Change for the Better, Part I
by Fr. Roger Landry - October 2, 2009
In our continuing survey of Catholic analysis of the present health care reform proposals, we turn this week to the most comprehensive analysis to be issued by any of the U.S. Bishops, a joint pastoral statement issued by Archbishop Joseph Naumann and Bishop Robert Finn, the ordinaries of the "two Kansas Cities," the Archdiocese of Kansas City in Kansas and the Diocese of Kansas City-St. Joseph, Missouri.
Their statement is entitled "Principles of Catholic Social Teaching and Health Care Reform" and describes the relevant foundations of the Church's social doctrine, applying them, in very clear language, to the present debate about the reform of health care. Their goal is not to just add two other opinions to the discussion, but to try to ensure that any changes in our health care system lead to "an authentic reform taking full consideration of the dignity of the human person."
They begin their pastoral statement by praising President Obama for making health care reform a priority of his administration and by stressing that the Church's interest in reform is far more than philosophical: one out of every four hospitals in the United States is run by a Catholic agency. They analyze the symptoms of the present inadequacy of our health care policy — the millions without medical insurance, the cost of health care, the pending insolvency of the Medicare Trust Fund, the shift in business practices to hire part-time or unmarried employees in order to minimize the cost burdens for health care, and the difficulties those with pre-existing conditions have in acquiring health care coverage — and note that almost everyone agrees that something must be done to fix it.
They remind us, however, that we have a duty to make sure that change is change for the better. "Change itself does not guarantee improvement," they declare, before adding that "many of the proposals which have been promoted" would in fact be changes for the worse, since they "would diminish the protection of human life and dignity and shift our health care costs and delivery to a centralized government bureaucracy." Effective health care reforms, on the other hand, "must be built on a foundation of proper moral principles." They affirm that the "rich tradition of Catholic social and moral teaching" is an excellent guide to guide the evaluation of the various health care reform proposals and remind the faithful that "no Catholic in good conscience can disregard these fundamental moral principles."
They present four such principles, the first two of which we will consider today.
The first is subsidiarity, "the principle by which we respect the inherent dignity and freedom of the individual by never doing for others what they can do for themselves and thus enabling individuals to have the most possible discretion in the affairs of their lives." This is one of the bedrock foundations of Catholic social teaching in general, but one which has not yet gotten sufficient application to the present health care debate, including in some Catholic circles.
With respect to health care, subsidiarity requires that "health care ought to be determined at the lowest level rather than at the higher strata of society." Recourse should be had to higher levels of government, it teaches, only when lower levels are incapable of meeting the needs. Therefore, a health care plan administered by the federal government should be used only as a last resort, when it has been shown that medical needs cannot be met by other means.
The bishops describe the dangers of the failure to observe the principle of subsidiarity by turning to the authoritative and ardent teachings of the recent popes. They first invoke Pope John Paul II, who described from personal experience the anthropological and economic dangers of the welfare state in general in his 1991 encyclical Centesimus Annus. "By intervening directly and depriving society of its responsibility," the pope wrote, "the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients, and which are accompanied by an enormous increase in spending." They next turn to Pope Benedict who elaborated on the dangers of the neglect of the principle of subsidiarity to health care in particular in his 2005 encyclical Deus Caritas Est: "The State that would provide everything, absorbing everything into itself, would ultimately become a mere bureaucracy incapable of guaranteeing the very thing which the suffering person — every person — needs: namely, loving personal concern. We do not need a State that regulates and controls everything, but a State which, in accordance with the principle of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need."
Violation of the principle of subsidiarity, therefore, leads in practice to continual violations of human dignity by making services far less personal and dependent on personal freedom and responsibility. That's why Archbishop Naumann and Bishop Finn declare that "it is vital to preserve, on the part of individuals and their families, the right to make well-informed decisions concerning their care. This is why some system of vouchers — at least on a theoretical level — is worthy of consideration. Valuing the right of individuals to have a direct say in their care favors a reform which, reflecting subsidiarity, places responsibility at the lowest level" — rather than, one can infer, at the level of the Department of Health and Human Services in the nation's capital.
The second principle they articulate is that "the life and dignity of the human person" must be the "driving force for care and the constitutive ground of human justice." Here the bishops reiterate, first, that it is "imperative" that any health care reform package "keep intact our current public polices protecting taxpayers from being coerced to fund abortions." They say that it is "inadequate" to propose legislation "that is silent on this morally crucial matter," precisely because of "the penchant of our courts over the past 35 years to claim unarticulated rights." They call for "explicit exclusion" of any vehicle to cover abortion services. An amendment to do just that has been under discussion this week in the U.S. Senate. Archbishop Naumann and Bishop Finn also state that in accordance with the dignity of health care workers and institutions, there must be clear protections for the "rights of conscience for individuals and institutions" so that they do not have to participate in procedures that violate their conscience.
Finally, they reaffirm that, flowing from human dignity, there is a "right to acquisition of health care," especially for those who, through no fault of their own, are unable to work. They make, however, two important clarifications: first, that "the right of every individual to access health care does not necessarily suppose an obligation on the part of the government to provide it;" and second, that "in our American culture, Catholic teaching about the 'right' to healthcare is sometimes confused with the structures of 'entitlement.'" After making these clarifications, they forcefully state: "The teaching of the Universal Church has never been to suggest a government socialization of medical services. Rather, the Church has asserted the rights of every individual to have access to those things most necessary for sustaining and caring for human life, while at the same time insisting on the personal responsibility of each individual to care properly for his or her own health."
They add that this erroneous sense of "entitlement" has clearly contributed to the present health care crisis. "Part of the crisis in today's system stems from various misappropriations within health care insurance systems of exorbitant elective treatments, or the tendencies to regard health care services paid for by insurance as 'free,' and to take advantage of services that happen to be available under the insurance plan. Such practices may arguably cripple the ability of small companies to provide necessary opportunities to their employees and significantly increase the cost of health care for everyone." They imply that health care reform needs to happen not just in congressional corridors but in every home.
We will take up third and fourth principles they describe — solidarity and the obligation to the common good — next week.
Father Roger J. Landry is pastor of St. Anthony of Padua in New Bedford, MA and Executive Editor of The Anchor, the weekly newspaper of the Diocese of Fall River.
