Disappointed
I spent part of the afternoon reading the Joint Pastoral Statement on Health Care Reform issued by Bishops Naumann and Finn. I have to say that I was deeply disappointed. I believe that bishops, both individually and collectively, have the right and the duty to guide the faithful in the formation of their consciences on important public issues. However, from the perspective of someone who has worked for 15 years in the health care sector, I feel the document ultimately fails, both as an explication of Catholic social teaching and as an effort to apply that teaching to the key issues at play in the reform debate. I don’t think the bishops have been well served by whoever advised them in the preparation of the document.
First of all, for a letter that bills itself as a reflection on Catholic social teaching, the document is remarkably thin on references to the major documents of that teaching. The letter cites Pope John Paul II and Pope Benedict XVI very briefly (and in a highly selective way) and cites no other conciliar or papal documents. Nor does the document cite any of the many documents prepared by the U.S. bishops’ conference which have attempted to apply Catholic social teaching specifically to social policy in the United States.
The result is a document that, in my view, presents a truncated understanding of Catholic social teaching as it applies to health care. The bishops write that the “notion that health care ought to be determined at the lowest level rather than at the higher strata of society, has been promoted by the Church as “subsidiarity.” Aside from the fact that there is little evidence that the Church has, in fact, historically applied the concept of subsidiarity to health care in this way, the principle is extremely vague. What does it mean to “determine” health care? And just what is the “lowest level?”
There are very few health care decisions in which “higher strata of society” are not implicated in some way. Hospitals seek accreditation from the Joint Commission. Employers set limits on what kind of health insurance benefits they offer their employees. The health care system in this country is a complex web of relationships that involve both private and public actors operating at the local, state and national level. In many cases, local is not always better, as can be seen by the ways in which physician practice varies widely by geography in ways that cannot be justified by patient characteristics. There are reasons—sound ones—why various levels of government have intervened in the health care sector. The idea that such intervention expands, as the bishops write, “the reach of government beyond its competence” displays a lack of understanding about the health care system as it currently operates in the United States.
Secondly, the document argues that the Church’s defense of a “right to health care” does not necessarily imply “government socialization of medical services.” I’ll concede the point, particularly since no one has actually proposed this. At some point, though, hard questions need to be asked how easy it is for a person living in the United States in 2009 to exercise a “right” to health care if they don’t have health insurance. People who think the public hospitals can take care of this problem really ought to travel out to Los Angeles, where one-third of the population lacks health insurance and the public hospital system is perpetually teetering on the brink of collapse.
The implicit suggestion of the document is that Catholic social teaching is comfortable with a two-tier system in which those with traditional health insurance have access to a full range of health care services while those without such insurance would rely on some sort of “safety net.” This solution sounds very much like the system we have now, with all the inequality in access and quality of care that it produces. At some point, these inequalities simply have to be seen as violating fundamental principles of justice.
Finally, and perhaps most disturbing, is that the document makes a number of statements that are simply factually incorrect, statements that seem to display a disturbing lack of knowledge about the health care system. The bishops write, for example, that “mandated health insurance benefits for full-time workers have created an incentive for companies to hire part-time rather than full-time employees.” Mandated by whom? Unless there is a union contract in place, employers (outside of Massachusetts) are under no obligation whatsoever to provide any health insurance at all and an increasing number of employers are either cutting out dependent coverage entirely or pricing it out of the reach of their employees.
Similarly, the bishops write that “our country, in some ways, is the envy of people from countries with socialized systems of medical care.” Who are these people? In which countries? Do they constitute anything close to a majority of people in these countries? While it is certainly true that all health care systems have their flaws, the polling that I have seen suggests that even the systems with the highest levels of socialization (e.g. Canada and the UK) enjoy overwhelming levels of support. Those supermajorities could be wrong, of course, but to suggest that there is widespread envy of the American system is a statement that has no factual basis.
I share the concerns of Bishops Naumann and Finn regarding certain aspects of the bills working their way through Congress, such as how they treat abortion. But legitimate concerns about these issues need to be separated from the quasi-libertarian criticisms of “government-run health care” that have little basis in reality and, in fact, stand in significant tension with the mainstream of Catholic social teaching.
