Robert Barron seems to be a bit more optimistic than I am about the reception of Pope Francis' Laudato Si'. For one thing, Barron sees the encyclical leaving a 'wake' behind, and I have been sadly compelled to see it as a flash in the pan, mainly because its teachings are 'hard.'
It is a wonderful coincidence, though, that Fr. Barron, a single day after my own post on Catholic social teaching, would ponder Laudato in terms of the prophetic (read: fiery and colorful) language of the document and the pope's speeches in Latin America. Though Barron's comments seem very accurate to me, he does not couch them in the terms of my previous post: subsidiarity, socialization and solidarity. Nonetheless, his contextualization is a good one, and he touches appropriately on the dignity of the individual and the common good.
I recommend Fr. Barron's article for those who seek a context for what this pope is about.
Showing posts with label Catholic social teaching. Show all posts
Showing posts with label Catholic social teaching. Show all posts
Tuesday, July 14, 2015
Monday, July 13, 2015
Subsidiarity, Socialization, Solidarity: Heathcare, Patients and Doctors
Subsidiarity, socialization and solidarity are the trinity of principles that form Catholic social teaching. To be sure, Catholic social teaching is as old as the Gospel itself, but it takes the form of official teachings at the end of the 19th century with Leo XIII's Rerum Novarum. The latest encyclical dealing with Catholic social teaching, Laudato Si', recently made a splash in global media, but has gone cold and will soon be forgotten. Quite simply, the principle of subsidiarity insists that, in the social order, whatever can be accomplished at the lowest level, for example the level of the individual or small community, must be accomplished there, and larger social structures such as higher levels of government should yield to the greater efficacy of the lower levels. Socialization, on the other hand, insists that what the lower levels have failed to do, or have accomplished ineffectively, or have ignored, must be enacted upon by higher levels of the social order. 'Human dignity' and the 'common good' drive the choices that locate where that good is best accomplished. Solidarity, has two meanings: first, it means that all humans at the various levels of community are in irrevocable relationships, and the common good is exercised at all levels of such relationships. The second meaning, more cynical, is simply to offer a less threatening term for socialization, as so many people hear in that latter term 'socialism,' a nasty word for liberal democracies seeking to balance political power.
Leo's encyclical reacted against the rise of socialism in response to the problems of labor by embracing subsidiarity; John XXIII's Mater et Magistra flowed in the other direction in response to laissez faire attitudes but also back again to socialization regarding healthcare and housing. Francis' Laudato Si' embraced an 'ontoecological' solidarity in response to the rape of the natural world and the further degradation of the poor. All three encyclicals are rewarding reads, and I highly recommend them as my brief summaries hardly do them justice.
The clearest validation of Catholic social teaching can be seen in the issues of American healthcare. The absolutely dismal failure of the American system gave rise to Medicare and similar programs, managed care, and the latest program, the Affordable Care Act (ACA). The failures are largely at the lowest levels, where people seek care through too few doctors and over-crowded hospital emergency departments. What we have here, as Strother Martin once noted, is a failure to communicate.
While Medicare is arguably the best idea that emerged in the American system, managed care, and its chimeric monstrosity, the ACA, while having the best of intentions, have taken Americans down the road to hell, as Samuel Johnson might have observed. The problem of course is the corporate greed that transformed the practice of medicine into a generator of wealth. This wealth generator has no objection if somewhere along the generation of mega-dollars a few people actually get the healthcare they need, but the system is designed to garner wealth for the few. America pays more than any other country per capita for its health system, but does not approach other countries' effectiveness and good outcomes: the 'common good.' Sadly, human dignity plays no role in the American system.
The failures at the points of service underscore a failure of subsidiarity, and mandates socialization. The American game of feigning commitment to free enterprise has left too much money in the hands of the few and too little, if any, improvements in healthcare delivery to actual Americans. Solidarity remains elusive in American healthcare because it is inconvenient to business interests that have usurped the very nature of medicine and healthcare and transformed it into another 'free enterprise'-government collusion to concentrate wealth in the hands of power structures.
