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It’s quite a night for politics in the Bay State tonight. The polls closed about half an hour ago on the first competitive race for a national office that I can remember in my lifetime. My sense is that, before this night is over,  Republican State Senator Scott Brown will have knocked off once heavily favored Mass Attorney General Democrat Martha Coakley for the open U.S. Senate seat that had been held by Ted Kennedy since I was a two-year old. It has been a lot of fun over the past few weeks to feel the momentum building for Brown’s candidacy in this deep blue state, as it has provided some hope that the leftwing lunacy prevailing in Washington D.C. might be brought at least somewhat under control. Not that I think Scott Brown is going to exert some magical power – he’s a deeply flawed politician who just happens to have enough common sense to seem like a bright bulb in a dull array – but he will bring a sorely needed fiscal seriousness to the table, and the loss of the seat will at least force the Democrats to play ball in the Senate.

More importantly, the establishment elite have been served unambiguous notice that the American people are not buying the lies that have been served up as “healthcare reform,” nor do they approve of the bald shenanigans that have accompanied it. If Brown wins tonight, of course the rules in Washington change. It’s simply incredible to think that the Democrats needed a super-majority to get that pig passed, yet thought it was perfectly OK to proceed with it anyway. What arrogance to think they could makeover a major part of our culture through brute force, without having to convince others through reason! But even if Brown fails tonight, it has become abundantly clear for all to see that the current direction of the Obama administration is a political dead-end – even if they can’t see that it is also a moral dead-end. If even Massachusetts Democrats could so much as come close to losing “the Kennedy seat” to an anti-Obamacare movement, that is one dead movement. Stick a fork in it.

In the on-going debate over how to improve the American healthcare and healthcare delivery systems, the professed intent of most of the players has been to increase “access” or “coverage,” by extending benefits to people who currently do not have such access. Ostensibly, this is because “access” and/or “coverage” is priced out of reach for these folks, on account of some combination of raw poverty, and unavailability of employer-provided/subsidized health insurance, which is the vehicle through which most non-elderly Americans access the healthcare system. I spent almost a decade of my life numbered among those without medical insurance, and I’m familiar with the significant limitations of the current model, from the distortions introduced by the prevalence of employer-sourced benefits, to the reluctance – especially among the young – to view healthcare costs as a necessary out-of-pocket expense, similar to food, clothing, or shelter.

In any policy debate, a central component of the debate is the question: Who benefits? Apart from identifying precisely what the need is, and how it might be met, we need to have an understanding both of who should benefit, as well as who actually would benefit under any given proposal. Perceiving that adequate healthcare, whatever its precise definition (which must be defined in order to make rational policy decisions), is a universal necessity for living a fully flourishing life, many public voices have taken to calling for the recognition of a universal right to healthcare, and, not infrequently, of identifying the various “reform” packages proposed by Democratic leadership with such a universal mission.

But what does “universal” mean when used in the current political context? Does it truly mean universal, or does it merely say universal while meaning something else? And if it says one thing while meaning another, what are the implications typically associated with the term that cannot be legitimately claimed under these current circumstances, given the reality of what is actually meant when the term is being used? In short: How can this idea be invoked honestly, and – hence – profitably?

Consistent with decades of Catholic social thought, the Catholic Church, at least in the form of the USCCB, has thrown its moral weight behind the idea of a program of universal access to healthcare (whatever that particular term might mean), but there certainly has not been a single proposal put on the table during this debate that would come close to meeting a catholic understanding of the term “universal.” However, I’ve seen no evidence of anyone in the American hierarchy pointing out that disconnect, with the exception of the particular incongruity confronted in the abortion problem.

To a Catholic, it is a breathtakingly cruel mockery to invoke the character of universality on a healthcare plan that not only excludes a subset of the human race from the scope of said care, but positively persecutes them to a violent death at the hands of those they love the most. Yet, to the progressives behind the current program, abortion is part and parcel of the initiating agenda. It is quite beyond me how the bishops think they can lie down with the whore of misanthropic progressivism, in a foolish attempt to sire a bastard offspring that will manage to obsolete charity through benevolent state power, yet avoid the stink that naturally arises (the public funding of abortion) when they do. The bishops, I trust, will continue to refuse to support any program that is remotely pro-abortion – I would not suggest otherwise – but until the architecture of reform is rooted in a philosophical and political view of the world that is not wedded to the legalized murder of innocents, it strikes me as myopic to think that there could be room for a legitimate cooperation, devoid of complicity in evil. I don’t get their willingness to be strung along.