Tags: catholic social teaching, Finn, health care reform, Naumann, subsidiarity
Thank you Peter. As I read through yesterday, I thought their citations seemed pretty selective and very partial. This in particular struck me: “An August 3, 2009 Statement of the National Association of Pro-Life Nurses on Health Care Legislation” which seemed to be generated mostly for the death panel accusations.
Where are these bishops getting their information–especially the worrying recitation of right-wing talking points? Staff advisers? The NRLC? Current or former GOP strategists, lawyers? The document contains a staggering amount of misinformation and Republican spin. Our health-care system is the envy of the world! Look how many foreign dignitaries come here for treatment! (I call that the “We have the best Mayo Clinic in the world!” argument.) Government meddling would stifle profit-driven innovation! The “class of dependents” line reminds me of the “welfare queens” canard… Do the bishops believe we are now to worry about health-care queens?
Preferential option for the rich?
So what happens now? Is a respectful response to this statement in the works–perhaps something from the CHA or the Fordham Center that Margaret and Peter Steinfels run? Surely Naumann and Finn’s brother bishops won’t do anything, either directly or indirectly. My main concern is for the good people in Kansas who might read this document and come to disturbingly inaccurate conclusions about Catholic social teaching.
Peter: Many thanks for this. You said what I have not the know-how to write.
I think Mark Jameson’s comment gets to the next step. Where is an alternate view, succinctly put, from the USCCB or individual bishops?
The proposed modification of our health care system is an area of public policy where reasonable people–and others–may well disagree. People are likely to have views arising from their experience, expectations, principles etc. How many Catholics, I wonder, are influenced by the pronouncements of their bishop in such a matter, influenced sufficiently, that is, to undergo a substantial change of attitude? How many would think that, qua bishop, their bishop has any expertise in this area, or is indeed any wiser than themselves?
“I believe that bishops, both individually and collectively, have the right and the duty to guide the faithful in the formation of their consciences on important public issues. ”
Clearly, the bishops have become the modern day equivalent of the scribes and the Pharisees. How are we not enablers by giving them more credence and benefit of the doubt than they deserve?
I think the good Bishops’ (mis)statement of the principle of subsidiarity is actually a nice window into the way the free-market Catholics actually understand that concept. Gone is the pragmatic, comparative principle that supports shifting things up to higher orders when more centralized systems can outperform decentralized ones (as they surely sometimes can) and in its place is an a priori commitment to the Hayekian unplanned order of the market.
Bravo, Peter. This statement was extremely embarrassing. Not only are the bishops unfamiliar with the economics of healthcare (understandable in itself), but they seem to be taking advice from the very right-wing brigade whose very reform proposals (tax credits etc) would — in most experts opinions — make the problem even worse. And the whole bit about people in socialized medicine “envying” the United States really takes the biscuit. These prelates need to get out more. They need to talk to some of ther brother bishops in Europe. They would learn that while there is often dis-satisfaction with healthcare, the US system is held up as the worst of the worst, a living nightmare that not even the most right-wing parties in Europe would embrace.
Yes, so many factual innacuracies. No understanding of what “socialized medicine” reallty means — it is the UK “single provider” model, not the more standard “single payer model”, neither of which – by the way – are on offer in this reform package. No understanding that the US pays twice as much as other countries with nothing to show for it. No understanding that rationing is a huge problem in the current system — by cost and by quantity.
As for subsidiarity, they seem to fall into the typical American right-wing confusion between real subsidiarity (which sees well-defined roles for the larger sphere) and love of the free market. There are very sound arguments for having the widest possible insurance pool — to spread the risk and thus lower everybody’s cost (that, by the way, is probably the number one reason why single payer is so efficient). And I would really like to ask these bishops why a government insurance plan violates subsidiarity, while a huge private insurance corporation that rations care based on the profit motive is just fine.
The really problem with this bishops’ conference is that the silent sane majority says quiet and let these guys steal the limelight and thus mispresent Catholic social teaching.
How many Catholics, I wonder, are influenced by the pronouncements of their bishop in such a matter, influenced sufficiently, that is, to undergo a substantial change of attitude? How many would think that, qua bishop, their bishop has any expertise in this area, or is indeed any wiser than themselves?
