Partakers with Devils

June 27, 2017

As anticipated, the Congressional Budget Office (CBO) “and the staff of the Joint Committee on Taxation (JCT) have completed an estimate of the direct spending and revenue effects of the Better Care Reconciliation Act of 2017,” the Senate’s version of the American Health Care Act of 2017 (AHCA), which was passed by the House of Representatives. The conclusion is that the “Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law,” which is “slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation.” Specifically, by “2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.” [1]

It has already been mentioned within these pages that, according to Catholic teaching, ensuring that citizens have access to necessary healthcare is incumbent upon government. [2] 22 million people losing their health coverage clearly does not meet that standard. But understanding why so many people will lose coverage provides insight that could be used in formulating a better plan.

According to the report, the massive loss of health coverage will not occur all at once. It is explained this way:

“CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.”

There are, thus, two main causes for the decline in coverage to be anticipated. The end of the penalty for not having insurance will mean that the young and healthy, who had to be bludgeoned by the Affordable Care Act into buying health insurance, will simply stop their coverage. But that won’t be the end of the story. Cutbacks to Medicaid and to the subsidies paid for the purchase of insurance will have their impact as well until the 49 million figure is attained. What do these things tell us?

Health insurance is not like most other products in that the more one needs it, the less health insurers want to sell it to him. They would love to have nothing but young and healthy customers, but that group is least likely to want to purchase from them. So the price is set low for the young and healthy, but high for the older and sick. The older and sicker one is, the more money he will need to buy health insurance. That means that there will be fewer purchasers in populations where there is the greater need, unless health insurance is subsidized or provided to those populations. But the Senate’s plan is to cut back on subsidies and Medicaid, leaving the citizenry subject to a perverse market, where the sellers prefer customers with the least need. 

What can justify such a system? Only the ideology Pope Francis warned about in Evangelii Gaudium, the ideology that defends “the absolute autonomy of the marketplace and financial speculation.” (Sec. 56) [3]   
For-profit health insurers must collect more in premiums than they pay out in benefits if they are to survive. As a result, they have to charge more to people who are more likely to require more expenditures: the older and the sick. And that is how the market works when it comes to health insurance. But it is clearly not the most humane outcome. It is not the most human outcome. It is apparent that the workings of the market are, in this instance, insufficient to meet human need.

Yet the superstition that holds that only the market can be heeded has its adherents. “We have,” Pope Francis says, “created new idols. The worship of the ancient golden calf (cf. Ex 32:1-35) has returned in a new and ruthless guise in the idolatry of money and the dictatorship of an impersonal economy lacking a truly human purpose.” (Sec. 55)

Why would a healthcare policy that will plainly cause harm gain such currency? It makes no sense from the human point of view. But, as it turns out, it has been commanded by the golden calf in its new guise: money and the impersonal economy. And so this god is obeyed.

But be warned that obedience to such a false deity is nothing that a Christian may partake of. As St. Paul warned us long ago: 

“But the things which the heathens sacrifice, they sacrifice to devils, and not to God. And I would not that you should be made partakers with devils. You cannot drink the chalice of the Lord, and the chalice of devils: you cannot be partakers of the table of the Lord, and of the table of devils.” (I Corinthians 10:20-21)