Three Misunderstood Things, 7-17-2017

This week: healthcare costs, the “Biblical” view of abortion, and sanctuary cities.


I. Cutting healthcare costs.

What’s misunderstood about it: Liberals and conservatives both talk about cutting costs, but mean different things. Liberals are usually talking about cutting the cost to society as a whole, while conservatives focus on cutting the cost to the federal government. Either side might be talking about cutting the cost to certain individuals.

The right follow-up question: When a proposals claims to “cut healthcare costs”, are those costs going away, or just being passed on to someone else? Or did that money pay for some needed care that someone is now going to do without?

*

Nearly everyone agrees that American healthcare is too expensive. Americans spend far more on healthcare, both per capita and as a percentage of GDP, than any other country in the world. That might be fine if our extra money bought us better health, but in fact the reverse is true: Our life expectancy at birth is similar to much poorer countries like Costa Rica and Cuba, and on average Americans die four years sooner than the Japanese or the Swiss.

So cutting healthcare costs is a sure applause line for a politician. But what does it mean?

An win/win outcome would be to deliver the same or better care more efficiently and effectively: Hospitals make fewer mistakes and produce fewer unnecessary complications. Treatment gets targeted better, so that no one has to suffer through (or pay for) a test or treatment had no chance of helping. Drugs replace surgeries, and diet/exercise regimens replace drugs. Preventive care catches conditions before they become serious (and expensive). Environmental and job-safety and product-safety standards expose people to fewer health-threatening risks.

Admittedly, it’s not always obvious how to get those win/win results. ObamaCare made some small steps in this direction, but we really don’t know yet whether they’re working, and those changes may not survive the ObamaCare repeal process.

So most cost-cutting proposals are not about those win/win solutions. Liberals often try to offer the same treatment for less money by squeezing providers: cutting insurance companies out of the loop via single-payer plans, capping the prices that drug companies or hospitals can charge, or paying doctors less. Those are great ideas unless you’re an insurance company, a drug company, a hospital, a doctor, or a lobbyist for one of those powerful vested interests.

Conservatives often cut costs by getting somebody to do without healthcare they would otherwise want, usually rationing by cost: Everything is available if you can pay, but you might “choose” not to pursue some treatment that would bankrupt your family. Perhaps Americans (especially poor and working-class Americans) really do seek massive amounts of unnecessary treatments, and they would stop if only they had more “skin in the game“, but I haven’t seen that in my own life. What I have seen is my wife taking monstrously expensive drugs to keep her cancer from coming back. If we were poor and had to pay for them ourselves, it would be really tempting to cross our fingers and hope.

And finally, both sides talk about cutting costs by transferring those costs to somebody else. For liberals, “somebody else” is usually the government, or (passing the buck one step further) the taxpayer. For conservatives, it’s the individual — especially if he or she is unhealthy. Capping what the government is willing to put into Medicare or Medicaid, for example, may help the government control its budget deficit, but it doesn’t do anything to lower the need for treatment or the cost of providing it.

Similarly, letting individuals design their own (cheaper) health insurance — letting people opt out of insurance for care they won’t need, like prenatal care for men or geriatric care for young people — may lower some people’s individual expenses, but the total number of pregnancies and old people hasn’t changed. The cost of caring for them hasn’t gone away, it has just shifted to somebody else.

II. Christianity and abortion.

What’s misunderstand about it: The belief that a newly fertilized ovum has the full moral worth of a baby (or an adult) is often described as the “Christian” or even “Biblical” position.

What more people should know: The Bible says nothing about conception, and what it does say about fetuses and souls points in a different direction. The current ensoulment-at-conception dogma didn’t solidify among conservative Protestants until well after Roe v Wade.

*

Religiously, the question of whether abortion is murder comes down to when the fetus acquires a soul. Souls, after all, are the difference between murder and what butchers have done for millenia. (If you believe a chicken has an immortal soul, you really should be a vegetarian.) Anti-abortion arguments often (and usually inaccurately) point to the number of weeks before a fetus has a heartbeat or can feel pain, but such physical traits are just placeholders for a metaphysical trait that can’t be recognized in a secular setting like a legislature or a courtroom: the presence of a soul.

Unfortunately, microscopes and ultrasound machines didn’t exist when the Bible was being written, so scripture never mentions the miraculous moment when a sperm enters an ovum, nor gives a detailed description of fetal development. The observable sequence at the time was: sex, the woman shows signs of pregnancy, the fetus begins to move on its own, and birth. No one knew how to break the process down much finer than that, and apparently God never whispered His superior knowledge into anybody’s ear.

