Motivations
by Nathan Brown
About why
It has been an interesting week in politics in Australia, which would take much longer to explain than this paragraph. In short, the former prime minister and outgoing foreign minister—Kevin Rudd—challenged the current prime minister for her leadership of their party and the Australian government. On a party vote of about 100 members, Australia could have seen a change in prime minister—after all, it happened the other way around less than two years ago. But the challenge failed and Rudd has lost his leadership roles in the government.
As the dust settles on this most recent leadership vote in the Australian government and before Rudd disappears into obscurity, it is worth remembering what may have been his most significant yet overlooked achievement as Australia’s foreign minister.
Last year, under Rudd’s leadership, Australia’s Department of Foreign Affairs conducted a major review of Australia’s overseas aid for development and poverty alleviation. In line with the United Nations’ Millennium Development Goals, Australia has become a world leader in moving toward dedicating 0.5 per cent of the country’s Gross National Income to these goals.
But more important was the profound change in the rationale for Australia’s contribution to the least developed countries and poorest peoples of the world. Instead of the previously stated goal of furthering Australia’s national interests through strategically helping the poor, “the fundamental purpose of Australian aid”—the new policy reads—“is to help people in developing countries overcome poverty.”
In many instances, the work done under this new policy may not look radically different from that of the previous policy but the question of motivation is significant—in all that we do, as nations, as churches and as individuals. An apparently identical act or idea is rendered profoundly differently by its why.
The Bible says there are some things we should do because they are the right things to do. As Jesus said, part of living humbly as His disciples is to be “hungry and thirsty for justice” (Matthew 5:6, NLT), to seek goodness in all its forms, including working for more goodness in the world beyond ourselves as agents of God’s kingdom here and now. In theory, it’s so straightforward. In practice, it’s more complicated. And our motivations get so easily muddled and muddied.
That’s why we can applaud initiatives, statements and policies that move our national, corporate, congregational and individual actions beyond self-interest toward doing things that are right and good simply because they are right and good. Whether this new Australian aid and development policy really changes priorities, whether it survives the loss of its political champion, and whether Australia is truly a more generous and altruistic nation on the world stage, remain to be seen but we can be encouraged by this impulse.
We should also take the opportunity to consider our own motivations in the good we try to do in various facets of our lives. We should also ask some of these same questions about initiatives and actions that the church undertakes. We might find ourselves doing some things different and doing other things kind of the same but with radically different motives. That will be good for us, as well as for those—and for Him—we seek to serve.
Nathan…
"….whether Australia is truly a more generous and altruistic nation…" in my opinion is determined more by its individual citizens' and voluntary organizations' philanthropic activities than its governmental budgetary priorities. Is it "altruism" to forcibly take funds (taxes) from a group of people and use a portion of it to help others? Doing so may in some way help those to whom the funds are directed but to call it altruism is a mistake.
Unless the Australian people see this as a legitimate use of taxes. Australians tend to have a different approach to Americans. We actually want the government to do most of what they are doing, which is why we sometimes even indicate we would pay more taxes if they went to our priorities like education, health and social welfare.
Kevin, what percentage of Australians "actually want the government to do most of what they are doing?" Sixty percent? Seventy-percent? Even at these high levels of support (if true), the government is still forcibly taking money from 30% to 40% of its citizens to use for social/justice initiatives. These initiatives may be worth while. Individual contributions to them are altruistic. Governmental contributions cannot be.
As an Australian taxpayer for over 40 years I believe the goal of dedicating 0.5% of our GDP is an excellent way to demonstrate Australia's solidarity with other, less fortunate countries. While we tax payers may not be able to guarentee how the funds are used and there may even be significant waste, the message our goverment representatives are sending is that we are all part of the human family and that those of us who are better off are willing to provide at least a measure of support. Thanks Nathan.
"the message our goverment representatives are sending"
"to help people in developing countries overcome poverty."
So, is the purpose to "send a message" or "to help people . . . overcome poverty?" Those are quite different goals.
