Thursday, April 26, 2012

Subsidiarity (Catholicism) - Wikipedia, the free encyclopedia

Subsidiarity (Catholicism) - Wikipedia, the free encyclopedia:

Paul Ryan has referred to his philosophical bent as having more to do with subsidiarity than Ayn Rand.  I consider myself well read, especially about theology, Catholic or other, but I was not familiar with this term, so here is the Wikipedia section on the Catholic take on it:

The principle of subsidiarity was developed by German theologian Oswald von Nell-Breuning.[2] His work influenced the social teaching of Pope Pius XI in Quadragesimo Anno and holds that government should undertake only those initiatives which exceed the capacity of individuals or private groups acting independently. Functions of government, business, and other secular activities should be as local as possible. If a complex function is carried out at a local level just as effectively as on the national level, the local level should be the one to carry out the specified function. The principle is based upon the autonomy and dignity of the human individual, and holds that all other forms of society, from the family to the state and the international order, should be in the service of the human person. Subsidiarity assumes that these human persons are by their nature social beings, and emphasizes the importance of small and intermediate-sized communities or institutions, like the family, the church, labor unions and other voluntary associations, as mediating structures which empower individual action and link the individual to society as a whole. "Positive subsidiarity", which is the ethical imperative for communal, institutional or governmental action to create the social conditions necessary to the full development of the individual, such as the right to work, decent housing, health care, etc., is another important aspect of the subsidiarity principle.

The principle of subsidiarity was first formally developed in the encyclical Rerum Novarum of 1891 by Pope Leo XIII, as an attempt to articulate a middle course between laissez-faire capitalism on the one hand and the various forms of communism, which subordinate the individual to the state, on the other. The principle was further developed in Pope Pius XI's encyclical Quadragesimo Anno of 1931, and Economic Justice for All by the United States Conference of Catholic Bishops.
“ It is a fundamental principle of social philosophy, fixed and unchangeable, that one should not withdraw from individuals and commit to the community what they can accomplish by their own enterprise and industry. (Pope Pius XI, Quadragesimo Anno, 79) ”

Since its founding by Hilaire Belloc and Gilbert Keith Chesterton, Distributism, a third way economic philosophy based on Catholic Social teaching, upholds the importance of subsidiarity.

The Church's belief in subsidiarity is found in the programs of the Catholic Campaign for Human Development, where grassroots community organizing projects are supported to promote economic justice and end the cycle of poverty. These projects directly involve the people they serve in their leadership and decision-making

So, as Inigo Montoya would say, "You keep using that word. I do not think it means what you think it means." I think we have centuries worth of ample evidence that charity cannot provide health care to nations, that economic justice and ending poverty are not possible through devolved local or institutional efforts. Some things require government, and Paul Ryan and so many others like to pretend that if we just "get out of the way," all of this will take care of itself. Never has, never will.
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Tuesday, April 24, 2012

Medical Professionalism Charter Principles | ABIM Foundation

Medical Professionalism Charter Principles | ABIM Foundation:

Principles of the Charter

The principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. The three fundamental principles below are a guide to understanding physicians’ professional responsibilities to individual patients and society as a whole. 1. Primacy of Patient Welfare 2. Patient Autonomy 3.Social Justice

Primacy of Patient Welfare
The principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.

Patient Autonomy
Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients’ decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.

Social Justice
The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.

We talk a lot about professional responsibilities within the medical profession. I think the first two principles of patient welfare and autonomy are uncontroversial (though not always easy!).

The last one, social justice, is just as critical, and I would argue largely uncontroversial around the world both within the medical profession and in societies as a whole. Only in America is this principle questioned, and only in a vocal and politically powerful segment of the population.

I think many physicians, especially our conservative fellow physicians, would be surprised (and disappointed) that every major medical organization in the US (and globally), and almost certainly their own specialty organization, have already endorsed the Charter, warts - social justice in their view - and all!

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Thursday, April 19, 2012

Vatican Reprimands U.S. Nuns Group -

Vatican Reprimands U.S. Nuns Group -

I often credit the nuns who taught me at St. Francis Elementary for the social justice subroutine that was programmed into me, and still runs, continuously. So, way to keep at it, Sisters!