This result was not the intent of the presidency and legislative bodies that shepherded ACA into being, but good intentions are often short-sighted and don't see the beast of unsatiable and unquenchable desire (capitalist-government entanglements) until it's too late. And the beast's brood ain't walking any of it back anytime soon. No, I'm afraid the disingenuous game of 'free enterprise' must yield to the common good and the dignity of the human person sooner or later. A single, single payer system will go a long way in removing the interlopers in the delivery of healthcare. A doctor and a patient must be free to operate without having to answer to stockholders and the wealth-generating machine that places obstacles to the delivery of care so that costs can be channeled into profits.
One way we can conceive the 'common good' is 'human dignity' writ large, and nowhere is the dignity of the human person more present than it the doctor-patient relationship. What happens at the bedside must be reflected at the larger order of social commerce, but, in fact, the flow is in the reverse direction. The commodification of healthcare and its transposition into transactions of goods and services has injected suspicion and hoodwinkery into the sacred space of disclosure and foreclosure, what was once a space of trust. The injection of distrust and malice infects both sides of the relationship. Defensive medicine confronts consumerism and both pound thunderously as the white elephants in the exam room. Doctors have forgotten how to speak to patients empathetically and effectively and patients feel cheated and injured when things don't go as well as Madison Avenue and the marketplace had promised.
The problem has become acute and the medical profession has decided to address it head-on in remediation of physicians' communication skills. Either under the aegis of hospice and palliative medicine, or medical ethics, or malpractice education, physicians hone their skills in role-play, scripted dialogue and general education in empathetic communication. Yet empathy itself cannot be learned, and patients' suspicions are not allayed by canned speech. Only time will tell if essential conversations between patients and doctors are becoming more effective and trusting.
The dignity of the human person as microcosm or macrocosm should begin in the relationship between a doctor and her patient. Human dignity and the common good root deeply in an "I" and an "other." The potential for intersubjectivity is always present in such relationships, if given the tools and skills that can facilitate meaningful communication. Subsidiarity and socialization go hand in hand in healthcare; and only in solidarity, as individuals and as smaller and larger communities, can the problems in healthcare become truly manageable. The human element in the sacred relationship between a patient and her physician is always poised to engender an authentic morality and ethic that goes all the way up and down.
Other equally authentic Catholic (or even strictly secular) viewpoints on the issue of healthcare abound; but unless the discussions become political or fall into the trap of ideology, other viewpoints must identify and stress the successes of our current system, of the situation at the bedside, of the current communication skills of physicians, and of the trust level of patients. Interpretations of the status quo will be judged by how well they ring true in the ear of the beholder.
Leo's encyclical reacted against the rise of socialism in response to the problems of labor by embracing subsidiarity; John XXIII's Mater et Magistra flowed in the other direction in response to laissez faire attitudes but also back again to socialization regarding healthcare and housing. Francis' Laudato Si' embraced an 'ontoecological' solidarity in response to the rape of the natural world and the further degradation of the poor. All three encyclicals are rewarding reads, and I highly recommend them as my brief summaries hardly do them justice.
The clearest validation of Catholic social teaching can be seen in the issues of American healthcare. The absolutely dismal failure of the American system gave rise to Medicare and similar programs, managed care, and the latest program, the Affordable Care Act (ACA). The failures are largely at the lowest levels, where people seek care through too few doctors and over-crowded hospital emergency departments. What we have here, as Strother Martin once noted, is a failure to communicate.
While Medicare is arguably the best idea that emerged in the American system, managed care, and its chimeric monstrosity, the ACA, while having the best of intentions, have taken Americans down the road to hell, as Samuel Johnson might have observed. The problem of course is the corporate greed that transformed the practice of medicine into a generator of wealth. This wealth generator has no objection if somewhere along the generation of mega-dollars a few people actually get the healthcare they need, but the system is designed to garner wealth for the few. America pays more than any other country per capita for its health system, but does not approach other countries' effectiveness and good outcomes: the 'common good.' Sadly, human dignity plays no role in the American system.