Joseph G., it’s true that nobody should consider the bishops natural experts in policy. But they do exercise authority when it comes to Church teaching — that’s the authority they’re foregrounding in this letter. My concern is not that they’ll change attitudes — that they’ll turn open minds against the idea of reform — but that they’re blessing and reinforcing preexisting partisan anti-reform attitudes. People who are already inclined to assume the worst about Obama or the Democratic Party can point to this and say, See, I’m thinking with the Church.
I don’t think it’s fair to give the bishops a pass on their lack of expertise on the inner workings of health care financing or policy. Catholic hospitals abound, usually administered by nuns, and they truly do understand what’s going on and how things work. If the bishops don’t know it’s not because they don’t have access to people who do know.
The bishops seem to confuse subsidiarity with private enterprise. In fact, the enterprise of health care, for a lot of reasons, has been driving all kinds of companies to become largern and regional if not national for some time now. The need to be national to survive economically does more to undermine a “local” solution for heatlh care needs than anything else I can think of. Along the same lines, a single payer system probably would do more to allow mission oriented hospitals to focus on their mission than on the business of health care than any other proposal.
These are complicated questions, and national or regional players can also provide efficiencies and benefits, but the fact that the bishops don’t even seem to know that these questions are out there more or less tells you all you need to know about how much honest effort they put into this letter. Not much.
Peter, which of the U.S. bishops documents would you have cited had you written this statement on Health Care Reform? With all due Respect, you presume in your statement that because these Bishops believe that the public option will,”expand the reach of government beyond its competence”, the Bishops dismiss the fact that there are sound reasons why various levels of Government have intervened in the Health Care sector, yet you concede the point that, “the right to health care”, does not necessarily imply “government socializing of medical services.” The Bishops would like to see the Government intervene with clear language that articulates the Right of Conscience for individuals and institutions, (1in4 hospitals are Catholic) and explicit exclusion of elective abortions from any Health Care plan.
Nancy:
The phrase “public option” does not appear in the document and it is by no means clear that the bishop’s criticism is limited to this aspect of the reform plans.
If you are asking what documents of Catholic social teaching I would have liked to see explored in more depth in this document, I can think of several. I might suggest starting with Pope John XIII’s “Pacem in Terris,” which spoke of the right to medical care (c.f. #11) and linked this with the concept of “necessary social services,” strongly suggesting a role for the public sector. I might compliment that with a reading of sections 73-76 of Vatican II’s “Gaudium et Spes,” which contain a nuanced reflection on the role of the state in social, economic and cultural life.
More recently, I might recommend section 15 of Pope John Paul II’s “Centesimus Annus,” which speaks positively of the influence of the Church’s social teaching in encouraging reforms in the areas of “social security, pensions, health insurance,” and defends a role for the state in the regulation of economic life. I would also suggest a look at Pope Benedict’s recent encyclical “Caritas in Veritate,” which contains a strong defense of the principle of subsidiarity and expresses concerns about an all encompassing welfare state. Benedict is also clear, however, that without an equal emphasis on the principle of solidarity, “subsidiarity” can easily give way to social privatism (c.f. #58)
The weight of the evidence suggests to me that the Church has long held that health care is an arena where government intervention—including intervention by national governments—is legitimate and often necessary. I am not aware of statements from episcopal conferences in any other nation that criticize their national health care systems on the basis of the principle of subsidiarity.
With respect to the USCCB, I might offer this paragraph, taken from the bishops’ 1993 document “A Framework for Comprehensive Health Care Reform.” This document remains the USCCB’s most comprehensive statement on the subject to date. Here is a relevant excerpt (link below):
“Applying our experience and principles to the choices before the nation, our bishops conference strongly supports comprehensive reform that will ensure a decent level of health care for all without regard for their ability to pay. This will require concerted action by federal and other levels of government and by the diverse providers and consumers of health care. We believe that government, an instrument of our common purpose called to pursue the common good, has an essential role to play in ensuring that the rights of all people to adequate health care.”
http://www.usccb.org/sdwp/national/COMPCARE.PDF
“My main concern is for the good people in Kansas who might read this document and come to disturbingly inaccurate conclusions about Catholic social teaching.”
Mark Jameson raises the same primary concern I have about the bishops’ document.
