Commonweal editor Paul Baumann’s review of George Weigel’s Evangelical Catholicism: Deep Reform in the 21^st Century Church is now available at the website of The Nation. Excerpts follow:

When President Obama was invited to give the commencement address at the University of Notre Dame in 2009, more than eighty bishops condemned the university. That a duly elected president of the United States should be regarded as a moral monster unworthy of being given a hearing—especially at a school as steeped in American patriotism as Notre Dame—is bizarre. The uproar and the bitter recrimination that followed Obama’s speech revealed how deeply divided and directionless the once formidably cohesive American Catholic Church has become. And if George Weigel’s new book is any indication of where the church’s hierarchy is headed, the divisions promise to grow deeper. Indeed, a good deal of the blame for the bishops’ belligerent public posture can be laid directly on the desk of the author of Evangelical Catholicism. …

According to Weigel, the evangelical Catholicism of his book’s title represents a necessary departure from the “Counter-reformation” or so-called tribal Catholicism of recent centuries. In his view, a Catholicism held together by ethnic affinities possesses neither the fervor nor the missionary commitment needed to meet the challenges of postmodernity. In place of the bricklayer bishops who built a Catholic subculture of schools, hospitals and civic associations across America, what’s needed today are bishops like the late John Paul II, men who speak of their faith in compelling, adamantine and fearless ways. These bishops will be disciplinarians, unabashed in demanding doctrinal obedience from priests, women in religious orders and those in the pews. Theologians and politicians who publicly dissent from church teaching must be told that they are no longer Catholic in “any meaningful sense.” Catholics who do not believe everything the church teaches should leave. (It will be interesting to see how this “new breed” of priests and bishops responds to the leadership of the recently elected Pope Francis, who seems to take a less confrontational approach to secular culture than Weigel does.) …

Why would Weigel assume that the “deep reform” of the Catholic Church is relevant to the political and cultural life of most Americans? Because he thinks that, as with Poland under communist domination, America’s fate is now intimately linked to that of Catholicism. “The Catholic Church is now the world’s premier institutional proponent of human rights and democracy,” he claims—by which he means that the church’s “social doctrine offers a principled framework” for the preservation of the West’s failing democracies. As far as Weigel is concerned, no other options are available.

What to make of these grandiose claims? In one sense, Weigel is repeating what the Catholic Church has always taught. Conversion is what Christianity is about, and so Catholicism, often married to Aristotelian and Thomist notions of natural law and natural rights, remains a vital force in the American political tradition. But the resources of that tradition are broader than the abstract and self-evident truths, invoked by the Declaration of Independence, on which Weigel places such emphasis. The tradition has made use of a variety of philosophical resources, including Enlightenment rationalism, civic republicanism, secular liberal rights theory and pragmatism. It is unlikely we will succeed in forging a more perfect union if we do not make use of all the political resources at our disposal.

You can read the whole thing here. (Update: We earlier noted the inclusion of a link at the end of The Nation‘s online version of the review; that link has since been removed.)

Today, Cardinal Timothy Dolan released a statement outlining the USCCB’s objections to the Obama administration’s revision of the revision of the contraception mandate. The new rule scotches the previous iteration’s much-maligned four-part definition of “religious employer,” and proposes arrangements to make sure religious employers — including colleges, hospitals, and charities — won’t have to pay for or refer for contraception coverage in their employee health plans. In other words, the Department of Health and Human Services listened to its critics and attempted to allay their concerns. As the editors of Commonweal put it, “This will do.” The U.S. Conference of Catholic Bishops disagrees. 

First, a word of praise for the tone of Cardinal Dolan’s statement. It avoids the hyperbolic rhetoric that has characterized this debate for far too long. The cardinal states that the bishops are open to further discussion. He acknowledges that the Obama administration “has heard some previously expressed concerns and that it is open to dialogue,” and promises “additional, careful study.” He notes that the new proposal does away with the “exceedingly narrow” definition of “religious employer,” which, the bishops claimed, “created a ‘second class’ of citizenship within our religious community” — subordinating Catholic charities to Catholic parishes. But apparently that’s not enough for the bishops.  Read the rest of this entry »

In their dispute with the Obama Administration over the HHS contraception mandate, a number of U.S.bishops have suggested that they will have to close hospitals, schools and Catholic universities if the mandate is not modified or withdrawn.

