Thursday, July 30, 2009

Here is a great reason why medical costs are so high.

If it's a medical emergency, Erie County 911 will respond, but there is one address many of its dispatchers know by heart.

They find Scott Graham usually waiting at that Buffalo address for his ambulance several times a week.

"Sometimes two times a day," Graham told 2 On Your Side. He suffers from Sickle Cell Anemia, a blood disorder. If left untreated, it can block blood flow to limbs and organs.

"It feels like somebody shooting me with battery acid, and I'm stepping on razor blades, and I'm having a heart attack at once," he said talking about the pain the disorder causes.

Graham doesn't have a job, insurance or car. So, when he feels bad, he doesn't call a cab. He calls 911 to have an ambulance drive him to the hospital.

A 2 On Your Side investigation found that from January 2006 to May of this year, Rural Metro Ambulance picked him up 603 times.

Medicaid picked up the tab for each ride, costing taxpayers at least $118,158.

Graham estimates he's requested even more rides. "I'd say about a thousand times."

Rural Metro and Erie County chose not to respond on camera about Graham's case. The county follows the same rules most emergency systems follow across the country. If you call, they must haul you to the hospital, no matter what your call is about.

Graham says he requests an ambulance because he can't see his doctor as much as he needs. He also says he gets help quicker by arriving in an ambulance rather than by cab.

2 On Your Side contacted Medicaid to have them look into the number of times Graham used an ambulance. Medicaid appeared more interested in how we got the information, rather than how much it cost taxpayers to pick him up.

Medicaid fraud and abuse costs $60 billion each year nationwide.

2 On Your Side contacted our lawmakers to discuss how to lower that number.

"As we look at health care reform," Senator Kirsten Gillibrand (D-NY) said, "we should also look at oversight and accountability for those programs to make sure that people aren't abusing the system."

Gillibrand says cracking down on abuse should be part of the major health care reform going through Congress to force more oversight.

Take Mr. Graham's case. His trips cost Medicaid $118,000, but the government reimbursements are low. In fact, most ambulance companies lose money, up to 30% or more, when they transport Medicaid patients, because the government simply does not pay the full cost. Therefore, Mr. Graham's actual cost to the ambulance company and to the health care system in general, is much more, as high as $360,000.

Erie County Executive Chris Collins, a Republican, says government is not the answer to limiting that type of alleged abuse and waste.

"Fundamentally, inherently I think the private sector is better able to do anything and everything compared to government," Collins said.

Instead, Collins said the solution is insurance that is private and not public.

"Would the type of reform that you're suggesting here be able to crack down more on this type of fraud?" asked 2 On Your Side's Michael Wooten.

"I'm actually talking about the basic design of the program in New York," Collins said. "where fraud is something we have to look at everyday. But the actual larger cost is the actual design of the program and the fact that we took the entire menu and said we'll provide it all."

Gillibrand disagrees.

"Bottom line then, expanded government-run health care can be efficient you believe?" 2 On Your Side's Michael Wooten asked Gillibrand. "Absolutely," she responded. "Talk to your mother. Talk to your father. Talk to someone who has Medicare. They're pretty happy."

Currently, New York has a dubious distinction of having the highest Medicaid costs in the entire country, about $2,300 per person. Collins said if we had a system similar the one in California, which does not provide as much care, we would save enough money to completely eliminate the county property tax.

Wednesday, July 29, 2009

State Health Reform: The Significance of Utah Health Insurance Reforms

Here is an inovative interesting health reform system being implimented in Utah that works to help with the problems. This one is not set up to take control of every part of our lives like the federal programs.

by Edmund F. Haislmaier
WebMemo #2569
Utah is currently implementing consumer-centered health insurance reforms enacted in March of this year.[1] The reforms are designed to increase choice, portability, and availability of private health insurance coverage. They are the product of a continuing, multi-year health reform process in that state.

This first set of Utah health reforms includes three key elements:

Insurance market reforms to create a new "defined contribution" coverage option for businesses and their workers;
A board to design and manage a companion risk adjustment mechanism; and
A "virtual" health insurance exchange to coordinate the various administrative functions of a consumer-choice market.
Creating a "Defined Contribution" Option

The centerpiece of Utah's reforms is a new option for employment-based health insurance that will enable employers to offer health benefits to their workers on a "defined contribution" basis.

An employer electing this option will no longer need to manage a traditional "one-size-fits-all" group plan for its workers. Rather, each worker, during the annual open season, will be able to pick from a menu of health insurance plans, all of which will conform to federal standards (such as guaranteed issue to employees and limits on pre-existing condition exclusions) so as to qualify for favorable federal tax treatment as employer-sponsored health benefits.

Utah will make this defined contribution option available to small businesses (those with two to 50 employees) effective January 1, 2010. The legislation also specifies that starting in January of 2012, businesses of any size will be allowed to elect this option.

Employers will still have the option of offering health benefits on a traditional group policy basis--either purchased from a commercial insurer or self-insured by the employer. However, the new defined contribution option will be less costly and less burdensome for employers to offer, and will give workers more choice and control over their coverage.

Employers who elect the defined contribution option must agree to establish a qualified "cafeteria plan" or "health reimbursement arrangement" in accordance with federal tax law, allowing their workers to pay any employee share of the premiums on a pre-tax basis regardless of what the employer contributes or which plan the employee picks.

Starting with Risk Adjustment

A second important element of the reforms is the creation of a "Utah Defined Contribution Risk Adjuster" with a board consisting of representatives of health insurers and private employers as well as the state's insurance department, the public employee health plan, and the Governor's Office of Consumer Health Services.

This board was created to determine the insurance rating (pricing) rules for the defined contribution market and to design a mechanism for adjusting (or pooling) risk across all insurers in the market. The objective is to enable consumers to easily compare the benefits and prices for various competing plans on the "front end" while on the "back end" adjusting payments to insurers so that the costs of expensive cases is spread among all insurers and all plans have incentives to compete in offering the best value to both healthier and sicker enrollees.[2]

The board is now finalizing its initial design for both elements. In general, the agreed design will work as follows:

Plan offerings will be partially risk-adjusted through pricing based on family status and age. There will be four family status categories: single adult, one adult plus one child, couple with no children, and family--which could be either a single adult with more than one dependent or a couple with one or more dependents. Age rating will be in five-year bands for adults between 20 and 64, with insurers permitted to vary premiums by no more than 4 to 1 between the lowest and highest priced age bands. The age of the employee will determine the applicable age band.

Thus, by simply entering his or her age and choosing one of the four family status categories, an employee will be able to compare competing plan benefits and applicable premiums. There will be no geographic adjustment to premiums as regional differences in health care costs were determined to not be a significant factor in Utah.

A common underwriting questionnaire will be completed by all employees signing up for coverage as part of a participating employer group in order to construct an insurance profile for the group. This is the same process as is currently used in rating traditional group coverage, and Utah law allows insurers to vary premiums by up to +/- 30 percent on a group basis. Thus, when an employee logs on and enters his or her employer's ID number, the software will automatically adjust the entire schedule of age and family premiums for the competing plans to reflect the rating factor assigned to the worker's employer group.
After the employees all pick their coverage, the employer will transmit a monthly total amount for all of the chosen coverage. A portion of that total will be what the employer contributes directly to coverage--determined according to the rules established by each employer for its plan--with the balance coming from pre-tax payroll withholding by the employees. The system has been designed to also accept payments from other sources, such as government subsidies for lower-income individuals.
The amounts transmitted to the insurers will be adjusted further based on which individuals chose which plan. For example, if two individuals have the same employer, are the same age, elect the same coverage status, and choose the same plan, then both will pay the same premium. However, if one is diabetic and the other is not, the insurer will receive a somewhat larger payment for the diabetic employee. Where this will really help is if the two employees opt for different plans. In that case, the differences in the premiums they pay will only reflect the differences in the design of the competing benefit packages--not differences between the employees in health status. Yet the plan chosen by the diabetic will get a somewhat larger slice of the total paid collectively by the employer and all of its workers for coverage.
Finally, an end-of-year adjustment among all participating insurers will compensate for any insurer ending up with a share of high-costs enrollees or claims significantly greater than the normal variation. Those adjustments will be done by the participating insurers--who will debit and credit each other in accordance with the rules they collectively established through the board--and will have no effect on the premiums paid by either the enrollees or their employers.
Everyone involved recognizes that this initial risk adjustment design will likely need further refinement and revisions as the insurers gain experience from operating in the new consumer-choice market. For example, the board will likely need to eventually phase-out the employer-group rating factor. That way, when a worker changes jobs but keeps the same coverage, his or her premium will not increase or decrease simply because the new employer has a different group-rating factor than the old employer.

Health Insurance Exchange

The law also established the Office of Consumer Health Services (within the Governor's Office of Economic Development) and gave it the job of designing and administering an Internet-based health insurance "portal" to function as Utah's health insurance exchange.[3] Any insurer will be able to offer coverage through the exchange if it is licensed in Utah and the plan it offers meets state and federal standards.

The exchange will be an online administrative system for employers to offer the new defined contribution coverage option to their employees; for workers and insurance brokers to use in comparing and choosing coverage; for employers, insurers, individuals, and intermediaries such as banks to use to collect and transmit premium payments from multiple sources; and for the state government to use to administer any premium assistance payments for private coverage on behalf of low-income individuals.

Utah's particular innovation is that rather than creating a single entity to perform all of the different administrative functions, the state is using a contracting process to simply network the different pieces and vendors, both existing and new, into a "virtual" health insurance exchange.

Current plans are for the exchange to begin signing up employers who want to participate the week of August 17, with the rest of the system in place for employees to choose coverage during the first open season in November, and for the coverage to take effect January 1, 2010.

The legislation also contains a number of other provisions that augment the key reform elements, including:

Consumer transparency requirements for insurance agent compensation and insurance plan benefits and practices;
Authorization of new "mandate-lite" health insurance policies; and
Authorization of a new lower-cost "conversion" policy for individuals eligible under federal or state law to elect conversion coverage following employment termination.
Benefits of Utah's Approach

Utah is looking to derive a number of benefits from this insurance reform approach.

More Employers Offering Health Coverage. Nationally, only 43 percent of employers with 50 or fewer workers currently offer employer-sponsored health insurance, and Utah's rate (32 percent) is even lower.[4] A major reason is that traditional one-size-fits-all group coverage puts most of the risk on the employer. In essence, the decision by a small business to start offering health insurance to its employees is a decision to jump onto the health cost escalator. Before deciding to offer group coverage, the employer has to be confident that it can handle future cost increases and also be willing to endure the annual hassle of finding or negotiating coverage that 75-80 percent of its employees will take, and then dealing with their complaints.

Utah's "defined contribution" option will allow employers to offer their workers quality health benefits while avoiding most of the associated risks and hassles. Under a defined contribution arrangement each employee gets to decide which plan best suits his or her needs and situation. Furthermore, employees can reevaluate their decisions each year at open season. When faced with a premium increase for the plan he or she picked last year, it is the worker who will decide whether the benefits are worth the extra cost or if another plan offers a better cost-benefit proposition.

A new insurance option that takes most of the risk off of the employer, combined with shared administrative functions through an exchange that also relieves the employer of most of the hassle factor, could eventually result in almost every employer in the state offering at least that coverage option to its workers.

A New Risk Management Tool for Workers. While it is true that defined contribution shifts risk to the employee, it also gives the employee a new tool to manage that risk: annual choice of coverage from a menu of plans with different benefit designs and premiums offered by different insurers. From the employees' perspective, that is a far better option than the current situation in which their employer picks a plan that is probably not their first choice and, as the premiums go up year after year, shifts more of the cost onto them by requiring them to pay higher co-pays or larger shares of the premium.

