Topic: F unAQs
Did you hear about the roofing company that went out of business because it didn't have enough overhead?
Q. Why did the cow visit the psychiatrist?
A. Because she had a moo disorder.
Is psychotherapy prpoerly considered a mitigating measure taken to relieve mental illness? And, if it is, should it be afforded the same degree of legal protection that is afforded to the use of psychiatric medication?
I believe the correct answer to both questions is "yes," and I've posted my opinion in a public comment on psychotherapy as a mitigating measure the Equal Employment Opportunity Commission's public docket regarding its proposed regulations implementing the ADA Amemdments Act.
Yesterday, Roger Randel sent me this wonderful spoof on the hype that is being used against health care reform. It's called "Cash for Codgers." Here it is:
CASH FOR CODGERS
And of course, we ALL know that if Congress enacts a health care reform package that threatens insurance company profits in ANY way, Iran will instantly invade California and a nuclear accident will eat New York!
Those who follow this blog know that I originally supported single-payer national health care, and still think it would be the best approach (though it has no chance of passage now). I later said that I supported the President's public outline for health care reform as the best realistic chance for reform, so long as it contained a "realistic" public option. However, the "bipartisan" plan that is slowly emerging is far from the President's outline.
While few details of the "bipartisan" health care reform package have been settled clearly enough to be fed to the public in written form, the comments of those involved in the process reveal both that few large changes may be expected and that some of the changes that will occur will be good for the insurance industry and bad for a lot of people. Some of these important details may be inferred from single comments that have been repeated, in one form or another, by people on both sides of the process. Other details must be inferred from pairs of apparently contradictory statements that can only be reconciled with each other by assuming certain plan details.
The first and most obvious problem with Congress' bipartsan approach to the issue is that, in counting the "cost" of the program, they are counting only the relatively short-term costs to be borne by the Federal Government through new taxes. To evaluate the REAL COST to the ENTIRE ECONOMY of health care reform would require a balancing of the new taxes required against the savings to individuals, employers, and state and local governments that will result from the reform. But Congress is not even attempting this. What the responsible members of Congress are publicly saying is that a reform that "costs" $1.6 trillion, or even $1 trillion, in new taxes over the next 10 years costs too much. This debate simply ASSUMES that the new taxes to pay for the government's end of the reform will simply be ADDED to the cost of the present system to its participants (individuals, employers and the government), and that none of the other costs will change. However, the immediate cost to the government is NOT the whole picture. It is, in fact, generally agreed that, if this country had a well-functioning health care financing and delivery system, this would ultimately save all of the participants in the system a great deal of money. It may well be that individuals and employers would end up saving more from the existence of a well-functioning system than they would pay in taxes to maintain it. But we will never know.
Second, we know now that, because of the expense, the public plan is off the table. There is still some talk of permitting nonprofit cooperatives into the market, but even that looks a little unlikely. Note that the very fact that a statute would be needed to merely permit nonprofits to offer health insurance amply proves the point I made in an earlier blog post that health insurance is NOT in any way a free market, but rather a market carefully regulated to insure consistent profits for oligopolistic for-profit insurance companies. This is absolutely not going to change. Nonprofit cooperatives, if permited at all, will have to play by the for-profits' coverage, pricing and premium-rating rules.
Third, we know that something at least similar to the current premium rating system, which only pools risks over employment-related groups and not over the whole population, is going to continue. We know this from the comments of some leading Democrats to the effect that the reform must be limited as requested by big labor, so as not to interfere with multi-employer group plans under collective bargaining agreements. But because both coverage for everyone and employer contributions for full-time employees are to be mandatory under the new system, the reform would not in any way interfere with union members' ability to get coverage at their employers' expense. Thus, what these Congressional Democrats are actually telling us is that the rating system that gives many union employees preferential premium rates is not going to change. This, in turn, implies that the current policy rating system is not going to change very much.
