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A Right to Be Healthy?

The other day, Philadelphia Archbishop Charles Chaput was interviewed by the National Catholic Register regarding the U.S. bishops ongoing struggle with the Obama Administration over the definition of a religious employer. He was asked about the statements of the U.S. bishops in favor of a right to health care. This was his response:

The bishops really do believe it. Health is a basic human right; we have a right to be healthy. Theres no declaration on the part of the Church that that has to be accomplished through government intervention. There are many ways of approaching health care, and I think its very important for Catholics to understand the fact that the Church, seeing health care as a basic human right, does not mean [to say] theres a particular method of obtaining that [right thats] better than another.

With all due respect to the Archbishop and his teaching office, I would argue that this statement seriously distorts Catholic teaching on the subject.

First of all, the right to health care is not merely reducible to the right to be healthy. When the major documents related to Catholic social teaching speak about this, they clearly indicate that the right to health care is meant to be understood as a right to medical care or treatment. Consider this excerpt from Pope John XIIIs Pacem in Terris.

But first We must speak of man's rights. Man has the right to live. He has the right to bodily integrity and to the means necessary for the proper development of life, particularly food, clothing, shelter, medical care, rest, and, finally, the necessary social services. In consequence, he has the right to be looked after in the event of ill health; disability stemming from his work; widowhood; old age; enforced unemployment; or whenever through no fault of his own he is deprived of the means of livelihood (paragraph 11)

Or closer to home, one might read the USCCBs 1993 statement A Comprehensive Framework for Health Care Reform:

Our approach to health care is shaped by a simple but fundamental principle: "Every person has a right to adequate health care. This right flows from the sanctity of human life and the dignity that belongs to all human persons, who are made in the image of God." Health care is more than a commodity; it is a basic human right, an essential safeguard of human life and dignity. We believe our people's health care should not depend on where they work, how much their parents earn, or where they live. Our constant teaching that each human life must be protected and human dignity promoted leads us to insist that all people have a right to health care. This right is explicitly affirmed in Pacem in Terris and is the foundation of our advocacy for health care reform. When millions of Americans are without health coverage, when rising costs threaten the coverage of millions more, when infant mortality remains shockingly high, the right to health care is seriously undermined and our health care system is in need of fundamental reform.

In this statement, the bishops go on to explicitly address the question of state action to achieve the right to health care:

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 to 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 government, an instrument of our common purpose called to pursue the common good, has an essential role to play in assuring that the rights of all people to adequate health care are respected.

There is simply no way to read these passages in a way that divorces the right to health care from the obligation of government to ensure that this right can be meaningfully exercised. At the level of language, it is contradictory to use the term right in a way that denies the need for an effective remedy to enforce that right. Section 8 of the United Nations Declaration on Human Rights--a document deeply influenced by Catholic Social Teaching--makes this point clear:

Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law. (#8)

Archbishop Chaput is correct that there may be more than one way for the state to allow meaningful exercise of the right to health care. In the United Kingdom, the government acts as the direct provider of medical care. In Canada, the care delivery system remains largely in private hands, but the insurance function is socialized. The Obama Administrations Affordable Care Act allows both care delivery and the insurance function to remain in private hands. However, it requires that all individuals purchase health insurance and provides subsidies to assist low-income families in doing this. It also creates a structure that--at least in theory--will promote both choice and vigorous competition between health care plans.Any of these options--and a number of others--would be morally acceptable under Catholic Social Teaching. What is clearly not acceptable is a system that relies heavily on private insurance while making it impossible for tens of millions of people to afford it. A system that forces these families to seek care in overcrowded emergency rooms fails basic principles of distributive justice that have been part of Catholic Social teaching for more than a century.The idea that the right to health care can be exercised apart from state action is--to put it mildly--a novelty in Catholic social thought that has no purchase outside the United States. Its popularity among certain American Catholics owes more to the baneful influence of libertarianism in this country than any serious engagement with magisterial texts. I suspect that the vast majority of the worlds bishops would find the concept nonsensical.I realize that the U.S. bishops are tremendously frustrated at the Obama administration and some would clearly like to ease the consciences of Catholics concerned about voting for a candidate that has promised to repeal health care reform. It is not, however, acceptable to distort the social teaching of the Church in order to accomplish this end. To paraphrase Governor Romney, bishops may have a right to their own chanceries and croziers, but they do not have the right to their own personal version of Catholic Social Teaching.