The Vatican’s assessment, issued on Wednesday, said that members of the group, the Leadership Conference of Women Religious, had challenged church teaching on homosexuality and the male-only priesthood, and promoted “radical feminist themes incompatible with the Catholic faith.”

The sisters were also reprimanded for making public statements that “disagree with or challenge the bishops, who are the church’s authentic teachers of faith and morals.” During the debate over the health care overhaul in 2010, American bishops came out in opposition to the health plan, but dozens of sisters, many of whom belong to the Leadership Conference, signed a statement supporting it — support that provided crucial cover for the Obama administration in the battle over health care.

The conference is an umbrella organization of women’s religious communities, and claims 1,500 members who represent 80 percent of the Catholic sisters in the United States. It was formed in 1956 at the Vatican’s request, and answers to the Vatican, said Sister Annmarie Sanders, the group’s communications director.

Word of the Vatican’s action took the group completely by surprise, Sister Sanders said. She said that the group’s leaders were in Rome on Wednesday for what they thought was a routine annual visit to the Vatican when they were informed of the outcome of the investigation, which began in 2008.

“I’m stunned,” said Sister Simone Campbell, executive director of Network, a Catholic social justice lobby founded by sisters. Her group was also cited in the Vatican document, along with the Leadership Conference, for focusing its work too much on poverty and economic injustice, while keeping “silent” on abortion and same-sex marriage.

“I would imagine that it was our health care letter that made them mad,” Sister Campbell said. “We haven’t violated any teaching, we have just been raising questions and interpreting politics.”

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Medicare to Expand Competitive Bidding on Equipment -

Medicare to Expand Competitive Bidding on Equipment -

Medicare officials estimated that competitive bidding for home medical equipment would save more than $42 billion in the next 10 years — $17 billion for beneficiaries and $25.7 billion for the Medicare program.

Ms. Sebelius said the savings showed the value of the health care overhaul signed into law by President Obama in 2010.

The competitive bidding program was established, with support from many Republicans, under a 2003 law that added a prescription drug benefit to Medicare. In 2008, Congress temporarily delayed the program and terminated supplier contracts that were in effect. The 2010 law expanded the program.

Medicare has historically used a fee schedule to pay suppliers. Officials gave this example of the savings: Under the fee schedule, Medicare would have paid $2,080 for an oxygen concentrator last year, and the beneficiary would have paid 20 percent, or $416. By contrast, with competitive bidding, Medicare paid about $1,395, and the beneficiary paid $279.

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Saturday, April 14, 2012

Off the Charts Blog | Center on Budget and Policy Priorities | “Double-Counting” Canard Quacks Again

Off the Charts Blog | Center on Budget and Policy Priorities | “Double-Counting” Canard Quacks Again:

Former Bush Administration official Charles Blahous has garnered some media attention by gussying up old, discredited arguments about the budgetary effects of health reform. But his paper adds nothing new to the debate.

Blahous claims the Congressional Budget Office’s cost estimate for the health reform law “double-counts” a considerable portion of the law’s Medicare savings. By subtracting these savings, Blahous asserts that — contrary to CBO — health reform increases the deficit.

But there’s no double-counting involved in recognizing that Medicare savings improve the status of both the federal budget and the Medicare trust funds. The outlooks for the budget and for the Medicare trust funds are two different things; some changes in law may affect one and not the other, but other changes affect both.

CBO estimates that health reform will modestly reduce the federal budget deficit. The Medicare actuary says that health reform will extend the solvency of the Hospital Insurance trust fund by eight years.

That’s no different than when a baseball player hits a home run: it adds to his team’s score and also improves his batting average. Neither situation involves double-counting.

CBO has accounted for deficit reduction in exactly the same way in previous Congresses, under both political parties. Until opponents of health reform latched onto the notion, no one accused CBO of faulty accounting.

For example, the Balanced Budget Act of 1997 and the Deficit Reduction Act of 2005 — both of which Republican Congresses approved — included Medicare savings that were counted as reducing the deficit and improving Medicare’s financial outlook. The Senate Republican Policy Committee rightly claimed credit for this result, and no one made charges of double-counting.