This rating system is the source of the largest inequities in the present system. Those who are fortunate enough to be employed by large employers that have large group plans, or by nationwide union-administered multi-employer groups under collective bargaining agreements will still get the best rates--though it's really hard to say whether those rates will go up or down as a result of the reform. Young, healthy people purchasing individual policies, and small employer groups wherein all of the covered employees are young and healthy will still get decent rates, though not as good as those eligible for large group plans. Small employer groups in which some of the covered employees are older or have health conditions will still pay very high premium rates. Individual premiums for older people and people who have ever had any serious health problems will remain often prohibitively high (though the insurance companies will no longer be permitted to exclude coverage altogether).
Fourth, it is obvious that there are going to be no realistic subsidies to support coverage for those who can't afford it. The test for subsidy eligibility is quite obviously going to be a straight household gross income "needs test," fixed as a percentage of the federal poverty line in the reform statute itself. It will make no distinction, for example, between a young healthy couple with healthy children that is eligible for coverage under a union contract and pays 20% of its household income for health insurance, and a couple a few years older with a sick child who must pay 70% of their identical household income in health insurance premiums. If the subsidy threshhold is set at 200% of the poverty line, as seems quite possible right now, and the household gross income of both of these hypothetical families is 199% of the poverty level, both families will receive identical subsidies, probably based on the average premiums for young healthy people. If the household income of both of these families is 201% of the poverty level, neither family will receive any subsidy.
Fourth, it appears that Congress is really intent upon enacting a measure that will make all of us who have been pressuring it for reform sorry that we ever asked, because it will make a large proportion of the population into involuntary lawbreakers. This can be seen by reconciling 1) the repated assertions by lawmakers on both sides of the aisle that the reform will mandate that all persons, or their employers, must purchase health insurance and 2) the apparently contradictory admission, by lawmakers again on both sides, that the packages they are presently considering would leave millions of Americans uninsured. Wait, if it's mandatory, that means everyone is going to be covered, right? Well, no. It means that everyone who can afford coverage is going to be covered. Many will still not be able to afford coverage, though required to purchase it. This group would include the millions of unemployed. Moreover, since eligibility for employer-sponsored group coverage would remain restricted BY LAW (as it is today) to "full-time," permanent employees, most of the millions who work one or more part-time jobs, or can only find temporary work, would also remain uninsured. The comments made by our members of Congress recognize this. These uninsured would not be covered under the new law, but would simply become involuntary LAWBREAKERS, criminals whose only crime was being too poor and/or employed by the wrong employer.
This leads to my final point. In an earlier posting in the "pure satire" channel on this blog, I asked how a law that would make mandatory individual purchase of health insurance would be enforced. In that posting, I facetiously compared compulsory automobile liability insurance laws to the proposal for compulsory health insurance. I suggested, by analogy to taking away the drivers' licenses of uninsured drivers, that the only logical penalty for failure to maintain compulsory health insurance would be to take away the lawbreaker's "breathing license." Unfortunately, Congress appears likely to take my satirical suggestion seriously. Several members of Congress have publicly suggested that the package they are now working out will include provisions that would remove from all health care providers (including emergency rooms, which now bear this burden) any obligation to provide treatment to any uninsured individual unless that individual immediately, at the time of service, pays for enrollment in a health insurance plan. This can only mean one thing for those who are really unable to afford the premiums the health insurance industry demands of them--for their crime they will be sentenced to death, at a random and unpredictable time, by untreated medical emergency. If the statuory income-based subsidy formula says you OUGHT to be able to afford insurance, but in fact you can't afford the rates imposed, we are going to take away your breathing license for your crime!
This will be a blog post--possibly the first in a related series of posts--that will get me in trouble with both sides of a highly polarized issue as to which both sides insist vehemently that "whoever is not fully for us is against us." In it, I will raise the question whether the political and judgmental tone, single-issue emphasis, and methods and tactics of the pro-life movement may actually encourage abortions.
Before I go any farther, let me declare this: I believe that unborn babies are humans and have rights. Therefore, I believe that abortion is a wrong, not a right.
However, I suspect that the highly polarized and judgmental political atmosphere surronding the issue may actualy encourage abortions for several reasons. The first and simplest is simply that people naturally want to do anything that is forbidden. This is not a new observation, by any means. In fact, the Apostle Paul discussed this matter at length in the seventh chapter of his letter to the Romans. Applying the principle to the sin of coveting, Paul explained that he would not have known what coveting was if God's Law had not forbidden it, but when he was told of that Law, "sin, seizing the opportunity afforded by the commandment, produced in me every kind of covetous desire." Romans 7:7-8. So by insisting on the prohibition of abortion as a motivation, we may actually be perversely increasing the attractiveness of abortion as a viable alternative.