But would the bishops really be required to do this?  While I’m sympathetic to the bishops’ concerns and support their efforts to broaden the exemption for religious employers, I do not think it is true that a failure in this regard would require the closing of Catholic institutions.  For the moment, I am going to set aside the question of whether closing is the most likely outcome or whether the institutions in question would merely be asked to sever their formal ties with the Church. Clearly, neither is a desirable outcome.

The concept in moral theology that is in play here is known as “cooperation.”  When we facilitate the acts of another person in some way, we are said to be cooperating with them.  If those acts are evil, then we may share some moral culpability for those actions.

In general, Catholics are called to “do good and avoid evil.”  If we share the evil intent of the other person (e.g. driving the getaway car to facilitate a bank robbery), it is said to be formal cooperation with evil and morally blameworthy.  However, if the actor is cooperating but does not share the intent of the other person (e.g. driving the getaway car because you have a gun to your head), their cooperation is said to be material.  Material cooperation may be permissible if the act of cooperation is not itself intrinsically evil (driving a car is, in itself, a neutral act) and there are proportionate reasons for the material cooperation (e.g. fear of death).

A related concept is the degree of proximity between the person cooperating and the original actor.  My moral culpability in the actions of another person may be greater if my actions directly facilitate his act.  If my actions assist the original actor only indirectly and I do not share his evil intent, this is said to be “remote material cooperation” and my moral culpability is reduced still further.

We can assume that some employees of Catholic institutions use contraception, which Catholic teaching holds to be an intrinsically evil act.  To what extent is the Church, as their employer, morally complicit in those acts?  Read the rest of this entry »

Last week Wheaton College, an evangelical school in the great state of Illinois, let it be known that they were joining the Catholic University of America in a lawsuit against the Obama administration over the contraception mandate. Why would an evangelical college sue over the contraception mandate when Protestants have no problem with artificial birth control? Because, as Wheaton President Philip Ryken explained during a conference call, “the mandate forces us to provide abortion-inducing drugs through the insurance coverage that we provide to our faculty, students, and staff.” And why now? The college was waiting to see what the Supreme Court would decide — and, according to its legal counsel, Wheaton is subject to the preventive-services mandate in six months.

That’s soon. Any chance Wheaton’s employee health plans are considered grandfathered — like the plans offered by the Franciscan University of Steubenville — and therefore exempt from the mandate? No, according to Kyle Duncan of the Becket Fund. What about an exemption? “There’s no question that Wheaton can’t qualify for any exemption from the mandate for the simple reason that it’s not a church or religious order,” Duncan continued, assuming that the Department of Health and Human Services would deny the college’s request for an exemption. What about the so-called safe-harbor provision, which would delay enforcement of the mandate for religious employers until August 2013? “Wheaton can’t profit by any safe harbor the government has offered simply for purely technical reasons about changes made to its insurance policy,” Duncan claimed.

Technical reasons? The safe harbor provision “has a number of technical requirements to be able to qualify,” Duncan elaborated. “For example, it has a cut-off date of February 10, 2012. Because of technical changes made to Wheaton’s insurance policy after that date, it can’t qualify. If that sounds arbitrary that’s because it is.”

No, it’s not.  Read the rest of this entry »

I hope you weren’t looking at Twitter just now. If so, you would have learned that the Supreme Court both struck down and upheld the Affordable Care Act. What actually happened is this: Chief Justice John Roberts read the majority decision, which, by a 5-4 vote, upholds the Affordable Care Act — including the individual mandate — with one exception: the federal government’s power to end state Medicaid funding is narrowly read. The Court said that while the law’s expansion of Medicaid is itself constitutional, it would not be constitutional for the federal government to withhold new existing Medicaid funding for states’ failure to comply with the expansion provisions. From the majority decision: “Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”

Early reports indicate it was Roberts’s vote that saved the law. ”Our precedent demonstrates that Congress had the power to impose the exaction in Section 5000A under the taxing power, and that Section 5000A need not be read to do more than impose a tax. This is sufficient to sustain it.” From footnote 11 (as pointed out by SCOTUSblog): “Those subject to the individual mandate may lawfully forgo health insurance and pay higher taxes, or buy health insurance and pay lower taxes. The only thing that they may not lawfully do is buy health insurance and not pay the resulting tax.” Justice Kennedy, reading the dissent — which was joined by Scalia, Alito, and Thomas — couldn’t disagree more: “In our view, the entire Act before us is invalid in its entirety.”

