Current Political and Cultural Challenges to Catholic and Free-Market Health Care

Remarks to the Catholic Leadership Health Care Insurance Conference

Thank you all for the great honor of speaking with you today about the political and cultural challenges to Catholic and free-market health care.  And many, many thanks to Bishop Vasa for his steadfast support for the work of many organizations in advancing health reform that will restore control to doctors and patients and their families over vital life and death decisions.

To introduce myself, I founded and am president of the Galen Institute, a think tank that has been working since 1995 to advance market-based ideas in the health sector.  We work with administration officials, Congress, governors and other state officials, and I speak with audiences around the country and abroad about these issues.  I see the many ways that the Information Age is putting growing pressures on centralized health care systems to respond to individual needs as people demand more control over their health care decisions. 

I would like to talk with you today about the pressures we are facing in the political environment, about the conflict in core principles of the Church, and describe a way forward to solutions that don’t need to force a choice among core values.  I hope I might be able to offer information that will help you to answer questions that you no doubt are asked about your support for freedom and free markets in health care.

The pressures facing the Church on health care

There often is confusion among Catholic leaders about conflicting priorities involving health care.  The Church’s mission to care for the poor leads to support for policies that would provide those who cannot pay for care with access to the care they need.  And Catholic hospitals need the resources to sustain their mission and clearly cannot provide unlimited care to the needy without reimbursement. 

The mission to care for the poor has lead many Catholic leaders to believe that the Church must therefore support government efforts to pay for health care and ultimately to provide universal health coverage.  The Church’s support for expansion of the State Children’s Health Insurance Program is a clear and immediate example.

But experience has proven that government payment for health care leads to government dictates of what must be covered.  By taking public money, these hospitals are under secular political control, causing great conflicts and lawsuits with the state over their ability to exercise their right of conscience over such fundamental issues as contraceptives and abortion.

Some Catholic hospitals have been forced to “choose between government accreditation and training residents in abortion procedures.”1  Clearly, this is not a choice we would ever want to force onto anyone and any hospital.

A different approach would have us look at the goal rather than the means and ask if there are other ways to achieve it while still adhering to Catholic principles and not compromising fundamental values and teachings of the church.

This conflict shows up in major ways that reach the newspapers, such as the dictate that Catholic agencies in Boston allow adoption by same-sex couples.  But it also shows up in smaller ways, including my own experience with being invited – and disinvited – to serve on the board of Providence Hospital in Washington, run by the Daughters of Charity and part of the Ascension Health System.  I was asked if I would be interested in being considered to serve on the board of directors.  I absolutely would have and saw this as an opportunity to help these leaders in our nation’s capital see another path.  I had been invited to attend several meetings – interviews really – that had gone quite well.  But then I had an article published in The Wall Street Journal arguing against expansion of the State Children’s Health Insurance Program to children into higher-income families.  I argued, for example, that expansion would make it more difficult for states to focus on finding the poorer children who already are eligible but not enrolled. I received a call shortly afterward telling me that several people at the hospital were quite upset about my position, and I was disinvited from being considered for the board.

So thank you for inviting me here.  I do believe that we are on the right path.

I would argue that rather than relying on government subsidies, Catholic medical institutes must first adhere to the fundamental teachings of the Church on individual responsibility, subsidiarity, and charity.

Individual responsibility: 

The common good is achieved by a society in which individuals are responsible beings in a moral society that embraces the truth about our humanity. This responsibility extends to ourselves, our families and our communities, and our expression of our love for each other through charity.
 
Expansion of the welfare state leads people to believe that someone else, and not they themselves, are responsible for their livelihood, their families, and their health.  But this is contrary to the teachings of the Church.  To quote Pope John Paul II2:

“Not only the world, however, but also man himself has been entrusted to his own care and responsibility. God left man ‘in the power of his own counsel.’ (Sir 15:14), that he might seek his Creator and freely attain perfection. Attaining such perfection means personally building up that perfection in himself.