Better Value. As seen from the experience of the Federal Employee's Health Benefit Program--the country's largest and longest operating defined contribution health insurance system--a consumer choice market puts simultaneous downward pressure on prices and upward pressure on benefits/quality, the only effective way to attain better value in a health system.[5]

Protecting and Assisting Consumers. Under Utah's defined contribution approach, all the insurance sold through the exchange will be state regulated and meet federal standards for employer-sponsored coverage. Participating employers and their workers can be certain that all the policies offered will be quality coverage from responsible insurers. In addition, insurance agents will be compensated not just for helping the employer offer coverage to its workers but also for helping the workers compare plans and select the ones that best meet their individual needs. Thus, employers can be confident that their workers will have access to licensed and trained professionals for help with picking their coverage.

Increased Portability. Over time, as more employers opt to offer health benefits on a defined contribution basis, more and more workers will be able to take their coverage with them from job to job.

Reducing the Number of Uninsured. Utah lawmakers view the creation of a defined contribution option for employer-based coverage as a first step in covering more of the uninsured. Making it both easier for employers to offer coverage and easier for workers to find and keep the coverage they prefer should result in fewer individuals experiencing gaps in coverage and thus being uninsured.

An Innovative Approach

Other states are pursuing their own variations of consumer-centered health reform. What Utah will soon offer is a working model of how states can design and implement a consumer-centered health insurance market that leverages existing resources with minimal regulation or disruption to existing arrangements.

Of particular interest to other states should be Utah's technological solutions for creating a "virtual" health insurance exchange and the lessons and insight that will come from its experience in designing a robust risk adjustment mechanism to support a consumer-choice market.

Utah's approach is, in effect, a marriage of advanced health care reform with advanced information technology.

Edmund F. Haislmaier is Senior Research Fellow in the Center for Health Policy Studies at The Heritage Foundation.


[1]State of Utah, "H.B. 188 Health System Reform--Insurance Market," 2009 General Session, at (July 29, 2009).

[2]For a further discussion of risk adjustment in health insurance, see Edmund, F. Haislmaier, "State Health Care Reform: A Brief Guide to Risk Adjustment in Consumer-Driven Health Insurance Markets," Heritage Foundation BackgrounderNo. 2166, August 1, 2008, at

[3]Additional information can be found at the Utah Office of Consumer Health Services Website at
-services/ (July 29, 2009).

[4]Kaiser Family Foundation, "Percent of Private Sector Establishments That Offer Health Insurance to Employees, by Firm Size, 2006," at (July 29, 2009).

[5]For a more detailed discussion of FEHBP's performance, see Walton Francis, "The FEHBP as a Model for Medicare Reform: Separating Fact from Fiction," Heritage Foundation Backgrounder No. 1674, August 7, 2003, at

Tuesday, July 28, 2009

As Racists Go, We are Rank Amateurs

By C. Edmund Wright
Mr. President, history and reality teach us that as racists go, we are, frankly, rank amateurs. And I am sick and tired of Ivy League elites like you and Professor Gates pretending otherwise.

What? You think I'm crazy?

Look at it this way. If we were worth a damn as racist whites, would we fall all over ourselves everyday to voluntarily watch, cheer for, emulate, take advice from and enrich folks named Tiger and Oprah?

Those are, after all, the two people that white racist America has anointed as the top cultural icons in our society. Ever heard about "the Oprah effect" or the ad campaign "I am Tiger Woods?" Let me translate for you: white Americans absolutely love these two black folks above any other athlete, actor, singer or even American Idol contestant on the planet -- and big business in search of evil profits -- knows it.

And by love, I mean whitey will pay to go see, pay to watch, pay to read and pay to do pretty much anything these two non-white folks do, eat, watch, read or wear. To be blunt about it, this is a bigger white to black money transfer than any of your big government schemes. This is spreading the wealth around that the Joe the Plumbers of the world can love.

This is hope and change that we can believe in -- because it is real and does not require a doggone thing from you, Jeremiah Wright or the nutty Professor Gates. (By the way, I lump Wright and Gates together because much of Gate's African American studies is simply a secular version of Wright's "black separatism.")

To reiterate Mr. President - the white love of Tiger and Oprah indicates that as racists go, we are rank amateurs.

And for the record, this is not new. Sometime before your first memoir, back when black cultural icons needed two names, whites felt the same way and poured millions and millions of dollars into the hands of Michael Jordan and Bill Cosby. Ever hear of "I want to be like Mike?" It was an ad campaign aimed at white kids. You must have heard -- being the athletic politician from Chicago and all. Or were you still suffering in Hawaii at the time?

The point is, not only are we rank amateurs as racists now, we have been that way for a few decades. The Cosby's were welcomed into more white living rooms than Sidney Poitier ever dreamt. We even now have a black guy starring as the "Wild Wild West." And I think he's pretty good at it. That is progress, though you won't hear about it in Al Sharpton's fund raising letters.

Sure, there are racists among us. I say some are among your staff, those in the pulpit at Trinity United Church and the Harvard faculty for instance. That's not the point. As a nation, we are decidedly NOT racist when compared to other nations. And if you're talking about a nation, that's the sole intellectually honest measure.

Consider: Would a Kurd ever reach icon status in Saddam Hussein's Iraq? Has there ever been a Mayan who captured the hearts and minds of Mexico? Would Ukrainians ever buy millions of books simply because a Chechen said to do so?

Heck no -- and these are folks who look much more alike than black Americans and white Americans. We can't even tell these folks apart "without a program" so to speak. Note the term is "balkanization" and not "Americanization."

And speaking of folks who kind of look alike but cannot stand each other, have you noticed that even the "friends" of the Palestinians do not want them living anywhere near them? So-called "supporters" of the Palestinians want to live with them about as much as Fred Sanford wanted to live next to Julio the Puerto Rican -- for the same "there goes the neighborhood" reasoning.

Of course Sanford wasn't racist -- because blacks can't be.

Meanwhile, tribal wars still rage across Rwanda, Sudan, Uganda, The Congo, Darfur and much of Africa where pre-teen boys are conscripted as soldiers and pre-teen girls are taken as their "child mothers." Tribal wars is just a nice way of saying race wars between races that look essentially the same.

Nothing like this has ever happened in our country and certainly is not happening today. Yet, Gates is all worried about racist cops and being burdened with being a "black man in America."

He should spend an afternoon as the white guy paired with Tiger, the Cablinasian-American.

The point is -- the United States -- all 57 of them -- have done more to correct our own racial wrongs than any nation in world history. We are way ahead of many nations much older than our little experiment in freedom and self-governance. Painful steps like the Civil War and the Republican led Civil Rights Act were forced corrections that simply moved the country more in line with our Constitutional principles of "life, liberty and the pursuit of happiness."

And the result is a country where whites and blacks are free to choose their own heroes and heroines. It works. Currently the best way for a white author to sell books to a white audience is to get added to a black woman's book club.

And nothing government did -- nothing that Jeremiah Wright preached -- or Professor Gates taught -- is relevant here at all. Or if it is relevant, it is only so as a negative force.

These are whites and blacks pursuing their own life, liberty and happiness through mutual associations. And while I think the country is making a really good choice in Tiger and a bad one with Oprah, the fact is I celebrate the fact that this is freedom in action. Free enterprise. Free markets. Free association. Even a little evil profit motive thrown in.

So how can you and Mr. Gates and Pastor Wright be so wrong about our country?

How is it that you are so stunned by the reaction to your stupid cop comment?


Perhaps in your Ivy League-Beltway- Media elite universe you are so surrounded by racists of all colors you are blind to the fact that the rest of us are working it out pretty well without your help. (Ok, we'll call them "race focused.")

After all, we know the Democratic Party was glad to finally have a "clean articulate black guy" like you on the ticket. We heard it from a brilliant government employee of some 40 years. I think he picked it up in that diner that had been closed for 29 years.

We've seen scared Republicans like Lindsay Graham pretend your Supreme Court Nominee -- that wise Latina woman -- is not "race-focused." We've seen erudite and enlightened luminaries like Colin Powell, Christopher Buckley and Peggy Noonan fall under your spell as well - preferring you to a white hick governor from Alaska.

Come to think of it, maybe there IS a racist America after all. I think it can be found among the media elites, the civil rights activists, the magnificent centrist pundits, Ivy League faculties, scared CEO's, liberals in congress and moderate Republicans in the areas of Washington and New York.

Allow me to apologize for our country.

The universal health care dogs that aren't barking

Thomas Lifson
Oddly enough, as the nation considers ObamaCare, the press is completely uninterested in the experience of Massachusetts and Hawaii, both of which have ambitious, and failed, experiments in trying to provide universal health care. Mitt Romney, the architect of the Bay State's health care plan, which is costing far more than expected, is largely absent from the airwaves, despite his legitimate claim to be an expert. The Boston Globe calls the plan a "failure" and notes "The state's plan flunks on all counts."

Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

As for Hawaii, the President's home state, Steve Gilbert of Sweetness & Light highlights the great hopes for Hawaii as a "model" (according to the New York Times) for the nation. He cites several articles over the years, which make illuminating background for considering ObamaCare. As usual, he highlights the relevant texts. View all of them here.

In Hawaii, as in Mass, once again, universal care has not been achieved, but costs have ballooned. Steve cites (and highlights) the following from the Honolulu Advertiser less than a month ago:

A law enacted in Hawai'i in 1974 that requires employers to provide health insurance for employees working at least 20 hours a week is being cited by researchers who are skeptical of similar mandates being suggested in the argument for universal health care.

The result of Hawai'i's Prepaid Health Care Act has been that businesses have relied more on employees who work fewer than 20 hours a week and thus aren't covered under the requirement, wrote San Francisco Federal Reserve Bank research adviser Rob Valletta and co-authors Tom Buchmueller and John DiNardo, both University of Michigan professors.

The results of the research into health insurance coverage in Hawai'i "imply that an employer mandate is not an effective means for achieving universal coverage," they wrote.

"Although overall insurance coverage rates are unusually high in Hawai'i, a substantial number of people remain uninsured, suggesting a need for alternative approaches if universal coverage is the ultimate goal," they said...

Isn't it time that everyone agrees that ill-considered plans turn out to be disasters when it comes to achieving universal health care? Federalism really is the laboratory of democracy, and the lab results are in. The president and his lapdog media need to be honest about what we have already learned.

10 Questions for Supporters of 'ObamaCare'

By Dennis Prager

1. President Barack Obama repeatedly tells us that one reason national health care is needed is that we can no longer afford to pay for Medicare and Medicaid. But if Medicare and Medicaid are fiscally insolvent and gradually bankrupting our society, why is a government takeover of medical care for the rest of society a good idea? What large-scale government program has not eventually spiraled out of control, let alone stayed within its projected budget? Why should anyone believe that nationalizing health care would create the first major government program to "pay for itself," let alone get smaller rather than larger over time? Why not simply see how the Democrats can reform Medicare and Medicaid before nationalizing much of the rest of health care?

