Wednesday, March 4, 2009

C'mon Conservatives: Do We Have a Free Market Answer for Medical Care?

The conservative movement is going nowhere, fast. And, sad to say, it has already lost the health care debate. How did it lose? By never showing up --the empty podium is telling.

There is no question that American health care is horribly broken. It is not just broken for those people who cannot afford to access it --in fact, it is less broken for them (through Medicaid, SCHIP, etc) than it is for basically productive people.

And, it is broken because it is an entire economy that has been exempted from the rules of the marketplace. One can point the finger of blame at "greedy" hospitals, "greedy" doctors, or "greedy" insurance companies, but much of the blame falls at the feet of, you guessed it, Uncle Sam.

In fact, the whole system is a post-War relic. It is the relic of Uncle Sam fixing wages in the second world war that motivated companies, based on market principles, to offer "benefits" --untaxed income. Among those benefits was health insurance --then a tiny fraction of the overall cost of employment. So, the whole system is based on an anachronism --wage and price controls.

One does not have to look far to see how perverse this is. Your coverage is dependent upon who you work for. If you work for GM you have better coverage than if you work for a GM dealer. You can be a very successful independent businessman and have worse coverage than the Wal-Mart cashier.

This perversity is built into the system. Name one other industry, other than the health insurance industry, that is built around denying its product to the very people who most need it? It is not the well who need the doctor, but the sick!

Sorry, Sam, this one's personal. Our daughter has a pre-existing condition. She acquired this about the same time our denomination saw fit to cancel its health policy. Most of our pastors are young and healthy, you see. And, if you are sick, or your child is, then sorry folks, we're out of luck. We've got our cheap individual plans. The big churches have their own groups. You're stuck.

Which was okay in Virginia, because they have guaranteed issue policies. But not MS, oh no. We are in the insurance dark ages here. But, I digress.

As it stands now, the whole system is horribly prejudiced. Prejudiced against whom? The self-employed and the small business --those too small to form "risk pools."

The answer to this is NOT socialized medicine. Socialized medicine perpetuates the problem. It has no natural cost control mechanisms. It tends to set the costs of products artificially low --which inevitably must make other costs inevitably high, lead to a decline in services, or the decimation of capital (aka crumbling hospital buildings).

The only answer to bring down costs is the market. Why does not Hospital A say, "We offer the same great service as Hospital B, but cost 30% less?" THat's what Wal-Mart does. TJ Maxx does not have the amenities of Macy's, but the products on the rack are the same. If doctors, hospitals, drug companies and insurers had to compete, it would drive the inefficiency from the system.

Now, there are other issues to be sure. Malpractice insurance is one. The artificially lowered prices of the government insurance plans are another even larger issue.

BUt, unless and until conservative address this issue, without the me-too-but less that is all too common, we will never gain a nationwide hearing. It is a crisis headed towards catastrophe --one that could be averted, if conservatives would apply their ideals to the problem.

Monday, March 2, 2009

Moral Positions and Rescue

Okay, meeting Jesus in Matthew 9:9-17.

As an evangelical and Calvinist Christian I struggle with two things that are difficult to reconcile, but which coexist perfectly in Jesus. Those two things are this: recognizing sin and evil as such, and reaching out to rescue people who are entrapped in those things.

I have said before that the way to deal with the broken sinner is with restoration, not condemnation. We are to be about rescue.

Jesus confronts people with different problems in different ways. In neither case does he discount sin. The two basic categories of people that Jesus addresses are the proud and the broken. The indifferent never appear on his radar screen --perhaps a topic for another post.

Jesus never sets out to break the broken. He does not break bruised reeds or quench smoking flax. Those who are broken find restoration. They do not find sanction for their sin, but deliverance from it (witness the Samaritan woman at the well). They know who they are and they agree with Jesus' assessment of them. They don't have to have it pounded into their heads. They know their guilt, and are hungry for forgiveness.

But, the proud are a different story. Jesus has hard things to say to proud people. His purpose is always loving --to show them they have no reason for pride, and to break them, and then restore them. To these people Jesus says hard things.

The struggle in preaching is this: some people before you are proud, and some are broken. What is more complicating is that some of the proud think they are broken (elder brothers who see themselves as the prodigal --thanks Tim Keller and Richard Sibbes for pointing that out). My own flesh craves the message of forgiveness even as I am sinning with a hard heart and a high hand.

And, the other complicating factor is upholding truth and righteousness. What if, upholding the BIblical teaching on human sexuality, both a denial of homosexuality and promiscuity. Some people out there are pursuing those lifestyles. Some are broken by them; some are hardened in them; all are destroying themselves and missing God's blessing.

The same could be said for every correct moral position: sanctity of life, business ethics, family relationships, gender roles, etc.

The answer of some is simply not to deal with those things, and just preach the gospel. But, this is not what Jesus or the apostles did. WHen Paul said he labored to know nothing but Christ and him crucified, it obviously wasn't to the exclusion of teaching on spiritual gifts, head coverings, sexual immorality or the Lord's Supper.

So, how do we do this? How do we uphold righteousness and yet preach grace? How do we reach sinners with the free message of grace, oppose the proud, and uphold the truth? Those are the three poles that all preaching must work within and balance.

May God make it so.