Seeking ethical health care reform

Health Care Reform

Used with permission from Bishop Walker Nickless, Sioux City, Iowa

The current national debate about health care reform should concern all of us. There is much at stake in this political struggle, and also much confusion and inaccurate information being thrown around. My brother bishops have described some clear “goal-posts” to mark out what is acceptable reform, and what must be rejected.

First and most important, the Church will not accept any legislation that mandates coverage, public or private, for abortion, euthanasia, or embryonic stem-cell research. We refuse to be made complicit in these evils, which frankly contradict what “health care” should mean. We refuse to allow our own parish, school, and diocesan health insurance plans to be forced to include these evils.

As a corollary of this, we insist equally on adequate protection of individual rights of conscience for patients and health care providers not to be made complicit in these evils. A so-called reform that imposes these evils on us would be far worse than keeping the health care system we now have.

Second, the Catholic Church does not teach that “health care” as such, without distinction, is a natural right. The “natural right” of health care is the divine bounty of food, water, and air without which all of us quickly die. This bounty comes from God directly. None of us own it, and none of us can morally withhold it from others.

The remainder of health care is a political, not a natural, right, because it comes from our human efforts, creativity, and compassion. As a political right, health care should be apportioned according to need, not ability to pay or to benefit from the care. We reject the rationing of care. Those who are sickest should get the most care, regardless of age, status, or wealth. But how to do this is not self-evident. The decisions that we must collectively make about how to administer health care therefore fall under “prudential judgment.”

Prudential and just concerns

Third, in that category of prudential judgment, the Catholic Church does not teach that government should directly provide health care. Unlike a prudential concern like national defense, for which government monopolization is objectively good — it both limits violence overall and prevents the obvious abuses to which private armies are susceptible — health care should not be subject to federal monopolization. Preserving patient choice (through a flourishing private sector) is the only way to prevent a health care monopoly from denying care arbitrarily, as we learned from HMOs in the recent past.

While a government monopoly would not be motivated by profit, it would be motivated by such bureaucratic standards as quotas and defined “best procedures,” which are equally beyond the influence of most citizens. The proper role of the government is to regulate the private sector, in order to foster healthy competition and to curtail abuses. Therefore any legislation that undermines the viability of the private sector is suspect. Private, religious hospitals and nursing homes, in particular, should be protected, because these are the ones most vigorously offering actual health care to the poorest of the poor.

The best way in practice to approach this balance of public and private roles is to spread the risks and costs of health care over the largest number of people. This is the principle underlying Medicaid and Medicare taxes, for example. But this principle assumes that the pool of taxable workers is sufficiently large, compared to those who draw the benefits, to be reasonably inexpensive and just.

This assumption is at root a pro-life assumption! Indeed, we were a culture of life when such programs began. Only if we again foster a culture of life can we perpetuate the economic justice of taxing workers to pay health care for the poor. Without a growing population of youth, our growing population of retirees is outstripping our distribution systems. In a culture of death such as we have now, taxation to redistribute costs of medical care becomes both unjust and unsustainable.

Moral obligation to provide care

Fourth, preventative care is a moral obligation of the individual to God and to his or her family and loved ones, not a right to be demanded from society. The gift of life comes only from God; to spurn that gift by seriously mistreating our own health is morally wrong. The most effective preventative care for most people is essentially free – good diet, moderate exercise, and sufficient sleep. But pre-natal and neo-natal care are examples of preventative care requiring medical expertise, and therefore cost; and this sort of care should be made available to all as far as possible.

Within these limits, the Church has been advocating for decades that health care be made more accessible to all, especially to the poor. Will the current health care reform proposals achieve these goals?

The current House reform bill, HR 3200, does not meet the first or the fourth standard. As Cardinal Justin Rigali has written for the USCCB Secretariat of Pro-life Activities, this bill circumvents the Hyde amendment (which prohibits federal funds from being used to pay for abortions) by drawing funding from new sources not covered by the Hyde amendment, and by creatively manipulating how federal funds covered by the Hyde amendment are accounted. It also provides a “public insurance option” without adequate limits, so that smaller employers especially will have a financial incentive to push all their employees into this public insurance.

This will effectively prevent those employees from choosing any private insurance plans. This will saddle the working classes with additional taxes for inefficient and immoral entitlements. The Senate bill, HELP, is better than the House bill, as I understand it. It subsidizes care for the poor, rather than tending to monopolize care. But, it designates the limit of four times federal poverty level for the public insurance option, which still includes more than half of all workers. This would impinge on the vitality of the private sector. It also does not meet the first standard of explicitly excluding mandatory abortion coverage.

I encourage all of you to make you voice heard to our representatives in Congress. Tell them what they need to hear from us: no health care reform is better than the wrong sort of health care reform. Insist that they not permit themselves to be railroaded into the current too-costly and pro-abortion health care proposals. Insist on their support for proposals that respect the life and dignity of every human person, especially the unborn. And above all, pray for them, and for our country.