The Problem(s) with Federal Health Care
The Catholic Medical Association has sent a pointed message to the Federal government: Back off and start over in planning for the future of health care in America. In a statement released earlier this week, the CMA said that “health-care reform encompasses both individual rights and the common good, ethical issues surrounding life and death, and economic issues ranging from taxes and property to economic competitiveness.” According to CMA’s analysis, all legislation now being considered will make things substantially worse in each of these areas, while doing essentially nothing to improve medical care, even for the poor.
Insurance and Medicaid
Let’s take the last point first. Current House and Senate bills would extend health insurance coverage to those who do not have it by moving them into Medicaid. But Medicaid costs are out of control in most states and some 40% of physicians refuse Medicaid patients because the government reimbursement rates do not even cover overhead costs. At the same time, for those who are already insured, the CMA notes that House bill provisions will make it impossible for any current health insurance plan to survive under Federal control, eliminating the possibility of patients choosing the plans that best match their own values and priorities.
The CMA points out that this problem will be exacerbated by a proposed “public option” which would compete with private health insurance, while in reality it will be impossible for private insurers to compete with a Federal option that can use tax money or increase the deficit to cover costs. The result will be that it will become impossible for citizens to own their own health plans, undermining the dignity of the person and the principle of subsidiarity, both of which are essential to sound health care. In contrast, the CMA advocates programs which will make it easier for people to take ownership of their own health insurance policies, targeting those who cannot currently afford the entire cost.
Speaking of costs, this remains an enormous problem. Current Federal plans address cost only through the exercise of bureaucratic control over the rights of patients and their physicians. These controls would invest enormous power in the Secretary of Health and Human Services (the CMA reports that the Secretary is mentioned 1,120 times in the House bill) and in a new “Health Choices Commissioner”. Even with this approach, the Congressional Budget Office has pointed out that current legislation will increase the costs of health care by billions of dollars, with no way to pay the bill.
The whole question of costs is particularly interesting politically. The Democratic leadership has made no bones about the fact that they have no chance of getting these proposals through unless they can act quickly, while President Obama is still reasonably popular and while the public labors under the illusion that the current recession is exclusively the fault of the private sector (which essentially followed Federal mortgage rules), and that nearly any kind of Federal spending, regardless of debt, will make things better. In the current orchestration of nationalized health care we are, in fact, witnessing one of the most astonishing displays of sheer political opportunism in the nation’s history, with potentially enormous plums in terms of contracts and jobs under political control.
Underlying it all is the same old ideological motivation which has shaped so much of recent American history: Increase Federal control to ensure that sexual license will not be threatened by the need for any woman to bring a child to term. As the CMA observes, White House officials and the Senate HELP Committee have refused to exclude abortion from health-care legislation, an exclusion which is essential if abortion is not to be mandated. CMA President Louis C. Breschi, MD, sounded the alarm: “Few people realize that, as things stand, abortion could be a required benefit in all health insurance plans, and it would be subsidized not only in health-care premiums, but also through taxation.”
As if this is not enough, efforts have been strongly resisted to amend current bills to prohibit the government from forcing health-care providers to perform or participate in abortion. Since the Department of Health and Human Services canceled the Conscious Protection Rule earlier this year, and since the “robust conscience clause” promised in recent comments by President Obama is nowhere to be seen, CMA Executive Director John F. Brehany, Ph.D. warns that “coercing health-care providers to deny their deepest values and ethical commitment to patients’ well-being will harm the medical profession and undermine trust in the provider-patient relationship.”
The Federal Myth
All of this raises a vital question which the CMA statement addresses only indirectly. With respect to life issues, the United States Federal government has demonstrated a fairly consistent immoral ideological bent over the past fifty years, an ideology more or less continuously evident in court decisions and frequently manifested in both Congress and the White House. Therefore, we must ask ourselves why any fundamentally moral person would wish to place medical care in the hands of the Federal government at all?