Because the Australain government has chosed to increase its level of international aid on the basis of helping, "people in developing countries overcome poverty" rather than, "… the previously stated goal of furthering Australia’s national interests through strategically helping the poor" says a lot about the character of some of our countries leaders. The fact that Kevin Rudd has proven to be among the most popular of our leaders says a lot about the character of the Australian people. The Australian government is not only endeavouring (vainly) to help developing countries overcome poverty but is sending a message to other first world countries to re-evaluate their motives in what and why they are doing regarding their international obligations.
It sounds noble. But that's the problem. It sounds noble while the results are typically very ignoble.
Nathan,
Unfortunately, nations providing aid to the poor in the past century has built a horrible track record of inefficiency and enriching those in power that has only gotten worse under the United Nations. But what concerns me more is that such actions have a more subtle and pernicious result by linking national identity with good works so individuals become disconnected from both the good and bad that results.
Nowhere in scripture do we find a justification or instruction for national charity. God's directions are for the individual to engage in acts of charity on the personal level, one-to-one and heart-to-heart because, when those acts are motivated by a heart energized by His love, then the hearts of those who are touched are turned to God. This illustrates what is the most horrible impact of national charity: it fails to demonstrate God's love on a personal basis and instead turns the attention and hopes of the recipients to the philosophies being promoted by the nation(s) providing the aid. The aims and purposes of the nations today are focused on anything but God and often are directly contrary to God. So, why would Christians want to support such a national policy, no matter how noble it sounds?
National attitudes vary tremendously. In the Scandanavian countries the citizens willingly
pay higher taxes in order to have universal health care and available child care. They consider this part of their contribution to the vitality of their country. This attitude is seen in many other nations, especially in Europe where their child care and parental leave policies, plus universal health care is considered the role of government to ensure the health and well being of its citizens.
The U.S., OTOH, takes its position as world policeman very seriously and thus a large portion of taxes goes to defense and foreign aid to numerous nations. The education, healthcare, and well being of its citizens are considered to be a private concern and that people should take care of themselves without "interference" from the government.
These are the major and essential reasons that the U.S., unlike nearly all first world countries, still believes that private, for-profit health insurance companies can best provide (competitively?) for everyone's needs with only those who are too poor should be subsidized by Medicaid and go to the very expensive ER for all healthcare needs. The current policy forces those unable to pay to seek the most expensive care. Are we crazy or not? When will this nation realize that universal healthcare for everyone is far less costly in administrative costs (look at the huge salaries and bonuses of the major healthcare administrators) than the government run Medicare?
Elaine,
The issue is not as cut-and-dried as you are describing. For example, the US Government spends almost ten times more on Medicare and Medicaid than it does on defense. Yes, many European nations provide universal health care. But to what results? Within five years of graduating from college in France, a majority of engineers, physicians, and other professionals will be working in other countries with no plans to return except to visit relatives. Why? To escape the high (and rising) taxes imposed to pay for things like universal health care and to avoid the growing regulations that prevent innovation. Every european nation is suffering from this same flight to lower taxes and greater freedom, though not as severely as France. The largest source of workers for Audi and BMW in Germany are the former communist countries of eastern Europe. But they're having to pay premium wages because there are so many high-paying jobs in those countries because taxes are lower and regulations less restrictive. One of the reasons Swedish auto maker Saab went out of business was poor quality because they couldn't replace their skilled workers who were retiring. Aircraft maker Airbus is now up to four years behind schedule on the delivery of some models of planes because their suppliers across Europe can't get enough skilled workers to produce the parts.
As for the cost of health care, the Number One factor driving up the cost of health care is government regulation. That cost has been estimated at 73 cents out of every dollar you pay for care, medication and supplies. Without that cost of regulation medical services would be more available, reliable and affordable. The cost to the government for the poor and elderly would be a fraction of what we are paying today and we could wipe-out the national debt in a couple years without raising taxes.
The Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage. This is a near perfect “apples to apples” comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.
In international perspective, the United States spends nearly six times as much per capita on health care administration as the average for Organization for Economic Cooperation and Development (OECD) nations. Nearly all of this discrepancy is due to the sales, marketing, and underwriting activities of our highly fragmented framework of private insurance, with its diverse billing and review practices, and its outcomes are far less than many of the nations.
Check last year's incomes for several major health insurers. Last year, Blue Cross/Anthem announced a 35% increase in health premiums. There was such a outrage expressed that they greatly reduced the planned increase.
