Written by Calvin Fox   
Friday, 27 September 2013 10:05

Until the late 19th century, health care (and the care of the Poor) in America was primarily the responsibility of the family, then the church and next the local community. This is not only a rural and small town model, it is also part of the Biblical Model for Health care. Only as a last resort, as medical care costs increased, was the State and Federal Government involved in health care.

Pay-ahead Insurance for health care from any source was virtually unknown in the US before 1920. Most sick people were cared for privately at home and by the family. As the costs for medical care increased, hospitals began to offer insurance coverage and then doctors did the same. That was the beginning of Blue Cross and Blue Shield private medical coverage in the 1930's. Commercial insurance companies began offering medical coverage in the 1940s. After WWII, businesses began offering insurance plans to their employees as part of their wages and benefits. This was done with the encouragement and regulation of the Federal Government. By the 1960's most Americans had private third party health insurance. There was a history of opposition to proposed Federal Health Insurance until the Presidency of John Kennedy when it found support in Congress.


In 1965 Medicare began as Federal single payer health insurance for the elderly. It was followed by Medicaid which is a welfare program (an entitlement, not insurance) that provided medical coverage for the poor. By 2001, Medicare and Medicaid provided 32 % of all health care costs in the US. The percentage has increased every year. In 2008, Medicare accounted for 13% (386 billion) of the federal budget. In 2010 it is projected to account for 12.5% (452 billion) of the total expenditures. For the decade 2010-2019 Medicare is projected to cost 6.4 trillion dollars or 14.8% of the federal budget for the period.

This week as I write this paper, Congressional Leaders are debating the vast expansion of Medicaid, changing it into a Medicare type program for the Poor. Governors are resisting the move. It could well bankrupt some States as the number of indigent, uninsured people applying for the aid is rapidly increasing. It will lead to drastic cuts in other health, education and welfare services as money is diverted from them to paying for increased Medicaid. (The National health Care Crisis goes hand in glove with the problem of Poverty in America. We will need to reduce the latter if we are to really control the former.)

Many believe that Government Health Insurance is mandated by the Constitution- that it is a "constitutional right" for all citizens. I do not agree. The Congress did not agree either until 1965. Nothing is said in the Bill of Rights or the Constitution that warrants a claim to such a "right". We are told in the Preamble that we have an inalienable "Right to Life". In practice, one's life can be forfeited or taken away by the Government as punishment for a crime or treason (Amendment V). The "Right to Life" is simply the right to self-preservation.

While health care is essential to living, insurance by the Government for the costs of that care is not required by the Constitution. Likewise, water, food and shelter are essential to life. No one argues that the Government is responsible to provide insurance to cover the costs of these things to all (or to any, for that matter) We are personally responsible and free to acquire them as needed. Health Insurance is in the same category as life and automobile insurance.

Insurance providers should compete and customers are responsible to find the exact coverage they want with the best value. Options that seem reasonable to me for Health Insurance for employees include Health Savings Accounts and Personal Wellness Accounts. These are ways to give employees money to be used by then to purchase insurance of their own choice or to save for medical expenses. This would also make the Insurance portable.

People need to know what the costs and payments for various treatments actually are and this will give them incentives to save, as well as knowledge necessary to make wise choices when buying care. Policies could have a high deductible, with most care being paid out of pocket from those Health Savings Accounts and Personal Wellness Accounts and Insurance itself covering only acute or catastrophic care. For responsible people who live healthy, this makes coverage affordable. In addition, Insurance should cover only what the customer wants. No one should be required to buy coverage not wanted nor be penalized for coverage of pre-existent conditions. Private Insurance should also be tax deductible for those who chose it, just as employee insurance is now tax deductible.

The major concerns most evangelicals have about proposed Health Insurance reforms being proposed by Congress seem to cluster around either abortion or euthanasia. Any Government Plan adopted must respect freedom of religious and moral conscience and not require tax-payer funded abortion or embryonic stem cell research and it must must not coerce or limit end of life decisions.

For those unable to afford minimal insurance coverage from any Provider, the State or Federal Government (taxpayers) could offer subsidies to them on a sliding scale. Unfortunately, this seems like it will continue to be a mounting problem and thus the increase in Medicaid. Again, it is related to the issue of Poverty.

"Liberty" is also said to be an inalienable right, but in practice, Liberty must be limited for the common good and by social contract. Likewise, any right to Life (or health care) must also be subject to the common good and be subject to social contract. Health care can not be unlimited and universal when there are limited resources that must be shared with all citizens who now number more than 307 million. Sharing for the common good is a Biblical principle. It must be fair and equitable.

This means that citizens (and corporations) must voluntarily contribute to the care of the Poor or those who can not pay for care. This is very Biblical. Making provision for tax free donations on personal and corporate income tax forms might go a long way to facilitate voluntary charitable donations for the common good.

The Preamble of the Constitution says that it was adopted to "establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity". Promotion of the "general welfare" meant promotion of the overall prosperity and well-being of the entire Nation. To the Founders, it did not specifically mean efforts to care for the sick and needy within the Nation. They did not believe the Federal Government has responsibility to guarantee all access to health insurance.

Certainly the Founders did not envision Federal Health Insurance when they crafted the Constitution. It is not there and they specifically wrote, in the 10th Amendment, that if it is not there it can not be added. "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." This means that the States can offer health insurance, as well as various types of welfare programs, but not the Congress. What the Congress has power to do is enumerated in Article 1 Section 8 of the Constitution. Among the powers delegated to Congress is the power "To regulate commerce ... among the several states... . This Commerce Clause is extremely important and has been used to mandate or allow all kinds of Government policies over the years. It is interpreted very broadly and usually has trumped a strict or narrow reading of the 10th Amendment. Supporters of mandatory Federal health insurance plans for all use the Commerce Clause to prove their case is "constitutional". I fail to see how my health care is a matter involving interstate commerce that needs to be "regulated" by Congress.

My conclusion is that there is no Biblical or Constitutional Mandate whatsoever for Federal Health Insurance for all (or for any) citizens, let alone for single payer or public option insurance coverage.



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Last Updated on Friday, 27 September 2013 10:13