A Catholic Framework for Evaluating Health Reform
August 2, 2009, 11:37 am
Posted by Cathleen Kaveny
As we go through the health care reform debate, it’s worth stepping back for a minute and taking a look at the big picture. Why is health care reform important? What should we care about?
Bishop Murphy’s letter on evaluating health care proposals is both comprehensive and concise.
In reviewing the various materials out there, I found that this longer framework for evaluating comprehensive health care reform issued by the Bishops’ Conference in 1993 (at the time of the last major push for reform) continues to be extremely helpful.
The University of Notre Dame should invite the Bishops as well as experts in Health Care, Buisness, Academia, Government, etc., to campus in order to come up with a Catholic framework for evaluating Health Reform.
Sorry, Cathleen. You have already provided us with a Good Catholic framework for evaluating Health Care. What we need is Health reform based on this Catholic framework for the Common Good. The University of Notre Dame should invite the Bishops as well as experts in Health Care, Buisness, Academia, Government, etc., to campus in order to come up with Health Reform based on this Catholic framework.
Why does “freedom of conscience” in these kinds of documents always seem to refer to the freedom of Catholics to refuse to participate in things like abortion, contraception, and so on. If “conscience” is a code word for “what the Catholic Church teaches regarding life issues,” freedom of conscience is a very limited concept. Don’t Jews and Unitarians and atheists have consciences, too?
Apologies for getting into the hot button issue right off the bat, but the first bulleted point is
• Respect for life. Whether it affirms and respects the sanctity and dignity of human life from conception to natural death. Whether it preserves the longstanding prohibition on federal funding for abortion.
Of course, you can’t fault the American Bishops for trying to promote the Catholic viewpoint, but still, for many people, it’s deja vu all over again. Like the presidential election, it’s all about abortion.
I’ve just read the two documents that Cathleen calls to our attention and have no trouble agreeing fully with what they say. Nonetheless, there is reason to worry about how these documents will be applied to any particular proposed legislation. The obvious, but not only, question has to do with the abortion question. Will what the documents say about abortion be a “non-negotiable?” Ought it to be so?”
A legal question for the lawyers among you: Would the sort of health care legislation now under consideration that precluded governmental financial support for abortions pass U. S. Supreme court review?
My far from fully informed impression is that it would not pass muster. If my impression is correct, then what would the UCCB documents entail?
Suppose that my impression is wrong and that such legislation could pass muster, but the proposed legislation does in fact include funding for abortions. Would the UCCB documents entail that such legislation, regardless of whatever other provisions it does contain, ought to be voted down?
I hope that some of you with relevant experience and knowledge can shed some light on my worries.
I note that the USCCB, Bishop Murphy< statemen tis dated in May.
The real health care battle has been set over the past few weeks and the next few months.
Over at Beliefnet ,Steve Waldman citing Tery Matingly questions how much effort the hierarchy has and will put into the issue.
He notes the only recent relevant note at the USCCB site is Cardinal rigali on the abortion concern.
It would be a pity if the Bishops did not follow a number of catholic groups in promoting the whole set of values ( a group or set of groups they are supposed to lead.)
David, in order to have Respect for Life, you must begin at the beginning.
David, in order to have Respect for Life, you must begin at the beginning.
Nancy,
And in order to claim to be in favor of freedom of conscience, you can’t limit it to the right of Catholics to adhere to what the Church teaches (or some particular group’s interpretation of what the Church teaches).
David, here is what can happen if your conscience is not grounded in The Truth to begin with:
http://cnsnews.com/public/Content/Article.aspx?rsrcid=51676
and this:
http://www.cnsnews.com/public/content/article.aspx?RsrcID=51756
What should we care about?
If anyone has been paying attention lately, would think caritas, veritas, and the dignity of the human person.
Perhaps, just perhaps, having all of those things means getting government, which is by its very nature coercive, out of it, including this falacious idea of government “reform” of the healthcare system and the healthcare financing system?
Perhaps, just perhaps, having all of those things means getting government, which is by its very nature coercive, out of it, including this falacious idea of government “reform” of the healthcare system and the healthcare financing system?
Bender,
Are you suggesting the government abandon Medicare and Medicaid? And what about the insurance industry? It is one of the most heavily regulated industries in the country. Should the government get out of the business of regulating private insurance?
It is certainly not the position of the Catholic Church that the government is not responsible for medical care for its citizens.
