Reflections From The Political Prism

“Everyone deserves world-class care”

Those who champion our existing health-care system, i.e., those who don’t want to change it, often point out that the Cleveland Clinic, along with other leading health facilities, draws patients from all over the world (Saudi Arabian sheiks, for example) because the Clinic offers them the best care in the world.

Yes, the sheiks look to the Clinic when they need the very best life-saving care. But if that is true of the sheiks, it is true also of the citizens of Peoria and millions of other Americans who would benefit from the Clinic’s world-class care. Obviously they can’t all be treated by the Clinic, even apart from financial considerations, because the Clinic can only accommodate so many. These millions of Americans must turn to whatever care is available to them, which may be far less than the Clinic offers. Why should we extol the care afforded Arabian sheiks, while ignoring the quality of care available to American citizens?

If we are judging the quality of a national health care system, we should focus not on the best instances, but on the overall picture. What kind of care does the average person get and (most of all) what kind of care does the worst-off person get? Elite institutions, such as the Clinic, can enter the picture as possible sources of ideas for improving the system as a whole. In making this sort of judgment, the quality of delivery systems, including insurance systems, must be considered along with the quality of medical care itself.

And on this score, the US ranks poorly. Compared with other industrialized nations on indicators such as infant mortality, our system is simply mediocre. Furthermore, the nation pays a shockingly high price for this mediocre result.

So the next time you hear of the Cleveland Clinic and its sterling record, think about extending that record to the nation as a whole. Think opportunity to receive care. Think delivery systems. Think insurance. Think cost containment. These are the important issues.

The Constitution?

Those who followed the Casey Anthony trial on TV may remember her lawyers, at the end, rejoicing in the fact that the Constitution had prevailed. They were alluding to the principle that had saved their client--the  principle that a defendant must be presumed innocent until proven guilty beyond reasonable doubt. Note the words the lawyers used: "the Constitution". To put it plainly, her lawyers implied that the presumption of innocence, which had been decisive in Casey Anthony’s trial, is a provision of the Constitution.

This raises the question: Where in the Constitution is the presumption of innocence prescribed or mentioned?

You can save yourself the trouble of looking. Presumption of innocence does not appear in the US Constitution. That is, it does not appear in the written Constitution. It arose in the common law of England and other countries, and was adopted into US common law through court decisions serving as precedents.

So like Casey Anthony’s lawyers, in talking of the Constitution, we are usually referring not merely to the written Constitution, but rather to that document itself plus an extensive system of principles set by precedent and custom, which may or may not have a direct relationship to the written document. In addition to the presumption of innocence, for example, the right of the courts to overturn legislation (judicial review) is not mentioned in the written Constitution. Neither is the Miranda rule. Yet both are counted as essential  parts of our Constitutional system.

Clearly, the Constitutional system changes with time, as new precedents are set. There was a time when presumption of innocence was a non-entity. Then it was asserted and taken as a precedent, and now it is unquestioned.

There is an important political point here. A theme often found in conservative argument is that we have departed from the Constitution--meaning the written document--and must return to its pure form by trimming away all the illegitimate functions of government that have proliferated with no basis in the written Constitution itself. But clearly, if we trimmed our system of laws down to those directly sanctioned by the Constitution, we would have a mere skeleton of the system we live under, the system on which our well-being depends.

So let’s not be taken in by the arguments of the Originalists, as they are sometimes called. I don’t think they want to strip our legal system bare. I don’t think they want to discard the presumption of innocence. Instead, I think they use their appeal to the written Constitution selectively, as a way of nullifying the rights and the policies they don’t like, those that through the years have increasingly brought justice and equality to our nation.

Who Needs to Think When Name-Calling Will Do?

The principle of progressive taxation is thoroughly ingrained in our conception of social justice and of democracy itself. It is supported by our basic feelings of justice, as well as by specific arguments. It can be argued that everyone depends on the society at large for protection and support, and therefore those who gain the most from that protection and support should give back the most. And it can be argued that no one has a moral claim to wealth beyond the average, since it is the result of circumstances, including market conditions, that have nothing to do with the moral worth of the individual. In any case, progressive taxation is a principle that occupies a firm place in our common conception of a just society.

But lately the principle of progressive taxation has been battered and torn. We find instances and situations in which taxation is actually regressive instead of progressive, in which high-income individuals pay a lower effective rate than those with lower incomes. In the absence of a specific explanation justifying the low rate, this is clearly unjust. Various individuals and groups--Warren Buffett and the Occupiers, to give just two examples--have called attention to the injustice.

A number of persons in the conservative camp, most notably some of the Republican candidates, have answered these calls by labeling them as “class warfare” or the product of “bitter envy” and the like. These complainers don’t argue against the principle of progressive taxation. They don’t have any concern for principle at all. They personalize the controversy, seeing it merely as an attack by one group against another group who have something they want, as a conflict between individuals living not in a society governed by principles but in the proverbial jungle, motivated by nothing but naked self-interest. Is there any better definition of a barbarian?

Yes, the barbarians are at the gates. Let’s make sure they are repelled.

One More Round of Bishops vs. Contraception.

No commentary would be complete without some consideration of the unfortunate behavior of the Catholic bishops in the recent contraception controversy. The situation has been well massaged in news stories, editorials and letters-to-the-editor, and probably in every other kind of media, including the social. I would like to reiterate just two basic points:

1) The Bishops cannot be speaking for the lay membership of the Catholic Church, for at least two reasons: The great majority of Catholic women (reported as 95% or 98%) use or have used contraceptives, and opposition to contraception is based on a moral theory, or moral theology, called Natural Law, which holds that morality is determined by goals set into human nature, e.g., procreation as the goal of sexuality. It strains credibility to believe that this theory is understood by the Catholic laity overall (I also have my doubts as to whether the hierarchy has subjected it to critical examination, but that’s another story). In any case, Natural Law is a bankrupt theory with no room for human sympathy and no foundation in fact or logic.

2) The administration’s requirements do not cover the personal life of anyone, Catholic or otherwise. It is directed only toward hospitals and other healthcare organizations, including those under Catholic auspices. These organizations are formed to serve the public; in Constitutional language, they are in commerce. They must perform their function fairly, without allowing their functioning to be affected by their tastes or beliefs. In this they are analogous to the public accommodations that are governed by anti-discrimination laws. Or to give a different analogy, Catholic hospitals refusing contraception would be like a hospital refusing to admit a gay person because its governing body believed homosexuality to be immoral.

The Catholic bishops refuse to recognize the public function of Catholic hospitals and attempt to impose their own dogmas on the public at large. And when this attempt is rebuffed, they accuse the administration of, “waging war on religion.”

Let’s be clear: The administration is not waging war on religion. It is waging a defense of fairness and equality.

Which brings up another dimension. It has been suggested that some political figures have taken up the bishops’ cause not for reasons having to do with religion but because they want to use the controversy to bludgeon Obama’s health care plan in toto. This makes it all the more important to resist and rebut the attacks.

It is probably too much to hope that the present moral theology of the Catholic Church be replaced by one that is more in touch with humanity. Failing that, I can only hope that more reasoned heads prevail in the current controversy and that the bishops come to realize their proper place in the American political system.