Part I. A Catholic Vision of Health Care
by Eric Brown & DarwinCatholic
The rich body of Catholic social teaching provides the faithful with moral principles to guide their thoughts and actions in political life. All too often, however, discussion of the Church’s social teaching is hijacked by a partisan political agenda — with the elements that seem to agree with one’s own party emphasized and all else ignored in order to give the stamp of Church approval to one’s party of choice. This deprives American Catholics of a meaningful analysis and reflection over the wisdom of the Church. This could not be more true on any subject than on health care.
The American bishops in Faithful Citizenship remind Catholics that “affordable and accessible health care is an essential safeguard of human life and a fundamental human right. With an estimated 47 million Americans lacking health care coverage, it is also an urgent national priority. Reform of the nation’s health care system needs to be rooted in values that respect human dignity, protect human life, and meet the needs of the poor and uninsured, especially born and unborn children, pregnant women, immigrants, and other vulnerable populations.” The Bishops also state that “religious groups should be able to provide health care without compromising their religious convictions.”
This is an often heated, passionate debate. It remains clear, however, from the American Catholic bishops that, “…although choices about how best to respond to these and other compelling threats to human life and dignity are matters for principled debate and decision, this does not make them optional concerns or permit Catholics to dismiss or ignore Church teaching on these important issues.” In other words, there is a clear and identifiable problem before us, which mandates a public dialogue and a just solution.
Yet, the very phrase “just solution” is loaded and not self-explanatory. In the American situation, there is scarcely an industry or person left without something at stake in the shaping of the health care system — whether it is hospitals and providers, insurance companies, drug companies, businesses and employers co-paying for their employees, religious and private institutions, non-profit organizations, or most importantly, American families. So what exactly does a “just solution” entail?
The Catechism of the Catholic Church list health care among the basic human needs which a society should help its members attain:
“Life and physical health are precious gifts entrusted to us by God. We must take reasonable care of them, taking into account the needs of others and the common good. Concern for the health of its citizens requires that society help in the attainment of living-conditions that allow them to grow and reach maturity: food and clothing, housing, health care, basic education, employment, and social assistance (2288).
Catholic social teaching is still comparatively in its infancy, finding its first clear expression under Pope Leo XIII in the 1890s, as the papacy (so recently divested of its temporal rule over the papal state and accepting its place as a strictly spiritual and moral authority) struggled to provide a clear application of Catholic moral and social teaching to the unprecedented turmoil society was undergoing as a result of the latter stages of the industrial revolution and the beginnings of a true mass society.
In respectful disagreement with the U.S. Catholic bishops, it is difficult to argue that health care is a “fundamental right” either theologically or philosophically — at least in the sense which the phrase has traditionally been used. Health care is not per se natural, therefore, not a natural inalienable right. Health care is no more a “right” than education is a “right”, in the sense that it is not something which one naturally possesses and only lacks to the extent someone takes it away. However, given its availability in the modern world, heath care is certain a basic human need and a prerequisite for a flourishing society — it is not a mere product or commodity — and therefore it is a national interest and a vital area of public policy. Further, one might argue that health care is a “civil right” in an affluent society, in that there is no reason as to why anyone should be unjustly denied basic health care.
The Compendium of Catholic Social Doctrine often talks about health care in terms of two vital principles: (1) preferential option for the poor and (2) solidarity. The means to achieve this goal is at the forefront of the debate. How much of a role, if any, should the government have in this regard? The Catechism seems to suggest that the government does have a role in societal affairs, though not without limits. The principal task of the state is to “guarantee…security” so that the people can work efficiently and honestly and enjoy the fruits of their labor.
Another task of the state is that of overseeing and directing the exercise of human rights in the economic sector. However, primary responsibility in this area belongs not to the state but to individuals and to the various groups and associations which make up society” (2431)
This latter point re-emphasizes the primacy of the principle of subsidiarity. Yet, for the sake of justice, “political authority has the right and duty to regulate the legitimate exercise of the right to ownership for the sake of the common good” (2406). The State can intervene to ensure respect for the universal destination of goods, particularly to those lacking. However, again, taking principles set forth at their word, this activity by the State cannot be arbitrary or in direct violation of the principle of subsidiarity.