The USCCB has a web page dedicated to health care reform that may allay that concern to some degree:
http://www.nccbuscc.org/healthcare/official_documents.shtml#letters
I’m not saying that the bishops as a group can’t do more–we all can–but there are links at the web page to a number of documents the USCCB has issued about health care reform, including the text of the statement given by Bishop William Murphy on 05/20/09 as part of the Senate Finance Committee’s roundtable discussion on “Expanding Health Care Coverage.” An excerpt from the statement:
“As Congress begins the task of drafting legislation, the bishops offer the following principles and criteria for health care reform. The principles are rooted in our belief that decent health care is not a privilege, but a basic human right and a requirement to protect the life and dignity of every person. All people need and should have access to comprehensive, quality health care that they can afford, and this should not depend on their stage of life, where or whether they or their parents work, how much they earn, or where they live or where they come from.
The basic assumptions we offer are these: 1) a truly universal health policy with respect for human life and dignity; 2) access for all with a special concern for the poor; 3) pursuing the common good and preserving pluralism, including freedom of conscience and variety of options; and 4) restraining costs and applying them equitably across the spectrum of payers.”
As I’ve said numerous times before, there’s a differenc beetween a right (say to teach) and the proper exercise of that right.
There seems to be no debate here on the inaccuracies of the document and I thank J.Peter for having to and nicely presenting its lack of understanding of Church teaching.There is also the matter of obviouys slant – it’s not enough to ponit to the USCCB statemnt -there needs to be a genuine effort to remove poltical partisanship from the uS hierachical ranks(they are enbtitled to their personal opinions but not to teach them as truth) before more folks jump ship!
William Collier: This statement from the USCCB is good, as far as it goes. And Peter Nixon’s link to the Conference’s 1993 document is also quite good. But the real problem here, it seems, is what to do about the current statement from Naumann and Finn. These two USCCB documents are no longer “current,” in that they have had their time in the limelight, and your eveyrday Catholic in Kansas is not going to go Googllng them to fact-check the accuracy of their pastors’ most recent statement.
The real question is whether anyone will dare to publicly correct the inaccuracies that these two bishops have published. What mechanism is there for that? And, what precedent? In my dream world, Bishops Naumann and Finn would publish a “clarification” of their points, essentially fixing their mistakes without having to eat crow.
But who is even in a position to correct them and help them do this? We saw what happened in Scranton. Essentially, a bishop is “pope” of his diocese, treated with great deference unless and until the real Pope removes him. And all the time, the people of the diocese are ill served.
Peter, if there is no public option, then there is no need to worry about ” expanding the reach of government beyond its competence.” I agree with you that the Bishops should use the documents you refer to in order to clarify their statement.
“Where is an alternate view, succinctly put, from the USCCB or individual bishops?”
These guys don’t challenge each other in public: saving face, scandalizing the faithful, blah blah blah. Abp Sheehan came close to doing so, but Naumann and Finn need to be challenged head-on. Their obvious kowtowing to the moneyed “faithful” is so blatant that it is sickening.
The episcopacy loses credibility each and every time it doesn’t open its mouths in the face of such blatant politicking by their brother bishops. Maybe if there were some sister bishops things might be a bit different —- but we’ll not know about that before Jesus comes, will we?
“I don’t think it’s fair to give the bishops a pass on their lack of expertise on the inner workings of health care financing or policy.”
Amen! If they are going to opine, they had better be prepared to have their positions challenged — prudently, of course. After all, that is what the theocons use as their excuse for challenging what they don’t like — prudence. Bishops need to remember what I learned in Cub Scout camp around a campfire many years ago: “If you don’t bear the cross, then you can’t wear the crown.”
A major problem is that those few Catholics who actually pay attention to what a bishop has to say these days tend to be those who believe anything that is said from Episcopal mouths. Critical thinking is not one of their virtues.
“If there is no public option, then there is no need to worry about expanding the reach of government beyond its competence.”
Nancy, I assume that, if you are not there already, when the time comes you will return social security payments and not sign up for Medicare, both of which can’t possibly meet your definition of government competence. I hope you or anyone you know/love needs VA care and benefits. Or disability social security benefits. Or protection by the civilian-run US military, which has not demonstrated any great degree of competence during the Cheney presidency.