Perhaps Americans have become so supinely dependent on government over the past few generations that they cannot conceive of any other solution to widespread social concerns than to shift more power to the highest possible governmental level. This knee-jerk reaction, unfortunately often exhibited even by Catholic bishops, amounts to a sort of instinctive violation of the principle of subsidiarity—one of the cornerstones of Catholic social teaching. The principle of subsidiarity, which holds that authority over human affairs should always be vested at the lowest feasible organizational level, is essential to human dignity because it is the only way to preserve the immense good of deep personal involvement in arranging one’s own affairs. As subsidiarity crumbles, tyranny and—in well-organized modern nation states—totalitarianism are the inevitable result. One would think the history of the twentieth century had already made this abundantly clear.
As I indicated above in commenting on health insurance, the Catholic Medical Association is one group that can conceive of solutions which honor subsidiarity. Their idea of targeting particularly needy persons with programs that will make it easier for them to purchase their own health insurance is a good example of the corollary that when there is an otherwise insurmountable obstacle at a lower level, the higher level of government should assist the lower level to be more effective. Thus health decisions should remain in the hands of the person and the family, with local health providers and support programs fully committed to assisting the needy to manage their own health care. The proper role of higher levels of government (i.e., state, federal) is to provide further assistance to targeted groups as needed. The myth that it is better for the Federal government to take over the responsibilities of the person, the family, various intermediary organizations, and lower levels of government is not only ludicrous but damaging to a just, harmonious and energetic social order.
The central message of Benedict XVI’s recent social encyclical Caritas in Veritate directs us to a similar conclusion. In several places, and for several reasons, the Pope states flatly that it is inadequate to think that “creation of wealth could be entrusted to the economy, and then the task of distributing it could be assigned to politics.” This is the classical dialectic of left and right. Let the businessmen pile up wealth; then let the government redistribute that wealth to others. Both the right, which too often sees business in terms of profit alone, and the left, which too often sees the government as a source of blessings it cannot possibly provide, have fallen into a secular trap by attempting to balance each other through this essentially false dichotomy. The Pope says that this “binary model of market-plus-State” is “corrosive of society” (39). Instead:
The canons of justice must be respected from the outset, as the economic process unfolds, and not just afterwards or incidentally. Space also needs to be created within the market for economic activity carried out by subjects who freely choose to act according to principles other than those of pure profit, without sacrificing the production of economic value in the process. The many economic entities that draw their origin from religious and lay initiatives demonstrate that this is concretely possible. (37)
What Benedict calls for is an extension of the spirit of gratuitousness that characterizes God’s relationship with man. Modern man too often feels that he is the author of his own life. This is a consequence of original sin, for the truth is that we have been given nearly everything that is critical to existence, including existence itself, gratuitously, out of the sheer love of God. Hence this “law of the gift” ought to inform all human activity, including economic activity, business activity, market activity:
The great challenge before us, accentuated by the problems of development in this global era and made even more urgent by the economic and financial crisis, is to demonstrate, in thinking and behavior, not only that traditional principles of social ethics like transparency, honesty and responsibility cannot be ignored or attenuated, but also that in commercial relationships the principle of gratuitousness and the logic of gift as an expression of fraternity can and must find their place within normal economic activity. This is a human demand at the present time, but it is also demanded by economic logic. It is a demand both of charity and of truth.
Application to Health Care
Health care is (for the moment) primarily a business in the United States, but like every business imitative it needs to be transformed through the infusion of the “spirit of gratuitousness”. Exactly how this should work must be left to the creative discernment and commitment of those most closely involved. Some of this spirit has already often been activated through free services to the poor, hospital emergency room care, volunteer clinics, and so on. But the law of the gift must be reflected also in medical screening and testing services, hospital bed availability, home care, insurance programs and much more. As the Pope says, the canons of distributive justice must be respected from the outset, as the economic process unfolds, and not just afterwards or incidentally.
There is much to be studied here, much to be rethought, much to be creatively implemented. Every human activity, says Pope Benedict, is a moral activity which must be directed toward the integral development of all the “players” in that activity—owners, employees, customers (such as patients), and the larger society which will be—or ought to be—affected by the activity. This may be a tall order, but it is what healthy societies do. Sadly, our society will never do it as long as our first response to every need is to call in the Feds.
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