The National Catholic Review
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Strategic Divide

Before Vice President Biden’s ill-fated visit to Israel last month, the handwriting was already on the wall. Anyone watching day-to-day events would not have been surprised that U.S. hopes of reopening the Mideast peace talks during Mr. Biden’s visit would have been upended by the announcement of Israeli plans for the construction of 1,600 homes in Arab East Jerusalem. For many months the Israeli police have looked away as Jewish settlers expelled Arab residents and occupied their homes in East Jerusalem. Elsewhere on the West Bank the military has seized more land and demolished homes for expansion of Israel’s security wall. Once-shared religious shrines have been declared Jewish heritage sites; nonviolent protests have been suppressed; and Israeli human rights activists have been harassed by police.

Had the United States chosen to listen, it did have a prophet interpreting events. In January, General David M. Petraeus, chief of the U.S. Central Command, which includes most of the Middle East and Central Asia, had warned the Joint Chiefs of Staff that Israeli policies and its obduracy in the peace process were harming U.S. strategic interests. As long as the Israeli-Palestinian conflict goes unresolved, the general counseled, Arab and Muslim governments across the region will distrust U.S. initiatives there.

The rift between the United States and Israel that occurred after the Biden snub now goes far deeper than diplomatic niceties over the timing of an unhelpful announcement. It is a seismic clash of strategic visions. American commitment to the Israeli people may be strong, but the alliance between the two nations is pulling apart.

Achieving Step One

Hurrah! The yearlong battle has been won, and the health care reform bill is now the law of the land. Most Americans will benefit from the legislation: the insured who could get sick or lose their job; those with Medicare/Medicaid coverage whose drug payments fall into “the doughnut hole” gap in coverage; and especially the 32 million Americans currently without insurance. But this historic achievement is only the first step in what must be a change of attitude among the body politic. Americans must abandon the notion that health care is a luxury for the privileged and a “fringe benefit” from employers but just a wish for the unlucky rest of the population. The truth is that not only should every American have health coverage, but that most actually can have it—thanks to this bill. Our government has completed a major exercise in “promoting the general welfare,” which the Constitution mandates it to do.

Part two of the required attitude shift will be more difficult to achieve. Having decided to provide nearly universal coverage, we Americans have to decide how to keep expensive health costs under control. The bill takes steps toward containing costs but does not go far enough. How the nation exercises fiscal responsibility matters. It ought not cut off some citizens’ coverage just to rein in costs, any more than a family facing hard times would let two or three members go without food while the rest eat up. Major cost-cutting choices lie ahead. But only a real shift in attitude, one that seeks to promote the common good, will ensure that the right choices are made.

Move Over!

The multigenerational household, long in decline in the United States, is staging a comeback. The number of U.S. families living together that include seniors, working parents and their adult-ish children has hit a 50-year high. During the first year of the current recession, 2007 to 2008, the number of Americans living in such multigenerational households rose by 2.6 million to 49 million people—a little over 16 percent of the total U.S. population.

The Pew Research Center report suggests that this increase continues a trend that began in 1980. Pew attributes the rise of such households to immigrant families moving into the United States and bringing the custom with them, but it reports, on a slightly less positive note, that our foreclosure-spackled economy has also had much to do with the upturn in multigenerational homesteading. With jobs harder to find and marriages delayed five years later than in 1970, children are moving back in with their parents after college even as their grandparents crowd in when their health or incomes require more assistance.

Such arrangements mean less loneliness and better health for older Americans. One can only hope that for the younger generation, they mean a chance to acquire some wisdom from their elders and enjoy economic breathing room to save a little cash.

They are going to need it. An unrelated study reports that the percentage of U.S. workers with virtually no retirement savings grew for the third straight year. According to a survey from the Employee Benefit Research Institute, workers who reported that they have less than $10,000 in savings grew to 43 percent in 2010, and confidence in their ability to save enough for a comfortable retirement declined to 16 percent of respondents, the second lowest point in the survey’s 20-year history.

Comments

lazaro alvarez, jr. esq. | 3/30/2010 - 8:44am

Mr. Ruais, your statements concerning the health care bill are uninformed or plainly dishonest! The new law preserves the Hyde Amendment which prohibits money for abortions.

You claim that health care for the elderly will be rationed? Again you are uninformed: Three points: first, health care is already rationed for all Americans under the present system and, in addition, some of our fellow humans get NO medical attention whatsoever! This includes children you RIGHTLY wish to save from abortion. Second, rationing, as you seem to suggest, is the brain child of political hacks who would like to see this law defeated. No such provision exists in this bill. Finally, under this legislation no one is prohibited from going outside the system and hiring his own doctor, regardless of his age. Finally, this bill delivers 34 million uninsured Americans to THE SAME INSURANCE COMPANIES we use today.