If there is no public option in whatever is presented to Obama for signature, he had better decline approval or he will have sealed his fate with enough people that he can forget about a second term in office.
Before I get the “there is no plan” response, there is at least one bill that has been passed in its entirety in the House. There are other proposals too, but the idea that people can’t focus their criticism on things that have been proposed in Congress because they haven’t been fully negotiated and sent to the president is silly. Particularly since we have been treated to masssive legislation that is signed less than 48 hours after it leaves conference, opponents are learning to get their licks in early.
That being said, for people who are so focussed on tolerance, progressives are the least tolerant of anyone else’s ideas. Why must everyone who disagrees with you be some sort of partisan hack? If you don’t accept the type of reform promoted by the president, you are either greedy, or selfish, or uncaring,
Maybe, just maybe, people are unwilling to accept the idea that through further government regulation and control we will have both higher quality and lower cost. I am serious when I ask, name one instance that this has actually happened. This isn’t just about the “public option.” All the versions being proposed involve the creation of additional beuracracies under HHS that will regulate – in fact dictate – the contents of acceptable private insurance plans, that will collect data on patients, treatments, and “effectiveness” and all proposals involve using various taxes, tax penalties, and/or fines to force acceptable health care financing decisions. As for the public option, you would have to be an economic idiot to not see that it is intended to drive at least some people out of private insurance if not eventually everyone. The president himself has said that’s what it is intended to do – that is before he was elected.
If we are worried about the poor – take care of the poor. Tell you what, you give everyone with an income over 100,000 a 100% tax credit for the first 1000 they give to charities providing health care to the poor and illegal immigrants, and they will have the best health care in the country in six months. There are many ways to address these issues outside a huge bureacracy. If we are worried about costs, free up the insurance market.
What do the following medical procedures have in common?
Lasik eye surgery
Minor facial cosmetic prcedures
Hair transplants
Teeth whitening
They all have increased in quality, decreased in price, and increased in accessibility over the last 10 years notwithstanding huge increases in costs and minor decreases in accessibility for almost everything else, and they are all driven by consumer choice.
Maybe we skeptics are just sitting at our $500 laptops at work taking home our $1 DVD rentals in one of the 500 different models of cars we can pick from and think there might just be something to this free market thing that we shouldn’t just dump in one fell swoop.
When someone recommends dumping the “free market” in one fell swoop, Sean, you’ll be the man to refute the idea. But till then: the other thing those medical procedures have in common is that they’re cosmetic and not life-saving. And people without insurance, or people in danger of losing the insurance they have if they get sick or lose their job, probably won’t feel better if you point out to them that hair-transplant technology has really improved.
uuhh, what Sean said, except for the “idiot” comment. We were not allowed to use the words “stupid’ or “idiot” when I was growing up, but we were allowed to point out that sometimes a person can be intellectually lazy.
The better examples Sean might have used are minute clinics and concierge practice. These are market developments that have arisen directly out of the failure of both private and government programs to provide a coherent model of accessible primary care services that are the mainstay of rational health care delivery. Although they are welcome in some respects, they highlight how little of what passes for health care policy is centered on the well-being, needs, not to mention the convenience, of people in need of medical care, and how much is centered on misguided reimbursement structures and opportunities for private gain.
I don’t think the bishops have the first idea what they are talking about. They are simply trying to put a little Catholic icing on their Republican talking point cake.
“a little Catholic icing on their Republican talking point cake?” Ummm, I forgot to mention we were also allowed to say, “that really makes no sense”.
Sean:
I’m seen the Lasik example offered in a number of settings. But it doesn’t really work as a model for the rest of health care.
Just to recall a little Econ 101, the key characteristics of an efficiently functioning market are 1) a reasonably standardized product; 2) low barriers to entry by new suppliers; 3) consumers with good information on their options.
These features obtain in the market for Lasik surgery. It is a discretionary expense, one that people do not need in order to function effectively in daily life. Demand is therefore elastic relative to price, so producers have an incentive to compete on costs. The one thing that is lacking in that market, I would say, is really good data that allows consumers to compare outcomes. So competition tends to focus more on cost than on quality.