“Indeed, just as man in exercising his dominion over the world shapes it in accordance with his own intelligence and will, so too in performing morally good acts, man strengthens, develops and consolidates within himself his likeness to God.”

In a state-controlled system, this divinely-inspired individual responsibility in using health care resources is replaced by political authority that ultimately leads to rationing of health care by the state.

The challenges will become even more intense going forward.  As medical technology advances and there are more and more options for healthcare goods and services that cost more and more money, the pressures will grow for someone to make decisions about access to these technologies that could have life or death consequences.

Subsidiarity:

Pope Benedict XVI wrote in his recent encyclical Deus Caritas Est, “We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need.”

Pope John Paul II in Centesimus Annus wrote, “The first and fundamental structure for ‘human ecology’ is the family, in which man receives his first formative ideas about truth and goodness, and learns what it means to love and to be loved, and thus what it actually means to be a person.  …It is necessary to go back to seeing the family as the sanctuary of life.” 

But government control over health care, and especially health care for children, violates that fundamental truth.

And later in the encyclical, he writes:  “By intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients…In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbours to those in need.”

When the state purports to assume this role in providing for the common good, it interrupts this principle of subsidiarity and usurps the proper functions of the individual, the family, the community, and the doctor-patient relationship.

Charity:

Pope Benedict XVI said in his first encyclical that the Church's work caring for widows, the sick and orphans was as much a part of its mission as celebrating the sacraments and spreading the Gospel. 

Charity is an essential expression of the Catholic faith and of our love for each other.  And our love for the poor must emphasize our compassion for them and our respect for the dignity of the individual. 

But a socialized system increases state dependency and diminishes motivation for charity. 

And the poor, with few if any options, are most disadvantaged by a centralized, bureaucratic system that robs them of their freedom to make their own decisions about their health care, their dignity and even their lives.  A child in Baltimore died several years ago because his mother was not able to find a dentist to see him, even though the child was enrolled in SCHIP.

Threats in the policy arena

There are immediate threats in public policies that would undermine the Catholic faith:

•    State laws dictate the services health insurance policies must cover, often forcing people to pay for services they have no desire to use and object to morally. 

•    Moreover, state legislators and courts have started forcing individuals and institutions to provide insurance for services that conflict with their deepest values, even while health care providers are being forced to provide or cooperate with dictates that conflict with their conscientious judgment.

•    With increasing frequency, pharmacists are facing charges of unprofessional conduct or being dismissed for acting on their convictions by refusing to fill birth control prescriptions or distribute the “morning-after” pill.

•    Government programs for children and low-income families, especially Medicaid and the State Children’s Health Insurance Program, not only fund unethical services (including abortion and contraceptives) but also provide a mechanism for paying for these services without parental knowledge or permission.


SCHIP: 
We are, of course, absolutely not against providing health care for children, as critics charge.  But we are against having the state replace the family in caring for children. 

Expansion of this program actually disadvantages the poor.  Three out of four uninsured children already are eligible for SCHIP or Medicare but are not enrolled.  Our experience, including a recent program in Hawaii, has shown that if the state provides health insurance for free, or nearly so, parents will give up their private, family coverage to get the subsidized state coverage. 

This is a bad bargain, not only because it divides families but also because the state plan leads to restrictions on access to doctors and hospitals, compromising the health care that children need and dividing the family, putting children under the care of the state rather than in the safety, care and love of their parents. 

Passage of an expanded SCHIP program was a top priority of the Obama administration.

The Obama administration’s agenda:
Partial birth abortion and denial of medical care for babies who survive abortions are unconscionable in a civilized society, yet, with the new administration, we risk having these policies expanded.  The threat of passage of the Freedom of Choice Act would deny states the right to create their own laws to protect life.  Further, virtually all of the health policies advocated by the administration, while couched in the language of freedom, would subsume more and more control over health care decisions to the state, robbing individuals and families of this most basic freedom.