2. President Obama reiterated this past week that "no insurance company will be allowed to deny you coverage because of a pre-existing medical condition." This is an oft-repeated goal of the president's and the Democrats' health care plan. But if any individual can buy health insurance at any time, why would anyone buy health insurance while healthy? Why would I not simply wait until I got sick or injured to buy the insurance? If auto insurance were purchasable once one got into an accident, why would anyone purchase auto insurance before an accident? Will the Democrats next demand that life insurance companies sell life insurance to the terminally ill? The whole point of insurance is that the healthy buy it and thereby provide the funds to pay for the sick. Demanding that insurance companies provide insurance to everyone at any time spells the end of the concept of insurance. And if the answer is that the government will now make it illegal not to buy insurance, how will that be enforced? How will the government check on 300 million people?

3. Why do supporters of nationalized medicine so often substitute the word "care" for the word "insurance?" it is patently untrue that millions of Americans do not receive health care. Millions of Americans do not have health insurance but virtually every American (and non-American on American soil) receives health care.

4. No one denies that in order to come close to staying within its budget health care will be rationed. But what is the moral justification of having the state decide what medical care to ration?

5. According to Dr. David Gratzer, health care specialist at the Manhattan Institute, "While 20 years ago pharmaceuticals were largely developed in Europe, European price controls made drug development an American enterprise. Fifteen of the 20 top-selling drugs worldwide this year were birthed in the United States." Given how many lives -- in America and throughout the world - American pharmaceutical companies save, and given how expensive it is to develop any new drug, will the price controls on drugs envisaged in the Democrats' bill improve or impair Americans' health?

6. Do you really believe that private insurance could survive a "public option"? Or is this really a cover for the ideal of single-payer medical care? How could a private insurance company survive a "public option" given that private companies have to show a profit and government agencies do not have to - and given that a private enterprise must raise its own money to be solvent and a government option has access to others'
money -- i.e., taxes?

7. Why will hospitals, doctors, and pharmaceutical companies do nearly as superb a job as they now do if their reimbursement from the government will be severely cut? Haven't the laws of human behavior and common sense been repealed here in arguing that while doctors, hospitals and drug companies will make significantly less money they will continue to provide the same level of uniquely excellent care?

8. Given how many needless procedures are ordered to avoid medical lawsuits and how much money doctors spend on medical malpractice insurance, shouldn't any meaningful "reform" of health care provide some remedy for frivolous malpractice lawsuits?

9. Given how weak the U.S. economy is, given how weak the U.S. dollar is, and given how much in debt the U.S. is in, why would anyone seek to have the U.S. spend another trillion dollars? Even if all the other questions here had legitimate answers, wouldn't the state of the U.S. economy alone argue against national health care at this time?

10. Contrary to the assertion of President Obama -- "we spend much more on health care than any other nation but aren't any healthier for it" -- we are healthier. We wait far less time for procedures and surgeries.

Our life expectancy with virtually any major disease is longer. And if you do not count deaths from violent crime and automobile accidents, we also have the longest life expectancy. Do you think a government takeover of American medicine will enable this medical excellence to continue?

Obamacare’s Effect on Seniors

Posted July 28th, 2009 at 9.24am in Health Care.
Today at 1:30 PM, President Barack Obama will participate in a health care “tele-town hall” at AARP headquarters in Washington, DC. The President is scheduled to answer questions about his health care plan from AARP members via phone, email, and even a live audience of about 40 AARP members and volunteers. We hope the event’s moderators will allow for a lively and honest debate, because our nation’s seniors stand to be huge losers under Obamacare:

Losing Your Doctor: Under the current system, more and more seniors are discovering that it is becoming harder and harder to find and keep doctors who will accept Medicare patients. A 2008 survey found that 29% of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24% the year before. This problem is compounded by the fact that our nation is facing a growing shortage of doctors. Obamacare promises to only make these problems worse. First, Obama plans to pay for up to a third of his plan by cutting $313 billion in Medicare reimbursements to health care providers over the next 10 years. This will only force more doctors to stop seeing Medicare patients. Second, Obama’s public “option” could decrease the annual net income of hospitals by $36 billion, while the annual net income of physicians could drop by $33.1 billion.

Facing a sharp reduction in their pay, more doctors will retire early and more bright students will elect to pursue other careers, thereby reducing access and ensuring lower quality health care for future generations as well.

Losing Your Coverage: 22% of all Medicare patients, which translates to 10.5 million seniors, are currently enrolled in Medicare Advantage plans. These health plans cover all of the traditional Medicare benefits and much more, including coor dinated care and care-management programs for enrollees with chronic conditions as well as additional hospitalization and skilled nursing facility stays. President Obama has proposed killing this program entirely. A new study for the Florida Association of Health Plans found that, because Medicare Advantage plans have richer benefits and lower deductibles and co-payments than traditional Medicare, seniors in that state would face dramatically higher payments if forced to give up their Medicare Advantage plans. Cost increases would range from $2,214 a year in Jacksonville to $3,714 a year in Miami.

Rationing Your Care: Another centerpiece to Obamacare is the creation of a federal health board that will ration your health care. Obama supporter and infanticide advocate Peter Singer made the case for rationing health care recently in the New York Times, writing: “The task of health care bureaucrats is then to get the best value for the resources they have been allocated.” Conservatives in Congress have given Obamacare supporters every opportunity to disavow government-rationed health care, but Obamacare supporters have voted down every anti-rationing amendment proposed. Make no mistake, Obama plans to pay for expanded coverage for the young and healthy by denying treatments to the old and sick. Americans can do better.

There is no question that America’s $2.4 trillion health care system needs to be reformed. But it should not be done on the backs of America’s seniors. Conservatives have a better vision for health care reform that cuts health care costs by reforming the tax system, enabling true health care competition, and giving families control of their health care dollars.

Monday, July 27, 2009

How a Bill Becomes Law: Chicago Style

Posted July 27th, 2009 at 6.18pm in Ongoing Priorities.
You might think that passing a bill through Congress is a really difficult and honorable task that involves late night debates, hours spent analyzing proposals and reading legislation, policy wonks splitting hairs over detailed issues and a healthy dose of respectful opposition and transparency. Oh boy, would you be wrong. In this Congress, it’s rahm rahm rahm, Chicago-style.

According to recent reports, Congressional leaders are censoring congressional mailings to avoid the appearance of two sides to the health care debate. And what is being censored? Democrats should be called “the majority,” and the “public option” cannot under any circumstances be called “government-run.” Not being able to say the “public option” is government-run is like being told you cannot call the Earth a planet. It’s simply incompatible with common sense, and the facts.

So for education purposes, here is an updated lesson on how a bill becomes a law in Washington.

Introduce a Bill, But Not the One You Really Plan on Passing: On Friday, June 26, 2009 the House of Representatives voted on final passage of the Waxman-Markey Cap and Trade Bill, a major piece of global warming legislation this year that will have a huge effect on the economy and the price Americans pay for energy. Both sides of this debate spent months arguing over the details. And then, at 3:09 am on June 26, the morning of the vote, the majority added over 300 pages to the bill. As of the final vote, not one member had a clear idea what was contained in that amendment.

Do Not Under Any Circumstances, Read the Bill: Reading the bill will only confuse the process and according to Congressman John Conyers (D-MI), it will also take upwards of two days and two staffers so it is not worth it. At the National Press Club this week, Congressman Conyers said: “I love these members that get up and say, ‘read the bill.’ What good is reading the bill if it’s a thousand pages, and you don’t have two days and two lawyers to find out what it means after you read the bill?”

Further, Majority Leader Steny Hoyer said “If every member pledged to not vote for [the health care bill] if they hadn’t read it in its entirety, I think we would have very few votes.” Hoyer continued: “I’m laughing because a) I don’t know how long this bill is going to be, but it’s going to be a very long bill.”

Make the Bill Very Long and Very Complicated: The best way to achieve the previous objective of not reading the bill is to take the length of War & Peace, double it, and then use that as a starting point. The current House version of health care legislation is over 1,000 pages long. The stimulus bill was over 1,500 pages long. The Cap and Trade bill was over 1,000 pages long, and remember, had 300 pages added at the last minute. No sneaky spending hidden in there, you can trust ‘em.

Bypass Your Committee: If the moderate voices of Congress wish to debate a bill in committee and propose alternative ideas, bypass the committee entirely. House Energy and Commerce Chairman Henry Waxman (D-CA) knows this rule well, and has suggested there is “no alternative” to bypassing the committee if Blue Dog Democrats don’t accept the terms of the deal he sets on health care reform this week. Yes, there is clearly no alternative.

Keep the American People in the Dark: When President Barack Obama took office, he promised on his transition website he would “not sign any non-emergency bill without giving the American public an opportunity to review and comment on the White House Web site for five days.” He failed to live to this promise on his very first piece of legislation. In fact, the website the White House unveiled to detail “transparent” stimulus spending was so bad, and lacked so little detail, that a cottage industry of private websites popped up to fill the void.

Censor the Opposition: If nobody reads the opposition, did it really exist? Of course not. In an attempt to keep the American people in the dark, you must not let them hear opposing views, especially during a week where the President sets aside one hour of primetime network television time to address his side. Congressman Kevin Brady (R-TX) tried recently to send a chart detailing the expansion of government under the current plan, and the House Franking Commission told him no, even though it did not challenge the chart’s accuracy or purpose. Congressman John Carter (R-TX) tried to call the public plan “government-run” and was promptly told to cease saying such obvious things. It’s much easier to pass a bill when you can write the talking points for both sides.

When the CBO Says Bad Things, Bring the Director in for a “Chat”: Last week, Congressional Budget Office (CBO) Director Douglas Elmendorf was summoned to the White House after his office released an analysis showing that the President’s health care plan would increase the deficit and not produce the savings it promised. This move was absolutely unprecedented, as Congressman Tom Pryce (R-GA) points out: “[This] reeks of the type of Chicago-style politics that American’s were warned about. The CBO was created to be independent and nonpartisan. To spoil that with political dealings in the West Wing only adds to American cynicism about the President’s misguided health care plan.”

Finally, Pass the Bill on a Friday: When passing really expensive bills that hurt the economy and fail to meet their objective, it is imperative this be done as late on Friday as possible, so by Monday people will have mostly forgotten, like the Waxman-Markey bill. The only thing better than a Friday is a Saturday in August when Americans are on vacation. Saturday, August 1 would be ideal for the health care bill, if there were to be one voted on before the recess. Luckily, that is the current plan.

So there you have the 2009 guide to passing a bill through Congress. There will certainly be changes to these rules, but we can’t promise you’ll be told of them.

Joe Biden vs Joe Biden on the Stimulus

Posted July 27th, 2009 at 2.55pm in Enterprise and Free Markets.
The care with which we are carrying out the provisions of the Recovery Act has led some people to ask whether we are moving too slowly. But the act was intended to provide steady support for our economy over an extended period — not a jolt that would last only a few months.

- Vice President Joe Biden New York Times, July 26, 2009.

The Recovery Act, as we call it, provides a necessary jolt to our economy to implement what we refer as “shovel-ready” projects, meaning projects that were on the books that were needed in the municipalities and the states that would improve the quality of life for our constituents, the competitiveness of our businesses, but were unable to be funded.

- Vice President Joe Biden, Remarks at The Progressive Governance Conference, March 28, 2009.

Jolt or not jolt, President Barack Obama’s $787 billion stimulus plan is proving to be a colossal failure. President Obama promised the American people that if his stimulus passed, unemployment would not rise above 8% and that the U.S. economy would have 138.6 million jobs by 2010. In reality, the Obama stimulus has already witnessed 9.5% unemployment and is 6.4 million jobs short of what was promised by 2010. Heritage fellow J.D. Foster explains where Obama and Biden went wrong:

The Keynesian stimulus theory fails for the simple reason that it is only half a theory. It correctly describes how deficit spending can raise the level of demand in part of the economy, and ignores how government borrowing to finance deficit spending automatically reduces demand elsewhere. Exculpatory allusions to idle saving simply do not wash in a modern economy supported by a modern financial system. Deficit spending does not create real purchasing power and so it cannot increase total demand in the economy. Deficit spending can only shift the pattern of demand toward government-centric preferences.

