Hat Tip Instapundit

This opinion piece by Keith Hennessey in The Wall Street Journal is full of good sense and seemingly sound strategy:

Now that the Supreme Court has ruled ObamaCare’s individual mandate constitutional, the direction of American health policy is in the hands of voters. So how do we get from here to “repeal and replace”?

Step one is electing Mitt Romney as president, along with Republican House and Senate majorities. Without a Republican sweep, the law will remain in place.

But a President Romney does not need 60 Republican senators to repeal core elements of ObamaCare. Democrats lost their 60th senate vote in early 2010 after Scott Brown took Edward Kennedy’s seat. To bypass a Senate GOP filibuster and enact portions of ObamaCare, they used a special legislative procedure called reconciliation.

Hennessey goes on to outline how reconciliation can be used in the Senate to avoid the filibuster.   More importantly, he goes on to advocate for implementing changes to the way in which Americans purchase health care, moving from an employer-sponsored plan to a marketplace where consumers purchase and own their own policies like car insurance.

Reform should start by replacing the tax exclusion for employer-provided health insurance with a flat tax deduction or credit. This should be combined with insurance reforms that allow consumers to buy portable health insurance sold anywhere in the nation, through their employer or on their own. That means you’ll be able to take your health insurance with you from one job to the next. Tax policy will no longer push Americans toward lower wages in favor of more expensive health insurance.

Top it all off with expanded contribution limits for health savings accounts, aggressive national medical liability reform, and structural Medicare and Medicaid reforms that dramatically slow the growth of government and deficits.

In 2009 and 2010 the nation took huge steps down a path toward more government control of health care. A shift to the consumer-based reform path is still available—if voters want it.

The difficulty with this free market approach is that… well, the market must actually be “free.”   Hennessey’s piece leaves out at least two, crucial elements for a free market in health care to function properly:  readily flexible supply and freedom for innovation.

Health care costs will never decline, no matter how many tax deductions and national health care plans are implemented, so long as the supply of doctors and nurses is kept artificially low.   In the current system, there are a relatively small number of spots available for those wishing to enter the medical profession.   Becoming a doctor is more like joining a medieval guild than any, other occupation (with the exception, perhaps, of the Delaware bar).   With all guilds, there is an inherent financial interest in preventing too many people from entering the field.   The guild decides how many new members it wants, irrespective of the actual, public need.  A key part of any health reform, then, must be a reform to the various controls that the Medical Guild has imposed to keep out new doctors.   This would include, by the way, the active recruitment of the world’s most talented doctors by liberally handing out work visas.

Increasing the supply of doctors, however, will not work without reforms which allow for drastic innovations in the supply of medical services.   Laws need to be loosened which would encourage doctors and nurses to form profitable practices that provide quality care at affordable prices.   The provision of medical services has changed very little over the last 70 years due in large part to restrictive laws that impede competition among doctors.   Similar reforms need to be implemented in the fields of biotechnology, pharmaceuticals and medical devices.

As just one example, the Federal Drug Administration should be transformed from a licensing agency with police powers to an advisory role.   Rather than prohibiting new drugs, procedures and devices from reaching the market until the F.D.A. has given its final approval, these products and procedures should be allowed quick entry with appropriate F.D.A. evaluations.   So, in the case of a new treatment for diabetes, the F.D.A. provides merely an evaluative opinion on its safety and efficacy.   It is left to doctors and, more importantly, to patients to decide whether they want to risk a new treatment that has, for example, a “red flag” of sorts from the F.D.A.    As time goes by, the F.D.A. may change the flag to yellow or even green.

Public perceptions play into the debate as well.  For better or worse, public attitudes about health care have shifted dramatically over the last 70 years.   Prior to World War II, the average person viewed doctors as specialists who were consulted only when a medical issue was too severe for the family to care for itself.   Doctor visits were far less frequent than they are today and no one much thought of having access to the most sophisticated and cutting-edge technologies to extend life.  Professional medical care today is seen as a right and access to expensive, marginal treatments, even for cosmetic or non-life-threatening conditions (sex change operations?  Really?) is considered essential.

In short, the problem with health care in the U.S. is not one that the Federal government needs to solve.   It is a problem largely created by the Federal government as a result of incessant meddling, regulation, taxation, over-hyping expectations of care, and anti-competitive policies.   The single, best thing that can be done to improve the health of our nation is to make the provision of health care more like the provision of automotive care— giving consumers a wealth of choices.

We may observe that in the wake of the Supreme Court ruling, for those searching for scholarly and learned legal analyses of the Affordable Health Care Act (“Obamacare”), the ruling by Judge Roger Vinson remains to this day the best there is.  A careful study of his opinion is all you need to know about the unconstitutional power grab by Congress we call Obamacare.  And practically speaking, the acceptance of the Congressional act and the associated SCOTUS ruling on the grounds that the American health care system is broken and in dire need of repair is ill informed.  The American health care system, while not perfect, is the greatest on the planet, which is why people come to America for health care from around the world.

