Ubi Caritas Est Vera, Deus Ibi Est

The title of this piece refers to the first line of an ancient hymn: “Where true charity is, there is God.” Health care—from the earliest times—has been at the nexus of organized religion, charity, and the community…

This would be codified by Constantine in 331 AD with his Christianizing of hospitals. In the 6th century, led by the Benedictines, Christian organizations were beginning to establish hospitals throughout Europe. This development would continue throughout the Middle Ages.

By the 15th century, secular and civic institutions would become involved in health care, but then—as now—charity (doing God’s work, if you will) remains a large part of the process. Indeed, given the ever-shrinking reimbursement schemes of the present day, charity is a more dominant factor than many people realize. As is readily apparent to the majority of providers, significant financial gain is a thing of the past. Thus, the desire to help people has once again—after more than 400 years—become the prime motivation for entering the field of health care.

For those whose charity leans more toward donating money, I would recommend consulting Charity Navigator, America’s leading independent charity evaluator. You might be surprised to see how poorly some of the big name health-related charities are rated. Likewise, you might get turned onto some very worthy outfits that could have escaped your notice.

What happens if we apply any conceivable definition of “charity” to the Affordable Care Act (aka Obamacare)? We’ll let preventive and climacteric medicine specialist Elizabeth Lee Vliet, M.D. weigh in:

One by one, the political promises fall like dominoes. The very groups that strongly supported government control of health care are now some of the ones getting stung badly. The effects are like a swarm of killer bees suddenly descending on the unsuspecting, stinging everyone in sight.

To wit…

1.     Health insurance premiums, including Medicare supplement coverage, are rising for virtually everyone—and everyone must be covered. Of course, you can always opt-out and pay the fine.

2.     Many workers are being cut back to fewer than 30 hours per week, so that employers need not cover them.

3.     Seniors were flat-out lied to, when told that there would be no cutbacks in their medical care. Vliet notes that an 80-year-old patient informed her that his heart medicine was no longer covered, “because I am too old now.” Moreover, preventive services and cancer screenings for older patients, such as prostate and breast cancer checks, are being cut to pay for “free” birth control pills.

4.     Vliet reminds us of what she calls “The privacy sting.” As she puts it “Your electronic health record will be used to decide what treatments you will be allowed. The IRS will be collecting expanded personal information about your income, habits, and family to decide what to sting you on penalties.” So much for the HIPAA Privacy Rule.

How ironic that we will very likely have to rely more on charity in the wake of an expanding government role in health care.

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12 responses to “Ubi Caritas Est Vera, Deus Ibi Est

  1. There must be voluntary giving of time, labor, money, and/or goods for there to be true charity (and to satisfy the Biblical definition). Paying taxes to supply others with healthcare, food, shelter, etc., is coercion; it is neither charity nor “giving one’s fair share.”

  2. Charity and caring historically have a lot to do with health care, because historically, that’s about all you could do for someone sick. Give them food and water, hold their hand, and hope for the best. Things are a lot different these days, and — paradoxically, to some — our expectations are higher. It’s nice when health care providers appear to give a damn, but we’re actually expecting people to be *cured*. Business has delivered the cures (or palliatives at least), and business is business. The ‘charity’ angle isn’t what it used to be.

    As far as the HIPAA Privacy Rule, what a crock. Look at the US Banking Privacy Act. It’s *all* about giving your private financial information to the government. Why should HIPAA be any different? Orwell wrought better than he knew.

    • Obamacare will return us to ars moriendi. Hospitals will return to their original role: hospices.

  3. Healthcare is a special economic problem and we haven’t found complete answers. I doubt we will.
    Healthcare is a special economic problem because, unlike food or housing assistance, it’s very expensive — serious healthcare, anyway, like trauma care and leukemia treatment. Heck, someone who needs an appendectomy is going to see bills close to $10,000 with no tangible outcome like a car or a house.
    Healthcare often has to be used at once rather than delayed. If you’ve just been in a car accident, it’s going to work poorly to say, “I’ll take my broken arm home until I save up some money for treatment.”
    Healthcare usually doesn’t have a lot of low-cost options. A family could use a two-bedroom home instead of a three-bedroom home; you can buy a less expensive car. But chemotherapy is chemotherapy; even shopping around will only help a little for finding lower costs.
    The upshot is that people sometimes need expensive services with no reasonable way to delay them or reduce the costs. A prudent person carries insurance — risk-sharing — for exactly this reason.
    Healthcare is almost entirely a private good — immunizations being an important possible exception. Private goods should be private-sector business. The prudent wil provide for themselves as best they can and pay the debt as best they can. The charitable will help those in need. That may leave gaps through which some people do fall. But it also keeps control and responsibility with the individuals rather than handing it off to the government.
    Government programs tend to metastasize, by accident or design. That’s a really good reason to use the government as little as possible, for genuine public goods, and keep as much as possible in the private sector.

  4. It often claimed that since medical resources are so expensive, the government must help. However, the bulk of the reason that such care is so expensive is that the government absolutely corrupts the market forces that would drive a reduction in costs. If the gov’t stopped paying, the costs would quickly plummet since all those doctors and technicians will discover they really do like to eat. granted in the meantime the mess would be ugly, eventually it would correct itself and affordability would make a comeback.

    • Indeed. Medical “insurance” itself was invented in reaction to government mandate (wage freeze in WWII).

      The solution is to make medical insurance insurance, with a high deductible, say $4,000 a year. Medical “insurance” has morphed into a third-party-payor system, which, as you say, has corrupted the market place. Insurance should protect you from major loss due to medical problems; it should not pay for your damn doctors visits, nor your routine prescriptions.

      And tort reform: simply eliminate punitive damages. Award actual damages, and no more.

      These two things will cut medical cost in half. It really is that simple.

  5. What also needs to be done is to eliminate laws that demand hospitals treat everyone regardless of their ability to pay. This just causes hospitals to increase costs for everyone else. Since insurance and Medicare negotiate lower reimbursements the hospitals are caught in a financial vise. This makes as much sense as legislating that any business must give away their services or products regardless of ability of the client to pay. We must re-institute charity hospitals.

    • Bill, there’s something more important than finances here. The Hippocratic Oath.

      The law that hospitals must take all is not there out of charity, but to protect the integrity of doctors who are oathbound to care for all in need. While wise use of resources is a necessary, we cannot allow ourselves to compromise on that.

      • The Hippocratic Oath has nothing to do with laws mandating that hospitals must absorb the costs of care. Doctors, as myself, regularly render care for free or at reduced costs but they can only due so if they can pay their overhead. Government mandates care less about the business of medicine. See the comment from Mr. Brooks.

    • Bill, one of my golfing buds is a hospital CFO. I asked him this AM how much charity work costs the hospital. He said 12-15%. Millions of dollars. As you said, they just gross up everyone else’s charges to cover it.

      He also said that, as Medicare and Medicaid reimbursements go down, others’ bills will go up. I think between us we can cut medical costs by two thirds.

      High deductible insurance, no punitive damages, and no government mandated free service. That’s the ticket.

      • I agree but as usual the problem for politicians is that there is nothing in it for them so legislation won’t happen.

  6. Allen Brooks

    Big government from city hall to DC hates private charity. That is why you see them banning food kitchens and “regulating” everything these people do. The reason is because the agencies want the money for themselves, they want to tax people instead of allowing them to give it charity. It was said of Judas: “This he said not because he cared for the poor, but because he was thief and had access to the treasury.”

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