Wyden-Bennett – a bi-partisan health reform bill before Congress – explicitly says that “A health insurance issuer must make available supplemental coverage for abortion services…”  SCHIP not only allows but in fact support abortions and contraception, often without parental consent or even knowledge.

At the end of the day the levers of power over health care decisions will be controlled either by individuals and their families, based upon their values, faith and moral guidance, or by centralized bureaucracies, either public or private. The structure of health care financing determines who controls these levers.  Economic policies do matter in health care and have profound effects.

Individual property rights in the control over insurance to protect against expensive health care needs are vital to devolving responsibility to individuals and to providing incentives to build a society grounded in the common good.

There is a better way.  We must adhere to first principles, and then find solutions that leave our values intact.   There is a difference between protecting rights and providing for rights.  They are two different processes. 

We must protect individual responsibility, subsidiarity, and charity.  Then, we can find new policies to provide access to health care. 

A statement from the Catholic Medical Association summarizes these policies:

1. Individual ownership of health insurance. Every American should be able to obtain needed medical care.  Congress could begin by providing a new set of incentives for Americans to purchase their own health insurance directly. These incentives should be properly structured to create an opportunity for people to purchase coverage that conforms to the dictates of their conscience and moral convictions. 

If we were to provide everyone with subsidies to purchase health insurance, they would have the choice and the option to select private insurance to cover themselves and their families.  Some will need additional subsidies because of their health or income status.  For those who don’t make an active choice, they could have a default policy purchased for them from among the approved plan being offered in their areas.  We can get to universal coverage without a centralized, state-controlled system.

2. Freedom from health insurance mandates. People must be able to purchase insurance that is free of restrictions and bureaucratic dictates, including state health insurance mandates.  States have enacted more than 2,000 health insurance mandates over the last several decades, including everything from toupees to in vitro fertilization procedures, and dictating the shape and structure of health plans for small businesses, individuals, and anyone else purchasing state-regulated policies. 

3. Choice of private insurance policies. The federal government and states should work together to provide more health care insurance options, giving individuals and families and employers the ability to choose among competing plans or to join groups and associations that share their values. Faith-based health providers must be able to develop and offer health care delivery systems that serve the needs of their members and communities.   New associations, including faith-based groups, would be welcome, even essential, additions to the array of health care options for families.

4. Comprehensive protection of conscience. No reform of the American health care system will restore the patient-physician relationship if health care workers are not afforded comprehensive protection of conscience. These protections should be enacted at the state and federal level so that health care providers are not required, for any reason, to participate in procedures that violate their religious or ethical beliefs.

I was honored last year to speak at a conference at the Vatican, sponsored by the Acton Institute and the Pontifical Council for Pastoral Health Care and attended by His Eminence, Cardinal Barragan.   After my talk, Cardinal Barragan told me I had put my finger into the wound of the problems we face in the health sector.

Pope John Paul II in Centesimus Annus said “It would appear that, on the level of individual nations and of international relations, the free market is the most efficient instrument for utilizing resources and effectively responding to needs.”

During his 1987 visit to the U.S., Pope John Paul II said “Among the may admirable values of this nation, there is one that stands out in particular.  It is freedom…Freedom was channeled to the fullness of human life, to the preservation of human dignity, and to the safeguarding of all human rights…This is the freedom that America is called to live and guard and to transmit.”

Every country’s health care system is unique and each has its own challenges in moving to a system that respects and supports the sanctity of the individual. I may suggest that the U.S., while it has many problems, may be further along this path in supporting individual freedom and rights over their own health care decisions and destiny. But all of us have an obligation to look for solutions that move us closer to the goal that advances the common good by respecting the dignity, the freedom, and the sanctity of human life.


1 Catholic Medical Association, “Report of the Task Force on Health Care in America,” May 2005, at http://www.cathmed.org/publications/Health%20Care.pdf.

2 John Paul II, Encyclical Letter Veritatis Splendor (1993), paragraph 39, at http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_06081993_veritatis-splendor_en.html.