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Peter Nixon is on target. The mental contortions of Archbishop Chaput and other bishops about a society's obligation to provide for the health of its members make them sound either wholly uninformed or devious.

From Archbishop Chaput's interview: "Theres no declaration on the part of the Church that that has to be accomplished through government intervention. "Peter - note the word "intervention". Here is how you summarize your argument: "The idea that the right to health care can be exercised apart from state action isto put it mildlya novelty in Catholic social thought that has no purchase outside the United States."Note that you're discussing state action, or state involvement, in the delivery of health care. But Archbishop Chaput talks about "government intervention". I think it's quite likely that he is talking about something different than you are. And taking his quote as a general statement, you and he are in agreement; the elements of Obamacare that you name, health care delivery and insurance - which does not encompass all that the legislation encompasses - call for relatively little government intervention. (Certainly, the argument has been made that other aspects of Obamacare that you don't treat in your post, e.g. its regulatory requirements, not only constitute government intervention, but overly burdensome or imprudent government intervention.)I strongly agree with you that Catholic social teaching isn't optional on this point: health care is a basic human right to which everyone has a right. But it doesn't therefore follow that Catholics must support Obamacare. Obamacare may not be the best way to deliver this basic human right. It may not work at all: it may fail to deliver health care to millions of Americans, or prove to be unaffordable, or both, or it may fail for some other set of reasons that hasn't been considered. We won't know for years whether Obamacare will meet this basic test of Catholic social teaching. Just as ignoring the health care needs of all isn't an option, supporting Obamacare and the party that unilaterally gave it to a nation - whose majority of citizens didn't ask for it and don't like it now - isn't mandatory.

Consider Jim P's penultimate paragraph. What he says there about Obamacare would be true of any program to provide widespread health care. Does follow that this set of "uncertainties" counts against Obamacare? Not in my book!

Jim P. --Granted, Obamacare is not the only system that might fulfill the basic needs of the American people. Note the word "might'. The question is whether or not at this point in our history there is any other adequate system which can/will possibly be implemented politically by the Congress. In other words, what are the real alternatives *politically* at this point? Answer: the only alternative at this point is Romney's let-the-health-industry-solve-the problems. But history has shown that the American health industry has already not solved our health system problems, but, rather, the health industry IS the problem. It has failed us miserably -- just note the millions who could not afford it.It follows that given the only real choice -- between Obama's system and Romney's -- Obama's is the only answer, imperfect though it is.

Jim - you say: "....Chaput talks about government intervention. I think its quite likely that he is talking about something different than you are." Sorry, appears that you are in search for an alternate or semantic difference to make some distinction?More: "...Just as ignoring the health care needs of all isnt an option, supporting Obamacare and the party that unilaterally gave it to a nation whose majority of citizens didnt ask for it and dont like it now isnt mandatory."Again, a famous person once said: "Democracy is the worst form of government except for all the others that have been tried". Thought the analysis did a good job of pointing out both the excess and inaccuracies of Chaput's reasoning as CST.....he said much more than that PPACA is just one approach. The principle and right was distorted in his telling....and trying to say that PPACA is just one of many approaches would be fine but Chaput doesn't offer any type of alternative; thus, he leaves the reader with the obvious conclusion that a vote for Obama is a vote for PPACA and PPACA is not acceptable. He actually confuses two areas using semantics to cover up his antipathy.Finally, you say from the usual Republican talking points - majority didn't ask for it, don't like it, and given to us unilaterally. Sorry, you ignore the history of PPACA; you ignore that Romneycare was the living example; you ignore that Republicans started the individual mandate idea. Allow me to remind that civil rights, war on poverty, the end of slavery to name but a few US government actions were not asked for by a majority of citizens and many did not like them. Can you deny that those decisions followed CST and improved the US common good? Unilaterally - actually, it was passed following the congressional rules currently in place. No Republican voted for it but that doesn't mean it was illegal which is what the term *unilateral* seems to convey. Lots of bills get passed when one party votes against it. Depending upon whatever polls you read, more than 50% of citizens now approve of PPACA and the approval rate continues to increase especially since the full law does not take effect unitl 2014.