The failures at the points of service underscore a failure of subsidiarity, and mandates socialization. The American game of feigning commitment to free enterprise has left too much money in the hands of the few and too little, if any, improvements in healthcare delivery to actual Americans. Solidarity remains elusive in American healthcare because it is inconvenient to business interests that have usurped the very nature of medicine and healthcare and transformed it into another 'free enterprise'-government collusion to concentrate wealth in the hands of power structures.
This result was not the intent of the presidency and legislative bodies that shepherded ACA into being, but good intentions are often short-sighted and don't see the beast of unsatiable and unquenchable desire (capitalist-government entanglements) until it's too late. And the beast's brood ain't walking any of it back anytime soon. No, I'm afraid the disingenuous game of 'free enterprise' must yield to the common good and the dignity of the human person sooner or later. A single, single payer system will go a long way in removing the interlopers in the delivery of healthcare. A doctor and a patient must be free to operate without having to answer to stockholders and the wealth-generating machine that places obstacles to the delivery of care so that costs can be channeled into profits.
One way we can conceive the 'common good' is 'human dignity' writ large, and nowhere is the dignity of the human person more present than it the doctor-patient relationship. What happens at the bedside must be reflected at the larger order of social commerce, but, in fact, the flow is in the reverse direction. The commodification of healthcare and its transposition into transactions of goods and services has injected suspicion and hoodwinkery into the sacred space of disclosure and foreclosure, what was once a space of trust. The injection of distrust and malice infects both sides of the relationship. Defensive medicine confronts consumerism and both pound thunderously as the white elephants in the exam room. Doctors have forgotten how to speak to patients empathetically and effectively and patients feel cheated and injured when things don't go as well as Madison Avenue and the marketplace had promised.
The problem has become acute and the medical profession has decided to address it head-on in remediation of physicians' communication skills. Either under the aegis of hospice and palliative medicine, or medical ethics, or malpractice education, physicians hone their skills in role-play, scripted dialogue and general education in empathetic communication. Yet empathy itself cannot be learned, and patients' suspicions are not allayed by canned speech. Only time will tell if essential conversations between patients and doctors are becoming more effective and trusting.
The dignity of the human person as microcosm or macrocosm should begin in the relationship between a doctor and her patient. Human dignity and the common good root deeply in an "I" and an "other." The potential for intersubjectivity is always present in such relationships, if given the tools and skills that can facilitate meaningful communication. Subsidiarity and socialization go hand in hand in healthcare; and only in solidarity, as individuals and as smaller and larger communities, can the problems in healthcare become truly manageable. The human element in the sacred relationship between a patient and her physician is always poised to engender an authentic morality and ethic that goes all the way up and down.
Other equally authentic Catholic (or even strictly secular) viewpoints on the issue of healthcare abound; but unless the discussions become political or fall into the trap of ideology, other viewpoints must identify and stress the successes of our current system, of the situation at the bedside, of the current communication skills of physicians, and of the trust level of patients. Interpretations of the status quo will be judged by how well they ring true in the ear of the beholder.
Sunday, June 7, 2015
Ghastly Hauntings
I'd like to respond to a little pushback to my "Haunted by the Holy Ghost," pushback that noted a certain vagueness to my appropriation of 'repetition,' as Caputo means it. I warn the reader that what follows is far more political than I intended or perhaps needs to be, but that's nonetheless how the challenge struck me, and how I've chosen to respond. If politics disturbs the reader, or if the reader doesn't want to risk being disappointed in me, I suggest ignoring this post.
I should have gone a bit further about what else is being repeated in our American culture lately---this is not really about religion per se, but it touches upon the salve of progress, that which enables the usurpation of religion by secularist-capitalist interests. Either side of the American political spectrum now speaks of income inequality. The right is just now entering the conversation and is giving voice to its newly found populism, while the left can't quite leave Robin Hood in the story books. Both sides are too modern, all too modern.
Either way, I should have added to my little litany of correspondences the new opiate of the people. While I am way too mainstream and centrist in my politics to be silly enough to embrace the values of any ideology, I would still say that while once religion played the opiate, now the illusion of participation in the grand capitalist narrative plays that role: move over God, and make room for Mammon----the IRA, the 401K, the 403B---the masquerade that regular people are really participating in global market forces.