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About the author

Remarks to the Catholic Leadership Health Care Insurance Conference

Thank you all for the great honor of speaking with you today about the political and cultural challenges to Catholic and free-market health care.  And many, many thanks to Bishop Vasa for his steadfast support for the work of many organizations in advancing health reform that will restore control to doctors and patients and their families over vital life and death decisions.

To introduce myself, I founded and am president of the Galen Institute, a think tank that has been working since 1995 to advance market-based ideas in the health sector.  We work with administration officials, Congress, governors and other state officials, and I speak with audiences around the country and abroad about these issues.  I see the many ways that the Information Age is putting growing pressures on centralized health care systems to respond to individual needs as people demand more control over their health care decisions. 

I would like to talk with you today about the pressures we are facing in the political environment, about the conflict in core principles of the Church, and describe a way forward to solutions that don’t need to force a choice among core values.  I hope I might be able to offer information that will help you to answer questions that you no doubt are asked about your support for freedom and free markets in health care.

The pressures facing the Church on health care

There often is confusion among Catholic leaders about conflicting priorities involving health care.  The Church’s mission to care for the poor leads to support for policies that would provide those who cannot pay for care with access to the care they need.  And Catholic hospitals need the resources to sustain their mission and clearly cannot provide unlimited care to the needy without reimbursement. 

The mission to care for the poor has lead many Catholic leaders to believe that the Church must therefore support government efforts to pay for health care and ultimately to provide universal health coverage.  The Church’s support for expansion of the State Children’s Health Insurance Program is a clear and immediate example.

But experience has proven that government payment for health care leads to government dictates of what must be covered.  By taking public money, these hospitals are under secular political control, causing great conflicts and lawsuits with the state over their ability to exercise their right of conscience over such fundamental issues as contraceptives and abortion.

Some Catholic hospitals have been forced to “choose between government accreditation and training residents in abortion procedures.”1  Clearly, this is not a choice we would ever want to force onto anyone and any hospital.

A different approach would have us look at the goal rather than the means and ask if there are other ways to achieve it while still adhering to Catholic principles and not compromising fundamental values and teachings of the church.

This conflict shows up in major ways that reach the newspapers, such as the dictate that Catholic agencies in Boston allow adoption by same-sex couples.  But it also shows up in smaller ways, including my own experience with being invited – and disinvited – to serve on the board of Providence Hospital in Washington, run by the Daughters of Charity and part of the Ascension Health System.  I was asked if I would be interested in being considered to serve on the board of directors.  I absolutely would have and saw this as an opportunity to help these leaders in our nation’s capital see another path.  I had been invited to attend several meetings – interviews really – that had gone quite well.  But then I had an article published in The Wall Street Journal arguing against expansion of the State Children’s Health Insurance Program to children into higher-income families.  I argued, for example, that expansion would make it more difficult for states to focus on finding the poorer children who already are eligible but not enrolled. I received a call shortly afterward telling me that several people at the hospital were quite upset about my position, and I was disinvited from being considered for the board.

So thank you for inviting me here.  I do believe that we are on the right path.

I would argue that rather than relying on government subsidies, Catholic medical institutes must first adhere to the fundamental teachings of the Church on individual responsibility, subsidiarity, and charity.

Individual responsibility: 

The common good is achieved by a society in which individuals are responsible beings in a moral society that embraces the truth about our humanity. This responsibility extends to ourselves, our families and our communities, and our expression of our love for each other through charity.
 
Expansion of the welfare state leads people to believe that someone else, and not they themselves, are responsible for their livelihood, their families, and their health.  But this is contrary to the teachings of the Church.  To quote Pope John Paul II2:

“Not only the world, however, but also man himself has been entrusted to his own care and responsibility. God left man ‘in the power of his own counsel.’ (Sir 15:14), that he might seek his Creator and freely attain perfection. Attaining such perfection means personally building up that perfection in himself.

“Indeed, just as man in exercising his dominion over the world shapes it in accordance with his own intelligence and will, so too in performing morally good acts, man strengthens, develops and consolidates within himself his likeness to God.”