Here is one of the Democrat leaders talking about the health care bill.

Six Straightforward Steps to Better Healthcare

To create a system that delivers more choices of higher quality health care at lower cost we need to take the following six straightforward steps:

Stop Paying the Crooks. First, we must dramatically reduce healthcare fraud within our current healthcare system. Outright fraud -- criminal activity -- accounts for as much as 10 percent of all healthcare spending. That is more than $200 billion every year. Medicare alone could account for as much as $40 billion a year. (Read about our latest CHT Press book, Stop Paying the Crooks, edited by Jim Frogue.)

Move from a Paper-based to an Electronic Health System. As it stands now, it is simply impossible to keep up with fraud in a paper-based system. An electronic system would free tens of billions of dollars to be spent on investing on the kind of modern system that will transform healthcare. In addition, it would dramatically increase our ability to eliminate costly medical errors and to accelerate the adoption of new solutions and breakthroughs.

Tax Reform. The savings realized through very deliberately and very systematically eliminating fraud could be used to provide tax incentives and vouchers that would help cover those Americans who currently can’t afford coverage. In addition, we need to expand tax incentives for insurance provided by small employers and the self-employed. Finally, elimination of capital gains taxes for investments in health-solution companies can greatly impact the creation advancement of new solutions that

create better health at lower cost.
Create a Health-Based Health System. In essence, we must create a system that focuses on improving individual health. The best way to accomplish this is to find out what solutions are actually working today that save lives and save money and then design public policy to encourage their widespread adoption. For example, according to the Dartmouth Health Atlas, if the 6,000 hospitals in the country provided the same standard of care of the Intermountain or Mayo health clinics, Medicare alone would save 30 percent of total spending every year. We need to make best practices the minimum practice. We need the federal government and other healthcare stakeholders to consistently migrate to best practices that ensure quality, safety and better outcomes.

Reform Our Health Justice System. Currently, the U.S. civil justice system is the most expensive in the world -- about double the average cost in virtually every other industrialized nation. But for all of the money spent, our civil justice system neither effectively compensates persons injured from medical negligence nor encourages the elimination of medical errors. Because physicians fear malpractice suits, defensive medicine (redundant, wasteful treatment designed to avoid lawsuits, not treat the patient) has become pervasive. CHT is developing a number of bold health-justice reforms including a “safe harbor” for physicians who followed clinical best practices in the treatment of a patient. Visit CHT's Health Justice project page to learn more.

Invest in Scientific Research and Breakthroughs. We must accelerate and focus national efforts, re-engineer care delivery, and ultimately prevent diseases such as Alzheimer's Disease and diabetes which are financially crippling our healthcare system.

Senator Jim DeMint’s “Health Care Freedom Plan.”

You see, Senator DeMint has done a great job in laying out the issue.

Of course, you wouldn’t know it based on the response from the Democrats. Did you know that in his primetime press conference, President Obama referenced folks like DeMint, blaming them for opposing Obama’s plan, trying to paint conservatives with no ideas of our own? Did you know that the day after that, the Democrats came out with a video against Jim DeMint, again saying his answer on health care was “No,” and that he didn’t have a plan of his own?

We at American Future Fund Political Action deplore their tactics and we feel you should have the record set straight.

Jim DeMint’s plan offers the following:

My plan puts individuals back in control of their health care decisions by offering every American a health care voucher — worth $2,000 for individuals and $5,000 for families — to purchase a plan that best works for them. It doesn’t force anyone who likes their employer-sponsored health care to leave it. If you like your current plan, you can keep it. If you don’t have insurance, or if you do have insurance but might want to shop around, you can claim the voucher. My plan finally allows comparable tax benefits for those without employer-sponsored care, like small business workers and the self-employed.

The plan also breaks down barriers and creates a nationwide insurance market that doesn’t restrict individuals from purchasing insurance plans in other states. It also allows greater flexibility to use Health Savings Accounts (HSAs) to pay for insurance premiums.

To bring down overall health care costs, my bill reduces predatory malpractice lawsuits against physicians and hospitals and brings more transparency to the industry by requiring that true costs of health care are disclosed before patients receive treatment. My plan also ensures that Americans with pre-existing health conditions would be provided access to affordable coverage through federal block grant funding of state high-risk projects.

This is the leading, conservative plan in the Senate, yet Democrats paint its author as one who has no plan.

Unbelievable, isn’t it?

Unfortunately, Democrats continue to ignore conservative plans because they frighten them. You see, Democrats know that conservatives, with their common sense solutions to health care reform, have them beat already. And they don’t want YOU to know it.

Why the Census Needs to Let ACORN Go

I wanted to share with you a column that I wrote with my colleague, Congressman Lynn Westmoreland (GA), regarding our concerns about ACORN’s involvement in the 2010 Census. It was published last week in The Hill, a Capitol Hill newspaper.

Don’t let ACORN taint the 2010 census

The Constitution doesn’t specify many duties that the federal government absolutely must carry out. For as long as our republic lasts, Americans will debate the meaning and intentions of the Constitution, but on requiring a decennial census, the Framers wrote with such clarity that no analysis is needed.

Today our nation has 100 times as many people as it did at our founding. Though much has changed, the headcount of Americans remains an essential function of our federal government. It’s how we apportion representatives in Congress and direct spending.

For such an endeavor to succeed, the process must have the trust of the American people. Unfortunately, the blatant politicization of the 2010 survey has undermined many Americans’ faith in the system.

From the get-go, the Obama administration sought to use the census for partisan gain. First, Obama Chief of Staff Rahm Emanuel — a former leader of the House Democrats’ campaign committee — tried to usurp the census authority of the Commerce Department. A public outcry killed that West Wing power grab, but the partisan undertones continued when the administration announced ACORN as a national partner in the census soon thereafter.

ACORN’s involvement casts a cloud of suspicion over what should be a nonpartisan process. ACORN has been under investigation — and at times indictment and consent decree — for various counts of voter registration fraud related chiefly to the 2006 and 2008 elections. In more than a dozen states, prosecutors and investigators have pursued ACORN for violating the public trust in one of the most critical of public functions: the electoral process. Yet, this is the organization that the Census Bureau wants to tout as a “national partner” in the collection of some rather personal information.

Just last week, Senior District Judge Richard H. Zoller, in hearing a case against an ACORN employee for voter registration fraud in Allegheny County, Pa., urged prosecutors to zealously pursue the “real culprit” in these criminal cases. “Somebody has to go after ACORN,” the judge said. A few months ago, Nevada’s Democrat attorney general, Catherine Cortez Masto, said ACORN’s own training manuals “clearly detail, condone and … require illegal acts.”

The Census Bureau says that ACORN is just one of thousands of organizations that help to promote the census. Fair enough. But no organization other than ACORN has raised as many red flags or engendered such a high level of distrust among the American people.

The Census Bureau says that ACORN won’t actually go door to door and that the bureau will thoroughly screen all the enumerators. Nevertheless, ACORN will recruit enumerators and provide space where people can fill out their surveys. In fact, on the form that ACORN officials filled out to become a partner, they also indicated that they will “appoint a liaison to work with the Census Bureau, encourage employees and constituents to complete and mail their questionnaire, identify job candidates and/or distribute and display recruiting materials, provide space for Be Counted sites and/or Questionnaire Assistance Centers, engage regional and local chapters of [its] organization” and a host of other activities.

Any organization so intimately involved wih helping Americans fill out census forms should have credibility beyond question. ACORN, a group credibly accused of filling out fraudulent voter registrations with the names of the Dallas Cowboys, utterly fails that test.

The Census Bureau alone determines who qualifies as a national partner. Unlike most rules written by government agencies, there’s no congressional involvement, no opportunity for public input and no public notice. The Census Bureau says that it will partner with any group that can encourage participation in the census. Only law enforcement organizations, tax assessors and hate groups are specifically excluded. Given the fears and concerns that many Americans have toward ACORN, its involvement may actually discourage participation.

If the Census Bureau wants to allay mistrust and encourage full participation in the 2010 census, it can take a giant step in that direction by dropping ACORN from its national partnership program.

Friday, July 24, 2009

What's Not Political About Health Care Reform?

By Andrew Cline on 7.22.09 @ 6:09AM

President Obama whined on "The Today Show" yesterday that politics was getting in the way of his noble effort to reform health care on behalf of the American people. To her credit, Meredith Vieira didn't buy it. And if Meredith Vieira doesn't buy it, Obama's got big problems.

Obama has always portrayed himself as the white knight riding to the rescue of the people. It's his heroic proposals vs. evil special interests. Period. He was at it again yesterday morning, but the veil of nobility is wearing so thin that even "Today Show" hosts can see through it.

When Vieira quoted Sen. Jim DeMint, R-S.C., saying, ""If we are able to stop Obama on this, it will be his Waterloo. It will break him," Obama saw his opening.

"All the previous questions you asked, that's the answer to," he said. "This is not about 'do we need a little more time to get this right, to be constructive, to talk to the policy analysts. This is all about politics. That describes exactly an attitude that we've gotta overcome. Because, what folks have in their minds is that somehow this is about me, it's about politics, and the ability to win back the House of Representatives. And people are thinking back to 1993 when President Clinton wasn't able to get health care, right after that the House Republicans won…"

At this point Vieira interrupted.

"But this is about politics, Mr. President. This is a key issue for you. You have a big stake in this. If this falls apart, that is not good for you."

Obama pulled his pensive stare-at-the-floor look, shook his head, and brought up "the people."

"Meredith, I, I, all I can say is that this is absolutely important to me. But this is not as important to me as it is to the people who don't have health care. I've got health care. This isn't as important to me as the family that's going bankrupt because they got a bunch of medical bills that they thought the insurance companies would cover. It turned out they weren't covered. So, yes, absolutely, I am deeply invested in getting this thing done. But this isn't Washington sport. This isn't about who's up and who's down. This is about solving an enormous problem for the American people."

It's all about the people! You'd think Obama was Zorro, he talks about "the people" so much.

Earlier in the interview, Vieira asked him why he set an August deadline for getting a health care bill passed through Congress. He actually said that it wasn't his deadline, it was the people's.

"The deadline's not being set by me. The deadline's being set by the American people."

You remember voting on that, don't you? Signing that petition to Congress to have health care reform passed by the August recess? Me neither.

Obama can pretend all he wants that only the other side is playing politics, but someone among the White House press corps ought to ask him this: Isn't proposing a government revision of 17 percent of the entire U.S. economy inherently political?

How is it that proposing massive government-initiated overhaul of the entire health care sector is not political, but opposing such a step is nothing but playing politics?

The president assumes that his rhetorical sleight-of-hand will get health care reform as he envisions it passed. But his assertions are transparently false. They are, in short, purely political. If Meredith Vieira can see that, the rest of the country can, too.

We've Figured Him Out

By Ben Stein on 7.24.09 @ 9:45AM

Why is President Barack Obama in such a hurry to get his socialized medicine bill passed?

Because he and his cunning circle realize some basic truths:

The American people in their unimaginable kindness and trust voted for a pig in a poke in 2008. They wanted so much to believe Barack Obama was somehow better and different from other ultra-leftists that they simply took him on faith.

They ignored his anti-white writings in his books. They ignored his quiet acceptance of hysterical anti-American diatribes by his minister, Jeremiah Wright.