But anti-abortion Christians really, really want Biblical support for their position, so they thrust an enormous amount of interpretation onto a handful of texts that are either vague or really about something else. For example, Jeremiah 1:5, which you will occasionally see on billboards: “Before I formed you in the womb I knew you.” That might be a lyrical way of saying that God had been planning Jeremiah’s mission for a long time, or it might more literally say that Jeremiah’s soul existed before his conception, but it actually doesn’t say anything about precisely when that soul entered the body that was forming in his mother’s womb.

Which is not to say that the Bible is silent about souls entering bodies. There is a text — I believe it’s the only one — that quite explicitly describes a soul entering a body. But it doesn’t say what anti-abortion folks want to believe, so it seldom gets mentioned in abortion arguments. I’m talking about Genesis 2:7, which describes the creation of Adam.

And the Lord God formed man of the dust of the ground, and breathed into his nostrils the breath of life; and man became a living soul.

In other words: God formed Adam’s body completely, and then his soul entered that body with the breath. The obvious implication is that a fetus is soulless until it breathes. The Christian Left blog does a more detailed discussion of how this view aligns with other places where the Bible mentions pregnancy and miscarriage.

From the early Christian era through the Middle Ages, many Christian thinkers identified the soul with motion, and so held that it entered the fetus at the quickening, which was variously identified at anywhere from 40 to 120 days.

The Catholic Church has been against abortion in any form at least since the 1600s, when it began hoping for Catholic families to outpopulate Protestant families. But Protestant opinion varied widely, even among theological conservatives, until after abortion became a unifying conservative political issue in the late 1970s: The theology appears to have followed the politics, rather than leading it. The history of this discussion has been completely written over in the ensuing years. Slacktivist characterizes this process with a line from George Orwell’s 1984: “We have always been at war with Eastasia.”

As for why this corruption of church history and biblical interpretation is necessary, I believe the root issue is female promiscuity. Pregnancy is a great blessing to families that are ready to raise children, but traditionally it has also been the ultimate comeuppance for unmarried women who think they can have sex without consequences. When abortion is freely available, pregnancy becomes a much less effective threat for keeping women in line. That’s what social conservatives are really worried about, and why they don’t see effective birth control as a solution to the abortion problem.

III. Sanctuary cities

What’s misunderstood about them: What they are. In no American city, whether it identifies as a “sanctuary city” or not, do local officials actively prevent federal immigration officials from detaining or deporting undocumented immigrants. The issue is entirely about the extent to which local officials help ICE.

What more people should understand: Federalism. Under the Constitution, state or local government officials can’t block federal agents from enforcing federal laws, but they don’t have to help.

*

The word sanctuary evokes the idea that once you get there, you’re safe. That’s certainly how it worked for Esmeralda in The Hunchback of Notre Dame.

No city in the United States is a sanctuary for undocumented immigrants in that sense. Federal agents of Immigration and Customs Enforcement (ICE) can go anywhere in the country and arrest anyone they believe has broken federal immigration laws. Local officials can’t stop them, any more than they could stop the FBI from arresting terrorists or the Secret Service from arresting counterfeiters. (Legally, churches aren’t sanctuaries either, even though many of them — including the one I belong to (that’s me in the back, under the chandelier) — are supporting a sanctuary movement. So far ICE hasn’t been willing to break down church doors to haul somebody away, but fear of public opinion is all that stops them.)

However, unlike in some other countries, American state and local governments are not divisions or departments of the national government. The system we know as federalism prevents the national government from simply issuing orders to state and local officials. In particular, cooperation between various levels of law enforcement is mostly voluntary. (This is not an entirely liberal or conservative thing; conservatives want local police not to cooperate with federal gun laws.)

Vox has a pretty clear video explaining the situation.

Whenever local police arrest somebody, fingerprints are taken and submitted to the FBI, which then shares them with ICE. If ICE recognizes those fingerprints as belonging to someone they want to deport, they can send the local police a request to hold the person for an additional 48 hours, which gives ICE time to send out its own agents to make an arrest. But local police don’t have to comply.

Depending on where you live, local police might respond on a case-by-case basis, or the local government might establish a policy. The extent to which that policy refuses cooperation is what defines a sanctuary city.

A separate issue is whether the national government can cut off funds to uncooperative cities. (Again, this is a not a strictly liberal/conservative issue. The Affordable Care Act said that states that didn’t expand Medicaid in the way the law described would lose all federal Medicaid money. But the Supreme Court ruled against that kind of strong-arming.) In January, Trump issued an executive order threatening to pull federal funding from sanctuary cities, but, a judge blocked the enforcement of this order, writing:

Federal funding that bears no meaningful relationship to immigration enforcement cannot be threatened merely because a jurisdiction chooses an immigration-enforcement strategy of which the president disapproves.

In May, the Trump administration appeared to back off. Attorney General Sessions issued a definition of sanctuary cities that applied to very few places, and the restricted funds were only law enforcement grants from the Departments of Justice or Homeland Security.

