping the rights and authority of individuals. I simply said. . . . obey the laws, pay your taxes and tolls and be a good citizen. What a novel concept. Where is it we can live where we don't have to pay taxes?
I opposed Bush's war. . . . there is nothing wrong with peaceful dissent as it is legal in this country.
As far as you being a sinner. . . . join the club, and in reality you are probably a better person than I. . . . . . .
But, I will continue to pay taxes and continue to support social welfare programs for those in need. . . . call me crazy. . . . I figure it is all a part of grown-up life.
Besides. . . . I really like the down and outers. . . the prisoners. . . . and the outcasts. . . . my peeps. . . . I guess I fit in.
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