Justice Roberts, who is now known to have changed his opinion during deliberations with his colleagues, was apparently concerned about the legitimacy of the Supreme Court if it struck down the act in part or in whole.  Professor Randy Barnett, who I respect a great deal, sees a silver lining in the cloud.  But the problem with all of this talk about recalibrating the Supreme Court of the future with a more federalist vision only goes so far as other (liberal) justices respect the doctrine of stare decisis.  With Ruth Bader Ginsburg, for example, this isn’t very far.  She sees reversal of D.C. versus Heller on the horizon with a “future, wiser court.”  So I see no silver lining in the cloud.  As one of my sons put it, Roberts was breaking a horse, and instead of bucking the horse out, he simply got off.  He gave up on his job.

Hopefully the monstrosity of Obamacare will be repealed in Congress, or at least, defunded by “future, wiser” Congressmen than the ones who voted in favor of it.  I suspect that the financial straits from which America suffers will make the decision for us all.  The entitlement system cannot long exist in its present state, and that which cannot continue, doesn’t.  But regardless of what the future holds for this monstrosity, it is important to understand more about it than the political machinations that brought it into being.

My own seminary professor, Dr. C. Gregg Singer, made the following observations on the social gospel (“A Theological Interpretation of American History,” pages 148 – 149):

The roots of the social gospel were theological in nature; it was essentially a new revolt against Calvinism and the evangelical position.  Its roots can ultimately be traced back to those developments which took place in European theology as a result of the rise of Hegelian Idealism, to the theologies of Ritschl and Schleiermacher in Germany which attempted to refashion Christian thought according to the prevailing philosophical currents and the attacks of German Higher Criticism on the inspiration and authority of the Scriptures.  The more immediate background for the new theology is to be found in Transcendentalism, the New England theology and writings of Nathaniel Taylor and Horace Bushnell, and the Oberlin theology popularized by Charles G. Finey …

These theologies not only seriously modified the doctrine of total depravity, but they presented a plan of redemption which was, in varying degrees, synergistic.  This synergism, giving to man some merit and some ability to accomplish his own eternal salvation, almost inevitably led to a view than man also has both the power and the mandate to make a heaven out of this earth and to transform it into a kind of Garden of Eden …

Regeneration was all too often regarded as little more than a willingness to join in a crusade for the realization of the Kingdom of God on earth … for the introduction of some kind of socialism into American society.

And this sort of thinking was prevalent among its adherents, especially Mr. Obama.  Do you doubt it?  Consider Mr. Obama’s own words in 2006 prior to his election.

Our failure as progressives to tap into the moral underpinnings of the nation is not just rhetorical, though. Our fear of getting “preachy” may also lead us to discount the role that values and culture play in some of our most urgent social problems.

After all, the problems of poverty and racism, the uninsured and the unemployed, are not simply technical problems in search of the perfect ten point plan. They are rooted in both societal indifference and individual callousness – in the imperfections of man.

Solving these problems will require changes in government policy …

Mr. Obama goes on to say that he believes in keeping guns out of inner cities (foretelling the Supreme Court dissent in Heller v. D.C. and McDonald v. Chicago, and the appointment of Sonia Sotomayor to the Supreme Court), and appears to blame the “gun manufacturers’ lobby” for the moral failings of inner city violence.  Thus does Mr. Obama’s policy decisions have a theological basis in the social gospel, but more specifically, liberation theology of the brand that was popularized in Central and South America in the mid-twentieth century.

On this view, religious commitment and the correction of the fallen state of mankind lies in the state and changes to laws regulations and policy.  Make sure to read again Obama’s view: the problems of poverty and lack of insurance are rooted in “individual callousness,” in the “imperfections of man,” and require “changes in government policy.”  Salvation and regeneration are corporate, or applicable to groups of people, not to be seen as a forensic phenomenon between God and individual men.

But health care should be seen as a commodity as much as, say, transportation, housing and food are commodities.  A person cannot survive (very well) without all of the above.  At one point in time these commodities were administered by Church deacons, with responsibility and accountability ensured so as not to encourage sloth and irresponsibility.  And giving was voluntary, not enforced by the power of a badge and gun.

But if health care is a commodity, then there is no prima facie reason to dissect it and severe it from the other commodities.  Any argument for forced provision of health care to other families by one with more means is disingenuous and hypocritical if it doesn’t include the same justification for the forced, shared provision of transportation, housing and food between families.  And such an argument should consider the history of socialism across the globe and the necessary questions it poses.  Does it share wealth or simply destroy it?  What role do families and the church play in such a schema if the state is responsible for cradle to grave security, and does this sort of thing usurp the authority of families and church?

In the end, regardless of the answers to the questions above, there is no question that there are theological underpinnings to Obamacare.  These underpinnings are to be found in liberation theology, the social gospel and ultimately in Hegelianism and Marxism.  The charge is reflexively leveled at conservatives and traditionalists that we mix church state.  But it’s just as easy to dismiss this charge on the grounds that one doesn’t have to be a member of any church to vote his or her conscience in the voting booth.  All laws are legislated morality.

But while this charge against conservatives is common, it isn’t nearly as common to admit or even see the religious foundations for progressivism.  It’s there nonetheless.  And as the savior said, and to the progressives I repeat, extract the log in your own eye before you go on any scavenger hunt for the spec in my eye.  Seriously study the religious foundations for your own views before we embark on a discussion of my own.  That includes Mr. Obama’s social gospel, Mill’s utilitarianism, or any other -ism or world view that presumes to inform me what I should be doing.