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April 13, 2012 11:21 AM Subsidiarity and Medicaid

By Ed Kilgore

As part of the counter-attack which Paul Ryan and his allies are conducting against his critics, we are being informed that far from being a Galtian figure championing the virtue of selfishness against the vice of altruism, he is in fact a devoted Christian thinker concerned about how best to help the wretched of the earth.

Ryan himself, in an interview with CBN’s David Brody, made that clear:

A person’s faith is central to how they conduct themselves in public and in private. So to me, using my Catholic faith, we call it the social magisterium, which is how do you apply the doctrine of your teaching into your everyday life as a lay person?
To me, the principle of subsidiarity, which is really federalism, meaning government closest to the people governs best, having a civil society of the principal of solidarity where we, through our civic organizations, through our churches, through our charities, through all of our different groups where we interact with people as a community, that’s how we advance the common good. By not having big government crowd out civic society, but by having enough space in our communities so that we can interact with each other, and take care of people who are down and out in our communities.
Those principles are very very important, and the preferential option for the poor, which is one of the primary tenants of Catholic social teaching, means don’t keep people poor, don’t make people dependent on government so that they stay stuck at their station in life. Help people get out of poverty out onto life of independence.

This heavy thinking really impressed Wall Street Journal columnist Daniel Henninger, which took it as a sort of self-evident refutation of the idea that Ryan might be motivated by something other than tender soliticitude for the poor:

Subsidiarity—an awful but important word—attempts to discover where the limits lie in the demands a state can make on its people. Identifying that limit was at the center of the Supreme Court’s mandate arguments.
The first major use of subsidiarity as a basis for public policy was in Pope Leo XIII’s famous 1891 encyclical “Rerum Novarum” (though the word itself doesn’t appear). Leo was seeking a way to protect the dignity of human beings caught during those years in the tension between unfettered capitalism and unfettered government. “The State,” he wrote, “must not absorb the individual or the family.” Arguments over where the balance sits have raged since.
The American left thinks this debate is settled. So, for example, any hint of Supreme Court dissent from settled doctrine justifies questions about its “legitimacy.”

Oh, really, it’s “the left” that has inflexible views about centralized versus decentralized methods of governing? Let’s take something really concrete, like the Medicaid program, the primary means whereby poor people (and in particular poor seniors) in this country obtain health services. It’s a joint federal-state program administered by the states, with roughly equal financial responsibility. States still make most of the calls about eligibility for the program and the scope of services, though over the years the federal government has used “super-matches” (very generous terms of assistance) to convince states to provide more (and more uniform) coverage.

Seems pretty “balanced” between federal and state responsibilities to me, particularly as compared with, say, the Medicare program, which is entirely federal (aside from a limited state role in provider reimbursement).

Paul Ryan wants to turn Medicaid into a “block grant” while reducing its funding level by about one-third over ten years. The details of his proposal are murky, but from past conservative moves in this direction, it’s likely he’s talking about giving states a fixed, capped sum in federal funds while eliminating most conditions for its use, as a way station to total state assumption of responsibility for low-income health care needs at some point in the future. So being poor in, say, Mississippi, with a large low-income population along with a generally low standard of living and a very conservative political culture, will become—even more so than it is today—a very different proposition from being poor in New York or California.

Does Paul Ryan really think government is “crowding out” civil society, its private charities and hospitals, in addressing the health care needs of the people of Mississippi? Is federal assistance thwarting the natural generosity of the wealthy and powerful of that state, who if left to their own resources, would take care of the problem on their own? Of course he doesn’t. But he probably does truly think block-granting Medicaid would help reduce “dependence on government” by the poor, which is another way of saying they need to learn to take care of themselves, find assistance on their own, or die.

You can certainly make that helping-the-poor-by-abandoning-them argument; people have been making it for centuries. But he shouldn’t try to hide that atavistic attitude behind the skirts of Mother Church, or pretend he is engaged in a conscientious application of Catholic social teaching.

Used the way Ryan and Denninger are misusing it, “subsidiarity” simply means abandonding public responsibilities where possible and dumping them on lower levels of goverment where necessary, with total abandonment the ultimate goal.

And sorry, Denninger is off 180 degrees in his assessment of the debate over centralization and decentralization of governing responsibilities. It’s not “the left” that’s trying to relentlessly increase centralized government power, but the Right that is determined to centralize power in the weathiest regions of the private sector. Disabling public-sector programs that have been in existence for decades based on decades of Supreme Court precedents is part and parcel of that agenda. “Subsidiarity” has absolutely nothing to do with it.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

Comments

  • Equal Opportunity Cynic on April 13, 2012 11:53 AM:

    The sad thing is, i actually think some of Ryan's points about locally-governed provision for the poor are good ones. As a Christian myself, i love to see the church (in its various forms, ecumenically) take on this burden for those less fortunate. I just don't trust the messenger one iota here.

