The measure of a society’s soul is how it treats its most vulnerable members. The internet is filled with wise, respected people saying just this. So is the Bible, the Quran, Dharma in the Hindu Vedas and Buddhist Sutras, the Torah, Indigenous American oral traditions, African tribal traditions, the teachings of Confucius, and many other cultural virtues.
A free, moral, just, great, good, right, society cares for its children and elderly, to quote people like John Paul II, Ghandi, Bonhoeffer, Mother Theresa, and Jimmy Carter to name a few.
Why, then, are we--a nation of many religiously faithful--able to tolerate the further imperilment of children and elderly? I’m speaking of the potential harms to the children and elderly of this nation—society’s bookends—found in the Senate’s recently released “Better Care Reconciliation Act of 2017.”
GOVERNING AS BALANCE
I too have been troubled that the ACA created more financial hardship for some groups in this country, like many middle-class self-employed folks. The reasons for this group’s troubles involved a lot of moving parts, including sicker insured pools and federally-mandated policy requirements. Insurers are unable or unwilling to wait out the initial costs of these factors.
As it were, the non-group market, about 20 million, needed relief and most experts have trying to address this issue. However, the majority of Americans who are employer-insured have seen a strong slowdown in the increase of premiums through the ACA, from 11% in 2000 to 4% in 2015.
More than 10 million more people were able to afford insurance through the ACA. Medicare for the elderly did not change and in fact saw improvements. In the majority of states, those who expanded Medicaid, the rates of insured rose by almost five times over those that did not expand.
Yes, the ACA has deficiencies and was not immune to back-room negotiations. However, it tried to provide stability for the most vulnerable, or as one Catholic bishop puts it, the least, the last, and the littlest. But it did so with cost being one factor in its objectives, and with a principle that from those who have more, more will be required.
MONEY AS FREEDOM?
The Senate bill is weakening the healthcare bookends of Medicaid and supplemental Medicare. More astounding is that the foundational arguments have to do with money.
The bedrock principle of providing for and protecting the most vulnerable is a central tenet in the Judeo-Christian tradition. It recognizes that those who care for the most vulnerable are also often caught in the net of vulnerability. Often caring for the elderly and children creates overwhelming challenges for many in their prime of life, including financial ones. This makes reducing premiums a good talking point even though the forecast for the Senate bill seems to undermine it.
Weakening Medicaid and requiring more “skin in the game” of elderly people through increased costs for their gap care will send a ripple effect through the health of the American work force for years to come.
WHICH CONSERVATISM?
I understand that conservative politicians seek to empower state’s rights, curtail federal spending, and restrict government coercion through taxes. These are positions that have withstood hundreds of years of debates. These famous principles ring hollow, however, when conservatives imperil the book ends for the sustainability of family, community, church, the work force, and civic life at large.
They ring hollow when the control of money is made synonymous with freedom.
The absolute priority of reducing the amount of GDP taken by programs that care for the vulnerable—a job that no state or private organization is willing to take on completely—represents a fundamental moral shift in the kind of conservatism that raised me: be generous, be faithful, be responsible, be kind, be accountable and be respectful.
While this ethos should apply to every citizen, in my opinion, it doesn’t. More importantly, it can’t. Life is much more fragile than the privileged in this country think it is. Growing up in a Christian household, Paul’s teaching that “it is more blessed to give than it is to receive” meant that civic freedom required a balanced understanding of all the moving parts of a society in which individuals are more interconnected than they can see on their own.
TILTING TOWARDS AMBIVOLENCE
I’m bothered that health care is now one more tool, like education, being used by the wealthy to buttress and grow their fortunes. In fact, the assessment by some is that the levers controlling health care and education costs favor the Aspirant Class because these are the primary areas of their “inconspicuous consumption.”
This is really the only conclusion that I can reach when most analyses of the Senate bill report a projected surge in benefits for the wealthy and a projected decrease in benefits for the poor. Shifting responsibility for Medicaid and premium regulation completely to states—whose primary mandate for policy is fiscal accountability—supports these projections.
As a Christian, I do not begrudge anyone their wealth. Jesus reminds us to be honest about it, however. In scripture, it is rarely the blessing that many Christians think it to be. In fact, wealth is most often a feature of fate and stands in the way of the flourishing of all God’s people.
This bill represents the attitude that age and class—being vulnerable in a society of many interconnected and moving parts, not the least of which are systems of racial privilege and ethnocentrism—are markers of expendability.
The least, the last, and the littlest are expendable. This is not the conservatism that I grew up with.