For more, be sure to visit the (hopefully not overwhelmed) SCOTUSblog. And you can read the Court’s opinions here (.pdf).

Today the Catholic Health Association released its comment (.pdf) on the Department of Health and Human Services proposal to accommodate religious employers’ objections to the contraception mandate. From the beginning, CHA has objected to the structure of the mandate’s exemption, which defines a religious employer as one that “primarily” serves and hires co-religionists, and whose purpose is the inculcation of its values. Still, when the Obama administration announced its intent to shift the responsibility of providing contraception coverage from religious employers to insurance companies, CHA praised the plan. Now, after studying the “advance notice of proposed rulemaking” (ANPRM), CHA says its initial concerns are “not relieved”:

Read the rest of this entry »

At the Catholic Theological Society of America business meeting today, the membership considered a resolution urging “federal and state government to exempt employers from funding or providing contraception and sterilization when such funding or provision directly violates the moral tenets of the employer’s religious tradition.” Even though the original version of the resolution was tweaked after initial discussion (e.g., the final version excised the original’s naming of the Obama administration), its chances of passing were never high. Privately, some CTSA members expressed a concern that a no vote would only serve to highlight the distance between the organization and the U.S. Conference of Catholic Bishops. But, thanks to an exceptionally clever intervention by one member, the CTSA dodged that bullet. Here’s the full text of the resolution:

Read the rest of this entry »

A major talking point in the Church’s opposition to the contraception mandate has been that the mandate goes beyond requiring employers to cover contraception and requires them to pay for products that, in the Church’s view, amount to abortion.  For example, the Notre Dame complaint (.pdf) repeatedly claims that the mandate requires Notre Dame “to provide, or facilitate the provision of, abortion-inducing drugs.” (see, e.g., para. 87, 90, 107, 109, 125, 140, 146, 147, 149, 156…and many more)  The complaint asserts that, as a matter of fact, Plan B “operates by preventing a fertilized embryo from implanting in the womb.”  Count IX of the Notre Dame complaint claims that the mandate is illegal precisely because it violates the APA’s commitment not to require employers to cover abortion services.  When the complaint lists the services to which it objects, it routinely uses the following formulation:  ”abortion-inducing drugs, sterilizations, and contraceptives.”

Why this emphasis on abortion in a complaint to block the contraception mandate?  The question is made a little more urgent by today’s article in the New York Times reporting that the weight of scientific evidence is decidedly against the claim pressed by the Notre Dame complaint (and many Catholic opponents of the mandate) that Plan B “operates by preventing a fertilized embryo from implanting in the womb.”   Read the rest of this entry »

On Tuesday the Franciscan University of Steubenville announced that it would stop offering students health coverage at the end of the summer. Why? Contraception coverage and cost:

The Obama Administration has mandated that all health insurance plans must cover “women’s health services” including contraception, sterilization, and abortion-causing medications as part of the Patient Protection and Affordable Care Act (PPACA). Up to this time, Franciscan University has specifically excluded these services and products from its student health insurance policy, and we will not participate in a plan that requires us to violate the consistent teachings of the Catholic Church on the sacredness of human life.

Additionally, the PPACA increased the mandated maximum coverage amount for student policies to $100,000 for the 2012-13 school year, which would effectively double your premium cost for the policy in fall 2012, with the expectation of further increases in the future.

It’s strange that the university would cite the contraception mandate as one of its reasons for dropping student health coverage now. First, the mandate doesn’t kick in until August 2013. And second, there’s a good chance the school will qualify for an exemption. Remember, the Department of Health and Human Services regulations exempt religious employers that primarily employ and serve co-religionists, and whose purpose is the inculcation of its religious values. If any Catholic college fits that bill, it’s Steubenville, whose student body is 95 percent Catholic. How do you think the school’s insistence that it’s not exempt will play at HHS when it applies for an exemption?

