Health Care, Catholic Care, and Catholic Culture
Though people differ on the remedy, nearly everyone agrees that health care in the United States is broken. As a company owner who provides top insurance coverage to his employees, I find that health care is not really broken for us. It’s just very expensive. But I hear plenty of horror stories from friends, and the national statistics are nothing to write home about. Several aspects of the problem demand special attention from Catholics.
Clearly one significant issue is the high cost of medical care (and medical insurance), which makes it more difficult than ever for people (and companies) to afford quality care. Moreover, when managed care companies attempt to compete by applying excessive pressure to reduce costs, care suffers dramatically. The anecdotal evidence relating to Kaiser Permanente, for example, suggests that many in that system have found it hard to get timely medical care, despite industry praise for the company’s methods of controlling costs. The largest part of the cost problem, of course, arises from the incredibly high standards of medical care we have come to expect, along with our growing neo-pagan desperation to prolong our lives. For these reasons, the problem of high costs is not likely to diminish any time soon. The main question, then, is how to cover those costs. On this question, Catholics have no special expertise, but they do have a special obligation to seek solutions which incorporate the principle of solidarity.
A second, and far more chilling, issue is the progressive decline in medical ethics as society becomes increasingly pagan. The sexual preoccupations of our culture have led to medical options that shouldn’t exist, and our collective flight from suffering is rapidly leading the elderly and the disabled to fear hospitals and nursing homes. Moreover, in states where assisted suicide is legal, it appears that doctors often gradually lose interest in “walking the walk” with their patients. Instead of treating the suffering and depression which may lead a patient to request suicide, doctors become more prone to accept suicide as an easy and cost-effective solution. There is an excellent article on this topic in the December issue of Catholic World Report entitled “A Remedy for America’s Healthcare Crisis” (not yet available online). A bright spot is that palliative care—the medical specialty which focuses on relief of the pain, symptoms, and stress of serious illness—is on the rise throughout the United States; yet it lags decidedly where assisted suicide is legal. Both moral care and palliative care ought to be great strengths among Catholic health facilities, not only to relieve physical distress but to address effectively the emotional and spiritual aspects of human suffering.
A third aspect of the problem is revealed by the numbers. As of 2007, nearly fifty million Americans were without health insurance coverage of any kind. That’s approximately 15% of the population, or one out of every six people. It would be irresponsible to argue that a nation in which 85% of the citizens have some form of voluntary health insurance is living proof that a broken system cannot be addressed through private coverage. Nor is it correct to assume that even the other 15% can never be treated unless they can pay for it. Nonetheless, the kind of regular medical care the rest of us have come to take for granted is essentially non-existent for a very large number of people whose only recourse is to the nation’s emergency rooms, or to free services provided by charitable groups. If it is a paradox that the Christian emphasis on the supernatural drives believers to serve the needs of others, then it is a paradox worth reinforcing in the field of health care. The Catholic Church in particular, with its highly-organized institutional character (for it is not a mere grass-roots association of the like-minded), has always led the way in providing medical care for the poor. In fact, Catholic acute care facilities, hospitals (557), health centers (417), and specialized homes (1,538) provided care to nearly one hundred million patients in the past year, making the Catholic Church by far the largest non-profit healthcare provider in America.
Erosion and Reclamation of Catholic Culture
While Catholic institutions should and undoubtedly will play a major role in solving the problems of contemporary health care, they are not immune from the three issues I’ve just outlined. Costs are very high even in a not-for-profit setting, and they are relatively higher now than they were in the days when religious orders were effectively devoted to this work. Sadly, practitioners in Catholic hospitals do not always practice medicine according to the teachings of the Church, and those who manage Catholic health care institutions have often failed to make ethical guidelines both clear and uncompromising. Finally, while Catholic institutions have contributed nearly $6 billion in community benefits in the last year, and have also lobbied hard for health care improvements, Catholic institutions obviously don’t reach everybody.
Some of these deficiencies are significantly exacerbated by the erosion of Catholic culture and Catholic values within the Church herself, as she has been adversely affected by the rapid secularization of our culture, especially since the 1960’s. That situation appears to be slowly improving as new religious communities replace old ones (or old ones undergo renewal), as our bishops become more counter-cultural, and as the more spiritually serious laity gradually grope toward something like the role envisioned for them at Vatican II. In fact, the emergence of dedicated lay people as the new leaders of the Church’s leavening of the social order holds considerable promise, as can be seen from successes in both education and pregnancy support over the past generation. That promise is only now beginning to be realized in the field of medical care. Quite apart from whatever national policies may or may not be implemented, a large part of a truly Catholic response to medical and other needs will have to come the old fashioned way, through the formation of culture.
Let me repeat that a large part of the response must come through the formation of culture. If you take this either as a useless generalization or as an enervating attempt to solve real problems by manipulating the abstract concept of “culture”, you couldn’t be more wrong. Culture is, in fact, always and everywhere essentially limited and concrete. New cultures begin to form in very specific ways wherever flashpoints of conflict with an older culture appear. Perhaps the first flashpoint for the rebuilding of a specifically Catholic approach to major cultural problems was education. As early as the 1960’s, parents began to realize that their children were losing their faith under the influence of secularized colleges, universities and even diocesan high schools. Where in the past, Catholic educational foundations had largely been in the hands of the hierarchy or religious communities, during the crisis of faith which dominated the second half of the twentieth century, dedicated lay people began to found elementary schools, high schools, and colleges, as well as to home school their own children. There are now in the United States perhaps a dozen distinctively Catholic colleges and universities, either recently founded or reformed, as well as a number of outstanding lay-run Catholic high schools and many lower schools. To be sure, this is but a drop in the proverbial bucket, and yet pockets of Catholic culture tend to form around all of these schools.