In a state-controlled system, this divinely-inspired individual responsibility in using health care resources is replaced by political authority that ultimately leads to rationing of health care by the state.

The challenges will become even more intense going forward.  As medical technology advances and there are more and more options for healthcare goods and services that cost more and more money, the pressures will grow for someone to make decisions about access to these technologies that could have life or death consequences.

Subsidiarity:

Pope Benedict XVI wrote in his recent encyclical Deus Caritas Est, “We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need.”

Pope John Paul II in Centesimus Annus wrote, “The first and fundamental structure for ‘human ecology’ is the family, in which man receives his first formative ideas about truth and goodness, and learns what it means to love and to be loved, and thus what it actually means to be a person.  …It is necessary to go back to seeing the family as the sanctuary of life.” 

But government control over health care, and especially health care for children, violates that fundamental truth.

And later in the encyclical, he writes:  “By intervening directly and depriving society of its responsibility, the Social Assistance State leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients…In fact, it would appear that needs are best understood and satisfied by people who are closest to them and who act as neighbours to those in need.”

When the state purports to assume this role in providing for the common good, it interrupts this principle of subsidiarity and usurps the proper functions of the individual, the family, the community, and the doctor-patient relationship.

Charity:

Pope Benedict XVI said in his first encyclical that the Church's work caring for widows, the sick and orphans was as much a part of its mission as celebrating the sacraments and spreading the Gospel. 

Charity is an essential expression of the Catholic faith and of our love for each other.  And our love for the poor must emphasize our compassion for them and our respect for the dignity of the individual. 

But a socialized system increases state dependency and diminishes motivation for charity. 

And the poor, with few if any options, are most disadvantaged by a centralized, bureaucratic system that robs them of their freedom to make their own decisions about their health care, their dignity and even their lives.  A child in Baltimore died several years ago because his mother was not able to find a dentist to see him, even though the child was enrolled in SCHIP.

Threats in the policy arena

There are immediate threats in public policies that would undermine the Catholic faith:

•    State laws dictate the services health insurance policies must cover, often forcing people to pay for services they have no desire to use and object to morally. 

•    Moreover, state legislators and courts have started forcing individuals and institutions to provide insurance for services that conflict with their deepest values, even while health care providers are being forced to provide or cooperate with dictates that conflict with their conscientious judgment.

•    With increasing frequency, pharmacists are facing charges of unprofessional conduct or being dismissed for acting on their convictions by refusing to fill birth control prescriptions or distribute the “morning-after” pill.

•    Government programs for children and low-income families, especially Medicaid and the State Children’s Health Insurance Program, not only fund unethical services (including abortion and contraceptives) but also provide a mechanism for paying for these services without parental knowledge or permission.


SCHIP: 
We are, of course, absolutely not against providing health care for children, as critics charge.  But we are against having the state replace the family in caring for children. 

Expansion of this program actually disadvantages the poor.  Three out of four uninsured children already are eligible for SCHIP or Medicare but are not enrolled.  Our experience, including a recent program in Hawaii, has shown that if the state provides health insurance for free, or nearly so, parents will give up their private, family coverage to get the subsidized state coverage. 

This is a bad bargain, not only because it divides families but also because the state plan leads to restrictions on access to doctors and hospitals, compromising the health care that children need and dividing the family, putting children under the care of the state rather than in the safety, care and love of their parents. 

Passage of an expanded SCHIP program was a top priority of the Obama administration.

The Obama administration’s agenda:
Partial birth abortion and denial of medical care for babies who survive abortions are unconscionable in a civilized society, yet, with the new administration, we risk having these policies expanded.  The threat of passage of the Freedom of Choice Act would deny states the right to create their own laws to protect life.  Further, virtually all of the health policies advocated by the administration, while couched in the language of freedom, would subsume more and more control over health care decisions to the state, robbing individuals and families of this most basic freedom.

