Byzantine Structures and the Splitting of Hairs

It is my firm conviction, firming up as this campaign year proceeds, that the fundamental problem in US health care -- one which none of the mainstream reformers ever address -- is the ubiquitous assumption that there are and as a matter of fitness there ought to be four distinct parties to a health care transaction.

Routine medical transactions in the US involve (a) an employee [if it is a covered family member of an employee this is a five-party model], (b) employer, (c) a health insurer whose direct relationship is with that employer not with the patient, and (d) the actual care provider, who is looking to that insurer for payment.

This byzantine structure is a legacy of the wage-price controls the feds imposed on the economy during WW2. Anything can be justified when there's a war on, right? but it had lasting effects. We ought to rethink the thing from its foundations.

In the meantime, we have the sort of insane debates we've seen recently.

Is Obama 'getting all Henry VIII' on the Catholic Church?

Not really. Nobody is going to have to put his head on the chopping block, a la Thomas More.

But consider ... the Church controls a variety of entities, notably hospitals, many of which compete with various secular entities in the business world, and it has through these entities a lot of employees, including many non-believers, whom it insures in accord with the four-party model above. It wants examption from the general requirement of insurance insofar as such insurance will cover matters prohibited by Catholic doctrine.

The administration says, 'okay, here's a compromise. We won't require that the Church provide or pay for these services. But we will require that your insurers do so.'

Now, I'm sorry, but that sounds like the splitting of hairs. Given the four-party structure, there is ony a difference in verbiage between the following two propositions:

1) You, as an employer, are required to insure your employees as to health services A, B, and C, even though you object on grounds of conscience to C.

2) You, as an employer, are required to insure your employees as to health services A and B -- we will allow you an exemption from providing C -- but we will require that insurer to pay for C anyway.

I agree with all parties in this exchange -- there is nothing to be gained but confusion by pretending that the difference between (1) and (2) is a difference of principle.

The problem, here, though, is that we take for granted the central role of the insurance industry, and of employment, and this warps all our other thinking and makes absurdities seem plausible. As John Stewart said on The Daily Show recently, if a Church or anyone else simply gave its employees cash the question wouldn't arise.  That's the great thing about cash -- it's the universal medium of exchange. What bills you pay, pills you buy, with the cash your employer has just given you isn't any of said employers' concern.

Furthermore (and given my libertarian sympathies I hate bringing this up, but for purposes of completeness I must) -- even if the government by force of law coerces employers into paying more money to a specific set of workers, as it does every time the minimum wage is raised for example, we would not generally assume that the coerced employer has anything to say about how the 'extra' money was to be spent -- on birth control pills, on Viagra, on sex toys, or even (another subject of some religions' scruples) on firearms. That becomes the employees' concern. There is no accomodation.

Were the US government to order all hospitals to increase the pay of their employees by x%, rather than imposing an insurance mandate that would cost the hospitals x% ... there would be various arguments you could make about that order of course. But the employees would be free to buy birth control pills (or Viagra) with that new x% and no one would say a word about religious "accomodation."

The whole issue of a religious 'accomodation' only arises -- and thus the hair-splitting between propositions (1) and (2) above only becomes possible -- because we're saddled ourselves with this four party paradigm.


This is all one of many many good reasons to get rid of that!

A Guide to Dorothy Sayers III

I've been conducting a review of the allusions that Dorothy Sayer introduced in her plan for a hypothetical poem. These are references drawn largely, though not entirely, from British history of the late 19th and early 20th century.  Let us continue:

the Lady with the Lamp, this is clearly a reference to Florence Nightingale (1820-1910), the founder of nursing as a profession.

the Lady-with-the-Lampshade-made-of-Human-Skin, The story arose out of Buchenwald originally, that the medical personnel were making human souvenirs for themselves and taking them home, and that among these were lampshades made out of human skin. The specifics can't be substantiated, but the "lampshade" story made it into a documentary re: Buchenwald made by director Billy Wilder.  Presumably the "lady" Sayers has in mind here was a hausfrau of one of those medical death-camp types.

Titus Oates (1649-1705) -- an Anglican priest who converted to Roman Catholicism in 1677, and thereafter told various tales about a supposed "popish plot" to assassinate King Charles II to which he had become privy. His accusations led to at least 15 executions. Eventually the government decided that Oates had been a perjurer, that the whole plot had been his invention, and he was imprisoned.

Captain Oates (1880 - 1912) -- An antarctic explorer.  He decided during a disastrous expedition that there weren't enough supplies for the group of four -- and he sacrified himself -- walking out of the tent into a blizzard and certain death.

Quisling -- a reference to Vidkun Quisling (1887-1945) a Norwegian politican who assisted Nazi Germany in the take-over of his country, and who was executed by firing squad soon after the fall of the collaborationist regime.

the Owner of 'Hermit', --  Hermit, a race horse, won the 1867 Epsom Derby, a race held in a snowstorm. His owner was Henry Chaplin (1840 - 1923), a Tory politician known for his advocacy of protectionist trade policies regarding agriculture.

the French Bluebeard -- Henri Désiré Landru (1869-1922), a serial killer convicted of and executed for the murder of ten women between 1915 and 1919.

Bacon -- Francis Bacon (1561-1626) -- English lawyer, statesman, and philosopher, known for his description of induction, which is still sometimes called the "Baconian method."

Roger Bacon (1214-1294) -- Franciscan friar, author of a work on the place of philosophy within theology, which he sent to Pope Clement in 1265. This Opus Majus also includes a notable discussion of the science of optics.

Roger Fry  (1866 - 1934), an art critic, and a member of the Bloomsbury group, stressed the formal properties of works of art at the expense of the "associated ideas."

the Claimant -- this may be a reference to Lambert Simnel (c. 1477 - c. 1525)  who as the dust was finally setling after the War of Roses claimed to be the Earl of Warwick, a claim that threatened to ignite the war again.

the Bishop of Zanzibar, Frank Weston (1871 - 1924)  the Anglican Bishop of Zanzibar (1908 - 1924) became involved in an intense dispute over whether Anglican clerics should administer sacraments to members of non-conforming Christian congregations such as Methodists, Presbyterians, etc.  Weston accused of heresy those who did want to admit the non-conformists.

Clarence Hatry, (1888-1965) a stock speculator who, to support a failing position in 1929, forged a series of municipal bonds. He was sentenced to 14 years in jail in 1930.

I hope to finish this up tomorrow.