Another, is the cost of prescription drugs. Canada negotiates for volume pricing, as does the VA. The Big Pharm lobby has worked with Congress to prohibit government negotiating for pricing, and American ends up paying much more than most other nations, many of which are produced in those same nations. The propietary drug makers do everything possible to prevent generic manufacturing when the patents expire, including "bribing" to hold them off the market and in the case of one of the oldest and most widely prescribed drug Premarin, which has been on the market approximately 50 years, Premarin makes a slight change in the inert ingredients and keeps its original patent safe.
Big Pharma is the biggest, if not biggest lobby in Washington, and they have lined the pockets of congress to prevent anythin encroaching on their very lucrative business.
Elaine,
It is easy to get lost in comparing what happens in one country or another as justification for or against a concept. That is exactly the argument that promoters of big government want you to get lost in so you won't talk as much about how much it actually costs, eliminating inefficient bureaucracies, etc.
The bottom-line question to answer about any regulation is this: does this improve the delivery of health care services? Regulations interfere with patient care and escalate costs. Medicare costs could be cut by more than half if benefits were paid directly to individuals in the form of a subsidy helping those who actually are on limited incomes buy private medical insurance.
I can't speak for the US, but studies in Australia have shown that, in our system, the cheapest option would be to raise the medicare levy from the current 1.5% to around 2% of income, which would allow free universal health care for all essential medical treatment. For someone on the average wage of $65,000 that would be $1300 a year (instead of the current $975), as compared to about $4,000 a year for most private insurance after a 33% subsidy by government (which is available to everyone earning less that $80,000/yr). Private insurance would then cover non-essential care. Very few would argue that cosmetic surgery, etc should be funded by tax payers. The American system is no doubt different, but I still would not assume that private health care subsidused by government would always be the better option. Nor do I doubt that both reduction in the amount of regulation, and a rationalisation of regulations, is needed in both cases.
Headline of a long article in NYTimes yesterday:
America Is Stealing the World’s Doctors.
Thomas,
Quick searches of factbooks don't show what I was describing. I'm an MBA, so my primary sources are economic research reports that go into considerable depth and often paint a far different picture than what you see in the news. The bit about Airbus came from the annual report of their parent company, EADS. "The Economist" did an in-depth review of why Saab went bankrupt. Their sales slid downward over about 15 years as their quality dropped and buyers became increasingly frustrated with having expensive cars in their garages that they could neither get fixed, drive or sell. What you described was just the final nail in their coffin.
Here are a few other things you'll discover when you dig deeper into a number of these other sources.
Albania has more millionaires than France or Italy combined. Companies like Renault, Toyota, Nissan, BMW and Mercedes Benz are building new parts plants in countries like Albania because tax rates and total production costs are so much lower.
The lowest unemployment rates in Europe are in the formerly Communist countries that have embraced Capitalism. That's also where taxes are the lowest and government regulations the least. The "middle class" in those countries is growing while it is shrinking in the rest of Europe and the US.
The largest number of French college graduates and technical professionals live not in France, but England, Venezuela, Canada and the United States. There are growing French populations in India, Malaysia, Thailand and a few other countries where those people pay less in taxes, so their take-home pay is higher than in their homeland.
France and England each lose half or more of their physicians within two years after completing either medical school or a residency program. The largest number of them came to the US and Canada, though that migration has slowed with the decline in the US economy.
By the way, the doctors at that clinic are not exactly philanthropists. They're making more money than their professional counterparts in the same specialties.
William,
That does sound interesting. How about also sharing web links to the sources mentioned above that have such?
"to help people . . . overcome poverty"
Certainly a laudible intention, in developing countries or anywhere else. Having spent the last several years implementing a government policy for just that purpose, and seeing the results first hand, I wonder: Is there any evidence that any government has any idea how to actually do that?
In the U.S., we are specifically forbidden to advocate or suggest most things which would achieve that result. Sometimes we are supposed to do the opposite.
Ed,
Surely, you jest! Bureaucrats not knowing what they're doing? What a preposterous thought! Priority One for a bureaucrat is collecting a paycheck so they've become very good at doing that. As for other results, they're of lesser importance.
