Comments for The Limits of Subsidiarity at http://www.thecatholicthing.org , comment 1 to 45 out of 20 comments http://www.thecatholicthing.org Thu, 23 May 2013 16:00:54 +0100 FeedCreator 1.7.3 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10932 I find this article incredibly ignorant of the causes and solutions for the correction of healthcare in the US, and, for that matter, in the world. The careless tossing about of terms which the author tries to rigidly define is not productive to a positive dialogue about what is wrong and what is right in the matter of government-controlled healthcare....especially when we see the disasters encountered with such policies in other countries. We must start with personal responsibility. That can be encouraged in many ways, and Paul Ryan's yeoman work in this area is paramount. To foster a system of irresponsibility, as has been done with federal welfare programs, and then expect otherwise responsible people to pay for the irresponsibility of many is ludicrous. To waste the resources (tax collections)of government on frivolous pursuits of more administration and aid, while failing to police those handouts already authorized is criminal....not "uncharitable", but criminal. There are many ways in which healthcare can be saved and even improved in this country if reasonable men and women will decide to provide reasonable solutions. Obamacare is not reasonable; it is a huge joke meant to increase government employment, taxation and government control of lives. Paul Ryan's plans are not the zenith of perfection either, but negative articles like this stack up barriers to constructive work that needs to be done to find real solutions. Stay out of politics, Peter, and stick with Biblical Studies. - James Stagg Tue, 17 Apr 2012 17:56:55 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10922 Too often these terms are discussed as if they are mutually exclusive instead of complimentary. Subsidiary does not have to mean by private people. Similarly, solidarity does not have to mean the federal government. We do have state governments in the United States of America. I am convinced it is this either/or arguing about everything is why we have no middle road in American politics. - Troy Jones Tue, 17 Apr 2012 02:19:42 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10919 The article leave a lot to be desired. First, Catholics have abdicated our own personal responsibility to the poor to the government. We only have to look at the giving levels at all Catholic churches. Catholics are at the low end of giving. When I (the youth minister) are in the top third of the giving at any Catholic church, we have a problem with giving. Second, most Catholic churches do not have a vibrant ministry to the poor. I am talking about a full time staff member who is dedicated to the widow, single mother, and poor. A staff member who knows the stories of every person in the parish as well as the needy in the surrounding community. I can think of only one parish who has such a staff member and that job was slimmed down a couple of years ago. Why can't parishes hire a nurse to treat the poor and elderly? Why can't churches set-up ministry to the home bound? Most churches are doing little so we end up turning to the state. The Catholic church was the first ones to do foster care. We were the first ones to help pregnant mothers. We were the first ones to help the sick and elderly. We have abdicated our personal responsibility. How many people reading this are giving 10% of their income to God? I doubt there is a single one. Yet, if every Catholic gave God 10%, we would be a force to reckon with in the USA. When we give over to the state christian charity, we lose. This is the key thing: We are not a humanitarian organization. We exist to evangelize. We exist to lead people to Jesus. When we hand over charity to the state, we lose out on our opportunity to lead the needy to Jesus. 'The poor will always be with us'. The poor need the gospel as much as the middle class and the rich. Helping the poor is our chance to share Christ. - Mark H Mon, 16 Apr 2012 16:50:41 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10918 "My main point was that Conservative Catholics should be realistic that the welfare state in one form or another is probably here to stay, and that we should seek to apply our principles and apply Catholic social teachings with that assumption in mind. Thanks for the stimulating discussion!" Not so fast, Pete Brown...you have threatened to unload yet another article on the Amish...please don't act as if the vigorous and logical opposition to this present contentions yet been effectively rebutted and all that's left is to politely pack up. In fact, Catholic social teaching *does* compel opposition to socialism. Read Rerum Novarum, and don't miss the fact that while Leo XIII critiques faults of capitalism, he in no uncertain terms damns socialism. And please don't miss the fact that most of the flaws that have been attributed to capitalism of the last century have been in fact crony corporatism, in bed with government and plutocrats, masquerading as free-market capitalism. We Conservative Catholics