They ignored his refusal to explain years at a time of his life as a student. They ignored his ultra-left record as a "community organizer," Illinois state legislator, and Senator.

The American people ignored his total zero of an academic record as a student and teacher, his complete lack of scholarship when he was being touted as a scholar.

Now, the American people are starting to wake up to the truth. Barack Obama is a super likeable super leftist, not a fan of this country, way, way too cozy with the terrorist leaders in the Middle East, way beyond naïveté, all the way into active destruction of our interests and our allies and our future.

The American people have already awakened to the truth that the stimulus bill -- a great idea in theory -- was really an immense bribe to Democrat interest groups, and in no way an effort to help all Americans.

Now, Americans are waking up to the truth that ObamaCare basically means that every time you are sick or injured, you will have a clerk from the Department of Motor Vehicles telling your doctor what he can and cannot do.

The American people already know that Mr. Obama's plan to lower health costs while expanding coverage and bureaucracy is a myth, a promise of something that never was and never will be -- a bureaucracy lowering costs in a free society. Either the costs go up or the free society goes away.

These are perilous times. Mrs. Hillary Clinton, our Secretary of State, has given Iran the go-ahead to have nuclear weapons, an unqualified betrayal of the nation. Now, we face a devastating loss of freedom at home in health care. It will be joined by controls on our lives to "protect us" from global warming, itself largely a fraud if believed to be caused by man.

Mr. Obama knows Americans are getting wise and will stop him if he delays at all in taking away our freedoms.

There is his urgency and our opportunity. Once freedom is lost, America is lost. Wake up, beloved America.

Why Religion Matters: The Impact of Religious Practice on Social Stability

by Patrick F. Fagan, Ph.D.


By extolling freedom of religion in the schools, President Bill Clinton has raised the level of debate on the importance of religion to American life.3 The time is ripe for a deeper dialogue on the contribution of religion to the welfare of the nation.

America has always been a religious country. "Its first Christian inhabitants were only too anxious to explain what they were doing and why," explains historian Paul Johnson. "In a way the first American settlers were like the ancient Israelites. They saw themselves as active agents of divine providence."4 Today, he adds, "it is generally accepted that more than half the American people still attend a place of worship over a weekend, an index of religious practice unequaled anywhere in the world, certainly in a great and populous nation."5

At the heart of religious practice is prayer: Americans pray even more than they go to church. According to a composite of surveys, 94 percent of blacks, 91 percent of women, 87 percent of whites, and 85 percent of men regard themselves as people who pray regularly. Some 78 percent pray at least once per week, and 57 percent pray daily. Even among the 13 percent of the population who call themselves agnostics or atheists, some 20 percent pray daily.6

When policymakers consider America's grave social problems, including violent crime and rising illegitimacy, substance abuse, and welfare dependency, they should heed the findings in the professional literature of the social sciences on the positive consequences that flow from the practice of religion.7

For example, there is ample evidence that:

The strength of the family unit is intertwined with the practice of religion. Churchgoers8 are more likely to be married, less likely to be divorced or single, and more likely to manifest high levels of satisfaction in marriage.
Church attendance is the most important predictor of marital stability and happiness.
The regular practice of religion helps poor persons move out of poverty. Regular church attendance, for example, is particularly instrumental in helping young people to escape the poverty of inner-city life.
Religious belief and practice contribute substantially to the formation of personal moral criteria and sound moral judgment.
Regular religious practice generally inoculates individuals against a host of social problems, including suicide, drug abuse, out-of-wedlock births, crime, and divorce.
The regular practice of religion also encourages such beneficial effects on mental health as less depression (a modern epidemic), more self-esteem, and greater family and marital happiness.
In repairing damage caused by alcoholism, drug addiction, and marital breakdown, religious belief and practice are a major source of strength and recovery.
Regular practice of religion is good for personal physical health: It increases longevity, improves one's chances of recovery from illness, and lessens the incidence of many killer diseases.
The overall impact of religious practice is illustrated dramatically in the three most comprehensive systematic reviews of the field.9 Some 81 percent of the studies showed the positive benefit of religious practice, 15 percent showed neutral effects, and only 4 percent showed harm.10 Each of these systematic reviews indicated more than 80 percent benefit, and none indicated more than 10 percent harm. Even this 10 percent may be explained by more recent social science insights into "healthy religious practice" and "unhealthy religious practice."11 This latter notion will be discussed later -- it is seen generally by most Americans of religious faith as a mispractice of religion. Unfortunately, the effects of unhealthy religious practice are used to downplay the generally positive influence of religion.12 This both distorts the true nature of religious belief and practice and causes many policymakers to ignore its positive social consequences.

Religious practice appears to have enormous potential for addressing today's social problems. As summarized in 1991 by Allen Bergin, professor of psychology at Brigham Young University, considerable evidence indicates that religious involvement reduces "such problems as sexual permissiveness, teen pregnancy, suicide, drug abuse, alcoholism, and to some extent deviant and delinquent acts, and increases self esteem, family cohesiveness and general well being.... Some religious influences have a modest impact whereas another portion seem like the mental equivalent of nuclear energy.... More generally, social scientists are discovering the continuing power of religion to protect the family from the forces that would tear it down."13

Professor Bergin's summary was echoed two years later by nationally syndicated columnist William Raspberry: "Almost every commentator on the current scene bemoans the increase of violence, lowered ethical standards and loss of civility that mark American society. Is the decline of religious influence part of what is happening to us? Is it not just possible that anti-religious bias masquerading as religious neutrality is costing more than we have been willing to acknowledge?"14 Other reviews15 also list the positive effects of religious belief and practice in reducing such problems as suicide, substance abuse, divorce, and marital dissatisfaction. Such evidence indicates clearly that religious practice contributes significantly to the quality of American life.

Given this evidence,

Congress should:

Begin a new national debate to help renew the role of religion in American life;
Ask the General Accounting Office (GAO) to review the evidence on the beneficial effects of religious practice in the relevant social science literature and report its findings to a national commission formed to promote the consideration of religious practice among U.S. citizens;
Fund federal experiments with school choice that include religiously affiliated schools;
Pass a sense-of-the-Congress resolution that data on religious practice are useful for policymakers and researchers as part of the public policy debate; and
Mandate a census question on religious practice. It violates nobody's freedom of religion for Congress to know the level and intensity of religious practice in America.
The President should:
Appoint judges who are more sensitive to the role of religion in public life, with the Senate ensuring that such is the case by ascertaining the stand of judges on matters of religion and its relationship to the Constitution;
Direct the Bureau of the Census to record levels of religious practice in the census for the year 2000 (time is running out for preparation of the census questionnaire); and
Issue a directive to all federal agencies making clear that cooperation between government entities and the social, medical, and educational services of faith-based organizations does not violate separation of church and state.
The U.S. Supreme Court should:

Review the decisions in which it has changed the laws of the land by changing commonly held beliefs regarding the Constitution and religion and send to Congress those that should have been the object of legislative action rather than judicial reinterpretation.
America's religious leaders should:

Be much more assertive in emphasizing the contribution of religion to the health of the nation and in resisting efforts to minimize religion in public discourse;
Make clear to their congregations that they are contributing not only to their own welfare, but also to the well-being of the nation by their regular attendance at religious worship;
Take special care of the religious formation of children, especially during the transition period from childhood to adolescence, when they are most likely to lose their religious faith;
Recognize that the church in the inner city, especially the black church, has a vital role to play in helping its people escape from the degrading culture of inner-city poverty; and
Encourage education leaders, social scientists, and social policy practitioners to rely more on religious belief and worship to achieve social policy and social work goals.
Religion and Happiness

Ever since Aristotle outlined the goal of a sound civil order in his Politics,16 social and political scientists and social psychologists have been particularly interested in what makes human beings happy. Happy people tend to be productive and law-abiding. They learn well, make good citizens, and are invariably pleasant company. It turns out that the practice of religion has a significant effect on happiness and an overall sense of personal well-being. Religious affiliation and regular church attendance are near the top of the list for most people in explaining their own happiness17 and serve as good predictors of who is most likely to have this sense of well-being.18 Happiness is greater and psychological stress is lower for those who attend religious services regularly.19 Those pursuing a personal relationship with God tend to have improved relationships with themselves and with others.20

A large epidemiological study conducted by the University of California at Berkeley in 1971 found that the religiously committed had much less psychological distress than the uncommitted.21 Rodney Stark, now of the University of Washington, found the same in a 1970 study: The higher the level of religious attendance, the less stress suffered when adversity had to be endured.22 Similarly, in a longitudinal study of 720 adults conducted by David Williams of the University of Michigan, regular religious attendance led to much less psychological distress.23

In 1991, David Larson, adjunct professor at the Northwestern and Duke University Schools of Medicine and president of the National Institute of Healthcare Research, completed a systematic review of studies on religious commitment and personal well-being. He found that the relationship is powerful and positive; overall, psychological functioning improved following a resumption of participation in religious worship for those who had stopped.24

Religion and Family Stability

There is a growing consensus that America needs to pursue policies aimed at re-strengthening the family. The beneficial effects of religious worship on family stability clearly indicate one way to help accomplish this. Professors Darwin L. Thomas and Gwendolyn C. Henry of Brigham Young University's Department of Sociology sum up earlier research25 on the quest by young people for meaning and love: "Research on love clearly indicates that for many, love in the social realm cannot clearly be separated from love that contains a vertical or a divine element.... Young people see love as the central aspect of the meaning of life; they believe that religion is still important in helping form judgments and attitudes."26 Their conclusion: "Family and religious institutions need to be studied simultaneously in our efforts to understand the human condition better."27

"Middletown," one of the century's classic sociological research projects, studied the lives of inhabitants of a typical American town, first in the 1920s and for the third time in the 1980s. Based on the latest round of follow-up research, Howard Bahr and Bruce Chadwick, professors of sociology at Brigham Young University, concluded in 1985 that "There is a relationship between family solidarity -- family health if you will -- and church affiliation and activity. Middletown [churchgoing] members were more likely to be married, remain married and to be highly satisfied with their marriages and to have more children.... The great divide between marriage status, marriage satisfaction and family size is... between those who identify with a church or denomination and those who do not."28

Four years later, Professor Arland Thornton of the Institute for Social Research at the University of Michigan likewise concluded from a Detroit study of the same relationship that "These data indicate strong intergenerational transmission of religious involvement. Attendance at religious services is also very stable within generations across time."29

"With striking consistency, the most religious among us [as Americans] place a greater importance on the full range of family and friendship activities," concluded a Connecticut Mutual Life report in 1982.30 A group of Kansas State University professors reached the same conclusion: "Family commitment is indeed a high priority in many American families and it is frequently accompanied by a concomitant factor of religious commitment."31 In yet another study conducted during the 1970s and 1980s, professors Nick Stinnet of the University of Alabama and John DeFrain of the University of Nebraska sought to identify family strengths. From their nationwide surveys of strong families, they found that 84 percent identified religion as an important contributor to the strength of their families.32 It should be noted that the same pattern appears to hold for African-American families: Parents who attended church frequently cited the significance of religion in rearing their children and in providing moral guidelines.33

Marital Satisfaction
Couples with long-lasting marriages indicate that the practice of religion is an important factor in marital happiness. Indeed, David Larson's systematic reviews indicate that church attendance is the most important predictor of marital stability.34 Others have found the same result.35 Twenty years ago it was first noted that very religious women achieve greater satisfaction in sexual intercourse with their husbands than do moderately religious or non-religious women.36 The Sex in America study published in 1995, and conducted by sociologists from the University of Chicago and the State University of New York at Stonybrook, also showed very high sexual satisfaction among "conservative" religious women.37 From the standpoint of contemporary American media culture, this may appear strange or counter-intuitive, but the empirical evidence is consistent.