Nonetheless, other problems remain at the gate. For example, it would be politically impossible to include health care coverage for illegal aliens in our policy implementation, but Catholic social doctrine in no way distinguishes among persons on the basis of citizenry. The Church’s legitimate voice in the argument must speak to the implications of the dignity each human person possesses as a creature formed in the imago dei. Not only does such a perspective transcend the status of citizenry, it by definition also transcends national boundaries altogether.

The truth of the matter is that if the issue is to be framed as one of universal social justice from a Catholic perspective, every right to healthcare ascribed to a “poor” citizen of Anytown, USA, must also be ascribed to non-citizens within our borders, as well as “the least among us” in the far-flung corners of the earth. I’m not proposing this as an ad absurdum argument against healthcare reform. To the contrary, I believe it is in fact entirely true that local illegals and the remote destitute have the same claims as the rest of us to anything that can be construed as a human right, including healthcare. Political rights can be circumscribed by politics, but not human rights.

Nor am I trying to make the perfect the enemy of the good – suggesting that the Church cannot or should not support a plan that partially solves a problem without solving the whole thing. Provided that a plan does actually show promise of making progress toward a legitimate goal (in my opinion, a dubious assertion in this case), it would certainly be appropriate to propose its provisional value. But invoking the symbolism of absolute terms like “universal” upon what is at best contingent is misleading, a situation particularly deleterious when it involves spiritual leaders entrusted with the task of distinguishing the contingent from the absolute. It not only lulls the gullible into a false sense of sanctity, but as in this case of Obamacare, it obfuscates the absurdity inherent in the project of reducing human brotherhood to a political program.

Of course, if the American people had to consider the possibility of tax-payer funding of a system of healthcare (whatever that means) that would serve the whole word, it would be (rightly) laughed down as a cruel hoax that was utterly impossible to fund, staff, administer, or police. But even if we proscribe the vast majority of the world’s needy, and limit participation to Americans, these practical absurdities, so readily evident when we consider the prospect of a genuinely universal scope, are hardly resolved, and common folk know that – as is evident from the steadily growing disapproval of Obama’s project among the American citizenry.

Nevertheless, supposing we get beyond the Catholic bishops’ amalgamation of the Church’s social doctrine regarding the universal dignity of man onto what is (of necessity) a much less ambitious undertaking – that of the forcible redistribution of particular resources among a recognizable elite (e.g. U. S. citizens and documented aliens) – we’re still faced with the hard reality that the finite inputs available to any such system will be far exceeded by the output demands that are implied in the expectations of pro-“reform” arguments calling for the expansion of “coverage” to some many thousands of people who are presently not covered.

Not only does this program threaten to bankrupt the country by redirecting huge sums of money from other needs and uses into the already financially bloated healthcare market, it is counting on the availability of services that often do not exist, both of which influences will only serve to increase the cost of healthcare, defeating the very purpose that the program allegedly seeks to serve. This is pretty basic arithmetic. We do not presently have a meaningful surplus of “health care,” and it will not be possible, within a rational universe, to provide additional goods and services without either increasing their supply, or reducing their availability in some other quarter.

This is precisely the prospect being faced by the elderly dependent upon Medicare, which is expected to lose half a trillion dollars in funding in order to make subsidy dollars available elsewhere. This funding shift can only exacerbate the problems providers like the Mayo Clinic already face with Medicare, and will surely accelerate the current movement by these providers out of the Medicare system. This is a pending elderly healthcare disaster being facilitated by the Democrats, even while the President himself is singing the praises of the very providers finding themselves forced to get out from under the abysmal government system. Incredible.

A knave, at this point, might be tempted to accuse me of thinking that those presently going untreated “don’t deserve” treatment, or some such hogwash, but that is not the case at all. I am merely pointing out what should be an obvious fact: that health care, like all goods and services, operates in a complex economy in which price and availability are strongly influenced by the levers of supply and demand. This influence is not a capitalist invention imposed upon hapless society by mean-spirited businessmen; it is an explanation of how economies really work. You can’t reduce costs by imposing a tax structure that reduces supply, increases demand, and depresses cash flow in the general private sector. And price-controlling healthcare services would ultimately have the same effect on healthcare as rent controls invariably have on housing: it’s a disaster for the poor, and for society on the whole.

I have yet to hear a proponent of progressivist “solutions” admit that this economic reality might possibly pose a difficulty to the healthcare socialization project. In their determination to believe the rightness of their cause, they seem to have convinced themselves that there is no real cost to any of this, that the problem of inequitable distribution is simply one of “unfairness” in which scarcity plays no role, and that they can even achieve better than market-optimal results while actively sabotaging market incentives, such as lowering the payments made to doctors under Medicare. Sheer delusion.