In light of these principles, The Catholic Health Association of the United States broadly outlines a conceivable “health care system” that is in conformity with Catholic social teaching. First and foremost, any health care system must be one that “truly promotes the nation’s well-being and respects the dignity of every person.”
CHAUSA believes that the nation’s health care system must be reformed for the following reasons:
Human dignity
Because each person is created in the image of God, each life is sacred and possesses inalienable worth. Health care is essential to promoting and protecting the inherent dignity of every individual from conception to natural death.Concern for the poor & vulnerable
The moral measure of society is how it treats the poor and vulnerable, who are particularly marginalized by a lack of access to health care.Justice
Health care is a basic human right alongside food and shelter, all of which are necessary for individuals to participate fully in society.Common good
The health and well-being of each person is intertwined with the health and well-being of the broader community. Access to health care is an essential element contributing to the common good alongside others such as education, employment and a safe environment.Stewardship
Our societal resources are finite, and we must make wise choices for how they are allocated. Health care resources should focus on the well-being of the community and be structured to deliver the care that is most medically beneficial and promotes public health.Pluralism
The health care system should allow and encourage involvement of the public and private sectors including voluntary, religious and not-for-profit organizations, and it should respect the religious and ethical values of patients and health care providers alike.
What does this health care system look like?
Available and accessible to everyone, paying special attention to the poor and vulnerable
- Ensure that each person has a core health benefit package covering services across the life span of care.
- Deliver the same level and quality of care to everyone without limits or variations based on age; race; ethnicity; financial means; or health, immigration or employment status.
Health & prevention oriented, with the goal of enhancing the health status of communities
- Make preventive care a core part of health benefits in every community and develop provider and patient incentives that reward prevention.
- Improve health literacy and education to help patients play a greater role in maintaining their own health and wellness.
Sufficiently and fairly financed
- Share the responsibility of financing among all stakeholders.
- Care for those who cannot help themselves by having all stakeholders, including government, employers, individuals, charitable organizations and health care providers, collectively assume responsibility.
Transparent and consensus-driven in allocation of resources, and organized for cost-effective care and administration
- Manage cost growth to promote affordability and sustainability; efficiently use facilities, equipment and services; minimize administrative expenses.
- Spend resources on care that is most medically beneficial.
Patient centered and designed to address health needs at all stages of life, from conception to natural death
- Ensure that services are coordinated and integrated all along the continuum of care — the system should be truly accountable for health outcomes.
- Design palliative and end-of-life care to ensure the best and most compassionate treatment for persons with serious, complex diseases and those in the final stages of life.
Safe, effective and designed to deliver the greatest possible quality
- Standardize and expand the use of information technology to improve clinical coordination, reduce medical errors and improve the patient experience.
- Use evidence-based medicine to optimize outcomes and quality; prioritize patient safety by minimizing the systemic causes of errors.
Without question, this is not the Catholic vision of health care, but it is at least a Catholic vision for possible reform. As Catholics and American citizens, we would do well to think a good deal over the next few months about what sort of health care reform would be beneficial (or at least acceptable) from a Catholic point of view, because it seems increasingly clear that the Obama Administration and the Democratic-majority Congress will be moving to draft a significant health care reform package this year. If we find ourselves with nothing more constructive to say than “yes” or “no” we are likely to find ourselves used or ignored by those who are clear on what their goals for American health care are.
From a Catholic point of view it would seem that any new system must be built on an ethical foundation; be respectful of both subsidiary institutions and solidarity with those most in need; and include a proper understanding of life, death, human sexuality, and bioethics. In the following posts in this series, we will seek to provide a diversity of Catholic views on addressing the health care issue, both in general terms and as regards the initiatives currently making their way forward in Congress.
The American Catholic 
How do you fairly finance this? Does having health care providers share in this financing include pay cuts? How do individuals contribute to this fair financing? Do the poor have to contribute something to this?
I might also suggest that Blackadder’s understanding of rights from a Catholic perspective is a good place to begin understanding this question. How is health care as a right to be approached from the perspective of Catholic Social Teaching.
heath care is certain a basic human need and a prerequisite for a flourishing society
This is, I think, pretty much all the Church means when it calls something like health care a right (it certainly doesn’t mean this in the Lockean sense of rights common to American political understanding).