These features do not usually obtain in the market for, say, CABG surgery. It is generally not a discretionary expense (although patients may have an option of going with stents rather than CABG). They generally have limited information about providers and the cost is so large that insurance is really the only way one can afford it. Since insurance covers the cost, consumers have less incentive to force providers to compete on cost. Many people, in fact, would be uncomfortable with the idea of thoracic surgeons competing on cost unless there was also good risk-adjusted outcomes data easily available to consumers.
I do believe that public policy can play a role in shaping more competitive health care markets, e.g. by requiring the disclosure of quality and cost data and pursuing strong anti-trust policies with respect to insurers. But even advocates of “managed competition” like Alain Enthoven believe that the government should standardize a benefits package so that consmers make easy “apples to apples” comparisons. But I’ll leave that discussion for another time.
“Maybe, just maybe, people are unwilling to accept the idea that through further government regulation and control we will have both higher quality and lower cost. I am serious when I ask, name one instance that this has actually happened.”
While I cannot vouch for lower costs, greater government regulation and control has led to acceptable quality in our meat-packing industries, pharmaceuticals, toys, furniture, and probably many other industries. Without vouching for quality, greater government control led to lower costs in finance and banking, or at least that is how I see the evidence of last year’s enormously expensive collapse of lightly regulated financial instruments.
I suppose we might look at military costs and quality that led to the US military active in war, rather than the uncoordinated state militias. Medicare and Social Security seem to provide a higher quality of life than we had without them.
Not only do consumers face the kinds of barriers outlined by Peter, but query whether society should allow suboptimal providers to continue apace even if they can convince someone to use their services. As the list of “never” events grows, I hope that hospitals, at least, are being forced to move in the direction such that patient can have some confidence of a high minimum standard of care no matter where they go. You really don’t know which hospital you are going to be closest to when someone runs into the car you are driving at a high rate of speed. We are already capacity constrained, and one problem with competition in health care is that no matter how we try to pretend otherwise, patients often choose based on superficial criteria (well-decorated private delivery suites or charismatic doctors) over the things that they should care about (low infection rate, low mortality rate).
I do agree with Sean rather strongly, however, that patients should at least be given accurate and clear financial information when they are considering elective services. That providers are able to hide the ball on this is really kind of scandalous. There is simply no way to have a market without price information.
Let me return to J. Peter Nixon’s initial comments. There is so much controversy about our bishops and what they say. From my previous posts it should be obvious that I have any number of criticisms about what bishops have been saying and doing. But here’s a huge problem for people like me.
I’ve been reading Jaroslav Pelikan’s 5 volume “The christian Tradition: A History of the Development of Doctrine.” It is clear that bishops and what they teach is an essential part of our faith. There is no substitute for them. They are the guarantors of the Tradition. And still we have so many instances of bishops saying and doing things that many of us find intellectually abhorrent. I cannot honestly say that I don’t share many of the criticisms of bishops that show up on this blog site. Here, I find what Bishops Finn and Nauman have said in their joint statement to be unworthy of serious discussion. Apparently Bishops Cupich and Murphey have said some more sensible things.
Two questions.
1. Atheological question is: What are we to make of the obvious quarresls among the bishops that we’ve seen on display recently and have apparently been regular features of the Church’s history?
2. If the health care debate is not the sort of issue in which lay people, by reason of their technical knowledge and their involvement in the hurly-burly of the world, have a basic role in trying to promote a set of policies that pay reasonable heed to the Gospel, the what could Vatican I have meant when it said that lay people have a distinctive role and set of responsibilities in the life of the Church?
I know that I have not framed my questions with all the appropriate precision that they deserve, so i ask you to be patient in reading them. But I do hope that some of you will address the substance of my questions, their poor formulation notwithstanding.
“1. Atheological question is: What are we to make of the obvious quarresls among the bishops that we’ve seen on display recently and have apparently been regular features of the Church’s history?”
Bernard, not only bishops but popes and people like Augustine and Athanasius have made mistakes, theologically. There are just too many examples. Bishops do have legitimate authority but that authority is only good when they are truly humble servants of the Lord and seek to help the downtrodden. With forty seven million Americans without insurance, mostly poor, it is an unforgiveable scandal that the bishops should align themselves with a political party rather than the needs of the poor.