David, here is what can happen if your conscience is not grounded in The Truth to begin with:
Nancy,
Conscience that is “grounded in the Truth,” or “well formed” — in the sense that I think you probably understand it — isn’t conscience at all. It is obedience to the Church. If you want everyone in America to obey the Catholic Church, and you want the government to impose Catholic principles by law, that is your right. However, it’s not “freedom of conscience.”
David, a conscience that is well formed is one that is grounded in The Truth to begin with. How can a conscience that is not grounded in The Truth be well formed?
F.Y.I.- http://insightscoop.typepad.com/2004/2009/08/pope-john-paul-ii-on-conscience.html
See the Webster case: http://en.wikipedia.org/wiki/Webster_v._Reproductive_Health_Services
Studebaker, thanks much for the reference. If you, or anyone else with lega expertise, wants to say more about the implications of this Webster case, I’d be happy to read what you have to say.
What Studebaker points to here is, I think, important to the issues at stake in evaluating the current healt care proposals. At least for now, I’m not convinced that Webster settles all questions about defensible public policy re abortions, but it is certainly relevant.
And how could I have forgotten Harris v. McRae, which held that the federal government can refuse to fund abortions. http://caselaw.lp.findlaw.com/scripts/getcase.pl?navby=CASE&court=US&vol=448&page=297
Thanks again, Studebaker. Harris v. McRae is quite clarifying. Apparently, my previous impression were incorrect.
Now, suppose that after a legislator does all that he or she can to keep federal funding for legally permissible abortions out of a health care reform bill, but loses. that is, suppose, all his or her efforts to the contrary notwithstanding, the proposed bill does include such funding. Would that inclusion, by itself, be sufficient to make it wrong for him or her to vote for the bill? Politically, I can see why one would not announce IN ADVANCE that this inclusion is not enough to derail the whole bill, but at present I don’t see that the inclusion would, by itself, require voting against such a bill.
Of course, this inclusion should not be made a necessary condition for SUPPORTING a bill.
I think this model – http://the-american-catholic.com/2009/08/03/catholic-health-care-our-lady-of-hope-clinic/ – is worth noting and considering as something Catholics can do to assist the poor.
A few more thoughts:
-Folks interested in the legal background and issues on conscienc eand poublic policy should lok at the transcript of the discussion at the Center For Religion and Culture At Fordham) website.
-The undergirding issue of health care reform is to see as many covered not only for help to them but for widening the pool and reducing costs. It’s about everybody, not just me and am I happy?
It’s called the common good!
-But now we’re moving on a “glide path” to universal care and God know when in the future that will be a reality.
-The issue that is primary in perspective is what is best for the majority of the American people.
One issue folks and those who kee are not moving the issue along.p harping about truth (as if they are the ones who really have that knowledge)
In his current column, Charles Krauthammer claims that the CBO has effectively killed the administration’s original vision of sweeping healthcare reform, and suggests that what finally will be enacted by year end would more accurately be dubbed health insurance reform. Here is his expectation of what we will end up with:
“the president will in the end simply impose heavy regulations on the insurance companies that will make what you already have secure, portable and imperishable: no policy cancellations, no pre-existing condition requirements, perhaps even a cap on out-of-pocket expenses.
“Nirvana. But wouldn’t this bankrupt the insurance companies? Of course it would. There will be only one way to make this work: Impose an individual mandate. Force the 18 million Americans between 18 and 34 who (often quite rationally) forgo health insurance to buy it. This will create a huge new pool of customers who rarely get sick but will be paying premiums every month. And those premiums will subsidize nirvana health insurance for older folks.”
The entire column is here:
http://www.chicagotribune.com/news/opinion/chi-oped0803krauthammeraug03,0,2708040.story
Judged by the criteria in Bishop Murphy’s letter, istm that such an outcome at least has a decent chance of fulfilling the Catholic vision. Of course, specific details (what about life issues? What about illegal immigrants?) could have a tremendous impact on whether, from the bishops’ point of view, the legislation succeeds or fails. But I’m heartened that we have a good chance of accomplishing something wonderful.
Jim – typical Krauthammer generalizations. He assumes that the current 45 million uninsured are mostly 18-34 years old and in good health. There is no mention of the FACT that most of these 45 million are folks in poor health; unemployed, immigrants, street people, and no mention of the “underinsured.”
FACT – changing insurance laws so that employers who purchase most of the insurance plans can not exclude pre-existing conditions, etc. will NOT bankrupt them – it could cut into their profits – they could take it out of the millions they spend on advertising and lobby efforts.