Here is the bottom line – it is an intolerable cruelty when, in this day and age, with technology and wealth at our disposal, when practically anyone in America can have their every whim or pleasure satisfied by a cheap consumer good, that a single person should die or suffer because they ‘didn’t have enough money’ to pay for health care.
When this happens it shows quite clearly what our priorities are – making sure everyone can be ‘free’ load up on limitless quantities of poison, but not free to seek out the cures to those poisons.
This, friends, is why I hate consumerism and the economy that drives it. I don’t even think we can address widespread healthcare problems such as obesity and all of its related ailments, or psychological disorders, or even cancer and heart disease, without addressing unscrupulous production and consumption.
After all, it is going to get even more expensive in the future. Think about it – with schools failing in many states, companies like McDonalds move in to pick up the tab, provided, in true Sopranos like fashion, that they get to peddle their disgusting ‘food’ to young children. Childhood obesity is on the rise; children are developing health problems and mental problems at younger and younger ages. Now we are looking at entire lifetimes of dependence upon treatments that should have never been needed.
All for what? Because we refuse to say ‘enough’. Sacred ‘freedom’ will not be satisfied until we are submerged in head to toe with the overwhelming temptations of every vice, mass produced, limitless in supply, and beamed at us every waking hour of the day through commercials, their success rate increased in proportion to how weakened we are by the garbage we have already consumed.
I honestly don’t know what the answer is.
Even in the system described above people will die from lack of health care. In the system described above it will be because certain procedures are denied or rationed.
Even in the system described above people will die from lack of health care. In the system described above it will be because certain procedures are denied or rationed.
Quite right. The advantage of a so-called universal system (if advantage is the right word) is that it creates the illusion that this doesn’t happen.
Joe,
Here is the bottom line – it is an intolerable cruelty when, in this day and age, with technology and wealth at our disposal, when practically anyone in America can have their every whim or pleasure satisfied by a cheap consumer good, that a single person should die or suffer because they ‘didn’t have enough money’ to pay for health care.
I think the answer here is basically: junk is much cheaper to produce than health care.
There are clearly two very different problems to deal with here, one is making sure that everyone is able to easily get access to the sort of basic health care which is incredibly cheap and easy for us to provide in the modern world and can help to reduce mortality to rates which are incredibly low by world standards. We’re not quite there yet, but it’s doable.
However, there’s a much more difficult question which I don’t think has very simple answers, which has to do with how much of the incredibly expensive kinds of health care to provide and how. If you’ve ever had a relative with an unusual form of cancer, you’ll see that huge, huge numbers of man hours go into developing treatments which provide people with somewhere from a few more months to a few more years worth of life. (And rarely, even complete remissions.) Tens or hundreds of thousands of man hours go into developing treatments for forms of cancer that perhaps a few hundred people have at a time. Getting the treatment can involve weeks of in patient care. And the benefits achieved are very mixed.
I’m not at all clear that any society can promise to give everyone that kind of treatment — certainly most countries with centralized health care systems don’t. Yet allowing those who have the money (personally or through some kind of insurance) to get that kind of care leads to the development of treatments that are affordable and efficient.
Darwin Catholic:
I’ll just drop in to say very briefly “great post!”, as there is quite much food for thought therein!
I only say briefly since if I were to engage the matter even more intimately, I would have to address the standard anti-Capitalist screed that a certain of your members seems remarkably wont to exhibit and, indeed, overindulges time & again in saecula saeculorum.
Never mind the fact that as even Michael Novak had rightly put it in his book The Spirit of Democratic Capitalism:
“Of all the systems of political economy which have shaped our history, none has so revolutionized ordinary expectations of human life — lengthened the life span, made the elimination of poverty and famine thinkable, enlarged the range of human choice — as democratic capitalism.”
The invention of the market economy in Great Britain and the United States more profoundly revolutionized the world between 1800 and the present than any other single force. After 5,000 years of blundering, human beings finally figured out how wealth may be produced in a sustained and systematic way. In Great Britain, real wages doubled between 1800 and 1850, and doubled again between 1850 and 1900. Since the population of Great Britain quadrupled in size, this represented a 1600 percent increase within one century.”
At its founding, the United States of America was at least as poor as the colonies of Spain in Latin America. These two Americas, North and South, equally colonies, and equally underdeveloped, were founded upon radically different ideas of political economy. The one attempted to recreate the political-economic structure of feudal Spain . . . the other attempted to establish a new order based on ideas never before realized in human history.”
