Who should pay for healthcare?
The problem with asking ‘who pays for healthcare?’ is that the question begs: ‘who has earned it?’
To heal is to help. Who deserves your help? Who does not? You are sparing someone from an injury they usually brought upon themselves. If your mercy just encourages further injury, are you really healing anyone?
‘Mortality’ and ‘Morality’ are etymologically related for a reason: there is no separating health and justice. To help is to render a judgment about deserving help. Unfortunately, because the modern world is built out of atheistic and thus amoral bricks* – modern medicine never addresses this moral aspect of health. It instead just throws up its hands and says it will treat everyone and anyone, without distinction, and by any means possible.
In practice, this means the only limit to what people call healthcare today is Materialist and Utilitarian: what services keep the lowest common denominator breathing for the longest period of time? And what degree of interventions can we afford in that order? The bigger the economy, the bigger the healthcare. Whatever people clamour for, that is what is provided.
The result is a healthcare system that can’t actually classify who is sick and does not try to find out. It handles complaints, not ailments. If it were otherwise we’d find cases where our system refuses to help people on something other than economic grounds. Alas, wherever we find such vestiges, they are readily assailed.
At first, this blind leviathan may not seem half bad – it still manages to do its basic role somehow, doesn’t it? People do live longer. Relief is usually found. Functions often restored. Isn’t any other method just as imperfect and unsatisfying in its own way?
But this assessment only holds if you ignore a great deal. In Canada, and all other public health systems (including medicare,) sickness and harm is actively promoted. Actual health is left on the cutting room floor. Gangsters, addicts, and idiots are preserved and encouraged while:
1) your granddad is put on a year long wait-list for heart surgery;
2) you pay out of pocket for your child’s vision and dental;
3) your clinically depressed sister is given pills – but not a therapist – to muddle through her issues; and
4) you yourself haven’t had a regular doctor in years;
…all because the system is too busy infusing six litres of donated blood to save a dying Fentanyl dealer. One we’ll release back into the wild – where he’ll ensure overdose calls then tie up all the ambulances. As an aside, they say medical malpractice is the 3rd leading cause of death. I wonder how often it is deliberate?
On top of this sad state of affairs, you’ll have to ignore that governments willingly go into debt to fund further healthcare. Expanding healthcare is always politically popular, and with no definition of health there is always room to expand it further. So in addition to being a bad system, it’s the largest bad system we can afford to construct. And because it is designed around complaints rather than actual sickness, it is always operating at maximum capacity – for there is no end to mans’ woe. Thus the system is forever over-burdened and demanding more funding.
The fact that this continues to work at all is due to the fantastic amount of money and oil we pour into it. Thereby acquiring what little concessions are actually necessary to keep working people on their feet. Saying ‘this works well enough’ is like saying we should burn down the forest to keep warm for the night.
So really, it’s a terrible system. Which is probably why people are so jingoistic about their system being the best in the world – while each population, native or immigrant, literally goes extinct under its tutelage.
You may assert that “There’s really no other way to tackle it, Mr. Cedarman. This is the fairest approach to an intractable problem: ‘treat everyone equally and to the utmost’ is the Hippocratic Oath. If we did it any other way, we’d become horribly petty with our medicine and scarcely help anyone at all. So whatever flaws it has, we should address them by other means.”
Ah, but have you read the Hippocratic Oath? It does not compel doctors to help anyone. It nowhere considers health a right or entitlement. Rather, it carries the ancient recognition that not everyone with an affliction is sick, and not everyone who is sick deserves help. It recognizes the moral dimension of health recently tossed out of the equation – the lack of which is the root of our problem.
The doctor – the healer – is a Judge carrying out a sentence. One that bandages rather than binds. Just as a judge can withhold or hand out punishment, a Healer can withhold or hand out rehabilitation.
If he treats everyone he sees – he’s really just always ruling in favour of mercy. Mercy is nice, but it’s supposed to be tied to repentance. The alcoholic may be forgiven, but he is still expected to get off the bottle. You’re not really helping him through mercy if he continues to destroy his liver thereafter.
Would you trust a court system that gave each thief a million dollars ‘to end thievery’ and each rapist a harem ‘to end sexual assault?’ Then why do we have a medical system that hands out Naloxone and Methadone?
That the doctor is making a judgment is inescapable. Unlike most professions, the judge and the doctor are explicitly dealing with the agency of other human beings. It is not incidental to their work but is rather the core of it. One has the power to restrain your agency by confining you with the Law, the other by leaving you confined with your sickness. This is not like the moral quandaries of an inventor who designs a fancier gun; the inventor doesn’t have the option of breaking or re-setting the fingers of whomever receives his weapon.
This complication of moral judgment is why the medieval universities made their highest faculties Law, Theology, and Medicine. What do these three have in common? They are all terribly nuanced disciplines. Here everything is case-by-case, with few formulae to be found. The correct course of action is always highly specific and contingent.
