ObamaCare and Catholic social teaching

The 9/2/09 issue of the Wall Street Journal, in its Notable and Quotable feature,  calls attention to an important article that Roman Catholic Bishop R. Walker Nickless of Sioux City, Iowa, published in his diocesan newspaper on the subject of health care and health care reform.  The article is important for two reasons: first, because there has been and continues to be a certain amount of confusion regarding Catholic social teaching as it affects health care; second, because Bishop Nickless goes to great lengths to base his discussion on principles, and not merely on tactical considerations.

Bishop Nickless begins by noting the importance of the ongoing debate over proposed reforms of our health care system:

"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."

After further noting particular concerncs for Catholic hospitals and health care professionals -- the possibility that the Government would attempt to force them to act in violation of Catholic teaching as well as in violation of their consciences--Bishop Nickless concludes:

"A so-called reform that imposes these evils on us would be far worse than keeping the health care system we now have."

However, Bishop Nickless doesn't stop here.  He goes on to enunciate several additional considerations of great importance.  The bishop's second point gets to the heart of the role that government should play in health care:

"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."

In other words, provision of health care must ultimately rest on prudential considerations that affect an entire society. Broad assertions of generalized "rights" without reference to underlying prudential considerations are not helpful. The relevant considerations include need, but also cost.  Another important prudential consideration, however, is this: who should be the main provider of health care, government or the private sector?  Bishop Nickless insists that health care provision is not only not a central concern of government as such, it is also likely to introduce harmful economic and policy distortions:

"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."

Clearly, there is much that could be said on this score.  Nevertheless, Bishop Nickless' reflections are an excellent starting point for any constructive discussion of these important issues.  Bishop Nickless places his own considerations in the context of demographic considerations:

"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.  ...  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."

I, personally, would suggest that further consideration needs to be given to the entire notion of taxation to redistribute costs.  Obviously, this occurs in many areas of our politics: national defense, public works, etc.  Just as obviously, when joined to false notions of "natural rights," and a failure to consider the human dignity that and emphasis on individual responsibility fosters, the redistributive use of taxation has led to many controversial and even "unjust" abuses of the government power to tax (my quotes refer to Bishop Nickless' words, above).  The power to tax is, after all, the power to destroy, and that destruction can have not only economic consequences but moral consequences as well.  Bishop Nickless appears to assume that Medicaid and Medicare were, initially in any event, established on a sound principle.  Without getting into the the particulars, which are far beyond my expertise, I think that is an area that would needs to be closely reexamined before moving on to adoption of any new reforms.

That Bishop Nickless is open to such discussions, and that the considerations involved are central to Catholic social teaching, becomes apparent from the bishop's final point.  That point addresses the whole issue of preventive care which, as several recent studies have shown, can actually greatly increase health care costs.  Bishop Nickless places the primary responsibility squarely on the individual:

"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."

The caveat "as far as possible" is a strong indication that Bishop Nickless, in the context of Catholic social teaching, does indeed recognize that cost is an important part of the entire health care equation.  No society can morally devote an endlessly increasingly portion of its resources to a poorly structured health care system, while ignoring the long term financial health of its future generations.

Having enunciated these four principles and their related goals, Bishop Nickless asks the all-important question: "Will the current health care reform proposals achieve these goals?"  His answer is a firm: No.  Not only would all current House and Senate proposals introduce government subsidized abortion (and likely several other morally objectionable features), but these proposals would strike at the heart of private sector health care provision.  The House proposal

"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."

And the Senate proposal would also "impinge on the vitality of the private sector" through various provisions.

Bishop Nickless' resounding conclusion:

"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.

Bishop Nickless' article begins at http://www.scdiocese.org/ and continues at http://www.scdiocese.org/Stewardship/healthcare/tabid/416/Default.aspx
The 9/2/09 issue of the Wall Street Journal, in its Notable and Quotable feature,  calls attention to an important article that Roman Catholic Bishop R. Walker Nickless of Sioux City, Iowa, published in his diocesan newspaper on the subject of health care and health care reform.  The article is important for two reasons: first, because there has been and continues to be a certain amount of confusion regarding Catholic social teaching as it affects health care; second, because Bishop Nickless goes to great lengths to base his discussion on principles, and not merely on tactical considerations.

Bishop Nickless begins by noting the importance of the ongoing debate over proposed reforms of our health care system:

"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."

After further noting particular concerncs for Catholic hospitals and health care professionals -- the possibility that the Government would attempt to force them to act in violation of Catholic teaching as well as in violation of their consciences--Bishop Nickless concludes:

"A so-called reform that imposes these evils on us would be far worse than keeping the health care system we now have."

However, Bishop Nickless doesn't stop here.  He goes on to enunciate several additional considerations of great importance.  The bishop's second point gets to the heart of the role that government should play in health care:

"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."

In other words, provision of health care must ultimately rest on prudential considerations that affect an entire society. Broad assertions of generalized "rights" without reference to underlying prudential considerations are not helpful. The relevant considerations include need, but also cost.  Another important prudential consideration, however, is this: who should be the main provider of health care, government or the private sector?  Bishop Nickless insists that health care provision is not only not a central concern of government as such, it is also likely to introduce harmful economic and policy distortions:

"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."

Clearly, there is much that could be said on this score.  Nevertheless, Bishop Nickless' reflections are an excellent starting point for any constructive discussion of these important issues.  Bishop Nickless places his own considerations in the context of demographic considerations:

"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.  ...  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."

I, personally, would suggest that further consideration needs to be given to the entire notion of taxation to redistribute costs.  Obviously, this occurs in many areas of our politics: national defense, public works, etc.  Just as obviously, when joined to false notions of "natural rights," and a failure to consider the human dignity that and emphasis on individual responsibility fosters, the redistributive use of taxation has led to many controversial and even "unjust" abuses of the government power to tax (my quotes refer to Bishop Nickless' words, above).  The power to tax is, after all, the power to destroy, and that destruction can have not only economic consequences but moral consequences as well.  Bishop Nickless appears to assume that Medicaid and Medicare were, initially in any event, established on a sound principle.  Without getting into the the particulars, which are far beyond my expertise, I think that is an area that would needs to be closely reexamined before moving on to adoption of any new reforms.

That Bishop Nickless is open to such discussions, and that the considerations involved are central to Catholic social teaching, becomes apparent from the bishop's final point.  That point addresses the whole issue of preventive care which, as several recent studies have shown, can actually greatly increase health care costs.  Bishop Nickless places the primary responsibility squarely on the individual:

"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."

The caveat "as far as possible" is a strong indication that Bishop Nickless, in the context of Catholic social teaching, does indeed recognize that cost is an important part of the entire health care equation.  No society can morally devote an endlessly increasingly portion of its resources to a poorly structured health care system, while ignoring the long term financial health of its future generations.

Having enunciated these four principles and their related goals, Bishop Nickless asks the all-important question: "Will the current health care reform proposals achieve these goals?"  His answer is a firm: No.  Not only would all current House and Senate proposals introduce government subsidized abortion (and likely several other morally objectionable features), but these proposals would strike at the heart of private sector health care provision.  The House proposal

"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."

And the Senate proposal would also "impinge on the vitality of the private sector" through various provisions.

Bishop Nickless' resounding conclusion:

"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.

Bishop Nickless' article begins at http://www.scdiocese.org/ and continues at http://www.scdiocese.org/Stewardship/healthcare/tabid/416/Default.aspx