hold no brief for the Bush Republicrats who "had to abandon the free market principles in order to save the free market. Also note that it was the confusion-sowing CINO liberals, like Hesburgh, and the Rockefeller Republicans who have manufactured the social side of our current crisis. Whether it's economics or social issues, we true conservatives are on the correct (and Catholic) side of things. " You choose well the setting of the Civil War and Catholic nuns' sacrifice, for a comparison point in history. In fact, Sister Obamacare Keehan and her liberal femi-nun-ist orders "Leadership Conference of Women Religious" major contribution of late has been to produce a promotional documentary on the importance of nuns to America. The extent they rely on 1800s and early 1900s is not even funny. Once the 60s hit, and sexual liberation evacuated so many orders, little happened in these orders beyond kumbaya. I shrank to view the website of the order that taught in my 1960s era elementary school - instead of habits, they flaunt clown-suits. Instead of the intellectual clarity I was bequeathed in their teaching, and the even greater precision that I see my own parents received, they are mired in slap-happy happy-talk. Liberal nuns sold their birthright of sacrificial sisterhood history for a mess of pottage...as I say, they are the "Angels of the Death Panels". They are benefiting off the reflected glory of their forebears and trying to milk all the borrowed public respect for nuns while providing none of the benefits or sacrifice those nuns gave. (Thank goodness, of course, for the new Catholic orders, who have nothing to do with LCWR!) Similarly, the present day technocrats are living off the borrowed image of the country doctor while prying into every bodily orifice and plying technocratic euthanasia like zombies. Please recognize that you have not effectively answered the arguments of your commenters before you sign off to write your article on the Amish, else it will be just as likely to miss the points your interlocutors have been making. - Sue Mon, 16 Apr 2012 08:50:42 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10917 On that we agree Michael. I think you're reading waaaay too much into my piece if you think I'm urging support for one or another political party. My main point was that Conservative Catholics should be realistic that the welfare state in one form or another is probably here to stay, and that we should seek to apply our principles and apply Catholic social teachings with that assumption in mind. Thanks for the stimulating discussion! - petebrown Mon, 16 Apr 2012 07:30:58 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10915 Peter you say "But let's stop pretending that Catholic social teaching compels one or another solution." Yes! Indeed. I think what Conservative Catholics would argue is that indeed particular economic policies are not compelled by social teaching one way or another. Given this fact then the social issues, ie the right to life issues should trump other concerns. We currently have a political party that favors abortion on demand throughtout all 9 months of pregnancy, abortion defined as an "unspeakable crime" by Vatican II. It is then obviously immoral to vote for someone who favors unspeakable crime and this is not offset by someone being more or less in tune with the Church's social teaching since as you point out we should stop pretending that Catholic social teaching compels one or another solution. This kind of pretense is what the left has been doing in order to justify voting for pro-abortion liberals. I agree they should stop. - Michael DePietro Mon, 16 Apr 2012 06:30:55 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10908 @ OK Michael, I appreciate your feedback. I don't deny that there have been no gains in efficiency. Hospitals stays are indeed much shorter than before. Many surgeries are less invasive. And so on But I stand by my assertion that health care remains very labor intensive in comparison to other economic sectors. And I also add that docs and nurses and tech make quite a bit more in the US than in other countries on average. I can't link here but you might do a little reading on the Baumol cost problem which affects all labor intensive industries. These sorts of structural issues are one important driver of costs. Though we can surely agree that govt. subsidies also play a big role. You've sort of admitted another of my points. Many people use the health care system alot more than before. I think this is for many reasons but mostly because they expect that health care can do much more for them. Ironically we have seen a huge increase in veterinary medicine for much the same reason. Vets can do more for sick dogs than before and can also sell patients on more expensive procedures, to owners who can afford them. There's little distortion from govt. here or from 3rd party payers...its largely just a case of people wanting to spend more money. And society in aggregate people are choosing to spend more on care for themselves even if its through Medicare or 3rd party insurance. Yes. Soc, Sec medicare and the rest will need some adjustments..Payments will