Divorce and Cohabitation
Regular church attendance is the critical factor in marital stability across denominations and overrides effects of doctrinal teaching on divorce. For instance, black Protestants and white Catholics, who share similarly high church attendance rates, have been shown to have similarly low divorce rates.38 Furthermore, when marital separation occurs, reconciliation rates are higher among regular church attendees, and highest when both spouses have the same high level of church attendance.39 Findings on the other end of the marital spectrum reinforce the point: A 1993 national survey of 3,300 men aged 20-39 found that those who switch partners most are those with no religious convictions.40

Significantly, cohabitation before marriage poses a high risk to later marital stability,41 and premarital cohabitation is much less common among religious Americans. "The cohabitation rate is seven times higher among persons who seldom or never attend religious services compared to persons who frequently attend," writes David Larson of the National Institute of Healthcare Research. "Women who attended religious services once a week were only one-third as likely to cohabit as those who attended church services less than once a month." Furthermore, "If the mother frequently attended religious services, both sons and daughters were only 50 percent as likely to cohabit as adult children whose mothers were not actively religious."42 Rockford Institute President Allan Carlson summarizes the pattern: "Social scientists are discovering the continuing power of religion to protect the family from the forces that would tear it down."43

The fact is that too many social scientists have failed to appreciate the significance of research on the relationship between family and religion. As another researcher of the same period concludes, "We may have underestimated this 'silent majority' and it is only fair to give them equal time."44 The centrality of stable married family life in avoiding such problems as crime,45 illegitimacy,46 and welfare47 has become indisputable. If such a stable family life is linked closely to a lively religious life, as these studies indicate, then the peace and happiness of the nation depend significantly on a renewal of religious practice and belief.

Religion and Physical Health

In public health circles, the level of educational attainment is held to be the key demographic predictor of physical health. For over two decades, however, the level of religious practice has been shown convincingly to be equally important.

As early as 1972, researchers from the Johns Hopkins University School of Public Health found that cardiovascular diseases, the leading killers of older people, were reduced significantly in early old age by a lifetime of regular church attendance. By contrast, non-attendees had higher mortality rates for such other diseases as cirrhosis of the liver, emphysema, and arteriosclerosis, in addition to other cardiovascular diseases and even suicide.48 Research on mortality patterns among the poor confirmed a decade later that those who went to church regularly lived longer.49 Since then, other studies have reinforced this general finding.50

Blood pressure, a key factor in cardiovascular health, is reduced significantly by regular church attendance, on average by 5mm of pressure.51 Given that reducing blood pressure by 2 to 4 mm also reduces the mortality rate by 10 to 20 percent for any given population,52 a reduction of 5 mm is a very significant public health achievement by any standard. For those over 55 years of age, the average decrease was 6 mm. Among those who smoked -- a practice that increases blood pressure -- regular church attendance decreased the risk of early stroke by 700 percent.53

Nor are the health benefits of religious commitment confined to the cardiovascular system. In 1987, a major review of 250 epidemiological health research studies -- studies which examined the relationship between health and religion and measured such additional outcomes as colitis, cancers of many different types, and longevity measures -- concluded that, in general, religious commitment improves health.54 A 1991 study of two national samples55 also concluded that the degree to which people prayed and participated in religious services significantly affected their health status, regardless of age.56

In what must be one of the most unusual experiments in medical history, Dr. Robert B. Byrd, a cardiologist then at the University of California at San Francisco Medical School, conducted a random-sample, double-blind study of the effects of prayer -- not by the patients but for the patients -- on the outcome of cardiac surgery. The study was published in 1982. None of the patients knew they were being prayed for, none of the attending doctors and nurses knew who was being prayed for and who was not, and those praying had no personal contact with the patients before or during the experiment. Outcomes for the two sets of patients differed significantly: Those prayed for ha d noticeably fewer post-operative congestive heart failures, fewer cardiopulmonary arrests, less pneumonia, and less need for antibiotics.57 To date, this study has not been replicated, though the intriguing results challenge the academic and medical community to verify or disprove them.

Religion and Social Breakdown

The practice of religion has beneficial effects on behavior and social relations: on illegitimacy, crime and delinquency, welfare dependency, alcohol and drug abuse, suicide, depression, and general self-esteem.

One of the most powerful of all factors in preventing out-of-wedlock births is the regular practice of religious belief. Given the growing crisis in out-of-wedlock births, their effects,58 and the huge social and economic costs to national and state budgets, this should be of major interest to policymakers.

It has long been known that intensity of religious practice is closely related to adolescent virginity and sexual restraint and control. This general finding, replicated again and again,59 also holds true specifically for black teenage girls,60 the group with the highest teen pregnancy rates among all demographic subgroups.61 Reviews of the literature demonstrate that, nearly without exception, religious practice sharply reduces the incidence of premarital intercourse.62 The reverse is also true: The absence of religious practice accompanies sexual permissiveness and premarital sex. This is confirmed in numerous studies,63 including a 1991 analysis of the federal government's National Longitudinal Survey of Youth.64

The impact of religious practice on teenage sexual behavior also can be seen at the state level: States with higher levels of aggregate religiousness have lower rates of teenage pregnancy.65

In an important study published in 1987, a group of professors from the Universities of Georgia, Utah, and Wyoming found that the main cause of problematic adolescent sexual behaviors and attitudes is not only family dynamics and processes, as previously thought, but the absence of religious behavior and affiliation. They further concluded that healthy family dynamics and practices are themselves caused to a powerful degree by the presence or absence of religious beliefs and practices.66 The same results also hold true in international comparisons.67

As with drugs, alcohol, and crime, the religious behavior of the mother is one of the strongest predictors of the daughter's sexual attitudes.68 It also has long been known in the social sciences that daughters of single mothers are more likely to engage in premarital sexual behavior during adolescence.69 These mothers are more frequently permissive in their sexual attitudes, and religion for them has less importance than it has for mothers in two-parent families.70 These findings also have been replicated.71

The religious practices of parents, particularly their unity on religious issues, powerfully influence the behavior of children. Thus, for policymakers interested in reducing teenage (and older) out-of-wedlock births, the lesson is clear: Religious belief and regular worship reduce the likelihood of this form of family breakdown. One faith-based sex education course that included both mothers and daughters, for example, was aimed specifically at reducing the teenage pregnancy rate. The results were notably successful: Out-of-wedlock births among the at-risk population were almost eliminated.72

Crime and Delinquency
A review of the small amount of research done on the relationship between crime and religion shows that states w ith more religious populations tend to have fewer homicides and fewer suicides.73

A four-year longitudinal, stratified, random-sample study of high school students in the Rocky Mountain region, published in 1975, demonstrated that religious involvement significantly decreased drug use, delinquency, and premarital sex, and also increased self-control.74 A 1989 study of midwestern high school students replicated these findings.75 Similarly, young religious adults in Canada were found in a 1979 study to be less likely to use or sell narcotics, to gamble, or to destroy property.76

What is true for youth is also true for adults.77 Religious behavior, as opposed to mere attitude or affiliation, is associated with reduced crime.78 This has been known in the social science literature for over 20 years.79

In research conducted in the late 1980s -- controlling for family, economic, and religious backgrounds -- a research team from the University of Nevada found that black men who eventually ended up in prison and those who did not came respectively from two different groups: those who did not go to church, or stopped going around ten years of age, and those who went regularly.80 This failure of faith at the onset of adolescence parallels the pattern found among those who become alcoholics or drug addicts. Clearly, the family's inability to inspire regular religious worship among emerging young adults is a sign of internal weakness.

Welfare Dependency
In his classic study The Protestant Ethic and the Spirit of Capitalism, Max Weber, the preeminent German sociologist of the first half of the 20th century, demonstrated the connection between religious practice and financial well-being among Protestants. Other work on the same theme shows that this is not confined to Protestants, but that it applies across a longer period of history and across denominational lines.

This link between religion and prosperity has important implications for the poor. In 1985, for instance, Richard B. Freeman of the National Bureau of Economic Research reported that:

[Church attendance] is associated with substantial differences in the behavior of [black male youths from poverty-stricken inner-city neighborhoods] and thus in their chances to "escape" from inner city poverty. It affects allocation of time, school-going, work activity and the frequency of socially deviant activity.... It is important to recognize that our analysis has identified an important set of variables that separate successful from unsuccessful young persons in the inner city. There is a significant number of inner city youth, readily identifiable, who succeed in escaping that pathology of inner-city slum life.81

Ongoing studies by Professor Ranald Jarrell of the Department of Education at Arizona State University West show the power of religious belief and practice in encouraging a spirit of optimism among socially at-risk but advancing children. The subjects are students at the De La Salle Academy, an independent school in the upper west side of Manhattan serving primarily poor inner-city black and Hispanic middle school children who show substantial academic promise. Within this group, the highest concentration of pessimists is found among students with the lowest attendance at church. Those who attend church weekly or more frequently, on the other hand, exhibit the following profiles:

They are more optimistic about their futures;
They have better relationships with their parents;
They are more likely to dismiss racism as an obstacle to reaching their goals;
They are more likely to have serious and realistic goals for their futures;
They are more likely to see the world as a friendly place in which they can achieve, rather than as a hostile world with powerful forces arrayed against them; and
They are more likely to see themselves as in control of their own futures, whereas those who do not attend church are more likely to see themselves as victims of oppression.82
Data from the National Longitudinal Survey of Youth (NLSY), the best national sample for tracking the development of America's youth from the late 1970s, clearly indicate the difference regular religious practice makes for those who grew up in poverty in the 1970s and 1980s. Among those who attended church weekly in both 1979 and 1982, average family income in 1993 was $37,021; among those who never attended church in 1979 or 1982, however, average family income in 1993 was $24,361 -- a difference of $12,660.83

Other studies also show that growing up in an intact family correlates significantly and positively with future earnings.84 However, the NLSY data show that regular religious practice benefits both those who grow up in intact families and those who grow up in broken families. The other differences remain, but the positive impact of religion on both groups is evident.85

Alcohol and Drug Abuse
The relationship between religious practice and the moderate use or avoidance of alcohol is well documented,86 regardless of whether denominational beliefs prohibit the use of alcohol.87 According to general studies, the higher the level of religious involvement, the less likely the use or abuse of alcohol.88

Persons who abuse alcohol rarely have a strong religious commitment.89 In their study of the development of alcohol abuse, David Larson and William P. Wilson, professors of psychiatry at Northwestern University School of Medicine, found that nine out of ten alcoholics had lost interest in religion in their teenage years, in sharp contrast to teenagers generally, among whom interest in religion increased by almost 50 percent and declined by only 14 percent.90 Robert Coombs and his colleagues at the University of California at Los Angeles School of Medicine found that alcohol abuse is 300 percent higher among those who do not attend church.91

Drug and alcohol use is lowest in the most conservative religious denominations and highest in non-religious groups, while liberal church groups have use rates just slightly lower than those for non-religious groups. But for all groups, religious commitment correlates with absence of drug abuse.92

Significantly, involvement in any religious denomination or group generally decreases the level of drug use regardless of whether the denomination teaches against the use of alcohol, although denominations that teach against any use of drugs or alcohol exhibit the highest rates of drug avoidance. Among traditional American religions, Mormons have the highest denominational association between religious doctrine and drug avoidance; they also have the most restrictive proscriptions against drug use. On the other hand, Roman Catholics have the highest alcohol use rate; their religion condemns the abuse of alcohol but does not proscribe its use.93