  • boatboy_srq on April 13, 2012 11:53 AM:

    To me, the principle of subsidiarity, which is really federalism, meaning government closest to the people governs best, having a civil society of the principal of solidarity where we, through our civic organizations, through our churches, through our charities, through all of our different groups where we interact with people as a community, thatís how we advance the common good.

    This is the key. You'll notice that in Ryan's list of institutions, no governmental body appears even once. But "churches" and "charities" are separate, and "all of our different groups" merit a special aggregate mention. Presumably he thinks the local parish (or a group like the Elks) at least as influential and important as City Hall.

    It's startling to hear a Catholic put the parish ahead of the Vatican - especially when we hear Catholics defend the church as a hierarchical institution not beholden to demands from the membership of the parishes or dioceses.

    If there is a better illustration of the theocratic bent of the modern GOP I have yet to see it.

  • kevo on April 13, 2012 11:54 AM:

    Cloaking cruel policies under the guise of peity is not only disturbing, it is wholly unholy! Why does Paul Ryan insist we must comply with his budgetary values when he is utterly confused as to just what a judicious budgetary value would look like? He approves of corporate welfare, but would deny subsistence help for hungry poor people.

    I don't know any practicing Catholics who embrace his form of "charity!" -Kevo

  • Some Guy on April 13, 2012 11:54 AM:

    It's not the state level. Ryan and the republican tribalists are thinking of much much more local government, where their scope of charity and responsibility extends to the walls of their affluent gated communities, and no further.

  • Eeyore on April 13, 2012 12:07 PM:

    This makes sense if you view the idea through the lens of "incentives."

    Take away all the money given to the poor at it gives them an incentive to become rich.

    Give all the money taken from the poor to the rich and it gives them an incentive to create jobs which help the poor.

    Of course, my disabled brother who relies on social security and medicaid might have a hard time replacing this financial support by getting a job as a yacht salesman handling the increased demand from the 1%, but that's his fault - he's just lazy.

  • Josef K on April 13, 2012 12:08 PM:

    This isn't going to end well, for any of us.

  • Peej01 on April 13, 2012 12:11 PM:

    Is it surprising that someone who is supposedly a religious writer doesn't know that the word is "tenets" not "tenants"?

  • Gandalf on April 13, 2012 12:13 PM:

    So what's stopping all these wonderfull institutions and individuals from performing all these wonderfull services now?
    Is Ryan so utterly devoid of any knowledge of history as to believe what he's saying would lead to a situation that's any better then say 17th century great Britaon or France.
    It's all about money for these contemptable slime. trying to cover your ass with some religous gobledygook is below contempt it's evil.

  • nerd on April 13, 2012 12:19 PM:

    Nice circular logic in Ryan's point.

    The existing services exist because the smaller communities were unable or unwilling to provide for those in need. So he is saying dismantle them and those 'closer to the need' will be pick up the slack. Part of the original problem was the lack of resources. The federal government, because of its size, can have the resources necessary. So what has changed that would allow for more locally based services? Nothing.

  • paul on April 13, 2012 12:20 PM:

    Ryan gives slime a bad name. Medicaid is precisely a program that helps people get out of poverty and become independent. If you're sick or disabled(or your families members are, for a poor person who can't hire help) you can't work. If you've grown up with a long list of untreated diseases, you're not going to be able to work as well, and you'll be stuck in poverty.

    Conservatives going back to %$#%#$ Otto von Bismarck and Winston Churchill understood this perfectly well (something like a third of british draftees in WWI were excused from conscription because they were too scrawny and sickly to fight). But Ryan and his ilk pretend not to understand such basic facts. If he is right in his claim that there is a just deity, I pity him.

  • jim filyaw on April 13, 2012 12:23 PM:

    paul ryan is not very bright. daniel henniger is not very honest.

  • Ron Byers on April 13, 2012 12:23 PM:

    I don't know if our Republican brothers have thought the whole block grant thing through. Right now money flows out of the blue states on the coasts to the red states in the midwest and south. This means there is money coming in from Democratic doctors and businessmen to pay Republican doctors and Republican businessmen to pay for the care of the poor in the poorer states. With the block grant plan reducing Federal tax money over time where will the money come from to pay the Republican businessmen and doctors in the red states?

    By the way, if you think the Catholic chruch is up to the task of providing for the poor, just look at their utter failure to take care of the poor in Latin America, Iberia and Italy. The Spanish and Italians depend on the Protestants in Northern Europe to help them take care of their poor. They are utter failures in Latin America where rich cities are surrounded by squalid slums.

  • martin on April 13, 2012 12:24 PM:

    You can't be a Randian Objectivist and a Catholic (or generic christian) at the same time, they are mutually exclusive. As long has Ryan claims both, he just a BS artist who attempts at moral philosophy are just fraud and should be treated as such.

    handhs thou sayeth Captcha

  • Area Man on April 13, 2012 12:51 PM:

    The notion that the poor are better served by axing public assistance programs and relying on private charities has never made the least bit of sense. If you actually care about the poor, then it's immaterial whether their aid comes from public or private sources. You simply want whatever is best for them, which ideally means more funding from all sources. If what you care about instead is, say, the evil nature of taxation, then that's fine. Just say so and quit pretending that you're making these arguments for the poor.