[BTW: If you show a Trump supporter the Vox video, they’ll likely respond with this video from 1791L. However, that video does not actually identify any mistakes in the Vox video.]

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Comments

  • Kaci  On July 17, 2017 at 9:04 am

    “If you believe a chicken has an immortal soul, you really should be a vegetarian.”

    I don’t know if it’s that simple. I observe dogs and and cats and pigs all having individual personality, but I eat pigs and some cultures eat dogs. (I don’t know if anyone eats cats but it wouldn’t surprise me). So I think we need to ask what a soul is. I think it’s very possible that the personality part of my cat will continue in some way after his physical death, just as I believe something similar will happen for humans.

    Humans have a lot of traits my cat doesn’t seem to have: a persistent self-concept, the ability to form complex organizations, concern about one’s mortality. At the same time, my cat seems to have more “selfness” than a dragonfly does. So it seems to me that ensouledness might be on some sort of a continuum among species rather than being a yes or no type of question.

    This has nothing really to do with your analysis of the biblical stance on abortion, which is great. And I don’t condone cannibalism.

    • weeklysift  On July 17, 2017 at 9:56 am

      Aristotle had a similar view. He believed the human soul was stratified into a vegetable soul, an animal soul, and a human soul. We share the vegetable soul with all living things, the animal soul with everything that moves under its own power, and the human soul with other people. He also believed the three souls developed at different stages of pregnancy.

    • Vestafell  On July 18, 2017 at 3:58 pm

      It’s hard to say that cats Dont’s have “concerns about one’s mortality”, just that we can’t really communicate with them to understand them. Yeah, they have far less ability to organize, lacks languages, etc., but these all seem so tangential to the foundamental qualities that make life what it is and give it value – what we may be referring to as souls.

    • wwax  On July 18, 2017 at 5:09 pm

      Recent studies have shown chickens to have a sense of self awareness that has only been seen in elephants, chimps, dolphins & humans, oh and I believe but can’t find the research in ravens. Does that change your opinion on eating them?
      I say this as someone that had a chicken sandwich for lunch. . https://www.springer.com/gp/about-springer/media/research-news/all-english-research-news/think-chicken—think-intelligent–caring-and-complex–/11952522

      • Kaci  On July 18, 2017 at 6:58 pm

        Neat article! I’m still eating them, but then I also am okay with people eating dogs, even though I don’t choose to.

      • 1mime  On July 18, 2017 at 11:20 pm

        Wicked sense of humor, wwax!

  • James  On July 17, 2017 at 9:28 am

    i really like this feature. 👍

  • Liz Broderick  On July 17, 2017 at 10:18 am

    Concerning abortion. I am a “fallen away” Catholic. Abortion has always troubled me. But in light of the stories we hear of child abuse, I prayed for clarity. What came to me was a thought which brings me comfort.
    If “you” don’t want me, Jesus does, and I will go to Him.
    “Suffer the little children to come to me, for their’s is the kingdom of heaven”.

  • David  On July 17, 2017 at 11:53 am

    Health costs & the Republican AHCA

    Returning “universal care” to the emergency room (by EMTALA, regardless of ability to pay) is a strange way to “cut” government spending. Before ACA, that care was funded by cost-shifting onto Medicare and those who could pay, mostly employer-based insurance. The ACA moved the Medicare money, and the AHCA doesn’t move it back.

    So the Republican government spending “cut” transforms a direct tax into an unfunded government mandate, cost-shifted primarily onto employers/employees.

    The AHCA doesn’t cut government-imposed costs. It hides them.

    And that’s before we consider outcomes and costs of primary/preventative care vs. ER care.

    • Kim Cooper  On July 17, 2017 at 7:23 pm

      In our experience, you really can’t get medical care at an emergency room unless it’s an emergency. We got turned away from the ER because it wasn’t enough of an emergency, but the county hospital wouldn’t see us without insurance even if I offered to pay in cash. Neither would Stanford. We had to rent a van and drive over 400 miles to go back to the original physician who treated the broken neck to get the halo contraption checked and tightened, and, later, removed — because the original doctor can’t refuse care. This cost us a lot extra.

  • MD  On July 17, 2017 at 10:41 pm

    Here’s an article about a program that actually reduces medical costs – and gets BETTER health outcomes in the process:
    https://www.washingtonpost.com/news/wonk/wp/2013/04/28/if-this-was-a-pill-youd-do-anything-to-get-it/

    But there’s not much talk about anything like that in the current healthcare debate.

    • weeklysift  On July 18, 2017 at 9:21 am

      I had forgotten about that article. Thanks for bringing it back to mind.

  • nrkatalyst  On July 19, 2017 at 3:53 am

    I love this new type of article that you’re doing on misconceptions. Very informative and non-partisan; exactly what the news needs more of.

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