If we are to protest the Evil that is Capitalism, might as well express equal abhorrence for even the vast array of other substantial benefits that had arisen which in fact have greatly enriched not only the prominent standing of our own nation and the lives of its citizens but other various peoples’ own lives as well, which I take it is but one of those other deplorably wicked manifestations of such an apparently ungodly system!
At any rate, anybody know what’s the address to the Socialist Party, USA?
I thought Blackadder made a very good point about the Swedish system the other day — about how it guarantees that everyone will have the same level of care, unless they pay for more, in which case… Well actually, not it doesn’t guarantee everyone gets the same level of care. 😉
This is where I (and this is why I’ll be in on the series to provide the conservative voice) think there needs to be a very clear distinction between the basic need to make sure that a minimum level of medical care (which is cheap and standard) is available to everyone, with subsidizing where needed, and the level of care which is clearly not basic.
Also, I think there’s far too much of reform advocates trying to gain support for their proposals by lumping in a bunch of middle class people who don’t need the proposal rather than coming up with a highly means tested system. One might almost think it was a cynical attempt to gain political support for the measures…
My difficult comes in defining what on earth “basic” means. I have a friend who’s decided that it was cheaper to go to college another year and pick up another major because she could keep the student health plan that covered shots for her very bad case of psoriasis. It’s expensive but she clearly needs it to function at a normal level.
I think if we start defining basic in terms of cost (like Darwin’s mentioned cheap & standard) we will not achieve a just health care system.
e,
There’s obviously a technological component as well, but I think Novak has a good overall point about democratic capitalism.
Along the lines of what you mention in regards to US history versus Central and South American — a history professor friend of mine was pointing out a while back that at the same time that Britain and other European countries were providing much of the investment financing for the US trans-continental railways, they were investing heavily in railways in Argentina. He argued that the who were seen as equally good bets to be the next world class emerging economy at the time — though in retrospect its obviously hard to see how people could have imagined such a thing. Arguably, it was primarily the cultural differences which resulted in the divergence.
Ironically, I think there’s a better case for the government providing (funding for) non-basic health care than for basic care. That is, I think it might make sense for the government to cover people’s spending beyond a certain threshold (say, 10-15% of one’s income) while leaving people to fend for themselves below that amount (if you want to adjusted the thresholds and/or provide some financial support for the poor in the form of vouchers below this level, that’s fine too).
http://graphs.gapminder.org/world/
This may contribute to the discussion. Enjoy.
Michael Denton,
I’d agree that there’s an element of need as well as cost which has to be dealt with justly — but at the same time cost is a pretty good indicator of the time and resources that go into something. And so long as we hold that we need to give just wages to people who work in health care, there comes a point where we have to start asking ourselves where to draw the line on cost. (Arguably, that’s one of the main purposes of statist solutions — they can cost ration without it seeming to be “all about money” since everyone is theoretically treated equally.)
at the same time that Britain and other European countries were providing much of the investment financing for the US trans-continental railways, they were investing heavily in railways in Argentina. He argued that the who were seen as equally good bets to be the next world class emerging economy at the time — though in retrospect its obviously hard to see how people could have imagined such a thing.
Argentina was actually richer than the United States up until the Great Depression (not sure on the exact date that we surpassed them). The divergence, I think, had less to do with culture than with bad policy on the part of the Argentinian government (e.g. the belief that the proper lesson from the 1930s was that autarky was the way to go).
Ironically, I think there’s a better case for the government providing (funding for) non-basic health care than for basic care. That is, I think it might make sense for the government to cover people’s spending beyond a certain threshold (say, 10-15% of one’s income) while leaving people to fend for themselves below that amount (if you want to adjusted the thresholds and/or provide some financial support for the poor in the form of vouchers below this level, that’s fine too).
To be clear on what I was getting at here:
I’d say that there’s a clearer need for society to make sure that each and every member has access to basic healthcare. For most people, this should be easily affordable, but where it’s not affordable I’d say there’s a strong case for government intervention.
Beyond a certain point, you get into rarely needed treatments that practically no one can afford on their own. I’d say there’s certainly a need for some sort of collective institutions to get large groups of people together to spread risk and cost in these instances, but I’m rather less sanguine about the government being the answer here.