have to be cut, taxes will have to be raised or some combination of the two. But let's be honest and admit if our preferred solution is to scale back or eliminate these programs entirely our position is not rooted in concerns about subsidiarity. It's more just opposition to the concept of social welfare programs. And for the record I agree with many of yours and the others' criticisms of the American welfare state. But I think it is quite a bit harder to imagine what would go in its place if it didn't exist at all. For me it is a necessary evil that comes with accepting the gains of modern capitalism. Moreover, these programs would be facing the same financial pressures if they were administered by states, cities, or even private firms. So let's have the political debate as we will. But let's stop pretending that Catholic social teaching compels one or another solution. Cheers - petebrown Mon, 16 Apr 2012 04:43:45 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10907 Subsidarity does not mean eliminating all consolidation. It simply means that decisions need to be kept at the lowest level of organization that will be effective, thus promoting both care and personal responsibility. As one who lives in Maine, it is hard for me to see how the minimum level of organization for my effective health care must be one that includes people in Alaska. - rob Mon, 16 Apr 2012 04:33:59 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10904 Thank you Sue. I appreciate your comments! RoderickA - RoderickA Sun, 15 Apr 2012 20:33:15 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10902 Peter: medicare and Social security are obvious disasters, both are approaching bankruptcy. Social security in particular is senseless since if you invested the money you pay in SS taxes your retirement would be significantly greater. As Medicare is bankrupt as well, it reimburses at rates less than cost particularly for hospitals and as such causes cost shifting and market distortions. Moreover since it essentially has set price controls ( It has effectively reduced reimbursement rates for physicians and hospitals and since private insurance often determines its reimbursement rates to the prevailing medicare rate, it has set price controls nationally.) This is inevitably resulting in rationing if via no other reason restricting the number of people willing to enter poorly reimbursing medical fields such as primary care. It has also lead to a system in which patients are discharged from the hospital faster, at times perhaps sooner that is ideal. Peter you seem make a lot of statements that are not supported by any evidence at all, and when you venture into medicine you are making statements that are simply incorrect. I am a physican ( pulmonary and critical care medicine). Actually physicians and nurses and the whole system is a lot more productive than before. First of all the patient volume is dramatically increased. (In the last 5 years the medical intensive care unit in which I see patients has gone from about 1000 admissions/ year to almost 1700, with the average length of stay dropping, and the mortality rate unchanged, and the acuity ( meaning the severity of illness is increased). So we are seeing more patients, who are sicker, and in fact sicker patients receive a larger number of interventions. Thus we are in fact more productive. There are scales for measuring such things, such as the TISS scale ( therapeutic and intervention scoring system, which you are obviously unaware even exists). As far as your statement about physician incomes increasing because the "demand for their services in increasing", This is incorrect. There are de facto price controls set by the existence of medicare, the incomes of physicians has been declining in real terms since the mid 90s. Salaries for nurses adjusted for inflation have been fairly flat since the early 90s, based on the National Sample Survey of Registered Nurses. Your last set of comments proves my point. It is no argument at all to say Medicare, SS etc are successes, it is an assertion. The fact that the programs are popular with the public is not a measure of their success because the public is not well informed as to the details of the programs, nor what alternatives to the programs exist. They are also unaware that the programs are resulting in effects that have not been linked in the popular mind to the programs themselves. For example most people do not like being discharged from hospitals faster than previously, and perhaps in a sicker condition, but they are not aware this is a consequence of a truly absurd reimbursement system. My essential point then remains that many are responding to the idea that a program "sounds good", but have no ideas what the actual details regarding the effects of the program are. - Michael DePietro Sun, 15 Apr 2012 18:29:07 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10900 This is a horribly flawed article. "Subsidiarists" as a term reflective of "people fearful or hostile to state provision of welfare"---how naive, how simplistic, how absurd. And then to suggest by some form of inferential reasoning that social security, medicare, and medicaid are "solidarity" innovations. This makes no sense, makes a mockery of the teaching found in Centessimus (sp) Annus, and conflates political solutions with the brilliant, timeless wisdom of Rerum Novarum and Centismus Annus. - Bob Sun, 15 Apr 2012 18:21:40 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10899 Subsidiarity is not fear or hostility of the state doing anything. It simply states that if a solution can be accomplishesd by a lower level of the state or society, it should be. So the question is: can the solution to healthcare needs be accomplished by a level lower than the Federal Government. The answer is a resounding yes, but is there the will to do it. JohnF - JohnF Sun, 15 Apr 2012 18:14:09 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10898 Yes it's obvious Medicare is a huge item of waste - lots of unnecessary tests and procedures being done. I speak from having worked as an analyst for Medicare programs. Social Security is broke, a failed Ponzi scheme. That doesn't make it any easier to shut them down, however and it doesn't mean there's not meaningful medicine being practiced under Medicare. Families plan for themselves given certain assumptions about what will be available. There would have to be some gradual shift to more local systems. But it could be provided with less waste if administered at a lower level - at least at the level of each church. And ideally things could move down to parishes and families. And if we have fewer intact families, perhaps that might be a mighty incentive for people to start patching things up. What if the Catholic Church undertook to provide health care on its own, using only the contributions of its members, like it has provided Catholic education? No more billing the federal government, but then no more having to dance to the piper's tune, either. We could define abortion, contraception, and ivf away as not-health-care. As for unemployment insurance, yes...that too is a disaster...and disincentive for getting people back to work. Double income families getting double unemployment checks is a huge corruption. As for welfare reform, that was RINO-Newt style welfare reform in the 90s you're talking about. Real welfare reform would promote marriage, natural families, and adoption and would discourage divorce and single-parenting. Outlaw abortion, and let teen single mothers see the many many married couples who would love to adopt their babies, if only they would give life a chance. You may think that I'm dreaming, but I'm not the only one! Couples are paying huge prices to undergo IVF, because it is simply too hard to adopt. Get rid of all the obstacles! Yes, Peter Brown, I'll take your one-way ticket back to Civil War times and take my chances with the medicine. At least babies weren't flushed down the toilet, grannies didn't have to watch their back in the hospitals and children didn't get sterilized or pornified by the government and we didn't have the national debt remaking our posterity into little more than slaves on the government plantation. Maybe we shouldn't have the half a million dollar hospital stays in America until they get cheap enough for third-worlders to have them, too. That'll happen a lot sooner if the medical field were unleashed to compete in a free market. - Sue Sun, 15 Apr 2012 16:50:05 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10897 @ Michael Pietro. With respect, I think you are confusing several things. Regarding the many things in the world, yes of course it is better to have decisions made locally. The federal govt.. does not set the price of gasoline or steak or bread or laptops because all the things that go into such prices are diffuse throughout the supply chain and cannot possibly be known to central authorities but only large numbers of disconnected local actors. But is localized decision making always better in every case? Obviously not. Many successful multinational corporations have become so successful by learning to standardize their operations. The local manager of a Mc Donalds has some autonomy of certain aspects of the running of a local restaurant. But McDonalds doesn't let him change the menu even if he thinks his customers might really like tandoori chicken and pad thai this week. Many companies have learned there is an immense value to branding and standardization of a product that can only come through top down decision making. And if you think about it, the Catholic Church standardizes many things from top down decisions in more or less the same way. I'm curious for you to tell us how health care should be financed locally. You also write "In terms of social welfare programs, it is pretty obvious in terms of their empirical success the large bloated federal programs favored by the Catholic left have been a disaster." I don't know....is it obvious that Medicare and Social Security have been a disaster? What about unemployment insurance? What about SSI for the disabled? We may have legitimate complaints about how these programs work in practice. They are expensive for instance. And the concern about welfare is moral hazard ie. it promotes the very things it is insuring against. Well that was what welfare reform