So if the contraception mandate doesn’t take effect until 2013, why rush to dump student health coverage?

Read the rest of this entry »

Last week, 47 of John Carroll University’s roughly 215 faculty members signed a letter to school president Robert L. Niehoff, SJ, asking him to accept the contraception “accommodation” and include such coverage in employee health plans. The faculty members express their concern that “the bishops have chosen a path of continued confrontation.” Given that the bishops “have rejected the accommodation offered by the administration,” they continue, “leads us to wonder what motivates their continued resistance.” Rejecting the bishops’ claim that the contraception-coverage mandate constitutes an attack on religious freedom, the faculty argue that mandate “is driven by a concern for women’s health.” The signatories include the co-founders of the university’s new public-health minor program, and members of the following departments: Biology, Classical and Modern Languages and Cultures, Communication and Theater Arts, Education, English, History, the Library, Math and Computer Science, Philosophy, Political Science, Physics, Psychology, Sociology and Criminology, and Theology and Religious Studies.

“Access to contraception is central to the health and well-being of women and children,” according to these faculty members. Therefore, they urge Niehoff to “stand up to those who would play politics with women’s health,” and “endorse a policy of insurance coverage of contraception that respects the religious liberties and health of all who teach and work at Catholic colleges and universities.” (You can view the entire letter here.)

Not sure if this is the first letter of its kind, but I doubt it will be the last.

First Tim Jost [.pdf], health-care law scholar:

Accommodation of religious belief and “neutral laws of general applicability” is not an easy task. I am a religious conscientious objector and object to the requirement that I must pay taxes to support war. Yet I do not consider the federal government to be at war with religion, even though it makes no accommodation for my religious beliefs, much less the accommodation that it affords those who object to contraception.

For two centuries that United States has been conducting an experiment virtually unprecedented in human history—a government that neither establishes nor forbids any religious beliefs. Sometimes, as with respect to laws prohibiting polygamy in the nineteenth century or my objection to war taxes, it has offered no quarter to minority beliefs. In other situations, as with the implementing of the preventive services requirement, the government has gone a great distance to accommodate minority beliefs, while at the same time trying to accommodate the needs of the majority. As a member of a religious group that has always Sydney  been in the minority, and is likely to stay there, I rejoice in this ongoing experiment. President Obama, himself a professed Christian, is not at war with religion, his administration is rather trying to find a peaceful solution to one of the many conflicts over religious values that characterize our diverse nation.

Second, our latest editorial:

Conservative Catholics complain that too many liberal Catholics instinctively greet every statement from the Vatican with suspicion, skepticism, or derision. It’s a fair point. The motives and judgment of those who appear unthinkingly hostile to all hierarchical authority should be questioned. Patient attention to the legitimate concerns of others and the presumption of goodwill on the part of those we disagree with are essential virtues.

Unfortunately, patience and the presumption of goodwill were not much in evidence in the response of the U.S. bishops and many conservative Catholics to President Barack Obama’s compromise on the question of mandated contraceptive coverage for employees of religious-affiliated institutions. Even before all the details of the president’s proposal were known, the bishops rejected it and then upped the ante by insisting that the only possible solution was to repeal the mandate altogether. In other words, the bishops are now demanding that no employer be required to offer free contraception coverage to its employees. To justify their response, they offered only the most tendentious reading of the possible flaws in Obama’s proposal. Now the USCCB is threatening a concerted political and public-relations campaign—during an election year—that casts the president as a determined enemy of religious freedom.

Most critics of the HHS contraception mandate have said the controversy is about religious liberty, not contraception. Some of the same critics have said that the question is not whether Catholics could comply with the mandate in good conscience if they had to, but whether the government ought to force them to comply with it in the first place. But these two claims are logically incompatible with each other.

Read the rest of this entry »

Show of hands — who was surprised that conservatives, conservative Catholics, and Catholic conservatives didn’t do a happy dance in response to President Obama’s revision of the contraception-coverage mandate?