Actually, for many bureaucrats, maintaining the 'system' actually outweighs pay considerations. Strange, but true. I suspect that pay may become an increasing consideration the further up the bureaucracy you move, which is why pay scales tend to be very wide in bureaucracies, with those lower down 'sacrificing' for the sake of the few at the top. Not following that system used to be a major strength of the SDA church system. Unfortunately, we let a few too many bureaucrats take positions within the church. If the church members were given a vote on whether we should purge liberals, fundamentalists, or bureaucrats from the church, I know which way I would vote. And I am not confusing administrators (a necessity in any organisation) with bureaucrats. The two form an overlapping but not identical set. Good administrators are a gift from God, bureaucrats are a different thing all together.
How is a "bureaucrat" defined? Anyone working in government–federal, state, county, city? It is true that there are many "free-loaders" who do little, but painting them all with the same brush is an easy way to disparage all those who carry on the functions of government; otherwise, there is anarchy. and what is suggested as a better, more efficient method to handle these duties?
How many "bureaucrats" are unnecessary in the SDA organization? Probably about the same percentage as in other government offices. Wherever there are excessive personnel and overlapping of duties, this is where there should be "downsizing." Many have expressed the frustration of duplication in union and local conferences, but what chance is they will ever be eliminated? Frugality begins at home.
Bureaucrats by nature put the system first. That is what a bureaucracy exists for. The main difference I see between a bureaucracy and the SDA system is that a bureaucracy is set up to achieve a specific objective (e.g. to collect taxes) and the objective determines both short term goals and methods, whereas the SDA church is committed to a belief system and mission that determines both short-term and long term goals, as well as the methods. The government can completely change the basis of taxation (e.g from personal income to a sales and services tax) and the bureaucracy will not change much at all, as its goal remains the same: to collect the tax. In the church, I see 'bureaucrats' as those who focus on raising 'taxes' (tithes and offerings) and the gathering of data that rarely becomes anything other than archives. For a bureaucracy, 'files' and 'policies' are as inportant as – sometimes more important than – the actual objective for which the bureaucracy was set up. A conference secretary who gathers information and uses it to advance the work of the church is a good administrator. A conference secretary who see gathering information, organising it, reporting it, and then filing it as his main work is a bureaucrat and should be voted out at the earliest opportunity. The same goes for a treasurer who sees gathering and spending money as his main priority. It is not so much what they do, but why they do it. Bureaucrats forget about the mission and about individuals, good administrators do not.
"Bureaucrats by nature put the system first. That is what a bureaucracy exists for."
How and why is this not a description of the SDA organization? Do they not put the SDA system first? If not, are they a good employee? The SDA system collects tithes and that determines both short term goals and methods. The church can also change the allocation and distribution of tithe regularly.
Your description describes both government bureaucracies of Adventism as well. When an employee is given the task of compiling data and statistics and then discovers it has all been worthless, what then?
I believe for many SDA administrators the mission of the church still comes before maintaining 'the system'. They may be distracted by circumstances into focusing on the system, but that is not what most would like to be doing.
Elaine,
Government agencies used to be called "bureaus." The people working in them in European government bureaus (German, in particular) came to be called "krauts" using a reference to sauerkraut, a food that Germans consider essential but has a sour taste and everyone loves to complain about. The term stuck because these government functionaries came to be viewed as essential to the government but something they had to put up with and couldn't do anything about.
Bureaucracies develop a self-protective nature to justify their continued existence and avoid change. They develop structures that are bound by rules focused first and foremost on producing a result in a particular way. Cost, effectiveness and service to their constituency or market are secondary. The majority of church leaders I know are dedicated in their service and driven by a sense of mission, they at least preserve the bureaucracy because it is the source of their paycheck. So long as they continue being paid there is no compelling reason for change. The structures under which they operate grew from a set of social, economic and other conditions. It is when those basis conditions change that the inflexibility of the bureaucracy is challenged and constituents begin complaining about how the bureaucracy is preventing the achievement of one objective or another.
What government regulations do you suggest be removed? Granted, there are many reasons for high medical costs. The cost for major procedures in most first world nations is much lower than the U.S. The exception: Cataract surgery in Switzerland is more expensive. Each nation has its own problems but there are thousands of wealthier citizens who are flying to India, Japan or other nations with excellent physicians and it is far less costly than in the U.S. The U.S. is unable to simply copy other nations but there are many ways to improve if we are willing to focus on possibilities rather than naming all the problems which will always be there.