I was involved in the founding of one such project, Christendom College in Front Royal, Virginia, in 1977, and my wife has taught part-time over a period of thirty years at one of the most noteworthy high schools, Seton School, in Manassas, Virginia, which was founded just a little earlier. The presence and impact of Seton School led the late Fr. John Hardon famously to advise: “If you want your kids to be Catholic, move to Manassas.” The effective witness of faculty and administration at such institutions, along with the larger communities formed by the deeply-committed Catholics who take advantage of them, creates an environment which nurtures Faith to stand the test of time. This eventually results in the formation of many other businesses run on Catholic principles, and it immediately causes a veritable explosion of authentic Catholic marriages and fine Catholic families.
Catholic Medical Care
After the legalization of abortion in America in 1973 created a new cultural flashpoint, Catholics were once again very quick to form crisis pregnancy centers to save babies and provide support for women in troubled pregnancies. Most readers are well aware of this effort, so I will pass over it quickly simply to identify it as a second major example of a Catholic response which was actually institutionally embodied. It led to the formation of concrete community entities, not just ideas. This incarnation of Catholic ideas in the concrete circumstances of the social order is the principal building block of culture, and these centers in fact serve as oases of Catholic culture around the entire country. They also serve as the beginning of a revived concept of Catholic medical care, for a large part of their work consists of holistically “treating” the distress associated with pregnancy while also responding to the particular medical needs of the women who seek their help.
In many cases, such an incarnate Catholic response requires a “critical mass” of highly committed Catholics in a specific geographical location. For obvious reasons, good schools tend to be powerful magnets for attracting this critical mass. Along with several other locations in America, Northern Virginia has become something of a Catholic oasis, both because of the large number of “unofficial” Catholic organizations (along with their employees and families) and because of the solidity of the bishops and priests of the Diocese of Arlington since its founding in 1974. It is not surprising, therefore, that Fairfax, Virginia was chosen by Dr. John Bruchalski in 1994 to be the location of a new kind of OB/GYN facility, devoted to a thoroughly Catholic vision of medical care. Bruchalski’s Tepeyac Family Center is not the only visionary, lay-run Catholic medical initiative in the United States, but it is the one I know best, and it does stand as a successful model for others.
During the early struggle to make ends meet, including the stupendous cost of medical malpractice insurance, Dr. Bruchalski eventually decided to incorporate as a non-profit, and to set up an umbrella organization, Divine Mercy Care, to raise funds and foster other related Catholic medical initiatives. For example, the first DMC Pharmacy has opened recently and, because of the high volume of requests for support and information from doctors around the country, there are plans to develop a nationwide resource center on fertility and pregnancy issues. DMC and Tepeyac are enormously popular among Catholics in Northern Virginia, and their annual fundraising gala is always both inspiring and highly successful. Support from the larger community enables the doctors at Tepeyac to provide exemplary OB/GYN care, including emotional and spiritual support, not only to paying customers but to an ever larger number of poor women facing either unwanted or medically-difficult pregnancies. Its team of six physicians and a nurse practitioner is devoted to caring for women regardless of “race, creed, culture, or income level.”
The Incarnation and Catholic Culture
As these new Catholic educational and medical initiatives become more widely known, and as an increasing number of flashpoints emerge in the contemporary culture wars, we can expect lay people to craft uniquely Catholic responses in a wider variety of cultural areas. Some others have already become visible, with varying degrees of success, such as moral investment funds. There are many potentially creative ways to implement such initiatives, but each initiative will be formed by the Catholic incarnational principle. In other words, Christian culture must be expressed as an embodiment—or a series of separate but related embodiments—of the Catholic Faith, which must be incarnated again and again in the concrete social circumstances of each place and period. Moreover, as the laity gain in spiritual strength and as reform takes place in dioceses and religious orders, vocations to the priesthood are beginning to improve in both quality and quantity. Thus the hierarchical Church can be expected to continue its slow process of renewal. Eventually, a significant number of existing institutions should be regenerated from within.
I have mentioned that, in many cases, the success of such initiatives requires a critical mass of committed Catholics in single geographical area. Despite the value I place on the work of CatholicCulture.org, there is something oxymoronic about an online Catholic culture. Whatever Catholic culture we find online will be valuable only insofar as it serves as a support and a catalyst for the concrete transformation of families, parishes, organizations, corporations, institutions and governments in the real world. That transformation has already begun in Catholic education and Catholic medical care, though these current pockets of Catholic culture must be multiplied and expanded before anything like a majority of people will have the opportunity to be touched and similarly transformed. Nonetheless, the work has begun, and some essential features of the process are now fairly clear: Fidelity to Christ, lay leadership, concrete (“incarnational”) implementations, supportive communities, widespread personal sacrifice, and unflinching resolve. That’s the kind of highly specific, muscular effort it takes to create an authentically Catholic culture. We’ve seen that culture begin to take shape already in several important areas. Where will it form next?
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