Peter Nixon has it right.Jim P. any action by government is considered an intervention by Chaput. It's free market speak. Where you got the idea that some government laws or programs or activities in this realm are classed by him as non-interventions is a mystery.

"(doesn't have) to be accomplished through government intervention" The Archbishop made a similar remark about our obligation to help the poor.But if it were true,wouldn't it apply to ALL Church teaching? Opposition to artificial contraception, same sex marriage, abortion doesn't need to be accomplished by government intervention.. Sounds a little anarchist.

Just to point out: there is no human right 'to be healthy.'

The idea that the right to health care can be exercised apart from state action isto put it mildlya novelty in Catholic social thought that has no purchase outside the United States. If you take a slightly longer view (longer than a few decades, that is), the true novelty is the very existence of such a thing as "health care" that actually helps people, let alone that must be provided by state action. Now that decent health care does exist of course, it's a nice thing to have a right to it, and if that right is possible only with state action, then state action we must have. But let's not forget the true novelty of the situation -- to the vast majority of Christians who have ever lived, the very worst health care available today would have seemed an impossible dream.

Stuart -- A very good point. Certainly it extends to the situation today in much of the world, Christian or not. But to us much has been given. We are a very wealthy country, even if we choose to spend our wealth unwisely. It seems to me we as a nation have an obligation to provide for the basic needs of our own, and beyond that to others in need as our capacity allows us.

When Archbishop Chaput says, "There are many ways of approaching health care," I wonder if the unstated minor premise is "some of them are governmental and some are free-market." That would be a silly position to take, but a lot of Americans believe in it.Otherwise, here is his problem, and it transcends Obamacare: If there is a right to health care, as the Church says there is, and if that right is recognized or given the force of law in this country, the right is going to involve access to abortion because a) abortion is considered health care (we disagree, but we don't have the votes) and b) the Supreme Court (six Catholics, five of them -- i.e., a majority -- appointed by Republicans) says it is a right. Short version: Abp. Chaput can't have his right, or allow others theirs, without accepting abortion in some way.

I think there are three issues which are continually overlooked1) a system that 'relies heavily on private insurance while making it impossible for tens of millions of people to afford it' without looking critically at the government interventions which make it so costly.2) Despite being a wealthy nation, we cannot afford to provide everyone with a heart transplant, for one example. There are limits to 'health care' just like every other human need which neither government involvement nor intervention can overcome.3) Providing 'entitlements' even to those without need, eg Medicare and Social Security to those who can readily afford to provide for themselves without government assistance.

Bruce:re: 2. I think our country actually could afford a heart transplant for everyone that needed one.

Irene and Bruce: Other less wealthy countries do.

@Bruce (10/16, 3:45 pm)Following on Irene Baldwin's comment, (and not overlooking your three issues):1) The U.S. health care system relies less on government interventions than virtually any other health care system in the industrialized world. Evidently it's not "government interventions" that make health care so costly in this country.2) Fortunately, not everyone in the U.S. needs or is asking for a heart transplant. Whatever the limits are to health care (and I agree with you that they exist), our society does not appear to have neared those limits. (When it does, there are numerous cost-saving measures that could be adopted.)3) Social Security is not in immediate financial trouble. It has relatively minor long-term issues that can relatively easily be addressed.The U.S. does not have a Medicare cost problem. The U.S. has a health care cost problem. Deal with that, and most issues with Medicare disappear.