Attendance at church and related religious activities has special significance for drug use among teenagers. In a 1985 study of young girls aged between 9 and 17, less than 10 percent of those who reported attending religious services weekl y or more often indicated any drug or alcohol use, compared with 38 percent of all those studied.94

The parental attitude to religion also is important in dealing with alcohol use. A 1985 study indicated that if the mother and father have deep, competing differences toward religious belief and practice, their children are more likely to use or abuse alcohol than are children whose parents do not differ on matters of religion. Conversely, if their parents' religious beliefs and practices are similar, children are far more likely to abstain from alcohol or to drink with moderation.95 Almost three decades before these findings, Orville Walters, then a research fellow at the Menninger School of Psychiatry in Topeka, Kansas, found that alcoholics who came from religious backgrounds tended to have mothers who were highly religious but fathers who were more non-religious.96

For over four decades it has been known,97 and replicated,98 that alcoholics with a religious background or strong religious beliefs are much more likely to seek help and treatment. Indeed, Alcoholics Anonymous, the major organization combating alcoholism in America, has known for over half a century that the most effective element in its program is its religious or spiritual component.99 David Larson of the National Institute for Healthcare Research notes: "Even after alcoholism has been established, religion is often a powerful force in achieving abstinence. Alcoholics Anonymous (AA) uses religion, invoking a Higher Power to help alcoholics recover from addiction."100

Paralleling the research on alcohol addiction, an early review of studies of drug addiction found a lack of religious commitment to be a predictor of who abuses drugs.101 Many more recent studies replicate this finding.102 As in so many other research studies, the best measurement of religious commitment is frequency of church attendance: "Overall church attendance was more strongly related to [less] drug use than was intensity of religious feelings."103 This is true for both males and females. According to Jerald G. Bachman of the Institute for Social Research at the University of Michigan, "Factors we found to be most important in predicting use of marijuana and other drugs during the late 1970's remained most important during the early 1980's. Drug use is below average among those with strong religious commitments."104 The more powerfully addictive the drug being considered, the more powerful is the impact of church attendance in preventing its use.105

In results almost identical to those for alcoholics, researchers at the National Institute of Drug Abuse, a section of the National Institutes of Health and the nation's premier drug abuse research facility, found in their interviews of narcotic addicts that "the addict had neither current religious preference nor a history of attending religious services.... In addition... the addicts' fathers were much less involved in regular or frequent religious practices, than were a parallel group of control fathers.... Religiously, the mother was far more involved than her husband, the difference in regular religious participation between the addict's parents being twice that for the control's parents.... Religiously, the addicts were significantly less involved in reading the Bible, and praying." They also had far more frequent loss of interest in religion during adolescence.106

Louis A. Cancellaro of the Department of Psychiatry at the Veterans Administration in Johnson City, Tennessee, writes that, "Like their fathers, addicts are less religiously involved than their normal peers, and during adolescence, less frequently make decisions either to become more interested in religion or to commit themselves to a re ligious philosophy to live by."107

In reviewing the religious treatment of addicts, research psychiatrists at the Duke University Department of Psychiatry concluded in 1992: "[The] role of religious commitment and religiously oriented treatment programs can be significant factors which ought to be considered and included when planning a mix of appropriate treatment alternatives.... Perhaps the greatest advantage of religious programs is their recourse to churches as a support system.... Religious treatment programs are not suitable for everyone. For those men and women who can accept the creeds, rituals, and commitments required of such programs there seem to be certain advantages."108

The practice of religion reduces the rate of suicide, both in the United States and abroad.109 In fact, the rate of church attendance predicts the suicide rate better than any other factor (including unemployment, traditionally regarded as the most powerful variable). Those who attend church frequently are four times less likely to commit suicide than those who never attend. Conversely, the national decline in church attendance is associated with a heightened suicide rate; fluctuations in church attendance rates in the 1970s paralleled the suicide rates for different subgroups: whites, blacks, men, and women.110

Steven Stack, professor of sociology at Pennsylvania State University, in a landmark 1985 study on the demography of suicide has found that "Families and religion change together over time.... As the importance of the domestic-religious institutional complex declines, the study finds a rise in the rate of suicide, both for the general population and for the age cohort at the center of the decline, the youth cohort."111 In another, earlier study, Stack broke new ground in finding that the effect of unemployment in causing suicide is greatl y diminished when religious behavior is factored into the equation.112

In inter-state comparisons, higher levels of church attendance are associated with lower rates of suicide.113 The same holds true in international comparisons.114

Religion appears to reduce the incidence of depression among those with medical problems. For instance, University of Michigan Professor of Sociology David Williams conducted a randomized survey of 720 adults suffering from leg and hip injuries in New Haven, Connecticut, in 1990. Those who attended religious services regularly were less depressed and less distressed by life events than those who did not. This finding held across age, race, socioeconomic status, educational attainment, and religious affiliation. Religious affiliation alone did not have these effects, but religious behavior did.115

Younger people also tend to experience fewer of the anxieties of growing up if they are religious. For instance, both male and female Texas high-schoolers found that religious beliefs gave meaning to their lives and reduced the incidence of depression among them.116

The absence of self-esteem weakens the personality and puts the person at greater risk for crime, addictions, and other social maladies.117 In all religious denominations, psychological weaknesses decrease as religious orthodoxy increases.118 Among college students, for instance, the practice of religion was shown in 1969 to have a positive effect on mental health;119 students involved with campus ministries were much healthier and made much less use of mental health services.

Significantly, self-esteem is linked to a person's image of God. Those with high self-esteem think of God primarily as loving, while those with low self-esteem think of God primarily as punitive.120 This was observed by Carl Jung, one of the most influential pioneers of modern psychology and psychotherapy: "Among all my patients in the second half of my life... there has not been one whose problem in the last resort was not that of finding a religious outlook on life. It is safe to say that every one of them fell ill because he had lost that which the living religions of every age have given their followers and none of them has been really healed who did not regain his religious outlook."121 Other evidence exists that people with a religious commitment, whether young or old, who become emotionally or psychologically distressed are much more likely to seek help.122

Understanding "Intrinsic" and "Extrinsic" Religious Behavior

Recent advances in the investigation of religious behavior have led social scientists to distinguish between two distinct categories or orientations: "intrinsic" and "extrinsic." Intrinsic practice is God-oriented and based on beliefs which transcend the person's own existence. Research shows this form of religious practice to be beneficial. Extrinsic practice is self-oriented and characterized by outward observance, not internalized as a guide to behavior or attitudes. The evidence suggests this form of religious practice is actually more harmful than no religion: Religion directed toward some end other than God, or the transcendent, typically degenerates into a rationalization for the pursuit of other ends such as status, personal security, self justification, or sociability.

The difference between these two forms of religious practice have implications for future research and for the interpretation of all research on religious practice. There is a radical difference between what religious people know to be conversion of the spirit or heart and simply conforming external behavior for its own sake, or for benefits derived from religious behavior.123

William James, professor of psychology at Harvard University in the early 1900s and a pioneer in the psychological study of religious behavior, was the first to make the social science distinction between the two forms of religious practice. Gordon Allport, his successor at Harvard in the late 1960s, concluded: "I feel equally sure that mental health is facilitated by an intrinsic, but not an extrinsic, religious orientation."124

The two orientations lead to two very different sets of psychological effects. For instance, "intrinsics" have a greater sense of responsibility and greater internal control, are more self-motivated, and do better in their studies. By contrast, "extrinsics" are more likely to be dogmatic, authoritarian, and less responsible, to have less internal control, to be less self-directed, and to do less well in their studies.125 Intrinsics are more concerned with moral standards, conscientiousness, discipline, responsibility, and consistency than are extrinsically religious people.126 They also are more sensitive to others and more open to their own emotions. By contrast, extrinsics are more self-indulgent, indolent, and likely to lack dependability. For example, the most racially prejudiced people turn out to be those who go to church occasionally127 and those who are extrinsic in their practice of religion.128 These findings have been replicated129 in a number of different forms.130

The contrasting effects show up in college students. Intrinsically religious students tend to have internal locus of control, intrinsic motives, and a higher grade point average.131 By contrast, a 1980 study indicated that extrinsically religious students were more dogmatic and authoritarian, less responsible and less motivated, had less internal locus of control, and had a lower grade point average. Intrinsically religious students were found to have a greater concern for moral standards and to be more conscientious, disciplined, responsible, and consistent, while the extrinsic were more self-indulgent, more indolent, and less dependable.132

In general, intrinsics are less anxious about life's ups and downs, while extrinsics are more anxious. Further, the religious beliefs and practices of intrinsics are more integrated; for instance, they are more likely to worship publicly as well as pray privately. By contrast, those who pray privately but do not worship publicly tend to have a higher level of general anxiety -- a characteristic of extrinsics generally.133 In an ironic set of findings on anxiety about death, extrinsics fared worst of all: worse than intrinsics and worse than those without religious beliefs.134 From a purely social science standpoint, the intrinsic form of religion is thus good and desirable, and the extrinsic form is harmful. Religious teachers, without being utilitarian, would agree.135

Religion and the Social Sciences

There is a tension between practitioners of social science and religious belief.136 Darwin L. Thomas and Gwendolyn C. Henry, professors of sociology at Brigham Young University, write: "From the work of Freud and others, much of the early history of the social sciences is characterized by the expectation that involvement in and reliance upon the religious institution will be associated with people who have a low sense of personal well-being."137

There is repeated evidence that much the same hostility to religion -- a hostility at variance with the attitude of the vast majority of Americans -- persists among members of America's professional elites.138

Stephen L. Carter, professor of law at Yale University, points out that "One sees a trend in our political and legal cultures toward treating religious beliefs as arbitrary and unimportant, a trend supported by rhetoric that implies that there is something wrong with religious devotion. More and more, our culture seems to take the position that believing deeply in the tenets of one's faith represents a kind of mystical irrationality, something that thoughtful, public-spirited American citizens would do better to avoid."139 However, the available evidence renders such opposition unreasonable.

Professor David Larson of Duke University Medical School draws attention to similar biases in the mental health professions. Consider The Diagnostic and Statistical Manual, the standard reference manual for the classification of mental illnesses, which essentially defines the practice of psychiatrists, clinical psychology, and clinical social work and is central to the practice, research, and financing of these professions. In the third edition, religious examples were used only as illustrations in discussions of mental illness, such as delusions, incoherence, and illogical thinking. The latest edition has corrected this bias.

Consider also the Minnesota Multiphasic Personality Inventory, one of the most widely used of all psychological tests. In the MMPI, all the positive religion-connected traits -- self-discipline, altruism, humility, obedience to authority, conventional morality -- are weighted negatively. Thus, to choose the self-description "I am orthodoxly religious" is to detract from one's mental health standing. Conversely, several traits that religious people would regard as diminishing themselves, at least in some situations -- self-assertion, self-expression, and a high opinion of oneself -- are weighted positively.140 The latest editions of the MMPI have removed the biased items.