I live in a populous area, just outside of Boston, which is also one of the world’s premier hotspots for health care technology. I suspect the supply-to-demand ratio for health care around here is about as high as it is anywhere, and it’s already not easy getting timely appointments, at least if you are not already a patient. Knowing what we know about the notoriously long waiting periods afflicting patients in Canada and other countries that have socialized their systems, how can we think we are seriously addressing any kind of lack-of-healthcare problem when we’re not attempting to find a way to increase the availability of healthcare itself? Trying to frame the healthcare access problem as one simply of inability-to-pay on the part of a victim class is both wrong-headed and counter-productive – unless your goal has less to do with caring for people than it does with establishing state control of healthcare. Clever slogans might be politically expedient, but they tend to be economic time-bombs.

The Democratic proposals put forth by each Congressional house would significantly raise healthcare costs across the board, fail to provide healthcare consumers with any needed new options outside of government controlled exchanges, destroy market incentives for both third-parties and healthcare providers, discourage providers from serving the elderly and other less affluent segments of society, discourage entry into the healthcare field at both institutional and personal levels, encourage artificial demand for unnecessary services by frontloading costs into taxes and premiums, create the typical government feeding trough and corruption that doling out tax dollars invariably creates, facilitate the continuation of enormous wastes of time, money, and resources as a consequence of medical malpractice law abuse, and, of course, exclude the most vulnerable members of the human race from even the most fundamental of protections. To call these plans “universal” in any sense at all – even provisionally – is an utter farce.

So who benefits? Beyond the advocates for unlimited state control of human society, I don’t see how anyone benefits. Sure, there will be rent seekers of various stripes who line their pockets – it’s impossible to spend $2.5 Trillion without making somebody rich – but the net result to the healthcare system- and the people it serves, will be a certain loss.

George Orwell, in his 1946 essay “Politics and the English Language” said: “Political language . . . is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.” There is no more apt description of the political discourse that has defined the “healthcare” issue in this country over the past year. Now that we’ve seen what the Democratic leadership has proposed for legislation, would it be out of line to suggest that someone might owe Joe Wilson an apology?

Of course, it was almost impossible to know much of substance of what was being proposed until the 2,000+ page monstrosities our elected representatives wouldn’t even have read before voting on were submitted as bills. For months, the public “debate” consisted of little more than partisan posturing from both major parties, save for some genuine disagreements over public funding of abortion, and the so-called “public option” insurance plan. Despite the constant “healthcare” rhetoric, the real target of political muscle-flexing is the medical insurance industry, although questions around requirements for treatment rationing did arise while the public option was still on the table, so actual healthcare questions may come back into play at some point.

It is impossible to draft coherent policy without a sound understanding of the issues at stake, and it is impossible to understand the issues at stake without coherent definitions of the terms of the debate. The thing that bothers me most deeply about this obvious boondoggle is the almost total lack of interest – among politicians, journalists, or the general public – in understanding the issues before taking a position or making a decision. As usual, we are, collectively, satisfied by an idealism unencumbered by facts, or by any kind of reasoning from ideas to consequences. I fear an economic train wreck coming, masquerading as yet more self-righteous do-goodism, and arrogating ever more power over people’s lives to the state. This is not reform, it’s the entrenchment of Big Brother.

The ideal at issue can be summed up as the universal right to healthcare. That sounds great, but what does it mean? In order to get from ideal to sound policy, all three terms (universal, right, and healthcare) need to be understood – not only insofar as their general implications through historical usage suggest, but also precisely how they are being circumscribed by the current context. We are far from any useful common understanding of any of this. In discussion, this ideal is sometimes modified to propose that everyone has a right to adequate healthcare. The “adequate” modifier is a step in the right direction, recognizing at least that there is not an unlimited right to healthcare, but at the same time, it really just adds a fourth term to the question requiring resolution. If we don’t know what adequate healthcare is, how can we craft policy to achieve it?

The central term of the debate, healthcare, is so vague and ill-defined that it can mean whatever anyone wants it to mean at any given time, and it invariably does – and you can be sure that trend will continue. Not one of the main actors in this debacle would dare to publically define exactly what constitutes “healthcare;” they’ll simply proclaim loudly that it must be reformed! It must therefore be said that the central idea of President Obama’s primary domestic priority is a weasel word which nobody actually understands, or can articulate coherently! This is a textbook example of how a commitment to a vague concept can be abused for unrestricted leverage in policy determination. The point, after all, is not actually healthcare (whatever that means), but “shaping the future of America.”