Irene -- a heart transplant costs $200,000, which means that for 300 million people, it would cost 60 trillion dollars. That would be every penny the federal government spends for the next 24 years.

Stuart- I was thinking of just the people who needed heart transplants; 2,000-3,000 per year in the US, I think. We could definitely afford to pay for that.An insurance consultant once told me that the procedures most impacting our insurance premiums aren't organ transplants, but care related to premature infants. We have about half a million premies a year in the US; the collective cost of caring for them far outstrips the expense of providing heart transplants. But I don't think very many of us would want to ration care to newborns.

Irene, jbruns and LukeI was thinking of 300 million people, not in the sense that everyone needs one, but that we cannot afford to spend hundreds of thousands of dollars on everyone.Let me relate a personal story which highlights the issue. A husband over 65 has a wife slightly under 65 who gets sick. For some reason, the wife has no health insurance. The husband can and does pay for his wifes full healthcare (he's a doctor). Cost is nearly $1 million. Wife dies. Husband sells home to help pay the expenses and moves into a smaller place. Middle-aged daughter complains mightly about lack of health insurance and expense. Considers it a great injustice. So with government health insurance, daughter has large inheritance at taxpayer expense. Also, government crowds out the husbands care for his wife and the wifes acceptance of the husbands sacrifice for her. That is I think the type of government intervention which Chaput and CST would not necessarily want.

Another quotation from Pope John XIIIs encyclical Pacem in Terris:(64.) "The public administration must therefore give considerable care and thought to the question of social as well as economic progress, and to the development of essential services in keeping with the expansion of the productive system. Such services include road-building, transportation, communications, drinking-water, housing, medical care, ample facilities for the practice of religion, and aids to recreation. The government must also see to the provision of insurance facilities, to obviate any likelihood of a citizen's being unable to maintain a decent standard of living in the event of some misfortune, or greatly in creased family responsibilities."So, the "public administration" has responsibilities relating to social progress, as well as to economic progress (to address the claim that economic progress necessarily cures social ills). The public administration has a responsibility for ensuring the adequacy of medical care. The government also has a responsibility for ensuring access to insurance.The language seems clear enough. No interpretation required, one thinks.- Larry Weisenthal/Huntington Beach CA

Bruce, I always hope the folks who come up with hypotheticals that will never affect most people have to undergo their hypothetical some day. But, in charity, I will not hope that for you. Something a little north of 80 percent of Americans couldn't come up with $1 million, even selling their house to help pay expenses. So you are worrying about denying to a small minority a chance to make sacrifices, and make their daughters make sacrifices, for their beloved spouse. And because you are worried about that loss of a chance for true holiness for the rich, you would deny health insurance to the rest of us. On behalf of the rich saints and of the rest of us, thanks.

I wonder when some one will take the trouble to point out to the GOP minions that the granddaddy of national health care was Otto von Bismarck (that old bleeding-heart radical) in 1883. In fact it was just part of a series of government sponsored social programs that, were the Iron Chancellor seeking to put them through today, would see him denounced as a socialist.One of his main points, of course, was to undercut the growing influence of the Socialists, but it takes a certain imagination, sadly lacking today, to see the possibilities there. And, of course, old Otto was staunchly anti-Catholic, which only makes matters worse. Even more staunchly than the Obama of the American episcopal imagination.

If you follow Bruce's logic, insurance companies could not exist.

PER BRUCE: "Despite being a wealthy nation, we cannot afford to provide everyone with a heart transplant, for one example."PER STUART: "Irene a heart transplant costs $200,000, which means that for 300 million people, it would cost 60 trillion dollars. That would be every penny the federal government spends for the next 24 years.ANN REPLIES: Hey, just a moment, you guys. It's time you started listening to what you're saying and stop such nutty exaggerations of the way Democrats think.If half the people had heart TRANSPLANTS there wouldn't be anybody left to supply transplants for the other have. Sheesh.

Oops -- should be, "other half".

Sorry, I misinterpreted what she said.

Tom,Nothing hypothetical about the story. It actually happened.