This is not like, say, Physics – hard as some find it – where a definitive formula can be discovered and applied with great confidence. Anyone in the medieval era who progressed to the ambiguity of Medicine had already studied the rigidity of Physics during his Quadrivium.
Gray questions must be asked:
- “What are the temporal and divine authorities, and what are their dictates in this matter?
- How do they shift or overlap?
- How bound am I by pragmatism?
- Who am I defying or obeying when I act or abstain?
- Did the person deserve this illness, the way a robber earns his ball and chain?
- What are the patients character flaws? Does the ailment correct those flaws?
- Am I an accurate enough judge of such a question?
- Is the short, life-risking procedure best? Or should I choose the longer, gentler, but insufficient medicinal trial?
- If I inform the patient, are they smart enough to comprehend the information?
- If I refuse to help, will he just go to someone with less scruples who will?”
What is healthy is moral, and vice versa. There is no such thing as ‘an unhealthy moral act.’ Everyone intuits that, say, risking your life to save a kid from a burning building is something a healthy mind would consider; even though it’s potentially suicidal or physically crippling to carry out. You wouldn’t exactly be ‘unhealthy’ for being too cowardly to do it, but no one would call you unhealthy if, fully aware of the dangers, you rushed in anyway.
This is in contrast to immoral people, whom we often call mentally ill. Whoever set that building on fire is ‘sick-minded,’ and we hope he either ‘gets the help he needs’ or gets the electric chair.
Just as there is no unhealthy moral act, there is no healthy immoral act, and we are often punished for them in very short order: like a hangover after excessive drinking. When syphilis first arose in Europe, a lot of clergymen developed sores because they had been visiting prostitutes. The disease exposed their hypocrisy, and a lot of other adulterers by-and-by.
“But,” you may interject, “organ theft is immoral, and the recipient improves his health!” No, he is merely not dead. He is now dependent on immuno-suppressive drugs that make him more susceptible to every illness. He is, in more ways than one, sicker than before. +
If, upon reading all this, you reflect that today’s most intense moralizers seem to be the least healthy among us – that they are categorically fatter, weaker, more violent, despondent, and neurotic; well, that tells you a great deal about their actual morals doesn’t it? They seem to get even sicker and more inflamed whenever they receive what they demand, don’t they? Well if it’s not improving their health…
Not all disease and disorder are caused by moral failings – but moral failings do all cause disorder and disease. Likewise: the morally correct thing will always improve your health – though not all things that improve your health are due to moral congruity.
It therefore follows that the institution of morality: Religion – which devotes itself to learning and promulgating correct action, and doing so by alms alone, should be in charge of administering Health. It has the most to gain in studying and undertaking the responsibility – and therefore the most to lose when it fails to do so. Religion can prove its knowledge of health for the soul by tending to the health of the body, and contend with other religions thereby. Indeed, we historically find religion preforming this exact role.**
I am not necessarily saying every priest should be a doctor (priests are functionaries first and foremost.) Nor am I saying every church should double as hospital. But I am saying we should desire and install something akin to this, and that we’d have a much saner healthcare system (and a less avaricious Church) if we did.
‘Whoa now. A healthcare system based on donation?! On repentance of sins? I have to be a Christian to get heart surgery?! What’re they gonna do? Stick a bunch-a leeches on me?”
Let’s tackle these individually.
First, donation. I will readily concede that the capacity of the healthcare system could shrink a good deal. That may be desirable depending on its bloat.
You may think any shrinking of the system is indefensible, but whatever nice things it gives you right now are thanks to the people coerced to pay into it through taxes and whatever future generations we are saddling with public debt to fill the gap, and the ratio of workers to dependents is approaching 1|1.
In other words, your nice things are based on stealing from people and intense short-sightedness. You are no more entitled to other peoples’ money than you are entitled to good health.
We can justify tax/theft when it comes to road infrastructure or developing a nuclear deterrent, because someone’ll come and steal everything – rather than just tax 25% – if we don’t have peace and the means to defend it; but grandma’s knee surgery is not crucial to national security and ‘bad knees’ is not an illness, it is a complaint.
(Braces cost, what, $100? $300? Why are we spending five-figures on giving geriatrics metal knees? It hurts? She can’t garden without it? If you’re doing all this to stay independent ie. away from your kids – show some real independence: buy your own damn knees.)
Anyway, where I come from, depending on your wealth, 3 to 13% of your income goes to the teetering health system. That is not unlike (though for most, substantially less) the traditional 10% tithe of the Church. Nor is it too dissimilar to the 2-20% parishioners give to their churches today.
Although, when people aren’t compelled to give money, they are tempted to keep it. So presumably healthcare funding would drop (up until the day you get sick, then you may feel very generous) and money would become erratic and difficult to budget. Holy men may be fine with that – but the MRI’s helium charge isn’t going to refill itself unless the parish coughs up some dough.