I wonder if the deep secret of capitalism is its tacit acknowledgement that it has limits when it comes to generating wealth, limits as to how much it can produce, limits when it comes to a place at the table, limits to who can garner that wealth---that whatever does trickle down never reaches the poorest among us (despite a recent, mind-boggling suggestion that America's poor are the richest poor in the world). Perhaps the existence of the poor reassures the producers, the wealth generators, that capitalism is humming along, that the poor will always be with us and always require some version of a welfare safety net, so that neo-liberals and just plain liberals can sleep well in their do-gooding.
I am trying to avoid an overreach here, but is it un-American or un-Christian to ask if the middle class has been bamboozled into thinking that its supplying money to the real players (the poor cannot get into the game) in the market is a winning strategy for securing their own wealth for the future? Remarkably, even after the Great Recession---where the middle class donated its wealth to bailing out the greedy---the illusion dies hard. By now, most have recovered their devastating losses and are even showing a little growth; that's the brain-deadening wool over the mind's eye.
We all should be haunted by moral hazard but the secret of Mammon keeps telling people that it was the wind that knocked over that lamp. For all the talk lately of the redistribution of wealth, what forces have done more to shift wealth than those whose access to the market have provided opportunity for shaping economic tendencies and sentiment? These are the high priests of the new secular church, not those leaders whose well-intentioned but misdirected and impotent calls for 'fairness' vilify them in the face of a convincing illusion that retirement is secure---now that mega-capitalists have convinced us capitalist-wannabees to invest in the new faith. Part of the reason the markets pale when even a hint of rising interest rates (the price of money, which right now is dirt cheap) raises its ugly head is because the mega-capitalists don't like putting their own skin in the game, and would much rather play with others' money. They feed on the slumber-inducing illusion that everyone can get rich if only they invest in the system. Of course they have no problem leaving those investors (read: those saving for retirement) out to dry when things heat up. Their wealth is far more secure than any wealth in the opiates of the regular guy's stock portfolio.
Who will tell the middle class, the spinal column of America, when the mega-capitalists will make a move, when the wealth is about to flow out of the drugged slumber of the pack of wishes (some call it investment risk and market uncertainty) called a portfolio? Whose planned retirements will survive a 30-50% (or worse) reduction of personal capital when the mega's feel the need to declare that 'greed is good' and make a risky move (well not that risky---for them---we will resupply them with money)? How many hits to the spine can America take before its back is finally broken?
Capitalism, it seems, is the very best shape for an economy adopt, and liberal democracy is its best buttress. Yet the capitalist dream is no viable repetition of religion. It does not know of a future of hope, only a short-term foreseeable time of wishes and gains. Capitalism's time is a strike-while -the-iron's-hot kairos---a season to be greedy. The Church has critiqued an unfettered capitalism's amorality if not its malicious tooth-and-claw competition for wealth; the Church, in turn, has been criticized for creating a straw-man capitalism---that such an unfettered capitalism does not exist. Unfettered or not, our capitalism will do just fine in ignoring the poor, hoarding the wealth, while crushing the back of the American worker---whether she is flipping burgers, assembling a car, teaching in the classroom, or asking someone to say "ahhh" and "cough".
There is no obvious solution to the incestuous relationship between establishment capitalists and the political structures that assure them of a nice safe sandbox. I remain committed to the Catholic Church's principles of social justice---solidarity and subsidiarity. These principles, of a certain wisdom and grace for which I hope and pray, can guide the size of a democratic government and harness the appetite of a capitalist economy. The balance between them is a work in progress and a source of hope in a future where we await the capitalism to come, a democracy to come, in the balancing act of a justice to come.
Perhaps then those ghastly hauntings that go bump in the night of a good conscience will start a march into the light, and we all can get a little righteous sleep.
I should have gone a bit further about what else is being repeated in our American culture lately---this is not really about religion per se, but it touches upon the salve of progress, that which enables the usurpation of religion by secularist-capitalist interests. Either side of the American political spectrum now speaks of income inequality. The right is just now entering the conversation and is giving voice to its newly found populism, while the left can't quite leave Robin Hood in the story books. Both sides are too modern, all too modern.