Lest we forget:
Lasik eye surgery
Minor facial cosmetic prcedures
Hair transplants
Teeth whitening
All of these are not considered elective (not medically necessary) procedures, not covered by any healthcare plan, nor a good example of any reason to NOT have a public option.
Even orthodontia, which IS covered by dental plans, has very limited coverage and, in most cases, is considered elective, not necessary.
Bernard –
It seems to me that the bishops quarrels among themselves about health care reform ought to be considered quite normal and an good thing IF they are not talking about the principles of Catholic morality, but instead are talking about their experience as persons involved with health care at least indirectely because of the Catholic hospitals they surely should know something about.
In other words, bishops *as bishop* ought to talk about settled principles of morality, and they are entitled to speak in the name of the Church in such matters. But bishops *as merely involved in practical, secular enterprises and decisions* (e.g., running hospitals in poor neighborhoods) should not talk in the name of the Church, but only as persons with something of interest to say based on their individual experiences.
Because they can have two different functions == one spiritual, one secular, I expect that in the latter matters there will be disagreement based on differing experiences, and, yes, based on their own political persuasions. But as Republicans or whatever they are, they should expect to be asked for justification of their views, and we probably should expect them to differ among themselves. Further, they should make it clear that they are speaking, not about moral principles, but about the *implementation* of moral principles, a function which is primarily the function of the laity.
True, many of the faithful find such disagreements unsettling, but that is their problem, and the bishops could lessen their distress if they made it clear when they are speaking as private citizens.
Here’s an observation in the two bishops’ statement that injects a welcome dose of realism that I believe would be taken for granted by most economists but that is largely missing from other ecclesiastical documents:
“Indeed 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…
When the individual has a personal, monetary stake or a financial obligation to pay even a portion of the cost of medical care, prudence comes to bear – with greater consistency – on such decisions, and unnecessary costs are minimized. 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.”
Away from home and being technically inept, I cannot provide a link. I recommend in the 2 September edition of the NYT “Changing Heath Care By Steps” by David Leonhardt.
as for some bishops making “inadequate” statements, I suppose for some of us who have been watching episcopal nominations since the late 1980s, this is not altogether surprising. And the pool, it seems to me, continues to shrink. Perhaps for some of us who lived through the period of the great Council, the moment is especially. we were so naive, they tell us. the night is dark, and …. Lead thou me on.
Is epescially dispiriting
I understand that the procedures I spoke of are elective, but that’s the point. When there is choice at the point of consumption consumers will drive down costs and increase quality generally. I don’t advocate dumping medical insurance, but a large percentage of our national medical bill is not for things for which insurance is necessary. Why, for example, do many “insurance” plans cover things like eyeglasses and routine physicals? Its like insuring your car for oil changes.
Where are these bishops getting their information–especially the worrying recitation of right-wing talking points?
I’m just startled that there are two Bishops in America who repeat right-wing, rather than left-wing, talking points.
When talking about theology one must be circumspect even with bishops and the pope.
Women expecially have been harmed by warped theology. While Jesus and Paul had women in important positions, later leaders devolved into patriarchy. Especially, Gregory the Great. It is acknowledged that Gregory the Great singlehandedly stratified Mary Magdalen as a prostitute. In a sermon whose text is given in Patrologia Latina, Gregory stated that he believed “that the woman Luke called a sinner and John called Mary was the Mary out of whom Mark declared that seven demons were cast” (Hanc vero quam Lucas peccatricem mulierem, Joannes Mariam nominat, illam esse Mariam credimus de qua Marcus septem damonia ejecta fuisse testatur), thus identifying the sinner of Luke 7:37, the Mary of John 11:2 and 12:3 (the sister of Lazarus and Martha of Bethany), and Mary Magdalene, from whom Jesus had cast out seven demons, related in Mark 16:9.
While most Western writers shared this view, it was not seen as a Church teaching, but as an opinion, the pros and cons of which were discussed.[30] With the liturgical changes made in 1969, there is no longer mention of Mary Magdalene as a sinner in Roman Catholic liturgical materials.
The Eastern Orthodox Church has never accepted Gregory’s identification of Mary Magdalene with the sinful woman.