Wyden-Bennett – a bi-partisan health reform bill before Congress – explicitly says that “A health insurance issuer must make available supplemental coverage for abortion services…”  SCHIP not only allows but in fact support abortions and contraception, often without parental consent or even knowledge.

At the end of the day the levers of power over health care decisions will be controlled either by individuals and their families, based upon their values, faith and moral guidance, or by centralized bureaucracies, either public or private. The structure of health care financing determines who controls these levers.  Economic policies do matter in health care and have profound effects.

Individual property rights in the control over insurance to protect against expensive health care needs are vital to devolving responsibility to individuals and to providing incentives to build a society grounded in the common good.

There is a better way.  We must adhere to first principles, and then find solutions that leave our values intact.   There is a difference between protecting rights and providing for rights.  They are two different processes. 

We must protect individual responsibility, subsidiarity, and charity.  Then, we can find new policies to provide access to health care. 

A statement from the Catholic Medical Association summarizes these policies:

1. Individual ownership of health insurance. Every American should be able to obtain needed medical care.  Congress could begin by providing a new set of incentives for Americans to purchase their own health insurance directly. These incentives should be properly structured to create an opportunity for people to purchase coverage that conforms to the dictates of their conscience and moral convictions. 

If we were to provide everyone with subsidies to purchase health insurance, they would have the choice and the option to select private insurance to cover themselves and their families.  Some will need additional subsidies because of their health or income status.  For those who don’t make an active choice, they could have a default policy purchased for them from among the approved plan being offered in their areas.  We can get to universal coverage without a centralized, state-controlled system.

2. Freedom from health insurance mandates. People must be able to purchase insurance that is free of restrictions and bureaucratic dictates, including state health insurance mandates.  States have enacted more than 2,000 health insurance mandates over the last several decades, including everything from toupees to in vitro fertilization procedures, and dictating the shape and structure of health plans for small businesses, individuals, and anyone else purchasing state-regulated policies. 

3. Choice of private insurance policies. The federal government and states should work together to provide more health care insurance options, giving individuals and families and employers the ability to choose among competing plans or to join groups and associations that share their values. Faith-based health providers must be able to develop and offer health care delivery systems that serve the needs of their members and communities.   New associations, including faith-based groups, would be welcome, even essential, additions to the array of health care options for families.

4. Comprehensive protection of conscience. No reform of the American health care system will restore the patient-physician relationship if health care workers are not afforded comprehensive protection of conscience. These protections should be enacted at the state and federal level so that health care providers are not required, for any reason, to participate in procedures that violate their religious or ethical beliefs.

I was honored last year to speak at a conference at the Vatican, sponsored by the Acton Institute and the Pontifical Council for Pastoral Health Care and attended by His Eminence, Cardinal Barragan.   After my talk, Cardinal Barragan told me I had put my finger into the wound of the problems we face in the health sector.

Pope John Paul II in Centesimus Annus said “It would appear that, on the level of individual nations and of international relations, the free market is the most efficient instrument for utilizing resources and effectively responding to needs.”

During his 1987 visit to the U.S., Pope John Paul II said “Among the may admirable values of this nation, there is one that stands out in particular.  It is freedom…Freedom was channeled to the fullness of human life, to the preservation of human dignity, and to the safeguarding of all human rights…This is the freedom that America is called to live and guard and to transmit.”

Every country’s health care system is unique and each has its own challenges in moving to a system that respects and supports the sanctity of the individual. I may suggest that the U.S., while it has many problems, may be further along this path in supporting individual freedom and rights over their own health care decisions and destiny. But all of us have an obligation to look for solutions that move us closer to the goal that advances the common good by respecting the dignity, the freedom, and the sanctity of human life.


1 Catholic Medical Association, “Report of the Task Force on Health Care in America,” May 2005, at http://www.cathmed.org/publications/Health%20Care.pdf.

2 John Paul II, Encyclical Letter Veritatis Splendor (1993), paragraph 39, at http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/hf_jp-ii_enc_06081993_veritatis-splendor_en.html.

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About the author