Either way, I should have added to my little litany of correspondences the new opiate of the people. While I am way too mainstream and centrist in my politics to be silly enough to embrace the values of any ideology, I would still say that while once religion played the opiate, now the illusion of participation in the grand capitalist narrative plays that role: move over God, and make room for Mammon----the IRA, the 401K, the 403B---the masquerade that regular people are really participating in global market forces.
I wonder if the deep secret of capitalism is its tacit acknowledgement that it has limits when it comes to generating wealth, limits as to how much it can produce, limits when it comes to a place at the table, limits to who can garner that wealth---that whatever does trickle down never reaches the poorest among us (despite a recent, mind-boggling suggestion that America's poor are the richest poor in the world). Perhaps the existence of the poor reassures the producers, the wealth generators, that capitalism is humming along, that the poor will always be with us and always require some version of a welfare safety net, so that neo-liberals and just plain liberals can sleep well in their do-gooding.
I am trying to avoid an overreach here, but is it un-American or un-Christian to ask if the middle class has been bamboozled into thinking that its supplying money to the real players (the poor cannot get into the game) in the market is a winning strategy for securing their own wealth for the future? Remarkably, even after the Great Recession---where the middle class donated its wealth to bailing out the greedy---the illusion dies hard. By now, most have recovered their devastating losses and are even showing a little growth; that's the brain-deadening wool over the mind's eye.
We all should be haunted by moral hazard but the secret of Mammon keeps telling people that it was the wind that knocked over that lamp. For all the talk lately of the redistribution of wealth, what forces have done more to shift wealth than those whose access to the market have provided opportunity for shaping economic tendencies and sentiment? These are the high priests of the new secular church, not those leaders whose well-intentioned but misdirected and impotent calls for 'fairness' vilify them in the face of a convincing illusion that retirement is secure---now that mega-capitalists have convinced us capitalist-wannabees to invest in the new faith. Part of the reason the markets pale when even a hint of rising interest rates (the price of money, which right now is dirt cheap) raises its ugly head is because the mega-capitalists don't like putting their own skin in the game, and would much rather play with others' money. They feed on the slumber-inducing illusion that everyone can get rich if only they invest in the system. Of course they have no problem leaving those investors (read: those saving for retirement) out to dry when things heat up. Their wealth is far more secure than any wealth in the opiates of the regular guy's stock portfolio.
Who will tell the middle class, the spinal column of America, when the mega-capitalists will make a move, when the wealth is about to flow out of the drugged slumber of the pack of wishes (some call it investment risk and market uncertainty) called a portfolio? Whose planned retirements will survive a 30-50% (or worse) reduction of personal capital when the mega's feel the need to declare that 'greed is good' and make a risky move (well not that risky---for them---we will resupply them with money)? How many hits to the spine can America take before its back is finally broken?
Capitalism, it seems, is the very best shape for an economy adopt, and liberal democracy is its best buttress. Yet the capitalist dream is no viable repetition of religion. It does not know of a future of hope, only a short-term foreseeable time of wishes and gains. Capitalism's time is a strike-while -the-iron's-hot kairos---a season to be greedy. The Church has critiqued an unfettered capitalism's amorality if not its malicious tooth-and-claw competition for wealth; the Church, in turn, has been criticized for creating a straw-man capitalism---that such an unfettered capitalism does not exist. Unfettered or not, our capitalism will do just fine in ignoring the poor, hoarding the wealth, while crushing the back of the American worker---whether she is flipping burgers, assembling a car, teaching in the classroom, or asking someone to say "ahhh" and "cough".
There is no obvious solution to the incestuous relationship between establishment capitalists and the political structures that assure them of a nice safe sandbox. I remain committed to the Catholic Church's principles of social justice---solidarity and subsidiarity. These principles, of a certain wisdom and grace for which I hope and pray, can guide the size of a democratic government and harness the appetite of a capitalist economy. The balance between them is a work in progress and a source of hope in a future where we await the capitalism to come, a democracy to come, in the balancing act of a justice to come.
Perhaps then those ghastly hauntings that go bump in the night of a good conscience will start a march into the light, and we all can get a little righteous sleep.
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