Ann, thanks for your remarks. The distinction you make between doctrinal and non-doctrtinal matters is clearly right and important.
Now let me say something about non-doctrinal episcopal pronouncements. This bears on the second question I asked, namely the one about the role of the laity. In these matters, should the institutional church not provide the context in which the expertise of lay people can figure in the positions that the Church leaders take on so many matters that affect the welfare both of Catholics and other people? Among these matters are those having to do with policies affecting the “social safety net,” social justice issues, Catholic schools, etc. In these matters, bishops do not, simply by virtue of their episcopal ordination, gain any special technical expertise.
In our local diocese, there is an Office for Social Action with a board chaired by a layman and largely populated by members of the laity. It has not been an especially effective office, but it could serve as something of a model if properly promoted and supported by the bishop. It could enlist relevant experts on various issues. Probably better than having an office like this in each diocese would be having state-wide offices of this sort.
Of course, for such offices like this to function well, the bishops involved would have to recognize the limitations of their own competences. They would have to give leeway to such offices and the experts called upon by them. In short, they would have to recognize that in these matters the notion of bishop as hierarch would have much more limited application than it does in doctrinal matters.
To make such offices effective would take time and prolonged effort. But wouldn’t it be worth it if we, as a Catholic community, had such an institutionalized way of bringing our faith to bear on the myriad practical matters that affect both our lives and those of our neighbors?
Without some such arrangement, I belieeve that the Vatican II talk about the role of the laity is just idle talk.
The bishops didn’t misuse the term “subsidiarity”, and their use of the term, in and of itself, does not denigrate the levels of government involvement in the delivery or financing of health care.
The principle of subsidiarity is grounded in the dignity of the human person. It recognizes that human persons have needs that cannot be delivered very well by individuals, and so social structures are both necessary and good. Surely heath care would be an example – we’re better off with social structures such as hospitals, risk pools, and government regulation (and many others besides).
At the same time, subsidiarity recognizes that there is something impersonalizing, self-serving, and opposed to the well-being of the human person about organizational bureaucracies (whether they are government, corporate, or of some other character). For example, large organizations typically place a high value on things like efficiency and cost control which are beneficial to the organization but quite possibly detrimental to the well-being of real human individuals (like patients).
And so the principle of subsidiarity exists in the tension between these two aspects – the need for social organizations, and the deadening tendency of bureaucracies generated by social organizations. .
Subsidiarity has both a “downward bias” and an “upward bias”. Subsidiarity tends, rightly, toward the most “local” social organization *that is capable of getting the job done*. Subsidiarity asks two questions of a health care policy: is it as local, as close to the patient, as it can be? At the same time, is it capable of doing what needs to be done? It’s quite possible that some aspects of the solution need to be at a national government level. But that shouldn’t be the default assumption, because it’s also possible that lower-level social organizations can also serve these needs at a level that is closer to the human persons being served.
Btw, the 8/14 edition of Commonweal leads off with an editorial in praise of subsidiarity, and its relationship to another fine principle of Catholic social teaching, solidarity. Both of these principles are, righly, brought forward by these bishops in their pastoral statement. Perhaps the statement could be better-crafted. But we should applaud them for highlighting the relevance and importance of these principles in our national conversation about helath care policy.
Well, Sean, regarding cars, most come with a pretty substantial warranty and preventive maintenance schedule, and the cost of “routine” maintenance while the car is under warranty is often very cheap. That’s because the manufacturer has an interest in not having to pay out under the warranty and scheduled maintenance helps to avoid that.
But as for people, the problem that has been identified is that when you make them pay out of pocket for a category of services (like check-ups or vaccines, or whatever) they are ill-equipped to choose between those services they really should want or need and those that are truly elective. The beauty of concierge (pejorative) or patient-centered (a little euphemistic) practice is that the doctor is more or less paid to make those decisions for you, with your consent of course.
There is also the hard problem of what constitutes a “routine” or “elective” procedure. Daily blood glucose monitoring is routine for diabetics but it’s certainly not supposed to be elective.
Posted by Jimmy Mac
on September 2nd, 2009 at 8:43 pm
That should, of course, read as follows:
“All of these ARE considered elective —-”
But most of you knew what I was trying to say …. didn’t you?