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February 17, 2013


I appreciate and admire Greg's insights into just about every area I have heard him address. His comments in the podcast from 17 February regarding Liverpool Care Pathway were insightful (and for the most part right on), but I did take a small issue with his comment that public health insurance system leads necessarily to the kind of abusive situation as they have in Great Britain with the Liverpool Care Pathway. I am Canadian and we have enjoyed a public health care system here for many years. It is not without its flaws, but it is also not leading to 'care pathway' situations such as the one discussed in the show. Our system has abuses: for example, abortions are publicly funded…an outcry from the Canadian Church has yet to be effective in convincing our politicians to change this. The only reason I bring this up is because of the force and emphasis that Greg placed on the thought that 'single payer' public health insurance arrangements lead necessarily to a 'Liverpool Care Pathway' end ("they always do…they have to"). I would contend that the deplorable "Liverpool Care Pathway" situation is a result not of a public health care system qua public health care system but, instead, a result of the deficient worldview and moral character of those involved in that system. To focus on whether or not it is a 'single payer' system is to focus on an issue unrelated to the bigger and more relevant issue. A health care system will lend itself to abuse not simply because of its structure (public / private / etc.) but because it is an arena for moral agents. There are many Christians in may different countries who will advocate for many different systems (our own Canadian system takes seriously our societal duty to care for the poor with equal access to healthcare regardless of income but it also creates long wait times and a culture of entitlement). I love to hear Greg voice a call for moral character within systems like this…all Christians must stand together on this. I was just a bit surprised that he would assign the same passion to speaking against public health care systems in principle because of the abuse of one in the UK.

Tom, thanks for your comment. It's actually not just happening in the UK. I recommend reading Wesley J. Smith's blog for more examples. Because all resources are limited (and even more shortages are created when the consumer is separated from the cost, as you noted above), when the government is in charge, they will make the decisions (and develop the procedures to make decisions) about who can continue to receive care. And it's in their interest for some people to die so they can give resources to others, especially as the entitlements become more and more difficult to fund, as doctors drop out of the system, etc. These things render a government-controlled system more likely to suffer from these abuses than a private healthcare system where the decisions are in the hands of the patients and their families, not subject to the rationing concerns of the government.

Different countries where the government runs healthcare may move a little or a lot in the direction where older people are denied care, but they all have to deal with rationing imposed by the government, and this means things like the Liverpool Care Pathway are a real inherent danger in these systems.

This isn't to say our system is perfect. We have high costs because we're separated from the price because everything goes through insurance (anything that separates the buyer from the cost will cause the cost to skyrocket, and the mess we've entered into now is certain to make things worse for everybody). It just means this particular problem isn't likely to show up in our system.

(Incidently, no hospital is allowed to turn away someone who can't pay, and we have many free clinics. That is, in our private system everyone does have access to healthcare. I don't think that's widely known outside the US.)

Hey, thanks for the feedback Amy. I had a quick look at the blog link you supplied but wasn't able to find the particular entry you must have been referring to. No worries, though.

The characterization of public health care (and I'll speak here for my understanding of the Canadian system) as putting pressure on people to die, and of placing patient needs and decisions into the hands of the government to make their health decisions, are in my experience unwarranted (and totally so). When I read or hear these types of American portrayals of public systems such as ours I find it difficult to recognize the system they are describing. It just hasn't been my experience of the experience of anything I've even heard of (within my circle of acquaintances or in the news). I might be wrong. I'm just saying that it doesn't seem recognizable in my experience.

Yes, I had understood that all Americans have access to healthcare, but it was my understanding that clinics and hospitals cannot turn away anyone in emergency situations—but 'emergency' care is arguably not 'health' care. This has increased non-recoverable expenses for private institutions and, hence, increased their pricing to make up for it. An argument can be made that this also creates an incentive for the health care provider to do little (and keep costs down) for the 'patient'. If public systems have this incentive as Greg indicated, I'm not sure how a private insurer avoids the same incentive. Any time 'health' becomes a commodity (public or private) this creates strange situations. Again, it's a moral issue, not a public/private system issue.

I am ill-informed about the actual state of health care in the USA but for that reason I should be more hesitant to draw comparisons and make comments about it. For the same reason I wonder why Americans are quick to draw such emphatic criticisms of public systems…when Greg describes the Liverpool situation and euthanasia in general as being inevitable results of a public system…I'm puzzled. I could very well be wrong, but I'm still puzzled.

For example:
Euthanasia is not legal in any Canadian jurisdictions (public system) but it is in Oregon, Montana, Texas and Washington (private systems). It's certainly being discussed in Canada (Quebec and BC most recently) but not as a function of the particular health care system…it's being discussed as a function of law. Yes, it's going to have to touch the health care system but the thing I wanted to note here is that the legality or presence of euthanasia is not a function of the particular health system (public or private) but of the moral climate of those involved in it. Your own private system is perfectly (and demonstrably) capable of the same terrible outcomes…be it abortion, euthanasia or the like.

I am 100% in line with just about everything I hear on STR, be it through Jay or Greg via podcast or your monthly newsletter. I think this is the first material point of issue I've had and really in the realm of the bigger picture I am not interested half so much in whether a system is private, public, or a blend of the two…with STR and every thinking Christian, I am interested in the preservation and sanctity of human life. At bottom I hold no strong allegiance to a public system per se (although I am convinced it is better, as far as my knowledge goes) or private system (which has its own significant benefits as you have pointed outl). I can agree to disagree on this one. With STR, my allegiance is to the Giver and Redeemer of life. And as far as that goes, STR is much admired for and capable in making a defence.

Thanks again for the discussion.

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