was all about! But complaining about the workings of social insurance programs is different from proposing what really could practically replace them if they didn't exist at all. Most people (including me) have taken the pragmatic step of recognizing the need for their existence while tolerating the inevitable shortcomings. - petebrown Sun, 15 Apr 2012 08:43:54 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10896 One last comment on the other issue of medicine. Yes it is expensive. The last three years of cancer treatment have taught me that much. Next time, when you whine about medical bills, take the time to consider the malpractice premiums each physician and hospital has to carry for practicing medicine, the performance of staff and quality of diagnostic equipment that comes into question every time a malpractice claim is litigated in court. In half of my life time of 28 years ago, the diagnosis for prostate cancer would have been less than a 50% chance of survivability and more than likely, I would not be here to write this. Yes, there are some physicians out there who should not be practicing medicine. Our faith teaches us only one who was perfect born form a mother without original sin and what did he get for being perfect, nailed to a cross dying an ignominious death. So, I guess there is no escape for the imperfect as well. We thank and praise the physician for saving our lives but wouldn't think more than a minute to sue them for great sums if they make a human error without malice, just a mistake. We rail against "Big Pharma" and forget what it takes to bring a pharmaceutical to market. The scientists from physicians to biochemists to synthetic chemists are highly talented and they don't come cheap. All have spent years in school learning their craft in both classroom, laboratory and publication. It is not uncommon for a pharmaceutical company to have hundreds of millions of dollars in development and testing before the medicine goes to market and begins to return any level of profit. What happens if the pharmaceutical fails after all that investment? It is also lost on many that many popular medicines though expensive also provide the additional dollars to research and develop medicines for small patient populations with rare diseases. Pharmacy patents have limited time before a generic is allowed to come to market. So while we wail and rail against the gouging and abuse that we all like to point to and at times occurs, where would some of us be without that medicine? Surviving cancer has driven home one important point i've lived by for many years...LIFE ITSELF IS RISKY BUSINESS. We all take a risk everyday when we get out of bed and I'll conclude with the famous quote of Ben Franklin, "Those who would trade their freedom and liberty for security are undeserving of either." - Frank Sun, 15 Apr 2012 08:34:04 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10895 Well I'm glad my piece touched off an interesting discussion. Yes Lauri, I think the debate is really about finance of the cost of medical care not govt. owning all the hospitals and employing all the professionals. So I think we're not as far apart on the issue as I thought before. You're right Aaron, solidarity and subsidiarity do ideally go hand in hand. Maybe the lead in could have been better expressed. But the larger point is that both subsidiarity and solidarity have been undermined by the workings of capitalism itself, as much as by govt. welfare states. I'm a strong capitalist of course, but we need to be honest about the tradeoffs here. A couple of you rightly complained about the high cost of medical care. No doubt some of it is due to inefficient state a federal regulations. For instance in many states it is illegal for a dental hygienist to clean a patients teeth unless she works for a dentist. COnsequently it is much more expensive to have teeth cleaned than it would be if we could visit a teeth cleaning clinic in a Walmart or something. And there are many regs like this. But this is only part of the overall cost picture. Much of medicine is expensive because it is still very labor intensive. It takes just about as many nurses to staff an ICU ward as 30 years ago, and just as many doctors and support staff to do most surgeries. And a doctor can only see one patient at a time and do one surgery at a time. The productivity gains felt in other sectors just haven't been felt so much in medicine yet. And it's only through increased productivity that prices can come down. But doctors, nurses and techs command higher and higher wages than before, mainly because the market demand for their work is growing. No one wants to admit it, but in the future docs and nurses will have to make less because medicare and private insurance will force down wages. But doing so more aggressively than they already are will be very controversial. I'm glad Manfred mentioned the example of the Amish. Answering that one is another whole article. Stay tuned. - petebrown Sun, 15 Apr 2012 06:10:18 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10893 I do not think Mr. Brown understands what subsidiarity means. It does not mean that charity should be dispensed