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Friday, April 6, 2012

Physician Salaries Vary Widely Among Academics

Physician Salaries Vary Widely Among Academics:

Go West, academic urologist. You may earn more than $455,000 annually there, compared to $300,000 in the Midwest.

(If you are an academic dermatologist, the Midwest is the place to be, not the West, if you want optimum income.)

Whatever you do in academic circles, if you seek a very nice, comfortable salary, be a department chair and a specialist. Then again, if you are engaged in academia, it isn't all about the money is it? There's more money in private practice, of course, but we'll get to that later.

There's a wide variation in physician-related academic salaries, often dependent on geography and rank within academic settings, says the Academic Practice Compensation and Production Survey for Faculty and Management of 2012. The Medical Group Management Association report, based on 2011 data, contains information on more than 20,000 faculty physicians and non-physician providers categorized by specialty, and more than 2,000 managers.

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Thursday, April 5, 2012

Down the Insurance Rabbit Hole -

Down the Insurance Rabbit Hole -

Justice Antonin Scalia subsequently expressed skepticism about forcing the young to buy insurance: “When they think they have a substantial risk of incurring high medical bills, they’ll buy insurance, like the rest of us.”

May the justices please meet my sister-in-law. On Feb. 8, she was a healthy 32-year-old, who was seven and a half months pregnant with her first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest down by a car accident that damaged her spine. Miraculously, the baby, born by emergency C-section, is healthy.

Were the Obama health care reforms already in place, my brother and sister-in-law’s situation — insurance-wise and financially — would be far less dire.
But, if Republicans have their way, even this is in danger, from Matther Yglesias via Slate:

“I’m not concerned with the very poor. We have a safety net there,” Romney told CNN. “If it needs repair, I’ll fix it.”

There's a certain logic to that position. Except that if you read Romney's policy agenda what he appears to think about the social safety net for the poor is that it should be drastically curtailed. He proposes the following five points:
  • Immediately cut nonsecurity discretionary spending by 5 percent.
  • Reform and restructure Medicaid as block grant to states.
  • Align wages and benefits of government workers with market rates.
  • Reduce federal workforce by 10 percent via attrition.
  • Undertake fundamental restructuring of government programs and services.
In other words he wants to cut the safety net, cut the health care part of the safety net, muck around with the federal workforce, and then cut the non-health care part of the safety net. To further clarify, he states that he "will immediately move to cut spending and cap it at 20 percent of GDP" while increasing defense spending. Which is to say he wants to cut social safety net spending. What's more "as spending comes under control, he will pursue further cuts that would allow caps to be set even lower so as to guarantee future fiscal stability," thus cutting social safety net spending even further.

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Tuesday, April 3, 2012

Medical Progress Today: A Two-Year Look Back at PPACA - Why it's Dangerous to Our Health

A Two-Year Look Back at PPACA - Why it's Dangerous to Our Health
 So bad it's good! This amazing piece, apparently from the Department of  Obtusity at the Manhattan Institute, takes a stab at criticizing PPACA. Big fail. Trying to finish up my semester here, so I will try to get back to this soon and deconstruct it, but I needed to leave a bookmark to remind me to do it. Enjoy.

How Dr. Emanuel and others think it is the responsibility of the taxpayer to pay for industry errors is beyond comprehension. If this was a pharmaceutical error, or medical device error, my guess is that the CEO of the offending companies would be hauled before Congress and affected families and patients would be called to testify against them - just like Congress did with Toyota.

Aha! Maybe that's it. Maybe the issue is that these hospitals have a designation of "not-for-profit." So in some people's distorted view of the world, maybe they can do no wrong, and for-profit business enterprises can do no right. If this line of thinking is out there, then no amount of regulation will make us safe.

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Guest column: End is near for independent oncology, cardiology practices | Green Bay Press Gazette |

Guest column: End is near for independent oncology, cardiology practices | Green Bay Press Gazette |

Cardiologists and oncologists now struggle to generate enough medical revenue to cover their costs to run the practice and pay physician salaries. "Pay the physicians less," you say? Well, the problem is that the shortage of physicians is so severe that the price to bring a cardiologist or oncologist in is set at a market rate. If you underpay your own physicians, they leave to go to someone who will pay them the market rate; then you have no one to treat your patients.