Second, and somewhat related to this, is the observation that, by making the primary focus of the issue the search for a prohibitory POLITICAL solution, we literally have INVITED the abortion industry, and the political and media allies it finances, to recast the issue in terms of a woman's "right" to her body. Precisely because of the vehemence of the Christian political block that has been trying for almost 40 years to restore the defunct prohibition on abortion, women with unwanted pregnancies--who are already hurting and vulnerable--are being told that Christians are trying to steal their "rights" and the only way they have to defend those rights is to choose abortion. Abortion, instead of being a wrong aganst the baby, becomes a kind of a civic duty.
Third, and probably most important, is the observation that the whole debate over legal prohibition of abortion has been a distraction from the real issues that created the problem. The real issues are spiritual, social and moral, but not mostly political. I'll start with issues that relate to the Church. What are we, as the Body of Christ, doing to encourage responsibility and natural love for children? What are we doing to assist mothers--whether or not in intact families--with their children? Do we approach unwed mothers, and unmarried pregnant women among us, , with real love and support, or as outcasts that we provide some "assistance" somewhere else, where we don't have to be reminded of them? Are we judgmental, attaching mental scarlet letters automatically, or are we showing real Christian love? And what are we doing to turn the hearts of the fathers to their children (even in intact families)? Behind every woman with an unwanted pregnancy is a man. That's just a fact of nature. What are we doing about it?
But because we have chosen to focus on changing the law, we are collectively not asking these questions--at least, not persistently enough to get good answers.
On June 12, there will be a presidential election in Iran. The two main contenders are current President Mahmoud Ahmadinejad and former Prime Minister (during the 1980s) Mir Hossein Mousavi. Both are fully committed to the Islamic Revolution (as is anyone who is allowed a voice in Iran today). Nevertheless, I believe Christians here should be praying for God's will in that election. Why? Let me give four reasons:
1. In spite of centuries of Islamic rule, culminating in the Islamic Revolution, there is still a fairly sizeable native Christian community there. Their lives and witness will be affected, perhaps very substantially, by the outcome of the election and the policies of the resulting government.
2. God still loves all of the Iranian people (even those committed to Islam)!
3. We are commanded to pray for "kings and all who are in authority" that we may "live peaceful and quiet lives in all godliness and holiness." I Timothy 2:1-2. This command is not limited to the "king" of our on country; instead, we are to pray for "kings," plural. If the matter is considered carefully, it is easy tounderstand that our ability to live peaceful lives doesn't depend only on our own government, it also depends on all of the other governments that could attack our country. Moreover, our ability collectively, as the Body of Christ, to live peaceful and quiet lives, depends on the actions of every king, every government on earth, because there are believers everywhere (including Iran).
4. The chances for peace in the entire region depend heavily on how militant the Iranian government chooses to be. If Iran becomes more conciliatory, the chances of peace in the region improve greatly. This depends, in part, on the mindset of the leader to be elected next month.
Our role in this election is to pray for God's will to be done in the election and for God to draw the winner to Himself. It is NOT to pray against any human being.
As those who have read much of this blog know, I have long supported national, single-payer health care. Nevertheless, I support the president's proposal for two reasons:
1) I have committed myself to support the President personally, as far as good conscience allows, for the good of the country, as explained in earlier posts on this blog.
2) I remember what happened to Hillary Clinton's health care reform proposal, during Bill Clinton's first term as President. At the beginning of the Clinton administration, there was a fairly strong national consensus in favor of health care reform. Mrs. Clinton proposed, with her husband's support, a plan that would have been a great improvement over the status quo, though it stopped well short of single-payer national health care (although the enemies of the plan accused her of proposing this). But several other proposals also had strong support in Congress. During the year or so that the supporters of reform were arguing among themselves about which plan to follow, the health insurance industry was able to mount a successful public relations campaign that completely derailed any reform. So, because the supporters of health care reform could not agree quickly on the details, we ended up with NOTHING.