For a writer who was trained as an MD, he comes to the table with lots of heavy baggage. And if you impose an individual mandate? How will this be paid for? No mention of the FACT that even a conservative estimate of the 45 million would indicate that they can not afford to purchase insurance currently.
Not only are there conscientious people outside of Catholicism, but the bishops themselves haven’t always been paragons of conscience-promotion when it comes to their dealings with unpopular clergy and laity.
That said, there’s no doubt that many aspects of the secular culture will confront moral people at one time or another. Taking a moral stand is easy when the law covers your back. And that’s not to say I’m not unsympathetic to the plight of people coerced into doing something against their moral principles. I’ve lost at least one job in my life because I stood up to the boss for what I thought were outright lies and injustice to eliminate a colleague. Life goes on … often with different employers.
I’m amused at the insistence on calling this “health care reform.” It’s not. We have good health care in the US. Costs have spiraled out of control and the insurance situation is a de facto monopoly from the perspective of most workers. Socialism? That’s a laugh–it’s not even capitalism, the way its working now. It’s closer to organized crime. People who demur from calling it “insurance reform” are, in part, drinking the corporate Kool-Aid on this one.
Bob, have no fear, when working with a Good Catholic framework on Health Care, the arian heresy would not apply.
Hi, Bill, re: the majority of the 45 million who are not 18-34 year olds in good health: you’re right, Krauthammer skips right over them. If the outcome is that those who are not young and healthy are left without an affordable health care option, that would be a tremendous injustice.
My understanding is that what will happen is that they will be required to purchase insurance (and perhaps it will be more affordable if insurance companies couldn’t price-discriminate against the unhealthy), and the government would subsidize premium payments if the insured can’t pay it all herself.
There is so much misunderstanding of the current law. Your employer (or an insurer on the employer’s behalf) cannot exclude you from participating in the employer’s health plan based on your health status, and the insurer cannot refuse to provide coverage based on the health status of the group or any particular member of the group. The is called “guaranteed issue” and all small groups are “guranteed” issue of any policy that an insurer issues in the small group market. Pre-existing condition limitations are also very restricted. This was the impact of HIPAA in 1996. Go here for an explanation geared to consumers: http://www.cms.hhs.gov/HealthInsReformforConsume/Downloads/HIPAA_Helpful_Tips.pdf
HIPAA made virtually no reforms in the individual insurance market, i.e., you can be denied insurance based on a pre-existing condigion. Moreover, many of the practices that are being decried (e.g., caps on benefits, high cost-sharing) are endemic in both the individual and group market segments. Finally, groups are also heavily underwritten, though most states have “bands” that require that the highest premium be no more than X% higher than the lowest (e.g., if the “average” is 1.0, the lowest can’t be lower than .85 and the highest can’t be higher than 1.7).
Regarding the uninsured: A higher percentage of under 30s are uninsured than just about any other demographic of legal residents. However, a higher percentage of those who are uninsured over 30 are unable to get affordable coverage and have a greater need for it. The older you are, the more true this is. Early retirees are in the most difficult and precarious situation. Opening Medicare up to those who are bona fide retirees would be the simplest way to deal with this group, who often “save up” their health care needs for when they become Medicare eligible anyway.
Private insurance accounts for less than 35% of health care reimbursement. The rate of private employment related health coverage has been declining for many years, mostly in the small group segment.
You are correct at least in some of the current bills in committees, Jim. The question is – who pays for the subsidity and how so that the uninsured can have coverage; will the coverage be equal to most employer plans?; etc. (devil is in the details)
Barbara – good points. I would suggest that private insurance is probably less than 15% – getting it is hard and very costly – average of $650 or more per month.
Would agree with your Medicare approach but to cover those you suggest, the age or qualifications would need to be lowered to 45-50 years of age. This also neglects to take into account the growing defict because of Medicare’s costs – some committee bills are trying to insert ways to control costs; eliminate FFS; move to chronic/mandated care for Medicare. It is just one more piece of a complicated pie.
Regarding the dialogue at Notre Dame, they should consider this:
http://www.fiercehealthcare.com/story/private-health-insurers-agree-revise-pricing-eligibility-pre-existing-conditions/2009-03-25
I see Fr. avangh at america Aug.17 issue now on line) has weighed in with some valuable points.
In the current atmosphere, we need all the objectivity and non-politicization we can get.