First, the U.S. Conference of Catholic Bishops complained that the religious exemption in the original mandate was far too narrow. They pointed out that Catholic institutions — animated by religious belief — that provided service in the areas of health care, education, and charitable work would be made to purchase health coverage that included services inimical to Catholic teaching. In other words, the bishops argued that their religious freedom was being infringed upon. And I agreed. Commonweal agreed. America agreed. The National Catholic Reporter agreed. E. J. Dionne. Mark Shields. Amy Sullivan. The Washington Post. The Economist. We all agreed that the Obama administration had overreached and needed to walk back the policy.

But then we started hearing other noises from the USCCB prolife office. The Hawaii arrangement? Phooey. It would force us to refer for immoral services. Then we heard bells. Taco bells, specifically, when USCCB Associate General Secretary Anthony Picarello floated the theory that the even if a Hawaii-like compromise was reached, the bishops still wouldn’t be satisfied because good Catholic employers, say, ones who owned Taco Bells, who didn’t want to provide contraception coverage — wherever they are — would not be exempt. That’s when some of us started to see the writing on the wall.

Read the rest of this entry »

President Obama has announced a major revision of the mandate requiring employers to provide contraception coverage in employee health plans. Under the new rule, senior administration officials confirmed, no religious institution will have to pay for health-insurance plans that include contraception coverage. Not houses of worship, not parish schools, not universities, not hospitals, not charitable organizations.

The outline of the new rule is fairly simple. Nonprofit religious institutions that do not fall within the narrow religious exemption will not have to offer employee health plans that cover contraception. Instead, the employer’s insurance company will have to contact employees directly and offer contraception coverage as a separate policy at no cost. (Religious organizations that primarily employ and serve co-religionists, and whose mission is primarily to inculcate its values, will not be covered by this new arrangement.)

Why would insurers agree to provide contraception services for free? Because, actuarially, it makes financial sense. The average pregnancy costs roughly $12,000. Enrollees who use contraception are cheaper to cover.

The revised ruling seems to have satisfied both Sr. Carol Keehan, president of the Catholic Health Association, who had criticized the original ruling, and Cecile Richards, president of Planned Parenthood, both of whom made statements praising the revised policy.

Given that religious institutions will not have to pay for policies that include contraception, and they there is no requirement that they refer employees for such services, the new policy directly addresses the legitimate objections raised by the U.S. Conference of Catholic Bishops.

We’ll see. More details as they come throughout the day.

Updates: USCCB press release:

“While there may be an openness to respond to some of our concerns, we reserve judgment on the details until we have them,” said Cardinal-designate Timothy Dolan, president of USCCB.

“The past three weeks have witnessed a remarkable unity of Americans from all religions or none at all worried about the erosion of religious freedom and governmental intrusion into issues of faith and morals,” he said.

“Today’s decision to revise how individuals obtain services that are morally objectionable to religious entities and people of faith is a first step in the right direction,” Cardinal-designate Dolan said. “We hope to work with the Administration to guarantee that Americans’ consciences and our religious freedom are not harmed by these regulations.”

Read the rest of this entry »

On Friday, the U.S. Conference of Catholic Bishops issued a sharp response to Thursday’s White House blog post purporting to clear up any confusion about how the contraception-coverage mandate will affect religious institutions. The USCCB’s press release goes through the White House blog post point by point, clarifying a couple of important issues, but obfuscating several others by employing a touch of the worst-case-scenarioism that fueled the bishops’ opposition to the Affordable Care Act. Let’s have a look:

Claim: “Churches are exempt from the new rules: Churches and other houses of worship will be exempt from the requirement to offer insurance that covers contraception.”

Response: This is not entirely true. To be eligible, even churches and houses of worship must show the government that they hire and serve primarily people of their own faith and have the inculcation of religious values as their purpose. Some churches may have service to the broader community as a major focus, for example, by providing direct service to the poor regardless of faith. Such churches would be denied an exemption precisely because their service to the common good is so great. More importantly,the vast array of other religious organizations – schools, hospitals, universities, charitable institutions – will clearly not be exempt.