It is estimated that by the end of 2012, 80 percent of all cardiologists will be employed by or leased to hospitals. Yes, it's the end of the small independent cardiology and oncology practice and it's happening right before our eyes.

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Budget battle pits atheist Ayn Rand vs. Jesus, say liberals -

Budget battle pits atheist Ayn Rand vs. Jesus, say liberals -

"I am no fan of big government, but there are far better ways to critique it than Rand's godless nonsense, especially for Christians"

Colson says in the video.

More than 6,000 people have signed a petition asking Ryan to put down Rand and pick up a Bible, according to Kristin Ford of Faithful America, a left-leaning online group.

"Ayn Rand's philosophy of radical selfishness and disdain for the poor and struggling is antithetical to our faith values of justice, compassion and the common good," the petition reads.

The American Values Network video, which Sapp said will be emailed to 1.2 million Christians in Wisconsin, opens with anti-religious remarks from Rand and segues into Republican leaders, including Ryan and Sen. Rand Paul, R-Ky., offering high praise of the Russian novelist.

"Rand, more than anyone else, did a fantastic job of explaining the morality of capitalism, the morality of individualism," Ryan says in a

2009 Facebook video excerpted in the ad. "It's that kind of thinking, that kind of writing that is sorely needed right now."

Ryan's spokesman, Kevin Seifert, said the congressman "does not find his Catholic faith to be incompatible with his feelings for Ayn Rand's literary works. ... Rand is one of many figures and authors that Congressman Ryan has cited as influencing his thinking during his formative years."

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An immoral budget that shuns social justice - JSOnline

An immoral budget that shuns social justice - JSOnline:

In response to Ryan's Republican budget last year, the U.S. Conference of Catholic Bishops warned House leaders that "a just framework for future budgets cannot rely on disproportionate cuts in essential services to poor persons." Just recently, the bishops' conference called on Congress to protect the safety net from harmful budget cuts. Ryan has ignored their wise counsel.

Ryan takes his Catholic faith seriously and has defended his policy approach in strong moral terms. But it seems he needs a refresher course in basic Catholic teaching. The Catholic justice tradition - as defined by bishops and popes over the centuries - holds a positive role for government, advocates a "preferential option for the poor" and recognizes that those with greater means should contribute a fair share in taxes to serve the common good.

Ryan and other conservatives hold tax cuts for hedge fund managers on Wall Street sacred even as they dismiss concern about rising income inequality as "class warfare." In contrast, Pope Benedict XVI denounces the "scandal of glaring inequalities." This is an accurate description when the 400 wealthiest Americans now have a greater combined net worth than the bottom 150 million Americans.

It seems that Ryan's budget is more indebted to his hero Ayn Rand than to the message of Jesus. Rand, a libertarian icon who mocked all religion and rejected the Gospel's ethic of compassion, has been praised by Ryan for explaining "the morality of individualism." Catholic values reject such radical individualism and the social callousness that it breeds.

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Sunday, April 1, 2012

Broccoli - Doctors for America

Broccoli - Doctors for America:

The health care market is unlike any other market because health care costs are unpredictable and are not meaningfully bounded on the upside. Break an arm and your costs could be in thousands of dollars. Have a heart attack and you’re in the tens of thousands of dollars. Get cancer and you could enter the hundreds of thousands of dollars category. There’s no way to prepare for such illnesses and their costs. That’s why health insurance exists, to smooth out these costs over a lifetime and to pool our resources to help those with catastrophic costs to pay for them. The purpose of mandating the purchase of health insurance is to have everyone pay into a system that they will eventually use. Equating broccoli and health insurance is specious and a sign of bad faith on the part of those making that argument. As far as I know, nobody has died because they couldn’t get their hands on some broccoli.
When broccoli is 1/6th of the economy of the nation, give me a holler. Maybe then it should be regulated.

In the meantime, what we are hearing is a deliberately misleading meme about 'limiting principles," AKA, "where do we draw the line?" My answer is that we don't draw the line at health care, a fundamental human need that now accounts for one sixth of all economic activity in the US. This is clearly NOT where to draw the line. We can argue about where TO draw the line when the Federal Government tries to mandate burial insurance or some other completely random pseudo-analogy thought up by Fox News and fellow travelers.

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