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.