Does the USCCB really expect readers to believe that parishes won’t be exempt? That, say, providing meals to the hungry — even as a “major focus” — would distract HHS from the fact that the primary function of a Catholic parish is to serve as a community of worship? That HHS would fail to notice that parishes are not for profit, that they primarily employ and primarily serve co-religionists, and that they exist to inculcate Catholic beliefs and values — in other words, that they meet all four (far too restrictive) conditions to qualify for an exemption from the contraception-coverage mandate?  Read the rest of this entry »

It almost seems absurd to repost information that is available in dozens of other places on the Internet, but a few folks have asked my take on the current health care endgame. 

After legislative maneuvering last week that led to the excision of the so-called “public option,” the Senate Democrats have 59 of the 60 votes they need to pass a motion to end debate on the bill (known as “cloture”) and move to a vote.  Assuming the bill then passes, it gets sent to a joint House-Senate conference committee where it gets reconciled with the House reform bill.  The consolidated bill is then sent back to both chambers for up/down votes.  In the Senate, this vote can also be filibustered.

So where is the final vote in the Senate going to come from?  There are two plausible options at this point.  The first is Ben Nelson (D-NE), a relatively conservative Democrat who has raised concerns about the bill’s treatment of abortion (he supported the failed Senate version of the Stupak Amendment) and the fiscal burden it would place on states. 

The second is Olympia Snowe (R-ME) a relatively liberal Republican.  Snowe has been concerned about the financial impact of the individual mandate and was more open to a “triggered” public option than some conservative Democrats.  She has also stated that she is less inclined to support the bill if Reid tries to hold the Senate vote before Christmas.  Snowe is also pro-choice, so any changes that move the bill in a more pro-life direction are not going to be much help in getting her vote.

Which Senator is more likely to come on board?  Reid seems to be focusing on Nelson right now.  Yesterday, Nelson reportedly rejected a compromise on the abortion language drafted by Bob Casey (David Gibson has the details).  Today he spent the morning in a meeting with Harry Reid.  His comments after the meeting suggest that he is still negotiating seriously.  One key question is whether improvements to the abortion language would be enough to bring Nelson aboard, or whether he will use an impasse on abortion to justify a vote against a bill he clearly dislikes on other grounds as well.

Meanwhile, rage on the Left about the excision of the public option has reached a fever pitch, with Howard Dean and MoveOn.org now actively campaigning to defeat the Senate bill.  Rich Trumka of the AFL-CIO has strongly suggested that the labor federation may oppose the bill, but SEIU’s Andy Stern is (somewhat reluctantly) on board.  The split in labor reflects differences in their base.  SEIU, which left the AFL a few years back to form a rival federation known as Change to Win, represents health care workers and low wage service workers, both of which stand to gain from reform.  The AFL-CIO represents industrial and buildings trades workers who are unhappy about the tax on high-end health benefit plans.  

A lot of the criticism from the Left has focused on Obama’s leadership.  They think he could have done more to pressure senators and build support for a public option.  I think it’s true that the White House did not have the “fire in the belly” for the public option (nor do I, for the record).  I think the critics vastly overestimate, though, Obama’s ability to bring pressure on the senators who have created the most difficulty for him.  Obama is relatively unpopular in places like Arkansas and Nebraska.  I joked to one colleague today that the only way that Obama was going to be able to pressure Blanche Lincoln (D-AR) was by threatening to come to Arkansas and campaign for her.

What does seem clear is that Obama and the Congressional Democrats need to end this impasse soon.  Obama’s poll numbers, while relatively stable in recent weeks, have fallen markedly since early in the year.  Congressional Democrats have lost the generic ballot advantage they had over Republicans early in the year.  If this struggle carries over into 2010, there is an increasing risk of losing Democrats facing tough re-election fights.

If health care reform does not get done in this Congress, it is fair to ask whether it can ever be done.  The political parties have become more ideologically homogenous and the ideological divide between them seems to be increasing. There is now an effective 60 vote requirement in the Senate on many major pieces of legislation.  Historically, the United States is a center-right country that generally embraces solutions from the left only in times of economic crisis (and sometimes not even then).  The Democrats are almost certainly going to lose several seats in both the Senate and House next year, giving the Republicans an effective legislative veto.   Advocates for health care reform can quibble about the details, but in terms of passing major reform, the time may well be now or never. 

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.