I am reminded of a saying that I must confess I once accepted as axiomatic (as does virtually everyone on the progressive left): that the rich get richer while the poor get poorer. No doubt the poor, like everyone else, sometimes do get poorer, and there are scenarios where the above dynamic would hold true (e.g. land grabs by the wealthy, or other usurpations of finite resources). But the saying is usually invoked as a denunciation of wealth growth in a capitalist context, where it makes absolutely no sense. As American wealth has grown, all but a tiny fraction of the populace has seen their standard of living rise to levels simply unimaginable to the vast majority of those whom history has called the poor. It turns out that a rising tide does indeed lift all boats, whether the progressives like it or not. The problem is that all boats don’t rise equally, and envy perceives this as an injustice, despite the fact that the process is actually working for everybody. Thus, it is blindness caused by envy that generates the mischaracterization of universal but uneven improvement as “the poor get poorer.”

Likewise, the actual problems in our healthcare system, and/or our healthcare delivery system, hardly seem to me to be of crisis proportion (after all, our healthcare system, by and large, is excellent, and the envy of the rest of the world). I agree that is prudent to be concerned about the rate of increase in healthcare costs proportional to the rest of the economy, but a large part of that cost increase is traceable to the technical revolution in the medical field, which is making more and more treatments available to people, yet which do not – and cannot – come free. Twenty or thirty years ago, we spent much less on medical costs, but we got much less in return. I don’t see anyone trying to turn back the clock on medical technology.

Because of the prevalence of third-party payers, whose role ends up encouraging the over-use of medical resources for non-critical and even frivolous problems, and who in turn have to bundle increased usage costs from both non-critical over-use and constantly emerging technological advances into their own pricing structure, consumers encounter premium increases that may not reflect their own usage of the healthcare system, eventually reaching levels that are economically disruptive, and even pricing them out of the market. We can talk about subsidizing these costs, but unless the causal issues are addressed, the costs are merely being shifted from one pocket to another.

The presence of these third-party payers has also distorted the pricing models of the healthcare providers themselves, inflating the pricing of direct payment markets to sometimes ridiculous levels, effectively eliminating the option of patients paying directly for as-needed a la carte care from providers, as had been the almost universal practice until very recently. This is part of what frosts so many young people who would prefer to stay out of the health insurance market (and who are likely to be forced now to take on these spiraling prices of the third-parties, both directly through premiums, and indirectly through taxation), that the costs for services for those without insurance plans are far and away higher than the insured indirectly pay through their third-party payer. Those who are uninsured not by choice are in an even worse situation. Simply requiring open accounting of provider pricing could go a long way in empowering cash customers (i.e. patients) in search of a fair deal.

The fact that the Democrats tried so hard to include a “public option” in the reform package demonstrates clearly that they do not understand the problems inherent in third-party payer systems, fail to see how sound risk management on the part of payers can limit those problems, and somehow still fail to grasp how much more distorted (not to mention corrupt) the market would be with an increased role for public agencies. It’s not that problems don’t exist in the delivery system; it’s that the Democrats seem bound and determined to make them worse in the name of making them better.

If the basic practical problem is that “healthcare” has become too expensive, there is absolutely nothing in the structure of the proposed reforms that will ameliorate that – in fact, all the guilty parties involved in this know full well that costs will increase. The Chief Actuary at the Centers for Medicare and Medicaid Services has suggested that, with the Reid bill in place, healthcare spending, as a percentage of GDP, will increase from 17% to 21% over the next decade. Nice reform. I also have to assume that this estimate is not assuming overall economic damage, due to the irresponsible tax increases associated with this plan, shrinking the projected GDP, which would almost surely raise the percentage of that GDP spent on government regulated healthcare to an even higher percentage.

If, as it appears, the primary objective is to make “coverage” available to more people, the obvious first step should be to repeal the anti-competitive 1945 McCarran-Ferguson Act, and the second step should be to set up supports for policy portability. What we get instead are Constitutionally dubious proposals to wreak havoc on the medical insurance industry, which appear so poorly thought out that it makes me wonder if this plan is really intended as a time bomb to get a nationalized program in place through the back door of private sector collapse. OK, that’s paranoid. Still…

And, of course, the one surefire way to realize immediate, significant healthcare cost reductions for everybody, tort reform, is, as always, nowhere on the Democrat’s radar as far as I know, despite the fact that, again, everyone involved knows what a real difference this would make. What a disgrace.