at the level of families and communities. Since he gets the definition wrong the rest of the essay becomes a non sequitor. The actual definition is the idea that a central authority should have a subsidiary function, performing only those tasks which cannot be performed effectively at a more immediate or local level. The concept is applicable in the fields of government, political science, cybernetics, management, military. This principal has the beauty of being empirically testable. For example the American military has found that giving lower ranking officers greater decision making authority missions can be more successfully carried out ( as compared with the military experiences of those countries which leave a greater percentage of decisions higher in the chain of command). In terms of social welfare programs, it is pretty obvious in terms of their empirical success the large bloated federal programs favored by the Catholic left have been a disaster. If I was some demonic entity that detested the poor and wished to grind them further into poverty I would simply follow the policies recommended by the USCCB committee on Peace and Justice. Lets just try looking at one fact, prior to 1965 the poverty rate in the United States was rapidly decreasing, post 1965 and the implementation of the liberal "great society programs" the rate of decline ceased and has floated around 12-14% ever since. This suggests that at best these programs do not work, but more likely they are not just neutral but detrimental, since the obliterated the decline in poverty that was already underway. In fact modern capitalism has done more to obliterate poverty and human want than any other system devised by man, that is why the poor in the United States are in fact wealthy compared to the middle class in places like India. The least wealthy 5% of people in the United States are wealthier than the wealthiest 5% in India. For those who would like to see the details read Branko Milanovic's book "The Have's and Have Nots". In any case what Catholicism teaches and what god commands is that we care about the each other, and seek to alleviate human misery, including poverty. This includes of course personal alms giving. In terms of public policy it mandates actually looking at the policies that work ( what are the actual causes of poverty and what things are associated with less of it.) The problem with the folks who like to throw around words like "solidarity" is that they do not seem to actually care if the policies they promote actually do anything to lower the rates of poverty and human misery. To the extent they do not, what they are doing is simply moral posturing. I am not a believer in subsidiarity because it is ideologically sound. I am a believer because the empirical data supports it, and more importantly in terms of economics the empirical evidence does not support the social welfare state. - Michael DePietro Sun, 15 Apr 2012 05:43:14 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10891 I agree with those on this thread who nix the either or pessimism in this article. The problem is that the health care industry is too big and too greedy. There are alternatives and they are not difficult to implement. Do not say simplistic. It will take time to implement, but it is not simplistic because it is subject to "tweaking".s How to get the greed of the insurance companies out of the mix? Non-profit health insurance entities like BCBS used to be.No shareholder profits or huge CEO salaries. How get greed of health care providers out of the mix? Encourage the schools to accept as many students as they can who are entering medicine as a vocation of service to others rather that to their own ego and pocketbook. How get greed out of hospitals? Nonprofits established as providers of service with no shareholders or overpaid CEOS. How get the greed out of big pharma? Tax breaks for manufacturers of quality generics, trust bust the big pharmaceutical companies which buy up generic manufacturers and shut them down to establish a monopoly. Allow for purchase by individuals from Canada or Mexico without penalty. How pay for it? Tax credits to the purcheser of insurance coverages and medicines. (For those who may have forgotten, tax credits come right off your tax bill or you get a rebate if you do not have a tax bill large enough to off set the credit) How manage it? As locally as possible. Why? Because I have been an HMO recipient and a private insurance member and now Medicare and HMOs and Medicare are terrible in too many ways to articulate. I have also worked in the healthcare industry. And get rid of the word industry in association with health care. - ann Sun, 15 Apr 2012 05:38:47 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10890 When the government particularly the US Government spends 50 to 80 cents on every dollar collected through taxes on bureaucratic overhead and not to those in true need for which the dollars through force of law were collected, then something is truly amiss and will remain so until there is some constructive rethink about the social gospel and the secular application of social justice. It's one of the easiest and most