TANGENTAt the synod, an Indonesian bishop, asking for more flexibility in liturgical translations, said that the the principle of subsidiarity is "the spirit of Vatican II". He said that collegiality is a kind of subsidiarity, and so called for more decision-making by bishops on the local level. I bet the Curial participants didn't like that one bit.http://ncronline.org/blogs/ncr-today/laugh-line-liturgical-translation

The word "right", like other once useful terms, has become so badly battered in political bar fights that it no longer applies to the real world, but only to a utopia in which scarcity has vanished and people life in perfect bliss, free from all want.

But when prelates and lawyers say "rights" they are using a term of art with meaning. They are not, one hopes, engaging in bar fights.

"Jim P. any action by government is considered an intervention by Chaput."If that is the case, then we must assume that Chaput also opposes Medicare. But I have never heard that he does. If someone can provide evidence that Chaput opposes Medicare, I'd be glad to read it.It may be that Chaput's views on government are more nuanced than "government always good"/"government always bad".

"The only alternative at this point is Romneys let-the-health-industry-solve-the problems. "Ann, that's not a very accurate description of Romney's plan to replace Obamacare. If anyone is interested, here is his diagnosis and proposal.http://www.mittromney.com/issues/health-careNote that government is integral to it. What does Chaput think about Romney's proposal? I have no idea.

Jim ==OK, Romney does give a regulatory function to the states and has the states take care of the poor, disabled and chronically ill. But then the same old greedy private insurance companies take over. He might make them a bit more competitive.By the way, his thinking that the feds care now for the chronically ill shows just how out of touch he is with ordinary people. The feds take care of those on Medicaid who are chronically ill, but if you're middle aged and chronically ill and have bad insurance or none, it's the emergency room for you every once and a while. (Where does he get these ideas of how ordinary Americans live?

"OK, Romney does give a regulatory function to the states and has the states take care of the poor, disabled and chronically ill. But then the same old greedy private insurance companies take over"But so does Obamacare have "the same old greedy private insurance companies take over".I happen to think that insurance companies provide genuine social value (without denying that they also can be greedy), but for good or ill, they are a well-entrenched part of our system of health care delivery. The senators who crafted the legislation now known as Obamacare thought it prudent to work with what is already in place. I think that's pretty defensible.I should make it clear that, in these comments, I'm not claiming that Obamacare is a really bad piece of legislation, that it somehow falls short of Catholic social teaching on the right to health care, or that Romney's plan is better. In fact, I think Peter's analysis is spot-on: the features of Obamacare that Peter considered, which surely are among its most important aspects, seem to fall within the orbit of Catholic social teaching. (I hedge a bit here and say "seem to" because, as I noted above, Obamacare is unproven. Consider Medicaid: a program whose intentions are wonderful and which is a critical piece of the national health care puzzle, but which fails to deliver health care to millions of the poor who qualify for it, and excludes millions of others. Medicaid is a cautionary example for both Obamacare and Romney's plan, istm.) Perhaps Romney's plan passes the Catholic social teaching sniff test, too, or perhaps not.But this is a determination that faithful citizens need to make. That process of determining is known as (here it comes) prudential judgment. Chaput is exercising his prudential judgment. While the quote from Chaput provided in this post doesn't explicitly criticize Obamacare, it's not difficult to imagine what he might mean. By "government intervention", it's likely that the HHS mandate is one of the things he has in mind. Recall that this is precisely the sort of violation of conscience protection that, in part, led the bishops to oppose the passage of Obamacare.Personally, my take is that the bishops would not be satisfied with a return to the status quo ante. But there are aspects of Obamacare that are so morally risky or odious that the bishops couldn't support its passage. Morally, it's a mixed bag - it's a big step forward in some ways, yet it's seriously flawed. If a way could be found to repair Obamacare, or to replace it with something less morally obnoxious, I expect the bishops would be pleased.

"Obamacare is not the only system that might fulfill the basic needs of the American people." Nor should the perfect be the enemy of the good.