I've explained my misgivings about the direction the President plans to take--mandatory private health coverage--in previous blog entries. Greatly summarized, they are:
1) If individual payment of health insurance premiums is to be mandatory, what is to be the penalty for failure to pay? A fine (wholly unrealistic if the problem is self-perceived inability to pay)? Prison time (which appears to be a self-defeating penalty, as it destroys the ability to pay)? Commitment to a mental institution? Seizure of property to pay past-due premiums? Random capitol punishment by death in a medical emergency?
2) Are insurers to be left free to rate policies as they do now? Do self-employed individuals and individuals whose employers escape the requirement to provide coverage still get the highest premium rates--only now compulsory rather than discretionary? Will individuals with pre-existing medical problems now simply be required by law to pay whatever premiums the industry demands of them? Do small employer groups remain small employer groups? Or are we to move toward community or national rating (which seems much more fair if payment of premiums is to be required by law)?
3) Will the formulas for premium subsidies be realistic? Government income formulas never are. Will the formulas take into account other types of debt that the law highly favors for payment, such as child support and student loans (both of which have strong enforcement mechanisms and virtual nondischargeability in bankruptcy), mortgages, and credit card debt. I recognize that, if a person cannot simultaneously make all legally favored payments and eat, he or she must stop eating and make the payments. But if a person truly cannot simultaneously make all of his or her legally-protected debt payments and the mandatory health insurance premium payment, which debt must yield?
I trust that Congress will be able to address these problems before the final markup of the bill, and that it will act quickly to make the reform a reality.
I'm beginning to see a picture that is bigger than the one I set forth eight and a half years ago in my Warning Against Idolatry.
It is clear now that we have walked off the edge of the cliff economically, just as I predicted in 2000, and are now falling.
It is also clear that we have an activist President who wants to do some pretty radical things politically about the economic crash. It is also obvious, for reasons I've explained in earlier blog posts, that for reasons of justice the President should be allowed to do many of the radical things he is attampting.
However, the bigger picture is this: The government's best efforts will not solve our economic collapse. The government's best efforts will not prevent massive homelessness and privation. Social unrest and violence will occur. The only solution to the problem is found in the Church, the Body of Christ, which brings God's power to earth.
The government will do its best, but ultimately God must provide, through His Church. It will be the Church thatshows sacrificial love and demonstrates the solution.
The problem is that the Church will not be able to do this in its present, divided state. I'm not talking now about denominational divisions, or about the need for oranizational mergers. I'm talking about divisiveness in the Church. I'm talking about partisanship--the habits of building our own personal or organizational following by attacking someone else and of building the loyalty of our followers by preaching fear of identified human enemies. This is expected in the world. It should not be found in the Church.
If we want to see the solution to our current problems developed by the Church, we need to abandon these traditional methods of building a loyal following and work together. We are, as Paul reminded us several times, followers of Christ, not of human leaders. Our loyalty is to be to Him.
I am now going to suggest something quite radical. Our abandonment of the traditional divisive methods must be complete. We must not limit ourselves to merely not seeking to demonize other Christians as often. Instead, we must cease to demonize any human--Christian or unbeliever--in order to build our following. This includes political leaders. It also includes militant unbelievers and radical followers of other faiths who lash out against Christ, or against Christians, in their ignorance. We must consistently resist the urge to make these humans (for whom Christ died!) into the enemy. Though they attack, we must not. Christ has called us to live differently, trusting Him. This is the only way to unity in the Church, and hence the only solution to our current problems.
One application of this involves the political focus of this blog: I've heard many of my Christian friends demonizing the President. They tell each other he is leading us into disaster, and urge me to join them in fighting against him. Because of his political and economic ideas, he is to them the enemy. But he is also our duly elected national leader. If the Church is to find the unity necessary to provide the solution to our national problem, it needs to get behind the President. As I have written on this blog before, we need to support him. We need to support him, not demonize him and wast effort and create division fighting him as if he were the enemy. He is not the enemy, and if the Church were to solidly get behind him, first in prayer and then in action (remember that he is calling for volunteer action on a large scale!), he could be a large part of the solution. But it won't happen while we are putting so much effort into fighting him!