of the time painful efforts to write a cheque to the Government. Write the cheque, attach to return and mail before the deadline. OK, I've done my duty for the year and thrown my obligated money at the problem so now I'm absolved from further effort to my neighbor and go about my daily business until next year. My reading of the Gospels over many years thoroughly convinces me that Christ wanted everyone of us to give more than just money, we are required to give of ourselves; our time, our abilities, and yes a portion of our money. "Social Justice" under the current definition and application of its secular adherents and a few too many Catholics as well is stuck and will remain stuck in the antagonistic paradigm of constantly throwing more and more and more money at the problem. The "War on Poverty" begun in the 1960's through the "benevolence" of LBJ has spent over 35 TRILLION dollars and no victory over this war in not even in sight. Insanity, that thing done over and over again while hoping for a different outcome? Are we not called to bloom where planted or replanted? The sense of community while dormant is not dead. It will reappear once enough of us reassume that mantle of obligation and tell government to reduce its efforts in an area of which it has failed through its largesse. - Frank Sun, 15 Apr 2012 04:11:49 +0100 http://www.thecatholicthing.org/columns/2012/the-limits-of-subsidiarity.html#comment-10888 I worked in the medical field for many years. I offer a few observations in the interest of re-centering some of the rhetorical explorations. The cost of developing new medical equipment and drugs is made artificially high by the demands of the FDA. The demands are bureaucratic in the extreme, to the extent that they were attempting to make developers of new products provide a paper trail of their thoughts! They reasoned that bad design starts with a bad concept and it does. The failure was in imagining that bad thoughts could be eliminated with the proper protocol. It is laughable idiocy that costs you (the reader) big money. The FDA also controls who may buy medical equipment. Say it cost 5 million to develop a medical sensor that can be used by eye doctors. That money includes the engineering staff, the quality control staff, the financial staff, the cost of heat and light and working space, the sales staff, the bureaucratic interface (every step in the process has to be documented and the documentation has to be documented) the technicians and so on. Not every eye doctor will buy the sensor and there is competition, so say the market for the sensor is 5,000 eye doctors in the US. Each doctor will have to spend a thousand dollars for the sensor to cover development costs before the cost of making it, selling it, shipping it, stocking it, advertising it and providing tech help and repair for it is paid for. Actually he is going to pay closer to $3000.00 for the sensor because of distribution. If he has 300 patients, and 100 of them might benefit from the sensor, he will have to charge each one $30.00 for a scan to cover his expenses, so make that $50.00 - except that he has to pay an individual to handle the paperwork load to get reimbursed so make that $100.00 and add $10 more to cover the liability insurance payment because a nurse in Indiana once poked out a patient's eye and the manufacturer was sued for $5 million. The government sets the usual fee for using the sensor! Most people don't know that. The sensor is not perfect because nothing is perfect. The doctor uses it to make an educated guess about what is happening with the patient - a diagnosis. In other words, the doctor does not provide health care as if it was a commodity (there is no such thing) the doctor makes judgments based on experience, intelligence, training, in a small window in time. Being human, the doctor is sometimes wrong. Notice that good doctors are wrong less, but all doctors are wrong sometimes. The doctor pays $100,000 a year for liability insurance. The government sets the limits for what patients can sue to recover after what a lawyer may determine is a fault in the diagnostic process. In other words behind every single expense is the government which then uses the problem of expense to take more control over the process. The way the FDA rules on new medical sensors biases the process toward what already exists, because the FDA knows nothing about medical technology and must rely on existing manufacturers to set standards which they do to benefit the products they already make. By the way the cost of the parts in the hypothetical sensor mentioned above is typically under $10. If the sensor could be sold OTC, it would cost about the same as a cheap digital watch - but nobody wants that because then patients would monitor their own health. Some would get it wrong and hurt themselves so it can't be allowed. But then some are eating themselves to death, drinking and driving, shooting up drugs and indulging in various deadly sins - and for them, we can't have cheap sensors. The reason computers are cheaper every year, but medical expenses go up faster than inflation is government in action. - Other Joe Sun, 15 Apr 2012 03:07:48 +0100