We cannot confuse Christianity with conservative or liberal politics. It is not about Republicans or Democrats; it is about our Lord and being faithful. A position on such a basic issue cannot be addressed merely by restating ideological positions of the right or the left. We belong to a different KINGDOM!

Tom Maher | 3/30/2010 - 2:35am
Rasmussen's weekly poll tracking the new health care law repeal effort came out yesterday Monday, March 29, 2010 for the first full week of the new law. The polls show that a 54% majority of voting Americans favor the repeal of the new health care law compared to 42% that favor the new law. Interestingly, a signficantly higher percentage of unaffiliated voter want the law repealed than do voters enrolled as republicans or democrats.

This new law is in big trouble when from the time of enactment into law a majority of voters want the new law repealed. This looks like the Temperance laws of the 1920s that banned drinking, something people had done for ages. The religious folks though it was great but the average citizen hated the law so of course it was repealed. Many of the more measured temperance components that people could actually agree on such as not allowing children to drink were kept as law.

The problem with health care law is it badly lacks common acceptance and supportfor most if not all of its provisoins. The public has no confidence in the provisions of this new law.
Ronald Ruais | 3/29/2010 - 4:13pm

Not only does the health care bill violate the dignity of the human person by funding abortions (called medical procedures in the bill). It will also violate the principle of dignity of the human person by denying health care to the elderly. The health care bill will ration health care for the elderly. Even President Obama doesn’t deny that this will happen. He stated that his own grandmother should not have had a hip replacement at her age paid for by a health insurance plan. But he quickly added that he would have paid for it out his own pocket.

Stuart Altman Professor of Health Policy Testifying before the Senate Finance Committee stated:”Remember, our population is aging. And with the very, very elderly, the costs go down, so that percentage should be falling, and it’s not. Second, the cost of care is growing by so much, so at the same percentage, it’s worth a lot more. So let’s go back to the issue of comparative effectiveness, which we’re supporting. That’s where that can have a big impact. It’s not only there, but that’s where the waste is. That’s where people are using technologies that really either don’t work at all or keep people alive for very limited [time] and [at] very high cost.”

Daniel “Stormy” Johnson, Jr., MD, FACR is a Visiting Fellow in Health Policy at The Heritage Foundation and a former President of the American Medical Association. In an article titled Memo to My Fellow Physicians: We Have Reached the Moment of Truth, said this: “... both proponents and opponents of single payer, realize is a Trojan horse for a Canadian-style single-payer system. Once private insurance is crowded out by the unfair competitive tactics of the federal government intruding into an already flawed marketplace, it will be a simple matter to consolidate all of these different groups into one single entity. What does this mean to physicians and their patients? “Clinical effectiveness research,” when operated by government instead of the medical profession, will become “cost effectiveness” restrictions on what care is available and to whom—determined by the federal government. It will only be a matter of a short time before Americans will enjoy the pleasures of “quality adjusted life years” wherein people my age will be denied services from which they might benefit because of their age and/or some other infirmity.”

This health care proposal is not reform it is a radical mutation. Since most of the ‘House’ believes in evolution, why not try evolving a system gradually, rather than having a mutation of a system with which most are satisfied? Try small bites. Cap malpractice and see what happens. Give incentives to the dubious 47 million to purchase health insurance.

The current proposal is replete (one count estimates 53) with committees, boards and potential czars with “funding as necessary” and development of “policies as necessary”. This is not a bill it is an open ended track to a one payer national health care scam.

The dignity of the human person cannot be trumped by the common good. Is it alright to kill the family’s youngest child in order to be able to afford college for the other children? Isn’t it good for the family in general to have a college graduate? We could create other example with more serious life threatening scenarios. It should be clear that the many cannot decide to violate the few because it benefits the many.

And Oh by the way, where will all of the new doctors required to meet the requirements of this program come from?

Ronald Pelley | 3/29/2010 - 1:14am

I agree in some aspects with the previous comments but also differ in significant ways.  To put my viewpoint in perspective I must give the following background.  I am a retired physician/scientist who expertise is in Pathology and Immunology/Microbiology.  I spent much of my career in academia but I have also worked in the private sector.  I still teach as an emeritus adjunct faculty in a large urban Medical School.

I and most of my physician friends believe that a major problem with the economics of medical care is that the incentives run against preventive medicine and in favor of proceedure mediated treatment of disease.  This means too few primary care physicians and too many radiologists and cardiothoracic surgeons. 

I must admit that I am quite happy with my large HMO that costs a fraction of Blue Cross Blue Shield.  My HMO is inclined to manage my Type II diabetes, hypertension and hypercholestemia rather than to treat MI, CVA, retinopathy and nephropathy.  If you really believed in surrogate markers, my BP, lipid profile and hemoglobin A1c say I should live forever (if only that were true).