It does appear that we spend, as a nation, some incredibly large amount of money (% of GNP), twice that or more in some cases of nations that have universal health care. It’s a money making business, no doubt about that.
Of course, I have some personal stake in this (as many find out when someone in their family has a severe or chronic condition, and so goes their retirement funds, despite their “wonderful” insurance). But you know, your friends will organize fund raising efforts. Happens where I live all the time. For police officers, for co-workers, for all sorts of folks who are well-insured.
God forbid that you have a pre-existing condition (or if you have just had a blood test or if you have mentioned anything related to any possible ailment, and your doctor has written this down), because you will not be getting insurance. Go to your state website. They will provide you with “high risk” insurance, if you have $1000.00 a month to spare (as in my state). With a waiting period, of course. Have COBRA? Hope you have $800.00 or so to spare a month, even though you may be too sick to work and have used up all your sick days. Hope you’re not sick too long, because you can’t carry COBRA forever.
Is our health care system a dreadful mess? I will personally attest to this.
Do I know how to fix it? Not a clue.
I think, had less to do with culture than with bad policy on the part of the Argentinian government (e.g. the belief that the proper lesson from the 1930s was that autarky was the way to go).
At the risk of sounding culturally triumphalist: Might it not be argued that some of the background for this bad decision making could be found in the relative political cultures of the British Empire versus the Spanish Empire?
Might it not be argued that some of the background for this bad decision making could be found in the relative political cultures of the British Empire versus the Spanish Empire?
Could be. I don’t think its a coincidence that all six Anglosphere countries are among the world’s oldest democracies, and that the same six are also all among the ten most economically free countries in the world (with former Brit colonies Hong Kong and Singapore taking two of the other places). On the other hand, Argentina did do well for quite a while.
Blackladder et al,
Re historic Argentina I invite you to check out the link I provided ( http://graphs.gapminder.org/world/ ). I encourage you to play with it for a few minutes. I think you will find it worth your while.
I don’t suppose it is a coincidence that Britain’s wealth was sustained by a bloody imperialist policy and slavery for several centuries, either.
I don’t suppose it is a coincidence that Britain’s wealth was sustained by a bloody imperialist policy and slavery for several centuries, either.
…as opposed to the Spanish? And how does that explain the current prosperity of these countries, which was the topic being discussed?
Mike,
That is a really cool site. (Couldn’t get it to work in IE at first, but now in Firefox I’ve got it humming.)
Actually, Joe, you might find it very interesting.
I think most of Britain’s wealth Joe came from political stability after 1745 and being the first nation to go through the Industrial Revolution. Slavery of course was abolished in the British Empire in 1833, before the British Empire gained its greatest extent. As to the contribution of the Empire to Britain’s wealth that is a hotly contested subject. I think the Empire was of some importance in the 18th to the mid 19th century as a net plus to the wealth of Britain, but that by 1900 the empire was no longer a plus and by 1920-30 the Empire was a drain on Britain’s resources. Of course this is merely a replay of the debate between the Little Englanders, the anti-Imperialists, and the Imperialists in England from 1900 to the dissolution of the Empire. I think it is significant that Britain’s fortunes declined precisely at the time that the Empire gained its widest extent following WWI.
Quite frankly, the principle of socialized medicine is quite popular with the Brits.
The NHS there costs roughly around 9% of the UK’s GDP while US healthcare costs a more substantially 15% of GDP.
In light of this, (though admittedly overly simplified) the average family in the UK pays a nearly punitive 9% for health as opposed to the US 15%.
Yet, while the principle of a socialized health system is remarkably agreeable even to the most conservative of Brits, things like quality of service & method of administration still predominantly plagues the system (at least, what’s been my impression according to various reports).
Quite frankly, the principle of socialized medicine is quite popular with the Brits.
The NHS there costs roughly around 9% of the UK’s GDP while US healthcare costs a more substantially 15% of GDP.
In light of this, (though admittedly overly simplified) the average family in the UK pays a nearly punitive 9% for health as opposed to the US 15%.
Yet, while the principle of a socialized health system is remarkably agreeable even to the most conservative of Brits, things like quality of service & method of administration still predominantly plagues the system (at least, what’s been my impression according to various reports).
P.S. – Sorry, forgot to tell you great post!