Despite this general hostility among social science and mental health professionals, the empirical evidence shows religion to be a very powerful and positive part of everyday life. Patrick McNamara, professor of sociology at the University of New Mexico, explains the difference between social scientists and religiously affiliated people generally: "Sociologists tend to see concern for personal challenge -- e.g. to get one's own moral life in order -- as somehow secondary to social challenge or the effort to identify and criticize those socioeconomic structures that inhibit the individual's own group from attaining a fuller human existence."141 McNamara continues: "In [the] typical social science analysis, the demands of the inner life are neglected and personal agency and autonomy exercised in the choice to examine one's own life and put it in order according to an internalized ethic of repentance... is not acknowledged."142

Despite the attitude of many professionals, Gallup surveys continue to indicate that one-third of the American people regard religious commitment as the most important dimension in their lives. Another third regard religion as a very important, though not the single most dominant, factor in their lives.143

Totally secular approaches to many issues -- public policy, psychotherapy, and education -- use an alien framework for this two-thirds of the population. The plain fact is that religion plays a powerful role in the personal and social lives of most Americans. It is a role that should be understood clearly by the professions, by policymakers, and by the media.

From many other areas of social science research -- family dynamics, group dynamics, marital dynamics -- positive reciprocal relationships with others are known to be powerful across a host of areas similar to those reviewed in this paper: stress, ability to relate with others in general, productivity, and learning, to name just a few. The core of the religious commitment is an intention to have a positive relationship with another Being, a transcendent and therefore all-available Being. Viewed in this fashion, the documented effects of religious commitment are not mysterious, but an extension of the effects which we know arise from positive relations between human beings. Thus, the findings on religion fit with the general corpus of what is known about relationships from the existing body of social science research.

Policy Implications

The evidence indicates strongly that it is a good social policy to foster the widespread practice of religion. It is bad social policy to block it. The widespread practice of religious beliefs is one of America's greatest national resources. It strengthens individuals, families, communities, and society as a whole. It significantly affects educational and job attainment and reduces the incidence of such major social problems as out-of-wedlock births, drug and alcohol addiction, crime, and delinquency. No other dimension of the nation's life, other than the health of the family (which the data show also is tied powerfully to religious practice) should be of more concern to those who guide the future course of the United States.

The original intent of the Founding Fathers was to bar the establishment by the federal government of a state-approved religion, not to bar religion from the operations of the state. Thomas Jefferson made this distinction very clear in the Virginia Statute for Religious Freedom (January 16, 1786):

We, the General Assembly of Virginia do enact that no man shall be compelled to frequent or support any religious worship, place or ministry whatsoever, nor shall be enforced, restrained, molested, or burthened in his body or goods, nor shall otherwise suffer, on account of his religious opinions or belief: but that all men shall be free to profess, and by argument to maintain, their opinions in matters of religion, and that the same shall in no wise diminish, enlarge or affect their civil capacities.144
George Washington summed up the importance of religion to the new nation with particular eloquence in his farewell address:

Of all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports. In vain would that man claim the tribute of patriotism who should labor to subvert these great pillars of human happiness -- these firmest props of the duties of men and citizens. The mere politician, equally with the pious man ought to respect and to cherish them. A volume could not trace all their connections with private and public felicity. Let it simply be asked, Where is the security for property, for reputation, for life, if the sense of religious obligation desert the oaths which are the instruments of investigation in courts of justice? And let us with caution indulge the supposition that morality can be maintained without religion. Whatever may be conceded to the influence of refined education on minds of peculiar structure, reason and experience both forbid us to expect that national morality can prevail in exclusion of religious principle.
'Tis substantially true that virtue or morality is a necessary spring of popular government. The rule indeed extends with more or less force to every species of free government. Who that is a sincere friend to it can look with indifference upon attempts to shake the foundation of the fabric?145

A policy can be friendly to the general practice of religion, and to the many different faiths in a pluralistic society, without in any way implying the establishment of a particular religion. Federal policies encourage many other institutions: the marketplace, education, medicine, science, and the arts. Even religion itself is explicitly encouraged by the tax treatment of contributions to religious institutions. It makes no sense, therefore, not to encourage the resource that most powerfully addresses the major social problems confronting the nation. Congress and the President can help to accomplish this by acting decisively in at least six specific areas:

Congress, and the Senate in particular, should lead a new national debate on the renewed role of religion in American life. With his recent guidance to school administrators on prayer in school, President Clinton has opened the national discussion. The Senate once was the chamber for debate on the great issues of the day. It is time for it to take up that role again on the relationship between the practice of religion and the life of the nation, on the health of America's families and the content of its culture.
America needs a major national debate on the true role of religion in a free and pluralistic society. For many decades, the once-prominent place of religion in society has been eroded. Religious leaders, who should be in the forefront of moral and spiritual renewal, have been cowed into a strange timidity. Americans of religious belief should not be bullied into believing that in all things related to the public good, religion is to remain off limits. The constitutional freedom of religion does not mean the constitutional barring of religion from the public square.

Congress should pass a resolution affirming that data on religious practice are important to the nation, to policymakers, and to the research needed to inform the public debate. The gathering of data that touch on religious practice often is blocked in research on social issues funded by the federal government.146 Because government funds a huge proportion of the nation's funded social research, this has a chilling effect. But the relationship between religious practice and the social issues under investigation by government, such as out-of-wedlock births, crime and delinquency, addiction, economic dependency, medical and psychiatric problems, and learning capacity, should be explored. A sense-of-the-Congress resolution would remove the excuse that it is not permissible for federally funded research to touch on this aspect of life.
Congress should mandate a census question on religious practice. The census for the year 2000 ought to ask about frequency of attendance at church or synagogue. It violates nobody's freedom of religion for Congress to know the level and intensity of religious worship in the United States. Also, many of the annual sample surveys conducted by the Bureau of the Census would be significantly better informed if similar information were gathered in those surveys.
Congress should commission research on the relationship between regular church attendance and social issues. This research should focus on the social issues which continue to increase the burden borne by the American taxpayer, including crime, drug use, health of the elderly, out-of-wedlock births, and poverty.
Congress should fund federal experiments with school choice that include choice of religiously affiliated schools. To deny financial support to parents who cannot afford to send their children to religiously oriented schools is to deny such education to those children who may need it most and confine it to those rich enough to afford it. The United States of America and the now-defunct Union of Soviet Socialist Republics are the only major modern states to deny funding to faith-based schools.
The President should appoint, and the Senate should confirm, judges who are sensitive to the role of religion in public life. Religion should not be crowded out of every activity in which government is involved. And yet, this is precisely what has been happening for the last 30 years as government has encroached more and more on virtually every area of American life: family, school, and marketplace. This does not make sense for any society -- and it has weakened ours.
Columnist William Raspberry has put his finger on the problem. In his historic majority opinion in the 1947 Everson v. Board of Education case (330 U.S. 1), notes Raspberry, Justice Hugo Black wrote that government is forbidden to "pass laws which aid any religion, aid all religion, or prefer one religion over another."

The first and third elements in the Black proscription seem to me to jibe with the "establishment" clause of the Constitution. The middle one suggests that the only proper position of government is hostility to religion -- which seems to be the prevailing view among civil libertarians and a majority of the Supreme Court.147
This calls to mind the words of the late William O. Douglas, one of the most liberal of Supreme Court Justices, who wrote in the 1950s:

We are a religious people whose institutions presuppose a Supreme Being. We guarantee the freedom to worship as one chooses. [When] the state encourages religious instruction or cooperates with religious authorities by adjusting the schedule of public events to sectarian needs, [it] respects the religious nature of our people and accommodates the public service to their spiritual needs. To hold that it may not would be to find in the Constitution a requirement that the government show a callous indifference to religious groups. That would be preferring those who believe in no religion over those who do believe.148
The Senate should ask all future candidates for federal court appointments to clarify their opinions regarding both the role of religion in the life of the body politic and their understanding of the Founding Fathers' intent on this issue.

But this problem is far too important to be left to government. America's religious leaders and individual citizens also must act:

They must draw attention to the enormous and beneficial effects on society of the true practice of religion. As leaders of the nation's religious communities, they should assert their right to be regarded as critical in the nurturing of stable marriages and healthy families. Religion performs the foundational work that ensures the success of secular society's other four basic institutions: family, school, marketplace, and government.
They must emphasize the need for religious formation. While the social works of mercy carried out by religious congregations will be needed more and more to repair the damage from the breakdown of the family, only a religious institution can give a religious orientation to those who are searching for answers to the mysteries of human life: love and suffering in birth, marriage, family life, and death. Religious beliefs help the individual acquire central organizing principles for life and an understanding of God. Aided by this sense and these principles, an individual can avoid the unnecessary suffering that stems from bad choices and attain the benefits that flow from good choices followed steadily through life. Today, schools are forbidden to participate in this critical work. Only religious leaders can provide this all-important service to society.
They must take special care of the religious formation of children at risk of losing their faith in God, especially during the transition period from childhood to adolescence. The empirical research indicates that there is a critical stage in the development of young adults, from around ten years of age through later adolescence, during which they decide whether they will engage in the religious dialogue of searching for ultimate truths and meaning. The young adolescent who turns away from religion at this stage may well lose his anchoring in the community and is at greater risk for a host of problems that can subvert his personal happiness for a lifetime. Increased attention to this aspect of religious ministry will yield great benefits to the nation. Of particular concern to public policy leaders are the problems that plague America's inner cities: out-of-wedlock births, addiction, and crime. These neighborhoods need the benefits of religious belief and practice. They are "mission" territories that beckon loudly.
They must use the ability of inner-city churches, especially black churches, to help low-income African-Americans escape from the degrading culture of inner-city poverty. Many religious leaders, with the best of intentions, have concentrated on the material aspects of their work, forgetting that the most powerful help they can give is in the spiritual dimension, and that this has a significant effect on material well-being. Regular church attendance will do more to help a child get out of poverty than anything else the religious leader can provide. And it will transform the community if most people can be persuaded to become church members.

The available evidence clearly demonstrates that regular religious practice is both an individual and social good. It is a powerful answer to many of our most significant social problems, some of which, including out-of-wedlock births, have reached catastrophic proportions. Furthermore, it is available to all, and at no cost.

America is at a crossroads. Political leaders as diverse as President Clinton, Senate Majority Leader Robert Dole, and House Speaker Newt Gingrich all have articulated popular concerns and fears about the level of the breakdown of American society.149 Almost simultaneously, Americans are becoming aware of the fundamental contribution that married family life and regular religious practice can make to preserving that society.

For the sake of the nation's future health, it is time to redirect public policy so that these two vast resources, instead of being weakened further, can be rejuvenated and encouraged. Many of the goals of social policy and social work can be attained, indirectly and powerfully, through the practice of religion. None of this invalidates education or social work, which operate at a different level of the human condition. However, as demands for social work outstrip (and give every indication of far outstripping) social work resources, it is good to know that the practice of religion is a powerful ally.
The practice of religion is good for individuals, families, states, and the nation. It improves health, learning, economic well-being, self-control, self-esteem, and empathy. It reduces the incidence of social pathologies, such as out-of-wedlock births, crime, delinquency, drug and alcohol addiction, health problems, anxieties, and prejudices.

The Founding Fathers, in their passionate love of freedom, promoted the freedom of all Americans to practice their religious beliefs, but Congress and the courts have crowded religion out of the public square. It is time to bring it back. Religious practice can and should be factored into the planning and debate on the nation's urgent social problems. Americans cannot build their future without drawing on the strengths that come to them from the practice of their religious beliefs.

The widespread practice of religious beliefs can only benefit the nation, and the task of reintegrating religious practice into American life while protecting and respecting the rights of non-practice -- rights that, despite persistent demagoguery on the subject, remain totally unthreatened -- is one of the nation's most important tasks. Academics of good will can do much in this area, and history will look kindly on those who help America achieve this wonderful