Unfortunately, all too much of our population smokes, overeats, fails to exercise, engages in unsafe sexual practices and various forms of substance abuse.  It is my experience that this same subpopulation is scared livid of HMO's.

That's how I see it.  But then prior to 1980 I kept saying that unknown infectious diseases from the tropics posed significant threats to America.  Eventually I learned my lesson and switched from working on disease of the poor to studying disease of the rich. 

lazaro alvarez, jr. esq. | 3/27/2010 - 5:09pm

It is unfortunate that Catholic Christians can address the issue of monetary costs for health care without due consideration to the human suffering of Americans unable to obtain medical attention. Christians must ask different questions and follow a different paradigm. First, we must consider the essential human needs that must be met. Second, we consider the most economical and efficient means to achieve the common good. Third, we find the means to pay for meeting said challenge. I don't want higher taxes, but essential human needs come first. There are costs we cannot defer without betraying Christian moral principles. I am very glad for the passage of health care reform.

JOHN WALTON MR | 3/26/2010 - 9:42pm

One wonders why "Health Savings Account" contributions were reduced in this bill.

One wonders why Congress and their staffers are exempt from participation.

One wonders why there is no tort reform.

One notes that a presidential "order" can be so easily overturned.

One observes that the Volstead Act was a disaster.

One observes that the imposition of wage and price controls by Truman and Nixon were economic disasters.

One observes that the Democrats in Congress used precisely the same fraudulent accounting methodology employed by Enron and Health South to attain a "pass" from the CBO.  I remind my Jesuit friends, that a "D" is also pass. The long term economic implications are nothing short of catastrophic for this country.

Next, my black-robed friends, Mr. Obama is going to do a little sheep-shearing by reducing the deductibility of charitable deductions to your high schools and colleges.

C Walter Mattingly | 3/26/2010 - 8:09pm

It is curious that America's editors have concluded that "most Americans will benefit from this plan."  With over a half a trillion dollars in cuts from Medicare, how will these massive  cuts benefit seniors? Will those who have private plans pay more or less (we all suspect the answer to that one)?  Most, or at least very many, will find increased costs and/or reduced services. 


As to step two, how to control costs, which America wisely recognizes is not going to happen despite democratic propaganda to the contrary, the best way is contained in the opinion section of today's NYTimes, Paul Ryan's piece, Fix Health Reforms, which is a two step process: clearly articulate a health reform we can afford, then repeal this plan and replace it with one that actually will control costs and balance expenses, starting with repealing the regressive tax preference of employment-based health care by taxing it and making it equitable with those who must buy their own coverage.  As Ryan correctly states, democrats never were much concerned about controlling costs but rather in expansion of government control of health care. That is why this plan cannot realistically perform its function and control costs. There is time to repeal, as many of the benefits do not kick in for 2-4 years, part of the facade to make the costs appear lower over 10 years by denying the services taxed and paid for. Also, as the current administration has now established reconciliation as a valid process for major legislation, only a 51% majority can repeal this legislation. We have reason to hope this will be the case.  November is important.


November will be an important date for the prospect of affordable health care.

C Walter Mattingly | 3/26/2010 - 8:08pm

It is curious that America's editors have concluded that "most Americans will benefit from this plan."  With over a half a trillion dollars in cuts from Medicare, how will these massive  cuts benefit seniors? Will those who have private plans pay more or less (we all suspect the answer to that one)?  Most, or at least very many, will find increased costs and/or reduced services. 

As to step two, how to control costs, which America wisely recognizes is not going to happen despite democratic propaganda to the contrary, the best way is contained in the opinion section of today's NYTimes, Paul Ryan's piece, Fix Health Reforms, which is a two step process: clearly articulate a health reform we can afford, then repeal this plan and replace it with one that actually will control costs and balance expenses, starting with repealing the regressive tax preference of employment-based health care by taxing it and making it equitable with those who must buy their own coverage.  As Ryan correctly states, democrats never were much concerned about controlling costs but rather in expansion of government control of health care. That is why this plan cannot realistically perform its function and control costs. There is time to repeal, as many of the benefits do not kick in for 2-4 years, part of the facade to make the costs appear lower over 10 years by denying the services taxed and paid for. Also, as the current administration has now established reconciliation as a valid process for major legislation, only a 51% majority can repeal this legislation. We have reason to hope this will be the case.  November is important.

November will be an important date for the prospect of affordable health care.

OBI OBIEKWE | 3/26/2010 - 4:36pm

The passage of the healthcare bill shows that political leadership without courage is like a car without engine.  Everything possible was done to derail the passage of the bill.  All failed because of political courage by a handful of men and women.  Hurrah to President Obama, Speaker Pelosi, Harry Reid and others. 

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