  • SadOldVet on April 13, 2012 12:52 PM:

    The one thing that differentiates 'man' from the 'lower species of life' is the ability to rationalize.

    Now it seems as if the lower species are learning that ability as well.

  • TCinLA on April 13, 2012 12:57 PM:

    Ah yes, the Catholic Church: 2,000 years of never leaving any emperor, king, duke, count, lord, knight, capitalist, war criminal or Nazi uncosseted, so long as they provided alms for the "good fathers" to feather their nests with. John XXIII was an aberration. Ryan would fit in perfectly with the church as seen any Sunday night for the next 12 weeks on "The Borgias."

  • tcinaz on April 13, 2012 1:03 PM:

    I was raised Roman Catholic, indeed attended 8 years of of Catholic education. Paul Ryan is the kind of Catholic who led me to renounce that religion. Once, Catholics abhorred war, except if it was fought on poverty; they supported a real separation of Church and state; they battled for Civil Rights, not just for Blacks, but women and other minorities; and they belived in a concept of social justice founded on acting out Christian values and morality despite what any law might permit. But at the same time, while a sex scandle was brewing beneath the surface, leaders of the Church allied themselves with conservative political ideology in the battle over abortion, which bled into restriction of other rights for women, most notably related to clerical roles women might play in the Church. As the sex scandle unfolded and the Church attempted to limit the damage, its relationship to conservative ideolgy hardened, and just as Republicans have driven moderates out of the party, so too were they driven from Catholic orthodxy. Today, the Church of Paul Ryan endorses an ideology that starts immoral wars while mouthing empty opposition; it actively opposes Civil Rights for millions of people on the basis of race, gender, and sexual orientation; it accepts in principle the notion that this wealthiest of states has no moral obligation to the poor or the sick; it places political power above moral obligation at official levels. Paul Ryan cannot hide his hyprocrisy behind religious banter, his actions and his associations speak too loudly.

  • LL on April 13, 2012 1:33 PM:

    Look, Paul Ryan is a dishonest, contemptible hack who was not only born on third and thinks he hit a triple, but, additionally, like most GOP politicians and more than a few Dems, he would sell his daughter into slavery and his mother for hamburger if it meant he could keep his office, and maybe get a more powerful office.

    Anyone who gives Ryan the least credibility is wasting their time. He doesn't give a shit about anyone or anything but himself and his rich friends, and his pathetic, perpetually adolescent crush on Ayn Rand. He's a selfish, amoral, repellent monster who, in a decent society, would be laughed back under the rock he crawled out from.

  • cwolf on April 13, 2012 3:30 PM:

    "... By not having big government crowd out civic society, ..."

    What part of Ryan fails to understand that Government IS Civic Society.
    Check your premises Paulie.
    His favs: civic organizations, churches and our charities - are just little clubs and in no way able to deal with a country that has ~350,000,000 population and a system clinically poisoned by money.

    Ryan is just another Limited Liability Person who likes to piss and throw shit from a great height.

  • Tom on April 13, 2012 3:57 PM:

    On Ryan's theological smoke:

    The key to exposing the convenience of Ryan's plea for "subsidiarity" is his "To me..." Ryan can say whatever he wants about how he equates it with federalism, but here's what the Encyclopedia of Catholicism (edited by Richard P. McBrien of the University of Notre Dame) says:

    "Properly understood, subsidiarity cuts in two directions. First of all, it carries a presumption against a direct involvement by large-scale institutions. The role of large-scale institutions is to support, not replace, the smaller ones.... Second, subsidiarity affirms that the role of larger institutions in the form of support is positive and necessary."

    In other words, you have to argue your case about what the balance needs to be for any concrete matter. Subsidiarity doesn't come down from on high to say Obama's Health Care bill is a priori wrong. In fact, you could argue (I do) that it is precisely a case of using the large-scale institution to support the good outcome of individual health insurance.

    I'm a Catholic. It has never been the case prior to recent years that the Church was an instrument of laissez faire economics. Here's F.C. Coppleston on Aquinas:

    "To represent Aquinas as participating in the political and economic controversies of the nineteenth century would be an anachronism. But we can say that thge policy of laisser-faire would not be compatible with his view of the purpose and function of political society and government. The task of the state is actively to produce the conditions under which a full human life can be lived."

    Health care anybody?

  • Quink on April 13, 2012 6:54 PM:

    Ryan is a contradiction. Politically, he despises government and hates taxes. Yet in terms of his professed religious beliefs, he belongs to a church that rules absolutely from the top-down and expects substantial financial donations of its members. I would bet that Ryan, in his heart, despises the teachings of the Catholic Church as much as he despises the shackles of the Constitution