But, if people don’t want to spend their money on healthcare, don’t they… deserve to have less healthcare? I know it’s quite common for people to neglect their health and keep their money – but the priest/doctor will be doing his rounds and check-ups and admonishing everyone for tithes anyway, so…
Maybe businesses give equipment, maybe governments develop drugs, but ‘what constitutes healthcare’ and ‘what is available to the patient’ is a matter for the church to decide and administer – and for the public to willingly fund this as charity rather than entitlement.
Second, repentance. If you read the Gospel, not everyone who gets healed is positioned to repent – or is even told what is going on at the time.
Repentance is when you realize you’ve done something wrong, maybe even discover why, and resolve not to do it again. Does this not sound like taking care of your health? Again, what is the distinction between health and virtue? Sickness and vice?
“What if I’m born with a congenital defect?” I have no idea. Maybe you’re better off not having it corrected? Maybe fixing them isn’t all that expensive or controversial and there’s nothing to worry about. Maybe it brings the whole town together to fund a medical operation for you, and that’s the only reason you were born with the defect to begin with. Maybe people would stop risking pregnancies in their late-30s if their kids were denied tax-paid procedures and defects would become less common altogether. These are heavy questions that devoted people have to answer.
Third, while I doubt – given Christianity’s precepts and historic behaviour – anyone would have much cause for concern about receiving care based on faith, that is not a very reassuring answer. However, this is irrelevant, because it’s silly to pretend that a parallel system based on profit would not develop alongside the primary one.
Even in Canada, where private-tier care is generally restricted to certain niches (dentistry, optometry, hospices,) everyone knows you can just fly elsewhere with a wad of cash if the primary public-care system is taking too long to help you. We call it ‘medical tourism.’
Taxation currently ensures the well-to-do still pay into the public healthcare system even if they leave the country to get faster help. So the bigger question is not ‘would you have access to care if you’re a Muslim’ (The Mosque would develop its own hospital, under this paradigm too, would it not?) But whether the richest citizens would bother donating into the general system at all.
I suspect they would – especially if they were seen doing it. A rich man paying taxes into healthcare is just ‘paying his fair share.’ That same rich man giving the same amount voluntarily will get a lot more respect from others then he does currently. But these are all finer points for particular situations and cultural nuances, so let’s not waste time on it here.
Fourth. The leeches. No one has a monopoly on stupidity, and blood-letting isn’t something you can lay at religion’s feet anyway. The Moderns loved it just as much while blood-letting was in fashion – and it was fashionable at least as early as 600BC.
The real question being asked behind the leeches is: would our technical understanding of medicine regress under this system? Well, look out your window. We are deep into magical thinking territory these days. Lysenko has risen from his grave and is demanding someone graft a pair of tits onto his chest, for Lysenko is now Lysenka. I have no firm answer for you; but I doubt any change would count as regression at this point.
What I do know is the logical deduction that a religious-medical system would both revive our understanding of true health and compel the churches to put that understanding to the test – which would surely abolish a great deal of error present in the faith and the people today.
* We’ll tackle that some other time. If you think you have some fancy solution to the ought-is question let me assure you, you are still wrong. You are still pulling values out of thin air without justifying why they are valuable.
‘X is good because Y is good because it Z… uh… continues the species somehow’ is just kicking the can a little further down the road. You have no idea what the consequences of preserving humanity will be. If you do not – and cannot – know the consequences of your action, how can you judge it desirable? ‘My evolutionary programming says its desirable.’ Well then you’re an automaton, and mechanisms don’t act morally.
Maybe you haven’t noticed this, but the nations that believe in a deterministic universe have <2.1 birth rates. You are not continuing the species, you are wiping it out. Robots don’t reproduce. Again, I’ll save it for another time.
+ A better objection would be to cite people who pay big money, legally, for infusions of young blood. For which we have recourse to the mythology of Vampires.
You may have noticed the past 30 years of pop culture have changed the vampire’s depiction to be younger, more seductive, more intelligent, and more sympathetic. Often they can walk in daylight. Or get their blood by consent. But the basic archetype of ‘an old, parasitic monster, sucking the life out of the young’ hasn’t changed – it’s just become less offensive to modern sensibilities.
Still, follow the future of the blood recipient who is greedily pursuing youth and vitality, and you will see they are not healthier for their immoral act, but on the contrary are more depraved and ruined than before.
** In keeping with the doctor and judge motif: although Health and Law are both informed by religious moral consideration – Health is voluntary but immutable, while Law is involuntary but mutable; that’s why we find Law under Government administration and Health under Religious administration.
Government authority is synonymous with Military authority, since the recourse to violence ultimately decides who governs. Thus the realm of Law belongs to those who can force you to obey laws.
This is partly what destroyed Catholicism – it’s a spiritual authority that tried to be a temporal one, which is nonsensical because you are allowed to disobey God – but cannot escape the consequences – which is exactly the case when you are reckless with your Health. But you are not allowed to disobey the Government – though you can escape the consequences. Which is exactly the case with Law. As you can see, these two spheres are mutually exclusive. By trying to occupy both the Church undermined the logic of each and lost itself in the process.