One proved way: Having regional medical offices where Medicaid patients can receive routine medical care rather than relying on the ER as is now done, and is up to 10X more expensive–and is paid by us, the taxpayers.
Elaine,
Many of the physicians in those overseas clinics people are flying to for treatment were trained in the US but find they can make far more money back in their home countries.
What regulations can we get rid of and reduce costs without reducing quality of care? For a starter, if you're not involved in a collision with your car, you can't be sued for damaging someone else's property with it. If you are involved in an accident, in most states the maximum anyone can get in damages is the limit of your liability insurance. Not so with doctors. In most states a doctor can be sued and found responsible for causing damage to a patient where they in no way contributed to the result. A classic case is the teen-aged girl who goes into the ER with stomach pains and the doctor finds that she's actually in labor, so he delivers the baby right there. But the baby has major birth defects that are the results of genetics and poor pre-natal care. The doctor gets sued, not because he caused the problems, but because he treated the patient and the law allows the plaintiff to pursue judgement from the doctor's current and future income if the jury doesn't think they're being sufficiently punished.
Let's look at the costs of delivering services. Right now if I go to my doctor with a sinus infection my insurance gets billed $85 for an office visit, plus any lab work she orders and the cost of prescriptions. I have a $20 co-pay for the office visit, usually have to pay something for the cost of lab work that the insurance doesn't cover along with a variable co-pay for medication, depending on whether it is brand-name, preferred or generic. The total cost can easily exceed $300. My insurance pays the doctor about $61, of which the doctor gets about $10 with the rest going to pay for staff to fill-out the paperwork required by federal regulations to both gather statistics about health care and to insure that I am being treated according to appropriate protocols and standards. The majority of people working in that office are clerical with the only medical people being the doctor and one nurse. Contrast that with the largest family practice clinic in town where they accept no insurance. You pay for services on your way out. They'll give you the paperwork to file for reimbursement from your insurance if you wish. After the receptionist and bookkeeper at the front desk they have nine physicians, three lab techs (and an on-site lab) and seven nurses. Their cash fees are less than half what they would otherwise bill to your insurance or medicare.
Entire books have been filled with examples of how regulations are driving medical costs higher.
" Their cash fees are less than half what they would otherwise bill to your insurance or medicare."
Nothing new there. I regularly get medical statements showing the medical services I have received and the charges. Medicare pays even less than half of their charges. They have agreed to accept Medicare payments and so it makes little difference what charges are shown, they are NEVER paid according to charges. These are very recent statements I have received:
Example: anesthesiology $1425 Medicare approv. $316.18 Medicare paid $107.98
ER visit (specialist) $528 " " 169.05 " " 135.24
This is an accurate sample. A "bird in the hand is worth two in the bush." Billing has no correlation with receipts.
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A recent news item is a perfect illustration of the irony in fighting against government mandated health insurance:
Mary Brown, a 56-year-old Florida woman who owned a small auto repair shop but had no health insurance, became the lead plaintiff challenging President Obama's healthcare law. But court records reveal that Brown and her husband filed for bankruptcy last fall with $4,500 in unpaid medical bills. Those bills could change Brown from a symbol of proud independence into an example of exactly the problem the healthcare law was intended to address.…
“This is so ironic,” Jane Perkins, a health law expert in North Carolina, said of Brown’s situation. “It just shows that all Americans inevitably have a need for healthcare. Somebody has paid for her healthcare costs. And she is now among the 62% whose personal bankruptcy was attributable in part to medical bills.”
And it's all of us taxpayers who end up paying for her medical costs that she ELECTED not to have! There will always be health care, whether it's paid for by insurance patients, or we taxpayers. It is NEVER FREE! In most states, you drive a car, you must have insurance. But if you have a body, you don't have to insure against disease or accidents, just go to the ER and the taxpayers will pay for it.
healthcare law because she was passionate about the issue.
Brown “doesn’t have insurance. She doesn’t want to pay for it. And she doesn’t want the government to tell her she has to have it,” said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation’s case, which the Supreme Court plans to hear later this month.